Childhood Obesity Is The Time Bomb Of The 21st Century

Medical concept- childhood obesity words written on label tag with stethoscope on wood background

When it comes to losing weight, most people find it extremely taxing to manage their diet and see real results in a significant amount of time. Obesity is a major health issue throughout the world and all the current trends and statistics highlight it increasing. Nutritionists appreciate gaining weight must start at birth and even before conception given foetal development. Unfortunately, weight gain can be too rapid in childhood and this never disappears in adulthood . For many, addressing the issues of adult obesity means tackling childhood obesity. The old adage of prevention being better than cure was never more important because of the issues even ‘trauma’ that accompanies dieting and the low success rates of achieving a positive outcome.

When it comers to dieting, the success rates are surprisingly poor in both children and adults. We know that only 2 percent of obese men and 3 percent of obese women in the UK ever return to a healthy weight with dieting and then only over a nine year period. That implies for many, the heavy influence our genes, our genetic make-up have on body mass and shape. Obese parents also appear to have obese children and what’s more do not seem to realize this is the case in their offspring. If childhood obesity can be prevented then so much the better.

Eating The Wrong Foods Causes A Lot Of Obesity

Many instances are known where consuming the wrong types of food and drink  is an issue. In the UK today, there is a £30 billion pound industry every year devoted to takeaway meals, home delivery and fast food. That is a massive business sector and one which is highly successful. Convenience also helps. Ready meals are a major aisle item in grocers ever since the microwave entered the kitchen from 1983 onwards. Compounding this issue is the increase in the packaging size of many goods. A 2 litre bottle of Coke introduced in 1978 is 10 times its original size.  Advertising also plays its parts where food businesses spend £1 billion every year getting their food message across. There are a number of features of the food industry which confound attempts to make dieting successful  particularly in the young.

The Situation In The UK On Childhood Obesity

The National Child Measurement Programme established a rather staggering statistic for the United Kingdom. About 10% of our four and fiver year olds in England are classified as obese. Tackling obesity means that a number of other disease states and conditions are minimised or at least regulated.

Dr William Bird MBE with a strong interest in social mobility and the influences on children’s nutrition stated to Sky News:-

 “Something is going badly wrong, childhood obesity didn’t exist 100 years ago, this is a man-made creation.

“What we are seeing is in the fat cells in the body, particularly in the tummy, they create inflammation which attacks the brain and arteries and that leads to diabetes, dementia even, depression and anxiety and cardiovascular diseases.

“These all start off in children and they just get worse.”

Initiatives To Reduce Childhood Obesity

There were a number of trials which sought ways to reduce the childhood obesity issue.  Three trials are worth considering:-

The Infant, Feeding, Activity and Nutrition Trial (InFant) set up in Melbourne, Australia. 

  • The approach depends on the level of education of the mother towards general nutrition. In this approach the systems for dieting need to be tailored to the individual. No-one method can be applied to the mass of obese people.

Health Beginnings Trial set up in Sydney, Australia.

  • The main finding was that with intervention, childhood obesity reduced as assessed by looking at the lower BMIs (Body Mass Index) being recorded. Unfortunately, the level of obesity in children started rising as soon as the intervention ended which illustrate another point that the focus of attention has to be almost a constant.

The USA’s Healthy Homes – Healthy Families Program

  • In this intervention, more vegetables were consumed along with less fruit juice but there was no letting up in the amount of fast food or sugary drinks consumed. Unfortunately, the program did not produce the desired outcomes. 

These are one-offs. They were not wholly successful but they pointed the way to better systems which needed to be holistic. 

The Whole Systems Approach

A more comprehensive approach has been adopted. These are the ‘whole systems’ method of thinking about childhood nutrition which rely on education at the heart of the program. Four are worth mentioning:- 

• Romp & Chomp
• EPODE (Ensemble Prevenons l’Obesite Des Enfants) – France (Romon et al., 2008)
• JOGG (Jongeren op Gezond Gewicht) – The Netherlands (JOGG, 2017)
• TCOCT (The Children’s Obesity Clinic Treatment Protocol)

The ‘Romp & Chomp’ program set up in Geeling, Australia taught children in daycare about eating better along with more play. The children in that program ate fewer packed lunches and drank less soft sugary drinks or ‘cordials’ as they are called over in Australia. Toddlers in that program were less likely to be overweight or even obese. 

