Call to action on childhood obesity

A study in Denmark that helps children fight obesity has had unprecedented success. Could it be replicated here, asks Sharon Ni Chonchuir.

A DANISH study has had unprecedented success in treating childhood obesity. Using a set of simple rules, paediatrician Dr Jens Christian Holm has helped more than 3,500 overweight and obese young people to lose weight and maintain a healthy lifestyle.

Is there really a straightforward way of treating the global obesity epidemic? And is there anything Ireland could learn from this study? One in four — about 327,000 — primary school children in Ireland are overweight or obese. These children are at risk of developing diabetes, high blood pressure, and heart disease in adulthood, and many develop health problems long before then.

A recent study by Temple Street Children’s Hospital found that children as young as three were suffering from arthritis and bone breakages as a result of the impact their weight had on their bones.

Denmark’s child obesity problem is similar in scale to Ireland’s. Dr Holm started his study in 2008. It focuses on young people aged between three and 24. All are initially admitted to hospital for 24 hours of tests to determine blood pressure, body fat, and more. They and their families then fill out detailed questionnaires about their diets and lifestyles.

“We ask about breakfast, lunch, and dinner, and what they drink and what sweets, fast foods, and snacks they eat during the day,” says Dr Holm.

“We ask how much time they spend watching TV and using computers; how much physical activity they do; how long they sleep; and more. Then we tailor a programme for them, making approximately 20 changes to their lives.”

Each programme is different but based on a general regime of three meals, lots of water, at least one hour of physical activity, and adequate sleep every day. The participants and their families follow this programme and check in with a team of paediatricians, dieticians, and nurses for a total of five hours per child per year.

Just how have they achieved their remarkable results with so little medical supervision?

Dr Holm believes the seriousness of his message is the key.“Lots of doctors will tell you 20 changes are too many for a child to make but they are wrong,” he says. “Children and families have to understand what they are up against when it comes to obesity.

All of these children want to lose weight and many have already tried and failed. That’s because the body fights weight loss to preserve body mass. Anyone who wants to lose weight has to put in a huge effort to counter that. We tell our patients there are no compromises.”

Temple Street Children’s Hospital has run W82GO, an intervention programme for overweight children, since 2008. Its dietician Niamh Kelly thinks the Danish study shows that Denmark takes child obesity more seriously than we do.

“We set three goals on our programme and sometimes children find it difficult to complete all three,” she says.

“In Denmark, they make 20 changes at their initial assessment. Even the fact they are admitted to hospital for initial tests demonstrates that the child and family recognise obesity as a serious disease and are willing to go to great lengths to reverse it.”

W82GO may not be as strict as the Danish programme but does share some similarities. Both follow a multidisciplinary lifestyle approach.

“Being overweight is not just about calories,” says Kelly. “There are a multitude of reasons why children become obese including diet, genetics, physical activity, sleep, parental factors, and more. All need to be considered in any intervention.”

A team of physiotherapists, paediatricians, nurses, psychologists and dieticians are involved in W82GO’s 12-month healthy lifestyle programme. They help children participate in sports, work on self-esteem, and learn about the importance of eating well and staying active. They teach parents about nutrition, reading labels, and shopping as well as skills such as setting goals and limits.

Like the Danish study, it works best if the whole family is on board.

“We only see the children for a limited period of time over the 12 months,” Ms Kelly said. “We educate and motivate them but it’s the parents who have the greater influence. They control what food is available and what physical activity the child can get involved in.”

The W82GO programme is being run in Tallaght, Cork, and Mayo on a pilot basis and there are other schemes targeting child obesity nationwide. These include Don’t Weight Parents in Galway, the Triple P Parenting Programme in the Midlands, and Healthy Food Made Easy in Cork, Dublin, Kildare, Wicklow, Longford, Westmeath, Laois, and Offaly.

“Work is being done at regional level in Ireland but more needs to be done,” says Dr Cliodhna Foley-Nolan from Safefood Ireland, a government agency that provides advice and support on healthy eating.

“We live in an obesogenic environment and when it comes to childhood obesity, we shouldn’t focus on the child alone. This is a problem that needs a whole family and maybe even a whole society to counter it.”

Dr Foley-Nolan thinks the Danish programme could be transplanted to Ireland, with modifications for cultural differences. However, Kelly believes that more financial investment would be necessary to replicate its success.

“They have the money, resources, and government support to back up a well-researched multidisciplinary approach,” she says.

“The scale of their obesity problem is similar to ours but there is no comparison between the two countries when it comes to the funding and resources available. We need a lot more.”

Dr Holm is adamant that we also need to become more serious in our approach. “Doctors are not doing a good job at the moment and children are suffering as a result,” he says.

“The medical profession is letting the children down by compromising and the children are the ones paying the price.”

MAKE A CHANGE

The treatment programme devised by Dr Holm and his team in Denmark involves each child making approximately 20 lifestyle changes. Here are some examples.

1. Always eat breakfast but avoid sweetened cereals, fruit yoghurts, and white bread. Choose oatmeal, brown bread, meat, fish, or vegetables instead.

2. Portions should be served up in the kitchen, not from pots and pans at the table.

3. Plate proportions at dinner should be half vegetables, a quarter brown rice, pasta, or potatoes, and a quarter low-fat fish or meat.

4. Wait 20 minutes before having second helpings. This allows time for the body to feel full.

5. Make sure you feel satisfied after each meal. Otherwise you’ll be tempted to snack later.

6. Never eat at the computer or while watching TV. You are likely to eat more if you do.

7. Limit fruit to two portions a day.

8. Limit fast food to once a month.

9. Limit sweets to once a week.

10. Limit juice, soda, iced tea, cocoa, and lemonade to once a week or half a litre in total. Sweet drinks create sugar dependence. Drink water instead.

11. Don’t watch TV or use the computer until after 5pm and only spend a maximum of two hours a day in front of a screen.

12. Go to bed early and at a set time.

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