tag:theconversation.com,2011:/au/topics/childhood-obesity-1955/articlesChildhood obesity – The Conversation2024-03-18T12:24:52Ztag:theconversation.com,2011:article/2232702024-03-18T12:24:52Z2024-03-18T12:24:52ZFree school meals for all may reduce childhood obesity, while easing financial and logistical burdens for families and schools<figure><img src="https://images.theconversation.com/files/580529/original/file-20240307-16-nylyj3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">School meal waivers that started with the COVID-19 pandemic stopped with the end of the public health emergency.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/plymouth-ma-a-student-at-plymouth-county-intermediate-news-photo/1242013592">Jonathan Wiggs/The Boston Globe via Getty Images</a></span></figcaption></figure><p>School meals are critical to child health. Research has shown that <a href="https://doi.org/10.3390/nu9090924">school meals can be more nutritious</a> than meals from other sources, such as meals brought from home. </p>
<p>A recent study that one of us conducted found the quality of school meals has steadily improved, especially since the 2010 <a href="https://doi.org/10.1001/jama.2020.9517">Healthy, Hunger-Free Kids Act</a> strengthened nutrition standards for school meals. In fact, by 2017, another study found that school meals provided the <a href="https://doi.org/10.1001/jamanetworkopen.2021.5262">best diet quality</a> of any major U.S. food source.</p>
<p>Many American families became familiar with universal free school meals during the COVID-19 pandemic. To ease the financial and logistical burdens of the pandemic on families and schools, the <a href="https://www.fns.usda.gov/coronavirus">U.S. Department of Agriculture issued waivers</a> that allowed schools nationwide to provide free breakfast and lunch to all students. However, these <a href="https://www.fns.usda.gov/cn/offsite-monitoring-after-phe#">waivers expired</a> by the 2022-23 school year. </p>
<p>Since that time, there has been a substantial increase in schools participating in the <a href="https://www.fns.usda.gov/cn/community-eligibility-provision">Community Eligibility Provision</a>, a federal policy that allows schools in high poverty areas to provide free breakfast and lunch to all attending students. The policy became available as an option for low-income schools nationwide in 2014 and was part of the <a href="https://obamawhitehouse.archives.gov/sites/default/files/Child_Nutrition_Fact_Sheet_12_10_10.pdf">Healthy, Hunger-Free Kids Act</a>. By the 2022-23 school year, <a href="https://frac.org/cep-report-2023">over 40,000 schools</a> had adopted the Community Eligibility Provision, an increase of more than 20% over the prior year.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wsFvSmkYbVU?wmode=transparent&start=30" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Many families felt stressed when a federal program providing free school meals during the pandemic came to an end.</span></figcaption>
</figure>
<p>We are <a href="https://scholar.google.com/citations?user=ihU7JuoAAAAJ&hl=en">public health</a> <a href="https://scholar.google.com/citations?user=VkqyJPcAAAAJ&hl=en">researchers who</a> study the health effects of nutrition-related policies, particularly those that alleviate poverty. Our newly published research found that the Community Eligibility Provision was associated with a net <a href="https://doi.org/10.1542/peds.2023-063749">reduction in the prevalence of childhood obesity</a>.</p>
<h2>Improving the health of American children</h2>
<p>President Harry Truman <a href="https://www.fns.usda.gov/nslp/nslp-fact-sheet">established the National School Lunch Program</a> in 1946, with the stated goal of protecting the health and well-being of American children. The program established permanent federal funding for school lunches, and participating schools were required to provide free or reduced-price lunches to children from qualifying households. Eligibility is <a href="https://www.fns.usda.gov/cn/fr-020923">determined by income</a> based on federal poverty levels, both of which are <a href="https://www.federalregister.gov/documents/2024/01/17/2024-00796/annual-update-of-the-hhs-poverty-guidelines#">revised annually</a>.</p>
<p>In 1966, the <a href="https://www.fns.usda.gov/cna-amended-pl-111-296">Child Nutrition Act</a> piloted the <a href="https://www.fns.usda.gov/sbp/program-history">School Breakfast Program</a>, which provides free, reduced-price and full-price breakfasts to students. This program was later made permanent through an amendment in 1975.</p>
<p>The <a href="https://www.fns.usda.gov/cn/community-eligibility-provision">Community Eligibility Provision</a> was piloted in several states beginning in 2011 and became an option for eligible schools nationwide beginning in 2014. It operates through the national school lunch and school breakfast programs and expands on these programs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Gloved hand placing cheese slices on bun slices" src="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Various federal and state programs have sought to make food more accessible to children.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/cafeteria-worker-puts-together-sandwiches-for-free-meals-as-news-photo/1213018954">John Moore/Getty Images</a></span>
</figcaption>
</figure>
<p>The policy allows all students in a school to receive free breakfast and lunch, rather than determine eligibility by individual households. Entire schools or school districts are eligible for free lunches if at least 40% of their students are directly certified to receive free meals, meaning their household participated in a means-based safety net program, such as the <a href="https://fns-prod.azureedge.us/sites/default/files/resource-files/NSLPDirectCertification2016.pdf">Supplemental Nutrition Assistance Program</a>, or the child is identified as runaway, homeless, in foster care or enrolled in Head Start. Some states also <a href="https://www.fns.usda.gov/cn/direct-certification-medicaid-demonstration-project">use Medicaid for direct certification</a>.</p>
<p>The Community Eligibility Provision increases school meal participation by <a href="https://doi.org/10.2105/AJPH.2011.300134">reducing the stigma</a> associated with receiving free meals, eliminating the need to complete and process applications and extending access to students in households with incomes above the eligibility threshold for free meals. As of 2023, the eligibility threshold for free meals is 130% of the federal poverty level, which amounts to US$39,000 for a family of four.</p>
<h2>Universal free meals and obesity</h2>
<p>We analyzed whether providing universal free meals at school through the Community Eligibility Provision was associated with lower childhood obesity before the COVID-19 pandemic.</p>
<p>To do this, we measured <a href="https://doi.org/10.1542/peds.2023-063749">changes in obesity prevalence</a> from 2013 to 2019 among 3,531 low-income California schools. We used over 3.5 million body mass index measurements of students in fifth, seventh and ninth grade that were taken annually and aggregated at the school level. To ensure rigorous results, we <a href="https://doi.org/10.1016/j.jeconom.2020.12.001">accounted for differences</a> between schools that adopted the policy and eligible schools that did not. We also followed the same schools over time, comparing obesity prevalence before and after the policy.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child scooping food from salad bar onto a tray; other children lean against the wall" src="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=381&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=381&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=381&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=479&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=479&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=479&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Free school meals may help reduce health disparities among marginalized and low-income children.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/westbrook-middle-school-fifth-grade-student-salem-bukasa-news-photo/469592304">Whitney Hayward/Portland Portland Press Herald via Getty Images</a></span>
</figcaption>
</figure>
<p>We found that schools participating in the Community Eligibility Provision had a <a href="https://doi.org/10.1542/peds.2023-063749">2.4% relative reduction</a> in obesity prevalence compared with eligible schools that did not participate in the provision. Although our findings are modest, even small improvements in obesity levels are notable because effective strategies to reduce obesity at a population level <a href="https://doi.org/10.1038/s41574-019-0176-8">remain elusive</a>. Additionally, because obesity <a href="http://dx.doi.org/10.15620/cdc:106273">disproportionately affects</a> racially and ethnically marginalized and low-income children, this policy could contribute to reducing health disparities.</p>
<p>The Community Eligibility Provision likely reduces obesity prevalence by substituting up to half of a child’s weekly diet with healthier options and simultaneously <a href="https://doi.org/10.1016/j.jhealeco.2022.102646">freeing up more disposable income</a> for low-to-middle-income families. Families receiving free breakfast and lunch save approximately $4.70 per day per child, or $850 per year. For low-income families, particularly those with multiple school-age children, this could result in meaningful savings that families can use for other health-promoting goods or services.</p>
<h2>Expanding access to school meals</h2>
<p>Childhood obesity <a href="https://doi.org/10.1542/peds.2021-053708">has been</a> <a href="https://doi.org/10.1001/jama.2020.14590">increasing over</a> the past several decades. Obesity often <a href="https://doi.org/10.1111/obr.12334">continues into adulthood</a> <a href="https://theconversation.com/obesity-in-children-is-rising-dramatically-and-it-comes-with-major-and-sometimes-lifelong-health-consequences-202595">and is linked</a> to a range of <a href="https://doi.org/10.2105/ajph.2016.303326">chronic health conditions and premature death</a>. </p>
<p>Growing research is showing the benefits of universal free school meals for the health and well-being of children. Along with our study of California schools, other researchers have found an association between universal free school meals and reduced obesity in <a href="https://doi.org/10.1086/723824">Chile</a>, <a href="https://doi.org/10.1016/j.ssmph.2022.101072">South Korea</a> and <a href="https://doi.org/10.1016/j.pubecp.2022.100016">England</a>, as well as among <a href="https://doi.org/10.1002/pam.22175">New York City schools</a> and school districts in <a href="https://doi.org/10.1162/edfp_a_00380">New York state</a>.</p>
<p>Studies have also linked the Community Eligibility Provision to <a href="https://doi.org/10.3368/jhr.57.3.0518-9509R3">improvements in academic performance</a> and <a href="https://doi.org/10.3102/00028312231222266">reductions in suspensions</a>.</p>
<p>While our research observed a reduction in the prevalence of obesity among schools participating in the Community Eligibility Provision relative to schools that did not, obesity increased over time in both groups, with a greater increase among nonparticipating schools.</p>
<p>Universal free meals policies may slow the rise in childhood obesity rates, but they alone will not be sufficient to reverse these trends. Alongside universal free meals, identifying <a href="https://theconversation.com/fixing-the-global-childhood-obesity-epidemic-begins-with-making-healthy-choices-the-easier-choices-and-that-requires-new-laws-and-policies-207975">other population-level strategies</a> to reduce obesity among children is necessary to address this public health issue.</p>
<p>As of 2023, <a href="https://www.americanprogress.org/article/5-states-addressing-child-hunger-and-food-insecurity-with-free-school-meals-for-all/">several states have implemented their own</a> universal free school meals policies. States such as California, Maine, Colorado, Minnesota and New Mexico have pledged to cover the difference between school meal expenditures and federal reimbursements. As more states adopt their own universal free meals policies, understanding their effects on child health and well-being, as well as barriers and supports to successfully implementing these programs, will be critical.</p><img src="https://counter.theconversation.com/content/223270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Jones-Smith receives funding from the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Anna Localio does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Since nutrition standards were strengthened in 2010, eating at school provides many students with healthier food than is available cheaply elsewhere. Plus, reducing stigma increases the number of kids getting fed.Anna Localio, Ph.D. Candidate in Health Services, University of WashingtonJessica Jones-Smith, Associate Professor of Health Systems and Population Health, Epidemiology, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2079752023-07-28T12:19:57Z2023-07-28T12:19:57ZFixing the global childhood obesity epidemic begins with making healthy choices the easier choices – and that requires new laws and policies<figure><img src="https://images.theconversation.com/files/539667/original/file-20230726-15-ftjegw.jpg?ixlib=rb-1.1.0&rect=14%2C51%2C4877%2C3388&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Clean and safe city parks can be important factors in supporting kids' health and well-being. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.mx/detail/ilustraci%C3%B3n/children-playing-in-the-city-park-ilustraciones-libres-de-derechos/478266830?phrase=children+playing+in+green+parks&adppopup=true">paci77/DigitalVision Vectors via Getty Images</a></span></figcaption></figure><p>The global childhood obesity epidemic has exploded. Over the past four decades, the world has witnessed a <a href="https://doi.org/10.1016/S0140-6736(17)32129-3">tenfold increase</a> in <a href="https://theconversation.com/obesity-in-children-is-rising-dramatically-and-it-comes-with-major-and-sometimes-lifelong-health-consequences-202595">obesity in children and adolescents</a> between 5 and 19 years old. </p>
<p>More than 124 million children across the world are <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#cms">currently considered to be obese</a>. In children under age 5, obesity used to be nearly unheard of. Now, more than 38 million young children live with this condition. </p>
<p>Researchers now estimate that there are <a href="https://doi.org/10.1016/S0140-6736(17)32129-3">more obese children than underweight children worldwide</a>. Children and adolescents who are obese are <a href="https://doi.org/10.1111/obr.12334">more likely to become obese adults</a>, setting them up for a lifelong trajectory of poor health. </p>
<p>With this growth in childhood obesity comes an <a href="https://www.cdc.gov/obesity/basics/consequences.html">increase in associated poor mental and physical health outcomes</a>. Conditions that were once rare in children are <a href="https://doi.org/10.1016/j.mayocp.2016.09.017">now becoming increasingly common</a>. These debilitating and costly diseases include <a href="https://www.who.int/news-room/fact-sheets/detail/hypertension#">hypertension</a>, <a href="https://www.cdc.gov/diabetes/basics/type2.html">type 2 diabetes</a> and others. </p>
<p>I am a <a href="https://scholar.google.com/citations?user=4WSwC68AAAAJ&hl=en&authuser=1">public health researcher</a> who studies and teaches about the factors underlying the obesity epidemic. My research seeks to understand what is driving these trends. Why are more and more people, including children, becoming obese?</p>
<h2>Parsing the numbers</h2>
<p>Childhood obesity was once <a href="https://doi.org/10.1038/sj.ijo.0802804">predominantly an issue within developed nations</a>. But it has become an emerging health concern even in the poorest countries and regions.</p>
<p>The standard <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">measure used to determine obesity</a> in children and adolescents has long been the body mass index, or BMI. This is a measure of an individual’s height as compared to their weight. Children whose BMI is a set threshold above the mean, or average, are considered obese. The role of BMI in defining obesity in children and adults may be changing, however. </p>
<p>Although BMI remains a low-cost and practical method for assessing obesity across populations – such as estimating the percentage of children in a particular nation who are obese – <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">growing evidence has shed light on its limitations</a> for use at the individual and clinical level. <a href="https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policy-clarifying-role-bmi-measure-medicine">Leading medical organizations</a> and researchers are encouraging physicians to consider the use of alternative measures, which may change the way children are screened for health risks related to their weight at the doctor’s office.</p>
<h2>Critical role of parents and caregivers</h2>
<p>In essence, childhood obesity is the result of kids eating and drinking more calories than they are burning off through play, movement and growth. Because of this, researchers have largely focused on understanding the individual eating and physical activity habits of these kids. </p>
<p>In the case of childhood obesity, researchers like me also know that parental figures play critical roles in both <a href="https://doi.org/10.1111/j.1748-720X.2007.00111.x">mirroring and creating opportunities</a> for physical activity and healthy eating. </p>
<p>However, attempts to address childhood obesity have often focused excessively on <a href="https://doi.org/10.1093/heapro/daq052">individual behaviors of parents and children</a> and too little on the environment where children and their families live. Research and statistics make it clear that this approach has failed and that new strategies are needed to understand and address why more children are becoming obese.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&rect=8%2C16%2C5483%2C3639&q=45&auto=format&w=1000&fit=clip"><img alt="A male and female adult shop for vegetables with a child and examine tomatoes from a stall at a farmer's market." src="https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&rect=8%2C16%2C5483%2C3639&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents and caregivers play a major role in creating opportunities for healthy eating.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com.mx/detail/foto/family-shopping-at-organic-farmers-market-imagen-libre-de-derechos/602378307">Thomas Barwick/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<h2>Social determinants of childhood obesity</h2>
<p>Social determinants of health refer to the conditions where people live, learn, work, play and worship that affect health and quality of life.</p>
<p>The U.S. Department of Health and Human Services has <a href="https://health.gov/healthypeople/priority-areas/social-determinants-health">described five broad categories</a> of social determinants of health. These include: </p>
<ul>
<li>economic stability </li>
<li>education access and quality</li>
<li>health care access and quality</li>
<li>neighborhood and the built environment, such as access to sidewalks and playgrounds</li>
<li>social and community context </li>
</ul>
<p>Social determinants can promote health. For example, neighborhoods with access to safe parks and green spaces and healthy food retailers may support healthy eating and physical activity for families. </p>
<p>But social determinants can also facilitate or encourage unhealthy behaviors. Because of their underlying role in contributing to health outcomes like childhood obesity, social determinants have been described as the “<a href="https://doi.org/10.1177/00333549141291S206">causes of the causes</a>.” In other words, if poor diet is one of the causes of childhood obesity, then the social determinants that shape a child and their family’s food environment – such as lack of neighborhood grocery stores or limited income to purchase healthy foods – would be a cause of that poor diet.</p>
<h2>Role of processed foods and physical inactivity</h2>
<p>Globally, people are spending more time in cars and less time walking – one of the most basic forms of physical activity. Even in the poorest nations, <a href="https://www.ucl.ac.uk/dpu-projects/drivers_urb_change/urb_infrastructure/pdf_transport/HABITATII_Abraham_poolong_kuala_lumpur.pdf">private car ownership rates</a> are skyrocketing. Kids who would inadvertently be engaging in physical activity just by <a href="https://doi.org/10.1016/j.jenvp.2010.04.005">walking or biking to school</a> are more likely to be taking cars and buses to school instead. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/HBTUcBgBVV4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Inactivity from, for instance, excessive time spent sitting in front of the TV and other devices and lack of safe areas to play after school, is a major driver of the childhood obesity crisis.</span></figcaption>
</figure>
<p>When it comes to food, societies in the U.S. and around the world are <a href="https://doi.org/10.1017/S1368980018003762">producing and consuming more calorie-dense</a> <a href="https://theconversation.com/ultraprocessed-foods-like-cookies-chips-frozen-meals-and-fast-food-may-contribute-to-cognitive-decline-196560">ultra-processed foods</a>. Advertisers are targeting children with these food products and sugar-sweetened beverages online and on television. </p>
<p>But for working parents with long hours or those who are unable to afford healthy groceries, these are often the easiest or affordable options for feeding their children. In fact, poor families are more likely to live in communities designated as “<a href="https://doi.org/10.1007/s12115-016-9993-8">food deserts</a>,” areas where there are few or no grocery stores and a high concentration of fast-food restaurants and convenience stores.</p>
<p>And children’s lifestyles have changed drastically, shifting away from outdoor physical activity into an increasingly sedentary way of life, in large part due to <a href="https://doi.org/10.1071/he16026">social media</a> and <a href="https://doi.org/10.1016/j.jadohealth.2010.02.016">screen time</a>. The role of screen time in the childhood obesity epidemic is a <a href="https://doi.org/10.1542%2Fpeds.2016-1758K">significant and growing area of concern</a> and research. </p>
<p>In my own research in Peruvian communities, parents identified many of these same factors as <a href="https://doi.org/10.1080/13557858.2019.1591347">barriers to their children being physically active</a>. Mothers complained about the lack of safe spaces for their kids to play. Local parks were full of crime, and yards were congested with traffic and other safety hazards. Mothers felt it was safer for their young children to be inside watching TV than outside playing. </p>
<p>This example is not unique to Peru. Parents around the world are contending with these challenges.</p>
<h2>Addressing the underlying causes</h2>
<p>The field of public health prioritizes <a href="https://doh.wa.gov/community-and-environment/worksite-wellness/healthy-nutrition-guidelines/cafeterias/guidelines/easy-choices">making the healthy choice the easy choice</a>. Combating the childhood obesity epidemic means making healthy eating an easier choice for children and families than staying inside and eating processed foods. </p>
<p>However, the reality is that much of the world’s population now lives, works, plays and worships in places that make it more difficult to choose healthy behaviors.</p>
<p><a href="https://doi.org/10.1016%2Fj.amepre.2014.07.011">Policies</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK114231/">programs</a> that address the social determinants of health are a critical part of curbing the childhood obesity epidemic. These include investing in community resources like playgrounds and <a href="https://www.nationalparks.org/explore/programs/open-outdoors-for-kids">free programs</a> that get kids outside. </p>
<p>Some nations and even U.S. cities have implemented “<a href="https://doi.org/10.1001/jamanetworkopen.2022.15276">sin taxes</a>” on sugar-sweetened beverages to discourage consumption. In Chile, policies have been created that <a href="https://doi.org/10.1186/s12966-023-01454-w">limit television advertising of unhealthy food</a> products toward children. Other policy examples include tax incentives and <a href="https://www.cdc.gov/obesity/downloads/healthier_food_retail.pdf">programs that increase access to healthy foods</a> and lower their cost. </p>
<p>In my view, every kid should be able to swim in the safe and accessible community pool rather than relying on their living room TVs to escape the blistering summer heat, or access fresh and affordable produce in their neighborhood instead of having to rely on fast food as the only close food resource. Childhood obesity is a preventable condition that communities can reduce most effectively by increasing access to resources that will allow them to live healthy lives.</p><img src="https://counter.theconversation.com/content/207975/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathleen Trejo Tello has previously received funding from National Institutes of Health's Fogarty International Center.</span></em></p>Obese children outnumber underweight ones globally, and ‘social determinants’ in kids’ lived environments play a fundamental role. Obesity in kids can lead to a lifetime of poor health.Kathleen Trejo Tello, Assistant Professor of Public Health, College of CharlestonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2030832023-04-11T16:28:34Z2023-04-11T16:28:34ZCost of living: why decreased access to swimming is harming children and young people<figure><img src="https://images.theconversation.com/files/519526/original/file-20230405-20-svvpf0.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C4368%2C3040&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-happy-kids-swimming-pool-underwater-2142729027">YanLev/Shutterstock</a></span></figcaption></figure><p>Swimming is a unique activity. Not only is it an Olympic sport but it’s also a form of exercise and a life-saving endeavour. How many other physical activities can boast such a claim? </p>
<p>So, it is no surprise that swimming holds such appeal in the UK, where there is a diverse range of enthusiasts. We have Olympic champions, a world record holding <a href="https://www.swimmingworldmagazine.com/hall-of-fame/bio/swimmer/jane-asher">nonagenarian</a>, a new wave of <a href="https://theconversation.com/is-a-cold-water-swim-good-for-you-or-more-likely-to-send-you-to-the-bottom-89513">cold water dippers</a>, competitive swimmers and parent and toddler groups who all love the water. For children, swimming is both a sporting endeavour and a fun leisure activity that is frequently associated with hot summer holidays. </p>
