Community & Public Health Nutrition: Combating Obesity in Hong Kong

This report examines the growing concern of obesity among young adults in Hong Kong and explores strategies for prevention through community and public health nutrition. It highlights the increasing prevalence of obesity, its associated health risks, and the influence of obesogenic environments. The Analysis Grid for Environments Linked to Obesity (ANGELO) framework is proposed for analyzing contributory factors. A key focus is on the efficacy of educational sessions in promoting healthier behaviors among individuals aged 18-25, with specific objectives and strategies outlined to improve dietary habits and reduce unhealthy food intake. The report also touches upon poor nutrition as a global public health issue, particularly in Australia, emphasizing the need for early intervention and addressing data gaps in understanding the effectiveness of educational programs. The evaluation framework suggests regular data collection through questionnaires to assess changes in motivation and behavior.

Running head: COMMUNITY AND PUBLIC HEALTH NUTRITION
Community and public health nutrition
Name of student:
Name of university:
Author note:

1COMMUNITY AND PUBLIC HEALTH NUTRITION
Question 2
Background
Obesity is one of the leading health concerns on a global scale at present due to its high
prevalence as indicated by statistical figures. The condition has been associated with an
augmented risk of chronic diseases such as cardiovascular diseases, diabetes, cancer, asthma and
hypercholesterolemia. Reports point out that that around 937 million adults are obese and around
396 million overweight adults across the globe. China has faced fast growth in the country’s
economy in the recent ten years. This has led to major changes in the lifestyles of individuals and
successive alterations in health patterns. The issue of growing prevalence of obesity is not
confined among adults only. Children and young adults also contribute to the total number of
obese individuals in the country to a significant extent (Hu et al., 2017).
According to Zhang et al., (2016) childhood obesity has been linked with increased risk
of obesity in adulthood that puts the individuals at risk of suffering comorbid conditions such as
hypertension and dyslipidemia. Much to the consternation of healthcare researchers both
developed and developing countries demonstrate dramatic increase in obesity prevalence in
recent times. China is one of the largest developing countries and has joined the world obesity
epidemic due to the rapid urbanization and economic growth. Hong Kong, an autonomous
territory in South China has recently come into focus for the high prevalence of obesity among
children and young adults. The prevalence of obesity among the youth and young adults in Hong
Kong has drawn significant attention in the recent past. The obesogenic environment
encompassing individuals aged between 18-25 years has been much discussed about recently due
to the possible burden on healthcare system. According to national report, the Census and
Statistics Department survey was noteworthy in bringing forward the issue of obesity among
young adults. The survey in 2015 accounted for the obesogenic environment among the youth in
Hong Kong. Around 13% of youth aged 18-24 had been suffering from obesity or overweigh
condition in the time frame between 2004 and 2014. The extent of physical activity carried out
by the target group was considerably less as per the reports, with the numbers between 51.3%
and 61.1%. Coming to the overall health condition of the population, it was noted that 1.3% had
been suffering from a chronic disease, most of which are linked with obese condition
(coy.gov.hk, 2015).

2COMMUNITY AND PUBLIC HEALTH NUTRITION
Sun et al., (2014) analyzed the prevalence of overweight and obesity among children in
China as indicated between the years 1985 and 2010. The study mentioned that individuals aged
between 7 and 18 years reported obesity and overweight condition at 8.1% (95% CI, 8.0–8.3%)
and 19.2% (95% CI, 19.1–19.4%). The data holds prime importance in the present context since
children who are obese in their early years have more chances of remaining obese in their
adulthood. Further, the increase in public health costs on the longer run is also noteworthy.
Much discussion has been put forward at different spheres to understand the contributory
factors for obesity and overweight. The literature of Ho et al., (2013) point out that the obesity
pandemic encompassing children and young adults in China has a distinct association with
under-activity and over-eating. Further, obesity has been denoted as a socially patterned issue.
The underlying concept is that socioeconomic status leads to a temporal rise. With the growing
trends in urbanization there has a rapid change in the dietary intake of individuals. This, together
with the lack of adequate physical exercise, has contributed to the patterns of weight gain among
youth. Change in lifestyle has diminished the scope of engaging in physical exercises in the
recent times. Advancement of technologies has been repeatedly blamed for the condition.
Further, cultural belief that youth who have increased body mass are healthier has also
contributed to obesogenic environment. Social misunderstandings regarding obesity being a
predominantly genetic condition is also an issue (Thompson et al., 2015).
Analysis of the obesogenic environment in Hong Kong needs a robust framework that
can successfully gain insight into the contributory factors for high prevalence of obesity. The
Analysis Grid for Environments Linked to Obesity (ANGELO) has been pointed out to be a
suitably defined and consistent framework that brings into limelight the key reasons behind the
obesogenic environment. The framework can be perceived as the conceptual model that
establishes a link between the fundamental elements of the environment connected with obesity.
The four spheres that are considered for the analysis are socio-culture, political, economic and
physical. The ANGELO is an efficient and flexible method of deciding upon a palan for obesity
prevention in communities (Simmons et al., 2009).

