Saving the Fat Kids
Children in Taiwan can get their hands on french fries, fried chicken and pearl milk tea at any time. Now, one in four elementary school kids is obese.
Saving the Fat KidsBy Ming-Ling Hsieh
From CommonWealth Magazine (vol. 518 )
In the eleven years since founding made-to-order tea beverage chain ComeBuy, company president Chen Kunchi has taken the chain from New York's Fifth Avenue to Berlin's Hackescher Market along a journey that has opened 225 outlets worldwide.
Having recently started a family, Chen has often been given to thinking about what kinds of beverages are best for kids.
So ComeBuy staff have had their shoulders to the grindstone of late, internally testing a new product designated for launching around May or June: pearl milk tea aimed specifically at kids.
"We plan on using preservative-free tapioca pearls and fresh milk rather than cream so mothers can feel more at ease," says ComeBuy marketing director Chang Hsiu-feng.
ComeBuy had already begun posting calorie count charts for all its products in stores two years ago.
In late January, Chang Pin-tang, the third-generation chairman of 88 year-old local carbonated beverage maker Hey Song, told reporters the company would institute a three-year plan to innovate and reinvent itself before the company's 90th anniversary. The most striking aspect of that plan will be the establishment of an educational foundation.
One of the primary aims of the foundation will be promotion of healthful eating and drinking habits.
"For instance issues of calorie and sugar content," Chang says. "Consumers want the nutrition, they want the enjoyment, but need to watch that they don't overdo it."
Half of Taiwanese Men Overweight
How to strike a balance between product promotion and consumer health has become a hot-button issue among food companies. At the core of that is the global obesity epidemic. There are currently around 1.5 billion obese adults worldwide, with nearly one in five overweight, as defined by the International Red Cross.
The statistics for Taiwan are even more startling.
According to the "National Nutrition and Health Survey" conducted by the Department of Health's Bureau of Health Promotion between 2005 and 2008, more than half of Taiwan's adult male population (51 percent) are either overweight or obese (as defined by Taiwan's Department of Health, a body mass index [BMI] of 24 or higher is "overweight" whilst a BMI of 27 or higher is "obese"). Among adult women in Taiwan, at least one in three are either overweight or obese (36 percent).
The World Health Organization (WHO) has even applied the term "epidemic" in describing the rapidity with which obesity has spread worldwide, labeling it "globesity."
According to WHO statistics, among G20 nations – those with the world's 20 largest economies – the U.S. ranks as the fattest, with more than 80 percent of the adult male and 77 percent of the adult female populations overweight (with a body mass index in excess of 25 considered "overweight" and a BMI over 30 defined as "obese" by US standards). Even kimchi-loving South Korea has more fatties than Taiwan, with more than half of both the adult male and female populations overweight.
The body weight crisis sweeping across the planet is putting immense pressure on food and beverage companies and has become a major vexing issue for a whole host of nations. which have gotten on board to begin setting forth "anti-obesity" government policies.
On March 11, a New York State Supreme Court judge struck down as unconstitutional New York City Mayor Michael Bloomberg's proposed ban on the sale of containers of sugary drinks larger than 16 ounces in restaurants, cinemas and other venues. Bloomberg said he would appeal the decision, vowing to take the fight against obesity to the end.
In an effort to contain the spread of obesity, Hungary's government began levying a tax on the salt and sugar in foods and beverages 18 months ago. An estimated two-thirds of Hungarians are either overweight or obese.
One in Four Primary Schoolers Overweight
Among the issues generating increasing concern is that of childhood obesity.
According to data from the U.S. Centers for Disease Control, in 2010 more than one-third of U.S. children and adolescents were overweight or obese.
Among Taiwanese primary school children, the ratio of overweight or obese kids hovered around an annual average of about one in four between 2007 and 2011, according to Ministry of Education figures. Among boys it was higher, at around one in three.
The health risks and implications of obesity for children are far more serious and far-reaching than for adults.
First, childhood obesity may lead to early onset puberty; in other words, development of secondary sexual characteristics prior to age eight in girls and age nine in boys, according to Taipei Medical University pediatrics resident Dr. Yang Chen.
A direct effect of early onset puberty may be early bone maturation, in turn leading to stunted growth.
Stunted Taiwanese Kids
As obesity and early onset puberty can both stimulate "bone aging," bone maturation can occur prior to the growth spurt, potentially leading to reduced height in these kids. There is a fixed period for bone maturation and growth. For instance, in girls bone growth can typically continue until age fourteen. But if a 10 year-old girl has the bone maturity of a 13 year-old, her growth spurt will be compressed, leaving just one more year for her to grow and consequently preventing her from growing as tall as she otherwise might have.
"The tall and strong when very young become short and fat when they grow up," says Hsu Hui-yu, director of the John Tung Foundation's Food and Nutrition Division.
Childhood obesity also puts kids at risk for high blood pressure, high blood sugar, high cholesterol and even cancer much earlier than they may otherwise have been.
The abnormal blood pressure, cholesterol and blood sugar levels found in overweight children are nearly twice those found in normal-sized kids, according to a 2009 survey undertaken by the Department of Health's Bureau of Health Promotion that sampled students at eight elementary schools and 16 kindergartens.
Aside from the "big three" issues (blood pressure, blood sugar, cholesterol), abnormal uric acid levels, asthma, and even breast cancer, colon cancer and rectal cancer are all health hazards for obese children.
I-Li Liu, a dietician with Taiwan Adventist Hospital's Department of Health Development, once consulted with a third-grade boy who was brought to the hospital's pediatric ward after collapsing at home due to high blood sugar. He was 140 cm tall but weighed nearly 60 kg.
Even more critically, obese kids are far more likely to grow up to be obese adults.
