By Amy Fleming/The Guardian
Jusna Begum lives near the South Bank in London with her four children, aged
between one and 11. When a health visitor told her that her three-year-old girl was “on the chubby side”, Begum was surprised. “I didn’t think she was at all; I had felt like my children weren’t eating enough.”
She did, however, accept an invitation to join a six-week healthy parenting programme called Henry. Four weeks in, she has rebooted her family’s lifestyle, from making dinner times earlier to allow for more activity before bed to the food she prepares. Coming from an Asian background, says Begum, “There’s a lot of fatty food – we use a lot of oil and salt in curries.” Her children also loved drinking juice and snacking on crisps and chocolate after school. “I would just allow them,” she says, incredulously. “I thought it was normal.”
In following her health visitor’s advice, however, Begum is in a minority. Just one-third of parents who are informed that their child is overweight or obese accept any help offered to them. Peymané Adab, a professor of chronic disease epidemiology and public health at the University of Birmingham, has been developing obesity prevention and management programmes for nearly 20 years, including studying parental responses. ?There is definitely under-recognition of obesity,” she says. “Part of it is that we base our judgment on what’s normal, what’s around us, and as more children become obese and overweight you compare and say: ‘My child isn’t that overweight.’”
In the 1980s, less than 2% of those aged five to 10 were obese. These days, one-third of children are overweight or obese by the time they leave primary school, yet many adults don’t see the problem. A 2014 study in the British Journal of General Practice found that parents don’t tend to class their children as overweight until they are in the 99.7th centile, which is morbidly obese.
From age three and up, the main way parents are informed that their children are overweight is through the National Child Measurement Programme (NCMP), which registers children’s body mass index (BMI), once at four or five and again at 10 or 11. But BMI, a calculation based on weight and height, has limitations – for instance, it underestimates body fat in south Asian children (the demographic with the highest levels of childhood obesity) and overestimates it in black children.
Another problem with the NCMP is there is no hard and fast procedure on informing parents of the result – it was set up to monitor trends, not as a screening strategy. “Some local authorities contact families of the children who were overweight and try to get them to engage in services; some don’t do anything other than send a letter,” says Adab. “We don’t know what the best approach is.” Many simply don’t trust the figures. “Even colleagues here, working in academia, have said they’ve binned that letter because they think it’s rubbish.”
Attempts have been made to word the notification differently, to little effect. “It’s an impenetrable problem,” says Adab – and it is exacerbated by our sugar-coated and deep-fried food culture. Her daughter was given chocolate by teachers as a reward. “I was part of our parent-teacher group and remember trying to speak up, saying maybe we shouldn’t have so many sweets,” she recalls. “All the parents thought I was from another planet.”
At least in primary school, there is some control over what children eat; the newfound autonomy of starting secondary school – and the sweet shops and fried chicken joints that come with it – poses the greatest challenge. Taste preferences are formed in early life: even exposure to flavours in the womb influences later habits, while sugar – separate to weight gain – conditions our brains to crave ever-bigger sweet fixes. “From a young age we can start getting children used to less sugar and less fat,” says Dr Angela Donin of the Population Health Research Institute at St George’s, University of London. “If they’re more used to snacking on savoury crackers that are high in oats or bran, and fruit and nuts, that will hopefully shape their preferences.”
Donin’s research has found that having a large breakfast every day, particularly a high-fibre cereal, is associated with lower adiposity. But swapping that in for sugary cereals can be difficult, not least because even plain old bran flakes are usually at least 10% sugar – you still have to read the labels.
For parents who are anxious about their children becoming obese, the temptation can be to restrict certain foods and stress the terrible consequences of eating them – but this approach comes with its own concerns about instilling complexes. “It is a difficult balance, but I don’t think we should be saying there are taboo foods that we shouldn’t have,” says Adab. “That extreme has definitely been shown to lead to problems. It’s fine to have sweets on occasion but it should be no more than once a week. Every day we drink water rather than fizzy drinks.” But this isn’t easy, she says, and there needs to be a bigger buy-in from schools and parents. “If it became the norm it would be different.”
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