The EPODE and JOGG schemes are mirrors of each although the earlier EPODE program set the agenda. EPODE has a more global reach with offshoot programs in Spain, mexico, Belgium, Australia and Greece.

JOGG is based on five pillars:-

  • Social marketing
  • political and governmental support
  • cooperation between the private and public sector as in a public private partnership
  • linking prevention with healthcare
  • scientific coaching coupled to evaluation

 At its height, the program had a national reach in 2016 of 832,000 children in 119 towns and cities. In 12 of those cities there was a reduction in overweight children in the earlier years between 2010 and 2014.

Obesity As A Chronic Disease

A body called the Children’s Obesity Clinic regards obesity as a chronic disease (Most et al., 2015). That means intervention is handled differently. Here, children with weight issues get referred to a hospital with their parents acting in support. They are visited by both paediatrician and a dietician along with other support workers including nurses, a psychologist and even a social worked if it is thought necessary. The target if that is the right term to use are the parents which are asked to control the social and nutritional environment the children are living in. It means regulating their feeding habits, managing their pocket money and establishing rules for bedtime and play. The program in this instance has both an individual and family aspect. It appears to work well ! The program has been adopted in various parts of Denmark where it has found most traction.

The Success Of These Interventions And Schemes

When the initiatives were successful, it could be seen that each was sustained, joined up between the different actors involved in diet and systematic. They were not ad hoc initiatives. They involved both clinicians and the community. The result has been a reduction in childhood obesity levels. It’s also worth noting that social class ‘health inequality’ has a bearing too on the success of the programs. These approaches helped especially disadvantaged groups which reduced the sense of inequality in nutritional status of both the child and to some extent the family.

Approach In the UK Now Being Adopted

Various local authorities are now looking at ways to tackle obesity using an holistic method. There is also a critical body called the Health Action Campaign which has lobbied the House of Commons Health & Social Care Committee in May 2018. Here, Health Action Campaign provided solid evidence of the various interventions mentioned already which have successfully reduced childhood obesity.

It’s worth noting some smaller schemes in the UK. Some schools like Abbey Hulton Primary School in Stoke On Trent (Staffs., UK) is trying different ways to tackle the obesity crisis in their children. This involves lunchbox monitoring. The school rewards children who have healthy food and they also hold maths lessons for example in a sports hall so that the children are active during learning. 

Some evidence suggest that how much we eat is influenced by the number of meals eaten. One piece of research in teenagers points the way.

Obesity Risk Reduced For Teens When Eating 5 Meals A Day

It appears that eating five meals a day, a breakfast, lunch, supper and some snacks might reduce obesity in teenagers, even if they have a genetic tendency towards putting fat on. A population study on over 6000 16-year old students from the Northern Finland Birth Cohort 1986 looked at dietary data during weekdays using self-administered questionnaires coupled with clinical examination. Birth, early and late childhood factors were examined.  Definitions for being overweight  were based on the International Obesity Task Force and International Diabetes Federation MetS paediatric criteria. The study showed that a five-meal-a day pattern was more closely associated with reduced risks of obesity in both genders and lower abdominal obesity in boys in particular compared to other meal patterns using 95% confidence intervals (Jääskeläinen et al., 2013).

The time of day when a meal is eaten does not appear to have as much influence on childhood obesity according to some recent research. Eating late at night is not associated with piling on the pounds for children.

References  

Jääskeläinen, A., Schwab, U., Kolehmainen, M., Pirkola, J., Järvelin, M.-R., Laitinen, J.  (2013) Associations of meal frequency and breakfast with obesity and metabolic syndrome traits in adolescents of Northern Finland Birth Cohort 1986. Nutr. Metab. Cardiovascular Dis. doi:10.1016/j.numecd.2012.07.006

JOGG (2017) Jongeren op Gezond Gewicht- JOGG (Young people at a Healthy Weight) Marieke Hendriksen National JOGG Project Bureau 2017

Most, S.W., Højgaard, B., Teilmann, G. (2015) Adoption of the children’s obesity clinic’s treatment (TCOCT) protocol into another Danish pediatric obesity treatment clinic. BMC Pediatrics 15:13

Romon, M., Lommez, A., Tafflet, M. et al. Downward trends in the prevalence of childhood overweight in the setting of 12 year school and community based programmes. Public Health Nutrition 

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