Asia Pacific Journal of Allied Health Sciences | Volume 5, No.

1 | September 2022
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Asia Pacific Journal of
Influences of Different Environmental Allied Health Sciences
Vol. 5. No 1, pp 93-102
Factors to the Increasing Rate of Obesity September 2022
in the Philippines: A Review ISSN 2704-3568

Kim Leonard G. dela Luna1, Maria Victoria O. Espaldon2, Janice B. Sevilla-Nastor3

University of the Philippines Los Baños, College, Los Baños, Laguna 4031 Philippines
kgdelaluna@up.edu.ph1

Abstract – The dietary pattern of the Filipino households for the past 25 years shifted to increased
energy density consumption as a product of urbanization and decreasing physical activity. This causes the
emergence of increasing prevalence of obesity in the Philippines. Thus, this study aims to understand the
growing overweight and obese cases in the country and to examine different environmental factors affecting
the prevailing food consumption patterns and nutritional perceptions in the modern Philippines. This paper
reviewed related articles and secondary data focusing on the environmental influences leading to obesity
across the globe and in the Philippine setting. It was observed that increasing rates of obesity tend to follow
the trends of urbanization and globalization posing risk in urban areas. This includes the adoption of
Filipino to trends brought by westernization as a secular trend of urbanization. Being a country with a long
history of colonialism, it is a consequence among Filipinos to have a high perception of cultural inferiority
as part of internalized racial oppression leading to vulnerability to rapid changes of urbanization and
globalization. Long-term strategies should become a public health priority to target the trends of obesity
across all age groups particularly women and urban households which are prone to increase risk of
developing obesity and limit its further negative effect on well-being.
Keywords – environmental influences, nutrition transition, obesity, obesity framework

[3]. However, recent data suggest that the gap between

INTRODUCTION numbers is narrowing between the industrialized nation
Many historical and cultural factors influence the and less developed nations in terms of prevalence in
current dietary intake and food choices of the obesity [4].
community. The dietary habits, food choices, and In the Philippines, there was a two-fold increase in
nutrition-related behaviors of people evolved from a the prevalence of overweight/obesity among adults
long history of colonialism, persecution, and from the year 1993 to 2015 with an annual average
segregation. Through the years, food consumption of increase of 0.66 percent (%). Meanwhile, obesity rates
Filipinos rapidly changes in response with among adolescents also continuously increased from
globalization. The rise serves as a troubling indicator of 1989 to 2011; wherein, there was a notable increase
the “globesity” that threatens to overwhelm existing from 8.3% to 9.2% from 2013 to 2015. Regions with
health care systems in the local and international realm the highest prevalence of overweight/obesity includes
[1]. the National Capital Region (NCR), Central Luzon, and
Spreading of health-related issues concerning non- Cavite-Laguna-Batangas-Rizal-Quezon
communicable diseases including obesity across the (CALABARZON). Consequently, the continuous
globe particularly has been associated with eating relative increase in the prevalence of overweight and
habits and poor dietary choices of western countries obesity among children (preschool and school age) was
which coincides with increasing influence of fast foods stopped in 2013 with a small decline in 2015.
outside Europe and America [1,2]. The problems Increased energy density became a constant dietary
related to obesity were first called the attention of the pattern in the Philippine household for the last 25 years,
World Health Organization (WHO) since early 1990 and this can be attributed to the effect of increasing
wherein an estimated 115 million individuals were urbanization- increasing household food availability
affected by this global pandemic while approximately [5]. The increasing intake of meat, fats and oils have
300 million individuals were experiencing health- contributed both to the increased energy and nutrient
related issues due to obesity among developed nations quality and bioavailability. These results contribute to

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the increased intake of cholesterol and saturated fats, cultural factors towards the increasing trend of obesity;
and most of the time accompanied by an inactive and (v) the study used a valid research and statistical
lifestyle, contributing to the alarming trends in the design to answer the research objectives.
increase of dyslipidemia, overweight and obesity
among adults [6]-[7]. Data extraction
To better understand the role of different The author recognized potentially related articles
environmental factors in this accelerating trend of based on abstracts and titles of the published articles.
obesity in the Philippines, this article review will Journals were retrieved and it was included if these
examine different environmental factors affecting the articles met the eligibility criteria. Extraction of data
prevailing food consumption patterns and nutritional includes the title, authors, duration, characteristics of
perceptions. Specifically, this review will attempt to the sample used, exposure and outcome variables,
explore how culture and community impact on the limitations, and result of the study. Other related
nutrition attitudes, food choices, and dietary intake of articles were used as foundation to support the
the population and identify segments of the population significant findings presented including some local
and community that should be targeted for education studies regarding the increasing prevalence of obesity.
programs, desirable components of nutrition education
programs. RESULTS AND DISCUSSION
1.1. Global pandemic issues of obesity
MATERIALS AND METHODS Changes in food supply for the last century was
very evident from simple and traditional foods going
Search Strategies
through the introduction of fast and convenient foods
This study utilized a narrative review through offered in convenience stores, restaurants, and
identification of eligible studies using different supermarkets [8]. Three (3) out of ten (10) adults
electronic databases such as PubMed, MEDLINE, BMJ around the globe was overweight and obese, whereas
Open Access and Science Direct. The major articles obesity among adults increases by fifty percent (50%)
reviewed were published from January 2009- in many countries. Meanwhile, obesity among
December 2019; however, the inclusion of supporting adolescents and children is increasing with extreme
literature was not restricted in reference to the year of cases observed among developed nations [9]. If the
publication. This literature review used the following numbers will sustain its robustness, there will be an
key phrases: “environmental factors related to almost 38% overweight and 20% obese adults by 2030,
obesity”, “nutrition-related attitudes and obesity”, globally [10].
“culturally-sensitive model related to obesity” and
“obesity in the Philippines”. Additional materials were Obesity rates in the United States dramatically
recognized by manual identification of reference lists increase by two folds compared to those individuals
of reviewed articles. Lastly, in-depth analyses of with normal nutritional status. For the last 10 years, it
different profiles were done through review of has sustained its increase achieving the Malthusian
secondary data from the available reports of the limit for obesity. Higher prevalence was recorded
Department of Science and Technology (DOST), Food among women irrespective to their ethnicity [11].
and Nutrition Research Institute (FNRI), National Meanwhile, European studies suggested that the
Economic Development Authority (NEDA), and prevalence of obesity in Southern and Eastern Europe
World Health Organization (WHO). was higher compared to Western and Northern
European nations in respect with their economic
Study selection differences. However, better results were observed in
In order to be included in this review, publications the younger population compared to their adult
were required to be: (i) published in a reputable and counterparts [12].
peer reviewed journals written in English language; (ii) One of the most concerned regions in terms of this
only studies using human model was considered; (iii) global issue of obesity were the developing countries
cross-sectional studies, ecological studies, systematic for the last decades [13]. However, the trend in these
reviews and meta-analyses, prospective and countries seems to be mediated by the wealth index and
experimental studies were considered to be the major educational attainment of the population providing
article for this review; (iv) the main objective of the differences between wealthy and poor individuals [14].
study is to investigate the different environmental and
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1.2. Issues of obesity in the Philippines prevalence of overweight and obesity in the country
The Philippines has been progressively affected by [15]. Figure 1 presents the overall trend among
transformation in terms of its economic structure due to different age groups including preschool children,
the introduction of neoliberalism and globalization. school children, adolescents and adults in terms of
Using the national estimates, it has been shown that the increasing rates of obesity in the Philippines. Data was
most affected population group are women and extracted from the Philippine National Nutrition
population living in highly urbanized regions (Table 1). Survey conducted from 1989 to 2015. The said survey
At present, females and people living and working in was conducted every five year and updated every 3
the urban areas recorded the most risk of increasing years [7].

