Child obesity: a weighty problem

28 Aug

I           The growth of obesity

I promise you that I am not a ‘fattist’! Some of my best friends and colleagues are fat.  However, we need to confront a situation which is not doing us any good.

Discriminating against people because of their race or gender is unfair.   People don’t have the option of being male or female, black, white or any of the shades in between.  However, we do have the choice in deciding what and how much we eat.

Would you say that we discriminate unfairly against smokers by banning them from smoking indoors?  No.  If they want to harm themselves, so be it.  The problem is they harm others – even when they smoke on our thoroughfares, polluting the air we breathe when taking a walk.   I resent having to share a bus-stop, for instance, with a “chimney” as the smoke damages my health.

In the same way, people who are overweight or morbidly obese disadvantage others in myriad ways.   For instance, consider the space they consume in trains, tubes, buses and, yes, even in aeroplanes.   When an obese person is hospitalised, special wheelchairs have to be rolled out to accommodate their bulk.   They need larger than usual beds. They also pose a huge expense to the National Health Service (NHS) because of weight-related illnesses.   

II          Addressing the problem

How have we come to such a state and what can we do about it?

For starters, we have to consider and deploy measures to engage in healthy living from an early age.   We adults have a responsibility for inculcating in children its importance.  The reality is that we are not doing enough.

While many schools/academies are obsessive about pupils’ progress and achievements in English and Mathematics at primary level and the English Baccalaureate subjects – i.e. English, Mathematics, a Science, History or Geography and a foreign language – at secondary, some appear to forget they also have responsibility for ensuring that our children have healthy bodies within healthy minds.   Looking at the increasing numbers of pupils who are fat, if not obese, if not morbidly obese, it appears that many more than “some” are failing.

In Western Europe, the UK has the highest number of youngsters who are obese.  Overall, 18% of our children are obese and another 15% are overweight – in total, a third of the child population.   The proportions are similar for boys and girls.   The number of children classified as overweight (including those who are obese) is inversely proportionate to household income, i.e. the poorer the family, the more overweight the children and vice versa.   Among children aged 8 to 15, only 22% of boys and 28% of girls are trying to lose weight. The majority aren’t. The prevalence of obesity has increased since 1995, when 11% of boys and 12% of girls aged 2 to 15 were obese.  Over the following decade, the number of obese and overweight children increased steadily.

Childhood overweight and obesity has immediate and long-term physical and mental health risks.

The National Health Service (NHS) spends £4.2 billion annually combatting diet-related diseases.  Conventional methods of prevention – i.e. social marketing and community-based interventions – fail to make the necessary impact.  We have become more conscious of healthy living and feel guilty when we overeat or not have our five portions of vegetables and/or fruit daily. However, a chasm lies between “feeling guilty” and acting on that emotion through self-restraint.

I grew up in India, where millions of people starve.  It has made it difficult for me, consequently, to understand how much we consume in England.  Besides overeating, huge quantities of food are wasted daily.  I see friends and relatives pile their plates with food, stuff their faces and end up wasting food because they have taken far too much.    I suffer to see this wastage knowing that there was not a morsel of food my late mother threw away in India when she knew that she could give it to the less fortunate.  Surplus and surfeit are the norm in here while food deserts in the underdeveloped parts of the world exist – a painful paradox.

Market-dominating retailers regularly drive down prices by selling us cheap, fast food, teeming with useless calories and questionable nutritional value. Advertisements stimulate our appetites causing us to consume food our bodies do not need.  How can we develop the determined mind-set of an Olympic athletic and self-control of a Himalayan sadhu to combat the daily bombardment of advertisements, bargains and misleading health labels to desist from having that extra burger or slab of chocolate?   One-hundred-and-fifty minutes of activity a week is futile to work off the calories of half a Domino pizza.

Look around and count the number of adults who are fat, obese and morbidly obese. They increase daily. These adults act as sad role models for our young people.   The London Borough of Newham has the fifth highest childhood obesity rate in the United Kingdom and the highest incidence of diabetes.   Only 15% of students eat in school canteens.

