INTERNATIONAL CHILD AND YOUTH CARE NETWORK

21 MAY 2003
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Obesity is now potentially a bigger world killer than famine — and the problem is so serious among children that they develop diabetes in their teens and even risk dying before their parents

How fast food is killing our children

For the first time in human history, feasting threatens to overtake famine as a global killer. According to a little-noticed Worldwatch Institute study, the number of overweight people has overtaken the 1.1 billion who are underweight. A report from an American think-tank calculates that obesity costs the US $92.6 billion (£57.2 billion) a year in medical expenses — as much as smoking. And, like smoking, it increases the risk of strokes, heart attacks and cancer.

Most worrying is the increase in obesity among children. Around one British child in five is overweight, and about one in 25 is clinically obese. Altogether, 300,000 children under 16 in the UK are obese: the number has doubled since 1980. Yet only 30 years ago obesity in children was rare, and extreme obesity was almost unheard of. It was so rare in the Sixties and Seventies that, says Jane Wardle, Professor of Clinical Psychology at University College, London: “We thought there must be something odd going on with these kids, that there must be something idiosyncratic about their relationship with food or with their fat storage systems, and if only we studied them enough we would find out what on earth was wrong with them.”

Wardle — co-founder of Weight Concern, a charity formed in 1997 to help the overweight, especially children — says the intervening decades have been an “enormous shock” because they have overturned the belief that only a tiny fraction of the population have the propensity to become oversized. The theory that human beings had a feedback mechanism — a kind of biological circuit-breaker that would kick in to quell appetite and prevent overconsumption — is a fallacy. The past 40 years have shown that, given the right environment of limitless energy-rich foods combined with sedentary pursuits, almost anyone can grow fat.

“People know that obesity is linked to heart disease and stroke, but recently there were stunning findings relating it to cancer,” says Wardle, who also runs Cancer Research UK’s health behaviour unit.

Professor Philip James, chairman of the International Obesity Task Force and a global authority on obesity, says the emerging generation of overweight children is an absolute health diaster. He is an outspoken critic of “unscrupulous” food companies and believes that they should have the obesity problem on their consciences. James is particularly concerned at the “appalling jump” in diabetes and the fact that the disease is showing up in ever-younger patients. He paints a horrific picture of a future in which diabetic children may be outlived not just by their parents but their grandparents. The IOTF had meetings last week with experts from different countries to assess the future need for kidney dialysis machines.

“I’ve seen teenagers of 14 with diabetes,” James says. “In Asia there’s a 20-year jump, with each generation developing it 20 years earlier than their parents. If they come from families with a genetic susceptibility to diabetes, it’s possible their parents are in their forties with diabetes and their grandparents are in their sixties with diabetes. If these children are diabetic in their teens, it’s almost expected for their parents to outlive them. It’s even conceivable that they could be outlived by their grandparents. Life expectancy is moving into the late seventies, and we know that there is something about the prewar diet that was conducive to long life expectancy.”

While Wardle thinks it an exaggeration to suggest that a generation of obese children will be outlived by their parents, she believes obesity might be enough of a health threat to reverse the trend towards longer life expectancy, which stands at 75 for men and 80 for women. “I don’t believe children will be dying at 30 while their parents are trotting about at 80 or 90, but it’s certainly possible that the increasing levels of obesity mean we won’t carry on the upwards progression in life expectancy. One paper published three weeks ago suggested the life expectancy of an obese person was seven years lower. It’s a marker for everyone that we’re not doing things quite right.” Interestingly, in February government statisticians noted for the first time an inexplicable drop in life expectancy in ten areas of Britain.

As well as hastening the journey to the grave, there is other evidence that excess kilograms exact a demanding toll. Last year the journal Archives of Disease in Childhood revealed that type-II diabetes, once known as adult-onset diabetes, had been observed in white teenagers (one of whom needed a cataract operation), and that the condition was becoming worryingly prevalent; Asian children are already a known risk group. Professor Edwin Gale, a diabetes expert at Bristol University, said at the time that these cases were “the thin end of a very large wedge”. A study published in The Lancet in 2001, carried out by Dr Patrick Tounian at the Armand-Trousseau Hospital in Paris, showed that obese children have stiffer, less elastic arteries than normal. It was a striking finding, suggesting that the first markers for stroke and heart disease, which appear in late adult life, actually emerge in childhood.

Wardle thinks the solution has to be drastic: “We need to modify our environment, and we need to turn the clock back decades in terms of food, so there is less supply. More food is being developed specifically for children and, in a good world, it would not be highly energy-dense. But these foods are higher in fats. There might be a problem with public support for limiting the food supply but I think that public support is there for limiting foods to children.”

Like obesity in adults, childhood obesity is caused by a “positive energy balance” — or children consuming more energy than they are expending. Experts generally agree that children are eating more energy-rich foods such as cakes, sweets and sugary soft drinks, and consuming more foods outside the home, which tend to be less healthy than home-cooked foods. Dr Pauline Emmett, a nutritionist at Bristol University, carried out a study last year of pre-school children which showed that confectionery consumption had risen 25-fold since 1950, a year after sweet rationing ended, and the consumption of soft drinks and juices had risen to 30 times the level in 1950. Emmett also found that the more educated the mother, the less likely her child was to become obese.

