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Kocher E, Wood D, Lim SC, Jackson-Morris A, Kataria I, Ngongo C, Sham Z, Chandran A, Nugent R, Mustapha FI. Community priorities for obesity prevention among low-income adults in Kuala Lumpur: a discrete choice experiment. Health Promot Int 2022; 37:6823575. [PMID: 36367424 PMCID: PMC9651037 DOI: 10.1093/heapro/daac156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Non-communicable diseases and associated risk factors, such as obesity, are prevalent and increasing in Malaysia. To address this burden and the heightened vulnerability of low-income communities to these risk factors, the Better Health Programme Malaysia conducted a partial-profile discrete choice experiment (DCE) to inform the design of a community-based obesity-prevention programme. The DCE survey was conducted with community members (n = 1453) from three publicly supported low-cost, high-rise flat complexes in urban Kuala Lumpur. In the survey, community members were asked to choose between different sets of potential evidence-based interventions for obesity prevention. Their responses to these choice tasks were analysed to quantify preferences for these different health interventions using a random utility maximization model. Based on these results, we determined participants’ relative prioritization of the different options. The most preferred interventions were those that reduced the price of fruit and vegetables; altered cooking practices at restaurants and food vendors to reduce salt, sugar and oil; and offered reward incentives for completing online educational activities. Community members did not prioritize several evidence-based interventions, including changes to product placement or product labelling, suggesting that these effective approaches may be less familiar or simply not preferred by respondents. The DCE enabled the clear articulation of these community priorities for evidence-based interventions that focus on the supply and promotion of affordable healthy foods within the local food environment, as well as community demand for healthier food options.
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Affiliation(s)
- Erica Kocher
- Global Health Division, Center for Global Noncommunicable Diseases, RTI International , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Dallas Wood
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Shiang-Cheng Lim
- RTI International, Global Health Division, Suite 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/2 Mutiara Damansara, 47820, Petaling Jaya, Selangor , Malaysia
| | - Angie Jackson-Morris
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Ishu Kataria
- Global Health Division, RTI International, 6th Floor, Commercial Tower, Pullman Hotel, Aerocity New Delhi 100037 , India
| | - Carrie Ngongo
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Zhi Sham
- RTI International, Global Health Division, Suite 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/2 Mutiara Damansara, 47820, Petaling Jaya, Selangor , Malaysia
| | - Arunah Chandran
- Non-Communicable Disease (NCD) Section, Disease Control Division, Ministry of Health , Level 2, Block E2, Complex E, Federal Government Administration Centre, 62590 Putrajaya , Malaysia
| | - Rachel Nugent
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Feisul Idzwan Mustapha
- Non-Communicable Disease (NCD) Section, Disease Control Division, Ministry of Health , Level 2, Block E2, Complex E, Federal Government Administration Centre, 62590 Putrajaya , Malaysia
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Lim SC, Kataria I, Ngongo C, Usek VS, Kudtarkar SR, Chandran A, Mustapha FI. Exploring the impact of COVID-19 movement control orders on eating habits and physical activity in low-resource urban settings in Malaysia. Glob Health Promot 2022; 29:17579759221091197. [PMID: 35578553 PMCID: PMC9760495 DOI: 10.1177/17579759221091197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic led Malaysia to introduce movement control orders (MCOs). While MCOs were intended to slow the spread of COVID-19, the effects of such measures on the noncommunicable disease (NCD) risk factors have not been fully explored. This exploratory study aimed to understand the effect of the MCO on the eating habits and physical activity levels of the urban poor in Malaysia as well as potential health promotion interventions during the COVID-19 pandemic. METHODS This rapid assessment used a mixed-method approach in three low-cost public flats in Kuala Lumpur targeting the B40, which is the bottom 40% of the economic spectrum. A total of 95 community members participated in a quantitative phone survey, while 21 respondents participated in a qualitative phone survey, including 12 community members and nine community health volunteers (CHVs). RESULTS The movement restriction imposed during the MCO significantly reduced the frequency and duration of respondents' physical activity. At the same time, respondents reported significantly increased consumption of home-cooked meals. More than half of respondents reduced their consumption of packaged snack foods (53.7%), street desserts (54.7%), fast food (50.5%), soft drinks (50.5%), and 3-in-1 or instant drinks (50.5%) due to limited access during the MCO. B40 communities were receptive to potential interventions to encourage healthier eating and physical activity leveraging digital approaches under the 'new normal'. Reported concerns included internet accessibility and affordability, functionality, and digital literacy. CONCLUSION The COVID-19 pandemic requires innovation to address diseases and risk factors at the community level. While movement restrictions reduced physical activity, they created opportunities for low-income individuals to have greater control over their diet, enabling them to adopt healthier eating habits. Lifestyle changes experienced by vulnerable populations provide an opportunity for creative and technology-enabled interventions to promote healthy eating and exercise.
