A checklist for curbing childhood obesity Free

The insight that childhood obesity is a problem is spreading fast. Most decision-makers involved in public health are aware of the fact that obesity early in life negatively affects self esteem and increases the risk of future diabetes and cardiovascular disease although the effect of obesity on cancer risk is less well known. Thus, childhood obesity is one of our major threats to public health and will cause a reduced life expectancy in the future if we do not act now.

The prevalence of obesity and overweight has increased 3-fold or more in most western countries during the last 25 years. It is generally accepted that the changes in society involving eating habits and physical activity are crucial. No other factors are of equal importance for the understanding of the childhood obesity epidemic. Thus, it is quite simple. We have to reduce the intake of sweetened drinks, sweet, and fat snacks; go back to a more regular eating pattern without snacking between meals; and increase the physical activity. However, although simple, the realisation of such changes is so difficult that we have to realise that we have a lost generation of adolescents and adults with habits so firmly rooted that it is not possible to affect their behaviour within a democratic society. Consequently we have to focus on younger children and start immediately when they are beginning school, i.e. at 5–6 years of age.

Measures taken to handle the situation are often too toothless. One reason seems to be the general but erroneous fear that tougher recommendations may lead to increased number of eating disorders especially among girls. There are no indications that recommendations regarding good eating habits and physical activity increase the risk of eating disorders.

Another problem is that short-sighted economical considerations sometimes are more important than long-term efforts to reduce childhood obesity. The European Union has difficulties handling the overproduction of butter and milk. In an attempt to both improve children's eating habits and reduce the overproduction of milk products, school lunches milk is subsidised. However the benefits of this initiative are markedly hampered by the fact that whole milk is three times more subsidised than low fat milk and consequently an unfortunate intake of high animal fat among children is stimulated by the EU.

The feeling of helplessness against the commercial and marketing powers of big companies such as Coca Cola and Mc Donald's also seems to reduce the willingness to act. However, in my opinion, a consequent use of the school as an arena to influence children to adopt a healthy lifestyle should not be underestimated. Furthermore, if schools have a firm attitude regarding sweet drinks and snacks it will be much easier for parents to have defined limits for their children as well.

What is most important if we effectively want to prevent childhood obesity, is it to modify food intake or physical activity? If we consider that a normal 10-year-old child weighing 30 kg has to walk for 3 h or run 10 km to burn the energy from an ice cream (300 kcal), it is easy to realise that increasing physical activity without a concurrent change of eating habits will be almost without effect. This is problematic both for decision-makers and parents because directions regarding restricted eating and reduced snacking may be considered more repressive and more negative than increased physical activity. Therefore most initiatives are aimed at physical activity. Of course, despite this reasoning we must not forget that there is a group of both lean and overweight children today who live an extremely sedentary life who are in need of help to become more physically active.

My simple list of measures is not too expensive and many things can be launched without any long start-up time.

• Ban all sweets, sweetened drinks, ice cream, and energy-dense snacks from nurseries, schools, and after school care centres. Inform parents about healthier alternatives if the children have packed lunch.

• Inform parents of their duty to ban all sweets, sweet breakfast cereals, sweetened drinks, ice cream, and energy-dense snacks from daily family life and encourage them that they are good care-taking parents if they reduce irregular snacking to a minimum.

• Increase activity of daily living for children. Teach them at a young age to take a walk instead of taking the bus. Use consequently the stairs instead of an elevator together with children.

• Subsidise whole grain food and fresh fruit and vegetables. This might provide a better and more functional incentive than extra tax on unhealthy foods.

• Reduce the subsidies on whole milk and increase them on low fat milk in schools

• Identify children with a pronounced sedentary behaviour and develop methods to increase their physical activity.