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Ladda Mo-suwan , MD, FRPedT, MS (Human Nutrition) Department of Pediatrics, Faculty of Medicine,

Obesity: Magnitude of problem in Thailand. Ladda Mo-suwan , MD, FRPedT, MS (Human Nutrition) Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. Prevalence of adult obesity in Thailand. %.

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Ladda Mo-suwan , MD, FRPedT, MS (Human Nutrition) Department of Pediatrics, Faculty of Medicine,

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  1. Obesity: Magnitude of problem in Thailand Ladda Mo-suwan, MD, FRPedT, MS (Human Nutrition)Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

  2. Prevalence of adult obesity in Thailand % Waist circ. 15.4% M>90 cm, 36.1% F >80 cm 5th National Food and Nutrition Survey (DOH, MOPH 2003) Ladda Mo-suwan

  3. 6-14y 6-14y Nutritional status of school-aged children % Whole country Ladda Mo-suwan

  4. 11 4 9 5 15 4 5 12 4.0 2005: Data from 268 primary schools(47,389 students)in urban settings  11.7% obesity (local ref) 14.7% overweight and 5.9% obesity (IOTF) HRN, NHF supported by TRF 3.7 2.1 Obesity Wasted Stunted 3.3 Ladda Mo-suwan

  5. Thailand MICS 2006 Ladda Mo-suwan

  6. 36% Increasing obesity in the young Mo-suwan L et al, 2004 Ladda Mo-suwan

  7. Medical Complications of Obesity Idiopathic intracranial hypertension Pulmonary disease Obstructive sleep apnea 7% Hypoventilation syndrome Metabolic syndrome Impaired glucose tolerance – 33.8% Diabetes - 2.8%, 10xin 20 y Dyslipidemia – 50% Hypertension Nonalcoholic fatty liver disease Severe pancreatitis Gall bladder disease Gynecologic abnormalities abnormal menses polycystic ovarian syndrome Joint deformities Skin Acanthosis nigricans striae From www.obesityonline.org

  8. Association of GPA with BMI status and changes of BMI status 1994 Mean GPA Regression coefficient p (95% CI) 1994 BMI status Underweight 2.60 + 0.78 0.06 (-0.12, 0.25) NS Normal 2.60 + 0.77 Overweight 2.37 + 0.71 -0.20 (-0.04, -0.37) 0.017 Change of BMI status over the two years Thinner 2.68 + 0.74 0.14 (-0.12, 0.0.41) NS Stable-non overwt 2.59 + 0.77 Stable-overwt 2.43 + 0.69 -0.14 (-0.32, 0.04) NS Becoming overwt2.11 + 0.73 -0.48 (-0.12, -0.84) 0.008 MO-suwan L et al. IJO 1999 Ladda Mo-suwan

  9. Nutrition situation and NRCDs in Thai adults(5th National Food and Nutrition Survey 2003) Male Female High LDL-C>130 mg/dl (%) 13-33 13-44 LOW HDL-C<40 mg/dl (%) 6-13 18-32 High TG >150 mg/dl (%) 6-46 8-37 Prevalence of DM (%) 6.4 7.3 Prevalence of high BP (%) 23.3 20.9 Kraisid Tontisirin, 2nd TCN 2007

  10. Weight loss business in 2007 costs 1.8 to 2 billion baht กันยายน 2550 Source: National Economic and Social Development Board Ladda Mo-suwan

  11. Thailand MICS 2006 National target7% Thailand MICS surveyed40,000 households in 76 provinces and additional 30,000 households in 26 provinces (NSO & Unicef) Ladda Mo-suwan

  12. นมแม่กับอาหารเสริม -- exclusive breast feeding 5% ------- Thailand MICS 2006 Ladda Mo-suwan

  13. Diet of children age2 y % freq/week Animal protein 90+ 5-7 Liver 73 2 Vegetables 85 4-6 Fruit 85 5-8 Soft drink 57 3-5 Instant noodles as snacks 85 1-2 Drinking yoghurt21 5-7 Source: Prospective Cohort of Thai Children (PCTC), supported by TRF, MOPH,WHO Ladda Mo-suwan

  14. Food, nutrition and life style factors(Data from various sources 2003-2005) • Sugar consumption in 2006 was 33.2 kg/person/y or 91 g/d or 17.2 % of energy intake from sugar • Average sugar intake from snacks and beverage in the preschool children: 40.4 g/d, 35.2% consumed less than 24 g/d (Wongkongkathep et al, 2006) • Soft drink beverage intake was 102 bottles/person/y • Increasing energy-dense snack consumption particularly in children, 2 packs/person/day • Increased alcoholic beverage intake, 81.7 liter/person/y in 2003 • Only 35.7 % of male and 23.7 % female from 6 years onward exercised regularly (NSO 2002) Kraisid Tontisirin, 2nd TCN 2007

  15. Energy dense foods & beverage • Snacks contributed 27% of DRI energy, 34% of sodium in preschool children (Chittchang et al, 2004) • School aged: Energy dense snacks contributed to 30% of DRI, fried snacks 7%, beverage 9%(Tangwitoon et al, 2006) • Expense on snack -- 3.7 billion USD/y equivalent to government budget for education or 15% of total budget(Maya Group, ThaiHealth) L Mo-suwan

  16. TV time (h/wk), DTC 2001 50% of preschool children watched TV more than 2 h/d (2006)

  17. School environment survey • School meal survey: 55% provide fruit 3/week  30% lower prevalence of obesity • Less than 1% had vending machines selling soft drink  2x higher prevalence of obesity • 41% organized extra exercise 3/week  20% lower prevalence Source: NHF surveyed 400 schools by sampling the largest school from each constituency all over the country in 2005 Ladda Mo-suwan

  18. School soft drink and snack policy Sale in school School-owned(%)(%) Soft drink free policy yes(85%) 15 28 no 80 34 Snack free policy yes (58%) 42 41 no 87 60 Schools that received financial support from the food/beverage companies had prevalence of obese students 1.5 times higher than those that did not. NHF survey 2005 Ladda Mo-suwan

  19. School environment and obesity • School milk program: free sweet milk, sweet drinking yoghurt increased risk for becoming obese and remaining obese over the 2 y about three times [OR 2.9, 95% CI 2.00-4.15] and OR 3.4, 95% CI 1.65-6.80, respectively), while non-sweetened milk reduced the risk (OR 0.1, 95% CI 0.04-0.22). • the risk was increased in children who were in schools having fried snack sold after hours (OR 10.7, 95% CI 5.37-21.19). (Thitiboonsuwan A, Mo-suwan L, Sangsupawanich P, 2006) Ladda Mo-suwan

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