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Balancing the scales in tackling childhood obesity

Today’s news (10.09.19) reporting recommendations from the Chief Medical Officer to ban eating on short journeys on public transport, to help stem the tide of childhood obesity, provides a reminder that many of the health problems we are witnessing are directly linked to life-style.  While single solutions can be a start to tackling the problem, many of these issues are multi-factorial and are linked to changes in life-style that have occurred in the last 30 years.

Reports in August of 2019 based on statistics gathered by The National Child Measurement Programme (NCMP) showed that 9.5% of reception age children in England (aged 4-5) were obese in 2017/18, with a further 12.8% overweight. These proportions were higher among year 6 children (age 10-11), with 20.1% being obese and 14.2% overweight.

In the absence of a medical reason for obesity, becoming overweight is the result of imbalance in a simple equation, when energy input in the form of nutrition becomes higher than energy output. Energy output involves factors related to general functioning, growth and activity. Declining levels of activity are a feature of modern technological societies. More time spent in sedentary pursuits equals less time engaged in physical activity.

But the story is not as simple as this, and technology is not the only rogue in the mixture.

As a society the ways in which we acquire food and the ways in which eat, are changing. In 2001, I wrote an article “Fast Food Fools the Brain” which was published in the TES under the title “Table Manners for a Tubby Nation”. In this I examined how satiety centres in the brain take up to twenty minutes to register. Not only the taste and calorific content of fast food, but the context in which it is eaten, can affect how many calories are consumed in a short space of time.

“Fast foods are exactly what they say they are: instantly available, eaten fast, often “on the hoof”, and they generally have a high fat/sugar and refined carbohydrate content. When food is eaten at speed, the brain does not have time to recognise that the body has had enough and respond by switching off the hunger signals, before more is consumed.

High sugar/fat/carbohydrate content foods cause an immediate and rapid rise in blood glucose and insulin levels. If too much insulin is produced, the blood glucose falls too low, which results in a craving for more sugar. It is at this stage that a child will demand a “quick fix” snack such as a packet of crisps, candy bar or fizzy drink (one fizzy drink contains the equivalent of seven teaspoons of sugar). This will temporarily relieve hunger pangs but a similar pattern will recur within two to three hours. Sugar-craving cycles increase the likelihood of obesity.

There is evidence that obese individuals secrete above-average amounts of insulin in response to food and are therefore more sensitive to sensations of hunger. Rapidly fluctuating blood sugar levels can also deplete the body’s ability to produce insulin in the long term, which may be one reason why children of 10 to 12 are now developing the type of diabetes that used to be found only in the middle-aged.

But, of course, it is not only the type of food children eat that has changed over the past generation. The manner in which we eat, is also very different.

Sitting down to a formal meal with set courses involves taking time over the food – usually longer than the 20 minutes that the hypothalamus needs to register “enough”. It also enables children to learn the value of regularly spaced and nutritionally balanced meals. If slow-glucose-releasing foods are taken at regular intervals, energy is released rather than stored as fat.

Cafeteria-style feeding and fast food outlets put the onus of choice upon the child. Children tend to select items they either know or that taste good – too often foods with a high refined carbohydrate and fat content. Canteen meals also require the child to select the entire meal in advance, as opposed to deciding after the first course whether a second course is necessary.

An increasing number of families do not have sit-down meals. Many children start the school day without breakfast with low level of blood glucose.

The body’s natural reaction to low blood sugar is to compensate by increasing adrenaline output. Such a biochemical combination can affect attention, concentration and impulse control. In the long term, sharp swings in blood sugar levels increase irritability, fatigue and bouts of hyperactivity. Food, after all, is fuel for the brain as well as the body.”[1]

Modern comforts such as central heating and transport mean that the amount of energy required is not the same as in former generations. Accounts of 7 course meals eaten by Darwin provide an example of this – but these feasts were consumed after walking from Chester to Shrewsbury – a very different consumption of energy from being driven to school.

Studies and research projects carried out in schools over the last 15 years have revealed a trend of decline in children’s physical skills, [2] [3] with a recent pilot project indicating that the prevalence of immature motor skills is higher amongst children from disadvantaged homes. The projects have identified a link between immature motor skills and lower educational performance.

The good news from some of these school based projects is that introduction of a daily movement programme can help to improve motor skills with “poverty related levels of dysfunction seeing a positive impact with complete closure of the gap between children from disadvantaged and advantaged backgrounds in measures of neuromotor performance and visual perception”[4]. The impact on visual perception is crucial because visual-perception is needed to support all written language tasks. In other words, physical skills affect more than simply physical coordination. The whole context of physical development and activity in the early years, matters.

When looking at solutions to problems such as childhood obesity, it is tempting to reach for simple answers, but obesity develops in a much broader context with many other factors being involved. Causes may include genetic determination of metabolic rate, early feeding patterns, diet selection financial resources and emotional problems that influence eating habits, but solutions must be found in the context of changing lifestyles and adjusting the culture surrounding food and children’s opportunity to engage actively with the physical environment to the physical needs of a changing world, to balance the equation as well as the scales for future generations.

[1] Goddard Blythe SA, 2001. Table Manners for a Tubby Nation. TES. 9th March 2001.

[2] Fylan F & Grunfeld B, 2004. An evaluation of the pilot INPP movement programme in primary schools in the North Eastern Education and Library Board (NEELB), Northern Ireland. www.neelb

[3] Duncombe R, Preedy P,. Accessed July 2019

[4] Scottish Attainment Challenge – Physical Active Health Intervention. 2019. Local Education Authority Report.

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