Burger babies: the future is fat

In schools, parks, shopping centres, and communities throughout the United Kingdom, fat kids are a common sight. Ghias Shafi explains why there is a growing risk of obesity in young people

The proportion of obese children in the United Kingdom is rocketing. In the United Kingdom alone, about one million children under 16 are obese.¹ More than one in four children in England are overweight or obese, and the prevalence of obesity among children aged two to 10 has dramatically risen, from 9.9% in 1995 to 13.7% in 2003¹. These statistics are a disturbing picture as the obesity epidemic spreads throughout the United Kingdom.

Sir John Krebs, chairman of the UK food watchdog, the Food Standards Agency, has labelled child obesity a ticking time bomb for life expectancy levels. He has also claimed that the trend means that young people today will have shorter lifespans than their parents—the first reduction in more than a century.² Just what is going wrong?

Playstation versus playground

The rise in obesity levels in recent years has been blamed on a combination of inactivity and consumption of excess sugary and fatty foods. Children are eating more calories than necessary, are increasingly spending time plugged into computer games, and are not doing enough physical exercise.

Research into the connection between childhood obesity and social class has shown that children from low socioeconomic groups are more likely to be obese and remain overweight or obese throughout early adulthood. Overweight children in China, however, are seen as a sign of prosperity. Although some people are more genetically susceptible than others to becoming obese, the rise in obesity has been too rapid to be attributed to genetic factors.

Lack of physical exercise has always been criticised in schools in the United Kingdom, and the government aims to get 75% of children doing two hours of sports a week, either inside or outside the curriculum, by 2006. Figures from the Qualifications and Curriculum Authority (a non-departmental public body), however, reveal that only one third of schools are meeting the target.³

The media

The media has always acted as a great channel of influence and a central tool of persuasion. The Food Standards Agency’s research shows that advertising influences children’s eating habits, and it therefore wants food packaging to carry health warnings. The agency is also concerned that popular entertainers and cartoon characters are promoting foods that contain dangerously high levels of fat and salt². About half of all foods advertised during children’s television are cakes and sweets, whereas fruits and vegetables do not feature at all.

A stark example of the sort of promotion that can cause problems was McDonald’s buy one, get one free offer on its Big Macs. One Big Mac contains around 23 grams of fat and 492 calories; eating two would therefore mean consuming 46 grams of fat and 984 calories⁴, which is more than half the daily requirement of fat and calories required by a child.

The media has made some effort to show the consequences of overeating, however, and one entertaining yet horrific example of this is the film Super Size Me, which portrays director Morgan Spurlock only eating food from McDonalds for a month and gaining 25 pounds (11 kilograms) in weight. He became increasingly depressed and started to get chest pain, headaches, sugar crashes, hypoglycaemia, and palpitations. But is this sort of health campaign enough for children to stop overeating?

Celebrity chef Jamie Oliver should be applauded for his commitment to improving the standard of school meals. He has rightly acknowledged that the one meal eaten out of the home can make all the difference to health, concentration, and exam results. Oliver has reportedly been told by one paediatrician that, “This is the first generation of kids who will die before their parents.”⁵ Oliver’s drive to improve standards can be seen as the first upturn after the 1980 Education Act, which dramatically dropped the standard of school meals.

Obesity: the physical and financial cost

The main risk related to childhood and teenage obesity is that it can persist into adulthood. Obese teenagers are 15 times more likely to become obese adults.⁶

There are numerous health risks linked with being obese in adulthood, including diabetes, heart disease, arthritis, and cancer. Obese children and adolescents may not just be storing up problems for the future, however, they may also face health problems while they are still young. Some common problems are:

• Glucose intolerance and diabetes, which normally develop in obese adults, are now being found in obese children. The latest audit of type two diabetes in children under 16, which two years ago identified 100 cases in the United Kingdom, is a gross underestimate. Experts say there may now be up to 1500 cases nationally and confirmed that the United Kingdom is sitting on a time bomb.⁷
  
• Obese children and adolescents have higher levels of cholesterol, triglycerides, and lipoproteins. They have higher levels of low density lipoproteins and low levels of high density lipoproteins. This pattern is strongly correlated with heart disease in later life.
• Less common disorders that can occur in obese children include hypertension and osteoarthritis. Hypertension is uncommon in children but occurs nine times more in children and teenagers who are obese than in those who are not obese. ⁸ Osteoarthritis and back pain are also often associated with obesity.

Psychological problems in obese children

It is not only physical suffering that is associated with obesity, however, there is also psychological suffering. Obesity has been linked with a low self image, low self confidence, and depression. Obese children are often teased at school and excluded from their friends. The Department of Education and Skills acknowledges that “evidence-based research points to a correlation between a healthy diet and educational performance”. The effects of obesity can therefore be far reaching.⁵

The NHS faces costs of up to £16 billion over the next decade as a result of increasing obesity and related illnesses.⁹ Academics at St Andrews University found that people in Britain are becoming fatter, and the knock on health problems will put increasing strain on the NHS budgets.

