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| Still and Heavy - Obesity and Physical Inactivity among Singaporean
Youths- Consequences and Challenges for the 21st Century |
| Michael Chia |
| Department of Paediatric Exercise Science, Dean for Faculty Affairs, Nanyang Technological University, Singapore |
| *Corresponding author: |
Michael Chia
Professor Department of Paediatric
Exercise Science
Dean for Faculty Affairs
Nanyang Technological University,
Singapore 637616
E-mail: michael.chia@nie.edu.sg |
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| Received August 16, 2012; Accepted August 18, 2012; Published August 20,
2012 |
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Citation: Chia M (2012) Still and Heavy - Obesity and Physical Inactivity among
Singaporean Youths- Consequences and Challenges for the 21st Century. J Obes
Wt Loss Ther 2:e107.
doi:10.4172/2165-7904.1000e107 |
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| Copyright: © 2012 Chia M. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited. |
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| Abstract |
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| Singaporean youths are a very sedentary lot where current levels of habitual physical activity in school and
outside of school are grossly inadequate to meet guidelines for having a normal body mass index and for good
metabolic health. Though youth obesity rates among Singaporeans appear to be stable over the last 10 years,
hovering about 10%, emergent evidence shows that Singaporean youth who were sitting for too much of the day, as
a consequence had twice the risk of suffering from insulin resistance which is a precursor to metabolic syndrome.
Sedentary behaviours including schooling-associated activities have also contributed to worrisome rates of myopia
among young people. Inactive physiology research among Singaporean youths represents a challenge and a fertile
area for future attention. Innovative whole school, home and community approaches are required to keep active
youths moving on a sustained basis and to engage sedentary youths in becoming physically active. |
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| Introduction |
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| The health and economic perils of obesity in adulthood in the
developed and developing nations are substantial, debated and well
established. Emergent research suggests that physical inactivity in
adulthood contributes to shortened lifespan [1]. Concomitantly,
physical inactivity throughout childhood and adolescence could
hasten an earlier onset of chronic metabolic disorders, cardiovascular
diseases, musculoskeletal disorders, vascular diseases, psychological
disorders and some cancers. Youth obesity in boys and girls, especially
in late adolescence significantly predicts adult physical inactivity and
adult abdominal obesity [2,3]. These data are suggestive that strategies
to increase regular physical activity habits and to reduce sedentary
behaviours should commence in early childhood through adolescence
and employ a holistic and multifaceted approach. |
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| Physically Still Most of the Time |
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| Singaporean children and adolescents are increasingly sedentary,
spending almost all their daily hours awake engaged in activities that
do not require much physical exertion. Adolescent boys and girls
polled in 2006 (N=1200) spent an average of 15 hours a day engaged in
sedentary activities- six hours of schooling, three hours of homework,
four hours of screen-time and two hours travelling to and from school
on motorized transport (unpublished data). Equivalent research using
objective motion sensors (heart-rate monitors) showed that older
children and young adolescents (total N=520; aged 9-15 years) of
normal body weight spent 86% and 94% over a 10-hour monitoring
time at heart rates that were below 120 beats per minute (bpm) over
three week days and that there were even more less physically active
over the weekend day-96% and 99% of the monitored time at HR<120
bpm [4]. Chia [5] reported on pedometer step count on 877 participants
aged 9–18 years in three schooling cohorts [primary (age, 9–12 years;
n=150 male; 156 female), secondary (age, 13-16 years; n=137 male; 138
female) and junior college (age, 17-18 years; n=140 male; 156 female]
in Singapore. He reported significant main effects for step count taken
outside of school compared to within school (5568 vs. 3881, p<0.05).
