Lan Qing Lin drops into a fighting pose and throws punches in time to the instructor’s rhythm. Battling a post-pregnancy tendency to gain weight, the office worker spends just over an hour a week at a BodyCombat class, working through a whirl of boxing stances in time to music.
“After a long day, I can punch out all the negative stuff in my mind,” says Lin, 36, who works in the corporate affairs department at Far East, a Singapore-based property developer. “After this, when I come home, I can be a nice wife and daughter-in law. It’s me-time for a working mum.”
Last year, Singapore’s health ministry declared “ war on diabetes”. As part of a broader push to curb the rise of the condition, Singapore authorities have encouraged employers and office landlords to host fitness sessions.
About 11 per cent of adults in Singapore have diabetes, according to official figures, one of the highest proportions in the world. The government estimates that, if left unchecked, about a quarter of Singapore residents will have diabetes by 2050. Lin does not have diabetes herself, though her father-in-law does. She exercises because, like many Singaporeans, she has a sweet tooth. “We all love cakes,” she says.
Behind Singapore’s vulnerability to diabetes is its extraordinary transition over five decades from a developing nation to Southeast Asia’s most prosperous country. The calorie-rich diet that fuelled labourers on the docks, or workers on the farmland that once dotted Singapore, makes less sense for the current generation of city-dwelling, white-collar workers. Singapore’s lifestyle has changed but the dietary preferences of its people — for bowls of white rice, fried noodles and deep-fried breads — has not.
Added to that is a genetic propensity to develop the condition; people in Southeast Asia become diabetic at a lower body mass index than Europeans, according to the World Health Organization. Rising obesity has contributed to the wider prevalence of diabetes in the country. The proportion of obese Singaporeans rose from around 7 per cent to nearly 11 per cent between 2004 and 2010, according to government figures. Singapore’s Malay and Indian minorities were more prone to being overweight than the Chinese ethnic majority, according to the data.
That means Singapore offers a glimpse of Asia’s future. Its approach to tackling diabetes provides clues for its giant neighbours, China and India, where the disease is also on the rise as incomes grow and populations shift rapidly from the countryside to cities.
In a country known for its paternalistic style of government, a combination of nudging and admonishment has achieved mixed results. “Educating people will only go so far,” says Yoong Kang Zee, chief executive of Singapore’s Health Promotion Board. “We just need to restructure the environment they are living in, so there is a new set of norms.”
One example of shifting norms has been the claiming of public space — from parks to office atria and shopping malls — for fitness programmes such as Zumba. “We will pay a trainer to go to the park,” Zee says. “There’s no marketing, just a trainer and a boom-box and see what happens. The first day a few curious aunties start dancing. It’s a handful by the second week. After three months it’s 60-100 people.”
Authorities here pay close attention to the psychology of exercise, noting that small companies tend to be more enthusiastic about corporate walking challenges, for example, as the social ties are stronger. Larger companies have been able to harness similar social bonds by organising internal teams for sporting activities.
At the BodyCombat session, Lin says the classes have encouraged her to broaden her circle of friends. “This is free for staff, and it’s quite good bonding time for me to meet colleagues from different departments,” she says. “We have now made friends and help each other at work.”
The government’s public health agency has targeted office workers with free early-morning workouts at fitness studios across the city. Called Sunrise in the City, this programme has now signed up 8,000 subscribers, up from 200 participants when it launched in 2013.
“When I look at how many people of different age groups there are out exercising [in Singapore] and compare that to the UK, it is miles apart,” says Julian Sham, Asia-Pacific lead for health at Accenture, the consultants, pointing out that Singaporeans are exercising more.
Singapore’s approach has emphasised flexibility, offering health screenings at car service centres as a way of reaching taxi drivers, who have traditionally used such service breaks as an opportunity to eat a curry puff, the local version of a meat pie. These screenings were followed up with one-to-one health coaching.
Educating people will only go so far. We need to restructure their environment
A pilot screening programme, also among taxi drivers, generated significant health improvements, the government says, with about half of participants who had unhealthy results at their screening seeing at least one improvement in a health indicator — such as blood pressure, blood sugar levels or cholesterol — a year later.
Efforts to encourage Singaporeans to change their diet have been less effective, however. Office workers tend to go out for their lunch breaks, heading to hawker centres, or markets, where stall-holders serve up traditional favourites such as chicken rice — a dish of roasted or poached chicken with rice cooked in the stock — or laksa, a spicy noodle soup.
Hawker stalls are a central part of Singapore’s social make-up, a place where all strata of society dine together and even the poorest can get a filling meal. “It’s fair to say that we have an attachment to our food,” Zee says. “It’s part of our identity.”
Authorities in Singapore have encouraged food outlets to offer lower-calorie options, to use healthier blends of oils for cooking, and to include whole grains, fruit and vegetables. Brown rice is now on the menu at bus drivers’ canteens. The emphasis has been on making small dietary changes. “We’re not going to get people to eat salad. We can’t change your char kway teow,” says the health agency chief, referring to a popular dish of fried ricecake strips. “But we can change the oil that’s used for your char kway teow.”