We Are What We Do (WAWWD) discovered that a fast-food outlet within 160 m of a school is associated with at least a 5.2% increase in obesity rates among 15-to-16-year-olds.   The food alone does not only lure youngsters; it is also a social space for them.  In addition, these places are associated with littering and anti-social behaviour.

In the world, 42 million pre-school children were declared overweight in 2013 by the World Health Organisation.  Several overweight children become obese adults.  They tend to develop diabetes and cardiovascular disease sooner rather than later.  Food, particularly cheap, fast food, is the gelignite – the fuse that has created a bomb of dreadful proportions causing premature deaths.

III        Some causes of overweight

What has brought about this sad state of affairs especially as the research has demonstrated that most understand that weight gain happens because of overeating and the absence of exercise?

Personal and emotional issues are contributors to weight problems.  Many youngsters are affected by bullying, which dents their confidence and isolates them from others.   Food is omnipresent when things in life go awry or tragedy hits them – such as the separation of parents or the deaths of loved ones.   Several youngsters moving to the UK from overseas are unsettled, disrupting their eating and exercise habits.

Research by Health Talk discovered that many young people said they were overweight because of cultural and family traditions which encouraged them to eat large quantities of food they did not need or particularly want. Most realised how much weight they had gained only when it was very late.

Some youngsters were confused by the mixed messages they received when growing up. For instance, grandparents plied them with sweets and cakes in their pre-teens. When they developed a taste for the confectionery, they were chided as they grew up, especially as they had previously been told that their weight was nothing but “puppy fat” which would disappear over time.

While they wanted their friends, family and teachers to help and encourage them to eat the right foods in the right quantities so as to lose weight, they resented criticism and being made to feel bad about their weights and sizes.

Dr Russell Viner of the Institute for Child Health and the Great Ormond Street Hospital explains how young people can ensure they consume sensibly to keep a healthy weight. What can we, in schools, do to build on this?

IV        Tackling obesity in schools

For starters, it is important that those who work in and oversee the work of schools – i.e. teachers, administrative and support staff and governors – present themselves as role models, which means keeping watchful eyes on their body mass indexes (BMIs).

The day job I hold is that of an educational consultant to school governors.  So impressed have I been with the voluntary work they do, that I decided nearly two years ago to emulate them by do a modicum of voluntary work for a leading hospital in North London.   While the work of the staff there is exemplary, I am dismayed by the number of them who are overweight if not obese.  The hospital has a special unit to tackle obesity, but, perhaps, it needs to start doing so with its own staff.

It’s not hard to work out what tempts them to overeat. The hospital has four cafes/restaurants on site.  As you enter the court which houses them you are greeted with a vast array of oversized muffins.  The management balk at the suggestion that the owners of this outfit cease selling the muffins on the grounds that the adults have the choice of not buying them.  However, if it helps staff members not to be confronted by temptation rather than having to resist it, shouldn’t steps be taken to remove the muffins?

We have seen the light in education by insisting that our caterers provide healthy meals for the pupils.  But there is more to be done.

First, we need to go further and encourage the pupils – primary and secondary – who bring packed lunches to make fruit and vegetables (rather than chocolates and crisps) vital parts of the content.  Far too many secondary pupils leave the school/academy premises at lunchtime and head in the direction of the fast food chains or the local corner shops to buy – yes, you have got it – chocolate and chips.  Is it possible to stop this practice?

Second, while we cannot require parents of pupils who prepare the packed lunches to provide healthy options, we can encourage them to do so.   Healthy options don’t have to be bland. They can be delectable and tasty.   May be there is a role someone can play in educating the parents on this matter.   It would be even better if this role can be played by someone who is not obese.

An extension of this is educating the children themselves about healthy eating – the dangers of over-eating – especially carbohydrates and foods filled with saturated fats and salt.  Tasty, more often than not, does not square with healthy.  We need to stress this with both, parents and pupils.