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Affiliation(s)
- Shiang Cheng Lim
- RTI International, Kuala Lumpur,
Petaling Jaya, Selangor, Malaysia
| | - Ishu Kataria
- Center for Global Noncommunicable
Diseases, RTI International, New Delhi, India
| | - Carrie Ngongo
- Center for Global Noncommunicable
Diseases, RTI International, Seattle, WA, USA
| | | | | | - Arunah Chandran
- Ministry of Health, Putrajaya, Wilayah
Persekutuan, Malaysia
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Eng CW, Lim SC, Ngongo C, Sham ZH, Kataria I, Chandran A, Mustapha FI. Dietary practices, food purchasing, and perceptions about healthy food availability and affordability: a cross-sectional study of low-income Malaysian adults. BMC Public Health 2022; 22:192. [PMID: 35090429 PMCID: PMC8795714 DOI: 10.1186/s12889-022-12598-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/13/2022] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
Malaysia has the highest rate of overweight and obesity among Asian countries. Obesity is increasing particularly among low-income populations. This study aimed to assess dietary practices among low-income adults in urban communities, including gender and ethnic variation, to inform the development of locally tailored, evidence-based interventions for health promotion.
Methods
This cross-sectional study was conducted from August to December 2020. Stratified sampling was employed to recruit 2983 low-income adults from households in the bottom 40% of the economic spectrum (B40) at six public, low-cost housing flats in the Federal Territory of Kuala Lumpur, Malaysia. Face-to-face interviews were conducted using a structured questionnaire to understand dietary practices, perceptions of healthy food availability and affordability, and factors affecting food purchasing decisions.
Results
A staggering 89.5% of B40 adults were found to not consume adequate daily amounts of fruits and vegetables. In addition, 68.1% reported consuming sugar-sweetened beverages at least once per week, including commercially packed ready-to-drink beverages, sugar-added self-prepared drinks, and premixed drinks. Intake was statistically significantly higher among men (71.7%), Malays (70.3%), and Indians (69.9%). Bread and other commercially baked goods were the most common processed foods, and 52.9% of respondents consumed it at least once per week. Majorities reported that healthy foods were moderately available and priced. The top three reported factors affecting food purchase choices were price (79.4%), availability (75%), and taste (73%).
Conclusions
Adults in low-cost housing communities have unhealthy dietary patterns with low intake of fruits and vegetables and high intake of ultra-processed foods and calorie-dense local foods, with variations across gender and ethnicity. The study highlighted the need for educating low-income families on diet-disease relationships and possibilities for inexpensive, healthy eating that rely on minimally processed fresh foods. Policymakers engaging the food industry are advised to consider how to increase the affordability and availability of healthy foods in low-income communities in urban areas.
