User:Allthebesthavefun/sandbox

= Obesity in Thailand =

With reference to 2016 data from the World Health Organisation (WHO), Thailand has one of the highest incidence of overweight citizens in the South East Asian region, second to only Malaysia. Obesity in Thailand has been flagged as a major source of health concern, with 32% of the population identifying as overweight and 9% obese. The NHES found that obesity in Thailand more than doubled during the period 1991-2014. This spike in obesity levels have been largely attributed to increased access to junk food and unhealthy switches from active to sedentary lifestyles, which are closely linked to economic growth in the country.

Classification of obesity
The internationally recognised method of measuring obesity is through the Body Mass Index. According to WHO, an overweight person has a BMI of ≥25. An obese person has a BMI of ≥30. However, while the WHO standard has been used internationally, studies have shown that it may not be accurate for the classification of obesity in the Asian context due to different body fat percentages and body compositions. Instead, an alternative standard should be used. As proposed by the International Association for the Study of Obesity and the IOTF in 2000, the WPRO standard is more appropriate for Asian populations. According to WPRO, an overweight person has a BMI of ≥ 23. An obese person has a BMI of ≥25.

Prevalence of obesity in the Thai population
According to WHO, overweight and obesity levels in Thailand have been steadily increasing over the years. With the percentage of overweight or obese adults increasing from 8.6% in 1975 to 32.6% in 2016.

Thai Adults
In 2004, a study involving 3,220 adults between the age 20 – 59 was carried out. The age adjusted overweight and obesity levels were found to be 28.3% and 6.8%, respectively.

Using the WPRO standard, results from the Thai Food Consumption Survey (TFCS) in 2005 showed that the combined prevalence of overweight and obesity in Thai adults aged 19 years and over exceeded 40%. An estimated 17.1% of those surveyed fell under the classification of overweight (BMI 23.0 – 24.9), 19.0% as class 1 obesity (BMI 25.0 – 29.9), and 4.8% as class 2 obesity (BMI ≥ 30.0). It was also found that obesity had a larger impact on women than men, with obesity and overweight rates at 46.1% and 35.5% respectively. Adding on, obesity was more commonly found to occur in urban settings as compared to suburban areas.

NHES is a nationwide survey which measures the health status of Thai citizens. As to date, 5 reports have been released over a period of 23 years. Namely in 1991, 1996, 2004, 2009 and 2014. Results from the 2009 survey showed an overweight and obesity level of 41% in females and 28% in males. 5 years later, the 2014 survey showed the prevalence of overweight and obesity in females increased to 43% and rose to 33% in males.

In 2011, the WHO found that 32.6% of Thais were overweight, ranking the country second heaviest in South East Asia, with higher obesity levels than more affluent nations including the Republic of Korea, Japan and Singapore.

Behavioural Risk Factor Surveillance System (BRFSS) was set up in 2005 to track the health status of Thais. It uses the WHO standard of BMI. According to the most recent report in 2015, it was found that overweight and obesity levels reached 30.5% and 7.5% respectively. This is an increase from the 2005 report by BRFSS which indicated levels of overweight and obesity at 16.1% and 3.0% respectively.

Children and adolescents
In 1992, a 5 year follow up study involving primary and secondary schools of Hat Yai municipality, south Thailand was conducted. This study, involving 2252 school children tracked overweight prevalence from childhood to adolescence. From the period 1992 to 1997, it was observed that 11.8% of children remain overweight. It was concluded that overweight children face a much higher probability of being overweight as adults, and are at higher risk of developing overweight related health diseases.

Comparing results from NHES released in 1996 and a separate national survey conducted in 2001, obesity in children aged 2 to 12 years experienced a rise. Obesity prevalence in preschool children (ages 2 to 5) increased from 5.8% in 1996 to 7.9% in 2001. Children in the age group 6 to 12 years saw an increase from 5.8% to 6.7%. Data also showed that obesity was a more prevalent problem amongst children living in urban areas, as compared to rural areas.

