Practice: Health & Wellbeing - Weighing in
Tuesday, June 29, 2021
Amid the controversy around proposals to periodically weigh school children, what can early years settings do to help tackle the child obesity crisis, asks Caroline Vollans
The average child has gained almost half a stone during lockdown, according to a survey of parents by the health and fitness site Total Shape. Perhaps that’s why the chairman of the National Obesity Forum proposed weighing children on their return to school last September, and then weighing them again in the spring to monitor their progress.
Jeremy Vine debated it on his Channel 5 show in August 2020, following it up on Twitter: ‘Should schools weigh pupils to make sure they shift the pounds they’ve put on during the lockdown?’ The response was angry and heartfelt, especially among those with experience of eating disturbances.
Jameela Jamil, campaigner for I Weigh, revealed on The Independent website last year, ‘Being weighed at school was truly the minute my eating disorder started at 12.’ While Elinor Barker, the British Olympic track cycling champion, ‘slammed proposals to weigh children when they return to school in September’, according to The Telegraph.
ON AN UPWARD TREND
Eating difficulties and body dysmorphia are rife, and on an upward trend. The increase in anxiety since the pandemic is likely to add to this. Standing on the scales can be a daunting prospect even for those of ‘normal’ weight. Whether in Body Mass Index (BMI) or kilos, the measurement positions individuals as being ‘within the norm’ or not, which can be hazardous.
However, the fact remains that obesity is no trivial matter. Public Health England estimates that a person with a BMI of 35 to 40 could be 40 per cent more likely to die of Covid-19. A BMI over 40 could increase that risk to as much as 90 per cent.
So, how can we approach this serious health problem in a way that is sensitive to the complexities of eating, weight and body size? We could start by reflecting on our understanding of obesity.
WHAT DO WE KNOW?
Obesity is one of those health issues that many of us claim to have at least some knowledge of. Lay theories usually rely on the simple equation of balancing energy consumed with energy burned. Weighing scales or BMI will inform us how we are doing.
BMI, however, is based on height and weight and does not distinguish between fat, muscle or bone. This limitation was made graphic when rugby player Jonny Wilkinson, in his prime, was clinically obese according to his BMI. Sporty teenagers might be similarly affected.
It is interesting that scientific researchers refute any notion of a simple cause of obesity. Neither are they confident about the prevailing ‘what goes in must come out’ idea. Rather, research shows the reasons for weight gain and obesity are complex and not fully understood.
In his book Spoon Fed, genetic epidemiologist Tim Spector argues that almost everything we have been told about food is wrong. ‘We have to realise that conventional one-size-fits-all dietary guidelines are now redundant … even genetically identical twins can respond to the same food in very different ways. The future of nutrition must be based on the understanding that each person’s body works differently.’
Dr Giles Yeo at the University of Cambridge researches the role of genetics in weight gain. On The Life Scientific on Radio 4 in January, he explained that some of us have a genetic variant that urges us to eat too much. Willpower, then, is much more difficult for some – they are not hardwired for it.
Obesity is a complex health issue. No single formula will explain it or eradicate it.
Dr Lala Manners is a movement and physical development expert in the EYFS.
Like the HENRY programme (see box), she stresses that, ‘Addressing anything to do with weight must start from a wellbeing perspective. We must consider the whole picture rather than isolating weight as the only issue. Creating and maintaining healthy environments, habits and lifestyles should be the principal focus from the beginning.’
Dr Manners has worked for many years on enabling children to enjoy their physicality and ways of moving. Her books offer countless ways and means of achieving this, at low or no cost.
‘Movement is a universal language,’ she says. ‘Regardless of social context, gender, age or level of competence, it can be enjoyed by everyone in some form or another. Being physical supports emotional wellbeing, enhances relationships, informs healthy behaviours and ensures the necessary level of strength, balance and co-ordination is maintained over the lifespan.’
She makes the important point that movement is a great equaliser. Walking, for example, is a skill that can be enjoyed by all age groups in various environments. She also highlights the inclusive nature of movement. ‘Differently abled can always move in some way and, unless medically advised, will have a movement routine to follow. It is critical not only for their emotional wellbeing, but also supports bone density, lung and lymphatic function.’
Looking forward, Dr Manners considers the early years sector as well situated to help. She says, ‘There are 36 references to health in the EYFS alone! Generally, practitioners know their children, families and communities well. Any approach must include a “bookshelf” of options that will need time, commitment and patience to introduce and implement.’
There is still much to be discovered about obesity, weight and eating. But it is becoming clear that genetics, poverty, psychological influences, junk food, unhealthy environments and lifestyle are contributing factors. As early years practitioners, we do not have much influence over some of the causes of obesity. Central and local government need to act together to reverse the rising trend of childhood obesity which lockdown has made even worse.
Having said that, there are steps we should now be taking to improve children’s health. For example, the importance of nutritious food must not be sidelined. As well as the early years voluntary guidelines, the Infant and Toddler Forum has numerous online resources addressing many aspects of this issue.
June O’Sullivan, CEO of London Early Years Foundation (LEYF), says, ‘For many years, I have been bewildered by our inconsistent attitude to chefs in nurseries. To me, they are central to the pedagogy.’
LEYF chefs carry out activities with children, have conversations with parents and provide demonstration sessions. She adds, ‘This inspired me to develop a professional qualification for them as well as create the LEYF Early Years Chef Academy, the first of its kind in the sector.’
We also need to make sure that every child is physically active every day. It is not enough just to offer opportunities and free-flow provision inside and out. What about the more sedentary children who are not getting highly active every day, challenging their physical skills and getting out of breath?
As Professor Iram Siraj said at Newham’s 2021 Early Years Conference, ‘More proficient gross motor skills result in better self-esteem, more favourable weight status, higher levels of physical activity and cardiorespiratory fitness. Better physical development is associated with developments in cognition and self-regulation.’
Healthier children are happier and they learn better. Surely that is preferable to taking a narrow approach of weighing children and shaming parents?
HENRY programme – supporting a healthy start in life
HENRY is an early intervention programme to improve children’s health and wellbeing. It works on the theory that what happens in childhood influences future physical and mental health. Introduced initially for obesity prevention, it now encompasses a much broader remit. It is one of the few programmes evidenced to work. For example, it has been running in Leeds since 2009. Between 2009 and 2019, while childhood obesity rates rose across England, in Leeds they fell significantly from 9.4 per cent to 8.4 per cent.
The HENRY programme is all about supporting parents and carers to provide a healthy start in life for their children. A healthy start is perceived holistically. Practitioners work on a range of areas that have a strong impact in later life, including breastfeeding, emotional wellbeing, parenting skills, healthy nutrition, oral health and a more active lifestyle.
The website advises: ‘Practitioners support families to take control of their own lives, identify their own lifestyle goals and plan to achieve them in a way that will work for their family. Families are then able to make and sustain lifestyle changes, contributing to a healthier community culture.’
HENRY has the strongest evidence base of any national healthy start programme in the UK. To reduce childhood obesity, practitioners need to learn from the programme’s success, and early years settings should work supportively with parents around children’s health and wellbeing. Working in partnership with health colleagues to improve every aspect of children’s health and wellbeing is key. Simplistic measures, such as regular monitoring of children’s weight, are unlikely to work.
- The Early Years Movement Handbook by Lala Manners (Jessica Kingsley)
- 50 Fantastic Ideas for Getting Children Activeby Lala Manners (Featherstone)