<p>That’s what makes recent reports into the dire state of children’s swimming so concerning. Last summer, a <a href="https://www.bbc.co.uk/newsround/62504602">BBC report</a> found that between 2019 and 2022, one in six local authorities in the UK had seen at least one swimming pool close, on either a permanent or temporary basis. Swim England, the national governing body for swimming, has <a href="https://www.swimming.org/swimengland/active-lives-children-young-people-report-2022/">estimated</a> that around 1 in 4 children leave primary school unable to swim 25 metres. That number is expected to rise to as many as 6 in 10 by 2025. </p>
<p>The situation is <a href="https://www.bbc.co.uk/news/uk-wales-64413464">even more parlous in Wales</a>. The chief executive of Swim Wales, Fergus Feaney, recently focused on some worrying statistics when he <a href="https://cofnod.senedd.cymru/Committee/13455">gave evidence to the Senedd</a>’s local government committee, as part of its inquiry into council leisure services. </p>
<p>Of particular note was that the cost of swimming lessons had almost doubled from £6.50 before COVID to a current average of £12.50. He also revealed that only 50% of Welsh primary schools take part in swimming tuition programmes. Feaney left the enquiry with a <a href="https://www.bbc.co.uk/news/uk-wales-politics-65114781">concerning statement</a>:</p>
<blockquote>
<p>We’re going to have a situation very soon, dare I say it, that white middle class children will be able to swim and the rest won’t. </p>
</blockquote>
<p>This raises questions about what the consequences of a decline in access to swimming for young people may be. Broadly speaking, there is the risk to life if children are unable to swim but also an impact on physical health, mental health, and life skills. </p>
<h2>Drowning</h2>
<p>Almost 20% of the England’s population <a href="https://researchbriefings.files.parliament.uk/documents/CDP-2022-0153/CDP-2022-0153.pdf">live</a> in coastal areas. In <a href="https://www.hutton.ac.uk/sites/default/files/files/publications/hutton_coast_booklet_web.pdf">Scotland</a>, more than 40% of people live near the coast, while in <a href="http://assets.wwf.org.uk/downloads/marine_survey_report_final.pdf">Wales</a>, it’s more than 60%. </p>
<p>Along with the rise in interest in open water swimming in lakes, rivers and the sea, these combined factors means there are safety concerns about the reduction in the number of children who are not competent in the water. </p>
<p>Many academic studies have highlighted that <a href="https://web.s.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=15770354&AN=161251924&h=Hs9w7Cil5%2b0csRsb3oe3%2fdzvfZqjd3rvzMaEkCx3lwtkCWsd9Vy2iqJTxLv1VYL3MbT6kHkA4ok8OXYVq8f1DA%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d15770354%26AN%3d161251924">swimming lessons</a> provide significant protection against drowning. Although, this may seem intuitive, children’s lives are at increased risk in our waters and abroad if the trend towards decreased access to swimming lessons continues.</p>
<figure class="align-center ">
<img alt="A person wearing red stands next to a yellow surfboard on a beach next to the edge of the sea. Two yellow and red flags fly on a pole next to them." src="https://images.theconversation.com/files/519587/original/file-20230405-16-g0il7l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519587/original/file-20230405-16-g0il7l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519587/original/file-20230405-16-g0il7l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519587/original/file-20230405-16-g0il7l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519587/original/file-20230405-16-g0il7l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519587/original/file-20230405-16-g0il7l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519587/original/file-20230405-16-g0il7l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Almost 20% of the UK’s population live in coastal areas according to the Office for National Statistics.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/red-yellow-flag-on-beach-lyme-479071357">Savo Ilic/Shutterstock</a></span>
</figcaption>
</figure>
<p>It is now well known that physical activity has a positive impact on <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-813">physical health</a> and can protect against illness and poor health. Engagement in physical activity at a young age can have a significant impact on not only a child’s physical health but also on their health as they move into adolescence and adulthood.</p>
<p>An important issue raised by Swim Wales’ Feaney was the reduction in access for young people in deprived areas. These individuals are already at a <a href="https://www.semanticscholar.org/paper/The-association-between-area-based-deprivation-and-Twaits-Alwan/546bab5579e88454c57a129f30be2c0b840fdff6">high risk</a> of obesity. So, removing access to swimming lessons takes away not just a fun activity but a protective factor against early obesity.</p>
<p>Swimming is also a low-impact activity that puts minimal stress on the joints and muscles, making it an ideal form of exercise for children who may be prone to injury or who have limited mobility. At the same time, it’s also a full-body workout that engages all of the major muscle groups and encourages the development of fundamental movement skills.</p>
<h2>Mental health</h2>
<p>Beyond the undeniable impact on physical health, swimming has positive impacts on mental health and general wellbeing. Swimming has been shown to <a href="https://www.sciencedirect.com/science/article/pii/S0165032717318669?casa_token=DGtImIuTQfEAAAAA:Pvde2ZApHF-RaOU4czB_jkjZ-vQdkyR6DBkWQ89fzEXN5TnnKVSHmPKLZwnvUyDfG3LMeExYsXc">improve depressive symptoms</a>, <a href="https://www.sciencedirect.com/science/article/pii/S1877042814064611?via%3Dihub">reduce anxiety</a>, and protect against mental ill health. </p>
<p><a href="https://www.psychologytoday.com/gb/blog/suffer-the-children/201608/what-we-can-learn-michael-phelps-about-adhd">Michael Phelps,</a> arguably the greatest swimmer of all time, has spoken at length about how swimming enabled him to cope with his ADHD. </p>
<figure class="align-center ">
<img alt="A smiling man wearing a gold medal around his neck holds his right hand over his heart." src="https://images.theconversation.com/files/519545/original/file-20230405-20-ednh6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519545/original/file-20230405-20-ednh6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519545/original/file-20230405-20-ednh6u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519545/original/file-20230405-20-ednh6u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519545/original/file-20230405-20-ednh6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519545/original/file-20230405-20-ednh6u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519545/original/file-20230405-20-ednh6u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">American swimmer Michael Phelps won 23 Olympic gold medals during his career.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rio-de-janeiro-brazil-08092016-michael-1856047420">Salty View/Shutterstock</a></span>
</figcaption>
</figure>
<p>However, mental wellbeing is about more than the absence of poor mental health. Swimming can help maintain <a href="https://repository.canterbury.ac.uk/item/88281/benefits-of-swimming-for-young-children">self-esteem</a> and increase confidence. <a href="https://journals.sagepub.com/doi/full/10.1177/0031721716647026">It also facilitates the development of a growth mindset</a>, which is the belief that you can develop your skills through hard work.</p>
<p>Swimming from a very young age in parent and baby lessons even has the potential to <a href="https://journals.sagepub.com/doi/abs/10.1177/00315125221090203?journalCode=pmsb">influence cognitive and motor development</a> in infants.</p>
<p>Engagement in competitive swimming provides young people with transferable skills around discipline, time management, social interaction, teamwork and decision making. And whether for leisure or competitive purposes, swimming has the potential to be a lifelong activity, providing us with some of the very building blocks we need to maintain a happy and healthy lifestyle. </p>
<p>The UK’s swimming governing bodies have now united under a campaign, which aims to “<a href="https://scottishswimming.com/news/save-our-pools/">save our pools</a>”. Indeed, swimming should be viewed as essential for the health of the nation for years to come, and therefore needs to be protected.</p><img src="https://counter.theconversation.com/content/203083/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Howells does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Access to swimming in the UK has been hit by COVID and the cost of living crisis and that has consequences for children and young people.Karen Howells, Senior Lecturer in Sport and Exercise Psychology, Cardiff Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952632023-01-26T13:24:11Z2023-01-26T13:24:11ZPeople blame and judge parents for children’s heavier weights<figure><img src="https://images.theconversation.com/files/503477/original/file-20230106-10808-bsbh5r.jpg?ixlib=rb-1.1.0&rect=237%2C1%2C721%2C537&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Would you hold the mother responsible for her daughter's weight?</span> <span class="attribution"><span class="source">Courtesy of Steve Neuberg, Arizona State University, and Jaimie Krems, Oklahoma State University</span></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Americans stigmatize parents of heavier children, specifically <a href="https://doi.org/10.1177/09567976221124951">blaming them for their children’s weights</a>, according to experiments conducted by <a href="https://scholar.google.com/citations?user=CpXzPwgAAAAJ&hl=en&oi=ao">our</a> <a href="https://scholar.google.com/citations?user=ofYV4l0AAAAJ&hl=en&oi=ao">team</a> <a href="https://scholar.google.com/citations?user=qiWqHHYAAAAJ&hl=en&oi=ao">of</a> <a href="https://scholar.google.com/citations?user=brp7lrcAAAAJ&hl=en&oi=ao">psychologists</a>.</p>
<p>The more a person views parents as responsible for a child’s excess weight, the more likely they are to <a href="https://doi.org/10.1111/cob.12202">view such parents as bad parents</a> who are lazy, overindulgent and incompetent.</p>
<p>Our findings corroborate what parents of children with higher weights have reported for years: that other people – friends, other parents, strangers or <a href="https://www.nytimes.com/2023/01/20/well/family/childhood-obesity-guidelines.html">even their pediatricians</a> – <a href="https://doi.org/10.1111/cob.12202">might blame them, dislike them and think they are poor parents</a>. </p>
<h2>Why it matters</h2>
<p>In the U.S., <a href="https://www.hsph.harvard.edu/obesity-prevention-source/obesity-trends-original/global-obesity-trends-in-children">about 1 in 3 children</a> have body mass indexes that would be categorized as overweight or obese. The number has <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm7037a3_w">grown during the COVID-19 pandemic</a>, meaning an increasing number of parents face stigma on account of their child’s weight.</p>
<p>This <a href="https://doi.org/10.1016/j.acap.2021.09.019">parental weight stigma</a> is just beginning to receive serious scientific attention but could have major effects on parents, children and families. </p>
<p>For example, <a href="https://www.washingtonpost.com/blogs/on-parenting/post/ohio-mom-loses-custody-of-obese-son-should-the-government-penalize-parents-of-obese-children/2011/11/28/gIQA1v665N_blog.html">family courts</a> <a href="https://www.cbsnews.com/news/five-year-olds-removal-from-family-spotlights-obesity-intervention/">across the U.S.</a> and <a href="https://www.theguardian.com/society/2021/mar/10/two-teenagers-placed-in-foster-care-after-weight-loss-plan-fails">internationally</a> have removed children with obesity from parental custody in large part due to their children’s weights. Family separation can have massive <a href="https://socialchangenyu.com/review/the-harm-of-child-removal/">negative effects on children</a>. <a href="https://doi.org/10.1177/09567976221124951">Our work</a> suggests that if judges react as our study participants did, they may view parents of heavier children as being bad parents simply because their children are heavier. </p>
<p>In reality, <a href="https://www.ncbi.nlm.nih.gov/sites/books/NBK19935/">weight is not solely</a> <a href="https://doi.org/10.1093/bmb/ldx022">under personal control</a>. In fact, <a href="https://doi.org/10.1016/j.jada.2006.12.013">dieting can</a> <a href="https://doi.org/10.1093/emph/eow031">cause weight gain</a>. Excess weight arises from a <a href="https://www.ncbi.nlm.nih.gov/sites/books/NBK19935/">complex interplay of genes, environment, diet and activity</a>. </p>
<p>Psychologists also know that <a href="https://psycnet.apa.org/record/2005-16248-000">weight stigma is associated with pervasive negative consequences</a>, including bullying, ignorant comments and feelings of painful invisibility – as well as diminished educational and <a href="https://doi.org/10.1037/a0020860">economic opportunities</a> and <a href="https://doi.org/10.1177/0956797615601103">worse medical outcomes importantly not simply due to one’s weight</a>. Experiencing weight stigma, insidiously, <a href="https://doi.org/10.1038/s41591-020-0803-x">might itself facilitate weight gain</a> and cause other negative effects.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A child's feet standing on a digital scale." src="https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Everyone loses in the blame game.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/childs-foot-on-fashionable-digital-scale-royalty-free-image/892826582">roman023/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>What still isn’t known</h2>
<p>If people blame and stigmatize parents of children with higher weights, what effects does it have on parents, on their children and on the parent-child interactions that are so important for healthy development? </p>
<p>We do not yet know, for example, if heavier children are aware people stigmatize their parents. If so, these children might not only be ashamed of their size, but also might erroneously feel responsible for how people treat their parents.</p>
<h2>How we do our work</h2>
<p>For this research, published in the journal Psychological Science, we ran <a href="https://doi.org/10.1177/09567976221124951">three experiments with over 1,000 U.S. participants</a> – about 75% white and 25% other races/ethnicities – over the course of 2022. </p>
<p>We randomly assigned participants to view one of four line drawings depicting a mother or father next to an 8-year-old daughter or son. We also included a short description of the parent and child. </p>
<p>In two of the line drawings and descriptions, the child was described and depicted as “healthy”-weight. In the other two, the child was depicted and described as having “obesity.” The parents were always depicted and described as being healthy-weight. This allowed us to conclude that study participants’ reactions to parents were due to their children’s weights, not the parents’.</p>
<p>We asked participants a few short questions about how good or bad a parent they thought the adult was. Participants also answered questions about what they believed influenced the child’s weight (as well as their academic performance and athleticism, to help obscure the focus of the study). Participants were given 100 “responsibility points” to allot to four factors that could be behind the child’s weight: parent behavior, child behavior, genetic factors and societal factors. </p>
<p><iframe id="wQDu1" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/wQDu1/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>As expected, people who viewed the child with obesity assigned more responsibility points to parent behavior and saw that parent as a worse parent. We found parent and child gender made little difference, <a href="https://doi.org/10.1016/j.acap.2021.09.019">consistent with other work</a>. </p>
<p>This is <a href="https://doi.org/10.1056/NEJMp1206519">consistent with previous research</a> showing people blame parents for children’s obesity more than people blame society or the kids themselves. </p>
<p>We also tested whether providing alternative explanations for the child’s weight would decrease the amount of blame parents received for it. When we told participants the child had a thyroid condition that caused her excess weight, they stigmatized the mother less, holding her less responsible.</p>
<p>Next, our team is exploring how parents’ own weight, income and race/ethnicity influences the stigma directed toward them on account of their child’s excess weight.</p><img src="https://counter.theconversation.com/content/195263/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While excess weight arises from a complex interplay of genes, environment, diet and activity, new research finds Americans hold parents responsible for excess weight in their kids.Jaimie Arona Krems, Assistant Professor of Psychology, Oklahoma State UniversityDevanshi Patel, Ph.D. Candidate in Clinical Psychology, Oklahoma State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1931832023-01-11T12:32:51Z2023-01-11T12:32:51ZWhy food deprivation in childhood is linked to obesity<figure><img src="https://images.theconversation.com/files/503211/original/file-20230105-15-zc5zbn.jpg?ixlib=rb-1.1.0&rect=10%2C21%2C7088%2C4704&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overweight-european-teenage-girl-hoodie-jeans-2166512821">Natalia Lebedinskaia/Shutterstock</a></span></figcaption></figure><p>As energy prices rise and the cost of living goes up, it is estimated that there are 4 million children from poorer households who have limited or uncertain access to healthy food.</p>
<p>My current PhD research is examining how this childhood food insecurity affects eating behaviour. Research suggests that food deprivation in childhood leads to obesity.</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398923/">2017 study</a> found that children between the age of eight and ten from homes that do not have easy access to healthy food are five times more likely to be obese compared to those from households that have enough food. </p>
<p>The study, which looked at 50 mothers and their children, found that children in households where food scarcity is a problem ate food when they were not hungry and were more likely to eat five or more snacks per day. </p>
<p>This is what is known as the “<a href="https://pubmed.ncbi.nlm.nih.gov/27464638/">insurance hypothesis</a>” – the theory is that people who do not have ready access to food eat more to store energy when they do have food, to avoid hunger in the future when food is scarce.</p>
<p>But another <a href="https://pubmed.ncbi.nlm.nih.gov/34551836/">recent study</a> conducted with 394 adults in the UK found no difference in the total energy intake of food-insecure and food-secure people. What it did find, though, was that the diet of people without ready access to healthy food was high in carbohydrates, with less fibre and protein than other people in the study. </p>
<p>The time gaps between when food-insecure people ate were also inconsistent when compared to those with ready access to healthy food. This could be due to financial reasons. The people who lacked access to food could not keep regular intervals between meals, but instead ate as food became available. </p>
<p>These research findings are concerning because eating <a href="https://www.nih.gov/news-events/nih-research-matters/eating-highly-processed-foods-linked-weight-gain">high-calorie foods</a> (often high in sugar and fats and classed as unhealthy food items) and <a href="https://pubmed.ncbi.nlm.nih.gov/25648986/">skipping meals</a> have been found to be linked with obesity.</p>
<p>It suggests that eating practices which result from food insecurity are factors that can lead to obesity. </p>
<h2>The role of stress</h2>
<p>The emotional toll of a childhood living in poverty may also lead to obesity. A 2018 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958160/">research review</a> of the factors leading to childhood obesity looked at the role played by family environment. </p>
<p>It suggests that low income, the inability to access or afford nutritious food and the stress caused by lack of income and food create a negative psychological and emotional environment for children. This family disharmony disrupts homeostasis – the body’s ability to monitor and maintain its internal state.</p>
<figure class="align-center ">
<img alt="Sad young girl looking out of window" src="https://images.theconversation.com/files/503214/original/file-20230105-2380-upc9wf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503214/original/file-20230105-2380-upc9wf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503214/original/file-20230105-2380-upc9wf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503214/original/file-20230105-2380-upc9wf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503214/original/file-20230105-2380-upc9wf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503214/original/file-20230105-2380-upc9wf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503214/original/file-20230105-2380-upc9wf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Stress has been linked to emotional eating.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-child-looking-out-window-on-23398030">gemphoto/Shutterstock</a></span>
</figcaption>
</figure>
<p>Over time, this research suggests, this can lead to obesity. One way this can happen is through overeating to cope with stress – what is known as “emotional eating” – when we use food to soothe or make ourselves feel better.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0195666313004741">Increased stress levels</a> cause <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831158/#:%7E:text=Stress%20and%20emotional%20brain%20networks%20foster%20eating%20behaviors,brain%20and%20food%20intake%20are%20now%20better%20understood">dysregulation</a> of certain peptides and hormones in the body, such as insulin, cortisol and ghrelin. In turn, higher levels of these hormones and peptides are associated with increased appetite for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831158/#:%7E:text=Stress%20and%20emotional%20brain%20networks%20foster%20eating%20behaviors,brain%20and%20food%20intake%20are%20now%20better%20understood">high-calorie foods</a>. </p>
<p>Children are particularly affected because they are in the process of developing habits that will last into adulthood. Negative emotions cause changes in parts of the brain that are responsible for the development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831158/">habits and memory</a>. If children eat comfort foods to reduce distress and this <a href="https://pubmed.ncbi.nlm.nih.gov/24931366/">becomes a habit</a>, they will use the same strategy to respond to <a href="https://pubmed.ncbi.nlm.nih.gov/24931366/">future stress</a>. Over time, this could lead to obesity. </p>
<h2>Emotional eating</h2>
<p>Other research studies have explored the link between emotional eating and obesity. A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593860/">study</a> conducted in 2019 with 150 adults explored the relationship between obesity and socioeconomic disadvantage, psychological distress and emotional eating. </p>
<p>It found that lower socioeconomic status was associated with higher distress, and that higher distress was associated with higher levels of emotional eating. In turn, higher emotional eating was associated with higher BMI.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.23033">Research carried out</a> at the University of Salford with more than 600 adults also found that that food insecurity was associated with a poorer diet, and that greater distress and eating to cope was linked with higher BMI. </p>
<p>This research was conducted with adults rather than looking at the childhood causes of obesity. But it suggests that psychological distress and subsequent emotional eating is a pathway that links poverty with obesity. </p>
<p>What’s more, a study <a href="https://pubmed.ncbi.nlm.nih.gov/19391020/">carried out in the US</a> with 676 adolescents from diverse backgrounds found that perceived stress, worries and confused mood were associated with emotional eating. </p>
<p>In the UK, 29% of men and 27% of women <a href="https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2019/main-findings">are obese</a>. This rate will be higher in the coming years if more is not done to protect children living in poverty.</p><img src="https://counter.theconversation.com/content/193183/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Khizra Tariq does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The emotional stress of growing up in a poor household may contribute to obesity.Khizra Tariq, PhD Candidate in the Nutrition, Psychopharmacology & Brain Development Unit, University of SalfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1937182022-11-03T19:00:57Z2022-11-03T19:00:57ZIs child obesity really going to shorten lives?<figure><img src="https://images.theconversation.com/files/493169/original/file-20221102-12-kspvcc.jpg?ixlib=rb-1.1.0&rect=43%2C0%2C4875%2C2641&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-young-children-running-towards-camera-289559627">Shutterstock</a></span></figcaption></figure><p>Rising life expectancy is one of the great success stories. If you were born in 1870, you’d expect to live until you were 30. But if you were born today, you’d <a href="https://ourworldindata.org/life-expectancy">expect</a> to live to 72, and the UN predicts it will continue to rise to 82 years by 2100. <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features10Mar+2011#:%7E:text=During%201881%2D1890%2C%20the%20average,83.9%20years%20for%20newborn%20girls">Australian</a> life expectancy is currently 84.</p>
<p>There is the occasional blip – world wars, famines, pandemics (even COVID seems to have knocked a year or so off life expectancy <a href="https://www.nature.com/articles/s41562-022-01450-3">globally</a>) – but over time, it just goes marching on.</p>
<p>That’s why I was surprised to read a <a href="https://hw.qld.gov.au/wp-content/uploads/2022/10/HWQld_Impact-of-Obesity-on-Life-Expectancy-in-Queensland_October-2022.pdf">report from Health and Wellbeing Queensland</a>, a government agency, suggesting life expectancy would fall by 0.6-4.1 years for children born in Queensland next year. According to the report, the problem is obesity.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1587606666631061504"}"></div></p>
<p>While being overweight and obese increases your risk of serious diseases, it doesn’t mean children born in Queensland or the rest of Australia will have a shorter life expectancy. </p>
<h2>Child obesity isn’t rising much, but we get heavier as we age</h2>
<p>The proportion of children who are obese and overweight in Australia rose very rapidly from about 1970, but <a href="https://pubmed.ncbi.nlm.nih.gov/19823187/">plateaued at about 25%</a> in the mid-1990s, and has remained thereabouts pretty much ever since. </p>
