Obesity Prevalence in China

Abstract

This study aims to understand the impact of poor nutrition and lack of physical activity on overweight and obesity population in China. Overweight and obesity are associated with an increased risk for age-related chronic diseases and have become an emerging healthcare threat in China. The study seeks to answer the research questions: how does the poor nutrition and lack of physical activity affect the prevalence of overweight and obese population in China? The goal is to analyze the demographics of overweight and obese population to see if the prevalence of these medical conditions directly associated with dietary quality and physical activity behavior.

Introduction

This study aimed to focus on both poor nutrition or nutrient quality and lack of physical activity and their effects on overweight and obese population in China. China is the fourth largest country and the world’s largest economy by purchasing power parity. There is a distinct lifestyle difference even within each regional in the country, from north to south and from east to west.

Rapid economic development, and the growth of global trade and culture exchanges have accelerated changes in people’s lifestyles in transitional societies like China. Among these changes, there is a significant shift in people’s food consumption from a traditional low-fat high carbohydrate diet to a westernized high-fat and high carbohydrate diet, especially in the major cities, like Beijing and Shanghai.

This dietary change is a result of multiple factors, which will likely to contribute to increase in obesity and chronic disease if combines with a sedentary lifestyle.

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Obesity is becoming an epidemic in China. It is estimated that one half of the Chinese population is pre-diabetic which is related to excess body fat. A modest 5% of body weight loss in obese subjects has been shown to result in improvements of metabolic disturbances (1-4). Successful treatment of obesity often requires an integrated approach that involves a combination of dietary and behavioral modification and exercise. A variety of diets have been tested to manage weight management and obesity in humans. Meal replacement as a part of a healthy diet has been shown to be an effective strategy for weight loss and weight maintenance in obese subjects.

Poor nutrition and lack of physical activity have known to promote inflammations that often lead to chronic disease conditions.

Intervention and results

The prevalence of overweight is rising worldwide despite increased spending on weight loss programs. There is agreement in therapeutic recommendations that people who are overweight and obese need to be counseled and given perspective and practical strategies for lifestyle changes. There is evidence that greater initial weight loss enhances the success of, and the adherence to weight loss programs. Moreover, the use of meal replacements has been accepted as an effective therapeutic strategy for weight loss (24-26).In 1963, Weight Watchers was founded to become the most commonly chosen commercial weight loss program based on groups of individuals coming together for self-help. As it developed, Weight Watchers incorporated a structured diet and exercise plan within a strong behavioral program designed by experts in the field. In contrast to many other weight loss programs, Weight Watchers maintained a fee schedule affordable to lower- and middle-income persons.

Early in its history, Weight Watchers became a convenient database for researchers who were no doubt attracted by its large membership (27-31). Evaluative research of the program progressed from descriptive reports of participant weight loss (32,33) to a short-term (4 weeks) study of weight loss by program participants compared to a self-help group (34), and finally to a randomized controlled study reporting results at 26 weeks and 2 years (35). Take Off Pounds Sensibly (TOPS) was founded in 1948 to provide peer group support to overweight people. It does not advocate any particular diet, leaving that decision to the participant and his or her physician. TOPS has grown to include 10 300 chapters with over 200 000 members (http://www.tops.org). Strictly speaking, TOPS is not a commercial program because it is a nonprofit organization whose member fees ($20.00 per year in the USA) are used to pay organizational expenses and obesity research (to date $5.4 million have been spent to fund obesity research by well known basic and clinical scientists).

The program consists of weekly meetings, which include a weigh-in, followed by a group discussion during which members talk about their weight loss efforts and give each other encouragement to continue.In 1970, Stunkard published a descriptive study of the weight loss achieved by 485 TOPS members enrolled in 22 chapters in West Philadelphia (36). This study had two interesting findings (i) 28% of TOPS participants lost more than 20 lbs, roughly equal to the weight loss reported in the literature up to that time by medical programs and (ii) there was wide variation in the average weight loss of individual chapters, suggesting an unidentified program component might be playing a part in the success or lack of success by individual chapters.

This was a cross-sectional study of active participants, saying little about the longer-term success of active participants or of those who chose to drop out. Nevertheless, the data seemed to indicate that TOPS was as successful as medically based programs. The variability in the success rate of individual chapters was thought to possibly reflected important interchapter differences in program content and presentation that, if identified, could provide insight on ways to improve the efficacy of weight loss programs.A follow-up study of the same chapters published four years later cast a different light on the success of the TOPS program, and dampened hope that an analysis of interchapter variability (noted in the first study) would lead to new insights on ways to structure more effective weight loss programs (37). In this study, the authors found that average weight loss of active members was similar between the earlier and later studies (15 lbs and 14.2 lbs), but that dropouts were high, 47% at 1 year and 70% at 2 years.

