Weigh to go

A MOTHER and daughter shopping trip ought to be a happy occasion but one Dublin-based mother dreads it. “My 10-year-old daughter has been overweight for a few years now and has become increasingly ashamed of her body as a result,” says the mother, who asked not to be named.

“She’s constantly saying ‘I’m fat’, especially when she comes out of dressing rooms.”

This mother has been struggling to deal with the problem. “I’ve modified the family’s diet and we don’t buy processed foods anymore,” she says.

“She is growing into her weight now but I worry about the damage that has already been done. She feels bad about herself because she is fatter than her friends at school.”

As a nation, we are getting fatter and so are our children. According to the Growing Up in Ireland Study released last year, 26% of nine-year-old children are either overweight or obese. It’s something medical professionals encounter in their work all too often and they are very worried about it.

“We have huge referral rates at Tallaght Children’s Hospital and it’s worrying for both the individual and society,” says Meave Graham, a paediatric dietician. “Overweight children face health risks such as diabetes, high blood pressure and heart problems. The medical system is finding it hard to deal with these issues now. Imagine what it’s going to be like in the future.”

These aren’t the only medical problems faced by overweight children. They are at greater risk of developing high cholesterol, bone and joint problems, sleep apnoea, stroke, osteoarthritis and several types of cancer.

The National Taskforce on Obesity found 2,000 Irish people are already dying prematurely due to obesityrelated illnesses every year, costing the state up to €4 billion annually. If our children are getting fatter, this problem is going to get worse.

Ruth Charles, a dietitian who founded Nutrikids which focuses on the nutritional needs of infants, children and adolescents, couldn’t agree more. “It’s more and more of an issue,” she says. “It used to be the case that it was a problem with teenagers starting secondary school and becoming more sedentary but now it starts much younger. I’ve seen 20-month old children who are obese.”

While experts are quick to recognise the problem, many parents are slow to do so. 54% of parents of overweight children and 20% of parents of obese children questioned for the Growing Up in Ireland Study said their child was “about the right weight” for their height, with parents who were overweight themselves being least likely of all to recognise their child had a weight problem.

“Getting people to recognise the problem is a big issue,” says Ruth Charles. “We’re a great country for excuses and I don’t know how many times I’ve heard the one about being big boned, not fat.”

While some families may be in denial about their children’s problems, this doesn’t mean they don’t exist. Overweight children make easy targets for schoolyard bullies and many suffer from low self-esteem as a result.

“My daughter hates having to get changed for PE at school because someone always says something,” says the mother we interviewed for this article. “I’ve had her come home from school in tears.”

Ruth Charles thinks this is common. “These children’s self esteem can take a huge knock,” she says. “Other people look at them differently. They cut the labels off their clothes so that nobody can see they are wearing clothes two to three ages too big. It gets to the point where they don’t want to go out and they can become more isolated and inactive. It’s a downward spiral.”

Aoife Brinkley, senior clinical psychologist at Temple Street Children’s Hospital and member of a team that oversees a weight treatment programme called W8 2 Go, is keenly aware the effect excess weight has on a child’s confidence.

“Not all of the children we deal with have psychological issues with their weight but the majority would, especially when you go into the older age groups,” she says.

“They are withdrawn and anxious and many of them have suffered from bullying.”

So, what should a parent do in this situation? Should they put their child on a diet?

Meave Graham is adamant that a diet is not the answer. “We never mention the word diet,” she says. “It’s a sensitive issue and you don’t want to talk about diets. You don’t want to single the child out either. It should be a case of looking at the whole family and what they eat.”

Ruth Charles recommends a multi-faceted solution. “There’s a package of factors involved in obesity,” she says. “One or more parents may be overweight. Family eating habits may be bad. There might be a lack of education as to healthy and unhealthy food. We’re certainly less active than we used to be. And the type of food we are eating has changed. We consume the same amount of calories but we’re eating more fat and sugar. Because a package of factors causes this, a package of factors will contribute to the solution.”

Aoife Brinkley also believes in taking a dynamic approach. W8 2 Go combines the work of dieticians, physiotherapists, paediatricians, nurses and psychologists. They have worked with 260 children over the past six years and their approach has always been a multi-disciplinary one.

“We work with children from the age of six upwards who have quite significant weight problems,” she says. “Essentially, we enrol them and their parents in a healthy lifestyle programme where they become part of a group that sees us for two hours every week for six weeks.”

During this time, the group follows various activities. The children play games under the guidance of the physiotherapist. “This gives them confidence in being active in front of their peers,” says Aoife Brinkley. “A lot of these children have opted out of sports so this is an important thing for them to do.”

As a psychologist, Aoife herself works with the children around issues of self-esteem and bullying. She also works with the parents on parenting skills.

“The parents are given a lot of information as part of this group work,” she explains. “They learn about portion sizes, fats and sugars and food labels and we even bring them on a supermarket trip to buy healthy food.”

