Insights Into Chinese Diets: A Social Marketing Formative Study

Introduction

More than 60% of all deaths worldwide are attributed to non-communicable diseases (NCD) (WHO, 2013) which are linked to four behavioural risk factors, namely tobacco use, prejudicial use of alcohol, unhealthy eating and lack of physical activity. Cardiovascular disease, cancer, diabetes and chronic respiratory diseases are four widely recognized NCDs (Demaio et al., 2014). The impact of NCDs extends beyond individuals to societies and governments who bear increased healthcare expenditure costs in addition to economic losses. Over the next 15 years, in middle and low-income countries the economic loss attributed to NCDs is estimated to amount to seven trillion dollars (Centers for Disease Control and Prevention, 2016). According to the World Health Organization (WHO, 2016) overweight and obesity indicated by raised body mass index (BMI) are a major risk factor for NCDs, including cardiovascular diseases (mainly heart disease and stroke), diabetes, musculoskeletal disorders (especially osteoarthritis – a highly disabling degenerative disease of the joints) and some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney and colon).

According to WHO (2016), obesity prevalence rates have more than doubled since 1980 and today an estimated 1.9 billion adults aged over 18 years are overweight placing an even greater proportion of the population at NCD risk. Of these, 600 million are obese (WHO, 2016). Overweight and obesity also extend to children with statistics indicating that 41 million children aged 5 years or less are overweight and obese (WHO, 2016). China, the context chosen for the study presented in this chapter, has an estimated population of 1.3 billion people and current WHO estimates indicate that 38.7% of adult Chinese men are overweight (WHO, 2016). Obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period, resulting in the accumulation of excess body fat.

Obesity is considered by WHO to be entirely preventable. However, it is important to acknowledge that obesity is a multi-factorial, wicked problem which requires adopting a wider focus that extends beyond the individuals who have accumulated excess body fat. There is an increasing understanding that combatting obesity requires multi-sector support ensuring that more conducive environments are built to encourage physical activity (Pang et al., 2017), attention is directed to product formulation and serving sizes through policy frameworks and more. The many factors contributing to obesity are best explained by the Foresight Obesity Map which displays factors contributing directly or indirectly. As a complex, interrelated web, together they prey on our inherent human vulnerabilities to gain weight. Energy imbalance is pictured at the core to highlight the process by which obesity occurs over time and more than 100 factors are organized into seven cross cutting themes. Food environment, biology, the activity environment, societal influences, individual psychology, physical activity and food consumption are all recognized as contributing to obesity.

A wide range of disparate fields and disciplines seek to deliver behavioural change. Examples of “behaviour change fields” include (but are not limited to) education, training, enforcement, infrastructure, technology, urban planning, community development, health promotion and social marketing (Tapp & Rundle-Thiele, 2016). While each discipline has evolved with its own unique theories, tools and techniques, there are also similarities between fields. Contemporary social marketing research and practice are characterized by broad thinking that ensures research extends beyond “individualistic” parameters and draws from a wider behavioural ecological system framework to enhance understanding of social markets (Brennan et al., 2016). In contrast to other behavioural change fields, social marketers seek to initially identify barriers preventing the desired behaviour from being undertaken. Within structural and social constraints identified social marketers then seek to understand how they can move and motivate change at the individual, social and built environment level based on available budget envelopes and timeframes.