Weighty issue

As diseases associated with poor diets crop up more regularly
among young people, Sarah Wellard looks at what can be done to turn
around an unhealthy situation.

Rates of childhood obesity have doubled in 10 years. Over the
next 10, obesity will overtake smoking as the number one cause of
ill-health and premature death in the UK. Type 2 diabetes, until a
few years ago a disease suffered only by the overweight and
middle-aged, is now being diagnosed in 15 year olds. The prognosis
for these children is appalling – by their 30s, some of them will
need kidney dialysis or transplants and some will go blind.

These are some of the alarming messages from last month’s
international conference on obesity held in Copenhagen. Inadequate
diet, low levels of physical activity and consequential ill-health
are problems confronting all western countries, with rates of
obesity growing faster in the UK than elsewhere.

The problem is that most of us are eating more calories than we
need for our increasingly inactive lifestyles. And it starts in
childhood, with an unwholesome diet of white bread, chips, savoury
snacks, biscuits, crisps and fizzy drinks. At the same time,
children are becoming less active. Forty per cent of boys and 60
per cent of girls aged seven and over are physically active for
under one hour a day. Fewer children are walking to school or
playing outside because of parents’ fears about safety. And the
overcrowded national curriculum means that outside play and PE are
being squeezed, with many children getting just one PE lesson a
week.

It’s also about our attitudes to food.  If you’re on the bus or
in the car or waiting at the doctor’s surgery and your toddler is
feeling bored and grumpy, what do you do? For many parents, the
answer is to hand them a packet of crisps or a biscuit to keep them
quiet. These children learn that eating is not so much about
satisfying hunger as relief from boredom.

Claire Halsey, a consultant clinical psychologist working in
five Sure Start programmes in the Stoke on Trent area, believes
that there is a much more basic explanation of why so many children
are overweight. “If children eat while playing with toys or in
front of the TV, it’s much harder for them to pick up the cues that
they are full. They’ve not noticed that they’ve been eating.  One
of the cues for fullness is in the mouth, from the working of the
jaws and tongue. We get very good results from encouraging parents
to turn off the TV and to stay with their children while they’re
eating.”

For many children, the problem is not just that they are eating
too much but that what they eat is nutritionally poor – loaded in
saturated fat and added sugar that increases the risk of heart
disease and some cancers in later life. On average children eat
less than half the recommended five portions of fruit and vegetable
a day. As a result, many children are deficient in vital vitamins
and minerals, including iron, vitamin A – important for the health
of the brain, eyes and arteries, and folic acid, which is essential
for cell division.

Poor children are the most likely to have an inadequate diet.
Fresh fruit and vegetables are often relatively expensive and
parents on low incomes may be reluctant to spend money on food that
children may not want to eat. And better educated parents might
have more understanding of what constitutes a healthy diet and why
it is important. However, obesity and inadequate diets are by no
means limited to poor and less educated families. So why isn’t the
message about healthy eating getting through?

Part of the answer may be that parents inadvertently put
children off eating certain foods at an early age.  A study
conducted by Jane Wardle, professor of clinical psychology at
University College London, found that if you offer a child a food
they have not eaten before and tell them it is good for them, they
rate it as less nice than exactly the same food offered without the
healthy eating message. It seems that parents tend only to bring up
the issue of healthy eating in relation to food children don’t want
to eat, so children learn to make a negative association.

Another explanation is that toddlers develop faddy eating as a
result of parents’ anxiety that they are not eating enough. Halsey
points out that for many people, their children eating well is
closely bound up with their self-esteem as a parent – most of us
have an ideal of a chubby, rosy-cheeked toddler. Parents end up
offering them less nutritious food which they know they will want
to eat.

Eating is one of the few things in children’s lives they can
have control over. You might have a parent and child not getting on
very well. Not eating becomes a way of expressing anxiety. Parents
get desperate and end up chasing their child around day and night
with their favourite food.

In cases like this, Halsey believes the answer is to
re-establish normal eating patterns. “Parents have got to take back
control and spend time building a more positive relationship with
their child. You present three meals a day and snacks at certain
times. If children don’t eat at one meal they have to wait until
the next.”

Paul Gately, principal lecturer in physical activity, exercise
and health at Leeds Metropolitan University, believes the obesity
epidemic is due to modern lifestyles. “The problem is that we lead
such busy lives.  People would rather be physically active but we
use the car because it’s quicker. People do know about healthy
eating, but if you need a snack you have what’s available. It’s
easy to pick up a packet of crisps or a chocolate bar.”

The answer, he says, is to encourage people to work out how to
put into practice healthy living in their own lives. “We try to get
people to plan better. For example, organising children to get up
that bit earlier so there’s time for a healthy breakfast and to
walk to school rather than go by car.”

Leeds Metropolitan University runs an annual “fat camp” for
overweight children – most are paid for by their parents, but a
growing proportion are funded by health authorities. Gately says
the camp is highly successful not because of the pounds children
shed while they are there, but because they learn to examine their
lifestyles and see how they can live more healthily. Eighty per
cent of children manage their weight effectively after leaving the
programme, Gately claims. 

The camp is used as a vehicle for testing out strategies that
work in promoting healthy living, which are then disseminated to
other health professionals. Parents have the opportunity to
participate, both through special seminars and by attending the
camp for a day. Gately adds: “I believe that parents are critical
but we have to assume that some parents aren’t going to be able to
help. We have to give the kids the confidence and skills to change
their own behaviour.”

Sowing the seeds of good habits

Bridgwater Sure Start in Somerset has a creative idea for
improving children’s diets and knowledge of food. The programme
employs a horticultural worker, Jo Valentine, who teaches children
in local preschools about food and growing plants and also supports
families who want to grow their own food at home, in the Sure Start
garden or in allotments. She also runs a healthy cooking and eating
group at a local family centre. 

Valentine says: “I start right at the beginning with the
children by harvesting seeds from fruit and vegetables.” We’ve had
fabulous garlic, lettuces, daffodils and broad beans planted in
containers in the preschool. I encourage children to get their
hands dirty – it’s magic for them to be able to dig up potatoes. In
the winter I bring in fruits from organic shops – mangoes and
starfruits. They cut them up and taste them and become familiar
with the seeds.

Valentine says that getting parents interested in growing
vegetables is more of a challenge, but she hopes that the
children’s enthusiasm and the experience of picking apples and
herbs in the garden may help cultivate their interest.