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UNU – IIGH Interna-onal Conference: “Obesity Crisis in Southeast Asia: Issues, Challenges, and Policy Pathways”
Food Prepara-on and BMI: Insights from the Malaysian Food Barometer
Elise MOGNARD PhD Taylor’s University
LIA "Food Studies: Food, Cultures and Health”
Kuala Lumpur, 17-‐18 May 2017
Obesity and NCDs in Malaysia
• Prevalence of obesity (only) have almost doubled over the last two decades among adult from 16.6% in 1996 to 30.6% in 2015 (NHMS, 2015).
• High ra-o of ea-ng out, specificity of the Malaysian food system (Poulain, Tibère, Laporte, & Mognard, 2014; Fournier et al., 2016). This paeern might be associated with development of obesity (Lee & Tan, 2007; Islam, Tai, Raja Abdullah, & Mohd Noh, 2010; Tan, 2010).
Obesity and ea-ng out • Food choices when ea-ng out usually high in energy content (Lachat et., 2011).
• No systema-c associa-on with body weight (Bezerra et al., 2012).
• Many methodological discrepancies – Defini-on of ea-ng out of home – Measurements
• Most of the studies in western countries (Bezerra et al., 2012).
Data Available Malaysian Household Expenditures Survey (MHES)
• Monthy household expenditures in Food-‐Away-‐From-‐Home (FAFH) posi-vely associated with income, Chinese households and urbanisa-on (Islam, Tai, Raja Abdullah, & Mohd Noh, 2010; Lee & Tan, 2007; Tan, 2010).
• FAFH total amount of household expenditures without discrimina-on FAFH acquired from fast-‐food restaurants, roadside hawkers, dine-‐in restaurants, food courts etc.
• No assessment of the weight and height.
Data Available Malaysian Adult Nutri-on Survey (MANS)
As for lunch, dinner & supper (“heavy meal aker dinner”)
⇒ Limited to “main” meals Under-‐es-ma-on of out of home (sok drinks)
Data Available Malaysian Adult Nutri-on Survey (MANS)
• 50% of the Malaysian obtain their food outside home.
• Posi-vely associated with Peninsular Malaysia and urbanisa-on. • Time alloca-on and prepara-on of the meals • Food environment
• Risk of development of obesity and NCDs. Importance of healthy meals in cafeterias, stalls and restaurants.
Source: MANS 2014, vol. 2, p.24
Malaysian Food Barometer
7
8
Nutri&onal survey Socio-‐anthropological survey
Interdisciplinary Dialogue
• Food consump-on – Vegetable – Meat and fish – Diary
• Nutrients – Carbohydrate – Fat – Protein – Micro-‐nutrients
• Variety
q Ea-ng out
q Food intakes – Food days – Meals and snacking , structures and composi-ons
q Representa-ons on food
q Percep-on of risk
9
Nutri&onal surveys
Socio-‐anthropological surveys
Interdisciplinary Dialogue
Sensorial analysis
Socio-‐cultural determinants Food lifestyles
Ea&ng decision
Malaysian Food
Barometer
7 main parts in the ques-onnaire: – Socio demographic and ethnic indicators;
– Food norms; – Food intakes of the last 24 hours;
– Cooking prac-ces; – Social representa-ons on food (including heritage);
– Health and risk issues.
10
Q9 The following ques-on is about the usual organiza-on of your meal. I will ask you to explain the different food items that your lunch, dinner and supper are usually composed of. 接下来的问题是有关于您用餐单。我将会问一些有关于您的早餐,午餐,晚餐,宵夜和茶点的餐单。
Soalan berikutnya tentang pertubuhan biasa hindangan anda. Saya akan meminta anda untuk menjelaskan barangan makanan yang berbeza yang anda makan untuk makan tengah hari, makan malam dan makan lewat malam biasanya terdiri daripada. [SHOW CARD]
A proper breakfast 完整早餐Sarapan pagi yang betul A proper Lunch 完整午餐Makan tengah hari yang betul A proper dinner 完整晚餐Makan malam yang betul A proper supper 完整宵夜Makan lewat malam yang betul A snack 茶点Snek yang betul � Tea -me 下午茶Watuk minum
Ques-onnaire
• Ques-onnaire: – 66 ques-ons – + 1,400 variables, including BMI
• Randomized sampling for: – States – Level of urbaniza-on (urban/rural)
• Quotas sampling for: – Age, – Ethnicity
• 40 minutes in face to face interviews • Languages : English, Bahasa,
Chinese • Age: From 15 years old to the very
elderly • Data collec-on: January -‐ May 2013
