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Overcoming obesity: changing hearts and minds [Community Practitioner (UK)](Community Practitioner (UK) Via Acquire Media NewsEdge) The National Obesity Forum has predicted that half of the UK's population will be obese by 2045 - revising its estimate to five years earlier than previously anticipated, costing the NHS around £50bn. Louise Naughton reports It is believed by some public health experts that, one day in the near future, pictures of hamburgers will be viewed in the same way as images of tobacco or alcohol. Earlier this year a new campaign group, 'Action on Sugar', warned that the amount of'hidden' sugar in our diets was having a serious adverse effect on the nation's waistlines. In response, commentators claimed this was an extension of the 'nanny state' and an attempt by the government to further restrict our freedom to eat whatever we choose. However, Dr Arpana Verma, Consultant in Public Health at Manchester University and Director of the Manchester Urban Collaboration on Health (MUCH), argues that what most people don't realise is that much of what they eat has been programmed into them by the international food and drinks giants through advertising and social marketing. 'Public health organisations must get better at translating our healthy living messages in the same way that the food and drinks companies do. This is a battle that we must fight and win,' she says. Dr Verma believes that junk food will find its way into the same categories as cigarettes and alcohol - but it is up to public health professionals to make this change come about faster. 'Things are changing, but this shift takes time. As public health professionals, we need to think about how we speed up that process and undo a lifestyle that been normalised and condoned by society and families for a long time. Initiatives such as the Responsibility Deal are great, but despite all these things we are doing, obesity rates are only getting worse.' The latest figures now show the UK has the highest rate of child obesity in western Europe. Around 31% of boys and 28% of girls aged two to 15 years are classed as overweight or obese, threatening to shorten their life expectancy by around 10 years and costing the NHS an estimated £4.2 billion a year. Decline or a blip? Despite this bleak picture, other research has shown that there has been a slight drop in obesity levels among primary school leavers for the first time in six years. According to data released by the Health and Social Care Information Centre (HSCIC) in December 2013, 33.3% of Year Six children measured for the National Child Measurement Programme (NCMP) were classed as obese and overweight compared to 33.9% the previous year. The reported figures are the first recorded fall for the age group in the history of the NCMP since it was established in 2007. Of the 489,100 children measured, the proportion of 10 and 11 year olds who were underweight was higher than the previous year; 1.3% up from 1.25%. The prevalence of obese and overweight children among Reception year children (four and five year olds) also fell in 2012-13 compared to the previous year (9.3% compared to 9.5%) and remains lower than seven years ago (9.9%). HSCIC Chair, Kingsley Manning, says the first drop in obesity prevalence among Year Six children 'stands out' in the report, but noted caution, stating that we need 'to determine if this is the start of a decline or more of a blip'. Broader public health strategies Dr Verma believes the popularity of sugarladen drinks and fatty foods is to blame for the rise in obesity rates over the past two decades. 'Changes in eating habits, such as increased consumption of sugar-sweetened beverages and high-fat foods, accompanied by a decreased consumption of fruit and vegetables, are associated with an increasing number of overweight children,' she says. 'Targeting children, particularly overweight children, with nutritional education is important, as it helps children form healthier long-term eating habits.' However, her team of researchers at MUCH says that single dietary interventions will not halt the global epidemic. Further, they claim such methods are not effective in increasing fruit and vegetable consumption among overweight and obese children. The team believes that much broader public health strategies are needed. Dr Paula Whittaker, Clinical Lecturer in Public Health at Manchester University, who was part of a research team conducting a systematic review of literature of interventions to change the dietary habits of overweight children, agrees. 'We found narrow interventions focusing on single aspects of behaviour are unlikely to achieve long-term change', she says. 'Instead, a holistic and targeted behaviour change approach in multiple aspects of children's lifestyles and their surroundings, including nutritional education, parental support and physical activity is required.' Dr Verma says that a sea change in how public health messages are transmitted and understood by the most vulnerable and deprived members of our society must occur - and quickly. 'Health literacy among the most deprived members of our society was found to be poor in single obesity interventions,' she says. 'It can't just be about peddling the same messages; we have to change hearts and minds if we are going to cause widespread change.' She advises health professionals to steer away from focusing on the risk of diseases from being overweight and obese, and instead promote wellbeing. 'The idea of disease and ill health is very frightening, and it becomes too easy for people to block out the messages,' she says. Such is the level of threat to our children's health that the World Health Organization (WHO) has devised a new action plan for population-based prevention for obesity. Following their monitoring of global data on childhood obesity, diet, physical activity and chronic disease under the Childhood Obesity Surveillance Initiative (COSI), a plan for population-based prevention of childhood obesity is expected to be developed imminently. In the meantime it has developed a tool, Prioritising areas for action in the field of population-based prevention of childhood obesity, accompanied by a guide to population-based approaches to childhood obesity that determines priority areas of action. While the tool has been tested in European regions, it is yet to be implemented. Simple solutions According to research carried out in the US, simple changes in how children and young people are fed could make all the difference. A study claims the childhood obesity