Obesity among school children in Thailand: inquiry on demand for and supply of fast food and healthy food and policy interventions.

1
Obesity among school children in Thailand
inquiry on demand for and supply of fast food
and healthy food and policy interventions.

• Sirinya Phulkerd
• 15 June 2007

2
Outline

• Background
• Study Aim
• Objectives
• Methods

3
Background

• Overweight and Obesity Problem in Thailand
• Facing of under-and over-nutrition, along with
  a rise in overweight and obesity among adults
  (Kanchanachitra et al., 2003).
• Ranked the third disease burden due to risk
  factor for female with 6.1 of total DALYs loss
  and 2.5 for male (the 2004 BOD study).
• Increasing BMI in all age groups between
  1986, 1995 and 2003 (the 2003 National Nutrition
  Survey), with the greatest increase in 30-39
  years of age.
• An increasing trend of obesity in Thailand,
  specifically among affluent urban populations
  (the 1985 Electricity Generating Authority of
  Thailand, Adults with Dental Diseases study in
  1989-1990, the 1991 study by Ramathibodi
  Hospital staff).
• An annual increase of 1.1 and 1.86 in the
  prevalence rate of overweight and obesity among
  Thai men and women age 20 years between 1991
  and 1996 (Popkin, 2006).
• Note overweight (25BMI30) and obesity (BMI30)

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Background (contd)

• Overweight and Obesity Problem in Thailand
• BOD attributable to physical inactivity,
  contributed to 1.0 among male and 1.8 among
  female (the 2004 BOD study).
• The physical activity among Thai children with
  obesity and non- obesity, reported lower than
  that recommended by WHO 2001.
• Increasing the energy derived from dietary fat
  from 8.9 in 1960 to 22.2 in 1995 (Kosulwat V,
  2002).
• Increasing household consumption expenditure on
  oil and fat by 56 in nominal term between 1998
  and 2005 (NESDB, 2004).

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Fast Food

• What is Fast Food?
• Food with high in fat, salt, and sugar, such as
  hamburgers, pizza, chicken, and sugar-loaded soft
  drinks, often called an unhealthy diet (WHO,
  2005).

• Fast food causes overweight and obesity, doesnt
  it?
• Fast food consumption are a probable causal
  factor in weight gain and obesity (WHO/FAO 2002).
  
• Fast food is one of the contributing factors to
  obesity epidemic especially among childhood (Hu
  FB et al., 2001 Slavin JL et al., 1999).

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Fast Food in Thailand

• Fast food rapidly expanded in Southeast Asia
  including Thailand in the 1990s and has become
  socially acceptable at affordable price for Thai
  people (Euromonitor, 2000).
• The growth of fast food franchises has
  influenced consumption and behavioral pattern of
  Thai people (Uusitalo U et al., 2002).
• The U.S. fast-food restaurants in Thailand had
  grown at an estimated 30-40 percent a year
  between 1999 and 2004 (Peter K, 2004).
• Pizza Co grew by 29, from 1,468 million bahts
  in 2003 to 1,893 million bahts in 2005. (Minor
  International Public Co Ltd. Annual report,
  2005).
• A strategy to boost demand with mobile delivery
  by Pizza Hut resulted in 40 increases in
  customers (Euromonitor, 2000 Businessday, 2001
  Bangkok Post, 2001).
• Ranked the ninth most commonly consumed light
  meals among Thai children aged 6-14 years (the
  2003 NNS).
• Among adult aged 15-59, 26.9 consumed fast food,
  comparing to 10.8 consumed brown rice and 3.5
  for dietary supplement (the 2003 NNS).

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Fast Food in Thailand (contd)

• Interventions
• No interventions for overweight and obesity
  prevention in relation to fast food industry in
  Thailand.
• Only several health promotion programs notably
  school-based weight control program (though the
  coverage is still low) and Healthy Thailand,
  launched through the Ministry of Public Health
  recently.
• Food labeling on nutritional fact and RDA,
  launched by FDA but not cover fast food
  products.

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Functional Food

• What is Functional Food?
• There is no internationally agreed definition of
  functional food, and most countries have no legal
  definition (WHO, 2004).
• In Japan Foods which are expected to have a
  specified effect on health due to the relevant
  constituents, or food from which allergens have
  been removed.
• In Europe, the FUFOSE (Functional Food Science in
  Europe) Satisfactorily demonstrated to
  beneficially affect one or more target functions
  in the body, beyond adequate nutritional effects,
  in a way which is relevant to either an improved
  state of health and wellbeing.

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Functional Food in Thailand
Functional foods are not dealt with specifically
by the food or drug legislation (FDA Thailand
2004).

• Nutraceutical and Functional Food Research and
  Development Center, PSU
• Functional food is a food product that contains
  high quantity of natural active
• ingredient, which has the ability to protect or
  relieve the consumer from certain disease
• or ailment, or improve their health or well being
  through its nutritional or medicinal
• properties.
• FDA-ongoing work
• adoption of health claims
• developing dietary supplement and functional food
  regulations
• developing guidelines for review of dietary
  supplements and functional foods
• developing standard label claims.

