We are living in an era where many think it is impossible to get children to eat anything healthy. At times parents may be choosing the easy way out and opting for foods that children take to immediately and these may not include the healthier options. They are not helped by restaurants either as these offer children's menus that present us with a limited choice of food, ranging from chicken nuggets and chips to hamburgers, fried sausages and similar foods all of which are high in fats and unhealthy. Party food is similar.

So what did children eat a few years ago when nuggets did not exist? Where have the home-made sandwiches and rabbit-shaped blancmanges gone to? Have we lost hope in what children can eat and instead opt for the easy ready-made food, while getting children used to the fried food and/or sweet palate from early on?

Research has shown that food habits are acquired at as young an age as five. At ages 5 - 7 children are at a stage where they are most receptive to acquiring food habits, so it is at this vulnerable age that children should be lured into healthy lifestyle habits of healthy food and physical activity.

A recent survey has shown us that Maltese children are the most obese in the world. I find this claim unfair as children have to date not been weighed or measured. This is just a projection from figures which are over 10 years old. We can only get a realistic picture when children will be weighed and measured at particular intervals, the simplest being on entry into compulsory schooling at the age of five and then at specific intervals. However, although this projected statistic incorrectly places Malta at the top of the list, we still have a large amount of obese children and this is now a concern that should be tackled through campaigns, national projects and school or community activities.

The whole Maltese population must realise that all stakeholders must contribute to minimising this problem. This would include restaurants, tuck shops, fast food places, the media, schools and school food policies, the health and education ministries and, most of all, parents.

On one hand parents have probably become more conscious these days on food and health but there is also a lot of misinformation and bad practice. Children need to be taught the right attitudes and behaviours towards food from an early age. One cannot say that the children will learn to eat the right type of food when they grow up. It is very difficult to change habits later on in life. The result is that as children grow older they are becoming more obese and this is then very difficult to reverse.

Obesity is normally caused by multiple factors that are a combination of obese parents, genetic factors, unhealthy eating habits, bad modelling from parents who will eat badly and not exercise, children having a low energy expenditure through more hours of watching television, playing video or computer games, no physical activity and having a high consumption of high fat snacks.

One usually knows a child is overweight or obese by having the weight and height taken and together with the knowledge of the child's age one can determine whether the child is within a healthy weight range or not.

The treatment for this is usually physical activity, a healthy diet management (not a restrictive diet), attitude and behaviour modification and good modelling from all the family. The whole family would need to change its eating habits and physical activity patterns. This would be done by eating healthy food, limiting portions, cutting down on high fat snacks, cooking at home rather than eating out too often and carrying out physical activity together where possible.

It is never too early to start.

Obesity is easier to prevent than to treat. Parent education is necessary as misinformation causes bad habits. One cannot afford to be lenient in this. For example, one has to pass on the message that healthy drinks are milk, water or freshly-squeezed fruit juices. Soft drinks should not be allowed and these days we eat out too often to allow children to drink these at restaurants.

Desserts are another issue. We should get our children used to the idea that a dessert is a fruit. One can have the occasional cake; however, desserts in restaurants are usually loaded with cream and sugar, so one should just omit. A child may be thin and afford the portion but this is all about habits and behaviours towards food. This is an investment in our children to remain healthy.

Restaurants should change their kids' menus if they should have them at all. One should offer healthy pasta dishes, healthy pizzas where children can make up their own toppings from a number of healthy foods, dips and raw vegetables, ricotta pies with a wholemeal low fat pastry, pitta bread with a healthy choice of fillings, etc.

If a kids' menu is to include a dessert and a drink this should include freshly-squeezed orange juice, water and milkshake without ice cream or loads of cream. The dessert should preferably include a fruit salad, apple pie, apple and dried fruit crumble, yogurt ice cream and ricotta-filled sponge cakes or baked cannoli.

I get very annoyed when at a restaurant my children will be choosing food from the main menu and try to select healthy options and the waiter suggests they look at the kids' menu and choose nuggets! The time has come for the Health Promotion Unit to suggest the kind of food restaurants should offer on a kids' menu.

A note to parents is that habits take time to form. It is not overnight that children take to healthy foods especially when bombarded with so many tempting high sugar and high fat foods and drinks. It takes repetitive tries and modelling by parents and an effort to provide the healthy food options at home.

To conclude, I will list a few other points to help prevent obesity in children and to get the whole family to eat healthily and live healthily:

Give children a variety of foods from early on to help them acquire different tastes. Children may take between 12 - 15 tastes of a food to get to like it; so don't give up too easily.

Do not overfeed. Children who become obese at a young age will probably remain obese.

Avoid adding sugar to fruit and drinks.

Limit the portion sizes and be careful in restaurants as portion sizes have grown over the years and this is resulting in a higher calorie intake. Share or ask for half portions.

From the age of five children can be given low fat dairy products such as semi-skimmed milk. Dairy products can be high in fat.

Cook and eat poultry without skin and where possible opt for fish and white meat.

Some cereals and cereal bars can also be high in sugar, so opt for ones that are high in fibre and low in sugar.

It is essential that packed lunches are always healthy and consist of a healthy snack, like a wholemeal sandwich with salad, lean meat or low fat dairy cheese, fruit and water. It takes time to get children to accept all this but introduce slowly and vary the lunch from week to week. Get children to suggest too and eventually make their own lunch too.

Low fat does not mean low sugar and vice versa.

Cook at home. Ready-made food is high in calories. Grill and bake - do not fry.

Teach children to eat at table with the family and to eat slowly as this can detect fullness.

Discourage eating while in front of the television as this can lead to numerous high fat or high sugar snacks.

Have plenty of fruit available at home and get children into the habit of having a fruit cocktail or vegetable soup when they arrive home from school rather than biscuits, sponge cakes, etc.

Do not use sweets as a reward as this is sending out a wrong message.

Serve as a good example yourselves! Eat healthily and do a lot of exercise.

Ms Mugliett is home economics lecturer at the University of Malta's Faculty of Education.

karen.mugliett@um.edu.mt

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