Figure 1. Trend of increasing rate of obesity in the Philippines across all age groups, 1989-2018

Overall, the prevalence of obesity in the Philippines product of urbanization and decreasing physical activity
has sustained its increasing trend since the 1990s and has among population [5].
almost increased by two-folds since 2003. Childhood Based on the recent result of the national survey, rice
obesity provided a small decrease from 9.1 % in 2013 to was still considered as the staple food among Filipino
8.6% in 2015 compared to its steady increase from the households followed by fish and its products, and
1990 to 2013. Meanwhile, the prevalence of obesity vegetables; however, there were no observed differences
among the adolescent population sustained its steady between the intake of rural from urban households. Urban
increase (9.2%) which can be attributed to their pre- households tend to consume more of meat and its
adolescence weight. The increase for the last decades was products, other cereal products, oils and fats, and
two-fold higher since 1992 with an annual average beverages while rural households tend to consume more
increase of 0.66%. The increase give way to the recent of starchy roots and tubers, rice and rice products,
number of 4 out of 10 overweight or obese Filipino adults vegetables, and sugar and its products. Highest wealth
as of today. Details were shown in Figure 1. [7]. quintiles dwelling in urban areas tend to have higher food
The emergence of the increasing trend of obesity consumption compared to their lowest quintile
across the Philippine archipelago for the last three decades counterparts. Also, urban households have higher energy
can be observed in the result of National Nutrition Survey intake compared to their rural counterpart. Processed
(Figure 1 and Table 1) [5]. The increasing trend of obesity foods which were usually consumed by urban households
can be attributed to changes in the dietary pattern of the were hotdogs while in rural households their processed
Filipino households for the past 25 years with the foods consumption usually includes canned and dried
interplay of different factors. There was an observable sardines. In relation to this, processed food consumption
shift of increased energy density consumption as a tends to increase as the wealth status of the household also
increases [16].

