China too must confront obesity

Interventions often fail to address the complexity of the problem. For instance, programs targeting childhood obesity only focus on the child but not the family, school and community - all of which can affect the outcomes. Interventions also need to encompass sociological factors such as education, availability of health information and media, and cultural beliefs.

Future strategies could focus on changing food pricing policy, influencing school policy on health matters and physical education, and changing the content of school canteens. Policies should aim to modify the environment, at both the school and community level, to support healthy lifestyle behaviours in children and adolescents. Educating parents and other care-givers to reinforce key messages outside school is also vital for any obesity intervention targeting children.

National plan being developed

Since 2005, a program called Happy 10 has been operating in schools in Beijing and other cities. It includes 45 types of activities from rope skipping to the triathlon. The education ministry has recommended that group dancing be incorporated into the national curriculum. And in May 2007, the Chinese Preventive Medical Association launched China's first week-long campaign against obesity in Beijing, Guangzhou, Shanghai and Shenzen. It included lectures by experts and free examinations to make people more aware of the hazards of being overweight.

The Ministry of Health is developing a national plan to prevent and control chronic diseases, which recognises obesity as a key risk factor for ill-health. A national education program on healthy lifestyle was initiated in May 2007, which included information on what constitutes a healthy diet and suitable levels of physical activity. But it will be several years before it can be evaluated.

Randomised trials show intensive behavioural interventions bring modest but sustained weight loss for adults.

Yet the China Nutrition and Health Examination Survey from 2002 - a nationally representative survey repeated every ten years on 250,000 randomly sampled individuals in China - suggests excess weight and obesity is increasing more in rural compared with urban areas, and more among males than females.

If China is to achieve what the West has so far failed to do, and halt its obesity epidemic, innovative and culturally-relevant prevention and intervention programs are urgently required.