<p>But the likelihood of becoming overweight or obese increases throughout the lifespan, or at least until deep old age. So as the current crop of kids age, they get heavier. When I was 40, 55% of my cohort were overweight or obese. By the time I was 60, it was 75%.</p>
<h2>Life expectancy and obesity have both increased</h2>
<p>Obesity <a href="https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks">increases the risk</a> of the major killer diseases: heart disease, stroke, diabetes, and cancer — and many other conditions. </p>
<p>So, the Health and Wellbeing Queensland report argues, we can expect a tsunami of obesity-related deaths in the future, even without an increase in current levels of childhood obesity.</p>
<p>At first blush, this sounds plausible.</p>
<p>But life expectancy has been increasing in countries where obesity has been increasing for decades. The obesity-related reduction in life expectancy previously <a href="https://click.endnote.com/viewer?doi=10.1155%2F2012%2F107989&token=WzMzNTQ0ODAsIjEwLjExNTUvMjAxMi8xMDc5ODkiXQ.OO78w18iQk5KASiZCC7c_gYdVUo">predicted</a> hasn’t happened. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/obesitys-paradoxical-impact-on-trends-in-life-expectancy-7981">Obesity's paradoxical impact on trends in life expectancy</a>
</strong>
</em>
</p>
<hr>
<h2>Obesity is associated with a higher risk of death but being moderately overweight isn’t</h2>
<p>A slew of <a href="https://pubmed.ncbi.nlm.nih.gov/23511854/">studies</a> involving <a href="https://pubmed.ncbi.nlm.nih.gov/23280227/">millions of people</a> have found, rather counter-intuitively, that although slightly overweight people are more likely to get heart disease and diabetes, or suffer strokes, they live longer. </p>
<p>These studies find that life expectancy is greatest at a body mass index (BMI) of about 27: pretty much in the middle of the overweight range. </p>
<p>However, obesity (BMI of 30 or more) is consistently associated with a higher risk of premature death.</p>
<figure class="align-center ">
<img alt="Woman on scales" src="https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our weight tends to increase as we age.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-photo-woman-legs-stepping-on-1947168976">Shutterstock</a></span>
</figcaption>
</figure>
<h2>So what’s the problem with the report?</h2>
<p>First, the report assumes “business as usual” – that is, childhood obesity levels will remain high, and the risk of disease and death associated with a given level of fatness won’t change. </p>
<p>But business is never as usual. Medical treatments improve, diet and activity change. </p>
<p>In fact, several studies have found that the level of fatness associated with the lowest risk of death has been increasing over time.</p>
<p>One <a href="https://jamanetwork.com/journals/jama/fullarticle/2520627">Danish study</a> found that in a cohort from 1977, the lowest risk of death occurred at a BMI of 24. By 1992, it was 25, and by 2008 it was 27. This probably reflects better medical treatment of people who are overweight or obese. </p>
<p>So by the time these children reach adulthood, even if they remain obese, their chance of dying prematurely will be less than it is today.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/obesity-has-become-the-new-normal-but-its-still-a-health-risk-118829">Obesity has become the new normal but it's still a health risk</a>
</strong>
</em>
</p>
<hr>
<h2>Some data underpinning the modelling are questionable</h2>
<p>There’s a second problem with this report. To estimate how much being overweight or obese increases the risk of death, the report relies on a <a href="https://www.sciencedirect.com/science/article/pii/S0140673609603184">2009 study</a> by an Oxford University-based group called The Prospective Studies Collaboration. </p>
<p>In contrast to the studies mentioned above, this study found the risk of death was lowest at a BMI of about 23-24. </p>
<p>However, the study relied in part on self-reported height and weight, and people tend to underestimate their BMI (we all think we’re a little taller and a little leaner than we really are). </p>
<p>This bias means that in these studies based on self-report, the lowest risk of death actually occurs at a higher BMI, rather than the reported 23-24.</p>
<p>This methodological flaw (and others) have been <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/jcsm.12378?fbclid=IwAR3us6e4MNq8-tsZ3SAM1o2u_EEPlluE8x3NircHqCdKAFpjfXn_YZbngHU&">pointed out</a> in relation to a different study using a similar methodology.</p>
<p>Another issue is that as we age, the BMI associated with the lowest risk of death increases. <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30288-2/fulltext">One British study</a> found that under the age of 50, the “least lethal” BMI is about 23. By the age of 80, it is closer to 28. </p>
<p>So that as people age, higher levels of fatness carry less risk. This may be because fat provides a nutritional reserve, or cushioning from falls, or because older people get better medical care. </p>
<figure class="align-center ">
<img alt="Woman walks on trail with poles" src="https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The studies on life expectancy aren’t what you’d expect.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overweight-woman-walking-on-forest-trail-1756682804">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Separating science from activism</h2>
<p>Finally, it troubles me that the report is openly activist in its intent. </p>
<p>The executive summary states that “to build social licence” for changes such as sugar taxes and advertising bans:</p>
<blockquote>
<p>people need to accept the gravity of the situation and believe that maintaining healthy weight for children is not solely a parental responsibility.</p>
</blockquote>
<p>This conclusion is nowhere justified by this report. The report doesn’t analyse factors driving obesity at all. It merely makes a mathematical projection of life expectancy. </p>
<p>Predictions about life expectancy arise from time to time, and we should always be wary about taking them at face value. As US baseballer Yogi Berra <a href="https://www.economist.com/letters-to-the-editor-the-inbox/2007/07/15/the-perils-of-prediction-june-2nd">said</a>, “It’s tough to make predictions, especially about the future.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-is-dragging-its-feet-on-healthy-eating-in-5-years-weve-made-woeful-progress-192393">Australia is dragging its feet on healthy eating. In 5 years we've made woeful progress</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/193718/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Olds has received funding from the ARC and NHMRC, as well as SA Health.</span></em></p>A new report predicts child obesity could reduce Australian life expectancy by more than four years. Here’s why you should be a little skeptical.Tim Olds, Professor of Health Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1808912022-07-05T13:46:15Z2022-07-05T13:46:15ZHealthy eating: children think their peers eat more unhealthy snacks than they actually do – changing this perception can lead to better diets<figure><img src="https://images.theconversation.com/files/471594/original/file-20220629-14-7zbvyy.jpg?ixlib=rb-1.1.0&rect=6%2C0%2C4578%2C3444&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-taking-potato-chips-inside-bag-1133783375">Stock_Good/Shutterstock</a></span></figcaption></figure><p>Obesity is a growing problem among young people in the UK. In 2020-21, 40.9% of year six children (age 10-11) were <a href="https://digital.nhs.uk/news/2021/significant-increase-in-obesity-rates-among-primary-aged-children-latest-statistics-show">measured as overweight or obese</a>. <a href="https://cls.ucl.ac.uk/wp-content/uploads/2020/12/CLS-briefing-paper-Obesity-prevalence-MCS-age-17-initial-findings.pdf">Research shows</a> that childhood obesity increases the likelihood of living with obesity as an adult. </p>
<p>Frequent snacking on foods high in fat, salt and sugar, such as crisps and chocolate bars, may be one factor contributing to high obesity rates. The UK government recommends that snack foods like this should be <a href="https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-10-healthier-eating#:%7E:text=eat%20at%20least%205%20portions,fat%20and%20lower%20sugar%20options">eaten rarely and only in small amounts</a> as part of a healthy diet. </p>
<p>But when we surveyed 252 11 and 12-year-old students at two English secondary schools to understand the perceived social norms for snacking on foods high in fat, salt and sugar, <a href="https://www.sciencedirect.com/science/article/abs/pii/S019566632100369X">we found that</a> students often overestimated the extent to which other students ate this kind of snack. We’ve also found that what their peers do appears to heavily influence how young people eat.</p>
<p>We <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjhp.12581">used these results</a> to find a way to reduce snacking among children, by informing them of this misconception.</p>
<h2>Snacking habits</h2>
<p>A <a href="https://cph.temple.edu/about/news-events/news/study-finds-association-between-adolescent-overweightobesity-and-snacking">2019 study</a> found that teens classified as overweight or obese ate more snacks which were high in salt, fat and sugar daily than those who were normal weight. </p>
<p>Our research started by trying to understand what influences young people’s diets through <a href="https://www.emerald.com/insight/content/doi/10.1108/BFJ-07-2019-0575/full/html">focus group discussions</a>. We found that young people aged 11 and 12 viewed their fellow students as strong influences on what they should be eating, and that they could be teased for eating more healthily. </p>
<p>We then focused on addressing misperceptions of <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02180/full">social norms</a> as a way to change the young people’s snacking behaviour. <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02180/full">Perceived social norms</a> are the unwritten rules or expectations that guide what we personally think or do based on what we think most other people think or do. </p>
<h2>Challenging misconceptions</h2>
<p>An approach based on social norms works by correcting these misperceptions between perceived and actual behaviour. Our research group has used this approach to address other health behaviour, such as <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258985">attitudes towards vaccine uptake</a> and understanding university students’ use of <a href="https://www.jsad.com/doi/abs/10.15288/jsad.2015.76.430">alcohol</a> and <a href="https://www.jsad.com/doi/abs/10.15288/jsad.2016.77.740">other drugs</a>. No studies had yet used this approach to understand snacking behaviour in students starting secondary school.</p>
<figure class="align-center ">
<img alt="Person selecting snack from vending machine" src="https://images.theconversation.com/files/471656/original/file-20220629-24-3rg1tr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471656/original/file-20220629-24-3rg1tr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471656/original/file-20220629-24-3rg1tr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471656/original/file-20220629-24-3rg1tr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471656/original/file-20220629-24-3rg1tr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471656/original/file-20220629-24-3rg1tr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471656/original/file-20220629-24-3rg1tr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">According to UK government advice, snacks high in salt, fat and sugar should be consumed rarely.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sell-technology-consumption-concept-hand-pushing-597624332">Syda Productions/Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S019566632100369X">We found that</a>, on average, students aged 11 and 12 overestimated how many snacks high in salt, fat or sugar their peers ate by 3.2 snack portions a day. We then <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjhp.12581">developed a campaign</a>, based at a school, to challenge these assumptions.</p>
<p>Students designed posters for display in their school. These featured information from the survey data we collected, showing that the students consumed fewer snacks than the common perception. We developed the campaign together with students and teachers. Based on their suggestions, we ran a competition where students voted for the best posters to be displayed around the school. </p>
<p><a href="https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjhp.12581">We found</a> that the 163 students who took part in the campaign were less likely to overestimate their peers’ attitudes to snacking, compared with students at another school who formed a control group. After three months, students at the school where we ran the campaign ate fewer snacks high in fat, salt and sugar, and had less positive attitudes towards snacking on these foods, compared with the control group.</p>
<p>Understanding beliefs around social norms, as well as involving young people in tackling misperceptions, can offer one way to help tackle the growing problem of obesity in children and teenagers.</p><img src="https://counter.theconversation.com/content/180891/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We wanted to find a way to reduce how much children snack on foods high in fat, salt and sugar.Rachel Povey, Associate Professor in Health Psychology, Staffordshire UniversityRobert Dempsey, Senior Lecturer in Psychology, Manchester Metropolitan UniversitySian Calvert, Research associate in the School of Medicine, Faculty of Medicine & Health Sciences, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1845282022-06-07T21:18:08Z2022-06-07T21:18:08ZEnding child hunger and food insecurity needs to be a top priority in Canada as well as globally<figure><img src="https://images.theconversation.com/files/467557/original/file-20220607-16-zd5db7.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5127%2C3440&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In the last three decades, the world has made considerable progress in reducing child malnutrition, but there is still work to do.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Achieving food security, improving nutrition and promoting sustainable agriculture are key to reaching one of the United Nations’ most critical Sustainable Development Goals: <a href="https://sdgs.un.org/goals/goal2">Zero Hunger</a>.</p>
<p>The goal is important for all people, but is crucial for children. There is work to do to meet this goal not just in low- and middle-income countries, but also in high-income countries. In <a href="https://proof.utoronto.ca/food-insecurity/#:%7E:text=1%2520in%25206%2520Canadian%2520children,these%2520households%2520are%2520food%252Dinsecure.">Canada</a> and the <a href="https://www.feedingamerica.org/sites/default/files/2019-05/2017-map-the-meal-gap-child-food-insecurity_0.pdf">United States</a>, <a href="https://www.fao.org/3/al936e/al936e00.pdf">food insecurity affects one in six children</a>. </p>
<p>Children rely on adults to nourish their growth and <a href="https://data.unicef.org/resources/fed-to-fail-2021-child-nutrition-report/">prepare them to become successful adults</a> in an increasingly <a href="https://www.fao.org/state-of-food-security-nutrition">precarious world of pandemics, war and climate change</a> — all of which threaten the global food supply, food affordability and the equitable distribution of food.</p>
<p>In my book <a href="https://www.ubcpress.ca/small-bites"><em>Small Bites: Biocultural Dimensions of Children’s Food and Nutrition</em></a>, I examine the challenges of feeding and nourishing children.</p>
<h2>Feeding children is a collective responsibility</h2>
<p>As a species, humans are “<a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674060326">co-operative breeders</a>.” For much of our evolutionary history, nurturing children has fallen on parents, grandparents, older siblings and extended relations.</p>
<p>Today that responsibility also extends to institutions such as daycares, schools and governments. It’s a responsibility that regrettably we have not adopted as our highest collective priority.</p>
<figure class="align-center ">
<img alt="Four children, three of them sitting at a table with green lunch trays." src="https://images.theconversation.com/files/467559/original/file-20220607-16-fxr7qu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467559/original/file-20220607-16-fxr7qu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467559/original/file-20220607-16-fxr7qu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467559/original/file-20220607-16-fxr7qu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467559/original/file-20220607-16-fxr7qu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467559/original/file-20220607-16-fxr7qu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467559/original/file-20220607-16-fxr7qu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Today, the collective responsibility for child nutrition includes institutions such as daycares, schools and ultimately governments.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In the past three decades, the world has made considerable progress in reducing child malnutrition.</p>
<p>In Nepal, where I conducted children’s nutrition research in the 1990s, an alarming <a href="https://doi.org/10.1371/journal.pone.0145738">60 per cent of children under five were stunted</a>, a term used to describe kids who are short for their age due to chronic malnutrition.</p>
<p>From 2001 to 2011 the prevalence of stunting in Nepal declined to 41 per cent from 57 per cent — the most rapid improvement ever documented.</p>
<p><a href="https://doi.org/10.1016/j.gfs.2017.02.001">A study</a> of this reduction in Nepal isolated five factors:</p>
<ul>
<li><p>improvements in maternal nutrition, increasing average birth weights</p></li>
<li><p>rapid growth in household income</p></li>
<li><p>educational improvements, especially in maternal education</p></li>
<li><p>increased access to health care, particularly prenatal, neonatal and postnatal</p></li>
<li><p>sizeable improvements in sanitation</p></li>
</ul>
<p>These improvements were brought about by broad social, economic and policy changes at both community and national levels, featuring the combined efforts of many partners.</p>
<p>Still, the world has a long way to go to achieve zero hunger by 2030, in keeping with the Sustainable Development Goals.</p>
<p><a href="https://data.unicef.org/resources/jme-report-2021/">In 2020</a>, 22 per cent of all children in the world under the age of five were stunted, 6.7 per cent suffered from wasting (being too thin for their height due to acute malnutrition) and 5.7 per cent were overweight.</p>
<p>Stunting and wasting are mostly low-income country phenomena, but even children being overweight — often assumed to occur only in high-income countries — is now common in middle- and low-income populations. The so-called “<a href="https://apps.who.int/iris/bitstream/handle/10665/255413/WHO-NMH-NHD-17.3-eng.pdf">double burden of malnutrition</a>” — being both undernourished and overweight — occurs in tandem with stunting and wasting within an individual, household or population. </p>
<p>For example, an individual with obesity may also have nutritional deficiencies due to a poor diet. At the household level, one member may be living with obesity while another has a nutrient deficiency such as anemia. On a larger scale, this double burden can affect neighbourboods, cities and regions. </p>
<h2>Child food insecurity in Canada and the United States</h2>
<figure class="align-center ">
<img alt="Brown paper bags with lunch items in them, seen from above" src="https://images.theconversation.com/files/467542/original/file-20220607-26-nbgu3q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467542/original/file-20220607-26-nbgu3q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467542/original/file-20220607-26-nbgu3q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467542/original/file-20220607-26-nbgu3q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467542/original/file-20220607-26-nbgu3q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467542/original/file-20220607-26-nbgu3q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467542/original/file-20220607-26-nbgu3q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bagged lunches await stapling before being distributed to students at a U.S. elementary school.</span>
<span class="attribution"><span class="source">(AP Photo/Rogelio V. Solis)</span></span>
</figcaption>
</figure>
<p>Child malnutrition is no stranger to high-income countries. In <a href="https://proof.utoronto.ca/food-insecurity">Canada</a> and the <a href="https://www.feedingamerica.org/sites/default/files/2019-05/2017-map-the-meal-gap-child-food-insecurity_0.pdf">United States</a>, food insecurity is more prevalent in households with children under 18, affecting about 17 per cent in this age group.</p>
<p>In Canada, food-insecure households with children are more likely to be headed by <a href="https://www.homelesshub.ca/sites/default/files/attachments/FOOD_INSECURITY_2020_EXEC_EN.pdf">lone parents and more likely to identify as Black or Indigenous</a>.</p>
<p>While the U.S. has a range of federally funded programs to address child hunger, such as the <a href="https://www.fns.usda.gov/wic#:%7E:text=The%2520Special%2520Supplemental%2520Nutrition%2520Program%2520for%2520Women%252C%2520Infants%252C,who%2520are%2520found%2520to%2520be%2520at%2520nutritional%2520risk.">Special Supplemental Nutrition Program for Women, Infants, and Children</a> and the <a href="https://www.fns.usda.gov/nslp">National School Lunch Program</a>, Canada has no government-funded programs dedicated to supporting children’s nutrition. It is the only nation in the <a href="https://www.healthyschoolfood.ca/post/school-food-in-the-g7-the-time-is-ripe-for-canada-to-catch-up">G7 without a national school meal program</a>.</p>
<p>Instead, Canada has a range of charitable efforts such as school breakfast programs and food banks staffed by volunteers.</p>
<p>What’s especially concerning in Canada is the lack of action at all levels of government to address the problem of food insecurity for children that is prevalent — and growing. In a <a href="https://www.unicef.ca/en/unicef-report-card-14-child-well-being-sustainable-world">UNICEF report</a> on youth well-being in 41 high-income nations, Canada was ranked 37 in working toward the Zero Hunger goal for children. Canada ranked ahead of only Malta, Turkey, Mexico and Bulgaria, with the U.S. ranked just above Canada at 36.</p>
<h2>What can we do to end child hunger and malnutrition?</h2>
<p>Reducing child poverty is critical.</p>
<p>Unfortunately, <a href="https://www.nytimes.com/2022/01/05/upshot/biden-child-tax-credit.html">U.S. President Joe Biden’s expansion of the existing federal child tax credit in 2021 during the coronavirus pandemic expired after Congress failed to extend it in 2022</a>. </p>
<figure class="align-center ">
<img alt="A child sitting in a grocery cart reaching for produce, with a man in a yellow shirt behind him" src="https://images.theconversation.com/files/467560/original/file-20220607-18-27qhan.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467560/original/file-20220607-18-27qhan.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467560/original/file-20220607-18-27qhan.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467560/original/file-20220607-18-27qhan.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467560/original/file-20220607-18-27qhan.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467560/original/file-20220607-18-27qhan.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467560/original/file-20220607-18-27qhan.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rising inflation has increased food costs, which has only heightened the crisis in children’s food security and malnutrition.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In Canada, cash transfers to families such as the <a href="https://www.canada.ca/en/revenue-agency/services/child-family-benefits/canada-child-benefit-overview.html">Canada Child Benefit</a> have helped to reduce poverty, but are not enough. <a href="https://proof.utoronto.ca/wp-content/uploads/2017/06/Paper-Tarasuk-BIG-EN-17.06.13-1712.pdf">Basic income guarantee</a> programs would go far toward reducing the most severe food insecurity among those at the lowest income levels.</p>
<p>In 2019, Prime Minister Justin Trudeau’s federal Liberal government announced its long-awaited <a href="https://agriculture.canada.ca/sites/default/files/legacy/pack/pdf/fpc_20190614-en.pdf">National Food Policy</a> that included, among other promises, a federal commitment to work with the provinces and territories to develop a national school food program to deliver healthy food to children before and during school.</p>
<p>Sadly, COVID-19 has stalled the implementation of that policy, while rising inflation has <a href="https://www.thestar.com/business/2022/05/18/lettuce-oranges-butter-and-beef-the-cost-of-grocery-staples-has-surged-again-and-theres-no-end-in-sight.html">increased food costs</a>, which only heightened the crisis in children’s food security and malnutrition. </p>
<p>A recent <a href="https://globalnews.ca/news/8863987/baby-formula-shortage-in-canada-leads-to-panic-buying">infant formula shortage in the United States that also affected Canada</a> is emblematic of the necessity for government intervention to ensure that goods vital to children’s survival are not under the complete control of the food industry. </p>
<p>Now more than ever, food policies targeting children are needed from all branches of government.</p><img src="https://counter.theconversation.com/content/184528/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tina Moffat receives funding from SSHRC, CIHR, and GWF. </span></em></p>Child malnutrition is no stranger to high-income countries. In Canada and the U.S., food insecurity affects one in six children under 18, but policies to address the issue are still lacking.Tina Moffat, Associate Professor, Department of Anthropology, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737392022-01-21T02:39:03Z2022-01-21T02:39:03ZKids whose grandparents are overweight are almost twice as likely to struggle with obesity<figure><img src="https://images.theconversation.com/files/441235/original/file-20220118-25-113hyg.jpg?ixlib=rb-1.1.0&rect=52%2C52%2C6937%2C4380&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/happy-grandparents-grandchildren-sitting-desk-600w-646595593.jpg">Shutterstock</a></span></figcaption></figure><p>School holidays can be a special time for extended families to gather. Children may see their grandparents at seasonal gatherings or as part of childcare arrangements to help working parents. New <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13405">research</a> suggests the biology, environment and the food they share contributes to children’s future health.</p>