11
0 10 20 30 40 50 60 70 80
Fem
ale
Mal
e 15
-19
20-2
9 30
-39
40-4
9 50
-59
60+
Nor
th
Cen
tral
Sout
h Ea
st C
oast
Ea
st M
alay
sia
Urb
an
Rur
al
Non
-Mal
ay
Mal
ay
Indi
an
Chi
nese
O
ther
s
Malaysia Food Barometer, 2013 Department of Malaysia Statistics, 2010
Gender
Age
Geographic Distribution
Urbanization
Ethnicity
N = 2,000
Ques-onnaire
Ea-ng Out Assessment
• Reconstruc-on of the week before
• Recall of the 24 hours with – Ra-o of frequency on intake (number of intake eaten out / number of intake
– Ra-o of frequency per individual (number of individual having at least on intake out)
12
Ea-ng Out Assessment (Reconstruc-on of the week before)
Ea-ng Out Assessment
• The reconstruc-on of the week before
• The recall of the 24 hours with – Ra-o of frequency on intake (number of intake eaten out / number of intake
– Ra-o of frequency per individual (number of individual having at least on intake out)
14
Ea-ng out assessment (24h Recall)
15
Ea-ng out assessment (24h Recall)
16
Food day paeern (24h Recall)
0
5
10
15
20
25
30
35
40
45
50
Btwn 0 and 2 intakes 3 daily intakes 4 daily intakes 5 daily intakes and more
Ea-ng out assessment (24h Recall)
18
Ea-ng out: Meals
• 61.65 % of the individuals have at least one meal per day outside of the home
• 12.5 % of individuals having their meals only at home have at least one meal prepared away from home
Ea-ng Out / Supplying Out One day before
Meals
Individuals Intakes (Meals only)
Intakes
Individuals Intakes (all)
20
Ea-ng out: Intake % on intake
Associa-ons
• Urbanisa-on • Gender • Age • Level of educa-on • Number of family members • Ethnic groups
22
Ea-ng out and BMI
r= -‐0.058; N = 2,000; P = 0.001
Ea-ng Out and BMI
(Χ2 (3) = 13.63; P = 0.003)
Urbaniza-on indicators
68%
13%
19%
Urbaniza&on Urban Suburban Rural
18%
49%
33%
Metropoliza&on Sabah Sarawak Rural peninsular Metropolitan city
Urbaniza-on / Metropoliza-on and BMI
As noted in MANS 2003 & 2014, no sta-scally difference according to the urbaniza-on
Prepara-on away from home assessment (24h Recall)
27
Prepara-on away from home Hawkers & Street Food
0
10
20
30
40
50
60
70
80
90
100
No intake Up to 25% of intakes From 25% to 50% of intakes More than 50% intakes
Prepara-on away from home Convenience Store, Supermarket Pasar
Mini
0
10
20
30
40
50
60
70
80
90
100
No intake Up to 25% of intakes From 25% to 50% of intakes More than 50% intakes
Prepara-on away from home Fast Food
0
10
20
30
40
50
60
70
80
90
100
No intake Up to 25% of intakes From 25% to 50% of intakes More than 50% intakes
Prepara-on away from home Food Court
0
10
20
30
40
50
60
70
80
90
100
No intake Up to 25% of intakes From 25% to 50% of intakes More than 50% intakes
Prepara-on away from home Mamak
0
10
20
30
40
50
60
70
80
90
100
No intake Up to 25% of intakes From 25% to 50% of intakes More than 50% intakes
Prepara-on away from home Coffee Shop
0
10
20
30
40
50
60
70
80
90
100
No intake Up to 25% of intakes From 25% to 50% of intakes More than 50% intakes
Prepara-on away from home Restaurant
0
10
20
30
40
50
60
70
80
90
100
No intake Up to 25% of intakes From 25% to 50% of intakes More than 50% intakes
Prepara-on away from home and BMI
Prepara-on away from home Restaurant & Coffee Shop and BMI
Χ2 (3) = 14.039; P = 0.003 Ra-o: Χ2 (3) = 13.595; P = 0.004
-‐2.5
-‐2
-‐1.5
-‐1
-‐0.5
0
0.5
1
1.5
2
2.5
Underweight Normal Overweight Obesity
No food intake
Presence of food intakes
Prepara-on Away From Home and BMI
r = -‐0.027; N = 2,000 ; P = 0.225 Χ2 (3) = 6.419; P = 0.093
Policy Design Implica-ons
Malaysian Public Health Ini-a-ves & Ea-ng Out
Malaysian Public Health Ini-a-ves & Ea-ng Out
Malaysian Public Health Ini-a-ves & Ea-ng Out
Policy Design Implica-ons
Food Decision is socially embedded
Drivers at the eateries
level
Conclusion
• Aeen-on to the social environment – Associa-on with BMI when intake is taken out – No associa-on with BMI when intake is prepared away from home
• Limita-ons -‐ Methodology: – Assessment of supply over a longer period?