Obesity in Thailand

Obesity in Thailand has been flagged as a major source of health concern, with 32% of the population identifying as overweight and 9% obese. With reference to 2016 data from the World Health Organization (WHO), Thailand has one of the highest incidence of overweight citizens in the South East Asian region, second to only Malaysia. The Thai National Health Examination Surveys (NHES) found that obesity in Thailand more than doubled during the period 1991-2014. This spike in obesity levels has been largely attributed to increased access to junk food, and unhealthy switches from active to sedentary lifestyles. These factors are closely linked to economic growth in the country.

Classification of obesity

The internationally recognised method of measuring obesity is through the Body Mass Index (BMI). According to WHO, an overweight person has a BMI of ≥25. An obese person has a BMI of ≥30. However, while the WHO standard has been used internationally, studies have shown that it may not be accurate for the classification of obesity in the Asian context due to different body fat percentages and body compositions. Instead, an alternative standard should be used. As proposed by the International Association for the Study of Obesity and the International Obesity Task Force (IOTF) in 2000, the Regional Office for the Western Pacific (WPRO) standard is more appropriate for Asian populations. According to WPRO, an overweight person has a BMI of ≥ 23. An obese person has a BMI of ≥25.

Prevalence of obesity in the Thai population According to WHO, overweight and obesity levels in Thailand have been steadily increasing over the years. The percentage of overweight or obese adults increased from 8.6% in 1975 to 32.6% in 2016.

Thai Adults In 2004, a study involving 3,220 adults between the age 20 – 59 was carried out. The age-adjusted overweight and obesity levels were found to be 28.3% and 6.8%, respectively. Using the WPRO standard, results from the Thai Food Consumption Survey (TFCS) in 2005 showed that the combined prevalence of overweight and obesity in Thai adults aged 19 years and over exceeded 40%. An estimated 17.1% of those surveyed fell under the classification of overweight (BMI 23.0 – 24.9), 19.0% categorised as class 1 obesity (BMI 25.0 – 29.9), and 4.8% as class 2 obesity (BMI ≥ 30.0). It was also found that obesity had a larger impact on women than men, with combined obesity and overweight rates at 46.1% and 35.5%, respectively. Obesity was more commonly found to occur in urban settings as compared to suburban areas. NHES is a nationwide survey which measures the health status of Thai citizens. As to date, 5 reports have been released over a period of 23 years. Namely in 1991, 1996, 2004, 2009 and 2014. Results from the 2009 survey showed combined overweight and obesity levels to be at 41% for females and 28% for males. 5 years later, the 2014 survey showed the prevalence of overweight and obesity in females increased to 43% and rose to 33% in males. In 2011, the WHO found that 32.6% of Thais were overweight, ranking the country second heaviest in South East Asia, with higher obesity levels than more affluent nations including the Republic of Korea, Japan and Singapore. The Behavioural Risk Factor Surveillance System (BRFSS) was set up in 2005 to track the health status of Thais. It uses the WHO standard of BMI. The prevalence of obesity in Thailand coincides with increased intake of sugary drinks. In 2010, it was reported that an average Thai consumed 93.9 litres of sweetened drinks on a yearly basis. This figure rose by 23.8% in 2015, to 115.6 litres.

Children and adolescents In 1992, a 5 year follow-up study involving primary and secondary schools of Hat Yai municipality, south Thailand was conducted. This study, involving 2,252 school children, tracked overweight prevalence from childhood to adolescence. From the period 1992 to 1997, it was observed that 11.8% of children remained overweight. It was concluded that overweight children face a much higher probability of being overweight as adults, and are at a higher risk of developing overweight related health diseases. Comparing results from NHES released in 1996 and a separate national survey conducted in 2001, obesity levels in children aged 2 to 12 years experienced a rise. Obesity prevalence in preschool children (ages 2 to 5) increased from 5.8% in 1996 to 7.9% in 2001. Children in the age group 6 to 12 years saw an increase in obesity rates from 5.8% to 6.7%. Data also showed that obesity was a more prevalent problem amongst children living in urban areas, as compared to rural areas. In 2003, a nationwide survey was conducted by the National Health Foundation. It involved 47,389 grade 6 primary school children in urban settings. From this, it was found that 16.7% of the children surveyed were either obese or overweight. In 2007, a school-based cross sectional study was conducted to determine the prevalence of obesity in Thai children in rural Ongkharak. This study tracked the height and weight of 1,140 children between the ages 6 to 15. The results were based on the International Obesity Task Force standard and revealed the prevalence of overweight and obesity levels to be 12.8% and 9.4% respectively. In 2013, another study was conducted in Ongkharak, to establish the association of obesity with hypertension in school children. A total of 3,991 students with a mean age of 9.5 years were studied. This study revealed that signs of hypertension were higher in obese and overweight children, as compared to children within the healthy weight range, at 49.5% and 26.5% versus 16.2% respectively. Furthermore, it was found that prevalence of overweight and obesity levels were 13.8% and 15.5% respectively. This is an increase from the previous study conducted in 2007. The Global Burden of Disease Study over the time period 1980 – 2013 showed that childhood obesity in developing countries increased from 8.1% to 12.9% for boys and from 8.4% to 13.4% in girls.

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