Short Communication - Journal of Public Health and Nutrition (2019) Volume 2, Issue 1
Childhood obesity prevention in Hong Kong: A life-course approach.Quach Ha Linh*
Department of Public Health, University of Hong Kong, Hong Kong
- Corresponding Author:
- Quach Ha Linh
Department of Public Health
University of Hong Kong, Hong Kong
Email: [email protected]
Accepted date: March 20, 2019
Citation: Linh QH. Childhood obesity prevention in Hong Kong: A life-course approach. J Pub Heath Catalog 2019;2(1):133-136.
Obesity has been a massive but silent killer, resulting in serious health problems such as cardiovascular disease, diabetes, hypertension and even cancer. In Hong Kong, the prevalence of children obesity is increasing yearly. Life-course approach has been recommended as a comprehensive prevention to reduce health burden of children obesity.
Childhood obesity, Life-course, Health prevention, Hong Kong.
Childhood obesity has become a major public health in Hong Kong . One major reason is the under appreciation of obesity's risk factors across the life course . Researchers have stated the relationship between family [3-5], development factors , activities and children's obesity. In face with obesity endemic, it is high time to take into account a life-course approach [7-9].
Three initial stages in life course will be analyzed with appropriate prevention measures and macro-level interventions.
Pregnancy and fetal development
Maternal obesity, a risk factor to higher birth weight, has shown association with children obesity [10,11]. Other risks predictors including pregnancy diabetes , pregnancy smoking  correlated with infant overweight. Evidently, mother's dietary and behaviors during pregnancy can determine infant's weight. Therefore, child obesity prevention should start from prenatal period. Dietary and lifestyle counseling , routine prenatal care , home visits and peer group  have shown significant improvement on maternal health. A program applying family-centered individualized approach to change pregnant women behaviors should be considered  by integrating collaboration between healthcare and social community .
Infancy, childhood and adolescences
Though there are not strong evidences of breastfeeding as a determinant of obesity , studies have shown breastfeeding practices have a modest protective effect on childhood and adolescent obesity [20-23]. Regardless of many interventions , breastfeeding practices in Hong Kong still decrease due to infant formula usage , workplace and public discrimination . To foster a supportive environment for women, Department of Health should consider pre and postnatal program including in-hospital and home breastfeeding support and consultants [27-29], maternity leaves, workplace and public breastfeeding policy. Mass media is also recommended for breastfeeding awareness and breastmilk substitutions control .
Nutrition, physical activities and screen time are important factors that can affect obesity status. Since children's habits are heavily influenced by family cultural and norms , parents are key agents of change to tackle obesity. Initially, parents’ feeding practices, behaviors  and their concern about children's weight  are important factors in determining children diet. Studies suggested early parent-focused interventions can have promising effects on children's obesity . Education sessions with parenting skills  and parentchild co-attendance  have shown a lot of impact. Besides parental-care, informal care from domestic workers and grandparents also associated with higher prevalence of children obesity . Though childcare intervention for grandparents have shown much progress in children's health [37,38], such intervention for domestic helpers are not prevalent. Further research into this may help design better interventions.
As where children spend most of their time in, school plays an important role in their healthcare. Nutritional and physical health campaigns have been exercised in many schools in Hong Kong with promising outcomes . However, the program might not achieve optimal effect with low parental engagement. Schools should consider better integrating schemes to encourage parents' participation, including parent-school discussion, parent-child workshop. Activities integrating school curriculum and parent-teacher association is highly recommended for better health outcomes [40-42].
In addition, health behaviors also shape by peer influences, most prevalence in adolescences. Studies show a strong association between peer pressure and the risk of obesity development, both negative and positive . School activities such as counseling, peer-to-peer groups can support students in this matter. Such school-based intervention should take into account cultural diversity, socio-environmental improvement and follow-up assessment .
Obesity prevention initiatives should also engage children centers, religious community, family clinics to support family nutrition education and physical activity . These institutions can easily deliver education through multiple channels. Besides, child centers and clinics can provide treatment and intervention for obese children . A multidisciplinary collaboration between family, schools and other community sectors should be considered to bolster healthy practices on obesity.
In the midst of obesity information, parents and schools might feel overwhelming to find a suitable dietary plan . Department of Health should consider publish a comprehensive guidelines for children's diet and lifestyle aligned with Hong Kong cultural and provide training on obesity prevention for healthcare staffs .
Besides primary prevention, to sustain healthy behaviors, intervention such as environmental changes and policy enforcement must take place. As media uses and global trade increases, so has children’s expose to obesity's risk factors . With increasing sugary products  and fast food , Department of Health should collaborate with government to target food and drink industry.
Multisectoral approaches through sugar beverage and fast food advertisement limitation [50-52], food labelling, fast food and sugar taxes [53,54] have been implemented in many countries with prominent reduction in unhealthy food consumption. Nevertheless, collaboration with governmental and private sectors including agriculture, trade, finance, civil development, etc. can contribute .
