THE EATING HABITS OF FILIPINOS:

CARBOHYDRATES AS A MAJOR CAUSE

OF DIABETES

By: Dwight B. Perez, MBA, Ph.D. (ABD)

2019
 Chapter I
INTRODUCTION

THE PROBLEM AND ITS BACKGROUND

INTRODUCTION

Diabetes is a chronic disease and is increasing in both prevalence and incidence worldwide.

Diabetes exerts a major impact in third-world countries, particularly in the Philippines. It is said

that Asia will see the greatest increase in the number of people with diabetes by 2025. This

increase in the burden of chronic diseases in Asia will significantly affect nations' respective

health care systems, both acutely and chronically

The food we eat is important for mankind because our health will depend upon it

Nevertheless, many people neglected to eat healthy foods and this resulted to diseases and even

costing human mortality. As such, in this study, the eating habits of Filipinos would be explored.

In a study by Al-Rethaiaa et. al., (2010), the eating habits of college students in the Kingdom of

Saudi Arabia had changed because of the rapid socio-cultural developments associated with

western foods. These changes resulted to obesity among the Saudi population and the study

conducted a survey among college students there in order to determine the prevalence of

overweight in relation to their eating habits (Al-Rethaiaa et. al., 2010).

Moreover, in a local study conducted by Lorenzo et. al., (2013) among high school students

from Pasig Catholic College in the Philippines indicated the presence of abnormal eating habits

and attitudes among the majority of respondents. As Lorenzo et. al. (2013) wrote:
 The prevalence of abnormal eating attitudes according to the EAT
scores was 14.5±3.2% among males and 15.0±3.5% among females,
comparable to the 7-22% found in Western countries. There was a
weak correlation between the EAT scores and BMI (r=0.180,
p=0.01), and between the EAT scores and Beck’s Depression
Inventory (r=0.187, p=0.01) (Lorenzo et. al. (2013).

In another study Deshpande (2009), stated that eating habits that are poor can result to health

and economic implications. Many students established their eating preferences early but as they

grow to become adolescence, their independence in their college days becomes important and

their food selection also changed. This is the basis of the Health Belief Model (HBM).

(Deshpande, 2009). Thus, a study was conducted among 194 students utilizing the Health Belief

Model (HBM). He wrote:

Poor eating habits are an important public health issue that has large
health and economic implications. Many food preferences are
established early, but because people make more and more
independent eating decisions as they move through adolescence, the
transition to independent living during the university days is an
important event (Deshpande, 2009).

The study concluded that the data strongly confirmed the Health Belief Model (HBM)

utilized in the study. Thus, this study is being conducted in order to improve the health

conditions of Filipinos through good eating habits.

BACKGROUND OF THE STUDY

The Health Belief Model (HBM) is a psychological model that attempts to explain and predict

health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The HBM

is based on the understanding that a person will take a health-related action (i.e., change to eating

healthy habits) if that person:

 1. thinks that a bad health condition such as unhealthy eating habits can be avoided,

2. has an optimistic expectation that by taking a suggested action, he/she will avoid a bad

health condition, and

3. believes that he/she can be successful in following a suggested health action.

The HBM is composed of four constructs which represents the perceived threat and net

benefits. These are: perceived susceptibility, perceived severity, perceived benefits, and

perceived barriers. These concepts were suggested in order to account for people's "readiness to

act." (Glanz et. al., 1997). An added concept, cues to action, would activate that readiness and

stimulate overt behavior. A recent addition to the HBM is the concept of self-efficacy, or one's

confidence in the ability to successfully perform an action.

THEORETICAL FRAMEWORK

Based on the review of related literature and related studies, the study choose the theoretical

framework of Deshpande (2009), and Glanz et. al. (2002) which utilized the Health Benefit

Model. The concept, definition, and application are summarized as adapted from Glanz et. al.

(2002).

Concept Definition Application

Perceived One's opinion of chances of Define population(s) at risk, risk levels;

Susceptibility getting a condition personalize risk based on a person's features
or behavior; heighten perceived
susceptibility if too low.