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Table 1. Prevalence of overweight/obesity in the Philippines aggregated by sex and region, 2008-2015
Disaggregation Preschool children School-aged children Adolescents Adults
2008 2011 2013 2015 2008 2011 2013 2015 2008 2011 2013 2015 2008 2011 2013 2015
All 3.3 4.3 5.0 3.8 6.6 7.4 9.1 8.6 6.2 6.7 8.3 9.2 26.6 28.4 31.2 31.1
Sex
Male 3.6 4.7 5.4 4.0 7.6 8.2 9.9 8.8 6.3 6.8 8.6 9.4 23.0 24.6 27.6 26.8
Female 2.8 3.9 4.6 3.7 5.7 6.7 8.2 8.4 5.9 6.6 7.9 8.9 30.1 32.0 34.4 35.2
Region
NCR 4.1 6.2 6.5 6.0 12.6 12.6 16.6 17.9 10.2 11.2 14.7 16.1 32.2 36.2 39.9 36.1
CAR 4.9 5.3 6.1 3.2 10.1 10.8 11.7 9.9 8.2 11.4 11.6 11.4 29.9 30.4 34.5 34.3
Ilocos
3.5 6.3 5.4 3.2 6.5 9.6 9.8 9.2 7.4 9.0 8.6 11.1 23.0 26.1 27.3 26.6
Cagayan Valley
Central Luzon 3.4 3.2 5.7 3.8 6.5 7.1 9.2 9.1 5.9 6.9 7.8 10.1 22.3 23.0 25.1 24.9
CALABARZON 5.1 5.1 6.2 5.9 8.4 11.0 11.9 12.5 7.8 9.6 10.8 12.7 29.8 31.9 32.6 31.4
MIMAROPA 3.9 5.9 6.6 4.9 8.7 12.1 12.1 11.3 8.7 8.9 9.6 11.8 29.3 30.2 33.2 33.1
Bicol 2.5 3.4 5.5 3.2 3.2 4.0 5.4 5.2 3.3 3.9 4.7 4.1 20.5 21.9 24.7 23.0
Western Visayas 1.6 3.4 3.8 2.6 2.7 4.0 4.6 4.0 2.6 3.0 4.2 3.6 20.5 22.5 24.7 24.2
Central Visayas 3.1 3.5 4.6 3.3 5.2 4.5 5.2 7.1 4.0 4.6 5.5 6.6 19.4 21.9 22.9 22.6
Eastern Visayas
Zamboanga Peninsula
2.2 2.6 3.6 2.6 4.5 4.3 7.9 6.0 5.5 4.8 6.0 7.1 28.0 28.0 30.1 28.3
Northern Mindanao 1.8 3.4 3.2 2.3 4.3 4.3 4.7 4.9 3.5 3.6 4.9 5.7 27.0 28.1 32.9 31.1
Davao 2.0 4.4 2.6 2.6 3.4 3.4 5.1 5.4 3.5 3.2 4.8 5.0 23.9 24.9 25.9 28.4
SOCCKSARGEN 2.2 2.4 4.8 1.9 5.5 4.0 6.7 5.0 4.5 5.0 7.1 7.3 29.1 27.7 33.9 31.8
ARMM 2.0 3.1 3.4 2.7 5.1 6.4 5.8 5.2 5.9 5.4 7.1 7.2 28.8 29.5 32.8 33.3
CARAGA 2.2 2.4 3.5 2.7 6.3 4.3 6.0 6.4 4.0 5.4 5.7 7.4 25.4 25.7 27.2 26.4
5.9 3.9 3.9 4.1 5.4 4.4 4.9 4.5 5.7 4.0 5.3 4.3 17.1 18.8 23.2 24.5
2.0 1.9 3.7 1.6 5.6 3.2 6.2 5.2 5.7 4.3 6.8 5.5 29.6 27.6 34.9 30.6
Source: FNRI, DOST
Aside from wealth index, urban-rural differences preferences that resulted to remarkable shift in dietary
affect the regional dietary patterns due to differences in patterns and food intake, particularly in highly urbanized
food availability, distribution, and access. The areas resulting to increasing trend of obesity. The
consumption of “other cereal and cereal products,” fats remarkable increase in FAFH intake consumption of
and oils, milk and milk products, and meats and meat Filipino households suggests that merging in the
products were higher compared to that of vegetables consumption incidence of these food consumed away
which are lower in urban areas compared to other regions from home implied a remarkable shift in the dietary
with different extent of urbanization. The regions with the patterns and behavior of Filipino households However,
highest proportion of urban population other than the the complexity of the growing issues of obesity in the
NCR were Central Luzon and CALABARZON which country can be best explained by understanding the
had almost 60% urban communities and had higher different factors related to obesity [17].
consumption of “other cereals and cereal products”, eggs,
milk and milk products, and meat and meat products. 2. Environmental factors resulting to increasing rate
Meanwhile together with Central Luzon, the region had a of obesity in the Philippines
lower intake of vegetables, starchy and tubers than most The complexity of the problem in terms of
of the region which were less urbanized [16]. obesity and its related conditions provides a new burden
In a related study, Food consumption Away from to the current public health system in the country because
Home (FAFH) per capita registered the highest annual of this recent economic prosperity. This can be explained
growth of 9.19% that explains the increase of FAFH per by a phenomenon called nutrition transition which said to
household at 8.59% per year from 2003-2012 [17]. It was exist among developing regions, where urbanization
supported by the results of the National Nutrition Survey rapidly increases, and food patterns were greatly affected
conducted last 2015 which found out that 32.2% of by the shift in economy and physical activity was greatly
households in the country took their meals and snacks affected by sedentary lifestyle. Increasing rates of
outside their home. Higher prevalence was found among overweight/obesity is a multifactorial trend evolving
the rich and richest quintile living in urban communities through different factors which will be comprehensively
particularly in CALABARZON, NCR, and Central discuss in the succeeding discussion.
Luzon. Snacks were the usual food consumed outside
home followed by lunch and dinner, respectively [5]. 3.3.1. Influence of food availability and supply
Most urbanized regions in the Philippines which Findings of several studies suggested that the reason
includes the NCR, Cavite, Laguna, Batangas, Rizal and behind the obesity epidemic can be attributed to the
Quezon (CALABARZON) and Central Luzon seems to changing environment including its food supply. Obesity
provide the biggest contribution in the level FAFH most likely followed the changes in caloric quality and
consumption among average Filipino household. The quantity of the available food supply for the population.
numbers are indication of the changing consumer From simple food production, the global shift forwards to
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the production of a more industrialized food system that increases the odds of developing obesity by 5.2%. A 0.1
provides a more convenient and processed foods miles distance from a fast-food restaurant corresponds to
originating from the cheap agricultural inputs [18]. an increase of 30 to 100 calories per day [27].
In the Asia Pacific Region, the largest provider of Meanwhile, presence of a fast-food store within a
calories are cereal products particularly rice and white half-mile within the residence increases the likelihood of
flour while the availability of vegetable oils had 1.6% of increasing the chance of gaining weight above
significantly increased for the last 50 years. Meanwhile 20kg. The effect still increases by 5.5% when the fast-
the increase in meat consumption can be attributed to food store is within 0.1 miles away from the residence.
importation of chicken meat which is usually high in fat. Moreover, the effect of half miles explains an increased
Regions in the Asia-Pacific are mostly food dependent caloric intake of 1 to 4 calories per day. Fast food chains
which implies that the population do not have the chance within the school vicinity increase the likelihood of 0.5%
to choose from a range of nutritious foods. Also, it seems increase of obesity for the last three decades among its
that the people in the Pacific were affected by economic students [28]. In a related study, the effect of fast-food
and social barriers that allow them to consume foreign chains in the vicinity also put the quality of the diet of
foods which are nutritionally-inferior compared to the students into jeopardy. It was found out that the odds of
locally produced foods fat [19]-[20]. consuming vegetables and juices per day decreases when
there is a fast-food chain within the vicinity compared to