3COMMUNITY AND PUBLIC HEALTH NUTRITION
Data gap
Obesity prevention initiatives in China have attempted to integrate different approaches
derived from the understanding of the contributory factors of the condition. While research has
strived to highlight the suitable measures for obesity prevention, gaps in data pertaining to
different domains have been criticized often (Yang et al., 2017). Not much has been done to
understand the extent to which educational programs are effective in bringing about health
behavior changes among the target population. There is an urgent need of collecting accurate
data on how educational programs can motivate young adults to adhere to a healthier lifestyle in
future. Further, there is a need of understanding the impact of educational sessions on different
age groups among the population.
Prevention of obesity has been associated with changes in health behavior among the
target population across literature from different countries. As pointed out by Zhang et al.,
(2018) educational programs have the potential to bring about changes in level of motivation and
impetus to adhere to a healthier lifestyle. The researcher support that the underlying principle of
educational programs is directed towards educating the individuals about the negative impact of
obese condition. Reduction in obesogenic environment has been achieved in a number of
countries after successful implementation of prevention programs focused on educational
sessions.
Goal for data collection
Based on the above discussion it is imperative to state that the goal for data collection
that can act as the basis for obesity prevention program would be to conceptualize the efficacy of
educational sessions in bringing health behavior modifications among individuals aged between
18-25 years. The effectiveness of such sessions is to be studied in relation to motivation level of
individuals to reduce intake of unhealthy food and adhere to a healthier dietary intake pattern.
The sessions are to have the objective of promoting the importance of eating healthy and
supporting self with nutritious food options (Hawkins et al., 2018).
Objectives and strategies
Objective 1

4COMMUNITY AND PUBLIC HEALTH NUTRITION
S- Evaluation of appropriateness and efficacy of an educational session in promoting the need of
healthy dietary intake for preventing obesity
M- Positive changes in motivational level of individuals aged between 18-25 years to
demonstrate healthy dietary intake
A- Data collection with appropriate tool
R- Suitable changes in health behavior
T- One month
Strategy 1.1
Changes in motivation level to ensure healthy dietary intake on the basis of education
imparted through the conducted sessions is to be measured for individuals in major high schools
in Hong Kong. Data collection is to be done with a close ended questionnaire at the before the
sessions and after the completion of the same.
Strategy 1.2
Changes in motivation level to ensure healthy dietary intake on the basis of education
imparted through the conducted sessions is to be measured for individuals in major colleges in
Hong Kong. Data collection is to be done with a close ended questionnaire at the before the
sessions and after the completion of the same.
Strategy 1.3
Changes in motivation level to ensure healthy dietary intake on the basis of education
imparted through the conducted sessions is to be measured for individuals in workplaces in Hong
Kong. Data collection is to be done with a close ended questionnaire at the before the sessions
and after the completion of the same.
Objective 2
S- Evaluation of appropriateness and efficacy of an educational session in promoting the need of
avoiding unhealthy food for preventing obesity

