Me’akai in Tonga: Exploring the Nature and Context of the Food Tongan Children Eat in Ha’apai Using Wearable Cameras

Abstract

Unhealthy food consumption is a key driver of the global pandemic in non-communicable diseases (NCDs). The Government of Tonga has prioritised NCD prevention due to the very high rates of NCDs in the Kingdom. This research examines the nature and context of the me’akai (food) consumed by Tongan children in Ha’apai using wearable cameras. Thirty-six randomly selected 11-year-old children used wearable cameras to record their lives for three days, as part of the wider Kids’Cam Tonga project. Images were analysed to assess the participants’ food consumption according to a new data analysis protocol for Tonga. Core foods were defined as including breads and cereals, fresh fruit, vegetables, meat and alternatives, and staple vegetables. Non-core food types included confectionery, unhealthy snack foods, edible ices, and processed meat. Tongan researchers led the research in partnership with the Government of Tonga. Overall, children were observed to have consumed a mean of 4.5 (95% CI 3.3, 6.7) non-core and 2.3 (95% CI 1.8, 2.9) core foods per 10 h day, excluding mixed meals. Unhealthy snack foods, confectionary, and cookies, cakes, and desserts were the most commonly consumed non-core foods, and fresh fruit was the most frequently consumed core food. Snacking was the most frequent eating episode observed, with children snacking on non-core foods four times a day (95% confidence interval (CI) 2.5 to 6.2) compared to 1.8 (95% CI 1.3 to 2.6) core food snacks per day. Most commonly, children were observed eating at home, at school, and on the road while out walking. The most common sources of food were the home, other children, and the supermarket. On average, children consumed one purchased product per day, almost all (90%) of which were non-core. Children were also observed eating an average of just less than one mixed meal per day. Less than half (45.2%) of all mixed meals observed were traditional foods. This research illustrates the presence, and likely dominance, of energy-dense nutrient-poor (EDNP) foods in the diet of these Tongan children. It highlights a transition from a traditional diet and suggests that these children live in an obesogenic environment, one that promotes obesity as a normal response to an abnormal environment. The findings support efforts by the Government of Tonga for the implementation of a healthy School Food Policy, junk food taxes, and initiatives to ban the importation of EDNP foods. This study has relevance for other Pacific Island nations and all nations concerned with addressing obesity and other diet-related NCDs.

The Frequency and Context of Snacking among Children: An Objective Analysis Using Wearable Cameras

“…A coding protocol was developed to guide the coding of children’s snacking behaviour ( Supplementary Material S1 ). Coding definitions were adapted from a previous wearable camera project on Tongan children’s eating behaviour [ 5 ], which we piloted and refined for use in NZ. These definitions (described below, with further detail in Supplementary Material S1 ) were subjected to an inter-rater coding reliability test of 11,662 images, on which three coders achieved >90% agreement for all codes.…”

“…Figure 1 shows several examples of snacking episodes. Like previous wearable camera studies [ 5 , 31 ], we considered snacking episodes as ‘complete’ when five minutes (approximately 43) images passed without further consumption evidence. After this time, evidence of further snacking was considered to be new snacking episodes.…”

“…Two studies found that wearable cameras enhance the accuracy of self-reported dietary intake [ 29 , 30 ]. Wearable cameras have recently been used as a sole methodology to investigate Tongan children’s eating episodes [ 5 ], NZ children’s beverage consumption [ 31 ] and eating and drinking behaviours during transport journeys among young Australian adults [ 32 ].…”

Sweetened beverage taxes and changes in beverage price, imports and manufacturing: interrupted time series analysis in a middle-income country

“…There was also a tariff exemption on bottled water and milk introduced in July 2016 to replace an existing 15% tariff [13]. During the study period there were no regulations relating to SSB marketing or SSB sales in schools with the exception of a voluntary school food policy which appears to have had little impact [14]. There were no major public awareness campaigns about the SSB tax changes and by 2017 just over one-third of the public were aware of the SSB tax increases [3].…”

Environmental Influences on Food Behaviour

“…The use of technology for menu planning, preparation and shopping was another theme that emerged from the study. Finally, Veatupu and colleagues [11] also used a new methodology, wearable cameras, to gain an in-depth understanding of the type of food consumed by 10–12 years children from Tonga and the context in which that food was obtained and consumed. The results highlighted that children obtained food—in particular, non-core foods—from a number of different sources including (but not limited to) other children, supermarkets, and convenience stores.…”