Dr. Catherine Conlon: Pandemic fueled obesity — what is the answer?

The last four decades have seen a tenfold increase in childhood obesity and this has been further exacerbated by the pandemic. Global childhood obesity rose from less than 1% in 1975 to nearly 6% in girls and nearly 8% in boys by 2016. The pandemic has added fuel to the fire.

For adults, the new weight-loss drug, Wegovy — recently approved for use in Ireland — offers real hope for significant weight-loss and health gain for those who use it long term. But it is not going to address the underlying problem: the obesogenic environment.

Findings from the UK National Child Measurement Program for the 2020/2021 school year estimate obesity prevalence increased from 9.9% to 14.4%. There have been no official studies in Ireland but there is reason to be concerned that similar trends exist here.

Grace O’Malley, clinical lead at the Child and Adolescent Obesity Service in Temple St Children’s Hospital, confirms the upheaval in children’s routine where bedtimes, sleep times, mealtimes and snack times were upended has led to an increase in obesity among children. She said there is likely to be a stark divide in terms of social inequality, with families from low-income groups suffering more.

We know the drivers of this — the profit-driven flooding of the market with cheap, energy-dense, nutrient-poor food and drinks, alongside urban landscapes that promote sitting down by either staring at screens or driving vehicles.

If we know what the problem is, why are we dithering to solve it? Here are a few key steps that we can take to address the obesogenic environment.

Regulate for a healthier environment

The Obesity Policy and Action Plan 2016-2025 recommends the “development of guidelines and support materials for those working in developing the built environment for urban development and planning in relation to reducing the obesogenic environment”.

This recommendation would be more effective if it specifically targeted the introduction of robust legislation to restrict planning for fast food outlets near (within 400m) schools.

The Obesity Action plans also recommends “the development of a code of practice for food and drinks promotion, marketing, sponsorship and product placement”.

Dr Catherine Conlon: The obesity crisis is far less of a problem of individual behavior and lack of willpower and much more about the environments around us.
Dr Catherine Conlon: The obesity crisis is far less of a problem of individual behavior and lack of willpower and much more about the environments around us.

For this to be effective it must be underpinned by legislation. A voluntary code is uncompetitive and of minimal effect. A non-voluntary code would level the playing field for the food industry to change the way food is marketed, sponsored, and promoted.

Britain has plans to introduce robust legislation in October 2022 to restrict advertising of foods high in fat, salt and sugar being shown on TV before 9pm and in paid-for advertising online, as well as restricting unhealthy food promotions in stores and online.

In June 2020, the newly elected Government committed to addressing obesity in Ireland with a Public Health (Obesity) Act, including restricting the marketing of unhealthy foods to children.

This legislation is likely to be fiercely opposed by the food industry as has happened in the UK, but it has the potential to make an impact and is overdue, with the ability to give parents and children an opportunity to have a “fair chance to make the healthy choice”.

Early years programs

One approach that has been shown to be useful is tackling obesity in the early years. ‘Right from the Start with HENRY’ is a UK program delivered by trained facilitators to small groups of parents over eight weekly sessions.

HENRY (Health, Exercise and Nutrition for the Really Young) is designed to provide parents of infants and preschool children with the skills, knowledge and confidence required for a healthy family lifestyle.

Evaluation of the program showed increases in the healthiness of family lifestyle, improvements in parenting and emotional wellbeing, increased fruit and vegetable consumption among parents and children, as well as significant reductions in consumption of foods high in fat and sugar. There were also positive changes in eating behaviors, physical activity, and children’s screen time.

If this all sounds too good to be true, Leeds has become the first city in the UK to report a drop in childhood obesity after introducing the HENRY program in 2009 — helping parents to set boundaries for children to say no to sweets and junk food.

Only a few other cities in Europe, notably Amsterdam, have achieved this and, like Amsterdam, the decline is most marked in families living in the most deprived areas where the problem is worst and hardest to tackle.

Over four years in Leeds from 2013 to 2017, obesity dropped from 11.5% to 10.5%. Among the more affluent families, obesity levels also dropped from 6.8% to 6.0%. The biggest decline was in the reception class at age four. From 2016 to 2017, 625 fewer reception class children were obese.

These changes happened after the introduction of HENRY in 2009, focusing on the youngest children and the poorest families. HENRY supports parents in setting boundaries for their children and taking a firm stance on issues from healthy eating to bedtimes.

The program encourages authoritative rather than authoritarian parenting. Authoritarian parenting is when children are told what to eat and do, compared to permissive parenting where children are asked what they want to do.

HENRY encourages authoritative parenting, where parents make it clear they are in charge but also respond to their children. Instead of being asked what vegetable they want for dinner, children might be asked whether they want carrots or broccoli. Instead of being told to go to bed, they are asked what bedtime story they would like. Instead of being told to stop watching television, they are asked would they like to turn it off or should the parent do it.

Similar programs, such as Parents Plus, operate in Ireland. The focus is on the delivery of educational workshops in schools, community services and primary care, supporting parents to make positive lifestyle changes for their families.

The key is avoiding a stigmatized blaming approach and instead adopting an empowering motivation approach to make practical and positive changes around family mealtimes, bedtimes, exercise as well as daily fun and time to connect with children.

The State has a mandate to protect the health and wellbeing of children which is not being met. This need has been accelerated by the pandemic where there are clear indications that obesity levels have risen substantially.

There is evidence that community development programs that support authoritative parenting around healthy lifestyles can play a role. As important is robust legislation to steer changes in the food environment if it is to become healthier, so that cinemas, leisure and activity centres, supermarkets, and food outlets offer and promote tasty healthier choices for everyone, but particularly for children.

Key to success is recognition that the obesity crisis is far less of a problem of individual behavior and lack of willpower and much more about the environments around us.

  • Dr Catherine Conlon is senior medical Officer in the Department of Public Health, St Finbarr’s Hospital Cork and former director of human health and nutrition, Safefood. Her book Modern Culture and Wellbeingwas published by Veritas in 2020.

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