5COMMUNITY AND PUBLIC HEALTH NUTRITION
M- Positive changes in motivational level of individuals aged between 18-25 years to
demonstrate avoidance of unhealthy food
A- Data collection with appropriate tool
R- Suitable changes in health behavior
T- One month
Strategy 2.1
Changes in motivation level to ensure avoidance of unhealthy food intake on the basis of
education imparted through the conducted sessions is to be measured for individuals in major
high schools in Hong Kong. Data collection is to be done with a close ended questionnaire at the
before the sessions and after the completion of the same.
Strategy 2.2
Changes in motivation level to ensure avoidance of unhealthy food intake on the basis of
education imparted through the conducted sessions is to be measured for individuals in major
colleges in Hong Kong. Data collection is to be done with a close ended questionnaire at the
before the sessions and after the completion of the same.
Strategy .3
Changes in motivation level to ensure avoidance of unhealthy food intake on the basis of
education imparted through the conducted sessions is to be measured for individuals in
workplaces in Hong Kong. Data collection is to be done with a close ended questionnaire at the
before the sessions and after the completion of the same.
Evaluation framework
Evaluation of the education sessions is to be done at the end of one month and at two
weeks interval for next four months. Regular data collection would ensure that the data
collection is apt. questionnaires are to be filled in by the participants that would have close-ended
questions. Data collected through such questionnaires would be straightforward. Statistical data

6COMMUNITY AND PUBLIC HEALTH NUTRITION
analysis would be easier for the same nature of data. The main advantage would be that the
evaluation results would be produced promptly.

7COMMUNITY AND PUBLIC HEALTH NUTRITION
Question 5
Background
Poor nutrition is a silent emergency in many parts of the globe, as it emerges to be a
significant public health concern in the respective countries. As an indicator of poor health
status, poor nutrition has a drastic impact on the health conditions of individuals suffering from
the issue, as well as on the economic and social development of the population. Poor nutritional
status has been denoted to be a common cause of mortality and morbidity among certain
populations across the world. Though Australia is making attempts to achieve good health status
of the population, poor nutritional status has been drawing attention in the recent past,
demanding an early response to address the issue (Cash et al., 2015).
Selected issue
Research indicates that poor nutrition among Australia’s population is a key concern at
present since the exact status remains under diagnosed and under recognized at different levels.
The impact of poor nutrition is drastic on the individual suffering from it. Individuals suffer from
physical and psychological impairment (Barker et al., 2011). The researchers point out that
malnutrition has a direct negative impact on the healthcare costs in the country owing to the
nature of the funding system adhered to. An increased length of stay in hospital due to poor
nutritional status is noteworthy. Further, healthcare providers are also subjected to increased
work load and service provision burden. The repercussions suffered by the individuals are
serious, as the key body changes include weight loss and comorbid conditions.
The prevalence of poor nutrition among the Australian population and the consecutive
impact can be understood from the reports of Australian Institute of Health and Welfare. Poor
nutrition has drawn the attention of public health researchers as 35-43% of patients suffer from
poor nutrition when considered for providing treatment in different healthcare facilities of the
country. The report pointed out that a survey carried out with eight residential aged care facilities
denoted 32-72% of malnutrition prevalence. This finding was successful in highlighting the poor
nutritional status of the individuals of the country (aihw.gov.au, 2012).

8COMMUNITY AND PUBLIC HEALTH NUTRITION
The economic burden of health conditions suffered in relation to nutrition had been
noteworthy. The direct costs of nutrition related diseases in the 1990s were approximately
$1.5bn. After addition of the indirect costs for lost earnings and premature deaths the amount is
at $2.25bn. There is a lack of updated data on the same context. Nevertheless, the figures are
likely to increase at the contemporary era (extranet.who.int, 2010).
Priority population and health determinants
Aboriginal malnutrition has become a national disgrace at the present times. It is a shame
for the country that even though the country is a major food producer of the world, a significant
number of Australians do not have access to adequate affordable and nutritious food. Research
indicates that indigenous women have more chances of suffering miscarriages and low weight
births as a result of poor nutrition. Almost 30% of the total indigenous Australian population
report to have restricted access to nutritious food. Further, individuals belonging to the culturally
and linguistically diverse (CALD) group are also at increased risk of suffering from poor
nutrition. The underlying reason is that people from this population have limited access to
transport facilities, and have low education level (aihw.gov.au, 2012).
Individuals from the lower socio-economic class have more chances of suffering from
poor nutritional status in Australia (Bryceson et al., 2016). Individuals who are unemployed or
come from poor economic households have limited access to nutritious food. The undeserved
population lives in areas where lack of access to food underscores how the determinants of
health influence nutritional status. In addition, those from single parent families also suffer from
poor nutritional status owing to limited access to food and limited awareness level.
Effectiveness of strategies
The Australian Health Ministers had put forward the ‘Eat Well Australia’: An Agenda for
Action for Public Health Nutrition 2000-2010, as a national nutrition strategy for combating the
high prevalence of poor nutrition across the country. Further, the National Aboriginal and Torres
Strait Islander Nutrition Strategy and Action Plan (NATSINSAP)’ was endorsed as the strategic
plan for addressing the poor nutritional status of the indigenous population. The two strategies
were implemented in such a manner that they complemented each other. The common goal was
to bring remarkable improvement in the health status of the country’s population in relation to

