Time to put up or shut up on childhood obesity
The solution is long-term planning, structural independence and serious investment
In the bottom-up approach to addressing childhood obesity, the issue is tackled at community level.
The National Obesity Taskforce of 2009 listed 80 points of action. One of the proposed actions (3.8) was: “Peer-led community development programmes should be fostered and developed to encourage healthy eating and active living.” It goes on to emphasise that vulnerable groups must be the primary targets. Nothing happened.
In 2016, another national obesity plan was introduced that lists 58 actions across 10 steps. Action 6.7 seeks to “develop and integrate evidence-based, effective, community-based health-promotion programmes targeted at high-risk groups within all community health organisations”, an action almost identical to the utterly redundant aspiration of the 2005 task force recommendations.
The designated lead for this action point is the Health Service Executive and the time frame is 2016-2020. To the best of this writer’s knowledge, still nothing of substance has happened at national level. But to truly tackle childhood obesity we need structures for public health nutrition which are independent of the Department of Health, we need medium- to long-term planning and we need serious national investment.
A recent study from the public health agency of Barcelona published in the February edition of the Journal of Nutrition demonstrates the powerful effect of such serious investment in on-the-ground programmes to combat childhood obesity. The target group was nine- to 10-year-olds and the programme was school-based. In all, about 1,500 children took part in the obesity prevention programme while a similar number served as a control group, receiving no special treatment. The teachers were trained by appropriate experts from the Barcelona public health agency and had access to their advice and guidance throughout the programme, which lasted for 12 months.
The programme itself comprised three parts. The first involved tutoring of students at individual level over nine sessions covering body image, growth, nutrition and physical activity and occupied about 10 to 14 class hours.
The second phase involved the promotion of physical activity, which started with the measurement of each individual student’s fitness level. Within the school, each participating pupil had to engage in a minimum of two hours of physical activity.
Outside the school, a similar target was set and the school facilitated this by identifying different opportunities for engagement in sport in the school locality and the programme provided financial help if families needed such support.
The third element involved the family playing a role in all aspects of the programme and providing a link between the classroom and the home. Families participated in a workshop which aimed to improve dietary and physical activity patterns.
The workshops lasted 1.5 hours and, at the conclusion, each family was required to agree on a healthy lifestyle programme that suited their particular needs and means and which would be implemented over the duration of the study. All pupils completed two detailed questionnaires on diet and physical activity under the supervision of the teachers.
In addition, parents completed questionnaires and teachers provided data on the implementation of the programme to ensure that there was no teacher-based bias in the degree of implementation of the programme.
The results showed a significant reduction in the incidence of obesity over the 12 months of intervention. At the the start of the project, 13 per cent of the pupils were classified as obese. At the end of the year those who participated in the programme showed an obesity rate (as measured by body mass index) of 7.4 per cent, which compared with a level of 11.4 per cent in the control group. Thus the intervention group showed a very sizeable reduction in obesity over the 12 month period, of the order of 40 per cent.
There are two routes to tackle obesity. The top-down approach of legislation and regulation such as sugar taxes, restricting fast-food outlets near schools, advertising restrictions, food labelling and the like. All play a role in helping to tackle the problem.
The second approach is the bottom-up approach where the issue is tackled at community level, as in this pilot programme from Barcelona.
The regulatory route costs little or no money, is politically popular and easy to implement, and gets considerable media attention. The community intervention route is far more complex, more challenging to implement, requires detailed planning, involves multi-sectoral co-operation, is costly, doesn’t really get politicians worked up and is not of great interest to the mass media. But the results, such as those in Barcelona, can be spectacular in comparison to the regulatory route.
My crude calculations would suggest that to devote 12 hours to individual training of pupils in schools and to run 1.5 hour-long family workshops for the half a million primary school children in Ireland, including expert back-up and training, plus administration, would cost at the most, 0.04 per cent of the present cost of obesity, officially declared to be of the level of €1.2 billion every year.
So the simple truth about childhood obesity is that it needs long-term planning, it needs structural independence from the Department of Health but most of all it needs serious investment.
Even an expert group to flesh out, in detail, options for such a programme with costs and structures that could really implement a national childhood obesity plan, would be a start.
Mike Gibney is emeritus professor of food and health at UCD