Saturday, September 10, 2011

The Economics of Fast Food in China (Letter L)

We were well aware that Western-style fast food is quickly "gaining ground" in China. However, the sheer number of fast food outlets, such as Kentucky Fried Chicken (KFC) and McDonald's, shocked us. I began to wonder... in cities such as Guangzhou and Beijing, with such a premium on space (skyscrapers are the norm), how could fast food chains afford to have locations on nearly every city block?

There are many reasons for the growing popularity (and profits) of Western-style fast food companies, in the United States as well as in China. Three important profit-making principles for fast food, anywhere in the world, are desirability (How can the company make the public demand its product?), availability, and low cost. By the end of our trip, it was painfully clear to us that McDonald's and KFC satisfy all three principles.


KFC and McDonald's modify their menus, offering familiar Chinese flavors (in addition to standard American fare).

*Red soybean McFlurries
*Ice cream cones include the option of Purple Sweet Potato and Honeydew Melon syrup:
*The chicken in the grilled chicken sandwiches is seasoned differently from its counterpart in the United States, and is cooked with lots of preservatives.

*Chicken sandwich patties contain little pieces of carrots and other vegetables.
*Some other options available at a Chinese KFC: corn on the cob, egg and vegetable soup, and Grass Jelly Milk Tea!
*We were also very surprised to find that at KFC, you can order a chicken sandwich with a side of... two chicken legs!


By linking the restaurant to popular culture (a well-known marketing tactic, to be sure), McDonald's targets children and teenagers.


*As in the United States, Chinese fast food chains open very early and close very late. McDonald's and KFC locations are routinely open 24 hours per day. 

*Since drive-thru ordering is impossible (lack of space), McDonald's and KFC offer bicycle delivery services.
*An interesting idea: McDonald's uses a separate, smaller window outside the store for ice cream and certain drinks. This helps to shorten wait time for smaller, cheaper items, and perhaps increases the likelihood of purchase, as a customer doesn't have to physically "go inside" to obtain the product. Very tempting on hot, humid nights in Guangzhou! Picture:

Low Cost

*This concept has been addressed in depth in previous posts, but to summarize: The restaurants attract middle-income and high-income people, who find eating out an attractive (and affordable!) alternative to cooking. The prices also draw in children and students with limited incomes.

Notable Advertising Strategies

*Identical advertisements are often placed side-by-side, in metro stations, near bus stops, and along escalators. Can't miss them!

*Graphics inside McDonald's ironically depict images of whole foods and exercise - two healthy things not typically associated with Western fast food!

*In-store and outside fast food advertisements always feature bright, bold colors and young people. 

All of these factors combine to create a global phenomenon that is difficult to resist.

The Generation Gap

Since fast food is a relatively new concept in China, the children are catching on more than the adults (who are more apt to prefer traditional foods such as rice, meat, and vegetables). However, we found that a typical homemade meal can still carry health risks.

Composition of a typical lunch or dinner eaten at home:
-Rice fills about half the plate
-Vegetables and protein fill the other half (slightly more vegetables than meat)

Our research team is concerned with the high amount of carbohydrates present at these meals, as starchy (simple) carbohydrates are converted to glucose in the blood. In the schools, we urged the children to adopt a modified plate composition:
-One-half vegetables
-One-fourth protein
-One-fourth carbohydrates

When all is said and done, people will normally eat food that is tasty, familiar, and inexpensive. If today's children are raised on McDonald's and KFC, they will more naturally assign all three of these characteristics to the food; thus, they are more likely to be faithful customers, perhaps throughout their lives.

It is clear that culinary norms are shifting in China; the question now is, how can the trend be shifted to encourage foods that are tasty, familiar, inexpensive, and HEALTHY-
...and can this reverse the patterns of obesity and type II diabetes mellitus?


Pizza Hut - deserves its own section!

