Over the past 20 years the levels of obesity in children and adults in this country have escalated. It is now estimated that one in three children are overweight and one in five are obese. One child in ten is obese by the time they start school.
The numbers of overweight and obese children in Britain doubled between the early 1980s and late 1990s. In a study of 2,600 children in England, the researchers found so many overweight and obese children in all the age categories that they described their findings as an 'epidemic of obesity in children in the UK' (Reilly, 1999).
Such figures show the scale of the problem in the UK, but it is a problem that is worldwide, increasing rapidly and affecting children in ever-greater numbers. There is an urgent need from Government to parents, from the food industry to early years settings, to take measures towards averting and tackling obesity in children.
Effects
Being overweight impacts on children's health, present and future. Health risks associated with obesity, which are generally on the increase, include:
* type 2 diabetes
* high blood pressure
* osteoarthritis
* back pain
* dental problems
* cancers
* coronary heart disease
* asthma
* problems with the foot structure and function
* premature death.
Some 30,000 deaths each year in England are attributable to obesity alone.
It is estimated that seriously obese children shorten their life spans by up to nine years. The scale of obesity in the UK means that for the first time in history, some of the current generation of parents can expect to outlive their children.
There is an additional financial cost. It is estimated that obesity-related problems cost the NHS 480m a year. Treating diabetes and diabetes-related conditions already takes up some 5 per cent of total NHS spending.
With increased fatness comes greater levels of inactivity, which:
* results in poor physical fitness, and exacerbates obesity and health problems. Hypokinetic diseases (those relating to lack of physical activity), including coronary heart disease, raised blood pressure, depression and obesity, are now evident in young children.
* hinders normal physical development, reduces endurance, causes leg pains from stressed joints and results in overweight children having weaker muscle strength and poorer motor skills and co-ordination than those with less body fat
* causes psychological problems (such as poor self-esteem and depression)
* results in social exclusion (for example, name-calling, bullying, non-participation in sports and exclusion from certain job opportunities).
This detrimental cycle of fatness, inactivity and more weight gain is one that only gets worse as children get older.
Causes
Obesity is caused by an imbalance between calories consumed and calories expended, and much of this imbalance stems from changes in children's diet and lifestyles.
Sugar and starch
In the past 50 years, children's consumption of biscuits has risen four times, confectionery by 25 times and soft drinks by 34 times, while their consumption of milk, bread, green vegetables and red meat has declined.
Children's consumption of high-calorie, but low-nutrient food and drink has rocketed, along with their weight.
The chief obesity risk in food is sugar. It seems to be added to almost everything, both sweet and savoury. So-called 'children's food' is stuffed with it. Children's breakfast cereals, for example, can be nearly half sugar.
Sweetened drinks pose a great problem, because sugar is not 'filling'. For example, a canned soft drink can have as much sugar as seven apples, and while no one would sit down and eat seven apples, it is easy to swallow a whole canned drink.
The other trouble with sugar is that it goes almost instantly into the bloodstream, giving a sudden, unnaturally high energy rise. To restore normal blood sugar levels, insulin takes sugar out of the bloodstream, causing a rapid drop in energy, and then the removed sugar gets stored as fat. So any sugar that we don't work off fairly soon after eating it (and who would wish to exercise then?) is likely to expand our waistlines.
A similar thing happens with other 'refined' high-calorie starches, such as white bread, white pasta and white rice. As such foods are much less filling than their wholefood counterparts, it's easy to eat large helpings.
Fatty food has even more calories than sugar, although it is filling. Nevertheless, many children are fed a constant diet of crisps, burgers, sausages, chips and breaded, deep-fried 'novelty' foods, all high in damaging saturated fat. With so much calorie-dense fare, even active children may not burn off each day's surplus calories.
Marketing allure
Poor diet is made worse by the tactics of the food industry. Some parents and carers may not appreciate how nutritionally bad 'children's' food and drink products are, but even those in the know often succumb to 'pester power' as their children are won over by clever advertising and marketing.
Up to 99 per cent of food advertised is for unhealthy salty/sugary or fatty foods, and advertisements for unhealthy food are shown more often in children's TV than in periods of adult viewing (Sustain, 2001).
Marketing has also changed attitudes to food preparation. Because ready-made meals are so profitable to the food industry, the consumer is told that they 'haven't time' to cook - although many healthy family meals can be ready in 30 to 40 minutes starting from scratch, and some can be done entirely in advance.
This has changed many people's whole relationship with food. Where once cooking meant preparing meals from raw ingredients, nowadays meals can be ready at the touch of a microwave button.
