(%) (%) NAHSIT NAHSIT TwSHHH TwSHHH NHIS III

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Download "(%) (%) NAHSIT 1993-1996 18 10.1 12.7 NAHSIT 2005-2008 18 18.9 17.1 TwSHHH 2002 20 19.2 13.4 TwSHHH 2007 20 23.3 19.0 12 15.1 14.6 NHIS III 2009 12-65"

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1 綜論 1,2 1,3 1,* (1) (2) (3) ( (2) ) 流行病學 ( Wo r l d H e a l t h Organization, WHO) % 23% [1] [1] (Organization for Economic Cooperation and Development, OECD) 2009 (35.7%)[2] * 10 iw@yam.com %[3] 2003 Peeters (Framingham Heart Study) [4] (Nutrition and Health Survey in Taiwan, NAHSIT) 10.1% 18.9% 12.7% 17.1%[5] (Taiwanese Survey on Hypertension, H y p e rg l y c e m i a, a n d H y p e r l i p i d e m i a, TwSHHH) % 23.3% 13.4% 19.0%[5,6] 2009 (National Health Interview Survey, NHIS) 2013, Vol.32, No.2 101

2 (%) (%) NAHSIT NAHSIT TwSHHH TwSHHH NHIS III NAHSIT TwSHHH 2002[5]; TwSHHH 2007 [6]; NHIS III [7] BMI [7] 2002 (National Health Expenditure, NHE) 2.9% 162 [8] ( ) ( ) ( ) ( ) 致肥胖的環境及生活型態因素 SCOPUS socioeconomic & obesity environment & obesity lifestyle & obesity sugar & obesity fast food & obesity exercise & obesity Taiwan & obesity 1. (1) Sobal Stunkard 1989 ( ) [9] 2004 Monteiro [10] Monsivais Drewnowski % 1.8%[11] Mozaffaria [12] 2009 ( ) , Vol.32, No.2

3 [7] (a, b) 2009 (46.0%) (43.9%) ( 586, ,980 ) ( 425, ,425 ) (32.9%,35.7%)[13,14] Cournot BMI (BMI= ) BMI (BMI= ) [15] 2011 Siervo 7 5 / [16] ,239 ( ) 27,995 ( ) 29,916 40,966 [17] % % 20% 57.7%[18] (a, b) 2008 (16.99% & 22.30%) (52.75% & 50.24%) (57.19% & 42.04%) (15.54% & 27.43%)[13,14] [19] Nayga [20] (2) Anderson 8,550 4 ( 5 ) ( 10.5 ) ( 2 ) 40% [21] ( ) ( %) ( %) ( %) ( %) ( %) ( %) ~ ~ ~ [7] 2013, Vol.32, No.2 103

4 2008 ([13] [14]) Anderson %, 15.5%, 12.1% 13.0% Anderson [21] % [22] [13] ,834 17, %[13] , Vol.32, No.2

5 2008 ( [13] [14] ) (3) Harding [23] Liou , (p<0.05) 3.4 (p<0.05) 1.7 (p<0.05) 4.2 (p<0.05) [24] (4) 2013, Vol.32, No.2 105

6 % ( 117,247 ) 15.6% ( 109,903 ) 7.3% ( 47,442 ) 8.7% ( 61,583 ) [13] (5) ( ) % 6 6.6% 63.7% 12.1% % 30.8% 87.1% 42.3%[25] % %[26] 9,278 [27] Liou 2 1.4(p<0.05) 1.8(p<0.05)[24] 2. (1) (Healthy People 2010) [28] [25] % 40.7% 25.6% 25.3%[25] Chou Pei[29] , Vol.32, No.2

7 (BMI 95%) (15% BMI 85%) (p = 0.038) (22% vs 4%) (2) (growth spur) [30] (Wisconsin Sleep Cohort Study) (BMI) U 7.7 BMI (leptin) % (ghrelin) %[31] % 49.1% 36.8% [32] BMI ( vs P=0.001) [33] 3. (1) BMI BMI [34] [35-45] 162% 7.6%[46] (2) (Sugar-Sweetened Beverages) Tordoff Alleva 530 [47] Ebbeling 224 BMI 0.57kgw/m 2 (P 0.045) 1.9kgw (P 0.04) [48] de Ruyter [49] Qi (Nurses Health Study, NHS) (Health Professionals Followu p S t u d y, H P F S) (Women s Genome Health Study, WGHS) 1 / 2-4 / 2-6 / 1.40 (95%CI ) 1.50 (95%CI ) 1.54 (95%CI ) 3.16(95%CI ) [50] 10 1 [51] 746 3,342mL 1,370 [52] 2013, Vol.32, No.2 107

