Childhood obesity

It can be difficult keeping up with making good food choices for children. Nutritionist Cindy Williams offers practical ideas that can make a difference to your child’s attitude to food and health for now and the future.

If you watch a movie or TV clip from the 1980s or earlier, you may notice that something more important than hairstyles has changed: it’s the size of our children. Over the past 20 years the number of overweight children has more than doubled. Today in New Zealand, one in five children are overweight and one in 10 children are obese.

These are epidemic proportions with serious consequences for our children’s health.

Why has obesity escalated so quickly in recent years?

The simple answer is that our children are eating more and moving less but the reality is complex and involves all levels of society. As more adults gain weight, their children are also more likely to become overweight, too.

We are eating more food, of the wrong type, more often. We are surrounded by food. Everywhere we go — the movies, shops, school events, sport venues, there is food, in larger-than-life serve sizes, and advertisements for food, enticing us to eat even if we are not really hungry. When we get home and sit in front of the TV we are bombarded with more unhealthy food ads. For many families, what were once treats or ‘sometimes’ foods have become everyday foods.

We are also less active. We drive our kids to school and after school activities because it is faster and safer than walking or cycling.

We are often so busy juggling multiple jobs or tasks that we have little time to take our kids to the park or for a bike ride. More of us live in houses that don’t have a backyard large enough to play in. And even if we do, many kids are more desperate to log into the latest computer game update than to grab a ball and play outside.

Either through busy lifestylesor too much screen time, children are getting less sleep, which can increase their risk of being overweight. One study found that reduced sleep during childhood was associated with increased risk of obesity by the age 32.

Short- and long-term effects

Being overweight harms almost every system of a child’s body — the heart, lungs, muscles, bones, kidneys, digestive tract and hormones that control blood sugar and puberty.

Excess weight puts stress on growing bones and joints, leading to orthopaedic problems such as sore knees and ankles. It’s easier to sit than to run around with sore joints and so the problem compounds.

Overweight children are more prone to respiratory problems, asthma and sleep apnoea. They may develop a fatty liver, high blood pressure and high cholesterol.

They often have low self-esteem, which can plummet into depression or an eating disorder. It’s hard to feel good about yourself when your movement is limited, you can’t wear cool clothes and yet, you can’t stop eating — even though you know you should. Extremely overweight children are also often a target for teasing and bullying.

Yet, what is most concerning about the growing numbers of overweight children is that they are developing what were once considered adult diseases such as heart disease, stroke, polycystic ovarian syndrome, osteoarthritis, some cancers and type 2 diabetes in their 20s and even teens.

Twenty years ago, type 2 diabetes was only seen in older adults. Now teenagers are developing this serious condition as a result of carrying too much fat around their stomachs. Too much central fat causes insulin resistance, which eventually leads to type 2 diabetes and subsequent damage to the kidneys, eyes and heart.

Does my overweight child need to go on a diet?

Going on a diet at any age sets people on a vicious cycle of deprivation, guilt and potential bingeing. Diet is a word that is best not to mention. The most effective way to help a child lose weight is for the whole family to set small goals with a focus on being healthy, not losing weight. Never give a reward for weight-loss.

Unlike adults, overweight children are still growing. Most don’t need to lose weight as such, but rather halt the weight-gain and allow themselves to grow into their weight.

Even small changes can make a big difference and they are more likely to become lifetime habits. Lead by example. Make sure your child feels loved and valued.

Encourage them to wear attractive, fashionable clothes. It’s easier to make healthy changes when you feel good about yourself. Sit down as a family and agree on two or three goals such as going for a walk after dinner instead of eating in front of TV, having a jug of water on the table instead of sweet drinks, or only having dessert on Sunday night instead of every night. For more help in setting and monitoring appropriate, healthy family goals, see a dietitian.

Preventing overweight kids: what can I do?

Today’s culture makes it tough for parents to keep their kids at a healthy weight. But there are steps you can take, starting right from a child’s crucial first few years. More and more research is finding that the first few years of life are critical for determining a healthy adult weight. This is when both physiological and behavioural patterns are set, often for life.

Babies who are breastfed until at least six months are less likely to become overweight as children. On the other hand, babies who are fed solids before four months or who rapidly gain weight in the first four months are more likely to be obese as toddlers. One explanation is that breastfeeding allows a baby to self-regulate, ie. stop when they are full. Sometimes through wanting a child to finish a bottle or through topping up the milk feed with solids, a baby under the age of six months may end up eating more than s/he needs and can lose the ability to know when s/he has had enough.

