Council Meetings (Question): Childhood obesity(2013.02.27)

According to the latest figures from the Student Health Service of the Department of Health (DH), the obesity rate among primary school students in the 2011-2012 school year was 20.9%. That rate dipped gently from the 21.4% in the 2010-2011 school year, but it was 4.5 percentage points higher than the 16.4% in the 1997-1998 school year, reflecting the worsening trend of the problem of childhood obesity in Hong Kong in recent years. Since obese children are more likely to have obesity-related health problems after growing up, DH and the Education Bureau have co-organised an EatSmart School Accreditation Scheme (ESAS) since the 2009-2010 school year to help promote healthy food culture in schools. Primary schools participating in ESAS have to meet objective criteria in four areas, namely implementing administrative measures, providing healthy lunches and snacks, and carrying out education and publicity, in order to attain the accreditation status. In this connection, will the Government inform this Council:

(a) of the number of primary schools participating in ESAS and the percentage of such number in the total number of primary schools in Hong Kong and among them, the respective numbers of primary schools undergoing assessment, having obtained the “Basic Level Accreditation” and having been commended as “EatSmart Schools”, in each of the past three years; whether any of the primary schools participating in ESAS has failed to obtain the Basic Level Accreditation; if so, of the reasons for that;

(b) apart from assessing the problem of childhood obesity, whether it has conducted any forward-looking study on childhood obesity, such as assessing the deferred effects of such problem on the health conditions of the adult population, as well as on the medical expenses, labour force and productivity of society, etc.; if it has, of the details; if not, the reasons for that;

(c) whether it has reviewed the effectiveness of various measures currently taken to address childhood obesity, including ESAS and measures such as promoting the development of habits of a healthy diet of “3 Low, 1 High” (i.e. low sugar, low salt, low oil and high fibre) and of doing more physical exercises among children; if it has, of the details; if not, the reasons for that; whether it has plans to enhance such measures (e.g. stepping up the promotion of healthy diet and education on the negative impacts of obesity in schools, as well as stepping up the measurement of “Body Mass Index” of school children, etc.); and

(d) whether it will review the current policy that schools should allocate no less than 5% of the total lesson time for physical education (PE) lessons, so as to increase PE lesson time, thereby increasing the amount of physical activities of school children and developing their habit of doing physical exercises, in order to alleviate the problem of childhood obesity; if it will, of the details; if not, the reasons for that?

Reply by the Secretary for Food and Health, Dr Ko Wing-man:


(a) To tackle the problem of childhood obesity in Hong Kong, the Department of Health (DH) has been running the ” EatSmart@school.hk” Campaign since the 2006/07 school year to raise public awareness and concern about healthy eating among children and to create an environment that is conducive to healthy eating in schools and the community. The campaign adopts multi-pronged strategies including alliance-building, publicity and advocacy, education and empowerment, creation of a supportive environment, as well as research and evaluation. In the 2011/12 school year, over 400 primary schools (including special schools) participated in the major activities under the Campaign, accounting for about 70% of the total number of primary schools in Hong Kong.

The EatSmart School Accreditation Scheme (ESAS) was launched under the ” EatSmart@school.hk” Campaign in the 2009/10 school year. Under ESAS, schools are to develop policies and implement measures on healthy diets with full co-operation between home and school, with a view to effectively implementing nutritional requirements laid down by DH regarding the supply of lunches and snacks. This serves to ensure that a “nutrition friendly” environment is in place for schoolchildren in their learning and nurturing. Upon fulfillment of the specified objective criteria, participating schools will attain an accreditation status under ESAS for a validity period of three years. As at February 2013, over 200 primary schools participated in ESAS, accounting for about one third of the total number of primary schools in Hong Kong. Currently, 73 of these schools have attained an accreditation status under ESAS. The relevant statistical figures for the past three years are at the Annex.

