Shedding light on a weighty problem (by Grace Chua )

Info Source: This article by Grace Chua is from the Sunday Times dated Nov 21, 2010.

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Shedding light on a weighty problem
Health economist stresses need to make it easier for people to exercise and adopt better eating habits
By Grace Chua


Trying to lose weight? Forget conventional wisdom. When it comes to fighting obesity, willpower alone would not cut it.

Worldwide, technology and cheaper food production are making it much harder for people to eat healthily and get exercise, said Duke-National University of Singapore health economist Eric Finkelstein, at a recent health and biomedical conference on the economics of obesity.

'The deck is stacked against humans,' said Professor Finkelstein, who has been based in Singapore for just over a year.

Singapore is no exception, he added, with hawker and fast food easily available, and convenient public transport.

The island state faces the same growing obesity problem as other developed countries: One in 10 people is obese; this is 10.8 per cent of the population, up from 6.9 per cent in 2004. Half the population do not exercise at all.

Obesity has a specific medical definition: having a body mass index (BMI) - a measure of body density - that is greater than 30.

The obese are at greater risk of ailments such as diabetes and heart disease. Also, the life expectancy of those with a BMI of over 40 can be 10 years shorter than that of someone of healthy weight - with a BMI that is between 18.5 and 24.9.

The health consequences of obesity also put a strain on hospitals and health systems - in the form of more patients and higher medical bills - and on employers, as sick people miss more days of work.

Yet, Prof Finkelstein and other economists have found that conventional information campaigns about the impact of diet and lifestyle do not work.

For example, in studies, obese people recognised that carrying excess weight was bad for their health, but that did not translate into action.

'People discount future health effects and things that have very small probabilities, such as diabetes, cancer and heart disease,' Prof Finkelstein said. That is why new incentives are needed to get people to change their lifestyle - and for that change to be sustained, he added.

Some tactics can be sneaky and ingenious. For instance, those eating off a plate with a line around its rim, an inch from the edge, ate less than people eating off a solid-coloured plate. The line produced the visual illusion of a smaller plate.

Others are more straightforward - such as higher insurance premiums for the obese, and entering them into a lottery where they win prizes for losing weight.

But do such measures work in the long term? 'We can't get people to keep the weight off long enough,' Prof Finkelstein admitted.

He is helping to assess the effectiveness of the Singapore Armed Forces' weight management programme and has also proposed studies using pedometers and different types of incentives.

Other measures, like the junk food taxes being bandied around in the United States and Europe, may do much to raise tax revenue, but little to trim waistlines.

US health economists have found that if a particular food type, such as salty snacks or carbonated soft drinks, is taxed, people tend to replace it with an equally unhealthy but untaxed substitute.

Where there are no cheap substitutes, such 'sin taxes' do work. For instance, all tobacco products in Singapore bear high import duties, a move which has helped cut smoking rates from a quarter of the population in the 1970s to 14 per cent today.

The Health Promotion Board (HPB) recognises that new incentives and strategies are needed. Chairman Lucas Chow, in a speech at the health conference organised by the National Healthcare Group and the National University Health System, said the agency has to reach out to people via new media like Facebook and engage them through public consultations. For example, the HPB's Facebook page was 'liked' by 15,836 people at last check.

But a mouse click to 'like' something is very different from eating healthy food or exercising regularly. How many of these 15,836 people are making some sort of commitment to a healthy lifestyle?

Also, the HPB's healthy-meal discount coupons may be outdone by $3 char kway teow at hawker centres and a value meal at a fast-food restaurant.

Restaurants and fast-food chains may offer healthy options like salads, but such items do not sell well. In a US study published in the Journal of Consumer Research last year, researchers found that adding a healthy option to the menu did not encourage people to pick that item. Instead, it had the opposite effect, where people picked even unhealthier options.

So getting people to eat healthily and exercise regularly is an uphill struggle. But they matter more than weight - as inactive, unhealthy thin people are also at risk for disease and death.

Prof Finkelstein weighed in: 'If you really want to get people to make long-term behaviour changes, you have to make those changes easy. You need to provide easy access to physical activity spaces, safe walking trails, and make healthy foods more known and more available.'

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A growing problem
Singapore faces the same growing obesity problem as other developed countries:
· One in 10 people, or 10.8 per cent of the population, is obese, up from 6.9 per cent in 2004.
· Half the population do not exercise at all.

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