Research has shown that there is a 50 percent likelihood that obese children will grow up to be obese adults; obese adolescents face a two-thirds likelihood of growing up to be obese adults.
"We have to take childhood obesity seriously, [we] can't just bury our heads in the sand and expect that it will go away," says Bureau of Health Promotion chief Chiu Shu-ti.
70% of Food Ads for Junk Food
Everyone from parents, government and schools to the food companies themselves are "food providers" for children. In this capacity they are the molders of the prevailing food culture and are the key to the childhood obesity issue.
Just outside the school campus lies an enticing world laden with the sugary and the fatty.
At four o'clock in the afternoon a group of elementary school kids surrounds an old-school fried chicken vendor in southern Taipei, less than five minutes' stroll from campus, each shouting their order over the others.
In fact, the road fronting the school, which at less than 300 meters long can be traversed in five minutes on foot, is crammed with no less than five vendors offering deep-fried snacks, and eight shops offering bubbly sweetened drinks, all of which are thronged with groups of passing school kids.
Outside another elementary school, the gate of which is festooned with a sign reading, "vending within 50 meters of school entrance strictly prohibited," three school kids head to the convenience store directly across the street where they each snap up different flavors of potato chips. Each bag of chips contains more than 300 calories, about the same as a brimming bowl of steamed rice.
Just a three-minute walk up ahead, at least two drinks shops and three fast-food chain outlets line the main thoroughfare.
Turn on the TV and junk food is being pitched even harder, grabbing the attention of young eyes.
Having monitored 1,900 hours of television advertising, the Bureau of Health Promotion found that, among food advertisements, 70 percent were for foods high in fat, sugar and/or sodium.
"Some adds for sugary drinks touted being 'the taste of love,' taking in boys and girls in one fell swoop, really scary," remarks Chiu Shu-ti.
Potato Chips for Breakfast!?
And parents, who most frequently don the hat of "food provider," also seem to be shirking their presumed role as nutrition watchdog.
Chung Kunchi and his wife Wang Ling, who make bento boxes (lunchboxes) with local organic ingredients as proprietors of "Real Taste Bento," serve on the healthy school lunch commission and PTA, respectively, at the elementary school their two children attend.
At the school, Wang says she often spotted a sixth-grader toting a big satchel filled with potato chips into class.
"I asked him: What is that? He said: 'breakfast,'" she says in disbelief.
In busy two-income households, many parents opt to directly give money to their kids and let them decide what to eat for breakfast and dinner. The parents are not only abandoning the watchdog role, they're enabling their kids, allowing them to eat whatever they please and indulging them with unhealthy foods.
Some parents don't have sound dietary habits themselves: on their dinner table you might find a big bottle of Coke, some takeaway fried chicken and pan-fried scallion cakes from a street vendor.
The dereliction of duty among "food providers" – from government, food companies and schools to parents – has resulted in kids lacking proper knowledge about food and developing unhealthy tastes from early childhood.
In 2008, the Formosa Cancer Foundation conducted a survey, asking kids: "Do you think potato chips are a kind of vegetable?"
The results showed more than 20 percent of kids either answering in the affirmative or saying they were unsure one way or the other.
The cancer foundation survey also found that, when ordering food out, the things kids opted for most often were "instant noodles" or fried chicken and high-sodium lu-wei (items stewed in soy sauce and spices) from street vendors.
Too Much Frying in School Lunches
If childhood obesity is to be contained, primary food suppliers will have to start taking more responsibility. In response, national governments across the globe have kicked off a "combating childhood obesity" plan of action.
In 2010, South Korea's parliament passed legislation banning junk food advertising from the airwaves during prime viewing hours for children.
France has imposed a "soda tax" on all sweetened beverages. Canada has begun a "childhood obesity control program" designed to assist overweight kids 12 to 17 years old in controlling their body weight.
Taiwan passed legislation eight years ago barring snacks and beverages containing sugar from being sold in elementary and junior high schools. The "National Nutrition Act" currently under deliberation in the Legislative Yuan would mandate that "the promotion or advertising of foods for which there is scientific evidence indicating a potential for causing obesity, metabolic disorders and/or high blood pressure may be subject to restriction."
City and county governments have begun to follow suit, setting forth their own plans for improving student health.
Yet as various national governments pursue policy objectives for "combating childhood obesity," Taiwan's approach remains inadequate.
Take the school lunches offered in elementary and junior high schools, for example. Although a maximum of only four meals is offered per week, an independent investigation by CommonWealth Magazine extensively documenting school lunch menus on offer at one top-tier Taipei junior high school over an eight-day period found five fried items such as french fries, fried chicken and deep-fried pork chops on the menu.
Yang Chen, the Taipei Medical University pediatric resident, says he once noticed how heavy his son's school bag was, only to find containers of sugary winter melon tea and bubble tea that had accompanied his school lunch stashed inside.
The fact is, however, that children's food preferences can be conditioned.
Liang Zhiyu, child star of the TV series Ni Yada, has been tucking into the pickles, radishes and carrots with his mom and dad since he was a toddler. The now fourth-grader continues to love his veggies, bringing fruits and salads to school every day, no matter how many of his classmates poke fun at him for eating raw veggies for breakfast.
Parents need to take responsibility for being on the front line of nutritional education and act as a nutritional watchdog in helping their kids avoid the dietary habits that lead to obesity.
The John Tung Foundation's Hsu Hui-yu , for example, cites a foundation study that found that children would drink half the volume of beverages if parents simply do not offer them.
With no victory in the war on obesity yet in sight, a top-down approach in controlling food sources and crafting a healthy environment are the only ways real change can be effected.
Translated from the Chinese by Brian Kennedy