Childhood obesity - When bigger is not better

Childhood obesity is a growing problem. We all recognise the need to take strong action. Schools are playing a central role in fighting childhood obesity despite financial constraints. But they should do even more to reduce the availability of junk food and increase students' daily exercise. Sandy Calleja Portelli delves into the problem and gets to know what needs to be done to tackle it.

The World Health Organisation (WHO) lists obesity as a chronic disease and a number of studies have ranked Malta near the top of league tables along with the US and Canada. Both these facts have been reported extensively in the local media and, in time, we seem to have become so accustomed to hearing them that we are no longer shocked by the knowledge.

In April 2007, consultant paediatrician (cardiology) Victor Grech, and Victoria Farrugia Sant'Angelo, head of school health services conducted a survey (BMI Study) of all five- to six-year-olds in their first year at primary school. 3,461 children were weighed and measured by school doctors and nurses and their body mass index (BMI) calculated. The results are alarming - according to the criteria established by the centre of disease control 20.6 per cent of girls and 19.9 per cent of boys were found to be overweight while 13.2 per cent of girls and 14.7 per cent of boys were obese.

Until recently a chubby child was considered a well-fed child and a skinny child immediately classed as a picky eater who needed to eat more. Considering, however, that a child who is obese at the age of 10 will probably be diagnosed with Type 2 diabetes before turning 40, "puppy fat" stops being cute and takes on the appearance of the health hazard it really is.

There are a number of factors leading to the increasing rate of obesity among our children with the main culprits being diet and our increasingly sedentary lifestyle. A British study published earlier this year also pinpointed schools' increased focus on tests as a major culprit. Our education system is arguably more focused on tests and exams than the British system and physical education often takes a back seat to the "more important" academic studies.

At present, primary schoolchildren are required to have just two hours of physical education a week during school hours with extra hours of physical activity and sports incorporated into the school breaks. Tanya Zahra, communications executive of Il-Kunsill Malti għall-Isports (KMS) tells me that many schools are failing to reach this target, although this may be partly due to the fact that a number of primary schools have playgrounds that are too small for their students' needs.

Secondary school students have even less physical activity incorporated into their school day, with first form students spending just 90 minutes a week on physical education which subsequently decreases to just 45 minutes weekly.

In both primary and secondary schools our guidelines fall far short of WHO's recommendation that children should exercise for at least an hour a day. In an effort to redress this, KMS currently runs two programmes: the "after-school programme", begun at St Benedict's College and aimed at secondary school students while the "community sports programme" was piloted with great success in four primary schools. Both programmes aim to expose children to the different types of sports available while giving them a chance to burn off some energy in between a schoolday spent sitting down and a sedentary evening of homework, studying or sitting in front of a PC or TV.

Sports coaches agree that children's participation in sports and other physical activity tends to decrease or stop altogether at the same time as major exams (11+ exam, O Levels and A Levels). Ms Zahra agrees that this trend has also been noted by KMS although she continues "for students sitting their O and A Levels this may also be related to other social activities such as going out with friends".

Students who opt to drop their favourite sport to make more time for studying might be interested to know that research is not on their side. On the contrary, recent studies show that students who regularly participate in sports and other extracurricular activities are more successful than their more "dedicated" counterparts.

Physical exercise alone is not going to solve anybody's obesity problem without an accompanying healthy diet. The beginning of the current scholastic year heralded the introduction of the Healthy Lifestyle Eating Plan (Help) in all state schools.

Help aims to promote healthy eating and physical activity among students and has bound tuck shops to provide healthy food in accordance with a guideline for school food providers. The guidelines include requirements such as using wholegrain ingredients, limiting processed foods and artificial additives. School food providers are also required to use fresh seasonal produce and avoid the use of oils and saturated fats wherever possible.

Schools have also introduced a school eating policy which includes packed lunches provided by parents. Maria Ellul, principal scientific officer (nutrition) at the directorate of public health regulation concedes that some schools have "with the very best of intentions, imposed the new eating plan without adequate consultation with parents. As a result some measures, such as banning the traditional birthday cake, are making parents uncomfortable. We cannot go from black to white overnight; it takes time to implement changes successfully."

"Tackling obesity requires lifestyle changes and should be a long-term process. Whenever sudden change is enforced, people tend to change their habits in the short term but go back to their old ways within a short period of time."

Ms Ellul points to the fact that the ability to adhere to the new guidelines is also dependent on a family's income; and here lies the crux of the matter. Wholemeal bread and pasta is more expensive than the corresponding products made from refined flour; as are the fresh vegetables needed to make a salad; and families in lower income brackets may struggle to stretch their budget far enough.

This correlation between a family's budget and the rate of obesity is also evident in the BMI study quoted above. Children hailing from the Grand Harbour region (Valletta, Floriana, Vittoriosa, Senglea, Cospicua and Kalkara) were found to be more likely to be obese than those living anywhere else in Malta and Gozo.

Family income is also a factor in treating an obese child after diagnosis. "Children from higher income families tend to be treated for obesity far more quickly than those reliant on the public health service.

"We are blessed with an excellent team of paediatricians within the public health sector and a child who is diagnosed as being overweight or obese will have all the necessary medical tests. Any medical condition identified will be treated with an impeccable standard of care," said Ms Ellul.

However, when the root of the problem is not a medical one, accessing the services of dieticians and nutritionists in the public sector is limited due to long waiting lists. Ms Ellul explains in more detail: "When a child's weight problems are down to lifestyle issues, it is often necessary to treat the entire family. Nutritionists need to work with mum and dad to encourage the adoption of healthier eating and exercise habits because it is often the entire family that needs to be treated".

There is no denying that our lifestyle has changed drastically over the last 10 years or so. As more mothers are balancing motherhood with their career, time is undoubtedly a valuable resource; and we feel the need to make the best use out of it. In our rush to cram as many errands as possible into the time available, we are making increasing use of our cars to get from A to B and leading increasingly sedentary lives.

With children it is often a case of "monkey see, monkey do" and children whose parents have a tendency towards physical activities are more likely to follow their example.

Paying for extracurricular sports activities can be very expensive, especially when one considers the costs of clothes and equipment required as well as tuition fees but taking a walk together is free. KMS also organises a number of sports programmes at drastically subsidised prices and the number of participants is increasing annually.

"It takes a village to raise a child" and it will take a nation to stop the burgeoning weight of our children. As we strive to ensure that our children excel in academic fields so must we ensure that they grow to be active, healthy adults.