Perceived One's opinion of how serious a Specify consequences of the risk and the
Severity condition and its consequences condition
are
 Perceived One's belief in the efficacy of Define action to take; how, where, when;
Benefits the advised action to reduce clarify the positive effects to be expected.
risk or seriousness of impact

Perceived One's opinion of the tangible Identify and reduce barriers through
Barriers and psychological costs of the reassurance, incentives, assistance.
advised action

Cues to Action Strategies to activate Provide how-to information, promote

"readiness" awareness, reminders.

Self-Efficacy Confidence in one's ability to Provide training, guidance in performing

take action action.

Source: “Theory at a Glance: A Guide for Health Promotion Practice" (1997).

CONCEPTUAL FRAMEWORK

The study of Deshpande (2009) suggested that eating habits that are poor can result to health

and economic implications. Most students established their eating preferences early but as they

grow to become adolescence. The study of (Tzu-Hsing Wen, Wei-Ling Tchong, and Gregory S.

Ching, 2015) about eating habits of college students in Taiwan, the study concluded that the

students eating habits were affected by their demographic backgrounds.

Furthermore, the study of Al-Rethaiaa et. al., (2010) discussed the eating habits of college

students in the Kingdom of Saudi Arabia. He further not that eating habits had changed because

of the rapid socio-cultural developments associated with western foods. The study of Sales

(1988) evaluated the results of a survey conducted among 1,000 adolescents from 19 public and

private high schools in the city of Manila. The results of the study indicated that male and female

respondents had different food preferences.

 This study conceptually aims to examine the role of food especially carbohydrates as a

major cause of diabetes in the Philippines.

STATEMENT OF THE PROBLEM

In the main this study aims to examine the eating habits of Filipinos particularly

carbohydrates as a cause of diabetes.

SIGNIFICANCE OF THE STUDY

This study is significant because it would contribute further to researches or studies that

concerns the eating habits in the Philippines. This study can be utilized by health and nutrition

professionals for gaining more insights as to how people eating habits will be improved.

Furthermore, teachers and education professionals can be able to utilized this study to educate

their student in terms of their nutrition and health. Finally, future researchers may also benefit

from this study in the aspect of eating habits and can help them in their studies.

HYPOTHESIS

The eating habits of Filipinos which is based on carbohydrates is the major cause of diabetes

in the Philippines.

METHODOLOGY

This study utilized primary and secondary data or sources in order to prove its hypothesis.

SCOPE AND DELIMITATION

This section aims to provide the possible scope and limitations as follows:

1. The scope of the study would be the eating habits in the Philippines particularly in the
consumption of carbohydrates as a major cause of diabetes.
DEFINITION OF TERMS (OPERATIONAL)

1. Demographic profile. It is operationally defined as the respondents’ background

in terms of age, gender, year level, and rank in the family.

2. Eating habits. It is operationally defined as the respondents’ choice of food for

for snacks, breakfast, lunch, and breakfast.

3. Proposed Health Program. It is operationally defined as a proposal that will be

recommended based upon the outcome and implications of this study.

 Chapter II

REVIEW OF RELATED LITERATURE AND STUDIES

RELATED LITERATURE

Foreign Studies

According to a study by Moreno et. al., 2008), the major gaps that were recognized in terms

of eating habits were the lack of harmonized and comparable data on food intake and lack of

comprehension regarding the role of eating attitudes. Moreover, food choices, food preferences,

and physical activity were also variables that were considered in the study and recommended

effective intervention methodologies (Moreno et. al., 2008). He wrote:

The main gaps identified were: lack of harmonised and comparable

data on food intake; lack of understanding regarding the role of
eating attitudes, food choices and food preferences; lack of
harmonised and comparable data on levels and patterns of physical
activity and physical fitness; lack of comparable data about obesity
prevalence and body composition; lack of comparable data about
micronutrient and immunological status; and lack of effective
intervention methodologies for healthier lifestyles (Moreno et. al,
2008).

