Singapore Says Childhood Obesity Is Environmental

Overlooking Singapore General Hospital

KK Women’s and Children’s Hospital in Singapore identifies the primary causes of childhood obesity as environmental:

An abundance of food allows for excessive intake of food from all food groups, especially fats. A diet high in fat is associated with increased prevalence of obesity.

The part about dietary fat, incidentally, is hotly contested by other nutritional belief systems. The hospital goes on to say:

Children no longer need to walk to school. They ride the school buses or are dropped off at the schools’ doorstep by their parents. Instead of engaging in outdoor games, children spend more time in front of the television or computer. The excess calories consumed then leads to obesity. Obesity management programs focus on decreasing caloric (food) intake and increasing energy expenditure through exercises.

For toddlers, one of the recommendations is to change the type of activity frequently, because of the short attention span of children who are 3 or younger. From ages 3 to 6, a child’s ever-improving motor skills can encompass ball games, tricycles, bicycles, swimming and, of course, running. From 6 to 12, “activities that focus on aerobic conditioning, strength and endurance development are encouraged.” Still, diet and exercise are not quite the whole picture: “Behavioral modification of the child and his family may enhance the effectiveness of these programs.”

The literature also uses the term “lifestyle intervention.” There goes that cultural difference again. In the U.S., when the government gets into the behavioral modification business, it sets a very large burr under a lot of people’s saddles. What does KK Hospital mean, exactly, by behavior modification? A lot of family involvement, for sure, with counseling and education for parents (as the major role models children will imitate) and other caregivers.

At the start of the program, a comprehensive family, social and physical activity history of the child will be taken. An exercise specialist will conduct a fitness assessment and will provide appropriate recommendations for physical activity based on the current physical activity profile and fitness level of the child. Following the assessments, the child will be enrolled into the structured exercise program at KKH Fitness Centre…. Participants will be required to set regular short-term lifestyle goals to help them achieve their long-term health goals.

About a year ago, a report was issued under the combined auspices of Singapore’s Ministry of Health, Ministry of Education and Ministry of Community Development, Youth and Sports. One of the innovations it noted was a change in methodology. Up until 2010, the weight-for-height chart was the tool most commonly used to monitor students’ conditions, and they were checked every month. Now, schools have switched to BMI-for-age charts, and the Body Mass Index of each student is checked annually.

Also in 2010, the Ministry of Education added an extra hour of physical education per week in primary and secondary schools, and put in motion plans to accommodate that extra activity by building or improving indoor sports auditoriums and hiring more P.E. teachers.

(to be continued…)

Your responses and feedback are welcome!

Source: “Obesity – Exercise,”, 2012
Source: “OHCHR Study on Children’s Right to Health,”, 10/10/12
Image by Erwin Soo


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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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