The BMA believes there should be a ban on junk food advertising and rules for the nutritional balance of school meals and prepared food. They have warned that without strong action, children will increasingly develop adult diseases such as type two diabetes, cancer, and arthritis. The BMA’s board of science has warned that if current trends continue, it is estimated at least one fifth of boys and one third of girls will be obese by 2020.¹⁰

At the June 2005 launch of the BMA’s report Preventing Childhood Obesity,¹¹ Dr Vivienne Nathanson, head of science and ethics at the BMA, said that, “It is madness that at a time when children are being told to eat less and do more exercise they go into school and are sold fizzy drinks and doughnuts and do less than two hours timetabled exercise a week”¹² The report has also called for the government to address schools, the food industry, and advertising. A compulsory compositional and nutrient standard for school meals should be introduced to set fat, sugar, and salt content. Manufacturers should reduce salt, sugar and fat in pre-prepared meals.

The law

Surprisingly, there is no law restricting the unlimited advertising that children are indoctrinated with on television. The government has so far taken a very soft approach by leaving manufacturers and advertisers to self regulate. As child obesity becomes an increasing problem, however, it is time for the government to take a more hands on approach.

Steve Sinnott, the general secretary of the National Union of Teachers, has been an open critic by stating that, “It is not good relying on self regulation: it hasn’t worked in the past and there is no reason to believe it will work now. The manufacturers of junk food and drinks have shown little willingness to regulate themselves. Now [the] government must act.”¹³

Charlie Powell, of Sustain, the alliance for better food and farming, states, “It beggars belief that the government is relying on a group with strong interests to develop meaningful proposals to restrict junk food promotions to children. Many of the industry bodies represented do not even publicly accept that there are unhealthy foods, let alone that they are part of the problem. Statutory controls are needed to protect children because each year of delay may result in another 220,000 children in England becoming overweight or obese”.¹⁴

The ineffectiveness of the voluntary approach has also recently been documented in a full report,¹⁵ which shows how voluntary codes are weak, unenforceable, lack independence, and are used by industry to avoid effective regulation. So, what is being done?

The Children’s Food Bill was presented to Parliament by Mary Creagh, MP for Wakefield, in June 2005. The bill aims to improve children’s current and future health and prevent the many diseases and conditions connected with obesity. The main aims of the bill are to:

• Protect children from the marketing of unhealthy food and drink products
• Introduce mandatory nutrition and quality standards for all school meals
• Prohibit the sale of unhealthy food and drink products from school vending machines
• Ensure compulsory food education and related practical skills in the national curriculum
• Place a duty on government to promote healthy food, such as fruit and vegetables, to children.

The bill is not yet law, however. In the meantime, under a recent proposal (to take effect from September 2006) fast foods and vending machines are to be banned from schools. The proposal, announced by the education secretary, Ruth Kelly, aims to end poor quality meals and snacks. Critics of the proposal have argued that the government should instead be using resources to regulate advertising of fast food companies and educating parents.

The solution?

It is evident that obesity stems from an amalgamation of lack of nutritional education in families and communities, lack of physical exercise, the media, and government inactivity. The solution is therefore anything but simple.

The involvement of families and communities is unarguably an essential element in children’s diets and levels of exercise. The Sure Start programme¹⁶ funds a variety of community based projects from cooking clubs to community cafes in disadvantaged areas. The Department of Health has also actively promoted the 5 a day initiative to encourage families to eat more fruit and vegetables. Because these are voluntary initiatives, however, encouraging people to get involved is difficult, especially with the busy lifestyles that we lead today. Could the United Kingdom learn a lesson from efforts made by the international community?

Lessons from abroad

The Personal Responsibility in Food Consumption Act, nicknamed the Cheeseburger Bill has been passed by the US House of Representatives. The bill aims to make it harder for people to sue the food industry for causing obesity. In a more extreme proposal, The World Health Organization in collaboration with the USA centre for Science in the Public Interest have previously considered a minimum purchase age for designated foods, preventing access to obese people in certain restaurants by implementing zoning restrictions, and even stocking some snack foods out of customers’ reach in an attempt to avoid the obesity epidemic.¹⁷

The implementation of food taxes has also been a popular idea of anti-obesity campaigners in the United Kingdom. In September 2003 and February 2004, there were talks for the tax to come into effect in Ireland and England, respectively. The fact that this has not been done means that a more methodical and structured approach is needed, rather than a panic based approach that will inevitably be unworkable.

The government needs to take a more proactive and targeted approach to childhood obesity by introducing mandatory regulation of television advertising.

