OVERVIEW
Childhood obesity is a growing concern worldwide. According to the World Health Organization (WHO), as of 2022, approximately 37 million children under the age of 5 were classified as overweight. Alarmingly, another 390 million children and adolescents aged 5 – 19 were also categorized as overweight, of which 160 million were considered obese1. This rising trend poses significant health risks, calling for immediate action to address and prevent childhood obesity.
Obesity is a defining risk factor for a range of chronic conditions, such as Type 2 Diabetes, heart disease, bone disorders, and even some cancers. Core Nutrition was recently asked to contribute to a research article tackling the pressing issue of childhood obesity and the current strategies in place that are aimed at combating this growing problem. In this blog post, we will respond to some of the research questions posed, delve into the common factors contributing to childhood obesity, and provide key tips and strategies to help manage and prevent this condition.
FACTORS CONTRIBUTING TO CHILDHOOD OBESITY
Research question: Is South Africa facing the same obesity crisis among children due to overeating?
The rising prevalence of obesity in South Africa, especially among children, is a serious cause for concern, as is seen globally. The most recent obesity statistics in South Africa revealed that 31% of men and 68% of women are classified as being overweight or obese, with 13% of children aged 6-14 falling into this classification. While overeating is a significant contributor, it’s far from the only factor contributing to obesity among South African children.
A common challenge lies in the typical staple South African diet, which is rich in refined carbohydrates, such as bread, pap, potatoes and pasta. While these foods can still play a part in a diverse diet, when consumed in excess these foods can contribute to obesity. Additionally, the availability and affordability of fast food and junk foods are major contributors to childhood obesity. In urban areas, in particular, fast-food outlets seem to be everywhere, making these unhealthy foods, not only accessible but also more convenient for families. Unfortunately, these foods are often very high in fats, sugar, and/or calories, but low in essential nutrients, contributing to weight gain and poor health outcomes, especially for children.
Another key factor is the increasingly sedentary lifestyle led by many South African children. With the increasing prevalence of technology, activities like playing video games, watching television, and using mobile devices have replaced outdoor activities and playing. Research suggests that children between the ages of 2 to 18 should engage in 60 to 180 minutes of moderate-intensity physical activity each day2. It is also recommended to limit screen time to no more than 2 hours per day. Children often model their parent's behaviour, so it’s essential that parents set a positive example. Simple changes can have profound impacts on your child’s health, so it’s encouraged to mimic the behaviours you want to set for them. Take your children on walks, encourage active play with toys like skipping ropes, trampolines, jungle gyms etc. and most importantly join in on the fun.
HOW CAN WE HELP REDUCE AND MANAGE CHILDHOOD OBESITY?
Research question: Could a ban on TV advertisements for fast food and junk food help curb childhood obesity and promote healthier lifestyles?
Implementing a ban on TV adverts that promote ‘junk foods’ could be a positive and necessary step in addressing childhood obesity. Children are highly impressionable, and research has shown that advertising, through means of TV adverts, social media, etc. can have a significant impact on their food choices. By reducing this exposure, we can start to create an environment where healthier choices are encouraged. However, placing a ban on these adverts alone will not be enough to tackle the problem completely. An initiative like this should be done in conjunction with health and nutrition-related education, teaching children and their families how to shift their lifestyle towards one that is healthy and balanced. A ban such as this can be effective when coupled with supportive health policies, and most importantly – making healthier, nutritious foods more accessible and available. Children do not always have a clear understanding of portion control and healthy eating habits; it is the responsibility of the guardian to moderate portion control and example healthy eating habits.
“We must be conscious not to label tasty unhealthy food as ‘bad’ and healthy (perhaps less tasty) food as ‘good’- as this can create the impression that healthy food is less desirable/ more of a punishment and unhealthy food is a reward. This can drive fussy eaters and avoidance of healthy foods”.
Nutrition plays an essential role in your child’s growth and development, providing the energy and nutrients required for daily activities, all while supporting overall health and healthy weight management. However, addressing overweight and obesity in children requires a different approach than with adults. Unlike adults, weight loss is not generally recommended for children and adolescents who are overweight or obese. These years are often critical for growth and development so implementing a weight loss diet may impact nutrient intake, which could hinder growth, lead to nutrient deficiencies, and impact overall well-being. Efforts should rather focus on cultivating healthy eating habits and an active lifestyle that supports growth without compromising nutritional needs, and this is where education is key. Many children will grow into their weight (i.e.: maintain their weight while their height increases gradually).