8 ( [33-44] 2000~ ) (3) 8, (44.3%) (24.0%) (16.4%)[53] (4) (Fat Tax) 1942 ( ) Carlson [54] Brownell ( ) [55] [54,56] ( ) ( )[55,56] ( 79 ) [57] 結論 , Vol.32, No.2

9 參考文獻 1. WHO. Obesity and overweight. Available at: html. Accessed May 31, O r g a n i z a t i o n f o r E c o n o m i c C o o p e r a t i o n a n d D e v e l o p m e n t (O E C D). O b e s i t y u p d a t e Av a i l a b l e a t : h t t p : / / w w w. o e c d. o r g / dataoecd/1/61/ pdf. Accessed June 11, Finkelstein EA, Trogdon JG, Cohen JW, William D. Annual medical spending attributable to obesity: payer and service-specific estimates. Health Affair 2009;28: Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Mamun AAL, Bonneux L. Overweight and obesity by middle age are associated with shortened lifespan. Ann Intern Med 2003;138: Yeh CJ, Chang HY, Pan WH. Time trend of obesity, the metabolic syndrome and related dietary pattern in Taiwan: from NAHSIT to NAHSIT Asia Pac J Clin Nutr 201l;20: TopicArticle.aspx?id= &parentid= /06/13 Bureau of Health Promotion, Department of Health, Executive Yuan, R.O.C. (Taiwan). Prevalence survey of high blood pressure, hyperglycemia, and high blood lipid profile in Taiwan, Available at: bhp.doh.gov.tw/bhpnet/web/healthtopic/topicarticle.aspx?id= &parentid= Accessed June 13, [In Chinese] download.html 2012/06/13 National Health Research Institutes. National health interview survey on drug abuse, Available at: Accessed June 13, [In Chinese] 8. Fu T, Wen T, Yeh P, Chang H. Costs of metabolic syndrome-related diseases induced by obesity in Taiwan. Obes Rev 2008;9(Suppl 1): Sobal J, Stunkard AJ. Socioeconomic status and obesity: a review of the literature. Psychol Bull 1989;105: Monteiro CA, Moura EC, Conde WL, Popkin BM. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ 2004;82: Monsivais P, Drewnowski A. The rising cost of lowenergy-density foods. J Am Diet Assoc 2007;107: Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011;23: asp 2012/05/07 Directorate-General of Budget, Accounting and Statistics, Exective Yuan, R.O.C. (Taiwan). A query system for major statistical indicators by cities and counties. Available at: pxweb/dialog/statfile9o.asp. Accessed May 7, [In Chinese] 2013, Vol.32, No.2 109

