Obesity in children and adolescents in Thailand:

Access and education issues for programming and policy in a post COVID-19 epoch


  • Lisa Pawloski Department of Anthropology, College of Arts and Sciences, The University of Alabama
  • Penelope Mitchell Department of Geography, College of Arts and Sciences, The University of Alabama
  • Kevin Curtin Department of Geography, College of Arts and Sciences, The University of Alabama
  • Teeranut Harnirattisai Faculty of Nursing, Thammasat University
  • Sararud Vuthiarpa Faculty of Nursing, Thammasat University


COVID-19, Location Science, Obesity, Spatial Statistics, Thailand


The crisis of obesity has been rapidly increasing in severity across the world. The purpose of this article is to explore the nature of the obesity epidemic, with attention to elements likely to persist in Thailand, and to develop policy and practice elements that could be implemented in a post-Covid environment. To develop the background for this work a review of access to healthcare, access to healthy foods, and the relationships of obesity and socioeconomic and cultural factors is provided. This review shows that in Thailand, the population at risk of obesity are more concentrated in urban areas where access to unhealthy food choices is ubiquitous. While obesity is highly correlated with low socioeconomic status and income in the U.S., the reverse is more often the case in Thailand, particularly among boys. Complicating the challenge of obesity has been the COVID-19 epidemic, as literature has linked obesity to an increased number of cases and deaths from COVID-19, with earlier findings across the world reporting that obesity in general increases complications related to many similar respiratory viruses. Access to health care is recognized as a gateway to population health as preventative care is less costly, easier to deliver, and if distributed as needed, can be effective in preventing large scale disease progression. These findings are used to develop suggestions for policy and practice that leverage historical successes in major public health initiatives undertaken by the Thai government. Moreover, since traditional statistical analyses do not take into account the role of spatial effects such as spatial dependence and spatial heterogeneity, there is an opportunity to incorporate novel methods in analyses of obesity in Thailand given that the spatial associations with prevalence of obesity are well known. Thailand has made many successful national efforts to reduce obesity across the nation with significant results.


The aim of this paper is to provide policy and intervention suggestions that can leverage that success with the growing understanding of the relationship between access, education, and obesity. Thailand’s history of public health success suggests that the obesity crises may be largely prevented if those national resources are brought to bear with an interdisciplary and long-term plan.


Download data is not yet available.


Curtin KM, Pawloski LR, Mitchell P, Dunbar J. COVID-19 and Morbid Obesity: Associations and Consequences for Policy and Practice. World Medical & Health Policy [Internet] [cited 2020 Nov 10];n/a(n/a). Available from: http://onlinelibrary.wiley.com/doi/abs/10.1002/wmh3.361

Anekwe CV, Jarrell AR, Townsend MJ, Gaudier GI, Hiserodt JM, Cody Stanford F. Socioeconomics of Obesity. Curr Obes Rep 2020;9(3):272–9.

Boonchoo W, Takemi Y, Hayashi F, Koiwai K, Ogata H. Dietary intake and weight status of urban Thai preadolescents in the context of food environment. Preventive Medicine Reports 2017;8:153–7.

Angkurawaranon C, Wisetborisut A, Rerkasem K, Seubsman S ang, Sleigh A, Doyle P, et al. Early life urban exposure as a risk factor for developing obesity and impaired fasting glucose in later adulthood: results from two cohorts in Thailand. BMC Public Health 2015;15(1):902.

Himathongkam T. Grocery Shopping Destination Choice and Obesity: an Empirical Study of Urban Population in Bangkok Thailand. 2016 [cited 2020 Dec 2];Available from: http://mars.gmu.edu/handle/1920/10615

Sakboonyarat B, Pornpongsawad C, Sangkool T, Phanmanas C, Kesonphaet N, Tangthongtawi N, et al. Trends, prevalence and associated factors of obesity among adults in a rural community in Thailand: serial cross-sectional surveys, 2012 and 2018. BMC Public Health 2020;20(1):850.