No significant difference was found for steps accumulated within or
outside the school in boys and girls across the schooling levels. He
concluded that daily accumulated step count was deficient by 35% of
the 16,000 and 13,000 steps recommended, respectively for male and
female youths to remain in the healthy body mass index range [6]. |
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| Yet unpublished data in studies conducted between 2011 and
2012 (Chia et al, unpublished) further established that: (i) Weekday
accumulated physical activity, measured using accelerometers on
220 youths, aged 13-15 years showed that 18 minutes were spent
engaged in moderate-to-vigorous physical activity (MVPA) but this
declined to 8 minutes over the weekend. Male adolescents engaged in
significantly more MVPA than female adolescents on the weekday (22
vs. 14 minutes; p<0.05) but not over the weekend day (7 vs. 8 minutes,
p>0.05); (ii) total sedentary time for the weekday was 291 minutes for
male youths and 337 minutes for female youths (p<0.05) (pooled mean
for both sexes was 313 minutes). Total time spent engaged in sedentary
activities for the weekend was 155 minutes for male youths and 223
minutes for female youths (p<0.05) (pooled mean for both sexes was
187 minutes); and (iii) total accumulated step count for the weekday
was 7818 and 2871 for the weekend day. |
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| Collectively these data suggest that in youths, behaviours of
physical activity and physical inactivity are distinctly different, that
among youths, there are different clusters-for example, high activitylow
inactivity; high activity-high inactivity; low activity-high inactivity;
that youths can exhibit different combinations of the physical activityphysical
inactivity spectrum. Importantly, further research is necessary
to tease out what will work in getting different cohorts of youth to
be physically more active and/or reduce the time spent in sedentary
activities especially while sitting or lying down. This mirrors the
recommendation by others reported elsewhere [7]. Emergent data on
adults using meta-analytics suggest that deleterious health outcomes
(especially metabolic syndrome or insulin insensitivity), which are
independent of body mass index, physical activity or exercise are
associated with time spent engaged in sedentary behaviors [8,9]. Innovative programmes to ameliorate sedentary youth lifestyles
should focus on all forms of sedentary behaviours like reading, doing
homework and worksheets, screen time spent on the computer, smart
phones and television viewing, passive travel, sitting or lying down.
Understanding why the different activity-inactivity clusters of youths
are physically active or not provides a framework for intervention that
is relevant, context-focused and sustainable and represents an urgent
area for research. |
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| Heavy-Youth Overweight and Obesity |
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| Information garnered from press reports and communications
from the Ministry of Education in Singapore show that youth obesity
in schools (greater than 120% of median weight for height), increased
from 2% in 1976 to a high of 15.5% in 1992, and thereafter was reduced
to about 10% in 2003 and has remained relatively stable at 10-12%.
Nonetheless, compelling data show that Singapore adults have higher
risks of heart disease than Caucasians [10] for a stipulated body mass
index and if adjusted for equivalent risk (BMI-body fat nexus), would
raise adult obesity of about 6% of the adult population (18-69 years)
to about 33%. Additionally, the international cut-off criterion for
youth obesity show that during puberty, growth curves for overweight
and obesity in youth among Singaporean male and females were
outliers and were greater than those of USA, Great Britain, Brazil, and
Netherlands [11]. |
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| Youth Perils of Being Still and Heavy |
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| Singapore has one of the highest rates of childhood myopia and
this is worrisome because an earlier onset of myopia increases the
risk of severe myopia in adulthood where complications could lead
to blindness. While there is a genetic influence to developing myopia
[12], some studies show a link between the time spent engaged in
near work (reading, screen time, etc), and also an inverse relationship
between the incidence of myopia, and also severity of myopia and time
spent outdoors, and total sports engaged in among more than 1400
Singaporean adolescents [13]. |
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| Yet to be published data on the metabolic health of Singaporean
youth (N=233; aged 13-15years), using accelerometers to measure
physical activity and blood tests to measure insulin resistance showed
that adolescents with elevated body mass index (BMI) were (i) twice
more likely to have elevated cholesterol (increased LDL-C, decreased
HDL-C and increased fasting glucose); (ii) thrice more likely to have
elevated resting blood pressure and (iii) 6.5 times more likely to