How to encourage healthy eating

• The food your children eat in childhood is most likely the food they will choose as adults.
• Buy only what you want your children to eat. If there are no chips in the cupboard, they can’t eat them.
• Train children to drink water when thirsty — not juice, cordial or soft drink.
• Keep the fruit bowl full and encourage children to help themselves.
• Keep a bowl of chopped fruit in the fridge for snacks and dessert.
• Check your attitude to feeding your kids. Do you show your love through food? Do you subconsciously want to ‘feed them up’? Try swapping time spent baking cookies for time at the park.
• Eat breakfast every day.
• Serve all meals and snacks on a plate and sit down to eat them.
• Eat together as a family whenever possible.
• Turn off the TV at mealtimes.
• Serve meals pre-plated to control portion sizes.
• Cook just enough to limit over-eating on seconds.
• Keep treats as treats. As parents we want to give our children treats but it is really a treat if it’s being eaten every day?
• When eating out avoid the kids’ menu unless it has a healthy option. If our children have chips and ice cream every time they eat out, why would they change that habit when they are older?
• Talk about food in terms of health and flavour, not kilojoules. Make it fun and interesting. Focus more on the foods that are great to eat.

What is normal?

With so many more children overweight it is easy for parents to assume their child’s podgy tummy is quite normal. But what really is a normal weight for a child?

Body mass index (BMI)adjusted for age and gender is the most commonly used measure. However, a child may be in the normal BMI range and still have too much stomach fat.

Experts now suggest that the waist, or waist-to-height ratio, is a better measure of potential health risk. For example, if your child’s waist is 55cm and height is 125cm, calculate 55/125 = 0.44. If it is over 0.5 your child may be overweight.

Myths

• It’s just puppy fat: Unless something changes, children do not just grow out of being over­weight. They may be happy, seemingly healthy kids, but too much fat around their stomach puts them at risk of serious health problems.
   
• Children need fat for their development: We all need fat in our diets, but the advice for children is the same as for adults. Children do not need proportionally more fat than adults, and limiting saturated fats by choosing low-fat dairy and lean meat is advised.
   
• He has big bones: Bone size doesn’t vary hugely between children and big bones are not the cause of a big tummy.

Disordered eating

The number of children suffering from disordered eating is increasing. It is most common during late adolescence and puberty but it can start as young as seven.

An Australian study of children with disordered eating aged five to 13 years found that 15 per cent were under 10 years of age.

Overweight children can be at risk of disordered eating due to unhealthy attitudes towards food. If your pre-teen shows a number of these signs, and you’re concerned, see your GP:

1. Sudden change in eating habits
2. Significant increase in exercise
3. Distorted body image, fear of becoming fat
4. Unusual interest in food
5. Anxiety
6. Weight loss

Play more, sit less

• Kids love to play and the more running, jumping and skipping they do in their pre-teen years, the more cartilage they develop in their joints reducing the risk of arthritis as adults.
   
• Find an activity your child enjoys. Enrol them in a club or set a regular time to do it with them. Don’t make them do a sport they are no good at. It will knock their self-confidence.
   
• Record favourite TV programmes so they can watch without ads. It will be less time sitting and also means not being exposed to tempting junk food ads.
   
• Don’t allow TV or screens in the bedroom.
   
• Older kids may like a pedometer to record how many steps they take while playing.
   
• If possible, walk or cycle to school. Many schools have a walking school bus. Support it, or set one up for your child’s school.
   
• Set active chores such as sweeping leaves, pulling weeds or taking the dog for a walk.
   
• Use an access code to control when your child uses screens.
   
• Set a timer on the computer so it automatically switches off after a set time.
   
• Plan or allow plenty of active play time — at least 30-60 minutes each day.
   
• Talk about play rather than physical activity — it’s more fun.
   
• Limit screen time to a maximum of two hours a day. A recent study found the more TV pre-school children watched, the fatter their waist and weaker their legs when followed up a few years later at primary school. The American Academy of Pediatrics recommends no screens for children under the age of two years.

Six ways to be a healthy role model

1. Quench your thirst with water, not juice, cordial or soft drink.
2. Don’t diet or talk too much about food and weight.
3. Try new foods together but don’t force children. Make it fun.
4. f you want kids to eat their vegetables, eat yours.
5. at as a family, at the table. Put down your knife and fork between mouthfuls and chat to your children.
6. Eat breakfast.