In another study ((Tzu-Hsing Wen, Wei-Ling Tchong, and Gregory S. Ching, 2015) about

eating habits of college students in Taiwan, the study concluded that the students eating habits

were affected by their demographic backgrounds. They wrote:

Results show that the students’ eating habits are affected by their
various background demographics, such as gender, year level, study
session, and personality. More importantly, results also show that
the Applied Foreign Language students scored highest on the
personality trait openness. Further additional implications on the
Big Five Personality are also given. In sum, the current study
provides the opportunity of opening up discussions explaining;
 perhaps not in whole, but in part why students act the way they are
today (Tzu-Hsing Wen, Wei-Ling Tchong, and Gregory S. Ching,
2015).
Thus, the study suggests that demographic factors are important in eating habits among

college students in Taiwan and this can also be possible in other parts of the globe.

The study of Sheehan (2017) observed that students learn better when they are well-

nourished and this improves their grades, alertness, memory and other school-related factors.

Sheehan (2017) explains:

Research shows students learn better when they’re well nourished.

Healthy eating has been linked to higher grades, better memory,
more alertness, faster information processing and improved health
leading to better school attendance, according to registered dietitian
Elisa Zied, author of “Feed Your Family Right.” Conversely,
unhealthy eating habits can negatively affect learning. Researchers
have studied a number of areas related to eating and learning
(Sheehan, 2017).
As such, concluded that unhealthy habits can affect learning negatively as researchers

confirmed a positive relationship between learning and eating (Sheehan, 2017).

HBM was applied to the study of eating habits among medical students composing of young

adults from 18 to 25 years of age (Ah-Haj et. al., 2015) in Sudan. The study concluded that a

majority of students have healthy eating habits and confirmed the Health Benefit Model. As he

wrote:

In conclusion, the majority of the students have healthy eating

habit and most of them have normal body weight. In spite of the
presence of educational grade deference related to some aspect of
eating habits, the students eating habits score is not influencing by
educational grade, and by socio-demographic variables (Ah-Haj et.
al., 2015).
The Health Benefit Model composition of four constructs represents the perceived threat and

net benefits. These are: perceived susceptibility, perceived severity, perceived benefits, and

perceived barriers. These concepts were suggested in order to account for people's "readiness to
act." (Glanz et. al., 1997). An added concept, cues to action, would activate that readiness and

stimulate overt behavior. A recent addition to the HBM is the concept of self-efficacy, or one's

confidence in the ability to successfully perform an action (Glanz et. al., 1997). This was also

supported by the study of Eisen et.al. (1992). Rosenstock (1974) also contributed to this

theoretical framework in his crucial work entitled: Historical Origins of the Health Belief Model

(Rosentock, 1974). The work of Becker (1974) supported personal behavior as a factor to

support health habits. This study confirmed the HBM framework as a reliable tool for studies in

health-related concerns.

In terms of the self-efficacy component of the Health Belief Model, Skinner & Menon (2005)

concluded in his study that self-efficacy was a significant factor to consider in the framework.

On the one hand, perceived susceptibility as a theoretical structure of HBM was confirmed as

significant in a study by Fishbein & Ajzhen (1975). Moreover, perceived benefits as defined as

one's belief in the efficacy of the advised action to reduce risk or seriousness of impact

had also been emphasized and confirmed by Griffin (2012). Perceived severity as a structural

component had been defined by Bish & Michie (2010) as one’s opinion of how serious a

condition and its consequences are. Their study confirmed the significance of perceived severity

as an important component of HBM.

Local Studies

In a study by Esguerra (2007), the eating habits of Filipino children had been changing as

they consume more intakes of junk foods and avoided vegetables. This resulted from the

proliferation of fast food chains and easy to prepare foods which had hampered their health. As

Esguerra (2007) wrote:

 Filipino children’s eating habits has been changing as they eat more
empty calories and no longer eat vegetables, the National Nutrition
Council (NNC) says in a study. They have been eating less than half
of the required consumption of vegetables as they resort to eating
hamburgers, potato fries and other easy-to-prepare food froerm fast
food chains. Sample population of children was taken from
metropolitan Manila and Cagayan de Oro City in the south, the study
said (Esguerra, 2007).
Thus, this just supported the previous studies about eating habits influenced by socio-cultural

factors. Moreover, according to a recent study by Acampado & Valenzuela (2018), one in every

three students had below average to poor dietary habits among the student population they

studied.