10 doh.gov.tw/bhpnet/web/healthtopic/topicarticle. aspx?id= &parentid= /06/07 Bureau of Health Promotion, Department of Health, Executive Yuan, R.O.C. (Taiwan). The prevalence of overweight and obesity in adults aged 18 and over in each city and county in Taiwan between 2008 and Available at: BHPNet/Web/HealthTopic/TopicArticle.aspx?id= &parentid= Accessed June 7, [In Chinese] 15. Cournot M, Marquié JC, Ansiau D, et al. Relation between body mass index and cognitive function in healthy middle-aged men and women. Neurology 2006;67: Siervo M, Arnold R, Wells JC, et al. Intentional weight loss in overweight and obese individuals and cognitive function: a systematic review and metaanalysis. Obes Rev 2011;12: ct.asp?xitem=30165&ctnode=4987&mp=1 2012/07/04 Directorate-General of Budget, Accounting and Statistics, Exective Yuan, R.O.C. (Taiwan). Monthly income of major jobs for employees, by educational attainment. Available at: ct.asp?xitem=30165&ctnode=4987&mp=1. Accessed July 4, [In Chinese: English abstract] gov.tw/fies/index.asp 2012/07/04 Directorate-General of Budget, Accounting and Statistics, Exective Yuan, R.O.C. (Taiwan). Taiwan area family income/expenditure survey. Available at: Accessed July 4, [In Chinese] Yeh MC. Obesity and employment-- are obese women more likely to be unemployed [Dissertation]? Taipei: Industrial Economics, Tamkang University, [In Chinese: English abstract] 20. Nayga RM. Schooling, health knowledge and obesity. Appl Econ 2000;32: Anderson SE, Gooze RA, Lemeshow S, Whitaker RC. Quality of early maternal-child relationship and risk of adolescent obesity. Pediatrics 2011;129: Chien CY. The current status of local marriages and families, and adult education programs about marriage in Taiwan. J Fam Educ Bimonthly 2011;31:6-19. [In Chinese] 23. Harding S, Teyhan A, Maynard MJ, Cruickshank JK. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol 2008;37: Liou YM, Liou TH, Chang LC. Obesity among adolescents: sedentary leisure time and sleeping as determinants. J Adv Nurs 2010;66: Census/moreCensus?id=d6f2e7b05b1b208891f98 5cfb92b9f1e4e5e18a02dc6d 2012/05/07 Department of Physical Education, Ministry of Education. Statistical database. Available at: e7b05b1b208891f985cfb92b9f1e4e5e18a02dc6d. Accessed May 7, [In Chinese] Lo KH, Pan LY, Lin MC, Chang HY, Shih YT. The analysis of special physical inactivity, higher energy intakes and body mass index of children in Taiwan: results of 2001 national health interview survey. Taiwan J Public Health 2003;22: [In Chinese: English abstract] 27. Yen CF, Hsiao RC, Ko CH, et al. The relationships between body mass index and television viewing, internet use and cellular phone use: the moderating effects of socio-demographic characteristics and exercise. Int J Eat Disord 2010;43: Chiang CC, Liou YM, Ho JF, Hung CW, Lu SY. A comparison of recommendations and policies for child and adolescent physical activity in different countries. National Sports Q 2009;38:73-9. [In Chinese] 29. Chou YC, Pei JS. Risk factors of adolescent obesity in Taiwan and its association with physical activity, blood pressure and waist circumference. Asian J Sports Med 2010;1: Fu XH, Lee HP. Sleep and health. Chinese J Med , Vol.32, No.2

11 2003;38:25-6. [In Chinese] 31. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004;1:e TEPS~News_050.pdf 2012/05/07 Taiwan Education Panel Survey. Newsletter: children, are you tired? Available at: edu.tw/tepsnews/teps~news_050.pdf. Accessed May 7, [In Chinese] Chiang MK, Yang YC, Wu JS, et al. The association between sleep duration and obesity in Taiwanese adults. Taiwan J Fam Med 2008;18: [In Chinese: English abstract] 34. Chiang PH, Wahlqvist ML, Lee MS, Huang LY, Chen HH, Huang ST. Fast-food outlets and walkability in school neighbourhoods predict fatness in boys and height in girls: a Taiwanese population study. Public Health Nutr 2011;14: Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 1996; [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 1997; [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 1998; 241. [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 1999; [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 2003; 130. [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 2004; 168. [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 2006; 158. [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 2007; 145. [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 2008; 127. [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 2009; 131. [In Chinese] Taiwan Chain Store Almanac st ed., Taipei: Taiwan Chain Stores and Franchise Association, 2010; [In Chinese] =3623&mp=4 2012/06/07 National Statistics, R.O.C. (Taiwan). Number of villages, neighborhoods, households and resident population. Available at: Accessed June 7, [In Chinese] 47. Tordoff MG, Alleva AM. Effect of drinking soda sweetened with aspartame or high-fructose corn syrup 2013, Vol.32, No.2 111

12 on food intake and body weight. Am J Gun Nutr 1990;51: Ebbeling CB, Feldman HA, Chomitz VR, et al. A randomized trial of sugar-sweetened beverages and adolescent body weight. N Engl J Med 2012;367: de Ruyter JC, Olthof MR, Seidell JC, Katan MB. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 2012;367: Qi Q, Chu AY, Kang JH, et al. Sugar-sweetened beverages and genetic risk of obesity. N Engl J Med 2012;367: com.tw/article/article.action?id= /06/07 Common Health Magazine. One serving of a less than half sugar beverage equals ten sugar cubes! The secrets that sugary drinks did not tell you. Available at: action?id= Accessed June 7, [In Chinese] Yeh LF. The relationships between the associated factors of the sugar-sweetened beverages and obesity among the high school students in Taipei [Dissertation]. Taipei: Department of Health Promotion and Health Education In-service Training Program, National Taiwan Normal University, [In Chinese: English abstract] h t t p://w w w. children.org.tw/news/advocacy_detail/ /12/02 Child Welfare League Foundation. A report on junk food commercials in 2012: restrictions on junk food commercial broadcasting to prevent childhood obesity. Available at: news/advocacy_detail/916. Accessed December 2, [In Chinese] 54. Engber D. Let them drink water! What a fat tax really means for America. Available at: slate.com/articles/health_and_science/science/2009/09/ let_them_drink_water.html. Accessed December 6, Mozes A. The fat tax: a controversial tool in war against obesity. Available at: com/index.php?p=news1&id= Accessed December 6, Salahi L. 'Fat tax' to lower obesity. Available at: Accessed December 6, html 2012/12/02 Tsai CJ. With little effect on the rising price of consumption, Denmark may scrap its fat tax. Available at: html. Accessed December 2, [In Chinese] , Vol.32, No.2

