Clare Collins is a Laureate Professor in Nutrition and Dietetics and Director of Research for the School of Health Sciences, College of Health, Medicine and Wellbeing at the University of Newcastle, Australia. Her research focuses on the impact of eHealth nutrition programmes on food-related health across key life stages and chronic disease conditions.
Data describing the global rise in obesity during childhood and adolescence are numbing. An increase from 4% in 1975 to 18% in 2016 equates to an increase from 75 million to 340 million children around the world. That’s roughly as many children as the entire population of the US.
Applying those statistics to a school classroom in 1975 represents an increase from about one child with overweight or obesity per class of 25–30 children then, to four or five children per class today.
What is child obesity?
Childhood obesity is a condition where the body’s content of fat (adipose) tissue is higher than would be expected. The severity of overweight is calculated based on age and sex using a child’s ratio of weight to height compared with population data.
Online calculators can be used to help identify a child’s weight status. This one from NSW Health Department also explains the results and links to information on nutrition and physical activity, and a free online treatment programme.
Does it matter?
Excess weight in childhood increases risks of developing particular health problems, such as asthma, high blood pressure and blood cholesterol levels in the short term. Poor psychological health, especially for girls and triggered in part by teasing and being bullied, has been reported. Once overweight or obesity develops, children are more likely to remain overweight during adolescence and then into adulthood.
Obesity in childhood increases the risk of adult high blood pressure, type 2 diabetes, heart disease, stroke and at least 12 types of cancers. Some of this effect is mediated by adult body weight, meaning that the association changes if body weight decreases, or increases, over time.
In the longer term children and adolescents with overweight and obesity are more likely to experience stigma, bias and discrimination. This can contribute to social isolation, lower educational attainment, economic disadvantage and poorer well-being.
What policies are needed?
Obesity prevention policies confirm the need to protect children and adolescents from the effects of obesogenic environments. A review of effective food policy actions identified that they can improve information, food and social systems and environments, especially when tailored to meet specific population needs.
Policies targeting environments that support children in developing healthy food preferences, including within the home, childcare settings and schools, can be effective. Additional targeted actions, such as breakfast programmes and family support programmes, are needed for those facing the biggest barriers in meeting healthy food intake goals.
Policies need ongoing evaluation of implementation to ensure the outcomes are as intended. To date, the most effective prevention policies are those that last up to two years and target improvements in both diet and physical activity, particularly during the early school years.
Early intervention and long-term support help families make small sustainable adjustments in their food patterns and lifestyle behaviours to help lower their risk of nutrition-related chronic disease.
What can health professionals do?
Health professionals working with families can:
- monitor child growth
- provide good information to families on nutrition and physical activity
- know when and where to refer those who need more support locally or online
What can parents do?
Our systematic review of over 100 dietary intervention studies on children with overweight and obesity confirmed that they lead to an improvement in child eating patterns. The review findings show a reduction in total intake energy, energy-dense, nutrient poor (junk) foods and drinks, and increased consumption of vegetables and fruit for children. Importantly, improvements were found in studies both up to six months and up to two years, despite some regression over time.
Interventions that were more effective used food-based guidance, tailored advice to individuals and families, and were delivered by qualified dietitians rather than providing general dietary advice only.
Putting it all together
It’s challenging to deal with the constant barrage of advertising that gets in the way of healthy food choices. Check out my previous blog on dealing with pester power.
Supportive home environments for nutrition do help children develop healthier dietary patterns. Strategies that help children include:
- Food rules: families with rules, such as not skipping breakfast or not eating in front of the TV, have adolescents with better food patterns than those with no rules.
- Regular meal and snack times: offering children foods from each of the food groups at specific times (breakfast, lunch, dinner, two to three snack times) creates healthy habits. Healthy children will not starve themselves so if they are not hungry, wait until the next scheduled time and offer food then.
- Focus on positive food behaviours: this means praising a child’s mealtime efforts to taste new foods and ignoring fussiness. Say for example, “I love the way you tasted that broccoli”. It can take many exposures to new taste before a child accepts it.
- Plan inexpensive meals that do not take long to prepare: foods that children can feed to themselves also help them learn, due to the stimulation of touch and smell.
- Eat together: sharing meals when you can helps children learn to eat healthily by copying those around them. Added benefits reported in cross-sectional studiesinclude better mental health, self-esteem and school success.