Singapore’s Efforts to Reduce Childhood Obesity, Revisited

Storytelling on Thursdays

A while back, Singapore was getting some good PR for keeping its kids thin. As Childhood Obesity News discussed, a comparison was made between the childhood obesity rate in Southeast Asia, which was 23%, and the rate in Singapore, less than half that number.

Reports talked about mental health literacy, in connection with a bulimia study where it was determined that health promotion programs need to be addressed not only to at-risk individuals, but their families and social contacts — in other words, everybody. We noted at the time:

Singapore’s Ministry of Education also focuses on ‘promoting mental wellness at an early age’ — and they mean pre-school — ‘to ensure our children have the coping skills to go through different life stages.’

This is meaningful because coping skills are exactly what kids need to have so they don’t become addicted to junk food through “comfort eating.” This comfort eating happens because they don’t have the skills to cope with life in a better way. Teach the coping skills, prevent the problem. So far, so good.

As of 2011, when the Singapore childhood obesity rate was stated as only 10.9%, what had they been doing to accomplish that? Back in 1992, they started a National Healthy Lifestyle Program which concentrated on public education campaigns convincing people to eat in a healthy manner and do more physical activity. The program also endeavored to “promote supportive environments, restrict the availability of energy-dense foods to children, and increase access to exercise and fitness facilities…”

Apparently, it worked, at least with children. The population as a whole is not faring so well. A report dated January 2012, only a couple of months later and authored by A/Prof. Goh Lee Gan and Dr. Jonathan Pang begins by saying that obesity (PDF) is increasing in Singapore. It lists the causes of obesity as “excessive food energy intake, lack of physical activity, and genetic susceptibility,” and goes on to say:

To be effective however, obesity prevention and control requires multiple prevention and control interventions across the lifespan.

Yes, but what are those coping skills and interventions, and how do they know there is a direct cause-and-effect relationship, or even an indirect one? The current efforts of the Health Promotion Board (HPB), which are tailored and customized for different environments, are grouped into five major areas:

(1) Health promotion policies;
(2) Promoting supportive environments through social programs;
(3) HPB collaborating with partners to promote healthy behavior;
(4) Empowering partners and individuals;
(5) Raising awareness through health education and communication.

Health promotion policies, which are different for adults and children, feature “evidence-based dietary and physical activity guidelines.” There are awards for schools, but so many schools have gotten on board, the awards are no longer quite so special when 80% of the schools get them. If a Singaporean is over 15 years old, the odds are 60% that she or he participates in some kind of workplace fitness program. And companies get awards for helping their employees achieve better health.

In the schools, Singapore has the intriguingly named Model Tuck-Shop Program. No, not truck stop. “Tuck shop” is British for “convenience store.” (There is also a Healthier Hawker Program, which is what Americans call street vendors. The Brits used to run Singapore, and left some of their terminology behind.)

This has been going on since 2003:

Schools are provided with a set of healthier food service guidelines that aim to limit students’ exposure to fat, salt, and sugars in food typically consumed in the tuck-shops, as well as increase their consumption of fruits and vegetables.

Physical education schools is called the Trim and Fit Program, and it admits to a primary concern about overweight students, as well as for every student’s health in general. A little history:

Following the review of this program in 2005, the program evolved into a Holistic Health Framework (HHF), which was formally established in 2007. The HHF seeks to broaden health promotion in schools beyond obesity prevention and fitness management by embracing a broader concept of students’ general well-being and developing their intrinsic motivation to lead a healthy lifestyle.

In the community, the government program collaborates with the People’s Association, Singapore Sports Council, and other groups, to gather folks together for aerobic workouts, running, brisk walking, and Tai Chi (which is especially excellent for the elderly). And the rather big-brotherly government of Singapore has the clout to encourage the cooperation of businesses, the food industry, the unions, non-government groups, and, of course, other government agencies.

The HPB also provides training for leaders in all these institutions and sponsors a kind of live viral program where “ambassadors” learn good healthy cooking skills and pass them on to others, who hopefully will then become ambassadors themselves. And there is also general-public media education, and even “road shows,” which would be fascinating to witness.

Healthcare providers in Singapore are urged to do the following:

• Proactively engage patients in conversations about their weight.
• Provide advice on lifestyle behavior changes to promote healthy weight.
• Refer patients to community-based healthy life programs.

Your responses and feedback are welcome!

Source: “Obesity in Singapore, Prevention and Control” (PDF),, 01/12/12
Image by kodomut (Zhao !), used under its Creative Commons license.

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