3.3. Food consumption patterns and utilization at their counterparts. Increased the consumption of fried
the individual level potatoes and sodas was also observed compared to those
Before the 21st century, mainstream research focused students studying in school away from fast food stores
on the risk factors of obesity at the individual level which resulting to higher rates of obesity [29].
are usually considered as modifiable and are primarily In the Philippines, the dynamics of food supply has
attributed to inactive lifestyle and poor dietary practices outgrown the increasing numbers of fast-food restaurants
[20]. Several studies postulated that the increased and convenient stores which provide quick and easy
consumption of specific food groups increased the access food to different stakeholders like students,
prevalence of obesity. This is the increase in consumption working mothers, professionals and all other individuals
of refined cereals and sugar-sweetened products including that demand faster food preparation. The appetite of the
the sugar-sweetened beverages [21]-[22]. In a related Filipino population in terms of fast-food products have
study conducted in the United Arab Emirates, it was found increased significantly, following the launch of fast-foods
out that the risk of developing obesity among girls who in the country 50 years ago [30] -[31].
always and frequently consumed their breakfast was However, the relative increase of international food
decreased by half-fold; however, those boys who had their chain brands has not always transformed into success
breakfast in school increased the chance of being obese by since many Western chains. The local brands that were
three-folds. The result of the study also showed that homegrown have been fair playing in the market
midnight snacking was significantly associated with compared to their Western brands counterparts because of
obesity among boys by increasing the likelihood of 1.2 but through and aggressive marketing [32]-[35]. Local fast-
not in girls [23]. food chains are more favored compared to Western-based
Moreover, increasing the odds of developing obesity fast-food restaurants which observed 70 per cent eating
due to eating breakfast in school cafeterias tends to be for once or twice a month only. Participants in this study
related to the consumption of high-energy foods. In also claimed that their first experience for this type of food
Bahrain, it was observed that high-caloric foods were the took place before they turned to five. Moreover, young
usual foods consumed in school cafeteria which includes adult Filipinos tends to be more prone to the negative
carbonated and non-carbonated beverages, cheese, and outcome of usual fast-food patronage because of their
broad beans. Usual snacking among adolescents and vulnerability against misinformation regarding the
adults became an important part of their dietary patterns products’ overall nutritional value. Hence, it was clear
which are usually high calorie containing with a direct that the local brand chains have a more competitive
link to increase risk of developing obesity [24]-[26]. advantage over its Western counterparts that capture the
sensibilities of the Filipinos [17].
3.4. Relative influence of fast food to obesity
Relative to dietary habits at the household level, 3.5. Influence of physical activity and lifestyle
evidence suggest that their relationship between Related to food habits and intake, the physical activity
consumption of fast-food products and obesity; however, of the global population became sedentary also. The
its causal role cannot be still explained. In a related study changes in the patterns of physical activity in the general
conducted in the US, it was found out that the availability population specifically among adolescents have relatively
of a fast-food service within one-tenth mile from a school changed because of increased screen time in television
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and indiscriminate use of internet and online gaming [36]. during their early years had been engaged in food
Alongside with the advent of technology, migration to preparation during adulthood [53]. In relation to this,
urban cities poses risks to the population by introduction research studies suggested that students tends to be
of different stressors such as congestion and traffic noise, dissatisfied with the available food in their schools that
fear of crime and crowding which are all potential source resulted in skipping meals. Also, children tend to prefer
of stress and fatigue. These results to a poor contact with buffet set-up that offers unlimited quantities from their list
the environment particularly “green spaces” which can be of favorite items [54]-[55].
defined as “open areas with natural vegetation” [37]. Related studies suggested that higher knowledge on
In a meta-analysis done by Kolehmainen and Sinja food showed healthier food practices and consumed a
[38], it was predicted that psychological stress can lead to variety of foods. It was also found out that improved
lower physical activity due to behavioral inhibition and a knowledge on food preparation tends to decrease the
predisposing factor for a more sedentary lifestyle [38, 39]. intake of fat but increase in the carbohydrate
Sedentary lifestyle of men and women leads to high consumption. These studies also revealed that males had
prevalence of overweight and obesity across different age a lower food knowledge compared to females, but they
[40]. I the Philippines, physical inactivity was reported at tend to have better dietary practices compared with their
42.5% among adult population with highest prevalence in counterparts [56,57,58,59]. Moreover, it was also found
Central Luzon wherein 5 out of 10 individual followed by out that usual involvement in cooking increased the
CALABARZON at 43.3% and NCR at 43.3% [41]. In a likelihood to have better dietary practices. In relation, the
study done in Pampanga, Philippines by Acampado and increase in participation in food preparation improves the
Valenzuela [42], it was found out that the physical activity likelihood of an adolescent to increase their vegetable and
was associated significantly with educational level fruit intake and decrease the chance of consuming fried
wherein greater proportion of physical inactivity was foods, sweetened products, high salt, and sugary foods
found in higher year levels and primary reason was lack during adulthood [60]-[61].
of time. It is also suggested that there are some enabling In the Philippines, limited studies explore the effect
factors associated with increased physical activity that of nutrition-related behaviors and food literacy in the food
includes involvement of their peers and friends, family intake and dietary patterns. However, in a study
support, sports equipment and skills related to it and an conducted by Florentino et al. [62], it was found out the
advice from a medical professional. students from private schools in Manila usually consumed
Aside from sedentary lifestyle, other related lifestyle high calorie food, animal products, fats and oils, sugar-
