Trim and Fit
Encyclopedia
The Trim and Fit program was a weight loss
program that targeted child obesity in Singapore schools
between 1992 and 2007. Introduced by the Ministry of Education, schoolchildren under the program were educated on nutrition
, calorie
control, and participated in intense physical exercise
and activities.
and in some cases, reportedly diagnosed with eating disorders. The TAF program has since been replaced by the Holistic Health Framework (HHF) which includes all schoolchildren.
and National Physical Fitness Award
test (a precursor fitness test similar to Individual Physical Proficiency Test
for National Servicemen
). The country's population at that time was showing an increase in obesity that became associated with health problems and loss of manpower for male conscripts in National Service, which caused many conscripts to be deemed unfit for deployment into combat service.
The program was deemed by observers as an interventionist measure, requiring students who were deemed overweight to be subject to additional intense exercises or physical activities for at least one and a half hours per week. These activities were organised during recess or at times set aside before or after lessons at schools' discretion. They were also issued with "calorie cash" - food ration coupons from which no more than a certain number of calories may be purchased and consumed in a recess break. The amount of calorie cash was inversely proportional to the child's obesity rate. Children which exceeded the 160% of the ideal BMI were referred to the Health Promotion Board
for follow-up action.
A direct impact of the TAF program was a reduction of the obesity rate of schoolchildren from 14% to 9.8% by 2002. Worldwide public health experts have evaluated the TAF model for possible replication around the world.
A carrot-and-stick approach was adopted in putting pressure on schools to meet the targets of fitness and obesity set by the ministry. Cash incentives were awarded by the ministry to schools were that exceeded fitness targets and created new strategies to maintain students' obesity levels. Schools that failed had to face "consultation" sessions with ministry officials. Schools were also ranked annually based on how well targets were met at national level. Schools were given a wide discretion in determining how TAF was to be implemented, which resulted in some schools going so far as to implement apartheid-like segregation - for instance, where children were grouped to sit at normal and overweight tables during recess.
was emphasized in implementation of the program, which formed the bulk of criticism of the program as being insensitive and heavy-handed. Several TAF participants reported experiences of stigmatization
, teasing
, physiological stress and lower self-esteem as they found themselves being singled out for being obese. It was also quickly pointed out that the name of the program contained a negative connotation, as its reverse acronym was 'FAT'. Despite such criticism, education officials continually insisted that the program was not out to stigmatize overweight children.
In 2005, a National University of Singapore
study of 4,400 schoolgirls linked TAF to an increase in eating disorders. It found that girls were more likely to have poorer relationship with their parents and their female friends. The findings correlated to a Singapore General Hospital
study released a week earlier which found that instances of anorexia nervosa
and bulimia increased six-fold from 1994 to 2002. The Ministry of Education quickly rejected these findings; claiming TAF was not a factor in the increase in anorexia.
Two years later, in 2007, the Ministry of Education decided to replace TAF with the Holistic Health Framework (HHF). The HHF intended to ensure the fitness and health of all schoolchildren.
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
program that targeted child obesity in Singapore schools
Education in Singapore
Education in Singapore is managed by the Ministry of Education , which controls the development and administration of state schools receiving government funding, but also has an advisory and supervisory role in respect of private schools...
between 1992 and 2007. Introduced by the Ministry of Education, schoolchildren under the program were educated on nutrition
Nutrition
Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....
, calorie
Calorie
The calorie is a pre-SI metric unit of energy. It was first defined by Nicolas Clément in 1824 as a unit of heat, entering French and English dictionaries between 1841 and 1867. In most fields its use is archaic, having been replaced by the SI unit of energy, the joule...
control, and participated in intense physical exercise
Physical exercise
Physical exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, as well as for the purpose of...
and activities.
Overview
Overall, the program was successful in reducing the obesity rate amongst schoolchildren from 14% to 9.8% by 2002. However, it came at a psychological cost of participants being stigmatizedShunning
Shunning can be the act of social rejection, or mental rejection. Social rejection is when a person or group deliberately avoids association with, and habitually keeps away from an individual or group. This can be a formal decision by a group, or a less formal group action which will spread to all...
and in some cases, reportedly diagnosed with eating disorders. The TAF program has since been replaced by the Holistic Health Framework (HHF) which includes all schoolchildren.
