Friday, October 8, 2004

SINGAPORE — The battle against the bulge starts young in Singapore. Fat children are separated from their classmates and ordered to do more exercising until they lose weight.

Mona Siow, 10, has been trying to lose weight for the past four years.

Instead of joining her friends at the canteen during recess every day, the fourth-grader and other chubby students gather in the hall and follow a teacher’s instructions to skip rope, run and dribble a basketball.

“I feel sad to be overweight when I look at people and they’re so skinny and can wear so many clothes,” said Mona, who needs to shed about 37 pounds before she can leave the program. At 4 foot 8, she weighs 128 pounds.

As a member of a Singaporean primary school’s “Health Club” — where membership is compulsory for overweight children — Mona does special exercises in addition to the regular physical education curriculum. Teachers monitor her height and weight every month.

Although the school does not put restrictions on what Mona can eat, teachers meet with her parents regularly to recommend healthier ways to prepare their daughter’s meals at home. Mona says she used to hate eating vegetables but has grown to like them.

More than a decade ago, this tiny but modern city-state’s leaders decided the best way to fight the war on expanding waistlines and ballooning health care costs was to begin with the generation growing up on a diet of fast food, television and computer games.

The government created a school-based intervention program that includes rigorous exercise for plump children and recommendations on food sold in canteens, where the aromas of Western-style meals mingle with the spicy smells of local fare.

Most schools in tropical Singapore have open-air lunchrooms catered by up to a dozen private vendors selling a variety of foods from their stalls. This allows students of different ethnic and cultural backgrounds with varied dietary restrictions to choose among Chinese, Indian or Western-style meals.

About three-quarters of Singapore’s 4 million people are ethnic Chinese. About 15 percent are Malay Muslims, with the rest mostly of Indian descent.

Vice Principal Ng Sock Hua says no more than two of 10 dishes served to the children are preserved, or canned.

“No deep-frying; only grilled food allowed,” she declared. “And I’ve asked them to hold back on selling caffeinated and soft drinks.”

But reality isn’t exactly as Miss Ng describes it. As she gives a tour of the canteen, she notices with some surprise that students are lining up for plates of french fries and chicken nuggets, and snapping up cans of Coca-Cola at the drinks stall. She has a stern word with the stall owners about the rules and then walks away.

“We try to monitor the vendors, but it’s not easy to ensure that they’re selling the right things,” she said, shaking her head. “They tend to provide the food that kids like to eat.”

Unlike the tight controls it puts on many aspects of everyday Singaporean life, the government issues recommendations rather than regulations about the food sold in school cafeterias. In turn, the school passes down the instructions to canteen operators, but checking on them is sometimes infrequent.

The sheer abundance of food and major cultural shifts over the past few decades have contributed to young people’s bad eating habits, said Gladys Wong, president of the Singapore Nutrition and Dietetics Association.

“In the 1950s, if you’re hungry, you drink water until Grandma prepares the next meal, and have to wait for Dad to come home before everyone eats together at the table,” Mrs. Wong said.

“Nowadays, if the kid is hungry, taking a break from the computer can be a TV dinner [or] frozen pizza [put in] the microwave,” she said.

These new habits are proving hard to break. The so-called health clubs have reduced the proportion of overweight students from 14 percent in 1992 to 10 percent in 2003, Education Ministry statistics show, but many, like Mona Siow, don’t shed the pounds.

“It’s quite disheartening to see students remain in the club for a number of years,” said Lim Ee Kheng, the school’s head of physical education at Mona’s school, the elite Singapore Chinese Girls’ Primary School. “To keep them in the club for a long time is bad for their self-esteem because there’s a stigma tied to it.”

If Mona fails to lose her required weight, for example, she is doomed to stay in the program until she completes high school.

The government also is trying to mobilize its adult population to fight flab. Every September, the city-state holds a monthlong fitness campaign aimed at getting the entire population to eat better and stay physically active.

The theme for 2004 is “Fighting Obesity” and the campaign began with a mass aerobic workout class that had 12,000 people sweating it out together on the beach.

Even Singaporean Prime Minister Lee Hsien Loong, who is tall and trim at 52, took part, with TV cameras capturing him sweating, punching and stomping it out with his fellow citizens.

Compared with the United States and Western Europe, Singapore’s vigilance seems remarkable. Two-thirds of Americans are overweight. Singapore Health Ministry figures show that one in three Singaporeans needs to lose weight, and about 6 percent of its 4 million people are obese — meaning at least 30 pounds too heavy.

But those numbers may expand dramatically as officials prepare to revise their measurement standards to match new research indicating that Asians suffer detrimental health effects at a lower weight than Caucasians.

“We noticed that although Singaporeans are less obese compared to people of [other] developed countries, our heart disease trend is similar to theirs,” said Mabel Yap, head of research and information at the government’s Health Promotion Board.

Mrs. Yap conducted a study that showed Singaporeans had 5 percent to 6 percent more fat in their bodies than European Caucasians of the same age and same body-mass index (BMI). The index is a calculation of weight and height commonly used to evaluate body fat.

To define obesity, most countries follow standards set by the World Health Organization, which defines “overweight” as a BMI above 25, and “obese” as a BMI of 30 or higher. These levels are largely based on data derived from research on Caucasians.

“If you truly want to define obesity, it should be about excessive body fat and related health risks,” Mrs. Yap said.

She has recommended that the country’s health policy-makers lower the BMI at which a person is considered overweight from 25 to 23. That could lead to as much as half of all the island’s residents being considered overweight, instead of just one in three.

“It’s enough to alarm,” she said.

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