Aekplakorn W, Mo-Suwan L. Prevalence of obesity in Thailand. Obesity reviews : an official journal of the International Association for the Study of Obesity 2009;

Thailand Multiple Indicator Cluster Survey 2019 | UNICEF Thailand [Internet]. 2020 [cited 2023 Jul 26];Available from: https://www.unicef.org/thailand/reports/thailand-multiple-indicator-cluster-survey-2019

Tangcharoensathien V, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W, Mills A. Health systems development in Thailand: a solid platform for successful implementation of universal health coverage. The Lancet 2018;391(10126):1205–23.

Bhurosy T, Jeewon R. Overweight and Obesity Epidemic in Developing Countries: A Problem with Diet, Physical Activity, or Socioeconomic Status? ScientificWorldJournal [Internet] 2014 [cited 2020 Oct 25];2014. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212551/

Popkin BM. The Nutrition Transition and Obesity in the Developing World. The Journal of Nutrition 2001;131(3):871S-873S.

Pawloski LR, Thurman S, Curtin KM, Ruchiwit M. The Spread of Obesity in Developing and Transitional Countries: A Focus on the Mekong Region, Southeast Asia. World Medical & Health Policy 2012;4(1):1–15.

World Health Organization. Obesity and overweight [Internet]. 2020 [cited 2020 Apr 6];Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012;70(1):3–21.

Hamer M, O’Donovan G, Stamatakis E. Lifestyle risk factors, obesity and infectious disease mortality in the general population: Linkage study of 97,844 adults from England and Scotland. Preventive Medicine 2019;123:65–70.

Torres L, Martins V, Faria A, Maioli T. The Intriguing Relationship Between Obesity and Infection. J Infectiology 2018;1(1):6–10.

Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell LF, Chernyak Y, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City. medRxiv 2020;2020.04.08.20057794.

Papagianni M, Tziomalos K. Effects of obesity on the outcome of pneumonia. Expert Review of Endocrinology & Metabolism 2017;12(5):315–20.

Thailand GDP 2005 - Google Search [Internet]. [cited 2020 Oct 20];Available from: https://www.google.com/search?q=Thailand+GDP+2005&oq=Thailand+GDP+2005&aqs=chrome..69i57j0i22i30i457.8083j0j7&sourceid=chrome&ie=UTF-8

Association of Southeast Asian Nations (ASEAN) [Internet]. [cited 2020 Oct 20];Available from: https://2009-2017.state.gov/p/eap/regional/asean//index.htm

Sakamoto N, Wansorn S, Tontisirin K, Marui E. A social epidemiologic study of obesity among preschool children in Thailand. Int J Obes Relat Metab Disord 2001;25(3):389–94.

Kosulwat V. The nutrition and health transition in Thailand. Public Health Nutr 2002;5(1A):183–9.

Teerawattananon Y, Luz A. Obesity in Thailand and Its Economic Cost Estimation [Internet]. Asian Development Bank; 2017 [cited 2020 Oct 22]. Available from: https://www.adb.org/publications/obesity-thailand-and-its-economic-cost-estimation

Cheong WS. Overweight and Obesity in Asia. :4.

Pengpid S, Peltzer K. Prevalence and correlates of behavioural risk factors of non-communicable diseases among adolescents in Thailand: Results of a national school survey in 2015. International Public Health Journal 2019;(3):281–8.

Pengpid S, Peltzer K. Underweight and overweight or obesity and associated factors among school-going adolescents in five ASEAN countries, 2015. Diabetes & Metabolic Syndrome 2019;13(6):3075–80.

Pawloski L, Ruchiwit M, Pakapong Y. A cross-sectional examination of growth indicators from Thai adolescent girls: Evidence of obesity among Thai youth? Annals of human biology 2008;

Pawloski L, Kitsantas P. Social determinants of overweight in Thai adolescent girls. American Journal of Human Biology 2009;21:264–5.

Banks E, Lim L, Seubsman SA, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours: cross-sectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(1):762–762.

Tungtrongchitr R, Pongpaew P, Schelp FP, Phonrat B, Mahaweerawat U, Paksanont S, et al. Vitamin B12, folic acid, ferritin and haemoglobin status of rural women in child-bearing age in northeast Thailand. J Med Assoc Thai 1997;80(12):785–90.