<p>According to the World Health Organization, <a href="https://www.who.int/news/item/06-05-2021-the-unicef-who-wb-joint-child-malnutrition-estimates-group-released-new-data-for-2021">39 million children under five years are overweight</a>. Some 25% of Australian children and adolescents <a href="https://www.aihw.gov.au/reports/overweight-obesity/overweight-obesity-australian-children-adolescents/summary">are overweight or obese</a>.</p>
<p>How parents contribute to their offspring’s obesity risk is <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2010.00751.x">well established</a> but the link between grandparents and grandchildren has been less clear. Our <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13405">systematic review</a> of studies involving more than 200,000 people around the world confirms obesity is transmitted across multiple generations of families. We still need to figure out why and how to break this cycle. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/4-ways-to-get-your-kids-off-the-couch-these-summer-holidays-123918">4 ways to get your kids off the couch these summer holidays</a>
</strong>
</em>
</p>
<hr>
<h2>Setting up for a lifetime of health issues</h2>
<p>Obesity among children and adolescents is associated with developing health problems. These include high blood pressure, cholesterol imbalance, insulin resistance, diabetes mellitus, accelerated growth and maturity, orthopaedic difficulties, psychosocial problems, increased risk of heart disease and premature mortality. </p>
<p>We examined the current global evidence on the association between grandparents who are overweight or obese and the healthy weight status of their grandchildren. We looked at 25 studies that involved 238,771 people from 17 countries. The combined data confirms obesity is transmitted multigenerationally – not just from parent to child but also from grandparent to grandchild.</p>
<p>We found children whose grandparents are obese or overweight are almost twice as likely to be obese or overweight compared to those whose grandparents are “normal” weight.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-we-ban-junk-food-in-schools-we-asked-five-experts-131566">Should we ban junk food in schools? We asked five experts</a>
</strong>
</em>
</p>
<hr>
<h2>Nature and nurture?</h2>
<p>Further research is needed into how children’s obesity status is influenced by their grandparents but there are likely two pathways at work. The influence could be indirect via parents’ genes or occur directly through the roles played by grandparents in children’s upbringing. </p>
<p>Let’s start with biological factors. Both egg and sperm cells <a href="https://www.science.org/doi/full/10.1126/science.aad7977">contain molecules</a> that respond to the nutritional intake of parents. This means traits that are susceptible to high weight gain can be passed on from grandparents to parents and then to their grandchildren. And <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226269/">evidence shows</a> genetics, environmental factors, lifestyle and eating habits all play key roles in predisposing individuals to obesity.</p>
<p>What we eat and feed our family members can lead to the expression of certain genetic traits (a term referred to as epigenetics) which can then be <a href="https://pubmed.ncbi.nlm.nih.gov/27288829/">transferred</a> to successive generations. Due to shared familial, genetic, and environmental factors, obesity tends to aggregate within immediate families and studies have consistently reported an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421118/">intergenerational transmission of obesity</a> from parents to children.</p>
<p>Food intake can also influence health and biology across multiple generations. In Sweden, a <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13405">study reported</a> adequate food for paternal grandparents at ten years of age reduced heart disease and diabetes and increased longevity among their grandchildren.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="baking cupcakes pulled from over by adult and child" src="https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Grandparents’ influence on their grandchildren’s obesity risk may be biological or a result of dietary choices.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-image-grandmother-granddaughter-cooking-on-1037964661">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Food and family</h2>
<p>So, grandparents’ weight status and choices about what and how much is eaten in their home could influence their grandchildren’s weight directly or via the children’s parents. These influences may be greater or less significant depending on the role grandparents play as primary care givers or in shared living arrangements. According to the recent Australia’s Seniors’ <a href="https://nationalseniors.com.au/research/health-and-aged-care/australian-grandparents-care">survey</a>, one in every four Australian grandparents provides primary care to their grandchildren.</p>
<p>Grandparents’ role as caregivers significantly affects children’s healthy eating knowledge, attitude, and behaviours. This might be seen in the meals shared, recipes passed down or special treats for loved ones. Such habits can add to childhood obesity risks, above and beyond genetic factors. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="family table with older man feeding young child" src="https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Grandparents regular provide childcare and therefore meals.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/grandpa-feeding-girl-healthy-little-600w-227939680.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-one-in-four-aussie-kids-are-overweight-or-obese-were-failing-them-and-we-need-a-plan-114005">More than one in four Aussie kids are overweight or obese: we're failing them, and we need a plan</a>
</strong>
</em>
</p>
<hr>
<h2>Working on prevention</h2>
<p>Our research shows the importance of including grandparents in obesity prevention strategies. In addition to parents, grandparents could be oriented to provide guidance on responsible feeding, recognising hunger and fullness, setting limits, offering healthy foods and using repeated exposure to promote acceptance. They can help encourage regular exercise and discourage coercive feeding practices on their grandchildren. </p>
<p>While our study shows a multigenerational link in the transmission of obesity, most of the available evidence comes from high-income countries – predominantly America and European countries. More studies, especially from low-income countries, would be helpful. </p>
<p>Further investigation into the effect of grandparents on grandchildren’s obesity across different races and ethnicities is also needed. Grandparents have varied social and cultural roles in the upbringing of their grandchildren around the world. More data could help design effective obesity prevention programs that recognise the vital importance of grandparents.</p><img src="https://counter.theconversation.com/content/173739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edmund Wedam Kanmiki does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p><p class="fine-print"><em><span>Abdullah Mamun receives funding from NHMRC, ARC, Queensland Health, and Health and Wellbeing Queensland. </span></em></p><p class="fine-print"><em><span>Yaqoot Fatima received funding from NHMRC, MRFF, Western Queensland Primary Health Network, Tropical Australian Academic Health Centre, Queensland Health, and Health and Wellbeing Queensland. She is a member of the Indigenous Sleep Health Working Party of the Australasian Sleep Association.</span></em></p>Whether it’s a special treat or family traits, children’s risk of being overweight or obese is strongly linked to their grandparents.Edmund Wedam Kanmiki, PhD Candidate, The University of QueenslandAbdullah Mamun, Associate Professor, The University of QueenslandYaqoot Fatima, Senior Research Fellow, James Cook UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1719122021-11-29T13:27:43Z2021-11-29T13:27:43ZThe pandemic is changing the way young people eat and how they feel about their bodies: 4 essential reads<figure><img src="https://images.theconversation.com/files/432998/original/file-20211121-13-8odyw3.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5455%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Studies show that spending more time on Instagram can lead to lower body satisfaction.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/body-image-issues-royalty-free-image/1293696418">OsakaWayne Studios/Moment Collection via Getty Images</a></span></figcaption></figure><p>Kids, like adults, cope with stress and anxiety in many different ways. </p>
<p>For example, while some children reach for more snacks <a href="https://www.health.harvard.edu/diet-and-weight-loss/struggling-with-emotional-eating">to deal with uncomfortable feelings</a>, others overexercise or restrict their eating in unhealthy ways. As a result, <a href="http://dx.doi.org/10.15585/mmwr.mm7037a3">rates of obesity</a> and <a href="https://doi.org/10.1016/j.jadohealth.2021.05.019">eating disorders</a> like anorexia and bulimia have both <a href="https://doi.org/10.1192/bjp.2021.105">increased among young people</a> during the COVID-19 pandemic.</p>
<p>Here are four recent articles from The Conversation’s archives that deal with kids, body weight and the COVID-19 pandemic.</p>
<h2>1. Child obesity</h2>
<p>Many programs over the past four decades have tried to get kids in the U.S. to <a href="https://www.usnews.com/education/blogs/high-school-notes/2013/07/01/junk-food-axed-from-school-vending-machines">eat healthier food</a> and <a href="https://letsmove.obamawhitehouse.archives.gov/">exercise more often</a>. Despite these efforts, child obesity rates have <a href="https://doi.org/10.1542/peds.2017-3459">continued to increase</a> – particularly <a href="http://dx.doi.org/10.15585/mmwr.mm7037a3">during the pandemic</a>.</p>
<p><a href="https://scholar.google.com/citations?user=z_m-TWIAAAAJ&hl=en">Amanda Harrist</a> and <a href="https://theconversation.com/profiles/laura-hubbs-tait-1275922">Laura Hubbs-Tait</a>, child obesity researchers at Oklahoma State University, designed an intervention that actually lowered kids’ body mass index, or BMI. </p>
<p>The key factor that made their program succeed where so many others before failed? A focus on acceptance from family and friends, they say.</p>
<p>In their <a href="https://www.mdpi.com/1660-4601/18/16/8744">study of over 500 first graders</a>, Harrist and Hubbs-Tait found that lessons on diet and exercise alone do not help kids at risk for obesity to slim down. Just as important, they say, is teaching new family dynamics and reducing the amount of rejection children face. That means showing parents how to emotionally support and comfort their children who are overweight, and teaching classmates to be <a href="https://doi.org/10.1016/S0885-2006(03)00024-3">more accepting of one another</a>.</p>
<p>“Knowing you can come home and talk about how angry and sad you are is essential to healthy physical and mental growth,” the <a href="https://theconversation.com/kids-with-obesity-need-acceptance-from-family-and-friends-not-just-better-diet-tips-to-succeed-at-managing-their-weight-168908">pair write</a>. “And children must also have friends and peers who accept them for who they are.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-with-obesity-need-acceptance-from-family-and-friends-not-just-better-diet-tips-to-succeed-at-managing-their-weight-168908">Kids with obesity need acceptance from family and friends, not just better diet tips, to succeed at managing their weight</a>
</strong>
</em>
</p>
<hr>
<h2>2. Eating disorders</h2>
<p>Physician <a href="https://theconversation.com/profiles/julia-f-taylor-1274431">Julia Taylor</a> and psychotherapist <a href="https://theconversation.com/profiles/sara-groff-stephens-1274445">Sara Groff Stephens</a>, both professors of pediatrics at University of Virginia, specialize in treating eating disorders in teens and young adults, which <a href="https://doi.org/10.1016/j.jadohealth.2021.05.019">spiked after the onset</a> of the COVID-19 pandemic. </p>
<p>When it comes to eating disorders, they say, <a href="https://theconversation.com/the-covid-19-pandemic-increased-eating-disorders-among-young-people-but-the-signs-arent-what-parents-might-expect-168634">three groups of young people</a> are often overlooked: <a href="https://doi.org/10.2147/AHMT.S147480">young male athletes</a>, <a href="https://doi.org/10.1007/s00787-018-1145-9">LGBTQ youth</a> and <a href="https://doi.org/10.1542/peds.2019-2339">“normal”-sized adolescents</a>. This last group includes young people who are average weight or even overweight, but may develop dangerously abnormal vital signs, electrolyte imbalances or severe gastrointestinal issues due to their unhealthy dieting.</p>
<p>“The recent COVID-related increase in patients presenting for care has reinforced that no group is immune from them,” Taylor and Stephens write. “Breaking down barriers for identification and treatment for all individuals – including boys, sexual and gender minority youth and kids across the weight spectrum – will improve outcomes for those who struggle with these significant illnesses.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-covid-19-pandemic-increased-eating-disorders-among-young-people-but-the-signs-arent-what-parents-might-expect-168634">The COVID-19 pandemic increased eating disorders among young people – but the signs aren't what parents might expect</a>
</strong>
</em>
</p>
<hr>
<h2>3. Weight stigma</h2>
<p>The COVID-19 pandemic has been hard and stressful for everyone – and being critical of people’s bodies doesn’t help, argue <a href="https://scholar.google.com/citations?user=Hk5hYZYAAAAJ&hl=en&oi=ao">Nicole Giuliani</a>, <a href="https://theconversation.com/profiles/nichole-kelly-409234">Nichole Kelly</a> and <a href="https://theconversation.com/profiles/elizabeth-budd-409224">Elizabeth Budd</a>, psychology professors at the University of Oregon who are also moms with young children.</p>
<p>The scholars believe health research and health initiatives place a disproportionate emphasis on kids’ weight. This draws attention away from <a href="https://www.cdc.gov/chronicdisease/about/index.htm">better predictors of chronic disease</a> such as smoking, lack of exercise or poor mental health. And it also reinforces weight bias, which they describe as “the belief that a thin body is good and healthy, while a large body is bad and unhealthy.” </p>
<p>Weight bias, in turn, <a href="https://doi.org/10.1007/s13679-020-00408-8">contributes to bullying and teasing</a>, which are common among youth and linked to disordered eating and depression, as well as poorer academic performance and health.</p>
<p>“To best support the physical and emotional health of children during this pandemic, we suggest reducing the emphasis on body size,” Giuliani, Kelly and Budd write. </p>
<p>They offer <a href="https://theconversation.com/if-you-want-to-support-the-health-and-wellness-of-kids-stop-focusing-on-their-weight-168062">five tips for parents</a>, which range from avoiding words like “fat,” “obese” and “overweight” to noticing when kids feel bad about their bodies after spending time on social media, and encouraging them to take a break. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-you-want-to-support-the-health-and-wellness-of-kids-stop-focusing-on-their-weight-168062">If you want to support the health and wellness of kids, stop focusing on their weight</a>
</strong>
</em>
</p>
<hr>
<h2>4. Social media</h2>
<p>Speaking of social media, Facebook officials have known since at least March 2020 that Instagram – the social media platform most used by adolescents – is harmful to teen girls’ body image and well-being. That’s according to an explosive <a href="https://www.wsj.com/articles/facebook-knows-instagram-is-toxic-for-teen-girls-company-documents-show-11631620739">Wall Street Journal report</a> published in September 2021.</p>
<p>But <a href="https://scholar.google.com/citations?user=tuYEhtgAAAAJ&hl=en&oi=ao">Christia Spears Brown</a>, a professor of psychology at University of Kentucky who studies social media use among teens, says researchers have been documenting these harms for years.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-weeklybest">Sign up for our weekly newsletter</a>.]</p>
<p>“[S]tudies consistently show that the more often teens use Instagram, the <a href="https://doi.org/10.1037/ppm0000182">worse their overall well-being, self-esteem, life satisfaction, mood and body image</a>,” Brown writes. “One study found that the more college students used Instagram on any given day, the <a href="https://doi.org/10.1037/ppm0000350">worse their mood and life satisfaction was that day</a>.”</p>
<p><a href="https://theconversation.com/facebook-has-known-for-a-year-and-a-half-that-instagram-is-bad-for-teens-despite-claiming-otherwise-here-are-the-harms-researchers-have-been-documenting-for-years-168043">Brown says parents can help</a> “by repeatedly talking to their teens about the difference between appearance and reality, by encouraging their teens to interact with peers face to face, and to use their bodies in active ways instead of focusing on the selfie.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/states-sue-meta-for-knowingly-hurting-teens-with-facebook-and-instagram-here-are-the-harms-researchers-have-documented-168043">States sue Meta for knowingly hurting teens with Facebook and Instagram − here are the harms researchers have documented</a>
</strong>
</em>
</p>
<hr>
<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/171912/count.gif" alt="The Conversation" width="1" height="1" />
Rates of obesity and eating disorders like anorexia and bulimia both surged among young people over the past two years. Scholars explain why, and how parents can support kids dealing with body shame.Kate Kilpatrick, Philadelphia EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1711162021-11-18T02:18:15Z2021-11-18T02:18:15ZIt might be uncomfortable to talk about. But obesity puts children at risk of severe COVID<figure><img src="https://images.theconversation.com/files/432317/original/file-20211117-23-1svtrta.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://s3-eu-west-1.amazonaws.com/wof-image-bank/Misys_SP2016041855.jpg">World Obesity Federation</a></span></figcaption></figure><p>Vaccinating children against COVID-19 is on parents’ minds, now Australia’s rollout is open to those aged 12 and over, and regulators are actively considering vaccination for five to 11 year olds. Many parents will be thinking about the pros and cons of their children being vaccinated. </p>
<p>Excess weight seems to be an important factor that increases the chance of COVID-19 progressing to severe disease, including in children. </p>
<p>Yet the benefits of vaccines for children with excess weight or obesity hasn’t received much attention. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/these-3-factors-predict-a-childs-chance-of-obesity-in-adolescence-and-no-its-not-just-their-weight-124994">These 3 factors predict a child's chance of obesity in adolescence (and no, it's not just their weight)</a>
</strong>
</em>
</p>
<hr>
<h2>What does the evidence say?</h2>
<p>Defining excess weight and obesity in a child is based on their weight and height (their <a href="http://pro.healthykids.nsw.gov.au/assess/">body mass index</a> or BMI). Like most aspects of health in children, that is expected to change as they grow and develop. </p>
<p>Many studies have shown children and young people with excess weight and obesity are more likely to go to hospital or become severely unwell with COVID-19.</p>
<p><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780706">A large study</a> of more than 43,000 hospital presentations of children under 18 years in the United States showed the main background health conditions that increased the chance a child would need admission to hospital with COVID were diabetes and obesity. </p>
<p>If admitted to hospital with COVID, having diabetes, obesity or heart disease increased the risk of severe disease requiring intensive care.</p>
<p><a href="https://www.medrxiv.org/content/10.1101/2021.10.28.21265616v2.full.pdf">A recent study</a> of more than 400 COVID admissions in children from Canada, Iran and Costa Rica showed obesity was associated with severe COVID-19, particularly among those aged over 12. Obesity was the only background health condition that increased the risk (three-fold) of severe COVID-19 in this age group.</p>
<figure class="align-center ">
<img alt="Doctor listens to a child's back with a stethoscope." src="https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432333/original/file-20211117-19-xsqbmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One study showed obesity was the only existing health condition that increased the risk of severe COVID in adolescents.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-doctor-listening-patient-lung-heartbeat-1690933801">Shutterstock</a></span>
</figcaption>
</figure>
<p>In Australia, <a href="https://www.paeds.org.au">two-thirds of children</a> who needed ICU-level care for COVID have excess weight (weight above the 95th percentile for their age), which is <a href="https://www.aihw.gov.au/reports/overweight-obesity/overweight-obesity-australian-children-adolescents/summary">at least twice the proportion</a> of children with excess weight in the general population.</p>
<h2>Why does weight seem to matter so much?</h2>
<p>It is not absolutely clear, but it seems excess weight and obesity particularly affect <a href="https://academic.oup.com/ooim/article/2/1/iqab001/6105076?login=true">how well our immune system can control the virus</a> early on in the infection.</p>
<p>It also seems to predispose us to a poorly regulated immune response later in the infection, leading to too much inflammation. </p>
<p>This so-called hyper-inflammation is a key cause of severe COVID-19. </p>
<p>How <a href="https://www.sciencedirect.com/science/article/pii/S1550413121000164">blood vessels respond to stress and inflammation</a> may also be compromised in people with excess weight and obesity, leading to complications such as kidney injury, blood clotting, stroke and heart attacks.</p>
<p>In adults, obesity is <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247461#pone.0247461.ref010">a major risk factor for severe COVID-19</a>too. It frequently occurs alongside diabetes, high blood pressure and other diseases in the so-called metabolic syndrome. All of these diseases have been associated with more severe COVID and similarly are linked to poorly regulated immune responses. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/multisystem-inflammatory-syndrome-after-covid-in-children-is-rare-but-makes-the-body-fight-itself-166822">Multisystem inflammatory syndrome after COVID in children is rare but makes the body fight itself</a>
</strong>
</em>
</p>
<hr>
<p>There may also be a <a href="https://www.science.org/content/article/why-covid-19-more-deadly-people-obesity-even-if-theyre-young">mechanical effect</a>, with obesity restricting chest wall movement reducing lung volumes and airway size under stress.</p>
<p>Obesity is also a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523028/">leading risk factor for severe influenza</a>, potentially through some similar mechanisms. </p>
<h2>What can we do about it?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=310&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=310&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=310&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=390&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=390&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432337/original/file-20211117-13-1incq54.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=390&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccines offer the best protection from COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaccination-little-girl-doctors-office-funny-1817977970">Shutterstock</a></span>
</figcaption>
</figure>
<p>Parents need to be aware their child’s weight can affect their risk of severe COVID. <a href="http://pro.healthykids.nsw.gov.au">These resources</a> can help determine where your child sits in terms of their weight.</p>
<p>Parents should also factor their and their children’s weight into their family decisions about COVID prevention, including vaccination. If you or they are overweight, vaccines offer the best protection from COVID.</p>
<p>If you think your child might have excess weight, talk to your GP and consider making some changes to the family’s physical activity, screen time, sleep and eating behaviours. The <a href="https://pro.healthykids.nsw.gov.au/wp-content/uploads/2017/04/HNSW_223347_Healthy-weight-and-habits-fact-sheet_Web_FA.pdf">Eight Health Habits fact sheet</a> provides some starting points for families. </p>
<p>Obesity also needs to be factored into national decision-making around vaccination priorities. When vaccines were first made available for children aged 12-15 years, a number of health conditions were listed as “conditions associated with increased risk of severe COVID-19”. Severe obesity was on this list, but the list wasn’t ranked, so weight received very little focus. </p>
<p>Among all the recommended groups that should be vaccinated, people with obesity should be a top priority given it’s one of the <a href="https://www.fda.gov/media/153508/download">highest risk</a> factors for severe COVID. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-kids-get-long-covid-and-how-often-a-paediatrician-looks-at-the-data-166277">Do kids get long COVID? And how often? A paediatrician looks at the data</a>
</strong>
</em>
</p>
<hr>
<p>Parents need to be aware of their and their children’s weight as an important issue in making decisions about vaccination. </p>
<p>Health practitioners and policymakers should prioritise excess weight and obesity as health conditions in current and future vaccine programs.</p>
<p>It might be uncomfortable to talk about, but weight is a key factor that makes COVID worse, even in children. We need to talk about it so parents can make informed decisions about their child’s risk and the benefits of vaccination.</p><img src="https://counter.theconversation.com/content/171116/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Britton receives funding from the National Health and Medical Research Council and the Commonwealth Department and NSW Ministry of Health</span></em></p><p class="fine-print"><em><span>Louise Baur is Director of the NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood. She has an NHMRC Leadership Fellowship (2022-2026) which supports research in the prevention and treatment of paediatric obesity. In 2020 and 2022 she received honoraria from Novo Nordisk for educational sessions on the management of adolescent obesity (funding to her institutional research cost centre).
