Getting ill and fat from stuffing our eyes with TV

Watching television and shopping are among the things I don’t do much of, so I was rather taken aback when, to fill time, I wandered into Best Denki, an electronics and appliances store. More than half the floor space was devoted to television sets, some of humongous size. It wasn’t so TV-heavy the last time I was here. Wow, TV-watching must be a really big thing in Singapore, I muttered to myself.

Does this explain the rapidly expanding girth of people here?

A meta-study recently published in the Journal of the American Medical Association reported that the more time spent watching television, the greater the incidence of heart disease and Type 2 diabetes. (Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality, by Anders Grontved and Frank Hu. Link to abstract).

No, it isn’t the result of radiation from the TV screen, nor is the relationship a directly causative one. Nonetheless, it almost surely stems from the sedentary habits associated with television-watching. There is also likely to be an association with consumption of snacks and sugary drinks, a common accompaniment to such entertainment.

The researchers reviewed eight previous studies that covered over 210,000 people with 6,428 cases of diabetes and 1,052 cases of cardiovascular disease among them and found that for every two hours of TV-watching per day, there was a 20 percent increase in diabetes over 8.5 years of follow-up and a 15 percent increase in cardiovascular disease over a decade of follow-up.

Three of the eight studies reviewed had also collected data on television-watching and mortality from any cause. Grontved and Hu found that for every two hours daily of TV-watching, the chance of dying from any cause increased 13 percent, as observed over a 7-year follow-up.

Interestingly, exercise doesn’t necessarily make up for long sessions in front of the tube. When adults who exercised the same amount but watched varying amounts of TV were compared against each other, those who watched more TV were still at a higher risk of dying during the study. Why that is so remains unknown.

See also the story in the Los Angeles Times.

* * * * *

That obesity is on the increase in Singapore is all too obvious. Here is a chart I found from the Health Promotion Board’s site:

Although the chart does not say so, I believe it uses the international definition of obesity (BMI 30 or more).

You can calculate your own Body Mass Index (BMI) by dividing your weight (in kilograms) by the square of your height (in metres). If it exceeds 25, you’re considered overweight, if 30 or more, you’re obese.

Actually, I believe the Ministry of Health has more data than the graph shows. In 2010, the ministry conducted a National Health Survey with a section on weight, but I can’t find the results anywhere on the web. If anyone can point me to a table or two, I’d be grateful.

Over the weekend, I found myself sharing a lift with a plus-sized young man. It was just him and me, but I felt rather crowded inside the lift with him, though part of the reason had to do with the smallness of the lifts in our public housing. The absurd thing was that he waited patiently for the lift with me on the ground floor, just to take it up to the second level. There was a flight of stairs right beside the lift and he could have gotten up to the second level in a tenth of the time it took us to wait for the lift to arrive, but I guess it was too much exertion to walk up the steps.

Town Councils have been spending loads of money retrofitting our housing blocks to get lifts to stop at every floor. The need comes from our aging population, but a side effect would be to help the obese stay obese — one more example of how the universe is full of unintended side effects.

Besides the cost to one’s personal health, obesity has social and environmental consequences. The carbon footprint is multiplied each time a lift is operated. Seats on buses and trains hold half a large person instead of an average one. Demands on the healthcare system increase.

Obesity represents one of best test cases for how we balance personal liberty and social costs, the control of which necessitates some form of social control. Why should others bear the costs of those who lead unhealthy lifestyles? On the other hand, surely people have the right to lead the life they want, including watching as much television as they wish, complete with fatty snackfoods and sugary soda.

With tobacco habits, we lean more and more on control, but with obesity, we generally respect individual autonomy. Why that is so might be a good question to ask.

That said, I am also aware of an increasing number of scientific studies that show a link between antibodies to human adenovirus-36 and obesity. There are indications that infection with this virus, usually associated with the common cold, may lead to a tendency to gain weight. In light of this, it would be simplistic to merely say that overweight people are entirely responsible for their status, though I would hasten to add that the relationship between antibody detection and weight is not straightforward. Some overweight people do not have antibodies to the virus, while others who have normal weight also demonstrate antibodies in their bloodstream.

Nonetheless, if weight gain is not entirely within one’s control, can social control be justified? Would doing so not amount to an unreasonable circumscription of liberty?

* * * * *

At long last, McDonald’s in Singapore is offering a grilled chicken salad among its menu choices. I gave it a try the other day and have to say it’s not bad. . . . but could be better. They could make it still healthier by having more vegetables in it and less chicken. The skin should also be removed. The salt content can also be reduced.