We were very surprised to note that Pizza Hut is a fine dining establishment in China. Nearly any type of food can be ordered (from rice and noodles to caviar and escargot... oh, and pizza, of course!). You can also order a bottle of wine with your meal:

The interior of the restaurant was much fancier than its American equivalent!

Sunday, September 4, 2011

Concluding Thoughts

We began our journey to China as a group of strangers ~ encountering a foreign culture ~ many for the first time. We ended our journey as friends. It was difficult to say goodbye to such gracious and thoughtful persons.

We will always remember the kindnesses that were extended to us.

What did we learn about obesity in China?

~ We learned that many of our assumptions about the pervasiveness of fast food were correct. Fast food is readily accessible and popular with young people in China.

~We learned that income and socioeconomic standing are influential in the obesity problem. We have collected data from 2 schools, varying in their economic standing, and we'll be analyzing that data this fall. Stay tuned.

~We learned that health education makes a difference for students, though the influence of peers is also a factor with regard to food choices.

~We learned that physical activity and exercise are important in China, though playgrounds and green space at many schools is limited. Blacktops are pretty common, though.

~We learned that the Chinese place great importance upon scholastic achievement, especially in science and math.

~We learned that Diabetes, Type 2 is a great concern. Surgical treatment of obesity (bariatric surgery) is now an option in larger medical centers.

Sunday, July 24, 2011

June 14th: Public Health, Orchids, and……………. The airport. Why does the end have to come so soon? (Rachel's Reflections)

Public Health was the last area of Chinese Medicine that we got to experience. This area was in a separate building from the hospital, and Lily met us there to show us around. Today was children's day, the day when parents bring in their children for check ups, immunizations, and neonatal assessments. We were able to sit in on some of the appointments and see a lot of really cute children. It was a wonderful way to start our last day in China.

Lily also showed us other areas of the public health building such as the TCM outpatient clinic and the IV medication station. They had a whole room full of chairs designated for patients receiving outpatient IV treatment. What a good concept.

After Public Health, we met up with Hu Jing once more. She took us to see the Orchid Garden. We get there only to find out that it is not orchid season; orchids are not in bloom until winter. This was kind of a let down, but there were plenty of other beautiful flowers and plants to see! The garden was so peaceful and so serene. It was a nice escape from the hustle and bustle of the city.

We met Rachel back at our hotel so that she could come with us to the airport. It was so sad leaving Jinan University, our home away from home for the past 3 weeks. I am still flabbergasted at how fast our time here went. I want to stay here forever!

Rachel said goodbye to us at the airport. This was the worst goodbye of them all. She had spent so much time with us and done so much for us that it was hard to think about leaving her. Tears were shed, and then it was off to meet our plane. United States here we come!

June 13th: Last Full Day ☹ (Rachel's Reflection)

I cannot believe how quickly the time here went!! It has already been 20 days and it breezed by in the snap of a finger. I am so heartbroken to leave this beautiful city and all of the amazing people that we have met.

The morning started off in the hospital. Lisa began by showing us around her floor, internal and post-op. It was interesting to observe the differences between this hospital and the hospitals in the United States. The supply carts and the med rooms were very open, and there was no who took out drugs or how many they took out.

We got to see the Maternity floor next!! Anja and I had been waiting our whole trip to visit this floor. This floor was extremely busy today. They had 34 moms, 29 babies, and only 24 beds! So they had some mom-baby pairs on beds out in the hallway. We were there during bath time so we got to see all of the babies massaged and bathed. The babies looked so fragile and precious. It was an awesome experience!

This afternoon was our last visit to Jinan Middle School. We had all really bonded with our classes, so this was a very bittersweet experience. Today was a discussion day. My class was very actively involved. They told stories such as:

"I used to eat fast food four times a week, and now I only eat it once a week."

"I never really like sports before you started working with us. Now I spend my free time playing basketball and doing other active things."

"Last night I had the choice of playing outside or playing video games on my computer. I chose to go outside and do some exercise."