To comprehensively tackle childhood obesity, public health in Hong Kong should consider intensive life-course approach not only in health sector but also other jurisdictions in government. An integrated, systems-oriented life-course model that incorporates at multilevel of prevention can help mitigate children obesity and overall obesity prevalence in Hong Kong. Under the light of school and parents play in the model, the impact on school and parents behavior should be monitored through a strong collaboration between healthcare providers and education sectors. The results should be evaluated by Center of Health Protection through cohort study or population behavior survey.
Conflict of Interest
The authors declare that they have no competing interests.
- Halfon N, Forrest CB, Lerner RM, et al. Handbook of life course health development. Springer International Publishing; 2018;169-96.
- Liu W, Liu W, Lin R, et al. Socioeconomic determinants of childhood obesity among primary school children in Guangzhou, China. BMC Public Health. 2016;16:416.
- Ip P, HF, So HK, et al. Socioeconomic gradient in childhood obesity and hypertension: A multilevel population-based study in a Chinese community. PLoS One. 2016;11:e0156945.
- Wang JJ, Gao Y, Lau PWC. Prevalence of overweight in Hong Kong Chinese children: Its associations with family, early-life development and behaviors-related factors. J Exerc Sci Fit. 2017;15:89-95.
- Kwok MK, Schooling CM, Lam TH, et al. Does breastfeeding protect against childhood overweight? Hong Kong's ‘Children of 1997’ birth cohort. Int J Epidemiol. 2010;39:297-05.
- Ho SY, Lai YK, Lam TH, et al. Risk factors and outcomes of childhood obesity in Hong Kong: A retrospective cohort study. Hong Kong Med J. 2013;45-47.
- Ko GT, So WY, Chow CC, et al. Risk associations of obesity with sugar-sweetened beverages and lifestyle factors in Chinese: The ‘Better Health for Better Hong Kong’ health promotion campaign. Eur J Clin Nutr. 2010;64:1386.
- Zhao Y, Wang L, Xue H, et al. Fast food consumption and its associations with obesity and hypertension among children: Results from the baseline data of the Childhood Obesity Study in China Mega-cities. BMC Public Health. 2017;17:933.
- Dutton H, Borengasser SJ, Gaudet LM, et al. Obesity in pregnancy: Optimizing outcomes for mom and baby. Med Clin North Am. 2018;102:87-106.
- Marchi J, Berg M, Dencker A, et al. Risks associated with obesity in pregnancy, for the mother and baby: A systematic review of reviews. 2015;16:621-38.
- Council NR. Weight gain during pregnancy: Reexamining the guidelines: National Academies Press; 2010.
- Weng SF, Redsell SA, et al. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch Dis Child. 2012.
- Asbee SM, Jenkins TR, Butler JR, et al. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: A randomized controlled trial. 2009;113:305-12.
- Olson CM. Achieving a healthy weight gain during pregnancy. Annu Rev Nutr. 2008;28:411-23.
- Bullock L, Everett KD, Mullen PD, et al. Baby BEEP: A Randomized Controlled Trial of Nurses’ Individualized Social Support for Poor Rural Pregnant Smokers. Matern Child Health J. 2009;13:395-406.
- Thangaratinam S, Rogozińska E, Jolly K, et al. Interventions to reduce or prevent obesity in pregnant women: A systematic review. Health Technol Assess. 2012;16:1-191.
- Nader PR, Huang TT, Gahagan S, et al. Next steps in obesity prevention: Altering early life systems to support healthy parents, infants, and toddlers. Child Obes. 2012;8:195-204.
- Kramer MS, Matush L, Vanilovich I, et al. Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 y: Evidence from a large randomized trial. Am J Clin Nutr. 2007;86:1717-21.
- Williams CB, Mackenzie KC, Gahagan S. The Effect of Maternal Obesity on the Offspring. Clin Obstet Gynecol. 2014;57:508-15.
- Gillman MW. Commentary: breastfeeding and obesity-the 2011 Scorecard. Int J Epidemiol. 2011;40:681-84.
- Arenz S, Rückerl R, Koletzko B, et al. Breast-feeding and childhood obesity-A systematic review. Int J Obes Relat Metab Disord. 2004;28:1247.
- WHO. Report of the commission on ending childhood obesity. WHO Geneva; 2016.
- Tarrant M, Fong DYT, Wu KM, et al. Breastfeeding and weaning practices among Hong Kong mothers: A prospective study. BMC Pregnancy Childbirth. 2010;10:27.
- Kong UH. World Breastfeeding Week 2017 calls for public support for breastfeeding. Government of Hong Kong; 2017.