However, a funny thing happened along the way. As I was about to tuck into it, a ‘McDonald’s  uncle’ (one of the restaurant’s elderly employees) who was tasked with clearing tables, walked past and looked quizzically at my order. He then quietly said to me that I should not bring outside food into a McDonald’s restaurant.

“But I bought this here,” I protested. “Haven’t you seen this item before?”

Apparently not. Apparently no one else has yet ordered it.

Doesn’t this incident illustrate the problem? We can go on about corporate social responsibility, and here at last, McDonald’s offers a healthier choice, but few among its customers seem to be interested in it. Looking around the restaurant, everybody else was stuffing their mouths with burgers and french fries. (It also made me wonder how long that salad in front of me had been sitting in the fridge before I ordered it.)

Then again, I won’t be so quick to praise McDonald’s. If they’re really serious about social responsibility, they would cut out fries and soda from all meal options. A burger meal should consist of burger + side salad + sparkling water.

And purveyors of television sets should sell them attached to exercise bikes. You sit on the bike in front of the screen and pedal like mad to generate the power needed to run the TV. How’s that for healthy entertainment?

30 Responses to “Getting ill and fat from stuffing our eyes with TV”

  1. 1 Ben 23 June 2011 at 22:11

    From what i know, the healthier option of green tea, orange juice and fresh milk are more expensive than soda. The meal you ordered is certainly more expensive than the standard meal. Normally people would rather spend 4-6 dollars for their McDonald meal and not more than that if their health permits.

  2. 2 ThePasserby 23 June 2011 at 22:15

    You know, reading this article makes feel like grabbing a packet of chips. Kidding! Time spent in front of the computer would have the same effect as TV-watching, I suppose. There have been reports of gamers dying from playing too obsessively.

  3. 3 Calculon 23 June 2011 at 22:27

    Those salad meals offered by fast food chain being healthier is a myth, a mere disguise to arrest an image problem. The most unhealthy thing on the menu, joint winners, is fizzy drinks and fries, neither filling but loaded with empty calories.

    I would say for being fat had an explanation, be it in the genes or lifestyle, my personal favourite is they are lazy, wills little self control, worst resort to surgery (gastric band).

    Will Self, novelist, suggested that the hate in this world is always equal, just that we always find new object of hate. be it Jews, skin colour, hippies, and yes fat people. heh.

  4. 4 liewkk 23 June 2011 at 23:11

    Some Strengths of Singapore’s public health promotion
    1. safe streets and parks for exercising and other physical activities
    2. mandatory fitness tests and remedial training for males national servicemen up to ages of 40-55.

    Main Problems
    1. Unrealistic health promotion adverts that do not take into consieration of cost when promoting healthier food like unpolish rice.
    2. timid and unimaginative policies towards F&B. They should start treating fatty foods with the similar category with that of tabacco and alcohol.
    3. Our local diet is way too unhealthy. The oily Malay, Indian and Southern Chinese indulgence is just too much. In contrast, South Korea and Japan has only 4% obesity rate compared to our 10%. (mainly deal to diet).
    4. The problem is actually severe among the ethnic Malay (25%) and Indian minorities (15%). We should start thinking of it as another problem of marginalisation and inequality. on the gender part, it seems that men can usually get away with looking bad and fat. With the exception of hair loss, most beauty and slimming ads target women predominatly.
    5. Yes. Long working hours behind the computers.

    On a positive note, there is some awareness of this issue. Roast Pigs are no longer in vogue in weddings, there are more fish soups and yong tau foo stalls around, and the participants for the annual Singapore marathon races are exploding every year. You got to register within a week or two at most if you want to be included (Although one does not see many ethnic Malay or Indian Singaporeans in the crowd. Just people who look like me).

    • 5 Poker Player 24 June 2011 at 11:46

      “Although one does not see many ethnic Malay or Indian Singaporeans in the crowd. Just people who look like me”

      Try the neighbourhood football field. And the strength-training section at some gyms. Hey, why am I doing this? The CMEL business from the other article is really infectious.

  5. 6 feeblechicken 24 June 2011 at 02:50

    One thing I’ve missed from working in New York City is the amount of calories printed in every restaurant menu including fast foods. They let me have a rough idea of how much I’ve eaten within the day. Just seeing that burger is 800 calories, tell me that I either shouldn’t be eating it or eat like a bird for the next 2 meals.

  6. 7 ape 24 June 2011 at 08:58

    Haha. I certainly like the idea of self powered tv on a bicycle or treadmill

  7. 8 Poker Player 24 June 2011 at 10:12

    An unintended consequence of a mostly conscript and reservist Army is that our obesity rates are not as bad as they could have been. Remembered a classmate who looked like he lost half his original bulk after 6 months.