crisis could be solved by ensuring youngsters serve their own food at the dining table. Researchers at the University of Illinois said that children who serve themselves, rather than being given plates of food, and who sit at the dining table and not in front of the television at mealtimes, are able to learn about portion sizes and to recognise when they are full, reducing their chances of becoming overweight. The researchers suggest parents should not pressure children into finishing what is on their plate as it can encourage them to eat more than they need. Instead, parents should ask children whether they are full or still hungry when they appear to have finished eating. Dipti Dev, one of the report's authors, says: 'Making kids eat when they're not hungry is probably the worst thing you can do. It teaches them not to pay attention to their body's signals.' The website NHS Choices said the research 'raises some interesting issues for both parents and childcare institutions in the UK' - especially around verbal cues and serving food 'family style'. 'But more research is needed as to whether such measures have an impact on children's eating behaviour, and ultimately on their health throughout their lives'. A study by Swansea University found that spoonfed babies were 'more likely to become obese' than infants who fed themselves. Researchers compared the weight and eating styles of children aged between 18 and 24 months weaned using a baby-led approach with those weaned using a traditional spoonfeeding style. They claimed those infants who were are allowed to feed themselves during weaning were 'less likely' to over eat as they were in control of their food intake - possibly leading to better appetite control in later life. NHS Choices has noted caution with the study's findings, claiming: 'Ultimately, it is what, rather than how, [children] eat that is going to have the most significant long-term influence on their future weight. Just like adults, children benefit from a balanced, lowfat diet that contains at least five portions of fruit and vegetables a day.' Failing our children The obesity problem in the UK has now grown to such a level that it has caused some children to be taken into care. Five children have been taken from their families by social workers because of overfeeding in the past year alone in England, including two in Wakefield, west Yorkshire, one in Oxfordshire, one in Salford and one in Hounslow, west London. A five-year-old girl from Wales was taken into care by social workers after her weight reached 10 stone with a BM1 of 70 - triple what it is recommended for her height, making her the heaviest child of her age ever recorded in the UK. Last year, five children were placed in care in Sheffield, Portsmouth, Lincolnshire, Slough and Harrow, north-west London. Parents who allow their children to become obese are 'unwittingly guilty of neglect' in the same way as those who are guilty of leaving their child malnourished, says Tam Fry, Honorary Chairman of the Child Growth Foundation. Fry says children who have been taken into care have been 'collectively failed' by the medical profession and wider society. 'These children are walking around in the countryside and towns of the UK in the full glare of health visitors, school nurses, teachers and doctors, and not one person has said "That can't be right - we ought to do something about that". 'This is where Cameron's "Big Society" comes into play because we are all responsible for identifying when a child is facing problems and for saying if they are too heavy. The same level of concern for an obese child needs to happen as with a starving child.' Fry praises America's first lady, Michelle Obama's work in the US, which has helped to reduce obesity rates in New York by 5% in the past three years. 'Obama's success is unbelievable and it is all down to one person. However, if you look to someone in Westminster to replicate that work, there is nobody you can name to take that forward. Despite being told time after time that obesity alone could collapse the NHS, no politician has been given the green light, power or inspiration to stand up and crack this.' In addition to a lack of leadership, Fry has called for an increase in children's weight measurement reviews and urges the government to uphold the Health Select Committee's decade-old recommendation to weigh every primary school pupil annually. 'This has never been implemented and that is why there is such a jump between obesity rates at reception age and when children come to leave primary school - there is no chance to intervene when a child's weight starts to climb. There is a body of evidence that points to a quarter of all children being overweight or obese at school entry [and] they didn't get that way overnight. 'If we had our way, we would have much more measurement activity. The medical profession as a whole has thrown the baby out with the bath water by not listening to people who have advocated this.' Dr Arpana Verma says more research is needed before we increase the frequency of measurement points of primary schoolchildren's weight to ensure we are not just 'measuring for measuring's sake'. Fry, however, strongly believes the 'every contact counts' initiative that is being spearheaded by the Department of Health's Jane Cummings and Viv Bennett is the only way to get around the sometimes uncomfortable issue of weight. 'If measuring your weight was done in a routine way like cleaning your teeth or putting your car in for an MOT, nobody would care,' he says. 'This can only happen if a patient trusts that the practitioner is acting in their best interests by carrying out such examinations and, thankfully, trust in GPs and community nurses is still strong, even if trust in hospitals has all but disappeared.' Fry is clear that NHS bosses and the various Departments of Health need to take greater responsibility for addressing the issue. 'The real problem is that the people who set the rules in the health service tend to be the older, more experienced academics and senior physicians who are coming to the end of their illustrious careers, who barely - if ever - get down to the coal face to see what is actually going on,' he says. 'As well as obesity, conditions such as rickets, gout, measles and scurvy are all coming back with a vengeance because the issues have been swept under the carpet for too long.' PUBLIC HEALTH ORGANISATIONS MUST GET BETTER AT TRANSLATING OUR HEALTHY MESSAGES IN THE SAME WAY THAT THE FOOD AND DRINKS COMPANIES DO Louise Naughton Assistant Editor (c) 2014 TG Scott & Son Ltd. |