Guagliardo MF. Spatial accessibility of primary care: concepts, methods and challenges. International Journal of Health Geographics 2004;13.

Walker B, Holling CS, Carpenter S, Kinzig A. Resilience, Adaptability and Transformability in Social–ecological Systems. Ecology and Society [Internet] 2004 [cited 2020 Feb 5];9(2). Available from: https://www.ecologyandsociety.org/vol9/iss2/art5/

Wan N, Zhan FB, Zou B, Chow E. A relative spatial access assessment approach for analyzing potential spatial access to colorectal cancer services in Texas. Applied Geography 2012;32(2):291–9.

Probst JC, Moore CG, Glover SH, Samuels ME. Person and place: the compounding effects of race/ethnicity and rurality on health. Am J Public Health 2004;94(10):1695–703.

Haenssgen MJ, Charoenboon N, Zanello G. You’ve Got a Friend in Me: How Social Networks and Mobile Phones Facilitate Healthcare Access among Marginalised Groups in Rural Thailand and Lao PDR. World Development [Internet] 2021 [cited 2020 Dec 10];137. Available from: http://libdata.lib.ua.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ecn&AN=1858903&site=eds-live&scope=site

Owen KK, Obregón EJ, Jacobsen KH. A geographic analysis of access to health services in rural Guatemala. International Health 2010;2(2):143–9.

Pawloski LR, Curtin KM, Gewa C, Attaway D. Maternal–child overweight/obesity and undernutrition in Kenya: a geographic analysis. Public Health Nutr 2012;15(11):2140–7.

Alvidrez J, Castille D, Laude-Sharp M, Rosario A, Tabor D. The National Institute on Minority Health and Health Disparities Research Framework. Am J Public Health 2019;109(Suppl 1):S16–20.

Hammond RA. Complex Systems Modeling for Obesity Research. 2009;6(3):10.

Medicine I of. Food Marketing to Children and Youth: Threat or Opportunity? [Internet]. Washington, DC: The National Academies Press; 2006. Available from: https://www.nap.edu/catalog/11514/food-marketing-to-children-and-youth-threat-or-opportunity

Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity pandemic: shaped by global drivers and local environments. The Lancet 2011;378(9793):804–14.

Moore LV, Diez Roux AV, Nettleton JA, Jacobs DR. Associations of the Local Food Environment with Diet Quality—A Comparison of Assessments based on Surveys and Geographic Information Systems. Am J Epidemiol 2008;167(8):917–24.

Kolak M, Anselin L. A Spatial Perspective on the Econometrics of Program Evaluation. International Regional Science Review 2020;43(1–2):128–53.

Curtin K, Pawloski L. Methodological Prospects with the Use of Geographic Information Systems and Spatial Statistics for the Evaluation of Alcohol Policy. World Medical & Health Policy 2014;6(3):242–61.

Anselin L. Thirty years of spatial econometrics. Papers in Regional Science 2010;89(1):3–25.

Fotheringham AS, Charlton ME, Brunsdon C. Geographically Weighted Regression: A Natural Evolution of the Expansion Method for Spatial Data Analysis. Environ Plan A 1998;30(11):1905–27.

Oshan TM, Li Z, Kang W, Wolf LJ, Fotheringham AS. mgwr: A Python Implementation of Multiscale Geographically Weighted Regression for Investigating Process Spatial Heterogeneity and Scale. ISPRS International Journal of Geo-Information 2019;8(6):269.

Lee KH, Heo J, Jayaraman R, Dawson S. Proximity to parks and natural areas as an environmental determinant to spatial disparities in obesity prevalence. Applied Geography 2019;112:102074.

Chen DR, Truong K. Using multilevel modeling and geographically weighted regression to identify spatial variations in the relationship between place-level disadvantages and obesity in Taiwan. Applied Geography 2012;32(2):737–45.

Oshan TM, Smith JP, Fotheringham AS. Targeting the spatial context of obesity determinants via multiscale geographically weighted regression. International Journal of Health Geographics 2020;19(1):1–17.

Fotheringham AS, Yang W, Kang W. Multiscale Geographically Weighted Regression (MGWR). Annals of the American Association of Geographers 2017;107(6):1247–65.