About one of every three students in each year level had below-
average to poor dietary habits, meaning they seldom eat proper types
of food. Findings of this study indicate the need for an intervention
that will effectively increase regular PA and ensure proper food
intake in the student population (Acampado & Valenzuela, 2018).

The results of this study indicated a need for an intervention that will effectively take care of

the needs of the student population.

RELATED STUDIES

Foreign Studies

. As mentioned earlier in the introduction, the study of Al-Rethaiaa et. al., (2010) discussed

the eating habits of college students in the Kingdom of Saudi Arabia. He further not that eating

habits had changed because of the rapid socio-cultural developments associated with western

foods. These changes resulted to obesity among the Saudi population and the study conducted a

survey among college students there in order to determine the prevalence of overweight in

relation to their eating habits (Al-Rethaiaa et. al., 2010).

 On the other hand, the study of Deshpande (2009) suggested that eating habits that are poor

can result to health and economic implications. Most students established their eating

preferences early but as they grow to become adolescence, their independence in their college

days becomes important and their food selection also changed.

Based on the premised above, the Health Belief Model (HBM) was utilized in this study

(Deshpande, 2009). He wrote:

To study the phenomenon of food selection, the heath belief model

was applied to predict the likelihood of healthy eating among
university students. Structural equation modeling was used to
investigate the validity of the health belief model (HBM) among 194
students, followed by gender-based analyses. The data strongly
supported the HBM. Social change campaign implications are
discussed (Deshpande, 2009).

Thus, Deshpande (2009) concluded that the data strongly confirmed the Health Belief Model

(HBM) utilized in the study.

Local Studies

Furthermore, in a local study conducted by Lorenzo et. al., (2013) among high school

students from Pasig Catholic College in the Philippines, The study indicated the presence of

abnormal eating habits and attitudes among the majority of respondents. As Lorenzo et. al.

(2013) wrote:

.The results indicate the presence of abnormal eating attitudes

among Filipino high school students from Pasig Catholic College,
which suggests that further study of eating disorders and their
associated risks is warranted (Lorenzo et.al., 2013).

Moreover, the study of Teves & Narciso (2017) conducted among high school students in

Mabinay, Negros Oriental studied factors such as demographic profile; extent of eating behavior

; healthy food perceptions; academic performance; and nutritional status. The study also

supported the contention that healthy foods can result to good learning and growth. The
perception of students also can affect their food selection and this influences their nutritional and

academic performance (Teves & Narciso, 2017). They wrote:

Maximization of growth and learning among students requires the

support of good nutrition. Students’ food perception affects their
food selection decision which in turn influences their nutritional
status and academic performance. Generally, students choose food
to eat based on taste, cost, nutritional benefits, convenience and
pleasure, among others. As they grow up and leave their family to
attend higher studies, it is a critical period for them because they
make their own food decisions that can impact eating behaviors. In
this study (Teves & Narciso, 2017).

Nevertheless, this study supported the view that there is a need for intervention to improve

the eating habits of college students in order to improve their health as this would affect their

academic performance.

The study of Sales (1988) evaluated the results of a survey conducted among 1,000

adolescents from 19 public and private high schools in the city of Manila. The results of the

study indicated that male and female respondents had different food preferences. Moreover,

respondents from the private schools had preference for more expensive foods because they had

more daily allowances compared to their public counterparts.

There were differences also in the food preferences between private

and public school adolescents. The likes of the private school
adolescents were definitely more expensive than those liked by the
public school students. The difference in their preferences could be
attributed to their daily allowance. Public school teenagers liked
inexpensive and satisfying food. The private school students
disliked beverages basically sold by ambulant vendors. Male
adolescents preferred foods associated with being masculine, young
and classy (Sales, 1988).

Thus, in the Philippine setting, the eating habits of Filipino students were similar to their

foreign counterparts in terms of the factors proposed by the Health Benefit Model (HBM).
 As this study would examine the eating habits of Filipinos, the next chapter discuss the

contribution of carbohydrates as a cause diabetes in the Philippines.