- Langer A, Campero L, Garcia C, et al. Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers' wellbeing in a Mexican public hospital: A randomised clinical trial. Br J Obstet Gynaecol. 1998;105:1056-63.
- Helen S, Cate N, Michelle F, et al. Interventions Designed to Promote Exclusive Breastfeeding in High-Income Countries: A Systematic Review. Breastfeed Med. 2014;9:113-27.
- Thangaratinam S, Rogozińska E, Jolly K, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: Meta-analysis of randomised evidence. BMJ. 2012;344:e2088.
- Rollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387:491-504.
- Lo K, Cheung C, Lee A, et al. Associations between Parental Feeding Styles and Childhood Eating Habits: A Survey of Hong Kong Pre-School Children. PLoS One. 2015;10:e0124753.
- Leung S, Leung C, Luk WJFHS, The Department of Health Hong Kong SAR Government. A survey of infant and young child feeding in Hong Kong: parental perceptions and practices. 2012.
- Anzman SL, Rollins BY, Birch LL. Parental influence on children’s early eating environments and obesity risk: Implications for prevention. Int J Obes. 2010;34:1116-24.
- Campbell KJ, Lioret S, McNaughton SA, et al. A Parent-Focused Intervention to Reduce Infant Obesity Risk Behaviors: A Randomized Trial. Pediatrics. 2013;131:652-60.
- Hesketh K, Waters E, Green J, et al. Healthy eating, activity and obesity prevention: A qualitative study of parent and child perceptions in Australia. Health Promot Int. 2005;20:19-26.
- Lin SL, Leung GM, Hui LL, et al. Is informal child care associated with childhood obesity? Evidence from Hong Kong’s “Children of 1997” birth cohort. Int J Epidemiol. 2011;40:1238-46.
- Gao Y, Griffiths S, Chan EYY. Community-based interventions to reduce overweight and obesity in China: a systematic review of the Chinese and English literature. J Public Health. 2008;30:436-48.
- Kicklighter JR, Whitley DM, Kelley SJ, Shipskie SM, Taube JL, Berry RC. Grandparents raising grandchildren: A response to a nutrition and physical activity intervention. J Am Diet Assoc. 2007;107:1210-13.
- Unit CHE, Protection CfH, Health Do, Region GoHKSA. Evaluation of [email protected] Pilot Project Executive Summary Department of Health; 2012.
- .Wake MA, McCallum Z. Secondary prevention of overweight in primary school children: What place for general practice? Med J Aust. 2004;181:82-84.
- Wang Y, Cai L, Wu Y, et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev. 2015;16:547-65.
- Tucker S, Lanningham-Foster LM. Nurse-led school-based child obesity prevention. J Sch Nurs. 2015;31:450-66.
- Trogdon JG, Nonnemaker J, Pais J. Peer effects in adolescent overweight. J Health Econ. 2008;27:1388-99.
- Ickes MJ, McMullen J, Haider T, et al. Global school-based childhood obesity interventions: A review. Int J Environ Res Public Health. 2014;11:8940-961.
- Pérez-Escamilla R, Hospedales J, Contreras A, et al. Education for childhood obesity prevention across the life-course: Workshop conclusions. Int J Obes Supplements. 2013;3(S1):S18.
- Hoelscher DM, Kirk S, Ritchie L, et al. Position of the academy of nutrition and dietetics: Interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet. 2013;113:1375-794.
- Casazza K, Fontaine KR, Astrup A, et al. Myths, Presumptions, and Facts about Obesity. N Engl J Med. 2013;368:446-54.
- Journalism and Media Studies Centre Uuniversity of Hong Kong. Red alert: Too much sugar in drinks for children, study finds. 2017.
- Research HKTDC. Processed food and beverage industry in Hong Kong. 2018.
- Mâsse LC, de Niet JE. School nutritional capacity, resources and practices are associated with availability of food/beverage items in schools. Int J Behav Nutr Phys Act. 2013;10:26.
- Woodward-Lopez G, Gosliner W, Samuels SE, et al. Lessons learned from evaluations of california's statewide school nutrition standards. Am J Public Health. 2010;100:2137-345.
- Long MW, Henderson KE, Schwartz MB. Evaluating the impact of a connecticut program to reduce availability of unhealthy competitive food in schools. J Sch Health. 2010;80:478-86.
- Zhou Z, Diao Q, Shao N, et al. The frequency of unhealthy food advertising on mainland chinese television (tv) and children and adolescents’ risk of exposure to them. PLoS One. 2015;10:e0128746.
- Powell LM, Chriqui JF, Khan T, et al. Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: A systematic review of prices, demand and body weight outcomes. Obes Rev. 2013;14:110-28.
- Kristensen AH, Flottemesch TJ, Maciosek MV, et al. Reducing childhood obesity through U.S. federal policy: A microsimulation analysis. Am J Prev Med. 2014;47:604-12.