have elevated blood triglycerides. Importantly, Singaporean youths
with higher levels of MVPA were 2.5 times less likely to have insulin
resistance and those with faster 2.4 km run times were 3 times less
likely to have insulin resistance. Conversely, sedentary youths were
twice more likely to have insulin resistance. |
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| Some data show that weight status affects the short-term cognitive
verbal memory recall among the nation’s top 10% of adolescent male
achievers from two premier schools. Male adolescents of normal
body weight correctly and significantly recalled more words than
their peers who were classified as overweight (>120% for height and
weight) over eight verbal memory recall trials [14] but others show no
significant and meaningful relationship between physical activity and
performance in Mathematics, English, and Second Language, in pen
and paper tests among lower primary school pupils aged 9-10 years
[15]. Such equivocal findings from Singapore, which echo the review
findings of international research [16] suggest that further research is
warranted. |
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| Engaging Digital Natives and Epic Learners |
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| Singapore has the third highest internet penetration rate (77.2% in
2011) in Asia, after Japan (80%) and South Korea (82.7%) [17], with
youths aged between 7 and 24 years having the highest adoption rates of
internet and computer use ranging from 96-99%, in the last 12 months
[18]. Singaporean youths of the 21st century can be described as ‘Digital
Natives’ and EPIC learners that they learn best through Experience,
that they engage best when they are invited to Participate, that they
learn through Imagery and that they are learners who are Connected,
with access to multiple sources of information. |
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| Chia [19] reported that Singaporean youths are exposed to cyber
sports at a young age even before they experience the physical sport.
This is not surprising since the ease and engagement offered by cyber
sports compared to the physical sport is compelling. The comparisons
are summarized in (Table 1). |
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Table 1: Cyber versus physical sport (adapted from 19). |
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| The challenge for physical education teachers and parents is how
to make the physical sport and game less unattractive to youths, either
by introducing some elements of cyber sports into the teaching and
learning of the physical sport or to offer a physical experience of sport
that is compelling and attractive and cannot be replicated by the cyber
sport. |
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| Schools play a leadership role in inculcating healthy habits for
activity [20] and also for alternative choices for sedentary behaviours
because children and adolescents spend a great deal of time in school
and formal schooling in Singapore is compulsory for 10 years (age 7-16
years). PRIDE for PLAY™ is an award-winning school programme that
infuses between 20-40 minutes of daily physical play in primary and
secondary schools in Singapore [21] and is an example of a groundup
initiative that has multilayered effects in developing happier and
holistically healthy children and adolescents [22]. Much work and
research remains to be done and not a moment is to be lost and we
need ‘all hands on deck’- schools, parents, community groups, national
sport associations, physical education teachers, coaches and health care
professionals in ameliorating the deleterious effects of too much sitting
and not enough ‘standing up’ for doing the right thing. The future
health and well-being of Singaporeans is at stake. |
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| About the Author |
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| Professor Michael Chia, PhD is Professor of Paediatric Exercise Physiology
at the National Institute of Education (NIE), Nanyang Technological University in
Singapore. He was formerly the Head of Physical Education & Sports Science at
the NIE. He is an active researcher in the physical activity, sedentary behaviour
and fitness in Singapore youths. He marshaled PRIDE for PLAY©, a 2010 World Leisure global award-winning school intervention programme for daily play for
primary and secondary schools in Singapore. He is currently the Dean for Faculty
Affairs at the NIE. |
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| References |
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- World Internet Stats
- Welcome to Asia's Most Comprehensive Social Media Wiki
- Chia M (2011) Beyond fitness and fatness in Singaporean youths. In: Adaptation Biology and Medicine, (Cell Adpatation and Challenges) PS Wang, CH Kuo, N Takeda and PK Singal, (Edt) Narosa Publishers 6: 471-479.
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- The latest education news, info for parents,and features from schools and teachers
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