factors that predict obesity are cigarette smoking and sweetened beverage that resulted to consumption of
excessive alcohol intake [43]-[44]. Cigarette smoking higher total energy, sugar and protein compared to public-
was positively associated with central adiposity school students which can be explained by income class
particularly among women [45,46]. Meanwhile, several differences. Hence, it is apparent that food- and nutrition
prospective studies suggested alcohol consumption and literacy can highly influence the food intake and dietary
drinking behavior is highly correlated with obesity and patterns of adolescents which can impact on the future
weight gain [47]. The increase in weight over four years nutritional status of an individual.
by exposing an individual to one shot per day of alcohol 3.7. Genes and ethnicity as a predictor of obesity
predicted an increase of 0.19 kilograms whereas, the Research studies also started to focus on the
relationship was found stronger on beer [22], [48]. Hence, environmental influences that interact with the genetic
the interplay of different stressors causes to increase the factors linking to obesity [63]. There are two major types
physical inactivity among the population leading to of obesity according to phenotype: the monogenic obesity
development of overweight/obesity. which is characterized by single-cell mutation that
eventually leads to insufficiency and the polygenic
3.6. Nutrition-related attitudes and food literacy obesity that includes many polymorphic genes that have
Nutrition-related attitudes such as food choices and complex interaction with the environment and the gene.
other considered behavior can also affect the dietary The major types of genes related to obesity are MC4R,
pattern of individuals by cultural and social factors [49]. PCSK1, POMC and BDNF which are all also
Several studies suggested that nutrition literacy has a big predisposing factors to other diseases. MC4R contains a
role in development of eating behavior of adolescents and coding sequence SNP at its downstream which can
further sustained during adulthood [50,51,52]. In a 10- increase the likelihood of being obese [64]. The likelihood
year longitudinal study conducted to track the of increasing food intake with related food behavior
involvement in food preparation of adolescence to phenotypes for polygenic obesity particularly SNP
adulthood to improve their quality of diet, it was found rs17782313 in MC4R and SNP rs9939609 in FTO
out that those individuals exposed to meal preparation
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sequence which predisposes obesity related to high fat and household and individual which are all leading to obesity.
energy intake [65]. Meanwhile, each dimension has been divided again into
In the study conducted in Europe and China, it has three major distinct classification of factors leading to
been reported that there was strong association between obesity which includes the basic causes which are all
the FTO gene polymorphism with obesity [66]. Same leading to the underlying causes that are all requisite
results had been established in terms of the relationship of factors to the immediate causes of obesity.
FTO to obesity in the study conducted in Singapore It has been discussed that the major driver of obesity
among Chinese, Malay and Japanese population [67]-[ across the globe is the rate of urbanization and
68]. globalization. The Philippines among other developing
Meanwhile, in the Philippines, it has been established countries also experienced stronger economy and
that the association of the homozygous allele of the SNP increasing Gross Domestic Product (GDP) and Gross
rs4994 had reached its statistical significance with percent National Product (GNP) for the last two decades which
body fat, Body Mass Index (BMI) and waist leads to increased urbanization of different regions. Along
circumference which are all predisposing factors to with rapid urbanization, the rates of obesity in the country
certain types of obesity. Meanwhile, the SNP in the first were also increasing particularly among adults. Filipinos
genetic sequence of FTO increased the likelihood of tend to experience negative perception towards ethnic and
increased BMI among Filipino women which suggests cultural inferiority because of a long history of
that gene was an important factor that increases the colonialism making Filipinos vulnerable to introduction
susceptibility to obesity [69]. Studies also suggested that of different Western commodities to the country including
Filipino and Asian- American women had higher visceral marketing of convenient and fast-food restaurants.
fat deposition compared with Caucasians that puts these Throughout the years, the number of Filipinos eating
populations into higher risk of having central obesity [70]- outside their home dramatically because of the demands
[71]. These contemporary studies highly suggest that the from their work and lifestyle. Nutrition-related attitudes
Asian population particularly women is at risk to and food literacy of children has also a direct impact on
developing obesity because of their specific genetic traits their future dietary patterns as adults. Improved nutrition-
that predisposes to higher food intake and central related attitudes and food literacy have been suggested to
adiposity. come up with better nutritional outcomes.
Increased globalization and urbanization also pose
4. An analysis of the increasing obesity cases in the risk to the available blue and green spaces for the
Philippines community which results in inadequate areas for physical
Culture has a robust influence on the nutritional status activities and leisure. These spaces have viable influences
of the population since it molds the food choices along on stress management that can affect the dietary behavior
with social influences that directly impacts their eating of an individual. Stress could further amplify the issues of
behavior [74]. Thus, in order to understand the multi- obesity by changing the dietary patterns and behavior of
factorial problem of obesity and its complexity based on individuals which results in higher food intake and
the present literature in the provided discussion it is increases the likelihood of involvement in different
necessary to infuse culture in the discussion [75]. Eating unhealthy lifestyle such as cigarette smoking and binge
habits are shaped by different environmental factors drinking [77]. Lastly, based on the genetic traits of the
however, many dietary habits are already inculcated in Filipino women tend to be at risk to develop obesity
culture and genes of the population from their root of because they have the specific receptor which are
origin or ethno-linguistic classification. This attempt has obesogenic in nature. Moreover, Asian including Filipino
been made to explain the multifactorial causation of women have higher central adiposity compared to their
increasing rates of obesity in the Philippines by reviewing Caucasian counterparts which increases the likelihood to
available literature and construction of a framework. develop obesity.
As presented in Figure 2, the different factors were
divided into three dimensions namely: environmental,

