(%) (%) 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

綜 論 1,2 1,3 1,* 1 1 3 (1) (2) (3) ( 2013 32(2) 101-113) 流 行 病 學 ( Wo r l d H e a l t h Organization, WHO) 280 44% 23% [1] 2008 15 2 3 2010 4300 5 [1] (Organization for Economic Cooperation and Development, OECD) 2009 (35.7%)[2] 1 2 3 * 10 E-mail: iw@yam.com 101 8 8 102 2 25 1998 78.5 2008 147 10 87%[3] 2003 Peeters (Framingham Heart Study) 3.1 3.3 5.8 7.1 [4] 1993-1996 2005-2008 (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) 2002 2007 19.2% 23.3% 13.4% 19.0%[5,6] 2009 (National Health Interview Survey, NHIS) 2013, Vol.32, No.2 101

(%) (%) 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 20.0 11.7 65 15.4 17.5 NAHSIT 1993-1996 2005-2008 TwSHHH 2002[5]; TwSHHH 2007 [6]; NHIS III [7] BMI 27 65 [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 2004-2006 372 1000 1.76 1000 18.16 10.3 19.5% 1.8%[11] Mozaffaria [12] 2009 ( ) 2008 102 2013, Vol.32, No.2

[7] (a, b) 2009 (46.0%) (43.9%) ( 586,479 643,980 ) ( 425,560 459,425 ) (32.9%,35.7%)[13,14] Cournot 1996 2001 2223 32-62 BMI (BMI=15-21.5) BMI (BMI=27.7-45) [15] 2011 Siervo 7 5 / [16] 2011 24,239 ( ) 27,995 ( ) 29,916 40,966 [17] 2010 20% 18 23 83.2% 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] 1993-1996 [19] Nayga [20] (2) Anderson 8,550 4 ( 5 ) ( 10.5 ) ( 2 ) 40% [21] 2009 12-64 ( ) ( %) ( %) ( %) ( %) ( %) ( %) 3 67.9 35.9 91.0 73.3 49.8 18.8 3~5 71.2 39.2 93.4 76.3 49.5 16.6 5~7 74.3 42.9 94.4 75.8 57.9 15.5 7~10 72.2 46.7 94.7 76.7 61.3 14.9 10 77.4 47.4 95.7 77.3 67.8 14.3 [7] 2013, Vol.32, No.2 103

2008 ([13] [14]) Anderson 977 15 24 36 26.1%, 15.5%, 12.1% 13.0% Anderson [21] 2010 54.47% [22] 1998 2.00 2003 2.88 2011 2.47 [13] 2004 2011 7,834 17,620 7 149%[13] 104 2013, Vol.32, No.2

2008 ( [13] [14] ) (3) Harding [23] Liou 2006 2007 8,640 13 16 2.3 (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

1998 2008 18.1% ( 117,247 ) 15.6% ( 109,903 ) 7.3% ( 47,442 ) 8.7% ( 61,583 ) [13] (5) 2001-2002 ( ) 3 54.1% 6 6.6% 63.7% 12.1% 3 6 80.3% 30.8% 87.1% 42.3%[25] 26.10 29.75% 2 69.97 73.37%[26] 9,278 [27] Liou 2 1.4(p<0.05) 1.8(p<0.05)[24] 2. (1) 2000 2010 (Healthy People 2010) 30 150 2006 420 [28] 2005 2010 [25] 2005 57.8% 40.7% 25.6% 25.3%[25] 2005 2007 Chou Pei[29] 2008 106 2013, Vol.32, No.2

559 12 18 (BMI 95%) (15% BMI 85%) (p = 0.038) 3 5.5 (22% vs 4%) (2) 16.5 9.15 6 (growth spur) [30] (Wisconsin Sleep Cohort Study) 30-60 (BMI) U 7.7 BMI (leptin) 5 8 15.5% (ghrelin) 5 8 14.9%[31] 2004 6 32.3% 49.1% 36.8% [32] BMI (6.2 1.3 vs. 6.5 1.1 P=0.001) [33] 3. (1) 2001-2002 359 2283 6-13 BMI BMI [34] 1996 2010 14 260 682 [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 641 4 11 250 104 18 477 6.35 7.37 [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 1.19 1.64) 1.50 (95%CI 1.16 1.93) 1.54 (95%CI 1.21 1.94) 3.16(95%CI 2.03 4.92) [50] 10 1 [51] 746 3,342mL 1,370 [52] 2013, Vol.32, No.2 107

( [33-44] 2000~2002 2005 ) (3) 8,325 6.6 1.6 (44.3%) (24.0%) (16.4%)[53] (4) (Fat Tax) 1942 ( ) Carlson [54] Brownell ( ) [55] [54,56] ( ) ( )[55,56] 2011 10 16 ( 79 ) 2012 11 [57] 結 論 108 2013, Vol.32, No.2

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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):101-113) 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. E-mail: iw@yam.com Received: Aug 8, 2012 Accepted: Feb 25, 2013 2013, Vol.32, No.2 113

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