The media can assist in raising awareness by advertising the government’s 5 a day regime during children’s television time rather than advertising sugary cereals and fizzy drinks. After all, the media is the main source of information for children in today’s society.

As a nation, we need to promote healthy lifestyles, including diets of lower energy density such as vegetables, fruits, and cereals. Hopefully, with the introduction of healthier school meals and the ban on vending machines in schools from next summer, food taxes and food zoning can be avoided.


Ghias Shafi, final year medical student, St Bartholomew’s and the Royal London School of Medicine and Dentistry
Email: GHIASSHAFI@aol.com


studentBMJ 2006;14:1-44 January ISSN 0966-6494

1. Mayor S. Obesity in children in England continues to rise. BMJ 2005;330:1044.
2. BBC news. Timebomb alert over child obesity. 9.11.03. http://news.bbc.co.uk/1/hi/health/3254375.stm
3. BBC news. Is school sport failing our children? 14.3.05. http://news.bbc.co.uk/sport1/hi/other_sports/sport_summit/4339277.stm
4. Weight loss resources. www.weightlossresources.co.uk (accessed 4 Dec 2005).
5. Times online. Jamie Oliver: it’s time to cut the crap. 20.3.05. http://www.timesonline.co.uk/article/0,,2092-1532856,00.html
6. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997;337:869- 73.
7. BBC news. Child diabetes time-bomb warning. 19.4.05. http://news.bbc.co.uk/1/hi/health/4462111.stm
8. Health Education Board of Scotland. Unusual physical health consequences of childhood obesity. 2004 .www.hebs.scot.nhs.uk (accessed 4 Dec 2005).
9. BBC news. NHS faces £16bn obesity bill. 5.12.00. http://news.bbc.co.uk/1/hi/health/1055093.stm
10. BBC news. Doctors urge tough obesity drive. 22.6.05. http://news.bbc.co.uk/1/hi/health/4119312.stm
11. BMA. Preventing childhood obesity. www.publichealth.nice.org.uk/page.aspx?o=newsfeed.Jun2005&item=8806998 (accessed 4 Dec 2005).
12. Guardian Unlimited. Ban unhealthy school vending machines-doctors. 22.6.05. http://education.guardian.co.uk/schoolmeals/story/0,15643,1512069,00.html
13. Guardian Unlimited. Children’s food bill back before parliament. 22.6.05 http://education.guardian.co.uk/schoolmeals/story/0,15643,1511426,00.html
14. Sustain. Government food and drink advertising and promotion forum is a waste of time. Sustain, 2005.
15. Children’s Food Bill—Why we need a new law, not more voluntary approach.: www.sustainweb.org/child_index.asp (accessed 4 Dec 2005).
16. Sure Start programme. www.surestart.gov.uk/aboutsurestart (accessed 4 Dec 2005).
17. Centre for Consumer Freedom. WHO wants a fat tax? 28.1.05. http://www.consumerfreedom.com/news_detail.cfm/headline/2336

       

           

	LIFE Burger babies: the future is fat       Ghias Shafi (January 2006)
	Pablo D. Albornoz (January 30th, 2006)       Medical student, 6th year, Universidad Nacional de Cordoba, Argentina pabloalbornoz@mail.com
	Dear StudentBMJ: The article by Ghias Shafi brings to consideration the impending threat of health problems related to children overweight. Children overweight is only the most visible of a group of risk factors for major (and preventable) diseases of adulthood, but fat is for most just a consequence of a lifestyle, wich starts in childhood and consolidates lifelong. It is not easy to impose lifestyle changes to diabetic or hypertensive people, how much difficult would be on those not suffering any consequence of their unhealthy lifestyle, and worse when they are children and adolescents feeling almost immortals and aloof from diseases of their grandparents. Fear of disease is fruitless in changing lifestyle. To forbid, to regulate, to ban dangerous foods and activities are less than half of what is needed. It is necessary to promote similarly seductive alternatives. We need to know why children are enticed to such unhealty habits and activities. Why they prefer computer games to sports? Why they prefer a donut to an apple? It is because adults did not gave them options? It is because the alternatives are not attractive? Healthy food is boring and tasteless. Routine physical exercise can be boring, Going to school can be boring. Sports often can't be played alone and need space, balls, etcetera. Healthier food is "healthier" only when eaten in moderate amounts. Incentives and rewards should not be forgotten. To make sports easily accessible and stimulate its practice, to make healthier foods as likeable and tasty as their high calories counterparts, are as important as negative regulations; to prohibit is a fast and easy escape for governments. Media can be indoctrinating and government should use them more and better. And food industry can keep their profit if they move from junk foods to more nutritious products, even vending machines would not be banned if their products were healthier. A commentary : beware of the correlation between overweight and lower social class in developed countries; it can be explained from confounding to oversimplification (or both).