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Figure 2. Conceptual Framework explaining the multi-factorial origin of obesity in the Philippines

CONCLUSION AND RECOMMENDATION

REFERENCES
The profound increasing rates of obesity in the
Philippines has been observed among adolescents and [1] Hawkes, C. (2002). Marketing Practices of Fast Food and Soft
Drink Multinationals: A Review. Globalization, Diets, and
persists into adulthood with higher prevalence among Noncommunicable Diseases. Geneva, World Health
women and in older age. The increasing rates of obesity Organization.
tend to follow the trends of urbanization and globalization [2] Prentice, A. M. (2006). The Emerging Epidemic of Obesity in
posing risk among urban dwellers. The interaction of Developing Countries. International Journal of Epidemiology
different environmental factors because of globalization, 35.1: 93–99.
secular trends, cultural and individual factors resulted in [3] Kim, S. & Barry M. Popkin. (2006). Commentary:
Understanding the Epidemiology of Overweight and
increasing prevalence in the country [77]. The obesogenic Obesity—a Real Global Public Health Concern. International
environment coupled with obesogenic traits amplify the Journal of Epidemiology 35.1: 60–67
existence of the problem that eventually lead to different [4] Stix, G. (2007). A Question of Sustenance. Scientific American
problematic conditions including non-communicable 297.3: 54–58.
diseases. [5] Pedro R, Barba C and de Leon R. (2008). Nutrition transition in
Thus, a framework linking the relationship to the Philippines. Philippine Population Review 2008; 6: 1-19.
Doi:10.3860/ppr.v6i1.264
different environmental and cultural factors could help the [6] 8th National Nutrition Survey. Facts and figures. Department of
national and local leaders to use it in their program Science and Technology: Food and Nutrition Research
planning. Long-term strategies should become a public Institute.
health priority to target the trends of obesity across all age [7] 2015 Updating National Nutrition Survey. Anthropometric
groups and limit its further negative effect on well-being. Measurement. Facts and Figures. Food and Nutrition
Improving access to healthy and nutritious food while Research Institute. Department of Science and Technology.
[8] Ng, SW.; Popkin, BM. Monitoring and understanding the US
legislating and narrowing the policies regarding the food supply: Dynamics and Challenges. Chapel Hill, NC:
marketing of convenient and fast foods must be enacted University of North Carolina at Chapel Hill; 2011.
to provide options for dietary behavior change among [9] Hruby, A., Hu, F.B. The Epidemiology of Obesity: A Big
individuals vulnerable to obesity particularly women and Picture. (2015) pharmacoeconomics 33, 673–689. Retrieved
households living in urban areas. Lastly, research must from https://doi.org/10.1007/s40273-014-0243-x.
be continuously done at the sub-community level to allow [10] Kelly T, Yang W, Chen C-S, Reynolds K, He J. (2008) Global
burden of obesity in 2005 and projections to 2030. Int J Obes.
local planners to develop more appropriate solutions 2008;32(9):1431–7.
which are culturally accepted in the norms of the society.