9COMMUNITY AND PUBLIC HEALTH NUTRITION
nutrition. The contribution of Strategic Inter-Governmental Nutrition Alliance (SIGNAL) in this
regard was appreciable. The Eat Well Australia initiative had been set in place in collaboration
with different other public health strategies. One of the most praiseworthy among them is the
‘Acting on Australia’s Weight strategy. Others include the National Mental Health Plan, the
National Alcohol Plan, the National Diabetes Strategy and the National Breastfeeding Strategy
(extranet.who.int, 2010).
A critical analysis is to be carried out for understanding the reason for limited success of
the Eat Well Australia initiative. Bastian (2011) analyzed the effectiveness of the strategy
through an interpretive approach considered in relation to the Bacchi’s method of problem
representation. The key concern that was brought into the limelight was that Eat Well Australia
initiative was ot successful to its maximal potential owing to different structural and economic
barriers. In addition, inadequate allocation of human resources was a key reason for the failure of
the strategy. Without the support from a robust healthcare professional workforce, it was not
possible to implement the strategy in practice to the optimal extent. In addition, the professionals
entitled with the tasks outlined in the strategy lacked professionalism and clear understanding of
roles and responsibilities.
Australia had come forward to implement policies in the past aiming to improve
nutritional status of individuals across the country. One such policy was the Food and Nutrition
Policy of 1992 that had the focus on improving provision for nutrition. In spite of attempts made
to enhance the provision of nutritious food for the communities, there existed certain drawbacks
in the approaches made. The most noteworthy among these was the lack of focus on structural
circumstances that were to be improved for improving the condition (Cullerton et al., 2016).
Hegedus and Mullan (2015) in this regard had highlighted that policies implemented in relation
to access to nutritious food lacked the support of social and cultural factors at the core level. The
policies were not based on the cultural factors and social attributes that led to the limited access
to care provisions in the country.
Willis et al., (2016) have highlighted that many individual states in Australia have
implemented distinct strategies to address the concern of poor nutritional status. The primary aim
of such strategies has been on treating the populations facing poor nutritional status in the
country. One noteworthy form of initiative has been the support for communal meal provisions.

10COMMUNITY AND PUBLIC HEALTH NUTRITION
The fundamental aim had been to put in place a robust provision for meal assistance in the
communities. However not many initiatives have been put in place till data that encompass a
robust nutrition screening for individuals at risk of poor nutrition status. Screening conducted for
identifying individuals who suffer from malnutrition is imperative for carrying out a detailed
assessment.
Recommendations
Since the aboriginal population is most vulnerable to suffer from poor nutrition, effective
strategies are to be put in place that addresses the specific needs of the population. This entails a
custom made approach that can adjust the nutritional strategies as per the specific needs of the
indigenous population. Most of the indigenous population lives in remote and rural areas. The
government must therefore come up with strategies that can be accessed by those living in the
remote and rural areas. In this regard it is also to be mentioned that the CALD population must
also be considered in this alignment (Edelman et al., 2017).
There is an urgent need of allocating funds for nutritional screening and assessment
among different populations in the country. The government must come forward to spend more
economic resources as well as appoint human resources for identification of the nutritional status
of the population so that related nutrient requirements can be addressed. The findings of the
screening initiatives are to be correlated with other health conditions to state a global
determination. The screening would give a clear picture of the contributory factors of interest,
the educational goals and need for future support. Additional systematic and comprehensive data
collection methods are to be used in future for categorizing available data (Wenhold, 2017).