The program
The TAF program was introduced into schools in 1992 as part of the National Healthy Lifestyle Campaign. It was a result of a 1991 review of the nation's health plan by a national committee. Students aged 9 to pre-tertiary education were required to undergo annual BMI measurementsBody mass index
The body mass index , or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing...
and National Physical Fitness Award
National Physical Fitness Award
The National Physical Fitness Award/Assessment Scheme is a test of physical fitness for Singaporeans as part of Singapore's Sports For Life programme...
test (a precursor fitness test similar to Individual Physical Proficiency Test
Individual physical proficiency test
The Individual Physical Proficiency Test is a test of physical fitness used by the Singapore Armed Forces, Singapore Police Force and Singapore Civil Defence Force to determine the level of fitness of their members....
for National Servicemen
National Service in Singapore
Conscription in Singapore, called National Service , requires all male Singaporean citizens and second-generation permanent residents who have reached the age of 18 to enrol in the military...
). The country's population at that time was showing an increase in obesity that became associated with health problems and loss of manpower for male conscripts in National Service, which caused many conscripts to be deemed unfit for deployment into combat service.
The program was deemed by observers as an interventionist measure, requiring students who were deemed overweight to be subject to additional intense exercises or physical activities for at least one and a half hours per week. These activities were organised during recess or at times set aside before or after lessons at schools' discretion. They were also issued with "calorie cash" - food ration coupons from which no more than a certain number of calories may be purchased and consumed in a recess break. The amount of calorie cash was inversely proportional to the child's obesity rate. Children which exceeded the 160% of the ideal BMI were referred to the Health Promotion Board
Health Promotion Board
The Health Promotion Board is a statutory board under the Ministry of Health of Singapore. It was established in 2001 to act as the main driver for national health promotion and disease prevention programmes, "with a vision to build a nation of healthy and happy people".HPB undertakes the...
for follow-up action.
A direct impact of the TAF program was a reduction of the obesity rate of schoolchildren from 14% to 9.8% by 2002. Worldwide public health experts have evaluated the TAF model for possible replication around the world.
A carrot-and-stick approach was adopted in putting pressure on schools to meet the targets of fitness and obesity set by the ministry. Cash incentives were awarded by the ministry to schools were that exceeded fitness targets and created new strategies to maintain students' obesity levels. Schools that failed had to face "consultation" sessions with ministry officials. Schools were also ranked annually based on how well targets were met at national level. Schools were given a wide discretion in determining how TAF was to be implemented, which resulted in some schools going so far as to implement apartheid-like segregation - for instance, where children were grouped to sit at normal and overweight tables during recess.
Psychological factors
Psychological motivation and peer pressurePeer pressure
Peer pressure refers to the influence exerted by a peer group in encouraging a person to change his or her attitudes, values, or behavior in order to conform to group norms. Social groups affected include membership groups, when the individual is "formally" a member , or a social clique...
was emphasized in implementation of the program, which formed the bulk of criticism of the program as being insensitive and heavy-handed. Several TAF participants reported experiences of stigmatization
Shunning
Shunning can be the act of social rejection, or mental rejection. Social rejection is when a person or group deliberately avoids association with, and habitually keeps away from an individual or group. This can be a formal decision by a group, or a less formal group action which will spread to all...
, teasing
Teasing
Teasing is a word with many meanings. In human interactions, teasing comes in two major forms, playful and hurtful. When teasing is playful and friendly, and especially when it is reciprocal, teasing can be regarded as flirting. People may be teased on such matters as their appearance, weight,...
, physiological stress and lower self-esteem as they found themselves being singled out for being obese. It was also quickly pointed out that the name of the program contained a negative connotation, as its reverse acronym was 'FAT'. Despite such criticism, education officials continually insisted that the program was not out to stigmatize overweight children.
In 2005, a National University of Singapore
National University of Singapore
The National University of Singapore is Singapore's oldest university. It is the largest university in the country in terms of student enrollment and curriculum offered....
study of 4,400 schoolgirls linked TAF to an increase in eating disorders. It found that girls were more likely to have poorer relationship with their parents and their female friends. The findings correlated to a Singapore General Hospital
Singapore General Hospital
The Singapore General Hospital is the largest and oldest hospital in Singapore, of which the foundation of its first building was laid in 1821....
study released a week earlier which found that instances of anorexia nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
and bulimia increased six-fold from 1994 to 2002. The Ministry of Education quickly rejected these findings; claiming TAF was not a factor in the increase in anorexia.
Two years later, in 2007, the Ministry of Education decided to replace TAF with the Holistic Health Framework (HHF). The HHF intended to ensure the fitness and health of all schoolchildren.