100
Asia Pacific Journal of Allied Health Sciences
Vol. 5, No. 1, September 2022
 Asia Pacific Journal of Allied Health Sciences | Volume 5, No. 1 | September 2022
__________________________________________________________________________________________________________________
[11] Ogden CL, Carroll MD, Kit BK, Flegal KM. (2012) Prevalence [31] Popkin, B. M., & Gordon-Larsen, P. (2004). The nutrition
of childhood and adult obesity in the United States, 2011– transition: worldwide obesity dynamics and their
2012. JAMA. 2014;311(8):806. determinants. International journal of obesity, 28(3), S2-S9.
[12] Bergho¨fer A, Pischon T, Reinhold T, Apovian CM, Sharma [32] Wilson, K. (2004). RP Fast-Food Chain Beats mcdonald’s at
AM, Willich SN. Obesity prevalence from a European its Own Game Philippine Daily Inquirer, June 27, 2004.
perspective: a systematic review. BMC Public Health. Http://money.inquirer.net breakingnews/view.
2008;8(1):200. [33] 2016 Annual Survey of Philippine Business and Industry
[13] Popkin BM. (2008). The World Is Fat: The Fads, Trends, (ASPBI) - Accommodation and Food Service Activities
Policies, and Products That Are Fattening the Human Race. Sector for All Establishments: Results. Philippine Statistics
Avery-Penguin Group: New York. Authority. Retrieved from https://psa.gov.ph/content/2016-
[14] Jones-Smith JC, Gordon-Larsen P, Siddiqi A, Popkin BM. annual-survey-philippine-business-and-industry-aspbi-
Cross-national comparisons of time trends in overweight accommodation-and-food-service-0 last April 4, 2020.
inequality by socioeconomic status among women using [34] Matejowsky, T. 2008. Jolly Dogs and mcspaghetti:
repeated cross-sectional surveys from 37 developing Anthropological Reflections on Global/Local Fast Food
countries, 1989--2007. (2011). Am J Epidemiol 2011; 173: Competition in the Philippines. Journal of Asia-Pacific
667--675. Business 9.4: 311–328.
[15] Matejowsky, T. (2009). Fast food and nutritional perceptions [35] Harris JL, Schwartz MB, Brownell KD. Marketing foods to
in the age of “globesity”: perspectives from the provincial children and adolescents: licensed characters and other
Philippines. Food and Foodways, 17(1), 29-49. promotions on packaged foods in the supermarket. Public
[16] 2015 Updating National Nutrition Survey. Dietary Health Nutr. 2009; 13:409-17.
Assessment. Facts and Figures. Food and Nutrition Research [36] French SA, Story M, Jeffery RW. Environmental influences on
Institute. Department of Science and Technology. eating and physical activity. Annu Rev Public Health 2001;
[17] Rufino C. (2014). The pattern of consumption for Food away 22:309–35.
from home (FAFH) of modern Filipino households. [37] Barton, J., & Pretty, J. U. L. E. S. (2010). Urban ecology and
[18] Hall, K. D. (2018). Did the food environment cause the obesity human health and wellbeing. Urban ecology, 12(1), 202-229.
epidemic? Obesity, 26(1), 11-13. [38] Stults-Kolehmainen, M. A., & Sinha, R. (2014). The effects of
[19] World Health Organization. (2003). Diet, food supply and stress on physical activity and exercise. Sports
obesity in the Pacific. medicine, 44(1), 81-121.
[20] Hill JO, Wyatt HR, Peters JC. Energy balance and obesity. [39] Dallman, M. F. (2010). Stress-induced obesity and the
Circulation. 2012;126(1):126–32. emotional nervous system. Trends in Endocrinology &
[21] Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton Metabolism, 21(3), 159-165.
SD, et al. Comparison of weight-loss diets with different [40] Cecchini M, et al. Chronic diseases: chronic diseases and
compositions of fat, protein, and carbohydrates. N Engl J development 3. Lancet 2010; 376:1775-84.
Med. 2009;360(9):859–73. 44. Doi:10.1016/S0140-6736(10)61514-0
[22] Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. (2011). [41] The Philippines Nutrition Facts and Figure 2015: Dietary
Changes in diet and lifestyle and long-term weight gain in Survey. 2015 Updating of the nutritional status of Filipino
women and men. N Engl J Med; 364(25):2392–404. children and other population groups. Retrieved from
[23] Bin Zaal, A. A., Musaiger, A. O., & D'Souza, R. (2009). http://enutrition.fnri.dost.gov.ph/site/preview.php?Xx=%20u
Dietary habits associated with obesity among adolescents in ploads/2015_DIETARY_SURVEY.pdf last April 6,2020.
Dubai, United Arab Emirates. Nutricion hospitalaria, 24(4), [42] Acampado, E., & Valenzuela, M. (2018). Physical activity and
437-444. dietary habits of Filipino college students. Kinesiology,
[24] Musaiger AO, Gregory WB. Profile of body composition of 50(1), 57–67. Doi:10.26582/k.50.1.11.
school children (6-18Y) in Bahrain (2000). Int J Obes Relat [43] Tan, A. K. G., Dunn, R. A., Samad, M. I. A., & Feisul, M. I.
Metab Disord; 24 (9): 1093-1096. (2010). Sociodemographic and Health-Lifestyle
[25] Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened Determinants of Obesity Risks in Malaysia. Asia Pacific
beverages and weight gain in children and adults: a systematic Journal of Public Health, 23(2), 192–
review and meta-analysis. (2013). Am J Clin Nutr. 202. Doi:10.1177/1010539509359535.
2013;98(4):1084–102. 47. [44] Bendsen NT, Christensen R, Bartels EM, et al. Is beer
[26] Hu FB. Resolved: there is enough scientific evidence that consumption related to measures of abdominal and general
decreasing sugar-sweetened beverage consumption will obesity? A systematic review and meta-analysis. Nutr
reduce the prevalence of obesity. Rev. 2013; 71:67–87. A recent systematic review examining
[27] Abdollah T (2007). Los Angeles Times. September 2007. the effect of beer intake on body weight. The paper includes
Retrieved from https://www.latimes.com/archives/la-xpm- cross-sectional, longitudinal, and experimental studies.
2007-sep-10-me-fastfood10-story.html last April 07, 2020. [45] Clair, C., Chiolero, A., Faeh, D. Et al. Dose-dependent positive
[28] Currie, J., dellavigna, S., Moretti, E., & Pathania, V. association between cigarette smoking, abdominal obesity,
(2010). The Effect of Fast-Food Restaurants on Obesity and and body fat: cross-sectional data from a population-based
Weight Gain. American Economic Journal: Economic Policy, survey. BMC Public Health 11, 23 (2011).
2(3), 32–63. Doi:10.1257/pol.2.3.32. Https://doi.org/10.1186/1471-2458-11-23
[29] Davis, B., & Carpenter, C. (2009). Proximity of fast-food [46] Ball, K., Timperio, A. F., & Crawford, D. A. (2006).
restaurants to schools and adolescent obesity. American Understanding environmental influences on nutrition and
Journal of Public Health, 99(3), 505-510. physical activity behaviors: where should we look and what