In 2003, a nationwide survey was conducted by the National Health Foundation involving 47,389 grade 6 primary school children in urban settings. From this, it was found that 16.7% of the children surveyed were either obese or overweight.

In 2007, a school based cross sectional study was conducted to determine the prevalence of obesity in Thai children in rural Ongkharak. This study tracked the height and weight of 1,140 children between the ages 6 to 15. The results were based on the International Obesity Task Force standard and revealed the prevalence of overweight and obesity levels to be 12.8% and 9.4% respectively.

In 2013, another study was conducted in Ongkharak, to establish the association of obesity with hypertension in school children. A total of 3,991 students with a mean age of 9.5 years were studied. This study revealed that signs of hypertension were higher in obese and overweight children, as compared to children within the healthy weight range, at 49.5% and 26.5% versus 16.2% respectively. Furthermore, it was found that prevalence of overweight and obesity levels were 12.8% and 9.4% respectively. This is an increase from the previous study conducted in 2007.

The Global Burden of Disease Study over the time period 1980 – 2013 showed that childhood obesity in developing countries increased from 8.1% to 12.9% for boys and from 8.4% to 13.4% in girls.

Diabetes and cost of obesity
In a statement released by the Thai Ministry of Public Health, NCDs were listed as the ‘No. 1 health issue’ in the country, ‘both in terms of number (of) causalities and burden of disease’. Diabetes was also flagged as one of the major components of NCDs plaguing the Thai population. Comparing data from NHES conducted in 2009 and 2014, the prevalence of diabetes increased from 6.9% to 8.9% (or an increase of about 300,000 citizens annually). As of 2017, 8.3% of Thai adults identified as diabetic.

Referencing the death register of the Bureau of Registration Administration, Ministry of Interior, it was found that between 2012-2015, the number of premature deaths caused by NCDs increased. In particular, it was found that deaths by diabetes increased from 13.2 to 17.8 per 100,000 people.

A 2009 joint study between the Health Intervention and Technology Assessment Program (HITAP) of the Ministry of Public Health and Mahidol University showed that the cost of obesity on the Thai health system amounted to $404 million or 12 billion baht annually. The research further revealed that direct health care cost for patients accounted for 46% (or $186 million) of total obesity costs. Indirect health care costs made up the remaining 54% (or $218 million), with opportunity costs related to premature deaths totalling $195 million and hospital related absenteeism totalling $23 million.

Government responses
Over the years, the Thai government has launched a series of health campaigns in an attempt to reverse this increasing obesity trend in the country.

Studies have shown that childhood obesity tends to lead to adult obesity. As a result, it has been suggested by academics that efforts to curb and prevent overweight obesity should start in childhood.

‘Foods for Children’
The strong presence of fast food advertising in Thai television has been identified as a major culprit in the development of unhealthy eating habits. In 2007, in an attempt to reverse this, the Thai FDA and Public Relations Department placed restrictions on food advertisements targeting children on prime-time television. ‘Foods for Children’ related advertisements were only allowed screen time of 12 mins per hour. In addition, fast food toys were banned and all unhealthy products had to be labelled with ‘Eat Less, Exercise More”.

Promoting regular exercise and physical activity
Efforts to encourage regular exercise and physical activity have been seen on the part of the Ministry of Public Health since 2009. Such initiatives include setting up exercise corners in public areas within society.

‘Thai People Have Flat Belly’
Launched in 2010, this campaigned for healthy food consumption and higher levels of exercise to reduce non-communicable diseases. A similar approach was taken by the Royal College of Physicians of Thailand to launch ‘Network of Flatless Belly Thais’ to reduce intra-abdominal adiposity and metabolic syndrome for Thai citizens.

‘Sweet Enough Network’
Set by the Ministry of Public Health’s Dental Health Division, to push for tighter regulations regarding sugary drinks in Thailand. In 2010, this campaign advocated the banning of sugary drinks sold in educational institutions as well as added sugar found in follow-up milk powder for babies. The Thai government responded by implementing a nationwide ban of added sugar in follow-up milk powder for babies.