</span></em></p><p class="fine-print"><em><span>Nicholas Wood receives funding from the National Health and Medical Research Council for a Career Development Fellowship. He holds a Churchill Fellowship. </span></em></p>Obesity and excess weight increase the risk of COVID progressing to severe disease, including in children. Vaccination is key to reducing this risk.Philip Britton, Senior lecturer, Child and Adolescent Health, University of SydneyLouise Baur, Professor, Discipline of Child and Adolescent Health, University of SydneyNicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1689082021-10-25T18:37:41Z2021-10-25T18:37:41ZKids with obesity need acceptance from family and friends, not just better diet tips, to succeed at managing their weight<figure><img src="https://images.theconversation.com/files/427326/original/file-20211019-17-17zr8vq.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5742%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Obesity intervention programs tend to focus on healthy food and physical activity. But is that enough?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-and-son-laughing-in-the-park-royalty-free-image/487374270"> kali9/E+ Collection via Getty Images</a></span></figcaption></figure><p>Hundreds of programs over the past four decades – from the removal of junk food from <a href="https://www.usnews.com/education/blogs/high-school-notes/2013/07/01/junk-food-axed-from-school-vending-machines">school vending machines</a> to Michelle Obama’s “<a href="https://letsmove.obamawhitehouse.archives.gov/">Let’s Move</a>” campaign – have tried to get kids in the U.S. to eat healthier food and exercise more often.</p>
<p>But none of these efforts lowered national child obesity rates. In fact, child obesity has <a href="https://doi.org/10.1542/peds.2017-3459">continued to increase</a>. This has been particularly true <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm7037a3_w">during the pandemic</a>.</p>
<p>We think we know why. Most programs that seek to lower children’s body mass index, or BMI, focus on healthy food and physical activity. But as child obesity researchers who specialize in <a href="https://scholar.google.com/citations?user=z_m-TWIAAAAJ&hl=en">human development</a> and <a href="https://directory.okstate.edu/index.php/module/Default/action/ViewPerson?dirkey=108906&campus=1">family science</a>, we know that slimming down requires much more than attention to diet and exercise. </p>
<p>Those factors are important, but we found that acceptance from family and friends also plays a critical role in slowing the rate of weight gain for children with obesity.</p>
<p>To reach this conclusion, we collaborated with colleagues to follow almost 1,200 children in first through fourth grades in rural Oklahoma to find out more about the lives of kids who are overweight or obese. Our intervention programs allowed us to compare a traditional food and exercise approach to managing child obesity with approaches that also targeted the social and emotional aspects of children’s lives.</p>
<h2>Family and peer acceptance</h2>
<p>We conducted a randomized controlled trial in <a href="https://doi.org/10.3390/ijerph18168744">29 Oklahoma schools</a>. More than 500 first graders who were at-risk for obesity – meaning their BMI was above the 75th percentile – were assigned to either a control group or a group that received a combination of three interventions. </p>
<p>These interventions focused on family lifestyle, family dynamics and the peer group.</p>
<p>[<em>Explore the intersection of faith, politics, arts and culture.</em> <a href="https://theconversation.com/us/newsletters/this-week-in-religion-76/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=religion-explore">Sign up for This Week in Religion.</a>]</p>
<p>The family lifestyle intervention focused on healthy food and physical activity. Participants learned to use a color-coded food reference guide similar to <a href="https://www.nhlbi.nih.gov/health/educational/wecan/downloads/urwhateat.pdf">this one</a> when selecting food. Parents tracked their children’s food consumption and physical activity, and also learned <a href="https://agris.fao.org/agris-search/search.do?recordID=US9032938">how to avoid conflict over food</a>. This conflict might involve arguing about how much the child is eating, whether the child can have dessert or whether the child has eaten enough of everything else on the table to get a second helping of a favorite food.</p>
<p>The family dynamics intervention added <a href="https://digitalcommons.usu.edu/fchd_facpub/627/">parenting skills</a> and healthy emotion management. Children’s emotion regulation and <a href="https://www.health.harvard.edu/diet-and-weight-loss/struggling-with-emotional-eating">emotional eating</a> are <a href="https://pubmed.ncbi.nlm.nih.gov/24131878/">significantly related</a>, so teaching children to manage their feelings may reduce their tendency to eat when they are stressed out or upset. Children were taught how to deal with negative emotions, express their feelings and value their uniqueness. Parents were taught to value their children’s emotions, provide comfort and understanding, support children’s problem-solving and accept their children as they are.</p>
<p>The peer group intervention taught social acceptance in the children’s school classrooms. Our research has shown that the more children weigh, the more their classmates <a href="https://www.doi.org/10.1111/cdev.12548">tend to dislike them</a>. However we’ve also demonstrated that we can <a href="https://doi.org/10.1016/S0885-2006(03)00024-3">decrease the rejection</a> that happens in elementary school classrooms by teaching children to be more accepting of one another.</p>
<figure class="align-center ">
<img alt="Group of young kids laugh and smile while holding hands" src="https://images.theconversation.com/files/428099/original/file-20211023-8398-epmlpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/428099/original/file-20211023-8398-epmlpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/428099/original/file-20211023-8398-epmlpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/428099/original/file-20211023-8398-epmlpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/428099/original/file-20211023-8398-epmlpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/428099/original/file-20211023-8398-epmlpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/428099/original/file-20211023-8398-epmlpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teaching kids to be more accepting of one another can reduce weight stigma and rejection.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/happy-multiracial-school-children-walking-thru-royalty-free-image/477699830">kali9/E+ Collection via Getty Images</a></span>
</figcaption>
</figure>
<h2>Effect on obesity</h2>
<p>We measured children’s heights and weights at the beginning of first grade and then after the intervention – in first, second, third and fourth grades. Only those children with obesity who received all three interventions – family lifestyle, family dynamics and peer group – had <a href="https://doi.org/10.3390/ijerph18168744">significant decreases</a> in BMI gains compared with the control group. </p>
<p>Ongoing analysis indicates that the peer group intervention was particularly important for children who were severely obese, with a <a href="https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html">BMI in the 99th percentile</a>.</p>
<p>Our results show that to reduce BMI gains in the early school years, kids need more than healthy food and physical activity. They need parents who encourage their healthy choices and accept their emotions. Knowing you can come home and talk about how angry and sad you are is essential to healthy physical and mental growth. And children must also have friends and peers who accept them for who they are – regardless of how much they weigh.</p><img src="https://counter.theconversation.com/content/168908/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Harrist has received funding from National Institutes of Health, United States Department of Agriculture/National Institute of Food and Agriculture, and Oklahoma Center for the Advancement of Science and Technology.</span></em></p><p class="fine-print"><em><span>Laura Hubbs-Tait received funding from United States Department of Agriculture/National Institute of Food and Agriculture, Administration on Children, Youth, and Families, and National Institutes of Health. She currently serves as chair of USDA Multistate W3005: "Developing synergistic approaches to healthy weight in childhood through positive relationships, diet quality and physical activity."</span></em></p>A study of over 1,000 children in rural Oklahoma found that social and emotional health may be just as important as diet and exercise in reducing child obesity.Amanda Harrist, Professor in Human Development and Family Science, Oklahoma State UniversityLaura Hubbs-Tait, Professor of Human Development and Family Science, Oklahoma State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1606212021-05-16T07:51:45Z2021-05-16T07:51:45ZSouth Africa must ban sugary drinks sales in schools. Self regulation is failing<figure><img src="https://images.theconversation.com/files/400513/original/file-20210513-21-1bdlcs8.jpg?ixlib=rb-1.1.0&rect=418%2C23%2C1083%2C812&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">White River Primary school in South Africa, sponsored by Coca Cola.</span> <span class="attribution"><span class="source">Roo Reynolds/Flickr</span></span></figcaption></figure><p>In 2017, Coca-Cola Beverages South Africa voluntarily <a href="https://www.timeslive.co.za/sunday-times/news/2017-08-12-how-coke-is-keeping-sugar-on-the-school-menu/">announced</a> that it would stop supplying sugary beverages to primary school outlets. The company also pledged to remove all branding and advertising from schools. The announcement took the form of a letter noting that that Coca-Cola Beverages wanted to play “an active role in addressing rising obesity rates in South Africa, especially among children”. </p>
<p>Childhood obesity is a serious and growing problem is South Africa. More than <a href="https://www.samrc.ac.za/sites/default/files/attachments/2019-01-29/SADHS2016KeyFindings.pdf">13% of children</a> are either obese or overweight. The consumption of liquid sugar is particularly harmful because it is absorbed so quickly into the bloodstream. Not surprisingly, sugary drinks and their marketing has been linked to obesity especially among children. Just a single sugary beverage per day increases that child’s chance of overweight by 55%. Similarly, once they become an overweight teen, there is a 70% chance they will not be able to lose the weight.</p>
<p>The food environment in schools plays a significant role in increasing access to sugary drinks. Children spend a lot of time in school during their developmentally important periods. Among others, the types of food and beverages children are exposed to at school influence their eating patterns and food preferences. </p>
<p>This is a concern for South Africans as children are exposed to <a href="https://pubmed.ncbi.nlm.nih.gov/26513442/">aggressive marketing</a> and <a href="http://www.sajcn.co.za/index.php/SAJCN/article/view/528">unhealthy foods and beverages</a> at schools. Of particular concern is learners’ excessive sugary drinks consumption. An average grade 4 learner (10-year-old) has around one to two <a href="https://www.ajol.info/index.php/jfecs/article/view/53995">sugary drinks per day</a>, with each soft drink containing up to nine teaspoons of sugar. </p>
<p>Obesity prevention efforts are clearly needed in schools. But what should these efforts entail? Our <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1898130">new research</a> shows that voluntary actions by industry are not part of the recipe. </p>
<p>The aim of our research was to see what drinks were available at schools after Coca-Cola’s announcement. Our audit showed that the company’s brands remained available in most of the schools. Our study highlights that ceding regulation to industry is risky; government regulations and legislation are needed.</p>
<h2>Tuck shop audit</h2>
<p>We studied the food environment across 105 public primary schools in South Africa’s Gauteng province. Schools were located in both affluent and in poorer areas. This allowed us to see if there were any differences in outcomes based on the socioeconomic status of the school. Fieldworkers visited tuck shops and other food outlets on school premises. They spoke to school staff to find out what was being sold to the children through the school stores or tuck shops. </p>
<p>In general, food consumed at schools can constitute up to <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1898130">20%–30%</a> of learners’ total daily caloric intake. This is either through the government school meal programmes in poorer areas, from the school tuck shops or learners’ lunch boxes brought from home. </p>
<p>Our study showed that two years after Coca-Cola Beverages pledge, carbonated sugary drinks were available in 54% of primary school tuck shops. These drinks were more available in fee-paying schools (86%) than no-fee schools (21%). When researchers looked at the availability of alternative low-calorie products, they found that none of the school tuck shops sold only low-calorie drinks. </p>
<p>Decision makers explained that schools faced challenges such as financing general school maintenance and staff salaries. They felt like they had to make a trade-off between revenue generation and the healthfulness of the products they sold in the tuck shops. We found that Coca-Cola Beverages South Africa is not the sole distributor to school tuck shops. Therefore, even when Coca-Cola Beverages South Africa would not supply sugary beverages, schools stocked their tuck shops through general commercial wholesalers. </p>
<p>When it came to advertising, only some schools reported that the company had done what was promised in the pledge, to remove all branding and advertising from schools. But this was the exception rather than the norm. Nearly one-third (31%) of schools had Coca-Cola branding or advertising on school premises. Much of the branding are billboards with the name of the school. Respondents reported that branding, in particular branded fridges, remained unchanged. </p>
<p>Less than half of the school decision makers interviewed in the study were aware of the pledge. This suggests that they either did not recall the letter or had not seen it. The study also revealed that there was easy access to unhealthy products outside school premises through informal food vendors and nearby stores.</p>
<h2>Recommendations</h2>
<p>Despite the common reliance on self-regulatory measures by commercial food entities there is no evidence to support either their effectiveness or safety, according to policy expert <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)62089-3/fulltext">Professor Rob Moodie and colleagues</a>.</p>
<p>A ban on sugary drinks sales and advertising is likely to hold more promise than voluntary actions in improving the diets of school-going children and contribute to obesity prevention efforts among children. There is promising evidence from other developing countries, like <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305159">Chile</a>, where a ban on unhealthy foods and beverages resulted in substantial reduction in sales of such products in schools.</p>
<p>Change must also happen in the wider school community, in line with our constitutional basis in the best interests of the child. </p>
<p>Students, school staff, parents, and tuck shop owners all play a significant role in creating a healthier food environment at schools. Making a change at the tuck shop might feel risky but small changes such as banning sugary drinks are an excellent start. This already happening across the globe. </p>
<p>Lastly, it is important that these changes are communicated with the wider school community. The health benefits of the changes should be explained, emphasising the positive impact on students’ nutrition, well-being and school performance. Learners should be able to question what they can buy at school tuck shops or are served for lunch. Every school child in South Africa is entitled to an easy and healthy dietary choice on a daily basis.</p><img src="https://counter.theconversation.com/content/160621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Agnes Erzse receives funding from from the SA MRC, IDRC Canada, the UK National Institute for Health Research through the University of Cambridge and Bloomberg Philanthropies, through UNC Chapel Hill.</span></em></p><p class="fine-print"><em><span>Karen Hofman receives funding from the SA MRC, IDRC Canada, the UK National Institute for Health Research through the University of Cambridge and Bloomberg Philanthropies, through UNC Chapel Hill.</span></em></p><p class="fine-print"><em><span>Nicola Christofides receives funding from European Research Council, UKRI. </span></em></p>A ban on sugary drinks sale and advertisements in schools is likely to hold more promise in improving the diets of children and help prevent obesity in children than voluntary actions.Agnes Erzse, Researcher, SAMRC/Centre for Health Economics and Decision Science- PRICELESS SA, University of the WitwatersrandKaren Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandNicola Christofides, Associate Professor, School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1554932021-03-08T15:19:32Z2021-03-08T15:19:32ZSouth Africa needs to change direction on maternal health to solve child malnutrition<figure><img src="https://images.theconversation.com/files/387728/original/file-20210304-15-1plejga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children are eating too much poor nutrient quality food and too little of good nutrient quality food.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>When we think about nurturing healthy children, we need to adopt a life course approach to maternal nutrition. In other words, a woman’s health for the benefit of herself and her child must be prioritised early in life.</p>
<p>We know that poor nutrition during pregnancy and infancy has <a href="https://pubmed.ncbi.nlm.nih.gov/17200031/">long-term consequences</a> for that generation of infants – malnourished mothers, birth malnourished infants. Health and nutrition during this critical window has far-reaching consequences and casts a long shadow of the increased risk of ill-health such as diabetes, hypertension and cardio-vascular disease.</p>
<p>At a <a href="https://pubmed.ncbi.nlm.nih.gov/23541370/">public health level</a>, good health, mainly through good nutrition, contributes to the economic productivity and development of society by decreasing the costs of ill-health and ensuring a good healthy workforce.</p>
<p>So how healthy are South Africa’s children?</p>
<p>South Africa is classified as a <a href="https://data.worldbank.org/?locations=ZA-XT">middle-income country</a> and has high <a href="https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locations=ZA">per capita spending</a> on health. Yet the nutritional status of South Africa’s children is deteriorating. While the number of children going hungry has reportedly <a href="http://www.ci.uct.ac.za/sites/default/files/image_tool/images/367/Child_Gauge/South_African_Child_Gauge_2020/ChildGauge_2020_screen_final.pdf">decreased</a>, access to energy-dense but low micronutrient-dense food is fuelling an increase in child overweight and obesity. </p>
<p>In 2018, 11% of children (2.1 million) lived in households that <a href="http://www.ci.uct.ac.za/sites/default/files/image_tool/images/367/Child_Gauge/South_African_Child_Gauge_2020/CG2020_CC_child%20nutrition.pdf">reported</a> child hunger. More than a quarter (27%) of children in South Africa are stunted – the most common manifestation of malnutrition.</p>
<p>Children are eating too much poor nutrient quality food and too little of good nutrient quality food. This profile illustrates the concept of hidden hunger or poor nutrition-security and demonstrates the insidious corruption that malnutrition meets out on children’s health and lives, now and into their futures.</p>
<p>If the country wants to change this, it needs to implement health and nutrition policies in girlhood and in the teen years.</p>
<p>Our <a href="http://www.ci.uct.ac.za/sites/default/files/image_tool/images/367/Child_Gauge/South_African_Child_Gauge_2020/CG2020_ch4_food%20and%20nutrition%20security%20of%20unborn%20child.pdf">paper</a>, written for an annual status report on South Africa’s children produced by the Children’s Institute at the University of Cape Town, argues that a child-centric food systems would reap benefits for society and for future generations. This food system would need to focus on food security and good nutrition. It would require multisectoral changes to the food system as well as the way in which healthcare services work.</p>
<h2>The risks and mitigation strategies</h2>
<p>Women who are either overweight or obese before conceiving a child or gain excessive weight during pregnancy are more likely to develop <a href="https://pubmed.ncbi.nlm.nih.gov/17200031/">gestational diabetes</a>. These women are also at higher risk of developing diabetes after childbirth. And babies born to women who are obese are more likely to be born large for their age and are at higher risk of being an obese child.</p>
<p>The mother’s weight isn’t the only potential risk to a child. When pregnant women experience nutrient deficiencies, it also affects the baby. For example, <a href="https://journals.sagepub.com/doi/abs/10.1177/1753495X20932426">iron deficiency in pregnancy</a> has negative effects on the development of the foetus’s brain.</p>
<p>Nutrient deficiencies also contribute to the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60937-X/fulltext">high incidence</a> of noncommunicable diseases in low- and middle-income countries.</p>
<p>The International Federation of Gynaecology and Obstetrics has set out some helpful guidelines for policy makers. These call for:</p>
<ul>
<li><p>Increased awareness of the impact of women’s nutrition on their health and the health of future generations.</p></li>
<li><p>Greater attention to the links between poor maternal nutrition and increased risk of later non-communicable diseases in the offspring as a core component of meeting global health goals.</p></li>
<li><p>Action to improve nutrition among adolescent girls and women of reproductive age.</p></li>
<li><p>Public health measures to improve nutritional education, particularly for adolescents, girls and young women.</p></li>
<li><p>Greater access to preconception services for women of reproductive age to assist with planning and preparation for healthy pregnancies and healthy children.</p></li>
</ul>
<p>In addition, we argue that the government needs to adopt a comprehensive package of interventions that extends social assistance to pregnant women to improve their nutrition and mental health, and the health, care and development of their children. For example, the child support grant could start in pregnancy. </p>
<p>This package of interventions could prioritise food and nutrition at every point of contact for a mother and her infant. </p>
<p>South African policy is moving forward long these lines but policies need to be accelerated.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-tracked-soweto-mothers-to-be-to-find-out-more-about-diet-and-obesity-patterns-138989">We tracked Soweto mothers-to-be to find out more about diet and obesity patterns</a>
</strong>
</em>
</p>
<hr>
<p>The interventions would be delivered beyond health and would require a multisectoral approach to ensure the optimal health and development of children from birth to age two years or older. This would also need to include early child development programmes which have seen a steady increase in utilisation over the past few years. </p>
<p>Healthy growing children are not only a moral and legal obligation but children remain a sustainable investment into a country’s future. To achieve this South Africa can draw lessons from other countries such as Brazil, Rwanda and Bangladesh. All have prioritised child nutrition and have reduced childhood stunting. Healthier children are healthier parents. </p>
<p>These countries have prioritised child nutrition by investing in general public nutrition literacy campaigns and have enforced legislation to protect children from the marketing of unhealthy foods. They have also ensured the scale up and implementation of a proven set of evidenced based interventions like maternity protection, promotion and protection of breastfeeding and the promotion and support for affordable localised diversified diets.</p><img src="https://counter.theconversation.com/content/155493/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chantell Witten is the Chairperson of the Child Health Priorities Association and the Nutrition Lead for the South African Civil Society for Women's, Adolescents' and Children's Health (SACSoWACH).</span></em></p><p class="fine-print"><em><span>Shane Norris receives funding from South African Medical Research Council, South African Department of Science and Innovation and National Research Foundation, UK Medical Research Council, Joint Global Health Trials (UK), National Institutes of Health, International Atomic Energy Agency and the National Institutes of Health Research (UK).</span></em></p>Malnutrition during the first 1000 days of life can cast a long shadow over a person’s life.Chantell Witten, Lecturer, University of the Free StateShane Norris, Director, DSI-NRF Centre of Excellence in Human Development, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1499532020-11-26T11:56:10Z2020-11-26T11:56:10ZHow gardening at school can tackle child obesity<figure><img src="https://images.theconversation.com/files/371272/original/file-20201125-19-1s46g0n.jpg?ixlib=rb-1.1.0&rect=782%2C0%2C6566%2C4902&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-children-field-trips-614431679">Rawpixel.com/Shutterstock</a></span></figcaption></figure><p>Childhood obesity is a major public health concern in the UK. Surveys conducted in 2017 and 2018 showed that 28% of children aged from two to 15 in England were <a href="https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2018/summary">overweight or obese</a>. Overweight and obese children have a greater chance of <a href="https://www.who.int/dietphysicalactivity/childhood_consequences/en/">staying obese</a> as adults. They are at risk of developing diseases in adulthood such as type 2 diabetes, cancer and osteoarthritis.</p>
<p>This rise in obesity has been fuelled by poor diet and a decline in physical activity. <a href="https://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/health-behaviour-in-school-aged-children-hbsc/publications/2020/spotlight-on-adolescent-health-and-well-being.-findings-from-the-20172018-health-behaviour-in-school-aged-children-hbsc-survey-in-europe-and-canada.-international-report.-volume-2.-key-data">Only 41% 11 year olds</a> in Europe and Canada have vegetables in their daily meals, while only 24% participate in at least an hour of moderate to vigorous physical activity (such as brisk walking or running) daily.</p>
<p>Tackling this problem early in childhood is important to develop lifelong healthy behaviour. One potential solution is integrating vegetable gardening into the school curriculum. This strategy both addresses low activity levels and models healthy eating. </p>
<h2>Getting children gardening</h2>
<p>In 2018, <a href="https://iris.ucl.ac.uk/iris/browse/profile?upi=RBELL62">Dr Ruth Bell</a> and I worked to design and study a school gardening project in a London primary school. We carried out this project together with the <a href="https://www.tcv.org.uk/">Conservation Volunteers</a>, a community volunteering charity working towards creating healthier communities, and <a href="https://www.meatfreemondays.com/">Meat Free Monday</a>, a not-for-profit campaign which aims to raise awareness of the impact of animal agriculture and industrial fishing on the environment and encourage eating plant-based meals. </p>
<p>Children at the primary school participated in regular gardening sessions, for two hours each week over a whole academic year. They also took part in educational sessions on the environmental and health benefits of plant-based meals, and were encouraged to taste and try new vegetables.</p>
<p>The gardening activities were designed around children’s own suggestions: they drew plans for developing the school grounds and created nature maps showing their ideas for the location of the garden and other features to encourage wildlife. </p>
<p>In the winter, the children prepared raised beds for growing spring crops – weeding, covering and refilling them with leaf mulch. They sowed seeds and took care of their grounds and the garden. </p>
<h2>Measuring results</h2>
<p>In order to <a href="https://www.mdpi.com/1660-4601/16/22/4320">assess the impact</a> on the children, we compared the gardeners against a control group. For half a year, 30 children in one class continued their regular indoor school sessions – the control group – while 30 from another class took part in the gardening activities. In the second half of the year, the control group were also given the opportunity to get involved in the gardening.</p>
<p>We asked all 60 children to wear <a href="https://www.activinsights.com/products/geneactiv/">GENEActiv accelerometers</a> for seven consecutive days to record their different activity levels. They also responded to a questionnaire that asked them about what they think of fruit and vegetables and how much of them they eat.</p>
<p>We found that children who participated in the regular gardening sessions spent less time sitting than their peers who had their classes indoors. The children attending the gardening sessions were also more active, taking part in more moderate to vigorous intensity exercise than their peers in the other class. In discussion with us, children mentioned growing muscles as they engaged in different kinds of gardening activities. </p>
<p>Although it was winter, that did not matter much to the children. They were eager to spend more time outdoors as they enjoyed gardening activities in the school grounds. </p>
<h2>Increased knowledge</h2>
<p>While our statistics did not show any increase in consumption of vegetables from the children who worked in the garden, the children told us that they knew more about plants, nutrition and the benefits of eating fruits and vegetables. Many children said that they were keen on trying new vegetables, and some of them said that they now ate vegetables that they would have previously transferred to their mum’s plate.</p>
<p>In winter, the children spent a lot of time on preparing the garden for spring crop growing and did not have the chance to taste the produce from the garden. Some of them thought they would have eaten more veggies if they could work in their gardens all year round, and could plant, harvest and taste their own garden grown veggies. </p>
<p>Teachers found that children who had not been performing well in the class found themselves doing better in the outdoor sessions, which then transferred to their regular school sessions. One student who was particularly struggling in the classroom showed leadership abilities and subsequently signed up to join the Scouts. Children with learning difficulties were also more engaged in the gardening sessions.</p>
<p>The children told us that they thought nature can bring people together and make people kinder and better. One of them mentioned having an argument with a friend in the classroom but making up during the gardening sessions. The children also expressed their frustrations with their school lunch options, and that they would have preferred more vegetarian or vegan options and variety in vegetarian recipes. </p>
<p>Integrating gardening sessions with the curriculum can inspire teachers to take classes outdoors. Wide-scale implementation could improve children’s health in the longer term and tackle the obesity pandemic.</p><img src="https://counter.theconversation.com/content/149953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matluba Khan is the Co-founder and Chair of the board of trustees of A Place in Childhood (APiC), a Scottish Charitable Incorporated Organisation. Matluba worked on the research project highlighted in this article as part of her previous role as a Research Fellow at University College London between 2017-2019. The project received funding from EU's Horizon 2020 programme and was part of a wider multi-country research project called 'INHERIT' (<a href="https://inherit.eu/">https://inherit.eu/</a>). </span></em></p>Growing fruit and vegetables gets children moving and gets them enthused about healthy eating.Matluba Khan, Lecturer in Urban Design, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1456852020-09-08T20:07:27Z2020-09-08T20:07:27ZNew Zealand is violating the rights of its children. Is it time to change the legal definition of age discrimination?<figure><img src="https://images.theconversation.com/files/356847/original/file-20200908-16-vo2p06.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4770%2C3185&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The comforting claim that New Zealand is a great place to bring up kids took another hit with last week’s damning <a href="https://www.unicef-irc.org/child-well-being-report-card-16">UNICEF report</a> on child well-being. </p>
<p>The latest in two decades of monitoring and comparing best practice for children in the world’s richest countries, the report gives New Zealand a dismal ranking of 35 out of the total 41. It highlights several crucial areas of failure:</p>