  8. 9 xtrocious 24 June 2011 at 10:32

    Seriously guys, it may be time to update our conventional “wisdom” about what is really making us fat…

    It’s not the fatty food – gasp – yes, you heard right…

    It’s all the “low-fat” stuff which comes loaded with sugar (mainly HFCS) to make up for the lack of taste once the fat has been removed…

    And the other main reason is carbs and processed food…

    I think LiewKK is just being absurd by suggesting a fat tax when there is NO direct links between saturated fats and the increased incidence of heart disease…

    Instead, more studies are emerging that the main culprits are carbs and sugar…

    For those who are interested to learning more, just look up Gary Taubes and read his book “Why we get fat”…

  9. 10 Anon. 24 June 2011 at 10:40

    Me thinks a campaign along the lines of “Get your stamina up. Make your wife happier in bed.” sex ALWAYS sells 😉

  10. 11 tk 24 June 2011 at 10:41

    a small subset of obesity does have genetic and medical causes, but overwhelmingly it is caused by a lack of exercise and a poor diet. yes, these factors are positively correlated with lower socio-economic status, but i still think a large degree of personal responsibility needs to be taken.

    what’s really sad is the number of fat kids i see waddling around, here and in the top 4 other countries in that chart. there’s a good case to be made that having an obese kid is akin to physical child abuse, as there’s nothing they can do to prevent it.

  11. 12 Gard 24 June 2011 at 10:42

    The publications are usually listed on the Health Promotion Board website:
    It appears that only the National Health Survey 2004 is published there. Perhaps they are still writing the reports for 2010.

    “You are what you eat” is the common saying. Epigenetics has pointed out that “you are what your ancestors eat.” This is an exciting new way of looking at things, as the economic benefits/costs are intergenerational.

    As for the TV watching and exercise puzzle, there are emerging hypotheses, such as:

    “… the amount of time you exercise and the amount of time you spend on your butt are completely separate factors for heart-disease risk”
    – Why your desk job is slowly killing you

    There was an energy expenditure chart around that shows that caloric expenditure rate is higher ‘lying down’ than ‘sitting.’ I used to find that unusual.

    Perhaps a small change can make a big difference: drink more water (or green tea). This includes forcing yourself to visit the toilet.

  12. 13 Poker Player 24 June 2011 at 11:38

    “Wow, TV-watching must be a really big thing in Singapore, I muttered to myself.Does this explain the rapidly expanding girth of people here?”

    Unlikely. After work, sitting around and not moving much was as prevalent 30 years ago as today. What’s different is that most work today is sedentary, and the food richer. For some families, at least until the 70’s, chicken was a luxury you had only a few times a year.

    • 15 The 24 June 2011 at 17:12

      angry doc – interesting data there.

      In 2004, 6.4% of males were obese; 7.2% of females were obese.

      By 2010, 12.1% of males were obese; 9.5% of females were obese.

      What could explain this percentage swing? NS training becoming less “siong”? Reservist training becoming more mechanized, and more war-games, computer simulation, or fitting wars on papers?

      • 16 xtrocious 27 June 2011 at 11:23

        How about this reason…

        More people are trying to become more healthy by eating “low fat” diets…

        But unfortunately, they just don’t work because most of these low-fat diets come with very high sugar content plus they are made from processed carbs (which turns into sugar in our blood very quickly)…

        Just look at America – see how fast obesity has increased since they went on the low-fat drive…

        Plus our older generations don’t shun natural fats – they are leaner, have lower incidence of heart diseases etc…

  13. 17 The 24 June 2011 at 17:06

    /// Obesity represents one of best test cases for how we balance personal liberty and social costs, the control of which necessitates some form of social control. Why should others bear the costs of those who lead unhealthy lifestyles? ///

    Should all airlines (and buses, etc) start to charge obese people higher fares, or double the fare if he/she takes up two seats?

  14. 19 Alf N. Spit 24 June 2011 at 18:26

    Exercise is dangerous. Safer to watch TV. Or see a hilarious play by some one or other.

  15. 20 YH@2 24 June 2011 at 21:52

    1. Just published 23 June in New England Journal of Medicine : Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men
    it also appeared in today’s ST, but i don’t think there are many ST readers here :)) French fries are the worst. Yoghurt and nuts are good. 6-8 hours sleep is optimal for no weight gain.

    2. re: social control and personal liberty. The problem with social engineering is that no one knows all the parameters of the system, and this leads to unintended (and sometimes awful) side effects.

