Q&A with Drs. Rui Li and Justin B. Moore on Physical Activity and Healthy Eating in China

PA Obesity in China

At JPHMP, our mission is to advance and disseminate impactful, practice-based evidence to inform initiatives and policies to improve population health. The public health researchers, academics, policy makers, and practitioners who contribute content to the journal support this mission and strive to improve public health for all communities through their research.

We sat down with Rui Li, PhD, at Wuhan University School of Health Sciences, and Justin B. Moore, PhD, at Wake Forest Baptist Medical Center to discuss the growing obesity problem among youth in China. 

JPHMP Direct: Dr. Li, can you tell us a little about yourself, your current position at Wuhan University, your educational background, and how has it informed the work you’re doing today?

Dr. Li: I am an Associate Professor in the Department of Healthcare at Wuhan University, China. My current studies focus on obesity and hypertension in Chinese adolescents. I am a graduate of Wuhan University (BS) and the University of Tennessee at Knoxville, which is where I obtained my PhD degree in Nutrition (Cellular & Molecular) from the Department of Nutrition at the University of Tennessee. My research mainly focused on the mechanisms underlying obesity and type 2 diabetes using animal models. In 2013, I joined the School of Public Health at Wuhan University as a faculty member and started to conduct research on obesity and hypertension in Chinese adolescents. I believed that macrolevel researchers were urgently needed to facilitate the implementation of healthy eating and physical activity policies and practices and thus to combat the high prevalence of metabolic diseases in youth.

JPHMP Direct: Dr. Moore, your expertise is in behavioral health with an emphasis on physical activity, healthy eating, and obesity prevention? How did your work with Dr. Li at Wuhan University come about?

Dr. Moore: I began working in China in 2014 and first visited Wuhan University in 2016. Dr. Li and I hit it off immediately. I was very impressed by his approach to training students and incorporating them into his research team. During my first visit, we started collaborating together on several manuscripts that resulted from data he had collected from adolescents and their parents on obesity related behaviors. We’ve worked together ever since.

JPHMP Direct: What is the impetus of this line of research, and why is it important for the health of Chinese youth?

Dr. Li: China is a developing country currently experiencing rapid changes in health and nutrition. Changing diets, sedentary lifestyles, and tremendous pressure for academic excellence have seen an alarmingly increased prevalence and severity of obesity among Chinese children and adolescents. No efforts should be spared to monitor the trends of the behavioral and health risk factors to inform school policies and programs aiming at preventing inactivity, unhealthy eating, and obesity in Chinese youth.

JPHMP Direct: Has the US or other western countries directly or indirectly contributed to this rapid change in health and nutrition in China to which Dr. Li refers?

Dr. Moore: Indirectly, I think the global economic competition plays a role. The Chinese government has successfully positioned China as a global economic power, which has greatly improved the economic position and quality of life of many of its citizens. However, with the good has come some bad, specifically the academic pressure on youth that Dr. Li astutely refers to. Directly, the US has contributed to the rising rates of obesity by exporting fast food to China. Traditional Chinese foods are being replaced by McDonalds, Pizza Hut, and KFC, especially among the youth. As we’ve seen in the US, a rise in consumption of convenience foods is usually followed by rising rates of obesity and related comorbidities.

JPHMP Direct: Dr. Li, do you have any personal experiences that have inspired or motivated you to work on this project?

Dr. Li: In 2014, we conducted a nutrition survey in Ganzhou, Jiangxi Province. Due to the history, geographical features and culture, the development of Ganzhou is relatively backward. It is a typical, concentrated and particularly poverty-stricken area in China. The main objective of this survey was to determine the prevalence of anemia in 6-18 month-old babies. What surprised me was the prevalence of anemia reached 50.8%. As one of the solutions, the local Health Commission freely distributed nutrition packs to the parents, and our research group organized a series of lectures to disseminate child health care and guide parental feeding. After a 6-month intervention, the prevalence of anemia was significantly decreased. That was my first personal experience that lifestyle intervention could significantly affect individuals’ and populations’ health status.

JPHMP Direct: Dr. Moore, you and Dr. Li are currently starting a new line of research to develop behavioral interventions in Chinese adolescents. Why is this line of research necessary and what are some of the challenges?

Dr. Moore: There is a robust literature about the determinants of obesity related behaviors in adolescents, but these studies have overwhelmingly been conducted in western countries. As such, it has a limited relevance to our work in China, since many of the theoretical relationships have not been empirically tested in Chinese youth. As such, we’re working to establish a conceptual framework to guide our intervention work, which is not an easy process. So far, the biggest challenge has been identifying scales to measure the constructs of interest that have been validated in Chinese youth. We’ve been forced in many cases to translate existing English-language instruments and are currently working to confirm their psychometric properties in Mandarin. That said, our partners at the participating schools have been amazingly cooperative and supportive, which has made the work so much easier.

JPHMP Direct: What are the potential societal impacts of this line of research?

Dr. Li: As mentioned above, China represents one developing country currently experiencing rapid changes in health and nutrition. Improving the health status of youth is a central goal of the Healthy China 2030 program, launched recently by the Chinese government. Accumulation of this sort of research will greatly evoke the general health consciousness and improve the health literacy of people, especially school administrators and policy makers who play a critical role in developing programs promoting physical activity and healthy eating.

JPHMP Direct:  Has anything surprised you about your work in this area? Any unusual findings or final thoughts?

Dr. Moore: I think the most surprising finding to date is how little some of the adolescents in our studies sleep. Our preliminary data suggest that the average high school student in China gets less than seven hours of sleep per night. We’re working to confirm those findings, but I think we have enough evidence to suggest that sleep quality and duration should be part of any multi-behavioral intervention that we would seek to implement. Sleep is a foundational health behavior, and insufficient (or excessive) sleep is a key indicator of overall health. Ultimately, I think we need to find ways to help youth manage stress and get appropriate hours of sleep before we tackle behaviors such as physical activity and healthy eating. That said, it’s going to take a comprehensive, multi-component intervention to affect lasting change. That’s the next big project for me and Dr. Li.

PA Obesity in ChinaRui Li, PhD, is an Associate Professor at Wuhan University School of Health Sciences. His research focuses on the dissemination and implementation of evidence-based strategies for the promotion of healthy eating and physical activity in Chinese youth.





PA Obesity in ChinaJustin B. Moore, PhD, MS, FACSM, is the Associate Editor of the Journal of Public Health Management and Practice and an Associate Professor in the Department of Implementation Science of the Wake Forest School of Medicine at the Wake Forest Baptist Medical Center in Winston-Salem, NC, USA. Follow him at Twitter and Instagram. [Full Bio]