11COMMUNITY AND PUBLIC HEALTH NUTRITION
References
Barker, L. A., Gout, B. S., & Crowe, T. C. (2011). Hospital malnutrition: prevalence,
identification and impact on patients and the healthcare system. International journal of
environmental research and public health, 8(2), 514-527.
Bastian, A. (2011). The future of public health nutrition: a critical policy analysis of Eat Well
Australia. Australian and New Zealand journal of public health, 35(2), 111-116.
Bryceson, K., Fitzgerald, M., & Annison, G. (2016). 'Stakeholder views in the development of
food and nutrition public policy in Australia'. European Journal of Public Health, 26,
280-280.
Cash, T., Desbrow, B., Leveritt, M., & Ball, L. (2015). Utilization and preference of nutrition
information sources in Australia. Health Expectations, 18(6), 2288-2295.
Cullerton, K., Donnet, T., Lee, A., & Gallegos, D. (2016). Exploring power and influence in
nutrition policy in Australia. Obesity Reviews, 17(12), 1218-1225.
Edelman, C. L., Mandle, C. L., & Kudzma, E. C. (2017). Health Promotion Throughout the Life
Span-E-Book. Elsevier Health Sciences.
Hawkins, S. S., Oken, E., & Gillman, M. W. (2018). Early in the life course: time for obesity
prevention. In Handbook of Life Course Health Development (pp. 169-196). Springer,
Cham.
Hegedus, J., & Mullan, J. (2015). Are we adequately providing support services for optimal
infant nutrition in Australia? A study in regional NSW. Australian journal of primary
health, 21(3), 293-298.

12COMMUNITY AND PUBLIC HEALTH NUTRITION
Ho, D. S. Y., Lai, Y. K., Lam, T. H., Chan, V., Mak, K. K., & Lo, W. S. (2013). Risk factors and
outcomes of childhood obesity in Hong Kong: a retrospective cohort study. Hong Kong
Medical Journal.
Hu, L., Huang, X., You, C., Li, J., Hong, K., Li, P., ... & Bao, H. (2017). Prevalence of
overweight, obesity, abdominal obesity and obesity-related risk factors in southern China.
PloS one, 12(9), e0183934.
Policy - Eat Well Australia: An Agenda for Action for Public Health Nutrition | Global database
on the Implementation of Nutrition Action (GINA). (2010). Retrieved from
https://extranet.who.int/nutrition/gina/en/node/8511
Simmons, A., Mavoa, H. M., Bell, A. C., De Courten, M., Schaaf, D., Schultz, J., & Swinburn,
B. A. (2009). Creating community action plans for obesity prevention using the
ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. Health promotion
international, 24(4), 311-324.
Sun, H., Ma, Y., Han, D., Pan, C. W., & Xu, Y. (2014). Prevalence and trends in obesity among
China’s children and adolescents, 1985–2010. PloS one, 9(8), e105469.
Thompson, A. L., Adair, L., Gordon-Larsen, P., Zhang, B., & Popkin, B. (2015). Environmental,
Dietary, and Behavioral Factors Distinguish Chinese Adults with High Waist-to-Height
Ratio with and without Inflammation–3. The Journal of nutrition, 145(6), 1335-1344.
Wenhold, F. A. (2017). Nutrition screening: science behind simplicity. South African Journal of
Clinical Nutrition, 30(3), 5-6.
Willis, E., Reynolds, L., & Keleher, H. (Eds.). (2016). Understanding the Australian health care
system. Elsevier Health Sciences.

13COMMUNITY AND PUBLIC HEALTH NUTRITION
Yang, T., Yu, L., Barnett, R., Jiang, S., Peng, S., Fan, Y., & Li, L. (2017). Contextual influences
affecting patterns of overweight and obesity among university students: a 50 universities
population-based study in China. International journal of health geographics, 16(1), 18.
Youth in Hong Kong A Statistical Profile 2015. (2015). Retrieved from
http://www.coy.gov.hk/filemanager/template/common/images/archive/research
Zhang, J., Wang, H., Wang, Z., Du, W., Su, C., Zhang, J., ... & Wang, Y. (2018). Prevalence and
stabilizing trends in overweight and obesity among children and adolescents in China,
2011-2015. BMC public health, 18(1), 571.
Zhang, Y. X., Wang, Z. X., Zhao, J. S., & Chu, Z. H. (2016). Prevalence of Overweight and
Obesity among Children and Adolescents in Shandong, China: Urban–Rural Disparity.
Journal of tropical pediatrics, 62(4), 293-300.