To address the problem, PASOO piloted an intervention program starting from 2004 to 2006 directed to school children in order to promote healthy lifestyle, with emphasis on the prevention of overweight and obesity. Called the Whiz Kids through Fitness Project, it involved a comprehensive program of physical activity and nutrition promotion among primary school children, starting in a private school in Metro Manila. The goal of the program was to have children who are physically and mentally fit, free from obesity and malnutrition, through healthy lifestyle practices. This involved a comprehensive program of physical activity and nutrition promotion among primary school children (Grades 1-3) starting in one pilot school, namely, St. Scholastica’s College. More specifically, the project sought to teach the children basic principles of proper nutrition and to integrate scientifically designed physical activities and exercises among Grades I to III pupils into regular school activities. From the results of the evaluation of the project, valuable lessons were learned to promote success and avoid pitfalls in implementation of such projects in the future. Among them are the need for full commitment of school officials and faculty, appropriate integration of nutrition and physical activity consistent with the curriculum, periodic training of teachers, involvement of school canteen, adequate school facilities, close monitoring of project implementation by a school coordinator, and innovative strategies for reaching out and involving parents.

PASOO has been collaborating with the FNRI together with some 14 other medical societies in the conduct of the National Nutrition and Health Survey. The first such survey was conducted in 2003 and the Association is again participating in a repetition of the survey which is presently being conducted nationwide. From the results of the 2003 survey, the applicability of the Asian cut-off points for the assessment for overweight (OW) and obesity (Ob) among adult Filipinos was assessed. The results showed a generally increasing trend in the rate of co-morbidities with increase in BMI, WC and WHR. Based on these results, tentative cut-off points for the indicators were estimated and tested against the distribution curves of each of the parameters by rate of co-morbidities. The tentative cut-offs were as follows: BMI, =23 kg/m2 for overweight and =27 kg/m2 for obesity for both sexes; WC, =85 cm for men and =80 cm for women, and WHR, =0.90 for men and =0.85 from women, indicating increased risk. Thus, the tentative cut-offs for BMI, WC and WHR for Filipinos derived from analysis of the national data from the National Nutrition and Health Survey appear close to recommendations for Asians but lower than the cut-offs recommended by WHO.

From the results of the 2003 National Nutrition and Health Survey as well as past surveys of FNRI, the epidemiology of OW and obesity Ob among Filipinos was studied. While it was evident that the prevalence of overweight in children was still relatively low, the prevalence started to rise at pubertal age especially in boys. However, in adolescence, girls overcame boys, and this gender difference persisted to adulthood. Dramatic increase in OW and Ob was seen starting in young adults, reaching a peak at middle age, before it diminished in the elderly. It was also clear that adult women had higher prevalence of OW and Ob than men (as assessed by BMI). When assessed in terms of waist circumference (WC) and waist-hip ratio (WHR), central obesity was also much higher in women than in men. We have also seen the influence of socio-economic status where rates of obesity increased with socio-economic status of the household with its accompanying lifestyle characteristics. Of more practical value was the clear observation that the rates of co-morbidities (diabetes, hypertension, elevated serum total cholesterol, LDL-cholesterol and triglycerides) rose with increasing BMI, WC and WHR values. The situation becomes even worse when in the last 5 years alone, the prevalence of overweight and obesity throughout the life span has been increasing, and is deemed to continue to increase as in the rest of the world unless effective and integrated public health measures are instituted.

In a review of the use of BMI, WC and WHR for the assessment of obesity, it was concluded that the best measure to use will depend on the purpose and objective of the exercise. In clinical practice, the combined use of WHR or WC and BMI would probably be a better predictor of metabolic risk and other consequences of obesity than either WHR/WC or BMI alone. For epidemiological studies, health economic planning and population screening, WHR or WC would probably be a better predictor of risk than BMI in order not to underestimate obesity as a public health problem. For self assessment and individual monitoring of progress, WC and even simple weighing, taken serially over time, would be enough.

In a review of eating behavior as a factor in the development of obesity, it was shown that increasingly large portion sizes of foods served, large variety of energy-dense foods, snacking and eating frequency, breakfast skipping, frequency of eating away from home including frequency of consuming fast food, restaurant food, and take-home foods, were shown to influence energy intake to a lesser or greater degree. It was concluded that understanding how these factors affect eating behavior and how negative eating behaviors could be changed positively, may provide the key to the prevention and management of obesity.