<ul>
<li><p>youth suicide rates are the second highest in the developed world, more than twice the average of the other rich countries surveyed </p></li>
<li><p>childhood rates of obesity are also the second highest </p></li>
<li><p>educational outcomes were already <a href="https://www.unicef-irc.org/publications/995-an-unfair-start-education-inequality-children.html">poor</a> and this latest report suggests they are getting worse</p></li>
<li><p>income inequality is a key problem</p></li>
<li><p>New Zealand children do not feel they are listened to.</p></li>
</ul>
<p>On the eve of an election focused on economic recovery, these findings raise important legal questions about the extent to which New Zealand is protecting young New Zealanders’ rights to health, education and an adequate standard of living. </p>
<h2>The gap in our law</h2>
<p>Those rights are protected in a range of international human rights <a href="https://www.mfat.govt.nz/en/peace-rights-and-security/human-rights/#international">instruments</a> that New Zealand has already accepted over the years, starting with the <a href="https://www.un.org/en/universal-declaration-human-rights/">Universal Declaration</a> of Human Rights 1948. </p>
<p>Everyone has these rights, including children, as New Zealand recognised in 1993 when it signed the United Nations <a href="https://www.ohchr.org/en/professionalinterest/pages/crc.aspx">Convention on the Rights of the Child</a>. Yet despite these international commitments, our domestic legal framework makes no overarching or explicit provision for children’s rights. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/two-inquiries-find-unfair-treatment-and-healthcare-for-maori-this-is-how-we-fix-it-144939">Two inquiries find unfair treatment and healthcare for Māori. This is how we fix it</a>
</strong>
</em>
</p>
<hr>
<p>Yes, there is a right to education. But, given the links between educational outcomes, health and economic inequality, this right by itself only takes us so far. </p>
<p>Our key piece of legislation, the New Zealand Bill of Rights Act 1990, does not include the right to health (physical or mental) or to an adequate standard of living – both strongly related to the right to education. </p>
<p>One of the roles of the Children’s Commissioner is to give <a href="http://www.legislation.govt.nz/act/public/2003/0121/latest/DLM230435.html">better effect</a> to the Children’s Rights Convention. However, the <a href="http://www.legislation.govt.nz/act/public/2018/0057/18.0/whole.html">Child Poverty Reduction Act 2018</a> makes no mention of children’s rights. That is despite <a href="http://www.nzchildren.co.nz/">recent findings</a> by the commissioner that New Zealand’s child poverty rates have hardly changed since 2012. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1301389721092812802"}"></div></p>
<h2>Children should seen <em>and</em> heard</h2>
<p>To ensure an integrated approach to child well-being and to plan for the future, the UNICEF report recommends the government listen carefully to the perspectives of children and young people. The prime minister has accepted that recommendation.</p>
<p>The fact is, however, New Zealand is already obliged to do this. The Children’s Convention requires that the <a href="https://www.ohchr.org/en/professionalinterest/pages/crc.aspx">best interests</a> of the child be a primary consideration in all actions affecting children. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-need-responsible-data-for-children-134052">Why we need responsible data for children</a>
</strong>
</em>
</p>
<hr>
<p>The convention also stipulates that the child has the right to express their <a href="https://www.ohchr.org/en/professionalinterest/pages/crc.aspx">views</a> and be freely heard in all matters affecting them. These principles have been <a href="https://www.refworld.org/pdfid/585150624.pdf">interpreted</a> broadly to apply to all matters affecting children, including decisions affecting their health, education and well-being.</p>
<p>To be fair, New Zealand is making some good progress here. The Children’s Commissioner has published a <a href="https://www.occ.org.nz/listening2kids/child-centred/how-child-centred/">child-centred</a> strategy to help decision-makers consider the implications of their actions for children. Similarly, the Ministry of Social Development has published a <a href="https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/resources/child-impact-assessment.html">Child Impact Assessment Tool</a>. </p>
<p>But these are policy statements only, and the UNICEF report would suggest they are not enough. </p>
<p>So, perhaps a better question might be asked: are young New Zealanders experiencing such poor outcomes because of their age?</p>
<h2>Expand the definition of age discrimination</h2>
<p>Imagine if the data contained in the UNICEF report referred to women, Māori or other minorities. We would of course have to ask whether such poor outcomes were the result of discrimination based on a shared characteristic such as gender, race or ethnicity.</p>
<p>Alas, it is not that easy with young people, even though they are defined by their age. International human rights law has only recently recognised <a href="http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=4slQ6QSmlBEDzFEovLCuW1a0Szab0oXTdImnsJZZVQdqeXgncKnylFC%2blzJjLZGhsosnD23NsgR1Q1NNNgs2QltnHpLzG%2fBmxPjJUVNxAedgozixcbEW9WMvnSFEiU%2fV">age-based</a> discrimination. The concept that <a href="http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2fPPRiCAqhKb7yhsqIkirKQZLK2M58RF%2f5F0vH%2bg0BeHNYSXl2ulaeIW9Y1nEBWXdUgC9p%2fn2WzRfn3fwsXNNC%2b2E7%2bbuK3ful8wJQP6BtAlEzFZVO26Bnyk9OH">young people</a> might be the victims of age-based discrimination is a work in progress. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-coronavirus-crisis-shows-why-new-zealand-urgently-needs-a-commissioner-for-older-people-139383">The coronavirus crisis shows why New Zealand urgently needs a commissioner for older people</a>
</strong>
</em>
</p>
<hr>
<p>New Zealand law has actually been ahead of international law since our Human Rights Act <a href="http://www.legislation.govt.nz/act/public/1993/0082/latest/DLM304475.html">prohibited</a> age-based discrimination back in 1993. The problem is the act itself sets an age limit and doesn’t apply to people under 16. </p>
<p>Maybe it’s now time to extend the prohibition on age-based discrimination to all young New Zealanders. </p>
<p>Changing the law on age-based discrimination may be no silver bullet. And there is no doubt that responding to the issues raised in the UNICEF report is a hugely complex task. </p>
<p>However, if the laws and policies affecting young people were subject to the same kind of legal scrutiny as other forms of discrimination, New Zealand might take one step towards demonstrating a more serious commitment to doing better by its young people.</p><img src="https://counter.theconversation.com/content/145685/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Breen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With UNICEF ranking New Zealand 35th out of 41 rich countries for children’s well-being, the gap between rhetoric and reality is wider than ever.Claire Breen, Professor of Law, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1449752020-08-26T13:08:34Z2020-08-26T13:08:34ZChildhood obesity could increase the risk of multiple sclerosis in later life<figure><img src="https://images.theconversation.com/files/354653/original/file-20200825-16-9wx3zf.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C3994%2C2640&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-view-scales-on-floor-kids-75942880">Child's feet on bathroom scale</a></span></figcaption></figure><p>Obesity and smoking are well-known risk factors for heart disease and cancer. What is less well known is that they are associated with an increased risk of multiple sclerosis (MS). </p>
<p>Several studies looking at how MS develops have associated <a href="https://pubmed.ncbi.nlm.nih.gov/31937597/">childhood obesity</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/29055459/">smoking</a> with a significant increase in the subsequent risk of getting the disease. <a href="https://pubmed.ncbi.nlm.nih.gov/20398859/">MS is becoming increasingly common</a>, and changing rates of childhood obesity and smoking may be contributing to this. </p>
<p>Studying the link between behaviour or events in childhood and later-life development of MS is complex. MS is an auto-immune disease of the central nervous system which affects around <a href="https://www.mstrust.org.uk/a-z/prevalence-and-incidence-multiple-sclerosis">one in every 500 people</a>. This means that a large number of people need to be studied from a young age to get an accurate picture of the effect of changes in behaviour or lifestyle on the risk of MS in adulthood. </p>
<p>While we know from earlier studies that childhood obesity increases the risk of MS, the findings don’t clearly show how changing patterns of childhood obesity in the population might affect the frequency of MS in the future. To better understand this, we looked at the proportion of MS risk that could be attributed to obesity and smoking. The results of our analysis are published in the <a href="https://academic.oup.com/ije/advance-article-abstract/doi/10.1093/ije/dyaa151/5897122?redirectedFrom=fulltext">International Journal of Epidemiology</a>.</p>
<h2>What is already known</h2>
<p>Many studies have looked at the relationship between smoking and MS. The largest of these included more than 590,000 people from around the world. It showed that <a href="https://pubmed.ncbi.nlm.nih.gov/29055459/">smokers are around 50% more likely to develop MS</a> than non-smokers.</p>
<p>Studying the relationship between adolescent obesity and MS is more complicated – few studies have weighed people in childhood and then follow enough people up to see if they develop MS. A study looking at the association between <a href="https://pubmed.ncbi.nlm.nih.gov/31937597/">genes associated with childhood obesity and MS</a> showed that people who are obese as children have a 20% increased risk of MS – a similar result to that seen in <a href="https://pubmed.ncbi.nlm.nih.gov/23549432/">smaller studies</a> that measured weight in childhood and followed people up into adulthood.</p>
<figure class="align-center ">
<img alt="Teenagers smoking cigarettes" src="https://images.theconversation.com/files/354848/original/file-20200826-16-1r0gh99.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/354848/original/file-20200826-16-1r0gh99.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354848/original/file-20200826-16-1r0gh99.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354848/original/file-20200826-16-1r0gh99.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354848/original/file-20200826-16-1r0gh99.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354848/original/file-20200826-16-1r0gh99.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354848/original/file-20200826-16-1r0gh99.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Smokers are around 50% more likely to get MS.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kids-smoking-cigarette-park-concept-health-439484626">Diego Cervo/Shutterstock</a></span>
</figcaption>
</figure>
<p>These results can be used alongside information about the frequency of <a href="https://pubmed.ncbi.nlm.nih.gov/28390697/">smoking</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/29029897/">obesity</a> in the entire population of a country, to calculate how much these factors contribute to MS risk in that country. As there is a time lag between childhood obesity, starting smoking and future MS development, we used current information to estimate how this might change in the future.</p>
<h2>How much do smoking and obesity contribute to MS?</h2>
<p>We found that between 10 and 14% of the population risk of MS in the UK, US, Russia and Australia in 2015 was attributable to smoking. This is much higher in Russian males (22%), reflecting high rates of smoking. By 2025, the population risk attributable to smoking is projected to decrease in all the countries studied to between 7% and 12%.</p>
<p>In the US, childhood obesity accounted for a higher proportion of 2015 MS risk than smoking. Childhood obesity in the US in 2005 accounted for 11% of MS risk in 2015. In the UK, this figure was 8%. Worryingly, when the potential impact of 2015 rates of childhood obesity are projected, this will contribute up to 14% MS risk in the US and 10% in the UK in 2035.</p>
<p>Trying to look at the combined effects of smoking and obesity is more complex, as the current evidence does not tell us the amount of overlap between the two factors. The overall effect is likely to remain roughly stable, as the increase in childhood obesity offset reductions in smoking. </p>
<p>While this research cannot tell us how childhood obesity and smoking increase MS risk, it shows that there is an urgent need to address childhood obesity. Increasing rates of childhood obesity mean that any gains in MS prevention caused by reduced levels of smoking will be lost. While cancer and heart disease occur in later adulthood, MS onset in young adulthood may have increased resonance with younger people.</p>
<p>Reducing childhood obesity and smoking is likely to have an important impact on MS incidence. Our work shows the size of the problem and highlights the need to act urgently.</p><img src="https://counter.theconversation.com/content/144975/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruth Dobson receives research support from MS Society UK, Horne Family Foundation, Biogen, Merck and Celgene. She has received honoraria and/or travel support from Merck Serono, Biogen, Teva, Sanofi Genzyme, Novartis. This work was performed on the Preventive Neurology Unit, which is funded by Barts Charity.
</span></em></p>Obesity in young people today may contribute up to 14% of overall risk of multiple sclerosis in 2035.Ruth Dobson, Clinical Senior Lecturer in Neurology and Honorary Consultant Neurologist, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1301562020-02-07T14:07:34Z2020-02-07T14:07:34ZRunning a mile a day can make children healthier – here’s how schools can make it more fun<figure><img src="https://images.theconversation.com/files/313802/original/file-20200205-149772-1hkofgp.jpg?ixlib=rb-1.1.0&rect=1%2C10%2C957%2C625&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Daily Mile gets children out of the classroom for fifteen minutes every day to run or jog, at their own pace.</span> <span class="attribution"><a class="source" href="https://www.facebook.com/thedailymile.uk/photos/a.634705280010769/1581957871952167/?type=3&theater">The Daily Mile </a></span></figcaption></figure><p>Children today <a href="https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more">spend more time sitting</a> than ever before. And <a href="https://www.nature.com/articles/s41366-019-0459-0#Ack1%20%22External%20website">research shows</a> that as they grow up, children tend to become more sedentary and less active.</p>
<p>This is where The <a href="https://theconversation.com/when-kids-run-for-15-minutes-in-school-every-day-heres-what-happens-to-their-health-96371">Daily Mile</a>, a teacher-led running programme for primary school children, aims to make a difference. Designed by a <a href="https://www.theguardian.com/education/2015/sep/28/daily-mile-school-st-ninians-stirling-scotland">headteacher</a> in Scotland in 2012 in a bid to get children more active, the concept involves children running laps of the playground or school playing fields for 15 minutes everyday. Its simple design combined with political, <a href="https://thedailymile.co.uk/media-centre/news/press-release-the-mayor-of-london-and-sir-mo-farah-back-the-daily-mile/">public health and celebrity endorsement</a> has seen it expand to over 10,000 schools in 78 countries worldwide. </p>
<p>Recent <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1049-z">research</a> has shown that The Daily Mile may help children become fitter and reduce their body fat. But with over <a href="https://thedailymile.co.uk/">2.3 million children</a> taking part over the last eight years, we wanted to find out what school children thought of The Daily Mile. </p>
<p>In our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228149">new research</a> that we conducted with our primary school health <a href="https://theconversation.com/schools-shouldnt-be-left-alone-to-deal-with-child-health-and-well-being-any-longer-69579">network</a>, <a href="https://happen-wales.co.uk/">HAPPEN</a>, we found that The Daily Mile can make a massive difference to children’s lives. It makes children realise they are good at running, that running is something they can do with friends and most importantly that they can have fun being active. </p>
<p>By talking to pupils, we also found that how schools promote The Daily Mile can greatly affect children’s experiences of it – and a lot of those we spoke to had great ideas on how to make it more fun and engaging. </p>
<h2>What the kids say</h2>
<p>On the whole, pupils enjoyed taking part in The Daily Mile but some also spoke of it becoming repetitive and boring. Pupils suggested playing music while running, setting up an obstacle course or running with a buddy around the mile to make it more interactive and fun.</p>
<blockquote>
<p>I like it because you can run with your friends and also listen to music, but it could be better by adding obstacles in maybe, hurdles or something</p>
</blockquote>
<p>This is important as research shows that finding a form of physical activity that <a href="https://www.sciencedirect.com/science/article/pii/S0277953616301733?via%253Dihub">you enjoy</a> increases the likelihood of you starting and <a href="https://www.researchgate.net/publication/338630390_A_Meta-Analysis_of_Self-Determination_Theory-Informed_Intervention_Studies_in_the_Health_Domain_Effects_on_Motivation_Health_Behavior_Physical_and_Psychological_Health">maintaining</a> a <a href="https://www.tandfonline.com/doi/abs/10.1080/17437190903229462">physically active lifestyle</a>.</p>
<p>In our research, children also told us they didn’t like it when The Daily Mile replaced their play time – as is the case in some schools. One of the children we spoke to told us:</p>
<blockquote>
<p>If it wasn’t taking up our play time which is one of the fun moments of the day, then I would do it, because it is during play I don’t really want to do it.</p>
</blockquote>
<p>Indeed, play is an essential component of child development and there has been a recent emphasis on the importance of <a href="https://www.telegraph.co.uk/education/2019/05/10/school-playtime-becoming-thing-past-generation-children-new/">protecting</a> the ever decreasing opportunities of school play times.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313803/original/file-20200205-149789-rcyixh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313803/original/file-20200205-149789-rcyixh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313803/original/file-20200205-149789-rcyixh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313803/original/file-20200205-149789-rcyixh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313803/original/file-20200205-149789-rcyixh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313803/original/file-20200205-149789-rcyixh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313803/original/file-20200205-149789-rcyixh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Daily Mile: making children fitter, healthier and more able to concentrate in the classroom.</span>
<span class="attribution"><a class="source" href="https://www.facebook.com/thedailymile.uk/photos/a.634705280010769/1524633864351235/?type=3&theater">The Daily Mile</a>, <a class="license" href="http://artlibre.org/licence/lal/en">FAL</a></span>
</figcaption>
</figure>
<p>Some pupils also told us how they thrived at the competitive aspect of The Daily Mile, but others were worried about “finishing last”. Encouraging pupils to set their own personal goals helped to tackle this and enabled children to see improvements in their running.</p>
<blockquote>
<p>Well I know it’s supposed to improve your running, and it did for me because at the start I couldn’t really run long distance, but now I can run about 36 laps nonstop running.</p>
</blockquote>
<p>Pupils in our study also reported enjoying The Daily Mile more when teachers ran it with them. </p>
<blockquote>
<p>I think the teachers should start running it, because they’re just like standing there while we’re doing all the running and I feel like they should be doing it … If they joined in I would run more.</p>
</blockquote>
<p>We also found that some schools would organise termly launch events to create excitement and enthusiasm in school around The Daily Mile – with parents, other family members and the wider community getting involved too. Pupils told us how much they enjoyed this, along with meeting local sporting celebrities who supported The Daily Mile. </p>
<h2>Long term impact</h2>
<p>Tackling health inequalities remains a <a href="https://gov.wales/sites/default/files/publications/2019-06/measuring-the-health-and-well-being-of-a-nation.pdf">public health priority</a>. So as part of our research we also wanted to see if the impact of The Daily Mile on children’s fitness differed between children living in poorer and wealthier areas. We found that deprivation didn’t matter – our findings seem to indicate that The Daily Mile can improve the fitness of all children. </p>
<p>While this positive news is to be welcomed, our research also highlights the importance of involving children in the design and delivery of programmes like The Daily Mile. As their great ideas could help to create meaningful and enjoyable experiences and encourage a lifetime habit of physical activity.</p><img src="https://counter.theconversation.com/content/130156/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Marchant receives funding from ESRC and the National Centre for Population Health and Wellbeing Research (NCPHWR). </span></em></p><p class="fine-print"><em><span>Charlotte Todd receives funding from the National Centre for Population Health and Wellbeing Research (NCPHWR)</span></em></p><p class="fine-print"><em><span>Gareth Stratton receives funding from Wales European Funding Office, British Heart Foundation, British Academy</span></em></p><p class="fine-print"><em><span>Michaela James receives funding from the National Centre for Population Health and Wellbeing Research (NCPHWR)</span></em></p><p class="fine-print"><em><span>Sinead Brophy receives funding from Health Care Research Wales, MRC, ESRC. </span></em></p>From obstacle courses to playing music, school children give their thoughts on how to make a daily run more exciting.Emily Marchant, PhD Researcher in Medical Studies, Swansea UniversityCharlotte Todd, Research Assistant in Child Health and Well-being, Swansea UniversityGareth Stratton, Chair in Paediatric Exercise Science, Swansea UniversityMichaela James, Research Assistant in Childhood Physical Activity, Swansea UniversitySinead Brophy, Professor in Public Health Data Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1298572020-01-20T13:04:15Z2020-01-20T13:04:15ZWalking to school is not enough to prevent obesity<figure><img src="https://images.theconversation.com/files/309923/original/file-20200114-93792-1anyfil.jpg?ixlib=rb-1.1.0&rect=0%2C229%2C4500%2C2647&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/father-little-daughter-go-school-daycare-719919334">NadyaEugene/Shutterstock</a></span></figcaption></figure><p>More children are overweight or obese nowadays because they don’t get enough exercise, it is often claimed. One of the UK government’s goals in the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/718903/childhood-obesity-a-plan-for-action-chapter-2.pdf">Childhood Obesity Plan</a> is to increase the number of children who walk to school. Walking is certainly healthy, but is it enough to combat childhood obesity? <a href="https://www.sciencedirect.com/science/article/pii/S2352827319302629">Our latest study</a> suggests it isn’t.</p>
<p>Using data on over 7,000 11-year-olds born in England, we found that children living in the most deprived neighbourhoods in England were most likely to walk to and from school and were also at the greatest risk of being overweight or obese. The most deprived children were also most likely to not take part in sport, spend lots of time in front of TV and computer screens and most likely to have an unhealthy diet (lots of sugary drinks and not much fruit).</p>
<p>We’re not suggesting that walking to school leads to childhood obesity, but that living in a poor neighbourhood and being poor does. Combating childhood obesity needs more than simply getting children to walk to school more often. That’s because <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/287937/07-1184x-tackling-obesities-future-choices-report.pdf">many factors</a> influence a child’s weight, including economic and environmental ones that affect physical activity and diet.</p>
<h2>Right to a healthy environment</h2>
<p>For too long behavioural intervention programmes that focus on education and personal responsibility have been seen as the answer to unhealthy lifestyles (physical inactivity, unhealthy eating) and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012651/full">childhood obesity</a>. We focus on treatment instead of prevention and wonder why we have a revolving door system – one that’s not working. </p>
<p>Behavioural intervention programmes are mostly ineffective in the long run and do little to <a href="http://www.mrc-epid.cam.ac.uk/wp-content/uploads/2016/10/WhiteM_etal_How_and_why_do_interventions_that_increase_health_overall_widen_inequalities_within_populations.pdf">tackle health inequities</a> when the policies and the social and environmental conditions that promote unhealthy eating and inactivity are left untouched. Even when behavioural intervention programmes are successful, there’s a new group of children waiting to take part in the next one.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-deprivation-linked-to-changes-in-eating-styles-in-early-childhood-127766">Social deprivation linked to changes in eating styles in early childhood</a>
</strong>
</em>
</p>
<hr>
<p>Children have a right to live in a healthy environment. Combating childhood obesity and its inequalities will only be achieved when the neighbourhoods children live in support physical activity and healthy eating. We need policies that ensure there’s a level playing field in terms of the accessibility and pricing of healthy food and active leisure opportunities. It should come as no surprise that childhood obesity is <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ijpo.12287">highest</a> and increasing at the <a href="https://www.mdpi.com/1660-4601/15/12/2612">fastest rate</a> in the most deprived neighbourhoods.</p>
<p>The facilities that support physical activity and healthy eating are typically less common in deprived neighbourhoods. Deprived neighbourhoods have the <a href="https://bmjopen.bmj.com/content/6/1/e008693">fewest parks and green spaces</a> and the fewest shops selling <a href="https://bristolfoodpolicycouncil.org/wp-content/uploads/2013/08/Food-Poverty-Report-July-2013-for-publication.pdf">affordable fresh food</a>.</p>
<p>Households in deprived neighbourhoods often have little disposable income, which makes accessing <a href="https://www.tandfonline.com/doi/abs/10.1080/03004430.2016.1194409">active leisure opportunities</a>, such as sports clubs, difficult. It also makes it harder to have a <a href="https://www.mdpi.com/1660-4601/15/6/1224">balanced diet</a> – the poorest households in England would need to spend <a href="https://foodfoundation.org.uk/wp-content/uploads/2019/02/The-Broken-Plate.pdf">74% of their budget</a> on food to achieve Public Health England’s healthy eating advice.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/309926/original/file-20200114-93792-9nu5ig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/309926/original/file-20200114-93792-9nu5ig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/309926/original/file-20200114-93792-9nu5ig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/309926/original/file-20200114-93792-9nu5ig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/309926/original/file-20200114-93792-9nu5ig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/309926/original/file-20200114-93792-9nu5ig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/309926/original/file-20200114-93792-9nu5ig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It can be hard to buy healthy food in the poorest neighbourhoods.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-uk-16-september-2012-closed-256404478">pxl.store/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Impact of austerity</h2>
<p>The government’s Childhood Obesity Plan recognises that the environment needs to change, but little is being done at a policy level to see this through. Children face <a href="https://www.tandfonline.com/doi/abs/10.1080/19406940.2017.1348964?journalCode=risp20">diminishing opportunities</a> to take part in active leisure as a result of cuts in public funding. <a href="https://jech.bmj.com/content/72/3/252">Public swimming and leisure centres</a>, which were once free for all children, face closure. Cuts to maintenance budgets and increased urbanisation place public parks and green spaces <a href="https://www.theguardian.com/uk-news/2017/jul/09/the-end-of-park-life-as-we-know-it-the-battle-for-britains-green-spaces-rowan-moore">under threat</a>, too.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/food-poverty-at-record-levels-a-childrens-book-on-food-banks-shows-how-normal-it-has-become-126476">Food poverty at record levels – a children's book on food banks shows how normal it has become</a>
</strong>
</em>
</p>
<hr>
<p>The food environment isn’t becoming any more supportive of healthy eating either. <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/296248/Obesity_and_environment_March2014.pdf">Fast-food outlets</a> continue to be built in the <a href="https://www.feat-tool.org.uk/">poorest neighbourhoods</a> and next to schools as <a href="https://www.ncbi.nlm.nih.gov/pubmed/29198220">healthy food prices</a> rise, and unhealthy foods become cheaper and more accessible. This is at a time when <a href="https://cpag.org.uk/child-poverty/child-poverty-facts-and-figures">child poverty</a> is rising in the UK and the <a href="https://www.itv.com/news/2019-08-28/child-poverty-crisis-leaves-family-living-hand-to-mouth-existence-foodbanks-liverpool-itv-exclusive/">poorest families</a> in society are struggling to make ends meet due to rising living costs, low wages and cuts to welfare benefits. We’re walking backwards not forwards.</p><img src="https://counter.theconversation.com/content/129857/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rob Noonan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Poor neighbourhoods are driving health inequalities in children.Rob Noonan, Lecturer, Appetite and Obesity, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1239182019-12-26T21:39:52Z2019-12-26T21:39:52Z4 ways to get your kids off the couch these summer holidays<figure><img src="https://images.theconversation.com/files/306259/original/file-20191211-95125-1qc2bm.jpg?ixlib=rb-1.1.0&rect=1%2C10%2C997%2C655&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Come school holidays, your school-aged kids are more likely to spend longer on their screens than they do in term time. Here's how to get them outside and active, with a bit of planning.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-image-cute-little-blond-1477614533">from www.shutterstock.com</a></span></figcaption></figure><p>The sun’s shining and there’s a trampoline in the backyard. Yet your kids want to spend their summer holidays lying on the couch playing computer games all day.</p>
<p>So what can you do to help your school-aged kids stay active and healthy this summer?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-one-in-four-aussie-kids-are-overweight-or-obese-were-failing-them-and-we-need-a-plan-114005">More than one in four Aussie kids are overweight or obese: we're failing them, and we need a plan</a>
</strong>
</em>
</p>
<hr>
<h2>Kids put on weight over the holidays</h2>
<p>In 2016, a <a href="https://www.ncbi.nlm.nih.gov/pubmed/27804271">US study</a> found that all the increase in fatness of school-aged children occurred over the summer holidays. During term time, kids get leaner and leaner, only to put it all back on, and then some, during the holidays. </p>
<p>Their <a href="https://www.ncbi.nlm.nih.gov/pubmed/17548760">fitness also declines</a> during holiday time. To make matters worse, changes are greater in kids from <a href="https://journals.sagepub.com/doi/abs/10.3102/0002831213502516?journalCode=aera">poorer, less educated backgrounds</a>, and the gap between rich and poor widens over multiple summer holidays. The work of the school is undone at home. </p>
<p>What’s going on, and what can parents do about it?</p>
<h2>Holidays are different</h2>
<p>Kids spend their time <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6765-6">differently on holidays</a>, as we showed in a study published earlier this year. </p>
<p>On holidays, Australian kids get 58 minutes a day more screen time than during term time, including spending 16 minutes a day more playing video games. They get 16 minutes less sport and vigorous exercise each day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-why-does-the-teenage-brain-need-more-sleep-29557">Explainer: why does the teenage brain need more sleep?