There is no question, Wardle says, that children are less active than in the past, with a well-established link between television watching and obesity, even among pre-school children. Last year Dr Barbara Dennison, from Columbia University in New York, reinforced the link by finding that the time spent by a child watching television was a reliable guide to how overweight the child was. Children glued to the box are less active, more prone to snack and more exposed to food advertising.

As always, prevention is seen as better than cure. Weight Concern runs weight management programmes for children, and, Wardle says, a child who sheds 5 per cent to 10 per cent of excess bulk is doing well. “The problem is, these children are not 5 per cent to 10 per cent overweight when they come to us. They are 50 or 100 per cent overweight, and the chances of them achieving a normal weight are very low.”

Should food and drink advertising aimed at children be banned?

The practice of advertising food to children frequently comes under fire, most recently with the furore over the Cadbury-Schweppes campaign to exchange chocolate bar tokens for sports equipment. The Food Standards Agency, the Government’s advisers, expressed anger at not being consulted over an endorsement of the campaign by the Sports Minister, Richard Caborn — which, the FSA says sent “mixed messages” to the public.

James believes that only when children reach teenage years can they make informed choices about their consumption, and blasts the junk food industry for targeting the young. “Their brilliant marketing device is to show that these are ‘treat foods’, and they spend hundreds of millions of dollars to manipulate children and increase their pester power on parents,” he says. “That’s an unscrupulous marketing system that needs to be constrained.” He adds that if the guilty companies don’t smarten up their act, then “these bad guys are going to be looked at in the same way as the tobacco guys”, making them vulnerable to lawsuits.

Debra Shipley, the Labour MP for Stourbridge, also has advertisers in her sights. She is campaigning to have advertising of food and drink to pre-school children banned, and tabled an early day motion to gauge Commons support. “Within 24 hours, 120 colleagues had signed it,” says Shipley, whose Children’s Television (Advertising) Bill now enjoys the support of health charities such as the British Heart Foundation. It will receive its second reading in July, and she has a meeting scheduled this week with Tessa Jowell, the Culture, Media and Sport Secretary. Shipley had always bristled against advertising to toddlers but parents in her West Midlands constituency convinced her that it was the relentless plugs for food and drink, not toys, that was the real scourge. “I asked them to actually tape and look at the advertising — at how long the adverts were, what the adverts were for, how frequent they were — and I thought they were going to come back and say, ‘How appalling, it’s all expensive toys’. Instead, they came back and said, ‘How appalling, it’s all food and drink’. And the food being advertised was hugely, overwhelmingly and shockingly high in fat, sugar and salt. Obviously eating one chocolate bar is not harmful but it’s the cumulative effect.”

How is child obesity measured?

Whether a child is overweight cannot be gauged using a simple BMI chart, because children’s bodies change as they mature. However, BMI can still be used provided age and sex is taken into account. The Weight Concern website has an excellent calculator and chart which can give guidance for children aged between five and 13 (www.weightconcern.com/bmi.htm ). The chart shows, for example, that a BMI of 19.2 for a girl is fine if she is older than 10, but if she’s seven she is overweight and for a five-year-old it indicates obesity.

How can I change my child’s diet?

As a working mother trying to keep her family healthy, Jane Wardle knows how fraught mealtimes can be: “If I ask my son whether he wants a pear or some grapes, he’ll say he wants the chocolate biscuit in the cupboard.” The solution, she says, is to not have those biscuits in the cupboard at all. Try to ensure that the food in the house is the kind of food you wish your children to eat. It is much harder, she says, for a child to fight over a foodstuff that isn’t present.

Wardle and her family try to practise what she preaches — her husband Andrew, also a psychology professor, dictates what goes in the shopping trolley. “Andrew’s very good at trying to make sure that there’s lots of the kinds of foods we should be eating, and not ready access to other kinds of food. Sometimes we do have a packet of biscuits, though.” The trick, she says, is to keep treat foods as treats, and bring them into the house only on occasions when they are to be eaten.

What puzzles Wardle is that while parents are concerned generally at things such as vending machines in schools, they don’t extend that to concern about what their own child eats. Commonsense tips include restricting foods such as sweets, crisps, cakes and chocolates, and eating complex carbohydrates (such as pasta), fruits and vegetables. “The re-introduction of the baked apple would be a very good thing,” she sighs. Wardle says parents should not worry that restricting certain foods will lead to the child becoming obsessed with them. Evidence suggests the opposite — children eat what they’re used to, and those fed healthy diets tend not to crave unhealthy foods. There is little evidence that parents who restrict children’s food intake are priming them for eating disorders later in life.

Parents should also be setting an example when it comes to being active. “Walk short distances rather than driving and don’t ask your kid to pass the remote control,” she says.

By Anjana Ahuja
http://www.timesonline.co.uk/article/0,,7-685564,00.html

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