Obesity among children on the rise in Singapore, but fat-shaming is not the answer

SINGAPORE: Unlike most kids his age, 11-year-old Kai (not his real name) hardly played with other children. At times he would tell his mother he did not have friends at school.

“I have heard my classmates calling me names like ‘fatty’ and ‘chubby’. It made me feel like I am different from them, so I would seldom interact or play with them,” he said.

Kai is 1.62m tall and weighs 70kg. This works out to a body mass index (BMI) of 26.7, putting him at moderate risk of obesity-related diseases. His BMI is above the 95th percentile for his age.

Obesity rates in Singapore are on the rise, especially among children and adolescents. The proportion of primary, secondary and pre-university students under 18 who were overweight rose from 13 per cent in 2017 to 16 per cent in 2021.

The increase was mainly observed in the last two years during the COVID-19 pandemic, according to the Ministry of Health (MOH).

But misconceptions about obesity continue, leading to fat-shaming attitudes and an overemphasis on the number on the weighing scale. Both can set back children’s health outcomes, doctors told CNA.

Kai’s mother, who requested that her and her son’s names not be used, said that he has been teased, bullied and even discriminated against due to his size.

She decided to bring him to a general practitioner when she noticed that he looked bigger than his peers, and became concerned that Kai would lose confidence or give up if his weight problem became more severe.

About half a year ago, Kai started treatment at the weight management clinic of KK Women’s and Children’s Hospital (KKH), supported by a team comprising a paediatrician, exercise specialists, dieticians, psychologists and medical social workers.

The changes were immediate. The first thing to go was fast food, which Kai used to eat “very often”, said his mother.

Because of Kai’s mother’s work as a software engineer, the boy’s main caregiver was his grandmother. Realising that Kai could be picking up unhealthy eating habits from the adults, they made changes.

The family now eats three meals a day, consisting of bread and mostly home-cooked meals of rice with meat and vegetables. They spend about S$300 a week on food.

Another change was how Kai spent his free time. Like many kids his age, he loved to play mobile and computer games. He did not like to exercise.

After KKH implemented a structured fitness programme for him, he became more active, swimming, doing group sports and going for nature walks on the weekends.

Over time, the changes turned inwards. Kai became more confident and started taking ownership of his weight management while working with his paediatrician, said his mother.

“He would actively ask questions at the clinic, so that he can find out how he can better manage his weight and what he should watch out for.”

“DON’T GO BY THE NUMBER”

If at this point you are wondering how much weight Kai has lost, you are asking the wrong question, according to Dr Andrew Sng of the National University Hospital (NUH).

“Don’t go by the number,” he said, explaining that two people who weigh the same can have completely different metabolic indices if one is sedentary while the other has an active lifestyle.

What matters is inculcating healthy habits that the child keeps up on their own, long after any external weight management programme is over, said the consultant in paediatric endocrinology.

This also counters a refrain he commonly hears from parents of overweight boys, who believe National Service (NS) will take care of the problem and do not take action earlier.

Their sons may lose weight in NS, but by then it may be too late to change their mindsets towards fitness, said Dr Sng. They could end up regaining the weight after leaving the structured environment of NS, he warned.

POVERTY AND OBESITY

Dr Sng’s patients are often perceived to be lazy because of their weight, but a “paradigm shift” is due in how people think about obesity, he said.

“People should think of obesity as a disease and not something that they deserve. It’s not something that patients, whether the young or the adults, brought upon themselves,” said the doctor.

He recalled a former patient who weighed more than 200kg at the age of 14. This boy’s mother was also overweight, and his family had a strong family history of ill mental health, said Dr Sng.

The most common cause of obesity is excessive consumption of carbohydrates and fats, and not eating enough fruits and vegetables.

Insufficient physical activity and greater reliance on vehicles to get around, instead of walking, also contribute to the problem, said Dr Elaine Chew, head and senior consultant of KKH’s Adolescent Medicine Service.

The excessive use of computers, mobile phones and television, as well as insufficient sleep, are other factors, she added.

But some factors are not within a person's control. Genetic and cultural factors, like a family history of obesity, can also contribute, said Dr Chew.

And as Kai’s case shows, the risk of obesity is also influenced by the availability of resources like money and time, and the effect they have on food intake.

“Usually healthy food takes more time to prepare, and unhealthy food such as fast food and snacks like potato chips can be much easier to access, and may even be cheaper,” said Kai’s mother.

This is known as the poverty-obesity paradox, where food insecurity is paradoxically associated with a higher risk of obesity, said Dr Sng.

Researchers have hypothesised that this is because of the high-calorie, palatable foods eaten by people with low food security, and the lack of knowledge, time and resources to engage in healthful eating and exercise.

MOH’s National Population Health Survey 2020 appears to reflect this. The survey uses the highest level of education attained as a proxy for socio-economic factors.

Adults educated up to primary level had the highest prevalence of obesity at 16.3 per cent. The proportion fell to 12.5 per cent for adults with secondary education, and 8.9 per cent for adults with post-secondary education.

FAT-SHAMING PARENTS

Beliefs about the causes of obesity matter because they have an impact on how people treat those who are overweight and obese, and an obese individual’s own self-perception.

A study published in April by researchers at Sengkang General Hospital and Singapore General Hospital found that out of 101 obese patients at weight management clinics, almost three-quarters blamed themselves for their weight issues.

More than 60 per cent said they had been stigmatised, criticised or abused as a result of their weight. About 34 per cent were bullied at school, while nearly 28 per cent said they had missed out on jobs, been overlooked for promotions or retrenched because of their weight.

“A commonly held misconception globally is that obesity is preventable, attributed to overeating and a sedentary lifestyle,” while ignoring genetics and environmental influences on gene expression, said the study.

“With conformist societal pressures, these individuals could be more likely viewed as not trying hard enough to lose weight or maintain a healthy lifestyle when compared to their non-obese counterparts.”

This has further ramifications on health. The study found that patients were more likely to report eating more unhealthy foods, overeating and exercising less in response to perceived stigma.

Such habits can compound weight gain and put patients at higher risk of eating disorders and mental health conditions, according to the study.

Parents themselves may make fat-shaming comments with hopes it will motivate their children, but this has not been proven effective and could harm their children’s mental well-being, said KKH’s Dr Chew.

Those with poor body image or who follow a restrictive diet plan could also be negative influences on their children, she added.

The weight management programme at KKH therefore provides parents and caregivers with counselling and advice to support their children through treatment. 

For Kai, going to the clinic sounded scary at first. But the fear went away when he realised that his doctors wanted to help him. His family also gave him a listening ear and encouraged him through the process.

“I can already see my weight improving, and I know that I just need to stay positive and continue to keep up good habits and keep active to improve my health,” he said.