 Chapter III

FINDINGS AND CONCLUSION

Based upon statistics coming from the Philippines Statistics Authority, the leading cause of

death in the Philippines as of 2016 for both sexes were Ischaemic heart diseases (12.7%),

Neoplasms (10.4%), Pneumonia (9.9%), Cerebrosvascular diseases (9.8%), Hypertensive

diseases (5.7%), Diabetes Mellitus (5.7%), Other heart diseases (4.9%), Respiratory tuberculosis

(4.2%), Chronic lower respiratory infections (4.2%), Remainder of diseases of the genitourinary

system (3.4%), Other causes of death (29%). As such, it can be seen that Diabetes Mellitus

ranked number six (6) among the leading causes of death. Diabetes Mellitus can also cause

complications and it can be kidney diseases or heart diseases. This makes it more deadly than

any other diseases.

Table 1. Top 10 Leading Causes of Death by Sex, Philippines: 2016

BOTH SEXES
Total Percent
All causes of death 582,183 100.0
Ischaemic heart diseases 74,134 12.7
Neoplasms 60,470 10.4
Pneumonia 57,809 9.9
Cerebrosvascular diseases 56,938 9.8
Hypertensive diseases 33,452 5.7
Diabetes Mellitus 33,295 5.7
Other heart diseases 28,641 4.9
Respiratory tuberculosis 24,462 4.2
 Chronic lower respiratory infections 24,365 4.2
Remainder of diseases of the genitourinary system 19,759 3.4
Other causes of death 168,858 29.0

MALE
Male Percent
All causes of death 334,678 100.0
Ischaemic heart diseases 44,472 13.3
Cerebrosvascular diseases 31,675 9.5
Neoplasms 29,516 8.8
Pneumonia 28,993 8.7
Hypertensive diseases 17,901 5.3
Respiratory tuberculosis 17,288 5.2
Chronic lower respiratory infections 17,049 5.1
Diabetes Mellitus 16,384 4.9
Other heart diseases 14,992 4.5
Assault 13,662 4.1
Other causes of death 102,746 30.7

FEMALE
Female Percent
All causes of death 247,505 100.0
Neoplasms 30,954 12.5
Ischaemic heart diseases 29,662 12.0
Pneumonia 28,816 11.6
Cerebrosvascular diseases 25,263 10.2
Diabetes Mellitus 16,911 6.8
Hypertensive diseases 15,551 6.3
 Other heart diseases 13,649 5.5
Remainder of diseases of the genitourinary system 7,981 3.2
Chronic lower respiratory infections 7,316 3.0
Respiratory tuberculosis 7,174 2.9
Other causes of death 64,228 26.0

Source: Philippine Statistics Authority, Vital Statistics

Division
Note: Figures are not adjusted for under-registration
Causes of death are coded based on the ICD-10 Rules
and Guidelines
Symptoms, signs and abnormal clinical and
laboratory findings, not elsewhere classified (R00-
R99) was not included in the top 10 causes of death

Non-communicable disease (NCD; noninfectious or non-transmissible diseases)—including

diabetes—in the Philippines account for 6 of the top 10 causes of mortality and are considered a

major public health concern. Diseases of the heart and vascular system continue to be the

leading causes of death, comprising 31% of all deaths. Other NCDs include malignant

neoplasms, chronic obstructive pulmonary disease, and chronic kidney disease. What is alarming

is that as deaths due to preventable diseases have been on a decline, lifestyle-related diseases due

to “Westernization” of the culture have begun to dominate as the leading causes of death,

particularly due to cardiovascular diseases, malignant neoplasms, diabetes, and chronic lower

respiratory diseases (World Health Organization, 2004).

At present, there are no published nationwide prevalence or incidence studies on type 1

diabetes (T1D). However, 1 survey was done in a municipality of Bulacan in Central Luzon
Region that showed a very low prevalence of T1D with only 7 cases diagnosed among children

aged 0 to 14 years during a 10-year period from 1989 to 1998. A recent survey on pediatric type

2 diabetes (T2D) in the Philippines also found a low prevalence at 0.91%. As a result of the low

prevalence of T1D, continuous glucose monitoring (CGM) devices and continuous

subcutaneous insulin infusion (insulin pumps) are not widely used. Standard home glucose

monitoring devices are readily available and affordable as well as various insulin preparations

that are generic and biosimilar via subcutaneous injections. There is little research on stem cell

therapy or islet cell transplantation for T1D in the Philippines.