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Functional Food in Thailand (contd)
Among adult aged 15-59, 3.5 consumed dietary
supplement, while comparing to 26.9 fast food
consumption and 10.8 for brown rice (the 2003
NNS).

• Interventions
• Few interventions on healthy food products such
  as
• Promotions in nutraceutical and functional food
  products, focusing on natural plant based
  ingredients such as Brown rice, Som Khaek
  (Garcinia cambogia), Makham Pom (Phyllanthus
  embrica).
• Service offered by private sectors such as
• Weight Control Program by MEDISCI
• Slim up Drain with Detox Program by Slim up
  Center

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Study Aim

• To better understand the demand for and supply of
  fast food and healthy food among school children,
  as well as document and assess the effectiveness
  of current policy interventions in order to
  recommend appropriate policy to curb overweight
  problems in Thailand.

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Objectives

• 1. To compare the profile and determinants of
  demand for fast food and healthy food between
  primary and secondary school children who are
  overweight and not overweight, including their
  parents.
• 2. To describe the pattern of market strategies
  for fast food and healthy food for general
  population and in particular among primary and
  secondary school children and their parents.
• 3. To assess the current policy interventions and
  recommend the future policies on supply and
  demand sides to curb overweight and obesity
  problems and promote healthy food and other goods
  and services.

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Method (1)

• For Obj.1 To compare the profile and
  determinants of demand
• for fast food and healthy food between primary
  and secondary
• school children who are overweight and not
  overweight, including
• their parents. (Result demand side
  characteristics)
• Conducting Survey
• Conducting Focus Group

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Conduct Survey

• Sample overweight/non-overweight children in
  primary and secondary
• school and their parents
• Site urban and rural areas of large cities in
  four regions (such as Khon
• Kaen, Songkla, Chiang Mai, Suphanburi, BKK)
• Instrument design questionnaires assessing
• demographic and socio-economic status
• psychosocial and behavioral factors
• family, friends, schools
• commercial sites
• consumerism
• areas of Thailand in which the person lives
• media
• perception and knowledge of current
  interventions, aimed at
• - the reduction of overweight
• - healthy behavior promotion on food and
  exercise

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Focus Group

• Design
• To discuss with the agents for change in primary
  and secondary
• schools in the survey sites e.g. teacher,
  principal, administrator,
• Teacher and Parents Association)
• What for?
• to explore their awareness, factors associated
  with diet and
• physical activities at school and home.
• to obtain information related to implementation
  of school policies for (a) wellness, (b)
  nutrition, (c) fitness, and (d) health among
  primary and secondary school children.

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Methods (2)

• For Obj.2 To describe the pattern of market
  strategies for fast
• food and healthy food for general population and
  in particular
• among primary and secondary school children and
  their parents.
• (Result Supply side characteristics)
• Literature Review

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Literature Review

• What for?
• To compare the growth of fast food and healthy
  food industries
• including marketing expenditure and strategies
  i.e.
• Market research
• Distribution
• Pricing
• Packaging
• Product development
• Advertising
• Sales promotions
• Public relations
• Sources based on information available from
  different national
• Sources
• Note Pattern of current marketing to school
  children (TV advertising, in-school marketing,
• sponsorship, product placement, internet
  marketing and sales Promotions) investigated
• in the study sites.

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Methods (3)

• For Obj.3 To assess the current policy
  interventions and
• recommend the future policies on supply and
  demand sides to
• curb overweight and obesity problems and promote
  healthy food
• and other goods and services. (Result The
  effectiveness of current
• policy interventions)
• Literature Review
• In-Depth Interviews

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Literature Review

• What for?
• To review international experiences of related
  policy interventions.
• To assess the availability and effectiveness of
  the current policy interventions (either by
  public, private and civil society) in Thailand
  for general population and school children, on
  overweight and obesity reduction, on fast food
  and healthy food, and physical activities in
  terms of
• Program output
• Outcome
• Target groups
• Program expenditure

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In-Depth Interviews

• What for?
• To deeply explore the respondents point of view,
  feelings and perspectives about the availability
  and effectiveness of the current policy
  interventions (either by public, private and
  civil society) in Thailand for general population
  and school children, on overweight and obesity
  reduction, on fast food and healthy food, and
  physical activities in terms of
• Program output
• Outcome
• Target groups
• Program expenditure
• Respondent Key policy-stakeholders

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Focus group discussions

• What for?
• To recommend appropriate policies in
  preventing/reducing overweight obese school
  children in Thailand (based on the results in
  method 1, 2, and 3).
• Group concerned stakeholders, including
• consumer group
• education group
• professional group
• public health group
• financial group
• regulators and legislators
• industrial and business
• non-government organizations

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