Chan, C.M.S.; (2008) Obesity in preschool children in Hong Kong. Doctoral thesis , University of London.

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Abstract

Background: Obesity is the world's fastest growing epidemic, especially in areas of rapid social and economic transition such as South East Asia. The prevalence of childhood obesity in Hong Kong and China has been rapidly increasing for a decade. The Medline database lists 100,000 articles on obesity, with hundreds of confirmed and putative "causes" and hypothesized (though rarely proven) preventive strategies. Contemporary scholars have called for obesity research to stop focusing on single issues (at the level of the genome, the individual, or society as a whole) and embrace multi-level theories that allow the interplay between micro-and macro to be explored and followed over time. Since little information of Hong Kong childhood obesity has been available, this study used Glass and McAttec (2006) and Sallis et al (2005) to study the aetiology of obesity in Hong Kong preschool children. The work described in this thesis aimed at investigating the social and cultural factors of childhood obesity in Hong Kong. Methods Mixed method research, including quantitative and qualitative tools was employed for this study. Ten in-depth case studies were undertaken of six obese and four normal weight preschool children recruited from four kindergartens with different socio-economic characteristics throughout Hong Kong. These case studies were built up from ethnographic observation at home, in kindergartens, in restaurants/cafe's semi-structured interviews with child, parents, grandparents, live-in foreign domestic helpers and teachers construction of genogram analysis of dietary diary and questionnaire to primary caregiver were used. The case studies were nested in a wider quantitative study of body image perceptions and attitudes to food and child rearing in 119 primary caregivers of preschool children. SPSS software was used to analyse quantitative data for descriptive statistics, correlations and factor analysis. Ritchie and Spencer's framework was first employed to sort out the qualitative data. Subsequently a further, multi-level theoretical analysis was used to link quantitative and qualitative data, first to generate individual case descriptions, second to draw themes across cases, and third to place the findings in wider historical and policy context. Findings: The findings affirm previous research that the onset of obesity is multifactorial and involves a highly complex interplay between inherited predisposition, physiology, and individual behaviour (especially dietary choices, active play, and sleep) which is itself influenced by personality, attitudes and preferences. All of these appear to be shaped and constrained by opportunities (e.g. availability and affordability of food), and the wider social and economic context of Hong Kong as a modem, rapidly developing free-trade society. The data suggest that the knowledge, attitudes and confidence of the primary caregiver (typically the mother), which are strongly influenced by social networks and level of acculturation, are critically important in determining behaviour predisposing to obesity in the very young. Family structure, whether the family eat together regularly, and norms about mealtime behaviour, also seem critical. Conclusions: There are neither simple causes nor simple solutions to the obesity problem. Mixed method research driven by multi-level theories can help generate hypothesis about how multiple antecedents interact to cause obesity in an individual. Based on the findings of the work described here, a small-scale intervention, the Adopted Healthy Family Scheme, has been developed and is at the preliminary pilot stage.

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