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Phulkerd S, Rachmi CN, Sameeha MJ, Borazon EQ, Thow AM, Trevena H, Saptari AF, Cheah YK, Wel CAC, Marquez VT, Sakulsri T, Thongcharoenchupong N, Poh BK. Identifying Opportunities for Strategic Policy Design to Address the Double Burden of Malnutrition through Healthier Retail Food: Protocol for South East Asia Obesogenic Food Environment (SEAOFE) Study. Int J Environ Res Public Health 2022; 19:528. [PMID: 35010789 PMCID: PMC8744775 DOI: 10.3390/ijerph19010528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 01/27/2023]
Abstract
Effective policies that address both the supply and demand dimensions of access to affordable, healthy foods are required for tackling malnutrition in South East Asia. This paper presents the Protocol for the South East Asia Obesogenic Food Environment (SEAOFE) study, which is designed to analyze the retail food environment, consumers' and retailers' perspectives regarding the retail food environment, and existing policies influencing food retail in four countries in South East Asia in order to develop evidence-informed policy recommendations. This study was designed as a mixed-methods sequential explanatory approach. The country sites are Malaysia, Indonesia, the Philippines, and Thailand. The proposed study consists of four phases. Phase One describes the characteristics of the current retail food environment using literature and data review. Phase Two interprets consumer experience in the retail food environment in selected urban poor communities using a consumer-intercept survey. This phase also assesses the retail food environment by adapting an in-store audit tool previously validated in higher-income countries. Phase Three identifies factors influencing food retailer decisions, perceptions, and attitudes toward food retail policies using semi-structured interviews with selected retailers. Phase Four recommends changes in the retail food environment using policy analysis and semi-structured interviews with key stakeholders. For the analysis of the quantitative data, descriptive statistics and multiple regression will be used, and thematic analysis will be used to process the qualitative data. This study will engage stakeholders throughout the research process to ensure that the design and methods used are sensitive to the local context.
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Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (S.P.); (T.S.); (N.T.)
| | | | - Mohd Jamil Sameeha
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
| | - Elaine Q. Borazon
- International Graduate Program of Education and Human Development (IGPEHD), College of Social Sciences, National Sun Yat-Sen University, Kaohsiung City 80424, Taiwan;
| | - Anne-Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney 2006, Australia; (A.-M.T.); (H.T.)
| | - Helen Trevena
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney 2006, Australia; (A.-M.T.); (H.T.)
| | | | - Yong Kang Cheah
- School of Economics, Finance and Banking, Universiti Utara Malaysia, Sintok 06010, Malaysia;
| | - Che Aniza Che Wel
- Faculty of Economics and Management, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia;
| | - Vanessa T. Marquez
- School of Economics, University of the Philippines-Diliman, Quezon City 1101, Philippines;
| | - Teeranong Sakulsri
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (S.P.); (T.S.); (N.T.)
| | - Natjera Thongcharoenchupong
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (S.P.); (T.S.); (N.T.)
| | - Bee Koon Poh
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
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Beh KH, Chuah KH, Rappek NAM, Mahadeva S. The association of body mass index with functional dyspepsia is independent of psychological morbidity: A cross-sectional study. PLoS One 2021; 16:e0245511. [PMID: 33497382 PMCID: PMC7837482 DOI: 10.1371/journal.pone.0245511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM The association between body mass index (BMI) and functional gastrointestinal disorders (FGIDs) has been inconsistent. We aimed to explore the association of BMI with FGIDs in a primary care setting to provide more data in this area. METHODS A cross-sectional study of consecutive Asian adults attending a primary healthcare setting was conducted. This study was conducted in 2 phases: The association between BMI and common FGIDs (functional diarrhea/FD, irritable bowel syndrome/IBS, functional diarrhea and functional constipation/FC) was studied initially. The influence of anxiety and depression on BMI and FGIDs was additionally explored in phase 2. RESULTS A total of 1002 subjects (median age 32 years, 65.4% females, 90.7% Malay ethnicity, 73.2% higher than secondary level education) were recruited between August 2019 to January 2020. The majority of subjects were obese (39.2%), and had central obesity (51.7%), while 6.1% had metabolic syndrome. The prevalence of FD, IBS, functional diarrhea and FC were 7.5% (n = 75), 4.0% (n = 40), 1.2% (n = 12) and 10.5% (n = 105) respectively, based on the Rome III criteria. Among individual FGIDs, FD subjects had more underweight adults (BMI<18.5kg/m2) compared to controls (13.3% vs 3.5%, P = 0.002) and being underweight remained as an independent association with FD [OR = 3.648 (95%CI 1.494-8.905), P = 0.004] at multi-variate analysis. There were no independent associations between BMI and other FGIDs. When psychological morbidity was additionally explored, anxiety (OR 2.032; 95%CI = 1.034-3.991, p = 0.040), but not depression, and a BMI<18.5kg/m2 (OR 3.231; 95%CI = 1.066-9.796, p = 0.038) were found to be independently associated with FD. CONCLUSIONS FD, but not other FGIDs, is associated with being underweight. This association is independent of the presence of anxiety.
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Affiliation(s)
- Keng Hau Beh
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Huat Chuah
- Gastroenterology and Hepatology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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