</a>
</strong>
</em>
</p>
<hr>
<p>They also get 40 minutes more sleep, staying up about 40 minutes later, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/9158439">sleeping in</a> 80 minutes more.</p>
<p>All this adds up: their overall energy expenditure is more than 5% lower. Over six weeks of school holidays, that amounts to an extra half kilogram of fat in a typical 11-year old, and that’s without counting changes in diet.</p>
<p>Kids eat differently on holidays, too. </p>
<p>On school days, kids can only eat during recess and lunch. Their options are limited by school-based healthy eating initiatives such as “fruit time”, healthy canteen menus, and the curriculum about healthy lunchboxes. </p>
<p>All that goes out the window on holidays. Kids fall victim to the gravitational pull of the big white box in the kitchen. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/306268/original/file-20191211-95111-1kcb5nq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/306268/original/file-20191211-95111-1kcb5nq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306268/original/file-20191211-95111-1kcb5nq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306268/original/file-20191211-95111-1kcb5nq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306268/original/file-20191211-95111-1kcb5nq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306268/original/file-20191211-95111-1kcb5nq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306268/original/file-20191211-95111-1kcb5nq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306268/original/file-20191211-95111-1kcb5nq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In the holidays, kids fall victim to the gravitational pull of the fridge.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-looking-open-fridge-family-letters-1110081056">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>On weekends and school holidays, kids have greater choice of how much, what and when they eat. Most (knowingly) choose <a href="https://academic.oup.com/heapro/article/23/2/144/712577">less healthy options</a>. </p>
<p>Later bedtimes mean more <a href="https://www.ncbi.nlm.nih.gov/pubmed/26264005">screen time</a> and more <a href="https://www.ncbi.nlm.nih.gov/pubmed/23295498">snacking</a>. Longer lie-ins often mean kids skip breakfast.</p>
<h2>The importance of structure</h2>
<p><a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0555-2">US researchers</a> coined the idea of “structured days”. School days, they argue, are characterised by consistency and structure, which regulate how kids use their time, and when and what they eat. </p>
<p>On school days, for example, two-thirds of kids get up within an hour of each other (roughly between 6:30 and 7:30 am); on non-school days, it is over three hours (between 6:45 and 10:05 am).</p>
<p>Their review of 190 studies compared children’s sleep, physical activity, sedentary behaviours and diet on school days and weekends. They found that in 80% of studies, weekends were associated with unfavourable activity and dietary patterns.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/306270/original/file-20191211-95120-1jrp4i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/306270/original/file-20191211-95120-1jrp4i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306270/original/file-20191211-95120-1jrp4i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306270/original/file-20191211-95120-1jrp4i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306270/original/file-20191211-95120-1jrp4i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306270/original/file-20191211-95120-1jrp4i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=454&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306270/original/file-20191211-95120-1jrp4i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=454&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306270/original/file-20191211-95120-1jrp4i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=454&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Unstructured time during school holidays can lead to longer lie-ins and missed breakfasts.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-caucasian-boy-sleeping-bed-742624951">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>During school term, the unhealthy impacts of unstructured weekend days are diluted. In contrast, the school holidays, and particularly the summer holidays, involve a long string of unstructured days and unfavourable activity and dietary behaviours. This leads to a decline in fitness and accelerated <a href="https://www.ncbi.nlm.nih.gov/pubmed/24367922">weight gain</a>.</p>
<p>The “<a href="https://journals.sagepub.com/doi/abs/10.1375/acri.39.3.398?journalCode=anja">filled-time perspective</a>” describes the sensible idea that when children’s time is filled with favourable activities, the time cannot be filled with unfavourable ones. </p>
<p>This suggests it is helpful to fill children’s time with favourable activities, like physical activity and excursions, to reduce the time available for unfavourable activities, such as snacking and screen time. </p>
<p>So what can parents do to keep kids healthy and active on school holidays? Here are four ways, with a proven track record.</p>
<h2>1. Get kids outside</h2>
<p>Studies consistently show time spent outside is strongly associated with both <a href="https://www.sciencedirect.com/science/article/pii/S2211335519301779">physical and mental health</a>. That effect is likely due to kids being more physically active outdoors.</p>
<h2>2. Try summer camps</h2>
<p>Summer camps are popular in Europe and North America, and <a href="https://travel.nine.com.au/destinations/aussie-summer-camps-for-kids/14d1b415-dab5-4b3c-9932-f613696ac0df">also run in Australia</a>.</p>
<p><a href="https://fr.wikipedia.org/wiki/Colonie_de_vacances">An estimated 1.3 million</a> French school children go off to their “colonies de vacances” each summer. In the US, over 14 million kids attend <a href="https://www.ncbi.nlm.nih.gov/pubmed/28350830">summer camps</a>. </p>
<p>Children who spend more time in summer camp are <a href="https://www.ncbi.nlm.nih.gov/pubmed/20334661">more active</a> than those who spend more time at home over the summer holiday. </p>
<p>Some <a href="https://www.ncbi.nlm.nih.gov/pubmed/28214251">80% of boys and 73% of girls</a> who attended a summer day camp met the daily physical activity recommendations of 60 minutes per day — about four times as many as those reaching that target during the year.</p>
<h2>3. Activity before screen time</h2>
<p>Only allow screen time when the kids have been physically active, even if that only means doing household chores. On holidays, kids spend <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6765-6">35 minutes more</a> each day doing chores, so this may be your chance to get your kids to pitch in. </p>
<h2>4. Plan the day</h2>
<p>Organise time for physical activity with your child. Have a game of beach cricket or a mini-Olympics in the backyard. Take the dog for a walk. Organise excursions to the museum, or even shopping, where they get to walk around. Have regular times for meals and relaxation.</p>
<p>Good luck.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-suburban-parks-offer-an-antidote-to-helicopter-parenting-115155">Why suburban parks offer an antidote to helicopter parenting</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/123918/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Olds receives funding from the NHMRC and the ARC.</span></em></p><p class="fine-print"><em><span>Amanda Watson receives funding from the NHMRC</span></em></p><p class="fine-print"><em><span>Carol Maher receives funding from the NHMRC.</span></em></p>The average Australian school kid spends more time watching TV or gaming and less time being active over their summer holidays. Could more chores be the answer?Tim Olds, Professor of Health Sciences, University of South AustraliaAmanda Watson, Research Associate, University of South AustraliaCarol Maher, Associate Professor, NHMRC Career Development Fellow, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1277662019-12-09T14:37:00Z2019-12-09T14:37:00ZSocial deprivation linked to changes in eating styles in early childhood<figure><img src="https://images.theconversation.com/files/304233/original/file-20191128-178078-16k2zav.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/463152221?src=3f21beb5-ca7d-4fc4-a36a-4e6cde4e0733-1-2&size=medium_jpg">Jonathan Oscar/Shutterstock</a></span></figcaption></figure><p>Childhood obesity rates are high in the UK, but not all children are affected equally – a family’s wealth makes a big difference to a child’s risk. Rates of overweight and obesity among children are <a href="https://fingertips.phe.org.uk/profile/national-child-measurement-programme/data#page/0/gid/8000011/pat/6/par/E12000003/ati/102/are/E08000016/iid/92026/age/200/sex/4">twice as high in the poorest neighbourhoods</a> compared with the richest neighbourhoods – and the gap is getting bigger. This means that children don’t get equal opportunities to live a healthy life, so it is important to understand why this is happening. </p>
<p>Our <a href="https://www.sciencedirect.com/science/article/pii/S0195666319304908">latest study</a> suggests that children’s eating styles may be part of the reason for the increased risk among poorer children. We found that children from poorer families were more likely to overeat in response to negative emotions and had a greater desire to eat in response to the taste, smell or sight of foods high in fat or sugar. </p>
<p>We used information from 2,400 British families with twins who were taking part in the <a href="https://www.geministudy.co.uk">Gemini study</a>, an exploration of children’s growth that began in 2007 when the twins were born. Parents described their children’s eating styles when they were toddlers (16 months) and again at five years of age. They answered questions about their children’s eating styles, including how much they enjoyed food, their fussiness around foods, their drive or compulsion to eat food after seeing or smelling it, and whether their child ate more or less in response to negative emotions, such as anxiety or distress. </p>
<p>The researchers also asked lots of questions about the parent’s level of education, their current job, the type of home they lived in and the area they lived in. They used this information to get a better picture of the families’ wealth and social background. It is rare for researchers to collect so much information about social and economic factors. Typically, they ask about one or two things, such as postcode or a parent’s highest educational qualification. But this approach is limited because it doesn’t provide a full picture of a family’s wealth and social position. This is where this study stands out.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/304234/original/file-20191128-178078-4iiw9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/304234/original/file-20191128-178078-4iiw9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/304234/original/file-20191128-178078-4iiw9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/304234/original/file-20191128-178078-4iiw9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/304234/original/file-20191128-178078-4iiw9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/304234/original/file-20191128-178078-4iiw9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/304234/original/file-20191128-178078-4iiw9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our environment plays a big role in what we eat.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/256404478?src=e9606ab4-261e-4d64-981f-6c6617056c66-1-28&size=medium_jpg">pxl.store/Shutterstock</a></span>
</figcaption>
</figure>
<p>We know that a child’s eating styles develop in early life and that children differ a lot in how they respond to food and the opportunity to eat. Some take much longer to finish their meal, are uninterested in eating and push their food around the plate, whereas others have a hearty appetite and are constantly asking for food. We also know that once a child’s eating styles have developed, they <a href="https://www.nature.com/articles/1602855">usually stay quite stable</a> as children get older and reach their teens. </p>
<p>Before this study, researchers knew very little about how a child’s social and economic background influenced their eating styles during the first few years of life. Our findings suggest that children from poorer families are already showing differences in their eating styles when they are toddlers, and these differences continue into early childhood. These eating styles may be part of the reason that rates of obesity among children from deprived backgrounds are much higher. </p>
<h2>Food environment – a likely culprit</h2>
<p>The key question that we need to answer next is why children from poorer backgrounds are more likely to overeat in response to a negative emotion or want to eat more in response to seeing, smelling, or tasting palatable food. Our study didn’t explore the reasons why eating styles differ, but there are several possible explanations. </p>
<p>Our environment heavily influences our eating styles and the foods we choose, and it tends to promote unhealthy food choices. And this is often worse for children living in poorer areas. For example, <a href="https://www.ncbi.nlm.nih.gov/pubmed/29198220">energy-dense foods are often cheaper</a>, <a href="https://foodfoundation.org.uk/wp-content/uploads/2017/07/3-Briefing-UK-Junk-Food_vF.pdf">heavily advertised</a>, in <a href="https://bmjopen.bmj.com/content/6/1/e008693">closer proximity</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482049/">more widely available</a>, than healthier alternatives such as fresh fruit and vegetables, which makes them more prominent and attractive.</p>
<p>Food advertising is impossible to avoid – we are regularly exposed to <a href="https://foodfoundation.org.uk/wp-content/uploads/2017/07/3-Briefing-UK-Junk-Food_vF.pdf">adverts for energy-dense foods</a> on the street – but prompts to buy and eat energy-dense foods are <a href="https://www.lambeth.gov.uk/sites/default/files/EB05_15_Relationshipfoodenviro,deprivationNCMPobesity.pdf">more common in poorer areas</a>, as is the number <a href="https://bmjopen.bmj.com/content/6/1/e008693">fast-food outlets</a>. Our findings suggest that these differences in the food environments between people living in poorer areas may contribute to the higher rates of obesity by encouraging overeating.</p><img src="https://counter.theconversation.com/content/127766/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alice Kininmonth receives funding from the Economic Social Research Council.</span></em></p><p class="fine-print"><em><span>Andrea Smith receives funding from the National Institute of Health Research, the UCL Catalyst Santander Fund, the Global Food Security programme, the UCL Global Engagement Fund, the UCL Public Policy Fund, the European Association for the Study of Obesity (EASO) and the UK Association for Obesity (ASO). </span></em></p><p class="fine-print"><em><span>Clare Llewellyn receives funding from the Economic and Social Research Council, the National Institute of Health Research, the Medical Research Council, the European Commission, FONDECYT National Fund for Scientific and Technological Development (in Chile), Hong Kong University & UCL Strategic Partnership Fund, MQ - Transforming Mental Health (UK charity), and Best Beginnings (UK charity). Clare has previously received funding from Cancer Research UK, and was an elected trustee for the UK Association for the Study of Obesity from 2013-2019. She is the author of three books about infant and toddler nutrition and feeding: 'Baby Food Matters’ (published by Yellow Kite in the UK), ‘An Appetite for Life’ (published by The Experiment in the US), and ‘Feeding for the First 1000 Days’ (published by Diamond Inc in Japan).”</span></em></p><p class="fine-print"><em><span>Alison Fildes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children’s eating styles are different in deprived areas.Alice Kininmonth, PhD Candidate, Human Appetite, University of LeedsAndrea Smith, Research Fellow in Behavioural Obesity; NIHR Obesity Policy Research Unit, UCLClare Llewellyn, Associate Professor in Obesity, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1254132019-10-23T09:47:08Z2019-10-23T09:47:08ZSnacking: the modern habit that could be putting your health and waistline at risk<figure><img src="https://images.theconversation.com/files/297670/original/file-20191018-56224-4of1h1.jpg?ixlib=rb-1.1.0&rect=49%2C17%2C2946%2C1976&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-eating-pretzel-while-traveling-by-1188229111?src=kQHlH7JsKisMspQump5RjQ-1-1">shutterstock/frantic00</a></span></figcaption></figure><p><a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">Cakes, biscuits and energy bars</a> are, for many people, just staples of everyday life – <a href="https://theconversation.com/food-labelled-snack-leaves-you-hungrier-than-food-labelled-meal-86507">the snacks</a> that keep them going through the day.</p>
<p>But most people don’t realise just how easy it is to over-consume calories while snacking. Women are advised by the government to consume <a href="https://www.gov.uk/government/news/behind-the-headlines-calorie-guidelines-remain-unchanged">2,000 calories a day and men 2,500</a>. And the NHS suggests aiming to have a balance of 400 calories for breakfast, 600 calories for lunch and 600 calories for the evening meal – leaving the <a href="https://www.nhs.uk/oneyou/for-your-body/eat-better/keep-track-of-calories-400-600-600/">remainder for drinks and health snacks</a>. </p>
<p>But research from the <a href="http://38r8om2xjhhl25mw24492dir.wpengine.netdna-cdn.com/wp-content/uploads/2016/08/16-07-12-Counting-Calories-Final.pdf">Behaviour Insight Team</a>, also known unofficially as the “Nudge Unit”, found that adults may be consuming an average of 3,000 calories a day without realising, partly due to snacking.</p>
<p>This is particularly significant given the <a href="https://www.gov.uk/guidance/phe-data-and-analysis-tools#obesity-diet-and-physical-activity">rise in obesity in children</a>. And the fact that <a href="https://learnenglishteens.britishcouncil.org/uk-now/read-uk/snack-culture">64% of young people snack</a> outside of meal times – with the majority of these snacks being <a href="https://learnenglishteens.britishcouncil.org/uk-now/read-uk/snack-culture">high in fat, sugar and salt</a>.</p>
<h2>Snack attack</h2>
<p>According to a <a href="https://academic.oup.com/advances/article/7/3/466/4558044">recent paper</a>, there are many reasons why people snack. It could be down to hunger and the need to eat, or more “distracted eating” – eating too much food while playing a game or watching the TV. Many people also eat through habit or association, such as at the <a href="https://academic.oup.com/advances/article/7/3/466/4558044">cinema or when meeting a friend for coffee and cake</a>. </p>
<p>The wide range of <a href="https://theconversation.com/hard-evidence-do-supermarket-checkouts-make-kids-obese-21344">snacks available to shoppers</a> is now evident in all outlets – in shops, transport hubs and vending machines. But rarely are these snacks of the healthy variety – think crisps, snack bars and chocolate. And these can often tip daily calories into excess without people realising – which can <a href="https://www.sciencedirect.com/science/article/pii/S0031938414001449">lead to weight gain</a>.</p>
<p>But rather than <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/837907/cmo-special-report-childhood-obesity-october-2019.pdf">banning snacking on public transport</a> altogether – as has recently been suggested by former chief medical officer Dame Sally Davies – food labelling, education and “choice architecture” (this is the way food is displayed to enable healthier choices) should be implemented more widely to help <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488793/">nudge people in the right direction</a>. </p>
<p>This is important, because generally, if people are hungry, they eat what is there. So by providing healthy options at an affordable price it should help people make <a href="https://shuspace.shu.ac.uk/bbcswebdav/pid-8312499-dt-content-rid-32666225_2/courses/44-606276-AF-20189/Applying%20behavioural%20insight%20to%20health%20Cabinet%20Office%20paper.pdf">better choices</a>. Indeed, when it comes to eating healthily, The British Nutrition Foundation also recommends people <a href="https://www.nutrition.org.uk/healthyliving/helpingyoueatwell/snacking.html">plan ahead and rethink their portion sizes</a> in a bid to cut out excessive eating.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/297671/original/file-20191018-56207-1vbg27w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/297671/original/file-20191018-56207-1vbg27w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/297671/original/file-20191018-56207-1vbg27w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/297671/original/file-20191018-56207-1vbg27w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/297671/original/file-20191018-56207-1vbg27w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/297671/original/file-20191018-56207-1vbg27w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/297671/original/file-20191018-56207-1vbg27w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Planning ahead with meals can make unhealthy snack choices less likely.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-hands-bag-fresh-vegetables-172462274?src=BVyZQk7H6I0F8WU21Qon6Q-1-44">Shutterstock/Evstigneev Alexander</a></span>
</figcaption>
</figure>
<h2>Feeling peckish</h2>
<p>Snacking today is just a normal part of eating for many. Indeed, the food industry has lured people into believing they cannot sustain themselves without the input of several hundred calories between meals – and a <a href="https://www.theguardian.com/food/2019/aug/30/from-quinoa-bars-to-salmon-skin-chips-whats-behind-the-snacking-revolution">whole “snack” industry has been established</a>. </p>
<p>Eating habits have also drastically changed over the years – with people now more likely to eat out while consuming less home-cooked food. Indeed, according to <a href="https://webarchive.nationalarchives.gov.uk/20130103024837/http://www.defra.gov.uk/statistics/foodfarm/food/familyfood/nationalfoodsurvey/">The National Food Survey</a>, in the 1950s, most households didn’t eat out – compare this with survey results from 1983, by which time most people <a href="https://www.gov.uk/government/news/the-uks-food-history-revealed-through-five-generations-of-data">ate three meals a week</a> outside their home. </p>
<p>Today, traditional family meals have been largely replaced by meals in front of the TV. Home cooking has also declined and been <a href="https://www.independent.co.uk/life-style/health-and-families/features/what-does-eating-ready-meals-do-to-your-body-a6894826.html">replaced by ready meals</a>. <a href="https://www.theguardian.com/food/2019/aug/30/from-quinoa-bars-to-salmon-skin-chips-whats-behind-the-snacking-revolution">People now also eat</a> out more often, have regular takeaways and snack in between meals. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-snacking-could-be-damaging-your-health-100978">Why snacking could be damaging your health</a>
</strong>
</em>
</p>
<hr>
<p>Combine this with a food industry that is selling for the benefit of the industry and not the health of the individual, and it’s not surprising that <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/287937/07-1184x-tackling-obesities-future-choices-report.pdf">unhealthy food culture</a> and snacking is now seen as normal.</p>
<p>But small swaps can make a big difference in overall calories. So next time you’re peckish, consider an alternative – a banana, a small handful of nuts or a pain low fat yogurt and fruit. All of which will fill you up and provide nutrients, rather than the added sugar and fat you don’t need in your diet.</p><img src="https://counter.theconversation.com/content/125413/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruth Whiteside does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Would a ban on snacking on public transport really help combat obesity? An expert in nutrition weighs in.Ruth Whiteside, Senior Lecturer In Public Health Nutrition, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1249942019-10-15T18:58:41Z2019-10-15T18:58:41ZThese 3 factors predict a child’s chance of obesity in adolescence (and no, it’s not just their weight)<figure><img src="https://images.theconversation.com/files/296995/original/file-20191015-98674-gln5an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The mother's education level is also a factor.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-mother-boy-portrait-578217337?src=dCwqXkU4i5Hc2wqArE3FgQ-1-51">Brainsil/Shutterstock</a></span></figcaption></figure><p>Three simple factors can predict whether a child is likely to be overweight or obese by the time they reach adolescence: the child’s body mass index (BMI), the mother’s BMI and the mother’s education level, according to our new research. </p>