13 Environmental and lifestyle factors of obesity Yi-Wen Chien 1,2, Tai-Yin Wu 1,3, Kuang-Yang Lin 1,*, Yi-Fan Wu 1, Kuan-Liang Kuo 1, Wei-Chu Chie 3 Obesity is the fifth leading risk factor of death globally. Obesity causes diseases related to metabolic syndrome individually and creates medical and financial burdens nationally. Many factors contribute to obesity including factors classified as hereditary or genetic, environmental, lifestyle, and endocrine or medical in nature. The aim of this paper is to explore the effects of environmental and lifestyle factors on the increasing obesity rates in Taiwan in recent years using three components. (1) Family component: to discuss the relationship between family socioeconomic status, quality of family life, parental body stature, changes in dietary habits and increased sedentary activity and obesity. (2) School component: to explore the relationship between decreased exercise and sleep deprivation due to academic pressure and obesity. (3) Societal component: to explore the relationship between Western-style fast food, sugar-sweetened beverages, the impact of mass media, fat tax and obesity. In this paper, we review existing literature and available statistics and propose potentially feasible solutions to the issue of obesity in hopes that through governmental policy implementation, this significant health problem in the people of Taiwan can be ameliorated. (Taiwan J Public Health. 2013;32(2): ) Key Words: obesity, environment, lifestyle, contributing factors 1 Division of Family Medicine, Taipei City Hospital Renai Branch, No.10, Sec. 4, Renai Rd., Daan Dist., Taipei, Taiwan, R.O.C. 2 Juguang Clinic, Banqiao Dist., New Taipei City, Taiwan, R.O.C. 3 Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C. * Correspondence author. iw@yam.com Received: Aug 8, 2012 Accepted: Feb 25, , Vol.32, No.2 113

14 評論評論 : 肥胖的環境與生活型態因素 1974 Marc Lalonde [1] Bloomberg [2] [1] [3-5] [6] [6] (MANGO) paulo@mail.ncku.edu.tw 138 參考文獻 1. Chandon P, Wansink B. Does food marketing need to make us fat? A review and solutions. Nutr Rev 2012;70: , Vol.32, No.2

15 2. Mariner WK, Annas GJ. Limiting sugary drinks to reduce obesity - who decides? N Engl J Med 2013: doi: /NEJMp Dobbins M, De Corby K, Robeson P, Husson H, Tirilis D. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged Cochrane Database Syst Rev 2009;(1):CD Rolls BJ, Ello-Martin JA, Tohill BC. What can intervention studies tell us about the relationship between fruit and vegetable consumption and weight management? Nutr Rev 2004;62: McCormack GR, Shiell A. In search of causality: a systematic review of the relationship between the built environment and physical activity among adults. Int J Behav Nutr Phy 2011;8: Casazza K, Fontaine KR, Astrup A, et al. Myths, presumptions, and facts about obesity. N Engl J Med 2013;368: , Vol.32, No.2 115

, %, 3.01%, BMI BMI 24 BMI 28 85cm 80cm ii

, %, 3.01%, BMI BMI 24 BMI 28 85cm 80cm ii 2003 4 , 2 22.4%, 3.01%, 2002 4 21 BMI BMI 24 BMI 28 85cm 80cm 2003 3 10 ii *, iii 1 1 2 1 2.1 2 2.2 3 2.3 3 3 4 3.1 5 3.2 5 4 6 4.1 6 4.2 7 4.2.1 7 4.2.2 8 4.2.3 8 5 9 5.1 9 5.1.1 10 5.1.2 2 11 5.1.3