It was very encouraging to hear how much these students had benefitted from our study. I hope that they can continue to implement these changes in their everyday lives.

The students took the survey once again to conclude our data collection. Overall between the 4 middle school classes at Jinan and the middle school class at Taian, there were 43 people with a family history of Diabetes. This is definitely an at risk population, and I hope that our study will have a lasting impact in the prevention of Diabetes.

Cathy and her class

Me and my class

Anja and her class

Laurelyn and her class

For our last night in Guangzhou, The Vice President of the hospital held a banquet for us. He invited every nurse and doctor that had helped us during our time at the hospital. It was such a nice night. The company was great and the food was delicious.

Wei Ju, the director of nursing, gave each of us a present before we left. It was so thoughtful of her. She gave Cathy and me gorgeous necklaces, and she gave Anja and Laurelyn fancy bracelets.

All of us with Peggy and Wei Ju. They were so great to us!!

Then came the emotional part of the night… goodbyes. How do you say goodbye to the people who had played such an integral role in getting us to China, who made our experience more than perfect, and who had become such dearly loved friends of ours? They have all been so great and so helpful. I wish that we never had to leave them. I would say that more than a few tears were shed.

Time for our last night’s sleep in Guangzhou……. So sad L

June 12th: Day with Hu Jing!!! (Rachel's Reflections)

Today we had our first relaxing morning of the trip. We didn’t have to be anywhere until noon! It was a well needed rest.

We met up with Hu Jing at noon for a day packed with fun!! It was a free day for us, so Hu Jing offered to show us around the city.

She took us first to the dragon boat races. This only happens once a year, and it is a VERY big deal. The Dragon Boat Festival goes on for 20 days, and it is comprised of multiple different events including the dragon boat races. This is just a simple competition between very ornate boats, but it drew a huge crowd! We could barely get our faces in to see what was going on.

Next stop was the Guangdong Museum. This museum is brand new, it just opened last year. It was such a cool looking building and the architecture was exquisite!

We first got to see the Chaozhou Woodcarving Art Exhibition. This form of art is famous for its richness and subtlety of details, delicate and elaborate designs, exquisite craftsmanship, and grand look. Some of the pieces were so intricate, yet so extravagant. They carved elaborate structures for things as miniscule as food containers, incense burners, and pillows.

Next was the Exhibition of Duan Inkstone. This inkstone was made in ancient Guangzhou and is purple in color, and smooth and moist in texture. Water was mixed with the stone and then used as ink. It developed from a functional object to an object for practical use and appreciation. These stones were intricately carved to perfection.

We also saw the selection of pottery and porcelain. China is considered the “Country of Porcelain” and it was clear as to why after seeing the beautiful displays of colorful porcelain and pottery.

The last exhibition was the Exhibition of Natural Resources in Guangdong. It had seven themes: Topography, resources, precious jades and stones, medicinal plants, wild animals living on land or in the sea, and ancient creatures.

I am so glad that Hu Jing took us to the museum. I feel that it was very beneficial for us to learn about the history of the Guangdong province. It helped me to gain an even greater appreciation for Guangzhou.

After the museum we headed to dinner and the opera J. On the way there, we walked through an amazing park with hundreds of different plants and flowers. It was very strange, however, because it was in the middle of all of the tallest skyscrapers in Guangzhou. There was such a huge contrast between the industrialization of the tall buildings and the serenity of the park.

Opera in the park was next on the agenda. What an unbelievable experience to have!! We got to see an opera in Cantonese! And we sat in the front row. Hu Jing translated the main points of the opera so we knew what was going on. It was so intriguing!

Saturday, July 23, 2011

June 11th: Cantonese and Baiyun Mountain (Rachel's Reflections)

Today was the second day of the Diabetes Conference. The featured speaker of the morning was from Hong Kong and was lecturing about self-monitoring of blood glucose. She began her lecture off in English, but switched to Cantonese about 10 minutes into it. So we got to hear a lot of Cantonese, but unfortunately could not understand any of it. It was still interesting to be a part of the conference.