    For example, eating fatty foods makes me more satiated at meals (hence eating less), happier and hence more productive at work. Making me cut fat out of my diet may lower the chance of clogged arteries, but also would make me more miserable, which is linked to other health and economic issues. It might also be better if the obese guy took the lift than to suffer knee problems.

    I just came across an article in NAR ( which wrote about an example of how Germany has co-pay and sliding scale subsidies basing on compliance of doctors recommendations. It is possible to have an affordable healthcare system for all and address concerns of non-compliance.

    Just wondering, are health care costs for obesity-linked diseases more than other diseases eg cancer?

  16. 21 Anonymous 25 June 2011 at 00:19

    It isn’t just the main meals we consume or the snacks we eat. It’s also the drinks too: tea, soft drinks, yoghurt drinks, etc. which’re loaded with sweeteners. Well, drinking some cane sugar isn’t bad for you but for quite a few, it does affect your craving for the next snack or sugary drink. I don’t know why there aren’t any drinks containing xylitol or stevia.

    Thank gods Daiso at IMM sells unsweetened green tea. Apart from drinking more water, I’ve started to drink more teas like green tea, rooibos, etc. at home.

    Food-wise, I’m still confused about things like coconut oil. *sighs* Some people say that kills while others say it doesn’t.

  17. 22 patrick 25 June 2011 at 11:37

    I don’t see why McDonalds should help us to lose weight. They are here to make money in the best way they see how, and they may choose to be as amoral as they deem fit. But there is no coercion to buy anything from McDonalds at all, and it is entirely up to us whether to eat there. Why should they be made responsible for our poor choices?

    • 23 Poker Player 25 June 2011 at 21:11

      I have seen this before. This sort of exemption from consideration for the greater good seems to apply only to commercial enterprises. Not to individuals, government agencies, political parties, charities, communities, etc.

      • 24 patrick 25 June 2011 at 23:37

        What is your point? What responsibility does McDonald’s have toward the customer or the greater good, other than to be completely truthful and forthcoming about the health consequences of its products? I think you’re confusing the manner of the offer with the contents of the offer. If I have not coerced you into buying a Cheeseburger and have not lied to you about what I’m selling, then there’s no way I can be blamed for the consequences of your decision. Within this framework, I would not be more culpable of making you sick/obese than if (a) I had never met you and (b) you had found a way to make a Cheeseburger on your own, and eaten it.

        The same goes for any transaction between private individuals, be they in the form of private charities, communities of private individuals, nonprofits, etc.

      • 25 Poker Player 27 June 2011 at 10:42

        patrick’s reply is exactly why Singaporeans got a different deal from Hongkongers from DBS. And it’s out own bank! (Used to be our de-facto central bank). Thank you Singapore mindset.

  18. 26 7homask 25 June 2011 at 12:43

    my point exactly patrick.

    and instead of coercing the population into eating well and getting some exercise with a big financial stick, why not use the “carrot” (haha) of building better infrastructure to get people out of their cars and off their couches.

    to wit:

  19. 27 Anders 25 June 2011 at 19:57

    Dudes! If you disregard from those poor sods who are overweight although they eat and live responsibly with the justification that “they are only a minority”, then what about justice and equality for other minorities?

  20. 28 tk 27 June 2011 at 16:51

    hmm my follow up comment to patrick’s didn’t get posted… but anyway, i think he’s absolutely on the mark. Maccas (mcdonalds) makes its money because fat and sugar taste good (to undeveloped palates … and drunks), are cheap to produce and (here) are dirt cheap to sell.

    however, maccas have not always been “completely truthful and forthcoming about the health consequences of its products”, but it’s case of lying by omission, not commission. that is being rectified. manipulative advertising geared to children can be legislated against.

    i stand by my original point though. if you’re too lazy to eat well or have a “medical” problem, fine, but don’t inflict that on your kids!

  21. 29 A.G. 25 July 2011 at 08:29

    “With tobacco habits, we lean more and more on control, but with obesity, we generally respect individual autonomy. Why that is so might be a good question to ask.”

    Smoking is a completely different issue because of the passive smoking side effect. If someone smokes in a room with me then I automatically smoke as well, involuntarily. If someone eat a super size burger meal next to me, then it doesn’t automatically cause me to get fat. Therefore, obesity can be considered an issue of individual autonomy, while smoking can’t because directly and physically impact the health of people around the smoker.

  22. 30 A.G. 25 July 2011 at 08:30

    I think that may also be a key reason why hash/marijuana is illegal, and alcohol is not. If you smoke hash, the people around you may get high as well (especially indoor). Therefore, smoking hash can not be a matter of individual autonomy. However when you drink, people around you don’t automatically get drunk although they may feel bothered in other ways.

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