[30] Matejowsky, T. (2007). SPAM and Fast food “Glocalization” should we count? International Journal of Behavioral
in the Philippines. Food, Culture & Society, 10(1), 23– Nutrition and Physical Activity, 3(1), 33.
41. Doi:10.2752/155280107780154088.
101
 dela Luna et al., Influences of Different Environmental Factors to the Increasing Rate of Obesity…
__________________________________________________________________________________________________________________
[47] French MT, Norton EC, Fang H, et al. Alcohol consumption and the social environment: Moving beyond the
and body weight. Health Econ. 2010; 19:814–32.] nature/nurture debate. National Academies Press (US).
[48] Economos CD, Hildebrandt ML, Hyatt RR. College freshman [64] Loos, R.J.; Lindgren, C.M.; Li, S.; Wheeler, E. Et al (2008)
stress and weight change: differences by gender. Am J Health Common variants near MC4R are associated with fat mass,
Behav. 2008; 32:16–25. weight and risk of obesity. Nat. Genet., 2008, 40 (6), 768-775.
[49] Shepherd, R. (1999). Social determinants of food [65] Loos Thorleifsson, G.; Walters, G.B.; Gudbjartsson, D.F.; et
choice. Proceedings of the Nutrition Society, 58(4), 807-812. al. Genome-wide association yields new sequence variants at
[50] Larson NI, Story M, Eisenberg ME et al. (2006) Food seven loci that associate with measures of obesity. Nat.
preparation and purchasing roles among adolescents: Genet., 2009, 41 (1), 18-24.
associations with sociodemographic characteristics and diet [66] Chang Y-C et al. Common variation in the fat mass and
quality. J Am Diet Assoc 106, 211–218. 39. obesity-associated (FTO) gene confers risk of obesity and
[51] Huang TTK, Kaur H, mccarter KS et al. (2004) Reading modulates BMI in the Chinese population (2008).
nutrition labels and fat consumption in adolescents. J Adolesc Diabetes. 2008; (57):2245–2252.
Health 35, 399–401. [67] Tan J et al. FTO variants are associated with obesity in the
[52] Pirouznia M (2001) The association between nutrition Chinese and Malay populations in Singapore. Diabetes. 2008;
knowledge and eating behavior in male and female 57:851–2857.:851–2857.
adolescents in the US. Int J Food Sci Nutr 52, 127–132. [68] Hotta K et al. Variations in the FTO gene are associated with
[53] Laska MN, Larson NI, Neumark-Sztainer D et al. (2012) Does severe obesity in the Japanese. J Hum Genet. 2008; 53:546–
involvement in food preparation track from adolescence to 553.
young adulthood and is it associated with better dietary [69] Marvelle A, Lange L, Qin L, Adair L, and Mohlke K.
quality? Findings from a 10-year longitudinal study. Public Association of FTO with Obesity-Related Traits in the Cebu
Health Nutr 15, 1150–1158. Longitudinal Health and Nutrition Survey (CLHNS) Cohort.
[54] Agostoni, C., Braegger, C., Decsi, T., Kolacek, S., Koletzko, Diabetes.2008; 57: 1987-1991.
B., Mihatsch, W., ... & Turck, D. (2011). Role of dietary [70] Park YW, Allison DB, Heymsfield SB, Gallagher D. Larger
factors and food habits in the development of childhood amounts of visceral adipose tissue in Asian Americans. Obes
obesity: a commentary by the ESPGHAN Committee on Res 2001; 9: 381–387.
Nutrition. Journal of pediatric gastroenterology and [71] Neta MR, Barrett-Connor E. Ethnic differences in visceral
nutrition, 52(6), 662-669. adipose tissue and type 2 diabetes: Filipino, African
[55] Dammann, K., & Smith, C. (2010). Food-related Attitudes and American, and white women. Obes Res 2005; 13: 1458–
Behaviors at Home, School, and Restaurants: Perspectives 1465.
from Racially Diverse, Urban, Low-income 9- to 13-year-old [72] 2015 Updating National Nutrition Survey. Dietary
Children in Minnesota. Journal of Nutrition Education and Assessment. Facts and Figures. Food and Nutrition Research
Behavior, 42(6), 389–397. Doi: 10.1016/j.jneb.2009.09.003. Institute. Department of Science and Technology.
[56] Venter I & Winterbach A (2010) Dietary fat knowledge and [73] Rufino C. 2014. The pattern of consumption for Food away
intake of mid-adolescents attending public schools in the from home (FAFH) of modern Filipino households.
Bellville/Durbanville area of the city of Cape Town. S Afr J https://www.researchgate.net/publication/269039321 last
Clin Nutr 23, 75–83. May 2, 2019.].
[57] Tsartsali PK, Thompson JL & Jago R (2009) Increased [74] Elmadfa, I. (Ed.). (2005). Diet diversification and health
knowledge predicts greater adherence to the Mediterranean promotion (57). Karger Medical and Scientific Publishers.
diet in Greek adolescents. Public Health Nutr 12, 208–213. [75] Christian M., Gereffi G. (2010) The Marketing and
[58]. Mirmiran P, Azadbakht L & Azizi F (2007) Dietary behavior Distribution of Fast Food. In: Freemark M. (eds) Pediatric
of Tehranian adolescents does not accord with their Obesity. Contemporary Endocrinology. Humana Press, New
nutritional knowledge. Public Health Nutr 10, 897–901. York, NY.
[59] Huang TTK, Kaur H, mccarter KS et al. (2004) Reading [76] James, D. (2004). Factors influencing food choices, dietary
nutrition labels and fat consumption in adolescents. J Adolesc intake, and nutrition-related attitudes among African
Health 35, 399–401.]. Americans: Application of a culturally sensitive model.
[60] Larson NI, Story M, Eisenberg ME et al. (2006) Food Ethnicity & Health, 9(4), 349–
preparation and purchasing roles among adolescents: 367. Doi:10.1080/1355785042000285375.
associations with sociodemographic characteristics and diet [77] Hawks, S. R., Madanat, H. N., Smith, T., & Novilla, M. L. B.
quality. J Am Diet Assoc 106, 211–218. (2006). Motivation for Eating and the Nutrition Transition in
[61] Vaitkeviciute, R., Ball, L. E., & Harris, N. (2014). The the Philippines. Age, 20(72.1), 10-1.
relationship between food literacy and dietary intake in
adolescents: a systematic review. Public Health Nutrition, COPYRIGHTS
18(04), 649–658. Doi:10.1017/s1368980014000962. Copyright of this article is retained by the author/s, with
[62] Florentino, R. F., Villavieja, G. M., & Laña, R. D. first publication rights granted to APJAHS. This is an
(2002). Dietary and Physical Activity Patterns of 8- to 10-
Year-Old Urban Schoolchildren in Manila, Philippines. Food
open-access article distributed under the terms and
and Nutrition Bulletin, 23(3), 267– conditions of the Creative Commons Attribution license
273. Doi:10.1177/156482650202300306. (http://creative commons.org/licenses/by/4).
[63] Faith, M. S., & Kral, T. V. (2006). Social environmental and
genetic influences on obesity and obesity-promoting
behaviors: fostering research integration. In Genes, behavior,

102
Asia Pacific Journal of Allied Health Sciences
Vol. 5, No. 1, September 2022