To attain an accreditation status under ESAS, schools need to formulate healthy eating policies, recreate the eating environment on campus, appoint new food suppliers and enter into new contracts, as well as to solicit the support of and provide training to teachers, parents, food suppliers and students. In addition, schools are also required under ESAS to establish an effective nutritional quality monitoring and follow-up mechanism. In light of their respective circumstances, the progress of participating schools may vary. DH will continue to provide professional support to participating schools and step up efforts to promote ESAS to other schools so that more students can benefit.

(b) DH has been conducting research on the issue of childhood obesity in Hong Kong. Early in 1993, DH conducted a territory-wide survey on 25 000 individuals ranging from birth to 18 years old with the Hospital Authority and the Chinese University of Hong Kong. Based on the findings of the survey, a set of growth standards were developed, including the weight for height percentile chart, to assess if the body weight of children would be considered optimal according to their body height. A child is diagnosed as obese or underweight if his/her body weight is 20% above or below the median weight for height. By making reference to the growth standards, DH assesses and follows up on the growth of children through the Maternal and Child Health Service and Student Health Service (SHS), and also monitors the prevalence of childhood overweight and obesity using the data, so as to facilitate the formulation of health promotion strategies and targeted measures.

According to the latest data in the 2011/12 school year, the overweight and obesity rate among primary school children in Hong Kong is 20.9% (15.9% for girls and 25.6% for boys). There has been a falling trend since the 2008/09 school year.

Overweight and obesity is attributable to unhealthy eating habits, the marketing and popularity of high fat and sugary foods, and the significant reduction of physical activity due to the change in lifestyles. Overseas and local medical research indicate that these unhealthy lifestyles are the cause of many non-communicable diseases (NCDs) such as heart disease and diabetes. They pose a heavy burden on individuals, families and health services, and cause significant harm to social and economic development. In 2011, NCDs accounted for about 60% of all registered deaths in Hong Kong. Some studies reveal that obese children are clearly more likely to remain overweight and obese in adulthood, and obese adults are more likely to suffer from such NCDs as heart disease, diabetes, stroke and cancer. This will affect productivity and weaken our economic and social development potentials in the long run.

(c) To effectively tackle the issue of overweight in our population, it is essential to organise efforts of society – fostering collaboration between the Government, public and private organisations, academic and professional bodies, media and members of the public – in a systematic and progressive manner to ensure the cost-effective utilisation of resources.

Concerning overweight students, DH conducted studies on the dietary pattern of students in primary schools in 2006, 2008 and 2012 respectively to review their eating habits and the effectiveness of the ” EatSmart@school.hk” Campaign. The 2012 study found that over half of the parents supported the schools’ implementation of administrative measures to promote healthy eating. There had been an increasing proportion of schools establishing healthy eating policies as compared with previous years. There had also been improvements in healthy eating behaviours amongst primary students. In comparison with schools in general, schools which had attained ESAS accreditation offered healthier lunch and snack items, students had a better knowledge of nutrition, and parents had greater awareness of DH’s healthy eating promotions.

SHS centres under DH provide regular health check-ups, individual counselling and health education services for primary one to six students, including counselling for overweight or obese students. In light of the students’ individual circumstances, the centres also refer the students to receive paediatric services from public hospitals for follow-up purpose. As mentioned in part (b) in this reply, the latest statistics reveal that the obesity rate among primary school children has shown a falling trend since the 2008/09 school year, which somewhat reflects the effectiveness of the various measures.

The Education Bureau (EDB), in the course of setting learning goals in the school curriculum, has also incorporated “Developing a Healthy Lifestyle” as one of its overarching goals with renewed vigour to motivate students to achieve by action. In subject learning, Physical Education (PE) and General Studies are relevant. For instance, the “Health and Living” strand under the General Studies curriculum at the primary level helps students acquire knowledge and develop skills as well as positive attitudes and values related to healthy eating. Schools can also make use of the school-based curriculum and various learning strategies, such as Moral and Civic Education and Life-wide Learning activities, to promote whole person development. Schools can incorporate the concepts and skills of self-management, striking a balance between work and rest, as well as effective physical exercise, to further help students develop a healthy lifestyle.

