We’re grappling with a rapidly increasing number of children who are obese. In the US, where a third of Americans are considered obese, a leading group of doctors have officially designated obesity as a disease.
But while most research into obesity focuses on health problems in adults - for example links with heart disease, diabetes, cancer and ultimately death - it’s clear that obesity is also a serious issue in children.
Current estimates suggest that about a third of two-to-15-year-olds are overweight, while 14-20% are obese - including many four and five-year-olds. A recent study found a four-fold increase in the number of children and young people in England treated for obesity-related problems between 2000 and 2009. Child bariatric surgery for weight loss is up from only one case in 2000 to 32 in 2009.
Obesity often runs in families and although this may in part be due to genetics, it mostly reflects the role of diet and activity and the way in which children learn how to behave from their parents.
We may be born with a slight preference for sweet foods but research shows that most of our taste preferences come from simple learning and that much of this learning reflects how we grew up and what our parents did.
We simply learn to like the foods which we are familiar with. Simple exposure influences what we like. We also learn to like foods by watching others, particularly our parents and peers. So if children see their parents eating fruit and vegetables they will learn that these taste nice. But if their parents eat cake, then this is what they will learn is good to eat. We learn through association.
Much research shows that rewarding children by smiling and offering praise when they eat healthy foods makes them eat more of these foods in the future.
But giving them ice-cream and saying “aren’t you lucky. You must have been a good girl” makes them learn that ice-cream is special. When a parent says “eat your vegetables and you can have pudding” it may encourage them to eat vegetables in the short term but in the longer term, pudding will be what they really want.
Parents play a clear role in children becoming obese. They are also an important part of the treatment process; if they want their child to eat well and be active they need to make this a fundamental part of how they as parents also behave.
We need a ‘nanny state’ if that’s what it takes
We live in an environment that is obesogenic (factors that make us fat) - in which it is increasingly hard to stay thin and easy to gain weight.
We also live sedentary lifestyles with easy access to high-calorie foods, and whatever the desire of parents or health professionals, or the will power of individual themselves, it’s very difficult to resist the temptations that come our way.
The government needs to step in. Whether this is branded a “nanny state”, an “infringement of civil liberties” or “undermining human rights” no longer matters. The right to choose goes out of the window when children are “choosing” to end up in hospital because of their weight.
“Do no harm” is the first rule of any health professional. It should also be the rule of any government. But it can also result in doing nothing. In the same way that health professionals may collude with their patients by trying not to upset them, governments may do harm in order to protect the right to choose.
We fear saying the wrong thing
At times, health professionals state feeling uncomfortable about mentioning that someone is obese for fear of upsetting them or preventing them from coming back.
But research exploring the use of language used in consultations suggests that although people who aren’t obese may find the term “obese” upsetting, the obese seem to find it less upsetting than when people use euphemisms such as “your weight may be damaging your health”.
Similarly, data from studies into smoking cessation suggest that simply raising the issue of smoking can promote the idea of stopping smoking in a significant number of people. When it comes to obesity, not raising the issue of weight may feel supportive and caring but could actually be colluding with someone who is obese and could end up doing more harm.
Given that obesity runs in families, raising the issue of weight with someone who is a parent or who may become a parent in the future may benefit not only the patient themselves but also future generations. It’s therefore the responsibility of any health professional not to collude and do harm by avoiding the subject.
The Imperial research shows that associated health problems may start earlier than we realised. Parents can take responsibility for their children becoming overweight and health professionals can help them to lose weight but this is made all the more difficult by our environment. Only with a collective effort - including the government - can we begin to tackle this issue.