Wachs M, Kumagai TG. Physical accessibility as a social indicator. Socio-Economic Planning Sciences 1973;7(5):437–56.

Wang F. Measurement, Optimization, and Impact of Health Care Accessibility: A Methodological Review. Annals of the Association of American Geographers 2012;102(5):1104.

Khan AA. An integrated approach to measuring potential spatial access to health care services. Socio-Economic Planning Sciences 1992;26(4):275–87.

Wang F. Quantitative Methods and Socio-Economic Applications in GIS [Internet]. Boca Raton: CRC Press; 2015 [cited 2020 Jan 28]. Available from: https://web.a.ebscohost.com/ehost/ebookviewer/ebook/bmxlYmtfXzkzNDYxMV9fQU41?sid=90b1fdab-a54c-48fe-bed4-6d5fcbefd059@sessionmgr4006&vid=0&format=EB&rid=1

Fryer Jr. GE, Drisko J, Krugman RD, Vojir CP, Prochazka A, Miyoshi TJ, et al. Multi-method assessment of access to primary medical care in rural Colorado. Journal of Rural Health 1999;15(1):113–21.

Pu Q, Yoo EH, Rothstein DH, Cairo S, Malemo L. Improving the spatial accessibility of healthcare in North Kivu, Democratic Republic of Congo. Applied Geography 2020;121:102262.

Delamater PL, Shortridge AM, Kilcoyne RC. Using floating catchment area (FCA) metrics to predict health care utilization patterns. BMC Health Services Research [Internet] 2019 [cited 2020 Feb 5];(1). Available from: http://libdata.lib.ua.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.581441910&site=eds-live&scope=site

Luo W, Wang F. Measures of Spatial Accessibility to Health Care in a GIS Environment: Synthesis and a Case Study in the Chicago Region. Environ Plann B Plann Des 2003;30(6):865–84.

Luo W, Qi Y. An enhanced two-step floating catchment area (E2SFCA) method for measuring spatial accessibility to primary care physicians | Elsevier Enhanced Reader. Health & Place 2009;15:1100–7.

Dai D, Wang F. Geographic Disparities in Accessibility to Food Stores in Southwest Mississippi. Environ Plann B Plann Des 2011;38(4):659–77.

Langford M, Fry R, Higgs G. Measuring transit system accessibility using a modified two-step floating catchment technique. International Journal of Geographical Information Science 2012;26(2):193–214.

Delamater PL. Spatial accessibility in suboptimally configured health care systems_ A modified two-step floating catchment area (M2SFCA) metric | Elsevier Enhanced Reader. Health & Place 2013;24:30–43.

Wan N, Zou B, Sternberg T. A three-step floating catchment area method for analyzing spatial access to health services. International Journal of Geographical Information Science 2012;26(6):1073–89.

Shadmi E, Chen Y, Dourado I, Faran-Perach I, Furler J, Hangoma P, et al. Health equity and COVID-19: global perspectives. International Journal for Equity in Health 2020;19(1):104.

World Social Protection Report 2017-19: Universal social protection to achieve the Sustainable Development Goals [Internet]. 2017 [cited 2020 Dec 16]. Available from: http://www.ilo.org/global/publications/books/WCMS_604882/lang--en/index.htm

Chavasit V, Kasemsup V, Tontisirin K. Thailand conquered under-nutrition very successfully but has not slowed obesity. Obesity Reviews 2013;14(S2):96–105.

Mayurachat Kanyamee, Warunee Fongkaew, Jutamas Chotibang, Patcharaporn Aree, Kennedy C. An Intervention Study of Changing Eating Behaviors and Reducing Weight in Thai Children Aged 10-12. Pacific Rim International Journal of Nursing Research 2013;17(4):317–28.



How to Cite

Pawloski L, Mitchell P, Curtin K, Harnirattisai T, Vuthiarpa S. Obesity in children and adolescents in Thailand:: Access and education issues for programming and policy in a post COVID-19 epoch. Health Workforce Education Journal [Internet]. 2023 Aug. 22 [cited 2023 Dec. 5];1(1):36-48. Available from: https://he02.tci-thaijo.org/index.php/hwej/article/view/259707



Review article