While numerous efforts are underway to combat obesity, including regulating advertisements, the largest gap in today’s society stems from a lack of education regarding nutrition and childhood obesity. The family environment is crucial for instilling healthy eating habits in children. Children are very receptive and impressionable, and they often mimic their parent's eating behaviours, activity levels, and overall lifestyle choices. When families prioritize nutritious meals and regular physical activity, they create a foundation for lifelong healthy habits. It is vital for family members to be educated about nutrition and healthy eating habits, allowing them to make informed choices. By creating a supportive environment that prioritizes health and wellness, families can significantly influence their children’s attitude toward nutrition, ultimately addressing and managing overweight and obesity.
HOW CAN DIETITIANS HELP MANAGE CHILDHOOD OBESITY
Dietitians are registered healthcare professionals who are qualified to help children, and their families make meaningful lifestyle changes to manage and prevent obesity, along with its associated health risks. By working closely with the children and their caregivers, dietitians can offer tailored nutrition advice and practical strategies to prevent and manage obesity. Below are some of the key ways that dietitians can assist and address childhood obesity:
Personalised Nutrition Plan
A Dietitian will conduct a full assessment of your child’s current health status and eating habits and design a nutrition plan tailored to their specific needs. The ultimate goal with children is to focus on promoting a well-balanced diet, that supports healthy growth and development while ensuring appropriate portion sizes and nutrient-dense foods.
One of the key aspects of childhood nutrition is ensuring that all food groups are included in their daily diet (i.e. lean proteins, complex and wholegrain starches, fruits, vegetables, low-fat dairy and dairy alternatives, and healthy fats). A dietitian will design a menu plan that incorporates a wide variety of these essential food groups, taking into account your child’s food preferences while gently encouraging them to try new foods, and fostering a positive relationship with food. For overweight or obese children, the goal is not to lose weight but for the child to grow into their weight, while instilling sustainable, healthy eating habits.
Nutrition Education and Support for Families
Parents and caregivers play a crucial role in shaping a child’s diet. A dietitian will work closely with families and caregivers, offering education on healthy food choices, meal planning, and how to prepare nutritious meals on a budget. They also provide valuable guidance on a variety of topics imperative to managing and preventing childhood obesity, such as understanding appropriate portion sizes, reading food labels, and packing balanced, nutritious lunchboxes and snacks.
Figure 1 shows the MyPlate model, a tool often used by dietitians. This model is a visual guide as to how a balanced plate should look: ½ plate vegetables and fruits, ¼ plate starch, and ¼ plate protein. This tool is handy for parents to ensure they’re preparing balanced meals and maintaining portion control to prevent and manage overweight and obesity in children.
Another useful tool often used by the Dietitians at Core Nutrition is our Lunchbox Planner (Figure 2). When it comes to packing a healthy lunchbox, it’s important to emphasize variety and balance and ensure that all food groups are included. Lunchboxes and snacks should be nutrient-dense to foster healthy growth and development. Some of our go-to healthy and nutritious snacks are fruit and yoghurt, veggie sticks and hummus, lean biltong, boiled eggs, crackers, rice cakes and homemade sweet treats, such as date balls. By incorporating these practical strategies, parents can ensure their children are well-nourished throughout the day and ultimately tackle the rising burden of childhood obesity.
Collaborating with Other Healthcare Providers
Dietitians often work within multidisciplinary teams, involving professionals such as psychologists, occupational therapists, and speech therapists, when managing and treating childhood obesity. Following a collaborative approach ensures that all aspects of the child's health including their mental, emotional, and physical well-being are looked after. By working together, healthcare experts can create a holistic plan that not only promotes healthy eating but also fosters long-term sustainable habits for the child and their families.
Childhood obesity is a multifaceted condition that requires urgent attention, due to the long-term complications often associated with this condition. By addressing the contributing factors and promoting healthy habits in the home and the community, we can work together to improve the health of the next generations.
References:
1. World Health Organization. (2022). Obesity and overweight fact sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
2. Wyszyńska J, Ring-Dimitriou S, Thivel D, Weghuber D, Hadjipanayis A, Grossman Z, Ross-Russell R, Dereń K, Mazur A. Physical Activity in the Prevention of Childhood Obesity: The Position of the European Childhood Obesity Group and the European Academy of Pediatrics. Front Pediatr. 2020 Nov 5;8:535705. doi: 10.3389/fped.2020.535705. PMID: 33224905; PMCID: PMC7674497.