Rush hour. A huge crowd had built up at the foot of the escalator going up to the metro concourse. Almost all commuters honoured the “stand to your left” rule, allowing those who wished to walk the right-side lane. But in fact, the walkers could not walk anyway, because there was one commuter who was as wide as the escalator, and despite trying her best to keep to the left, she could not free up enough space beside her to allow others to pass.
On the train itself, there was one guy trying to contain himself within one seat, but he overflowed his own space so much that no one else chose to squeeze into what remained of the seat to his left.
This was in a car with seven seats abreast. The first generation of carriages had nine seats abreast, but metro rail operator SMRT reduced it to seven for subsequent orders because the average size of Singaporeans had grown too big for the original, smaller seats.
Well, on that train that morning, the row of seven seats served only six, since the big guy effectively occupied two.
From nine to six – a 33 percent reduction in effective capacity of our infrastructure. Don’t be surprised if average ticket price per head needed to go up 50 percent just to compensate. (Why 50 and not 33? It’s a reciprocal number.)
Obesity has costs, personal and social.
The personal costs should be familiar to us all: both health-wise and psycho-social. On the health front, obesity is related to increased incidence of heart disease and diabetes among others. On the psycho-social front, there are self-esteem and consequent relationship issues.
That said, let’s keep the discussion about trends at a macro level. It is very easy for such a conversation to slip into the mode of mocking and demeaning larger people. Let’s avoid that; as individual persons, each of us is beautiful in our own way regardless of physical shape or size.
Body Mass Index
The Straits Times reported on 8 November 2010 that 10.8 percent of Singapore’s population is obese, up from 6.9 percent in 2004. The news story did not clarify how obesity was defined, nor could I find it from the Health Promotion Board’s website which the newspaper cited as the source of the data.
There are various ways to determine obesity in adults, including skinfold measurements, but for mass data collection, perhaps the simplest approach would be to use the Body Mass Index (BMI).
The BMI so simple, you can work it out for yourself. All you need to know is your exact weight in kilograms and height in metres. Your BMI is your weight (kg) divided by the square of your height (m).
1. Weight = 75 kg, height = 1.68 m. BMI = 26.57
2. Weight = 94 kg, height = 1.74 m. BMI = 31.05
3. Weight = 59 kg, height = 1.65 m. BMI = 21.67
The US Centers for Disease Control interprets BMI in the following way:
BMI <18.5: Underweight
BMI 18.5 to 25.0: Normal for adult
BMI 25.0 to 30.0: Overweight
BMI >30.0: Obese.
While Singapore’s 10.8 percent obesity rating is below that in the United States and other Western countries like Britain and Australia, the trend worries the Health Promotion Board (HPB).
‘This is a very worrying trend for us,’ said HPB chief executive officer Lam Pin Woon yesterday.
Singapore’s obesity trend – a 0.65 per cent increase a year – is similar to that seen in the US and Britain 30 years ago.
Obesity in these countries has become a major problem.
‘We have to do something now. Otherwise, 30 years down the road, we’ll be where the US and Britain are now,’ Mr Lam said.
— Straits Times, 9 Nov 2010, More Singaporeans are too fat.
Current data indicate that about 35 percent of people in the US are obese and another 35 percent overweight. In the UK, about 20 – 25 percent are obese and another 40 percent overweight.
Singapore’s data was released in conjunction with the launch of HPB’s annual National Healthy Lifestyle Campaign, whose focus is to urge more exercise and a proper diet.
Let me be blunt: it won’t really work. Spreading the message may shave off a percentage or two, but it’s not going to stop the trend. No campaign that requires people to sacrifice immediate pleasure for some distant reward works.
That doesn’t mean we don’t do it; there is a need to provide public information about nutrition and to shore up the aspirational value of a healthy, active life. The HPB should run the Healthy Lifestyle Campaign by all means, but let’s not fool ourselves into thinking it will make much of a difference.
If we are serious about stopping the trend in its tracks, much tougher measures are needed. Some of these, I will admit, bother the civil libertarian in me, but let me discuss them anyway.
Basically, the measures fall into two groups:
1. Lifestyle “key performance indicators” backed by carrots and sticks.
2. Recoup external costs from suppliers of bad nutrition.
A simple example of a Type 1 KPI would be introducing National Service and Individual Physical Proficiency Tests (IPPT) for females up to age 45. Overweight males and females at age 18 would have to undergo extra time in National Service. How much extra? Whatever is necessary to get their BMI down to 25.0. Only when they reach BMI 25.0 would their two or two-and-a half years of the usual National Service start.
This is followed by two decades of IPPT with rewards and penalties (including mandatory weight-loss residency programs and remedial training) attached. The vast civil service for example, can include IPPT results in annual assessments.
If a person can stay under BMI 25.0 up to age 45, he is very unlikely to go far beyond that for the rest of his life.
I am sure that many readers will react with horror to the above. Of course it bothers me too: such measures are arguably draconian and intrusive. But admit it: they will work far better than any number of campaigns.
It is also true, however, that such measures are politically very difficult to implement. Easier to justify would be laws that are aimed at recouping the external costs of bad nutrition. In other words, tax and regulate bad food.
Actually, we do something analogous all the time with alcohol and tobacco and with gambling too. We know that consumption of these substances and indulgence in gambling have personal and social costs. It is considered uncontroversial that society imposes a tax to recover the health and social support costs it must bear. It is also uncontroversial that the state regulates the supply of these pleasures, through sales licensing or prohibitions such as that against driving a vehicle with blood alcohol levels above a certain limit. So why not with fattening food?
For many years now in the US, some people have argued that fast food needs to be taxed. In San Francisco, a new law will come into effect next November that prohibits restaurants from offering toys that are bundled with children’s meals, unless the meal meets certain nutritional standards. See this report on BBC. Such a move is only a tiny step forward. To be really effective, far wider rules may be needed, for example:
(a) An across-the-board excise tax on sucrose sugar, to rise steadily to levels comparable to the tax on tobacco.
(b) A similar tax on saturated fats and oils (note however, that the nutritional disvalue of saturated fat is still being debated).
(c) All restaurants, foodcourt stallholders, even coffeeshop hawkers, need a special licence if they intend to offer deep-fried food. The quota can be limited, with annual auctions to set the price. That should crush the growing trend toward consumption of french fries, fried chicken and so on.
(d) Government and foodcourt or fastfood/coffeeshop chain owners to get together to establish maximum guidelines for serving sizes based on total calories per meal. Individual stall holders to be contractually bound to keep within these guidelines when averaged over a representative sample of their product offer.
Do I expect to see anything like these in the near future? No. I am realistic, but it also means I am pessimistic about Singaporeans’ girth. Looking at some of our schoolgirls and schoolboys, we can see our future.
Of course the argument will be made that nobody wants to pay extra taxes or suffer extra restrictions. But pay we will anyway, if not in the form of taxes on specific items as sketched out above, then as general taxes to support overloaded and ever-expanding medical services. Prices for transport will increase to reflect lowered effective capacity per unit of infrastructure. Overhead mark-ups on supermarket items will creep up when supermarkets have to widen their aisles to suit their wider customers, thus lowering their effective return on space.
Obesity has the potential to be a very costly epidemic. A societal discussion is needed. Now.