Big in Taiwan

In the gym at Da Li Elementary School in Taipei, a session of compulsory aerobics

By Polly Hope

In the graduation hall of Da Li Elementary School in Taipei, a group of around 30 overweight eleven-year-olds jump around to the synthesised sounds of Chinese group-aerobics music. But although the music and the faces make it a cheerful scene, these children are living examples of a major threat to health across Asia: childhood obesity.

More than one in five secondary-school-age children in Taiwan are now overweight, and the government is growing concerned about what that means for the nation's health - and its future health budget. The Ministry of Education has now launched a nationwide campaign to slim down heavier public school pupils.

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All students are regularly weighed and measured and their data kept on file, but now those who're overweight for their height and age are being encouraged to do extra 30-minute sessions of aerobics, two or three times a week. They also take classroom-based lessons about food groups and nutrition, livened up with rhymes, cartoons and sloganeering. So far the scheme is still being tested, but we met some children who'd already lost weight by just a term's worth of the extra PE.

Taiwan is proud of its public health-insurance system, which means that anyone can enjoy high-standard care in its modern hospitals, and that the vast majority of the island's 21 million people have medical insurance. But if these overweight children don't lose weight before they grow up, they may suffer from some of Taiwan's biggest health risks - diabetes, high blood pressure, strokes or heart attacks - much earlier in life than their parents did.

Dr Philip Yu-An Ding: 'we're very concerned'

Dr Philip Ding, chief of cardiology at the Veteran's General Hospital, a gleaming landmark in Taipei's northern suburbs, notes that while he used to treat heart-attack patients in their 50s and 60s, he's now taking care of some aged under 40 - and obesity is largely to blame. "We are really worried about this problem", he notes: "we have to warn people now, not to shock them, but so they can change their habits before it's too late."

To try and nip child obesity in the bud, Dr Chwang Leh-Chii, who's head nutritionist at the same hospital, runs special counselling sessions for overweight children and their parents. Responsible for the hospital's own food (on wards and in canteens), as well as pushing for better public policy on weight and diet, she stresses that dieting alone won't solve the problem. Traditional attitudes, a culture of punishingly heavy study for exams, and even town planning have to change too.

Dr Chwang Leh-Chii believes that public spaces are as important as private diet

When Dr Chwang studied a cohort of Taipei's 11 year-olds, she found that over 20% of boys and 13% of girls were overweight. (Various researchers told us that Taiwanese parents are still more tolerant of boys' excesses: they see academic achievement as much more important for a boy than their looks or their athletic prowess.)

Obesity rates are rising all over the world, and the reason's the same everywhere: too many calories and not enough exercise. But Taiwan has particular problems with both parts of that equation.

The island's incredible population density, and its high-rise, concrete cities, don't leave much room for physical exercise. Flats are small, few children have back yards to play in, and there aren't enough public parks or facilities. "I think the exercise classes are a good idea in the short term, but kids might feel stigmatised", says Dr Chwang. "We really need children to naturally build up a good diet and exercise habit, with better facilities near where they live, so their parents can take them there to play."

While Taiwanese children replace the farm work and long walks of their parents' generation with Nintendo, soap operas and the Internet, they're also eating a completely different diet. Dr Chwang is particularly worried by the sugary fizzy drinks which now wash down burgers as well as noodles - but even Chinese green tea is now sold ready-sweetened in many supermarkets.

Presenter Julian Pettifer shares a plate of noodles with cookery expert Angela Chen

Western-style fast foods are edging out traditions of home cooking - not just because young people love their image and marketing, but also because people here are so busy. "In most families, both parents now work", we were told by Angela Chen, a cookery expert whose mother, Fu Pei-Mei, was one of Taiwan's most famous TV chefs for decades. "So, for instance, most of my friends don't cook - they might just visit their mother once a week and bring back a pot of chicken curry."

But one legacy of the traditional Chinese preoccupation with food survives: the lingering suspicion that a fat child is a healthy, thriving child. Many parents report that however hard they try to control their sons' and daughters' eating habits, grandparents keep on stuffing them full of the choicest morsels.

Prof. Sun with his famous 'door of cartoons' at Taipei University

Professor Sun Chung-Hsing, a sociologist at National Taiwan University, points out that this attitude is deeply rooted in Chinese history and culture. Historically China has been afflicted with so many floods, droughts and famines that too much food has only ever been a dream. "My own father joined the army in the 1930s not out of patriotism, but simply because in the army you got fed! When you look at traditional images of emperors, of the Buddha, and of our local deities, you can see many of them have this plump, fat figure. It was considered a mark of good fortune, an honour."

And there's another aspect of Taiwanese life to frustrate a dieter's best intentions: the sheer number of eating and drinking places around. No city block is without some sort of 'fast food', be it plastic fast-food palaces, fried noodle stalls, 'home-style' restaurants, which can serve you up three or four plates of Chinese food for less £3 - or the sprawling 'food courts' in the basements of department stores, offering everything from Danish pastries to Indian samosas. It's normal here to eat out four or five nights a week - and inevitably, diners eating restaurant or street food can't control how much fat, sugar or salt they're taking in.

Will the Ministry's message help these kids avoid a fat future?

In its new lesson plans about food and exercise, the Education Ministry exhorts children to remember good eating habits with a rhyme. It may not translate too elegantly into English, but the message is clear: "I'm a smart little kid, who loves all the five food groups. When I'm thirsty, I drink plain water - when I grow up, I'll have health and a great future."

Also in this edition of Crossing Continents: a heated debate on the touchy subject of Taiwanese identity. Taiwan's people may eat, speak and act Chinese, but do a century of local rule and now modern democracy mean they have developed a culture and outlook of their own?