To further tackle the problem of childhood obesity, DH launched the ” StartSmart@school.hk” Pilot Project in 30 pre-primary institutions in the 2010/11 school year to encourage and support these institutions in their pursuit of cultivating healthy eating and active living habits among children. The Pilot Project was well-received. According to the survey findings on the evaluation of the Pilot Project, about 80% and 60% of the principals noticed that there were improvements in eating habits and physical activity among students respectively, while about 70% of the parents considered that the Pilot Project had effectively helped their children improve their living habits. In January 2012, in collaboration with the EDB and the Leisure and Cultural Services Department, DH implemented a territory-wide ” StartSmart@school.hk” Campaign. In the 2011/12 school year, training has been provided to some 900 school personnel from over 240 pre-primary institutions (accounting for about 25% of such institutions in the whole territory). In parallel, DH has also arranged for announcements of public interest to be shown on television to remind parents of the importance of cultivating healthy eating habits and physical activity in their children.

Apart from specific programmes, the Government also advocates and fosters through a variety of means a culture in society that supports healthy eating at different stages of life.

The practice of parents in feeding their infants has an important bearing on the future eating habits of their children and has correlation with childhood obesity. Breastfeeding plays a crucial role in preventing childhood obesity and therefore DH has all along endeavoured to promote, protect and support breastfeeding. In respect of older infants, the introduction of solid food is crucial for them to build up healthy eating habits. DH therefore has also strived to enhance parents’ knowledge and skills of feeding their infants, including avoiding overfeeding, arranging adequate physical activities and a balanced diet etc. for their infants.

At the community level, the ” EatSmart@restaurant.hk” Campaign launched by DH since 2008 has received favourable response and support from the catering sector. So far, over 1 000 catering workers have received training and about 600 restaurants are providing EatSmart Dishes to customers under the Campaign. DH has also launched a new media publicity campaign on Central Obesity since mid-2012 to encourage members of the public to make wise choices for their health.

In addition, since July 1, 2010, all prepackaged food products must carry nutrition labels except for those exempted from the requirements. The label must include information on the contents of energy and the seven nutrients specified for labelling (namely protein, carbohydrates, total fat, saturated fatty acids, trans fatty acids, sodium and sugars). Members of the public may take note of the energy, fat, sugar and sodium contained in the foods and make healthier food choices, preventing over-consumption and the associated risk of obesity and other chronic illnesses (such as hypertension). This also helps overweight/obese children and their carers understand the calorie and nutrient values of food, enabling them to make food choices for better health. The Food and Environmental Hygiene Department has organised a number of promotional activities, including the “Live it, Use it” Nutrition Labelling Promotion Award Scheme held since 2010-11. The Scheme encourages students to organise promotional activities on nutrition labels in school and community settings to enhance the knowledge, understanding and use of nutrition labels by students and target groups, so that they can make use of nutrition labels as a tool in daily life to make suitable food choices and practise healthy eating.

Through various measures and activities, we will continue to actively promote a healthy eating culture and public awareness of the importance of regular exercise with a view to improving health of the public.

(d) According to the recommendations of the Curriculum Development Council of Hong Kong regarding the duration of PE lessons, schools should allocate 5% to 8% of the total lesson time for PE development from Primary 1 to Secondary 3, and no less than 5% of the total lesson time from Secondary 4 to 6. Schools may extend the duration of PE lessons appropriately according to the actual circumstances where necessary.

The objective of PE lessons in schools is to enable students to acquire basic skills and knowledge about sport and to cultivate their interest and positive attitudes towards sport through participation in physical activities, so that they know to choose a suitable physical activity during leisure time to develop an active and healthy lifestyle. Hence, we should not solely rely on PE lessons to increase the amount of physical activity among schoolchildren. It is more important for students to develop an active lifestyle and engage in various types of physical activities for energy expenditure during leisure time.

Moreover, under the current framework of life-wide learning under the curriculum reform, schools make available different opportunities such as sports day, interest classes, school team training and contests for students to do more exercise in addition to general PE lessons. This enables students to develop wider interests and potential in sport and helps them to build sustainable healthy lifestyles.

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