Gestational diabetes (GDM) is prevalent in the Philippines. Published data from the Asian

Federation of Endocrine Societies Study Group on Diabetes in Pregnancy (ASGODIP) showed

that the Philippines has a GDM prevalence of 14% in 1203 pregnancies surveyed. Because of

this high prevalence rate, the Unite for Diabetes Clinical Practice Guideline (CPG) recommends

universal GDM screening for the Filipino population. The ASGODIP data found that about

40.4% of high-risk women were positive for GDM when screening was performed beyond the

26th week of pregnancy. In a cohort of Filipino women with GDM delivering babies

with macrosomia in the Cardinal Santos Medical Center, >75% were diagnosed between

gestational weeks 26 and 38. In another cohort population from the Veterans Memorial Medical

Center, 50% of GDM cases were diagnosed between gestational weeks 31 and 40. The Filipino

CPG recommends adopting the criteria by the International Association of Diabetes & Pregnancy

Study Groups for interpretation of the 75-g oral glucose tolerance test as GDM screening (Unite

for Diabetes, 2015).

T2D is the most common type of diabetes in the Philippines. In 2009, a cohort study derived

from the a larger population-based investigation in 1998 was revisited and demonstrated a 9-year
incidence rate of T2D in the Philippines to be around 16.3%. In the latest survey published by

the Food and Nutrition Research Institute in the Philippines (the Eighth National Nutrition

Survey of 2013), the prevalence of high fasting blood glucose based on the World Health

Organization criteria of >125 mg/dL for individuals >20 years old was 5.4%, an increase of

0.6%, compared with the same study in 2008. The highest prevalence rate was found among the

richest in the wealth index, those living in urban areas, and those in the 60- to 69-year age group

in both sexes. These studies show an alarming growth rate of T2D in the Philippines

commensurate with an upward trend in worldwide prevalence (Food and Nutrition Research

Institute (2015). In the 2014 prevalence estimates published by the International Diabetes

Federation, it is estimated that there are 3.2 million cases of T2D in the Philippines with a 5.9%

prevalence rate in adults between the ages of 20 and 79 years. Around 1.7 million people with

T2D remain undiagnosed. The estimated cost per person with T2D in 2013 in the Philippines is

$205, which is comparable with neighboring countries such as Thailand ($285) and Indonesia

($174.7).

As such, since carbohydrate is a major component of rice, and carbohydrates had proven to

be converted to sugar that caused diabetes milletus, many Filipinos were able to get the disease

as a matter of eating habits. It is recommended that only one cup of rice should be eaten every

meal in order to avoid the disease.

Based on the review of related literature and related studies, the Health Benefit Model will

be utilized to help in the eating habits of Filipinos. The concept, definition, and application are

summarized as adapted from Glanz et. al. (2002).

Concept Definition Application

 Perceived One's opinion of chances of Define population(s) at risk, risk levels;

Susceptibility getting a condition personalize risk based on a person's features

or behavior; heighten perceived

susceptibility if too low.

Perceived One's opinion of how serious a Specify consequences of the risk and the

Severity condition and its consequences condition

are

Perceived One's belief in the efficacy of Define action to take; how, where, when;

Benefits the advised action to reduce clarify the positive effects to be expected.

risk or seriousness of impact

Perceived One's opinion of the tangible Identify and reduce barriers through

Barriers and psychological costs of the reassurance, incentives, assistance.

advised action

Cues to Action Strategies to activate Provide how-to information, promote

"readiness" awareness, reminders.

Self-Efficacy Confidence in one's ability to Provide training, guidance in performing

take action action.

Source: “Theory at a Glance: A Guide for Health Promotion Practice" (1997).

Thus, based on the steps above enumerated, the psychological factors that affect eating

habits of Filipinos will be altered due to the benefits the new eating habits can give them.
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