Dropouts were also found to lose a lesser amount of weight compared to those who remained with the program. The success of active participants did not reflect the overall success of the program. The second survey showed less variability in weight loss between chapters. Also, the rank order of chapters had changed from the first survey. It appeared that the differences in weight loss between chapters were not due to programmatic differences, but rather due to differences in the characteristics of their participants. Although these two studies do not substantiate the weight loss efficacy of the TOPS program for most of its enrollees, it should be said that TOPS is one of the least expensive programs available to people seeking support in losing weight.

Synthesis of research

Herbalife was founded in 1980 with a sales and marketing plan in which distributors were compensated for their sales of product and encouraged to form a social network of customers, who consumed product regularly, and potential distributors, who in turn recruited others to the business of selling weight management and nutritional supplement to others. This program grew over the twenty years from 1980 to 2000 and was extended globally to many countries. Beginning in about 2001, Dr. Enrique Varella, a college professor living in Zacatecas, Mexico, began organizing NC to enable individuals to afford to consume a daily meal replacement shake in a group setting, even if they could not afford to buy the usual product containing about 30 servings of the product. A unique feature of the club is that individuals do not pay for product directly.

Rather, they join the club for a daily affordable fee comparable to what would have been spent on a high fat breakfast. As this model evolved, it became clear that many subjects who experienced positive results wanted to start their own clubs. The club directors would train them in the preparation of shakes and proper social interactions in the clubs and the number of clubs grew progressively. The number of clubs is currently over 55,000 worldwide. Herbalife distributors from other countries have come to Mexico to learn how to establish this type of club. There are about 5000 NC in China; 504 NC in Southern California; 389 (77%) have Latino owners and mostly Latino members (personal communication from Herbalife).

The clubs grow organically with high rates of retention in the long-term, addressing one of the key deficits of earlier versions of group weight loss programs. As shown below, about 40 percent of participants in a recent survey (see Appendix for Preliminary Work) had participated in the clubs for more than one year. Social support is a core component of many theories and models of behavior change and is likely to exert sustainable effects on weight change through a variety of mechanisms, including provision of advice, feedback to enhance skills, and emotional support. In recent years, health researchers have begun to explore how chronic, noninfectious disease might proliferate through social contagion, as people learn from and react to those around them. The idea that social ties serve as conduits for the spread of ill health as well as potentially healthy behaviors has considerable implications for public health policy and practice. However, the sociocultural mechanisms by which such types of social contagion might occur remain poorly specified.

One of the most highly cited examples of this type of social contagion model appears in a study by Christakis and Fowler (38). Using longitudinal data from the 32-year Framingham Heart Study, they observed that that obesity appears to spread through social ties, especially mutual friendships, over time. As with other studies that have observed social clustering of obesity, Christakis and Fowler could not determine from the data the specific social, cultural, and ppsychologicalmechanisms by which such contagion occurred. However, they speculated about underlying pathways, including both socially shared norms about the acceptability of being overweight and socially shared behaviors.

Problem statement

Research questions

Herbalife NC represent a world-wide network of over 50,000 health and wellness clubs. A purpose of these clubs is to provide social support to members to lose weight and pursue a healthy llifestyle, andthey offer varying levels of group support, activities, and product supplementation. Although there is growing anecdotal evidence of weight-loss success in these clubs, there is a lack of quantitative data to demonstrate whether this success is attributed to the products, the club environment, or their interaction. The main research question is: what is the effectiveness of the NC model in promoting weight loss and other positive health outcomes.

The primary objective of the study is:

1. To evaluate the effectiveness of 16-weeks participation in Nutrition Clubs (NC), utilizing partial meal replacement diets, on weight loss for overweight and obese Latina women by comparison to a control group encouraged to lose weight at home using publicly available information that describes dietary and physical activity guidelines to promote weight loss. The secondary objectives of the proposed study are:
2. To determine the effects of NC participation on body composition (determined by DEXA scan), laboratory measurements (plasma glucose and lipids), and mood and health-related quality of life before and after participation in NC and in comparison to the control group.
3. To explore the social network developed by NC participants through questionnaires directed at participants, family members and friends.

In this study, we will examine the hhypothesisthat: 1) participation in a NC, utilizing partial meal replacement diets, leads to more effective weight loss than general dietary advice; and 2) participation in a NC is associated with improved health-related quality of life, positive mood changes, and increased social support by comparison to the control group encouraged to lose weight at home using publicly available information that describes dietary and physical activity guidelines to promote weight loss.