Energy in, energy out - tackling childhood obesity

If the persistent challenge of tackling childhood obesity is to be met, the Scottish Government should use longer-term thinking and consider taking a firmer approach with the food and drink industry. That was the collective view of Holyrood’s recent policy event on the subject. 

Statistician Craig Kellock, of the Scottish Government’s health survey team, revealed the scale of the issue in Scotland, with 29 per cent of children at risk of being overweight or becoming obese. There has actually been a small decrease in the last two years, he said, but not enough to be statistically significant. The figures have been fairly stable. 

Certainly, having nearly a third of Scotland’s children at risk is no statistic to be celebrated, it was agreed. As well as BMI, the survey measured physical activity and diet, and it was these factors which became the focus of the day.

Surprisingly, three quarters of children in Scotland exercise to the recommended level, with half either walking or cycling to school. However, Stuart Hay, director of Living Streets Scotland, said a quarter of children were still being driven. Scotland has seen significant investment in routes to school, he said, but perceptions it isn’t safe remain. The Walk to School campaign has engaged 98 schools in Scotland across 21 local authorities, delegates heard. 

Children’s physical activity levels are associated with that of their parents, in particular the mother, according to Kellock.

The time spent being sedentary is of greater concern. Sitting for long periods carries health risks, independent of physical activity levels, and may interfere with healthy behaviours. 
“Time at screen may interfere with sleep,” said Kellock. “What we see is with increasing sedentary time, children are more likely to snack on unhealthy foods, so sweets and chocolate. Same is true for non-diet soft drinks and crisps.” 

Dr Diane Jackson, research fellow and lecturer at the Rowatt Institute of Nutrition and Health in Aberdeen, conducted an in-depth analysis of family behaviours with voluntary test subjects because “if you just ask people, they lie”.  
Increasingly, screentime is not just at the television but on tablet computers, she pointed out. “It’s quite scary - screentime has become a lot more accessible to kids.”

Home economics teacher Elaine Gardner, from Bannerman High School in Glasgow, called for food education to be given parity with PE, which is treated as a core subject until S4. “It would be really interesting if a fraction of the money spent on obesity was invested into food education,” she said.

Gardner added although she had an increasing number of pupils choosing home economics beyond S2, budgets were tight and she had been forced to charge them for practical lessons. Also, pupils were starting S1 with poor practical skills. 

“When you talk to them about food and what happens in their kitchens at home, they often talk about their grandparents, their grans making soup, making stews. They don’t talk about their parents in that same way. It’s as if there’s a missing generation when it comes to practical skills in the kitchen and I think that’s possibly the education system,” she said.

Gardner used the example of her husband running the marathon as an instance of where knowledge of energy in was just as important as the calories being burned, or energy out. “Energy out is a key part of our health, and we really need a huge focus on energy in. That’s where food education is the most important player,” she said.

In Tayside, teachers have been instrumental in designing pathways for children in an integrated approach to childhood obesity, according to Dr Laura Stewart, manager of NHS Tayside’s Weight Management Pathway. The ‘Fun Fit Tayside’ pathway goes all the way from prevention to working with obese children, she said. “We have a one, two, three message: one hour of physical activity, two hours of screen time and three healthy meals. That’s the fundamental which runs through Fun Fit Tayside.”

The approach was set up after Stewart and colleagues had come to the conclusion professionals were scared to raise children’s weight with parents, who often didn’t recognise when their child had a weight problem.

Dr Angela Jones of Newcastle University revealed a study of parents in Gateshead in which two-thirds describe their children as ‘normal weight’, with terms like ‘puppy fat’, ‘baby fat’ and ‘chubby’ commonplace. Most parents use extreme cases as indicators, she said, comparing their own children against very obese children.

Jones showed an online tool which she and colleagues had designed which allowed parents to compare what they thought their children’s body size was with what it actually was once height, weight and age details were entered into the system. 

But with television such an integral part of everyday lives it was agreed parents are up against it. 

Dr Stephanie Chambers of the University of Glasgow highlighted the impact of advertising foods that are high in fat, sugar and salt to children. The most prominent example was the sponsorship of the Glasgow Commonwealth Games by Irn Bru. 

Gardner said the only industry contact she’d had offering to help with her teaching had been from “a famous sugary drink manufacturer”.
“The government needs to think about tackling the industry,” said Mairi McLachlan of Lanarkshire Community Food and Health. 

“It feels like we can’t do any more. It’s the government and industry - the retailers - which need to do more.”
But how does the Government embed a longer-term vision? “I think the Scottish Government is best when it’s boldest. We see the smoking ban, so they have a track record. It’s about making the case of going for the big stuff,” said Hay. “It’s not about asking for more funding”, he added, “it’s about asking for consistent funding for a number of years.”

Stewart concluded: “I’m going to be radical and say tax the high fat, high sugary food, and put it towards tackling obesity.”