If schools are to play their part in reducing obesity, they need to develop healthy eating policies that are implemented in every day school life, urges dietitian Dimple Thakrar.
The World Health Organization (WHO) regards childhood obesity as one of the most serious global public health challenges for the 21st century. Obese children and adolescents are at an increased risk of developing various health problems, and are also more likely to become obese adults.
The National Child Measurement Programme (NCMP) measures the height and weight of around one million school children in England every year, providing a detailed picture of the prevalence of child obesity. The latest figures, for 2014/15, show that 19.1 per cent of children in Year 6 (aged 10-11) were obese and a further 14.2 per cent were overweight. Of children in Reception (aged 4-5), 9.1 per cent were obese and another 12.8 per cent were overweight. This means a third of 10-11 year olds and over a fifth of 4-5 year olds were overweight or obese.
Data is also available from the Health Survey for England (HSE), which includes a smaller sample of children than the NCMP but covers a wider age range. Results from 2014 show that 31.2 per cent of children aged 2 to 15 were classed as either overweight or obese.
The SACN report review found: high levels of sugar consumption are associated with a greater risk of tooth decay; the higher the proportion of sugar in the diet, the greater the risk of high energy intake; drinking high‑sugar beverages results in weight gain and increases in BMI in teenagers and children; and consuming too many high-sugar beverages increases the risk of developing type 2 diabetes.
Obesity runs in families
It is well recognised that children who are obese are likely to have obese parents. Obesity that runs in families can be due to environmental factors (such as poor eating habits learned during childhood), or due to relational and behavioural factors (such as poor boundary setting), as well as certain genetic traits being inherited from parents. Therefore, family involvement in interventions is important to ensure improvements in outcomes benefit the whole family and can be maintained.
Up to 79 per cent of children who are obese in their teens are likely to remain obese as adults, according to NICE’s guideline on managing overweight and obesity among children and young people. This can lead to health problems in adulthood such as type 2 diabetes, heart disease and certain cancers. Various diseases or conditions may be associated with obesity in children. Type 2 diabetes, a condition previously found almost entirely in adults, is now being diagnosed in children and young people. Being overweight as a child can also impact on self esteem and quality of life, as well as cause depression.The quality standard is expected to reduce excess weight in children and young people under 18 years and improve dietary habits, as well as the time spent being inactive or sedentary. It should also reduce the prevalence of type 2 diabetes in children and young people, and the use of children and adolescent mental health services (CAMHS).
Can schools make a difference?
It is obvious from the evidence above that the childhood obesity epidemic in the UK today is multifactorial, multilevel and involves many agents from health, schools and parents, as well as the leisure and hospitality industry. However, it is very clear that schools, as children spend a large part of their week there, have a vital role and responsibility too. They are in a position to reduce the incidence of childhood obesity from early years and beyond.
These issues have to be addressed is several ways simultaneously. A single level, one method approach is not appropriate as this is a very complex issue that requires small but consistent daily messages from all areas of school and home life. Successful school programmes need to include the whole school community, including head teachers and teaching staff, school governors and budget holders, and school children. It should also involve catering staff and suppliers, including vending machines, and parents and Parent Teacher Associations.
Healthy eating policies
In order to address the reduction and prevention of childhood obesity, schools need to develop healthy eating policies that don’t just sit on a shelf but that are implemented in every day school life. The attitude towards healthy foods should be a very positive and healthy approach to eating and drinking for the whole school community.
It is advisable that schools focus on key nutritional messages that have been identified nationally. These include reducing free sugars to 19g/d for 4-6 year olds, 24g/d 7-10 year olds, and 30g/d for 11years and over. Reducing highly refined, fatty and sugary snacks e.g. crumpets and chocolate spread is also crucial, as is increasing fruit and vegetables to increase dietary fibre, vitamin and mineral intakes. Promoting more age appropriate portion sizes and mindful eating is also key.
This is all very well I hear you say, but how can this be achieved amongst the job of educating children?
Initially, there needs to be a focus and drive on the importance of good nutrition on improving learning productivity. It is well documented that a healthy nourished mind and body will improve concentration through improved mood and a well fuelled brain. This is only evident with the drop in concentration before meals and snack times and is evident in those children who come to school without breakfast. In adults there is growing evidence to suggest that adults who consume a healthy breakfast are less likely to be overweight. This can be explained by drops in blood sugar causing the brain to reduce concentration and focus on a task, resulting in high fat and sugar snacking.
However, highly refined fat and sugary snacks and breakfasts cause an energy/sugar high but then a sudden energy/sugar drop, causing poor concentration and poor focus. The highly refined foods and snacks often hold very little nutrient benefit as well as being poor long lasting brain fuel. The improvement of snacks provided in school alone can have a major impact on improved concentration and therefore improved education results and Ofsted reporting. It is so obvious and simple: putting the right type of fuel/food in the child’s body will contribute to producing maximum learning results.
This can only be achieved if schools make good nutrition and hydration a priority and invest in changing whole school culture and philosophy around healthy snacks and meals to help mindful eating becoming the norm.
How can this be achieved?
This task needs to be addressed in two phases – the educators and supporting adults and then the children.
It starts from changing mind set and educating staff to have a healthy attitude to their own diets and health. Management investing in healthy work plan programmes such as The British Dietetic Association Work Ready Programme, which address staff’s thoughts, beliefs, behaviours and habits around food and hydration. Making healthy small nudge suggestions like having fruit in the staff room instead of cakes and biscuits or taking lunch breaks as part of the culture to improve productivity. Work Ready Dietitians, like myself, are trained accredited registered Dietitians and are able to provide workshops/education groups for education staff as well as parents, ensuring that the nutrition messages are consistent and evidence based.
Once the staff’s mind set and correct nutrition knowledge has been addressed, school policy and culture can change to improve the health and wellbeing of the children. Small changes can be implemented like slowing mealtimes down and allowing children to socialise and enjoy the food. Avoid over feeding children by offering age appropriate potions of balanced meals and encouraging eating when hungry and stopping when full to avoiding over eating, as well as ensuring that meals are balanced and provide all the key nutrients. Say no to the clean plate stickers and instead look to implement mindful eating stickers. Schools should also help children to identify their hungry and full signals, a life skill that many adults struggle with, and offer pupils healthy snacks such as fruit and vegetables as standard practice across the school. It can also be helpful to encouraging non-food rewards or birthday treats such as stickers or toys rather than sweets or cakes. These are just a few of the possibilities and there are many other ideas and resources on the change 4 life page.
Whole school approach
This whole school approach encourages the whole school to believe, lead and develop a healthy and beneficial attitude to food for life, having maximum input on staff and pupil productivity and reducing child and adulthood obesity collectively.
This helps to prevent the overweight/obese children from being singled out and supports and encourages parents to follow suit, as schools have the power to influence and ultimately change health and educational outcomes for life. A multilevel, consistent, all-inclusive approach to tackling childhood overfeeding in schools is the only way this huge growing epidemic can be tackled, in my opinion.