This photo taken on July 22, 2016 shows customers queuing in front of the Hong Kong Soya Sauce Chicken Rice and Noodle stall in Singapore. (ROSLAN RAHMAN / AFP)
SINGAPORE - Getting Singaporeans to eat healthily has been an uphill battle that the Health Promotion Board (HPB) has been fighting for years.
It has been working to introduce low-calorie menu options in restaurants, canteens and foodcourts since 2014, for example. An earlier attempt to tackle hawker food failed to gain traction. Before that, the focus was on labelling healthier products in supermarkets.
The latest effort to get Singaporeans to chow down smarter was announced on Sunday, and aims to have four in 10 hawker stalls selling at least one healthier dish by 2019. If dishes at a stall meet the calorie limit, they get a label marking them as the healthier option.
Taking the battle of the bulge to eating places makes sense, given findings from the 2010 National Nutrition Survey, which found that six in 10 people eat out at least four times a week. Some even take both lunch and dinner outside their homes on a regular basis.
The HPB has kicked off by identifying 63 common hawker dishes which are usually under 500 calories - including mee soto, century egg porridge and masala thosai. These are healthier than the 700-800-calorie dishes typically on offer.
The need to promote healthier options has assumed a new urgency, with the numbers showing that Singaporeans are not eating well enough in terms of food better for their health.
A recent HPB study found that the median body mass index (BMI) has increased from 22.23 to 23.15 over the past 15 years.
In other words, Singaporeans today are on average 3kg heavier than they were in 2001.
Overall obesity rates went up by 0.7 percentage point every year from 2004 to 2010, reaching around 11 per cent in 2010.
Calorific consumption has also risen. In 1998, only a third of the population exceeded their daily recommended intake (34 per cent). In 2010, just over a third did not (41 per cent).
A look at what is helping to drive the HPB's latest efforts to get Singaporeans to mind what they munch, raises the question: Why are people eating so badly?
A key factor is that many existing food choices out there are not very healthy to begin with, and it can cost more to ask for a healthier version. Brown rice, for example, costs more than white rice. A bowl of salad can cost two to three times the average hawker centre meal.
In terms of eating dishes that are nutritious, wherever they are consumed, home-cooked meals are ideal. But how feasible is this for the majority of time-pressed working adults, especially if they are the ones doing the cooking?
The fact is that hawker food is always going to be the most affordable and practical option for most people - even if it is far from healthy.
The latest move in the HPB's Healthier Dining Programme, involving attempting to identify
hawker dishes that are under 500 calories, does not solve the fundamental problem. There are few affordable alternatives to hawker food, so no matter how unhealthy it is, people will not stop eating it.
Perhaps it is time to start looking at how to make healthy food both affordable and low-cost.
Convenience stalls offer ready-to-eat meals, but they are often high-calorie options such as butter chicken or nasi lemak. Why can't they create healthy pre-packed foods as well?
NASI WITHOUT THE 'LEMAK'?
Then, there is the problem of taste. For many people, healthier options such as brown rice and wholegrains take some getting used to.
At the same time, they expect local hawker favourites to taste a certain way - no matter how many calories they might contain. After all, what is nasi lemak without the "lemak"?
This is part of the reason why the HPB's original Healthier Hawker Food Programme failed to take off.
First launched in April 2011, the scheme aimed to give diners healthier options by getting hawkers to use healthier ingredients - often with less oil and less salt.
However, hawkers baulked at having to tweak their time-honoured recipes. Some felt that the difference in taste might scare off regular customers. Others simply found that the recommended ingredients - such as healthier oil blends - were too much of a hassle to purchase.
"It was very heavy going," recalled HPB chief executive Zee Yoong Kang. "It was very high-risk for many of these hawkers, who had to change recipes that had been developed over decades."
The scheme gradually lapsed, with many hawkers reverting to their old ways.
In any case, the health payoff must have been marginal for many foods. A starchy plate of black carrot cake can hardly be considered a "healthier choice", even if it was fried with healthier oil.
This is not to say that there is no place for healthier food in hawker centres and coffee shops.
Stalls can start by putting more nutritious brown rice on the menu, or using a mixture of white and brown rice as the default, to appeal to pickier tastebuds.
There is also the option of substituting wholegrains into noodle dishes by cooking with wholemeal noodles instead.
The HPB has already started funding local firms to develop such products that taste no different from the original.
While it is still early days, the outlook seems promising. If healthy meals taste as good as what Singaporeans are used to eating, and cost the same, there is no reason diners will not bite.
Brown rice still remains more expensive than white rice, but the gap is closing as demand rises, Mr Zee said.
This is similar to what happened with wholemeal bread and white bread about a decade ago. These days, the price difference between both types is negligible.
Beyond hawker centres, the fight to reduce the bulge is also taking place in schools. All school canteens now have to serve healthier meals with plenty of fruit and vegetables. Deep-fried and processed foods, such as nuggets or hotdogs, are not allowed. Perhaps starting young and building that acquired taste is the key.
By the time children of this generation are old enough to make decisions on their own, choosing the healthier option might just be a reflex.
TOO MANY CHOICES
Lastly, there is the problem of choice. As far-fetched as it sounds, having more food to choose from actually makes a person eat more.
This is bad news for Singaporeans, who cannot traverse a neighbourhood mall without passing shops selling everything from curry puffs to cream buns.
The science behind this is a phenomenon known as "sensory specific satiety", when a person gets "desensitised" to a certain taste but quickly regains his appetite once he is served something new.
"If you repeatedly eat the same food, you get tired of it," said Professor Jeyakumar Henry, who heads the Clinical Nutrition Research Centre. "But in Singapore, we have the fortune of having increasing access to diverse foods, and food variety always increases food intake."
In other words, Singaporeans are eating so much unhealthy food simply because they can. Put in a different way - there really is always room for dessert.
Countries grappling with obese populations have tried different ways to tackle the problem of unhealthy eating.
In Mexico, where more than 70 per cent of people are overweight or obese, a 10 per cent surcharge has been slapped on sugary drinks since 2014.
And in Japan - which has one of the lowest obesity rates in the world - waistlines of adults aged between 40 and 74 are measured annually. People are sent for counselling if they bust prescribed limits.
Here, there has been the One Million Kg Challenge, where Singaporeans stood to win prizes if they lost weight or managed not to put on any extra.
Such incentives or penalties may be effective in changing behaviour in the short term, but they are no substitute for intrinsic motivation.
Once a campaign ends, how many people put back the kilos they have lost? Place a tax on sugary drinks, and people turn to desserts to satisfy their sweet tooth instead.
In other words, people need to develop the self-discipline to look at a dessert menu - or a plate of deep-fried calamari - and tell themselves: "Not today."
Policies can be formulated to nudge people into making the healthy decisions, but it is ultimately up to individuals to pull their weight.