Keep Kids Healthy by Dr Ian W Campbell

10 October 2007

It’s often claimed that we are in the midst of an epidemic of childhood obesity. Some even claim that because of obesity many of our children will live shorter lives than their parents. So just how serious is this modern problem? What is causing it, what are the consequences we face, and what can we do about it?

According to the International Obesity Task Force (IOTF) the UK has one of the highest levels of childhood obesity in Europe. Figures released by the Government in 2007 state that while almost one third of our children are overweight, as many as 16.9% of boys and 16.8% of girls between the ages of 2-10 years are obese and at significantly increased risk of disease. The total number of obese children is of huge concern, but the rapid rise in numbers is worrying when we consider that just 12 years ago less than 10% of children of a similar age were obese. In fact Ed Balls, the Minister for Schools estimated that by 2050, if we don’t take action now, half of our children will be obese. Among obese teenagers two thirds already have evidence of raised blood sugar, high cholesterol levels or raised blood pressure. The consequences faced by our children are significantly increased risk of type 2 diabetes (once thought of a disease of middle age), heart disease, some bone and joint disorders, psychological difficulties and even some forms of cancer.

What causes obesity?

From a scientific point of view the cause of the problem is very simple. Our energy balance equation determines whether we gain, or lose weight. If a child consumes more energy through food and drink than he or she expends through exercise and general living, that extra energy is stored by the body as fat. Fat mass builds up in the abdomen, around the child’s internal organs, creating the so-called apple shaped obesity and leads to ill-health. The solution therefore would appear to be very simple and is often stated by those who take a light hearted view of the problem: move about more and eat less. The reality however, and a situation I am faced with every day in my clinical practice, is that for the majority of children this type of throw-away advice simply doesn’t work. The underlying causes of obesity are much too complex.

The key to managing the problem effectively is to change the environment. By environment we mean the way our children live, the way they are educated, the promotion of unhealthy foods, access to affordable healthy foods at school, and at home. It means making the streets safe for them to walk to school, improving their activity levels at school either through PE classes or access to a safe playground, increasing opportunity for sport, and general encouragement to get up off the sofa, leave their computer games and TV, and be more active. Much of this lies well beyond a child’s control and so they are reliant on their parents and carers to take the lead, indeed to lead by example. Parents too face their own pressures with long working hours, financial constraints and sometimes a lack of agreement on what’s best for their kids.

A study for the Schools Food trust (SFT) found that children eating packed lunches, though happier with their meal, were often less healthy than kids on school dinners who were more likely to have fruit and vegetables as part of their daily lunch, and less likely to have unhealthy snacks. Jamie Oliver’s campaign to improve the quality and uptake of school meals has failed. Children have been turning away from school meals, preferring home prepared lunch boxes. The mistake that has been made is that the children weren’t listened to. They simply don’t like what’s being offered. And here is a key pointer to how we need to address this problem. If our children are to live a healthier lifestyle, they need to be willing partners to bring about the changes that are needed.  This is not to say of course that a good mum or dad doesn’t need to say “no” from time to time; rather that children need to be intelligently and openly educated about what a healthy lifestyle means, and why it’s important to them, not just in the future, but right here and now.

I firmly believe that government, the health industry and health professions have a key role to play in helping parents provide a healthy environment for their children. However, as a father, I also believe that health for kids needs to start at home. So while we’re waiting for everyone else to get started what can we parents and carers do to help our children secure a healthy future? And how can you tell if your child is overweight?

How to measure overweight in children

It’s can be difficult to tell if your son or daughter is overweight. Many of their friends will be too. Asking them to stand on a set of scales can be embarrassing for them and it’s important not to create ill feeling so often observation is enough. If they appear large round their waist, if you have difficulty finding appropriately aged clothes to fit, if your child can’t keep up when running with his or her friends, if they are being teased at school about their weight, these are indicators that there might be a problem. Doctors use the Body Mass Index (BMI = weight in kg / height in m2) to measure fatness. In adults a BMI greater than 25 is overweight, above 30 is obese. But because a child’s body shape and safe fat levels vary as they grow you need to plot their BMI on a centile chart, available from the Child Growth Foundation, to determine whether they are overweight or obese (www.childgrowthfoundation.org). Alternatively you could ask your doctor or health visitor to check it for you.

Making changes as a family

A healthy lifestyle is for everyone in the family. Concentrate on health, not weight. Talk to your children, agree on sensible, sustainable small changes and make them together. Try and eat together as a family as often as possible; not only is it more fun it’s also been shown that children who eat with their parents eat more fruit and vegetables and are less likely to be overweight. Make breakfast an important meal every day. Children who eat breakfast have been shown to be healthier, have less time off school, and have better behaviour and improved concentration; their teacher will thank you! Another simple step is to reduce sugary drinks and snacks. These empty calories have little nutrition but lots of unnecessary calories. Make fruit and veg a priority. Only one in five of us achieve the recommended 5 portions each day so start by increasing your daily intake by one or two portions and build up from there. Not only are they better for you but they will fill your child up and make them less hungry for less healthy alternatives. Children, particularly under the age of seven, still need some fat in their diet, in milk and cheese for example, but where it’s not needed, keep it to a minimum. Think about portion sizes; our plates have become bigger over the years and we heap them higher. Make sure vegetables fill over half the plate. For snacks try fresh fruit chopped-up, or a handful of nuts. Try not to associate food with reward or punishment. And don’t forget that the occasional treat is absolutely fine.

Few children get the one hour of exercise they need every day to stay healthy. Any form of activity can be helpful. Walk with them to school, encourage them to take part in school activities, to join after school clubs. Limit the hours they spend watching TV and playing on computer games each week and encourage them to go out and play, but make sure they understand why; in my experience most children respect this kind of “contract”. Have a trampoline (with surround netting) in the garden. Go for a family bike ride or walk at the weekend and in the evenings and spend time with them chatting as you walk; your kids will love it.

There is so much we as parents can do to get our children off to the right start for a healthy active life. Make health a family priority. Concentrate on a healthy diet and active lifestyle, never on weight or dieting. Be active as a family. What’s good for the health of our children is good for mum and dad’s health too. Our children deserve nothing less.