<p>The study, published in the <a href="https://www.nature.com/articles/s41366-019-0457-2">International Journal of Obesity</a>, found these three factors predicted whether children of all sizes either developed weight problems or resolved them by age 14-15, with around 70% accuracy. </p>
<p>One in four Australian adolescents is overweight or obese. This means they’re <a href="https://www.nature.com/articles/s41366-019-0461-6">likely to be obese in adulthood</a>, placing them at <a href="https://www.who.int/gho/ncd/en/">higher risk</a> of heart disease, diabetes, Alzheimer’s and cancer. </p>
<p>Combining these three factors may help clinicians target care to those most at risk of becoming obese in adolescence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-one-in-four-aussie-kids-are-overweight-or-obese-were-failing-them-and-we-need-a-plan-114005">More than one in four Aussie kids are overweight or obese: we're failing them, and we need a plan</a>
</strong>
</em>
</p>
<hr>
<h2>Targeting care to those who need it</h2>
<p>GPs are <a href="https://www.ncbi.nlm.nih.gov/pubmed/18953227">well placed to both prevent and treat</a> excess weight and obesity. But time constraints make it difficult. Few parents make appointments to address concerns about weight, so most counselling occurs in the context of a visit for something else.</p>
<p>It’s also difficult for GPs to know which children might need this counselling. GPs don’t want to offer treatment to the overweight or obese child who is going to <a href="https://pediatrics.aappublications.org/content/135/2/e292">grow out it</a>. Nor do they want to raise the topic of excess weight to a child who is in the normal weight range, without good reason. </p>
<p>Targeting care, whether treatment or prevention, to those who really need it avoids wasting resources and harm from over-treating children who will grow out of their weight issues. But until now, we haven’t been able to predict on the spot who these children are.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weighing-kids-at-school-has-more-pros-than-cons-but-the-reasons-may-surprise-you-100387">Weighing kids at school has more pros than cons but the reasons may surprise you</a>
</strong>
</em>
</p>
<hr>
<h2>Our study</h2>
<p>We set out to determine whether simple factors, such as those available to GPs in a standard appointment, could accurately predict which normal-weight children were likely to become overweight or obese, and which heavy children were likely to resolve to a normal weight by adolescence. </p>
<p>By drawing on the <a href="https://growingupinaustralia.gov.au/sites/default/files/tp1.pdf">Longitudinal Study of Australian Children</a>, we considered this question in close to 7,000 children. Children were recruited in 2004 at 0-12 months or four to five years of age and followed up every two years, across six time points, to age 10-11 and 14-15 years respectively.</p>
<p>At each time point, interviewers measured children’s height and weight (except 0-12 months), and parents reported their height and weight, allowing us to calculate their BMI.</p>
<p>We also selected 23 other obesity-related factors clinicians could readily ask in a routine appointment. These included historical factors – such as the child’s birth weight, duration of breastfeeding, mode of delivery and the mother’s education levels – and questions about how often they ate high-fat foods and sugary drinks, their enjoyment of physical activity, and levels of disadvantage in their neighbourhood. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/297017/original/file-20191015-98653-cq4opd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/297017/original/file-20191015-98653-cq4opd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/297017/original/file-20191015-98653-cq4opd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/297017/original/file-20191015-98653-cq4opd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/297017/original/file-20191015-98653-cq4opd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/297017/original/file-20191015-98653-cq4opd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/297017/original/file-20191015-98653-cq4opd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The researchers also looked at how often the children ate high-fat food.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-years-old-boy-eating-french-143265838?src=iWBJf5n4eZ_ujohkR_vV6A-1-13">Romrodphoto/Shutterstock</a></span>
</figcaption>
</figure>
<p>Other studies have tended to look at these factors in isolation or to examine predictive factors at a single time point. We were able to look at the combined effects of all the questions across all the time points throughout childhood.</p>
<h2>What did we find?</h2>
<p>Three consistent factors in both age groups predicted the development or resolution of weight problems by adolescence: the mother’s BMI, the child’s BMI and the mother’s level of education. </p>
<p>For every one unit increase in the child’s BMI at age six to seven, the odds of developing weight problems at 14-15 rose three-fold. It also halved the odds of the weight issues resolving. </p>
<p>Similarly, for every one unit increase of the mother’s BMI when the child was aged six to seven, the chance of the child developing weight problems by 14-15 increased by 5%. The odds of weight issues resolving decreased by 10%. </p>
<p>In addition, at two to five years of age, children whose mothers had a university degree had lower odds of being overweight or obese. For children who were already overweight or obese at two to five, those whose mothers had a university degree were more likely to have their weight issues resolved by adolescence.</p>
<p>Together, these three factors were around 70% accurate in predicting both the development and resolution of weight problems. </p>
<p>Only 13% of normal-weight six to seven year olds, with none of these three risk factors, became overweight or obese by age 14-15. </p>
<p>In contrast, 71% of those with all three risk factors became overweight or obese. </p>
<h2>How could these findings improve care?</h2>
<p>Unlike genetic information or blood tests, these three factors are available on the spot. And despite their apparent simplicity, they include a complex mix of genetic, environmental and lifestyle information about our health. This data is impossible to measure accurately in a brief – or even long – doctor’s appointment. </p>
<p>These three questions may help health practitioners target treatment to high-risk children.</p>
<p>Of course, even if we can accurately identify children at risk of becoming overweight or obese, we still lack effective prevention methods. Lifestyle interventions, such as counselling to improve the quality of their diet and increase physical activity, remain the first choices. However, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27621413">effectiveness of these interventions is limited</a>. We urgently need more effective tools to prevent and manage excess weight and obesity in children. </p>
<p>If you’re concerned about your child’s weight, <a href="https://www.rch.org.au/weight-management/management/#children-familes">speak to a professional</a> such as a dietitian, GP or paediatrician. They can also help manage other conditions that can accompany obesity, such as anxiety and high blood pressure.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-things-parents-can-do-to-improve-their-childrens-eating-patterns-95370">Five things parents can do to improve their children's eating patterns</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/124994/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Lycett receives funding from the National Health and Medical Research Council and the National Heart Foundation. </span></em></p><p class="fine-print"><em><span>Anneke Grobler receives funding from the Thrasher Research Fund, MRFF and RCH foundation. </span></em></p><p class="fine-print"><em><span>Markus Juonala and Melissa Wake do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One in four Australians is overweight or obese by the time they reach adolescence, but it’s difficult to predict who is at risk. These three questions can help.Kate Lycett, Senior Research Officer, Deakin University; Honorary Fellow, The University of Melbourne, Murdoch Children's Research InstituteAnneke Grobler, Statistician, Murdoch Children's Research InstituteMarkus Juonala, Professor of Internal Medicine, University of TurkuMelissa Wake, Paediatrician and Director of Generation Victoria (GenV) , Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1170322019-05-28T14:40:02Z2019-05-28T14:40:02ZWe tested baby food sugar levels in South Africa. This is what we found<figure><img src="https://images.theconversation.com/files/274110/original/file-20190513-183096-1eu8vnq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are calling for legislation limiting the amount of sugar in baby food.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>South Africa has the highest rates of childhood obesity in the world, with an alarming figure of <a href="https://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00-092016.pdf">13%</a>. The global average stands at <a href="https://www.gainhealth.org/wp-content/uploads/2017/11/GNR-Report_2017.pdf">6%</a>. One of the main causes of South Africa’s rate is the rapid growth of the country’s commercial food industry. This has led to increased consumption of cheap, easily accessible and ultra-processed food that is high in sugar. </p>
<p>We <a href="http://www.samj.org.za/index.php/samj/article/view/12597/8810">analysed</a> the sugar content of a variety of baby food products. The study sample included commercially available baby foods – including boxes of cereals and jars of processed food – targeted at children under 12 months and sold in supermarkets and other major retailers in South Africa. We collected data on sugar content and compared this with recommended intake guidelines. We also checked if the sugar content was added sugar or free sugar – the kind often found in processed food. </p>
<p>We also characterised the food based on back of the package information. This wasn’t easy as the facts are provided in tiny font that is difficult to read and interpret. For example the content is usually shown as grams per 100 ml or per serving, not in teaspoons. </p>
<p>Our findings showed that most baby cereals have added sugar. This is a concern because they are often the first food given to babies when they are weaned. We also found that pureed fruit and desserts had very high levels of sugar (20g or more per serving; that’s about 4 teaspoons).</p>
<p>This is bad news for the future health of South Africa’s population because it encourages a “sweet tooth” in children – in other words a preference for foods that taste sweet for the rest of their lives. </p>
<p>Sugar is a big contributor to increased tooth decay. It also results in childhood weight gain and obesity that causes preventable diseases later in life such as diabetes, high blood pressure and cancer. Although the sweet-taste preference is present <a href="https://www.ncbi.nlm.nih.gov/pubmed/23660363">at birth</a>, exposure to too much sugar early in life can affect <a href="https://academic.oup.com/ajcn/article/99/3/723S/4577491">what people eat</a>, including a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351274/">preference</a> for sweet things. </p>
<p>What this adds up to is that, in the long term, sugar in baby products will contribute to South Africa’s rising burden of noncommunicable diseases and will affect life expectancy. </p>
<p>Global weaning guidelines recommend that babies get fed complementary foods that don’t have added sugars. The aim is to ensure that the threshold for sweet tastes is set at lower levels. In turn, this helps prevent health problems in both childhood as well as later in life. </p>
<p>We conclude that there’s an urgent need to start regulating sugar in baby foods. South Africa’s childhood obesity crisis won’t be resolved unless the baby food industry stops promoting the development of sweet preference from an early age.</p>
<h2>What we found</h2>
<p>Commercial baby foods are <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/qualitative-exploration-of-rural-feeding-and-weaning-practices-knowledge-and-attitudes-on-nutrition/6D1156ED9699CB3D90B75AD2150DABA6">often introduced as first foods</a> to infants in South Africa because they are convenient and easy to use. This makes our findings particularly alarming. </p>
<p>We collected and analysed the sugar content of 235 baby food items from 12 different manufacturers sold in major South African supermarkets. Nearly 90% were prepared baby food products, of which 35% were pureed fruit and 20% were pureed meals. </p>
<p>Only one in five of the baby foods in the study had acceptable levels as defined by the World Health Organisation (WHO) – that is, less than 20% of total calories was derived from sugar. </p>
<p>But nearly 80% of cereals and pureed desserts contained added sugar. Processed meals that contained added sugar, including honey, were a carrot blend with semolina and two types of breakfast oats.</p>
<p>The study also shed light on the fact that little information was available to consumers on the ingredients used in the baby foods. For example, it was almost impossible to identify which products had added sugar versus those that had intrinsic (natural) sugars only. Both are unhealthy in processed products. </p>
<h2>Recommendations</h2>
<p>On the basis of our study, we have a number of recommendations. The first is that the amount of sugar in baby food should be regulated as a matter of urgency. To start with, mandatory disclosure of added sugar by manufacturers and the introduction of a food labelling system is essential. </p>
<p>A promising example is <a href="https://www.ncbi.nlm.nih.gov/pubmed/24102671/">Chile’s warning octagonal logos</a> that tell consumers if a product exceeds a recommended limit of sugar. There is already <a href="http://www.dii.uchile.cl/%7Ecnoton/AENS_2018.pdf">less demand</a> for juices and cereal with high sugar content. </p>
<p>And given the importance of serving sizes in controlling obesity, information on nutrients per portion and the number of portions per package should be included. It would help if this were standardised across all related food products, which is currently not the case. </p>
<p>Consumers can’t make informed choices about what’s in the food they are feeding their infants without easily understandable labels of calorie and nutritional information. Even if they wanted to stick to the WHO’s <a href="https://www.who.int/nutrition/publications/guidelines/sugars_intake/en/">recommendation</a> that the intake of free sugars should be reduced to less than 10% of total energy intake, the public can’t do so because of a lack of clearly understandable information.</p>
<p>We also recommend limiting sweet, processed baby foods in favour of healthier alternatives. </p>
<p><em>We acknowledge the contribution of Agnes Erze in the preparation of this piece. She is a research fellow at the SAMRC/Wits Centre for Health Economics and Decision Science/PRICELESS.</em></p><img src="https://counter.theconversation.com/content/117032/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Hofman currently receives research funding from the IDRC (Canada), UK Wellcome Trust, UK National Institutes for Health Research, Bloomberg Philanthropies and the South African Medical Research Council. In the past, she has also received funding from the Bill and Melinda Gates Foundation, WHO and UNFPA.</span></em></p><p class="fine-print"><em><span>Nicola Christofides does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A study showed that most baby food products have a high sugar content.Karen Hofman, Professor and Program Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA ( Priority Cost Effective Lessons in Systems Stregthening South Africa), University of the WitwatersrandNicola Christofides, Associate Professor, School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1142452019-03-27T14:12:19Z2019-03-27T14:12:19ZParents should monitor their child’s weight from the age of two<figure><img src="https://images.theconversation.com/files/266072/original/file-20190327-139356-6qppyo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/632097332?size=medium_jpg">Sharomka/Shutterstock</a></span></figcaption></figure><p>One in five children in England <a href="https://www.gov.uk/government/publications/childhood-obesity-applying-all-our-health/childhood-obesity-applying-all-our-health">are overweight</a> by the time they start primary school. Nationally, children are <a href="https://digital.nhs.uk/services/national-child-measurement-programme/">weighed and measured</a>, aged four to five, during their first year of school. But findings from our new study suggest that to prevent obesity parents should keep an eye on their children’s weight from as early as age two.</p>
<p>Our team conducted a <a href="https://doi.org/10.1016/j.pmedr.2019.100834">review of 54 studies</a> internationally that reported child height and weight measurements taken since 2000. Pooling data from over 700,000 children, we plotted typical body mass index (BMI) growth curves for boys and girls between the ages of four and 11 years old, showing the predicted trajectories for subsets of children with higher and lower BMI values.</p>
<p>We also examined the findings of eight studies that followed up the same children over time to identify individual growth patterns and pinpoint when these diverged. We found that most studies agreed on four distinct patterns of growth, including subsets of children with increasing higher than normal BMIs. As some of these studies measured children from before the age of four (some even from birth), certain “early increasing” growth patterns associated with higher risks of obesity in later life were detectable as early as the age of two.</p>
<p>Meanwhile, 5-19% of children fell into a “late increasing” class, which only separated from other groups of children at age five to six years. This means that relying on the current practice of measuring children twice (on entering and leaving primary school) may fail to spot many children who have a normal weight when they start school but develop weight problems in subsequent years.</p>
<p>Part of the problem of measuring infrequently is that the four-to-11 age range encompasses peaks and troughs in growth. The timing of these growth spurts are critical to child development and can predict a later risk of obesity and certain diseases in adulthood, including <a href="https://www.scopus.com/record/display.uri?eid=2-s2.0-84939839096&origin=inward&txGid=d6a1fbb97d6f3f68876a0ca943afe50e">metabolic syndrome</a>, <a href="https://www.scopus.com/record/display.uri?eid=2-s2.0-84906307267&origin=inward&txGid=7873668695b80bb1877ca882a34cfafa">non–alcoholic fatty liver disease</a> and <a href="https://www.scopus.com/record/display.uri?eid=2-s2.0-44649129271&origin=inward&txGid=b6670e5f1179b38b1cbf21d32440a0ca">type 1 diabetes</a>. One-off measures of height and weight may not be enough to identify the shape of these patterns and pick out those children on higher risk trajectories. Based on our findings, we would recommend annual measurements from at least the age of two.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/266074/original/file-20190327-139361-1wzllq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/266074/original/file-20190327-139361-1wzllq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=367&fit=crop&dpr=1 600w, https://images.theconversation.com/files/266074/original/file-20190327-139361-1wzllq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=367&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/266074/original/file-20190327-139361-1wzllq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=367&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/266074/original/file-20190327-139361-1wzllq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=461&fit=crop&dpr=1 754w, https://images.theconversation.com/files/266074/original/file-20190327-139361-1wzllq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=461&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/266074/original/file-20190327-139361-1wzllq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=461&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children only have their BMI measured twice in primary school.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/425756197?size=medium_jpg">winnond/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What is ‘normal’?</h2>
<p>You might think it would be easy to spot overweight children by looking at them, but that isn’t necessarily the case. Obesity is becoming more commonplace at younger ages, so <a href="https://theconversation.com/obesity-is-now-so-normal-that-many-parents-cant-see-if-their-child-is-too-fat-31032">parents may have trouble spotting the signs</a> in their own children. One <a href="https://bjgp.org/content/65/633/e234">UK study</a> found while few parents overestimated the weight of their child, a third believed them to be a healthy weight when they were overweight according to commonly used growth reference standards.</p>
<p>BMI in children is calculated in the same way as for adults (weight in kilograms divided by height in meters squared), but the way thresholds are used to identify underweight, overweight and obese children is more complex. In the UK, this is commonly done by making comparisons to children that were measured during the 1990s, before the obesity epidemic emerged. Globally, there is a lot of debate about which growth reference charts we should use, with the World Health Organisation, International Obesity Task Force and the US Centers for Disease Control and Prevention each having its own chart.</p>
<p>For our review, we focused on BMI as the most widely used measure globally, but we recognise that there is an ongoing debate about the most appropriate ways to measure children and the <a href="https://www.scopus.com/record/display.uri?eid=2-s2.0-77952172540&origin=inward&txGid=b024a1fd94a55993ce94de903ffa04c3">relevance of the thresholds used</a>. For example, one of the <a href="https://theconversation.com/we-asked-five-experts-is-bmi-a-good-way-to-tell-if-my-weight-is-healthy-96985">recognised limitations of BMI</a> is that it does not take muscle-to-fat ratio into account. </p>
<p>Also, thresholds may not be equally relevant to different populations around the world. We could not find recent data for many nations with high rates of adult obesity, so we don’t have as full a picture of the global situation as we would like. Having said that, we found unprecedentedly high BMI levels in children aged four to 11 years in Kuwait, Pakistan, the US, Spain, Greece and a Pacific Island community in New Zealand.</p>
<h2>Stitch in time</h2>
<p>If being overweight has become more commonplace, merely watching children grow up won’t cut it. Parents and carers need simple, regular feedback about their children’s growth from an early age so that they intervene early enough to prevent later health problems. </p>
<p>Most times, feedback about BMI alone – while valuable – may not be enough to prompt changes in lifestyles. Policymakers also need to recognise and act on the influence of the <a href="https://www.kingsfund.org.uk/projects/time-think-differently/trends-broader-determinants-health">wider determinants of health</a> – including access to health services, living and working conditions, and social norms – if we are to find the most effective ways of helping families lead healthier lifestyles.</p><img src="https://counter.theconversation.com/content/114245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lamiece Hassan receives funding from the Medical Research Council and Health Education England. </span></em></p>Children’s body mass index is only measured twice in primary school. This is not enough, new study suggests.Lamiece Hassan, Research fellow, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.