We had heard that Baiyun Mountain was a must-see attraction in Guangzhou, so we decided to go climb it. This was our first adventure without a translator, and man did we feel lost!! I had definitely taken for granted our translators up until this point. Communication is hard without them! We took a taxi there because we could not figure out the bus system. We made it safe and sound!

The hike to the top of this mountain took a little under an hour. It was a good work out for our legs J The view from the top was incredible! At least what we could see of it… It was pretty cloudy and smoggy, so visibility was not great. Nevertheless, we got a great view of the city and of all of the beautiful greenery. It was worth the hike!

A young man approached us on the way down the hill and asked if we were American. He had learned English, and he was eager to practice it. How fortunate for us!! He was very intelligent and fun to talk to. He helped us figure out how to get home, so we boarded the bus (much cheaper than a taxi.. only 2 Yuan, which is approximately 30 cents) and headed back to Jinan University!

Anja, Laurelyn, and I met Jenny, Joy, and Sampson (Jenny’s boyfriend) for dinner. We were excited to see them again! We hadn’t seen Joy or Sampson since our first day in Guangzhou. For dinner, we went to the little noodle restaurant that Rachel had brought us to at the beginning of our trip. We couldn’t imagine not eating there again before we left! It was delicious, and super cheap! Jenny, Joy, and Sampson really enjoyed it too. We had a great time with them, but sadly this marked the beginning of our goodbyes. L We have grown so close to so many people here. I never want to leave them! I hate saying goodbye. I know I will see them again someday though.

June 10th: The Beautiful City of Zhuhai! (Rachel's Reflections)

Zhuhai City, also known as the Harbor City, is located at the southern tip of the Pearl River Delta. It is a beautiful garden-like coastal city with 146 islands off of the coast. We departed early in the morning with Eva and Lisa to spend the day in this paradise city.

Zhuhai has a sister hospital to the Affiliated Hospital at Jinan University, so they main purpose of our visit was to see the hospital and learn more about it. The People’s Hospital of Zhuhai as 2 campuses with over 10 buildings! It is a very large hospital. They are in the process of undergoing a project to improve patient care and patient satisfaction. They were very excited about the results that they were getting and it was encouraging to see such a large emphasis on maximizing patient experience.

The hospital staff was very excited to have us visiting today. We got to meet with the President of the hospital, the Vice President of the hospital, and the director of nursing at the hospital. I felt very honored that they all took time out of their days to meet with us. The President gave us a presentation about the hospital and the changes that they have been making. It was very interesting!

After this meeting we were able to tour the hospital. We got to tour many different departments and meet many nurses during our tour. Their hospital is very, very nice. I am glad that I was able to experience this hospital as well as the hospital in Guangzhou just so that I could get a better overall idea of healthcare in China.

The Zhuhai Hospital had a very slick system for their out-patient department. I was very intrigued by it. The patients each have their own card that has all of their information on it: medical history, immunization records, anything that has ever been recorded in their charts. When they came to check in they would simply swipe their card and it would bring up all of their information. It was a very efficient system, and something that I think would work very well in the United States.

We had lunch with everybody that we had met that day at the hospital. They took us to a restaurant that was in a ship on the bay! It was so cool! We once again had a private room with huge windows overlooking the sea and the city line… Amazing! They truly spoil us here. I do not think that I have met a single person that is not downright hospitable and respectful. They are great!

Before we departed back to Guangzhou, we visited the “Fish Woman.” She is a very important attraction in Zhuhai. She almost reminded me of the Statue of Liberty. It was a big sculpture of a mermaid that sat off the coast in the bay. The sculpture itself is a landmark of Zhuhai and is based on a local folk tale.

It was a long day pack with fun and good company, but it was time to head back to Guangzhou. Goodbye Zhuhai!!