This holistic approach is now considered best practice. “In many ways, it’s a simple equation: these children are taking in more energy than they are using,” says Aoife Brinkley. “But there are emotional and behavioural issues that make it more complicated. Changing behaviour is not as simple as it sounds. But involving the parents enhances the effectiveness of the treatment. They control what their children eat.”

Meave Graham believes the figures speak for themselves. “Three out of five adults are overweight and they are more likely to have overweight children,” she says. “We need to look at the entire family’s eating habits and lifestyle and take a family-based approach.”

Even school-based programmes such as Food Dudes - which encourages children to eat more fruit and vegetables and has been run in more than 2,300 primary schools since 2007 - recognises the role that family has to play. “Food Dudes introduces children to a variety of fruit and vegetables,” says Mike Neary, who manages the programme for Bórd Bia.

“They taste them at school and get rewarded for eating them. But the second phase of the programme is just as important and it involves the parents and getting the children to eat more fruit and vegetables at home. This is perhaps the most vital part of all.”

Some 90% of the food children eat comes from their own home so it’s obvious that parents are the ones who need to be educated. But what do they need to know?

“The National Children’s Food Survey in 2004 found that children’s school lunches contained too much salt and sugar,” says Meave Graham. “87% ate sweets, crisps and chocolate on a daily basis. These should be occasional treats so there shouldn’t be a stock of them in your cupboard.”

Ruth Charles goes further in her desire to see parents better educated. “We need a public health campaign as healthier parents lead to healthier children,” she says. “This campaign should include everything from pre-natal care and breast feeding to weaning stages, when to introduce different foods and what is a healthy food and why.”

If education is key to the solution to this problem, it seems class has its role to play too. The Growing Up in Ireland Study found children from unskilled manual working class households were significantly more likely to be overweight and obese (boys 29% and girls 38%) than their peers from professional households (boys 19% and girls 18%).

“There is definitely a class element with a higher frequency of weight problems in lower socio-economic groups,” says Aoife Brinkley. “But it’s not as simple as education. Access to safe play areas can be an issue with some families. They might live in a flat complex and there might be bullying in the community, so much so that it’s not safe to let the children out. Then there’s the perception that healthy food is more expensive to prepare.”

Ruth Charles has a different opinion. “It used to be class related and there was an issue with lack of education but not so much anymore,” she says. “It’s just that the middle class has the funds to do something about the problem.”

While there are differing views as to the causes of childhood obesity, the solutions are for the most part the same. “Leave the TV and the computer and get outdoors and get active,” recommends Meave Graham. “Sixty minutes a day of moderate activity will make a big difference.”

“Recognise that there is a problem and take action,” urges Ruth Charles. “Start by changing one thing like not buying a certain food.”

“Take a whole family approach,” says Aoife Brinkley. “Increase your activity by walking to the shops, cycling to school and doing things as a family so that it’s not all about the one overweight child. Watch your access to high-fat and sugar treats and increase your intake of fruit and vegetables. Also be aware of your own role as a model of healthy behaviour. Eat well and your children probably will too.”

Ruth Charles is optimistic about the long-term outcome. “Kids are lucky,” she says. “If you can manage to keep them at the weight they are at, they will grow into it. There’s no real need for weight loss. So, get them more active.” With children, it’s all about the long-term approach, says Aoife Brinkley. “You don’t want to just focus on the diet and losing weight. That’s a short-term approach. You want a long-term approach that changes the behaviour.”

That is what the mother of the 10-year-old girl with weight problems is hoping for. “We’re working on it as a family,” she says. “Her weight is probably going to go. I just hope it’s not going to leave her with psychological problems.”

HEALTHY EATING TIPS FOR FAMILIES

1. Establish regular meal times. Children should have three meals and two healthy snacks every day. Eat together as much as possible, making mealtimes fun and sociable occasions.

2. Foods that are high in fat or sugar - crisps, sweets, biscuits, chips, etc - should only be eaten in small amounts once or twice a week. Limit the amount of these treats that are available at home.

3. Children should have six to eight cups of non-sugary drinks every day. Water, milk and sugar-free squash are good options while fizzy drinks are to be avoided.

4. Children should have at least five portions of fruit and vegetables every day.

5. Reduced sleep has been linked to obesity, so improve sleep routines. Aim for between nine and 11 hours a night.

6. Aim for at least 60 minutes of fun moderate physical activity every day.

7. Make activity a part of your routine. Walk or cycle to school. If getting the bus, get off one stop earlier and walk the rest of the way. Use stairs instead of lifts. Do housework. Play games.

8. Set realistic goals for the family: small steps are much more likely to lead to long-term lifestyle change and improved health.

9. Even if you are only concerned about one family member, make changes for the whole family. You don’t want that child feeling singled out.

10. Have fun by involving the family in meal planning and preparation and even growing some food. Play more.

Dance together. All of this counts as activity and it’s fun.

¦ If you are worried about your child’s weight, talk to your GP