Third, there is the very important matter of bullying in schools/academies.  Children who are overweight must be helped not censured. Staff members recognise this.  Not so many pupils: they make the overweight ones the butt of taunts and criticisms.

Bullying for most young people, researchers have discovered, begins at primary school and is worst between years 8 and 13 (ages 12 to 18).  It consists of name-calling, pushing and shoving, being “out-casted” and sometimes having clothes and belongings spoiled or stolen.  Bullying happens during lessons, in corridors, the playground and on journeys to and from school.

Overweight youngsters try to avoid getting bullied by keeping low profiles and not reacting.  A few fight back but then are viewed by the staff members as being aggressive.  Some report the bullying to their parents but many parents make matters worse by becoming upset and getting angry and aggressive with the teachers.  Where teachers take action against the bullies, the action sometimes redound on the victims to their detriment.    The upshot for these overweight youngsters is to self-harm, hate school and take extra helpings of pizzas, crisps and chocolate for the sake of comfort – making them even more overweight.   Schools must try to convert this vicious circle into a virtuous one.

Some overweight young people told researchers that being able to talk to sympathetic teachers and team leaders at school was useful provided they could actually do something to assist them.   Having good friends at school was, by far, the most helpful thing.

The fourth strategy is to engage young people in sport and exercise.   Chinese pupils start every day with whole school, coordinated exercise – not just to tone their bodies but also to make them more alert and geared to learning.   I have yet to come across a school in England that does this.

The government has legislated that every pupil must have at least two hours of Physical Education/Sport a week.   Some schools do much more by causing their pupils to participate in extra-curricular activities after or before the normal school day.   This is to be applauded.  Also, pupils should be encouraged to walk or cycle to school rather than have their parents drive them there and back causing traffic jams.

Finally, we need to find a way to motivate young people to help themselves keep trim.

Researchers questioned young people about what they wished adults – especially the health professionals – to do to keep their weights to reasonable, sensible levels.  Their list is worth noting.

  1. Talk to us as people and don’t lecture us. Support us.
  2. Use plain English.
  3. Be sensitive to our problems and our needs.
  4. Pay more attention to the mental health of some of us who are overweight teenagers and others who are children.
  5. Provide us with useful advice and information.
  6. Take time to listen to us and understand our needs.
  7. Don’t be condescending towards us. You are there to help us.
  8. Be friendly.
  9. Be knowledgeable.
  10. Be sympathetic.
  11. Don’t be blunt or lose your temper as it could scare us.
  12. Do make sure we understand the health risks of being overweight or obese.
  13. Encourage us to achieve little goals at a time.
  14. Don’t bombard us with information. Leaflets alone are not enough.
  15. Doctors need to remember that eating disorders affect some of us who are boys.

It’s difficult to teach an old dog new tricks.  Ask my children about how difficult it was for them to teach me a modicum of technology.  They find it daunting because with age it becomes harder to learn.      It would certainly help if we hard-wire our children (while young) to engage in healthy living – with the proper diet and exercises, to avoid eating between meals (sometimes called “grazing”) – than to require them in their later years when they are building their careers to reduce weight.  We will be able to save considerable money dealing with the ill-health that accompanies obesity.

Prime Minister Theresa May has overruled the Health Secretary Jeremy Hunt on a series of tough measures to tackle obesity – such as restricting advertising and promotional deals on junk foods, despite Public Health England’s desire for such steps to be taken to prevent children becoming fat if not obese.  This is so as to come to terms with the difficult economic state in which we currently are. According to The Times, measures to force companies take action not to push and advertise fast foods (in the way in which the media is not permitted to advertise cigarettes) have been abandoned.  This is sad.  However, adults have a responsibility to model and promote healthy living with children in a free country. There is a case for not making the United Kingdom a nanny state and promote a climate for people to act and live responsibly.

We need to remember this with our eating habits to reverse an overweight trend that otherwise can become an epidemic.

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