Physical inactivity
Running parallel to children's rising consumption of sugary, fatty foods is their declining levels of physical activity. Until recently we were a physically active nation, but this is no longer the case, with children experiencing uncharacteristically inactive lifestyles from a very early age (Armstrong, 1998). This is due to a range of factors, including:
* Parental concerns Parents are apprehensive about letting their children out to play for fear of traffic hazards, 'stranger danger' and accidents while they play. As a result, children are discouraged from playing in parks, or sometimes even within the family garden, and so they have less time for play and self-selected activities.
* Lifestyles Young children readily adopt their parents' lifestyles, so inactive parents tend to have inactive children. Children are generally ferried by car to nursery, to friends' houses, to the shops - all part of a busy family life, but seriously lacking in real activity. The number of children walking or cycling to school has fallen from 67 per cent in 1986 to 55 per cent in 1996.
* TV and computers Children spend more time watching television or playing computer games, and often eating calorie-dense foods while doing so. Such activities also condition children to be less active.
* Educational practices Current practice within the early years sector has not helped the problem of reduced levels of activity in young children.
Many settings emphasise the importance of holistic planning but fail to put this into practice, while many others have come under pressure to concentrate on children's literacy and numeracy skills at the expense of their physical development.
Time to act
What is clear is that there is now an urgent need to tackle children's poor diet and levels of inactivity. The first years of a child's life are a period of enormous growth - cognitively, socially, emotionally and physically, a growth that shouldn't be impeded by poor health and fitness.
Patterns of behaviour are also established in these formative years, with poor eating habits and low levels of physical activity continuing into adulthood. Fat, inactive children tend to become fat, inactive adults.
Early years settings can make vital contributions to tackling the problem on both fronts by:
* providing children with good healthy food and adequate physical activity
* being role models, promoting positive attitudes to eating and an active lifestyle
* educating parents about the importance of a healthy diet and physical fitness. Children's diets are influenced by the educational status of parents and carers, with levels of obesity higher in families where parents are least educated about the importance of a healthy diet.
The greater problem is likely to be diet. No amount of exercise by children will be sufficient to work off the worst excesses of a sugary, fatty diet.
But fitness cannot be ignored. Gabbard (1998) talks of children's first five years as being 'the window of opportunity' for building a solid foundation for movement.
Nor can it be assumed that the current raft of Government healthy eating policies alone will stem the current obesity epidemic. Can encouraging children to eat a piece of fruit a day really have significant long-term effects in the battle against obesity?
Prevention rather than cure
Most importantly, early years practitioners need to approach the problem primarily from the point of view of prevention rather than cure. Young children should not be put on diets or submitted to rigorous exercise regimes.
When children become fat, it means that certain irreversible changes have taken place in their bodies, creating extra fat cells (harmless preadipocytes cells have been turned into fat-making adipocytes cells). As this change is for life, future weight control is harder. So stopping children from getting fat in their earliest years is vital to their short- and long-term well-being.
WHAT IS OVERWEIGHT AND OBESE?
Overweight means that a person's body weight has increased above a certain level in relation to their height. Various techniques and equations are used to measure this, including body mass index (BMI), in which BMI = weight (in kilograms) divided by height (in metres) squared.
Obesity means an unacceptable level of total body weight of fat (Hills & Wahlqvist, 1994). As a general guide, many doctors define a young person as obese when the total body weight is more than 25 per cent fat in boys and 32 per cent fat in girls.
REFERENCES
* Armstrong, N (1998) Young people's physical activity patterns as assessed by heart rate monitoring. Journal of Sport Sciences, 16
* Gabbard (1998) Windows of opportunity for early brain and motor development. Journal of Physical Education, Recreation and Dance. Vol 69
* Reilly, J Dorosty, A & Emmett, R, (1999) Prevalence of overweight and obesity in British children. Cohort study. British Medical Journal, 319
* Sustain (2001) TVdinners - What's being served up by the advertisers? London: Sustain
* Hills, AP & Wahlqvist, ML (1994) Exercise and Obesity. London: Smith-Gordon General references
* Department of Health (2002) Chief Medical Officer's Annual Report
* Food Standards Agency (2000) The national diet and nutrition survey of young people aged four to 18 years. London: HMSO
* National Audit Office (2001) Tackling obesity in England. London: HMSO
Jonathan Doherty is head of early childhood education and a senior lecturer in physical education at Leeds Metropolitan University
Mary Whiting is a food writer and author of titles including Managing Nursery Food and Dump the Junk.
