Worth the weight: the tough battle against childhood obesity

“Mum, nobody wants to come on a playdate here because you’re too healthy.” Even as a passionate believer in encouraging children to love healthy food, Deirdre Doyle found that comment from her seven-year-old hard to stomach.

“It kind of breaks my heart,” admits the mother-of-three from Greystones, Co Wicklow. “Then I am thinking, should I give in to the seven-year-old or should I stand over my principles?”

It’s a dilemma countless parents will recognise when it comes to children and food preferences. Fending off their clamour for substances high in fat, salt and sugar can be a daily – even hourly – battle.

You can appear to be an uptight kill-joy when stopping the consumption of a chocolate biscuit here and a fizzy drink there. But it’s not just an occasional item of nutritionally-challenged food that comes your child’s way, junk food is in their face at every turn – offered by well-meaning family and friends; in shops, restaurants, garages and vending machines; and at its enticing best in the creations of advertising gurus.

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Doyle, who runs The Cool Food School, is better equipped than most to withstand pester power for "treats". She has studied nutrition and earlier this year started her own business offering workshops on healthy food as fun for children in pre-schools and upwards.

Her approach is “to take food off the dining room table and into a fun environment where kids are playing with it”. They are encouraged to touch, smell and taste various fruits, vegetables and other healthy food, but not pressurised to eat anything.

When her own children are giving out about not being allowed to eat things their peers can have, she tries to explain to them that she has been to “school” to learn about this and probably knows a bit more than some other people.

“It’s a minefield,” she says, for a parent trying to take a stand against the junk food that is all around us. “It’s just so all pervasive, it’s just everywhere.”

That's why she was pleased to find solidarity in a parents' campaign against junk-food advertising, which was recently launched by the Irish Heart Foundation (IHF) as part of its "Stop Targeting our Kids" drive. The obesity "epidemic" has led to children as young as eight being diagnosed with high blood pressure and having an increased risk of heart disease, as well as for diabetes and at least 13 different types of cancer.

As a starting point, parents are being asked to sign its petition. The campaign, bolstered by a poll showing that 71 per cent of Irish adults support a ban on junk-food advertising to kids, is looking for the current restrictions during children's TV programming to be extended to a 9pm watershed to incorporate "family viewing" time.

Codes of practice

They are also urging the Government to add regulatory teeth to the voluntary codes of practice it announced it had agreed with the food industry last February, covering non-broadcast media, sponsorship and retail product placement – and of which little or nothing has been heard since.

The statutory regulations don’t apply to social media platforms and the campaign wants to raise awareness of online targeting of teenagers, who are used by junk-food advertisers to become unwitting marketers through tagging and sharing.

“I am just one person on my own,” says Doyle but she hopes the collective voice of parents can make a bigger difference.

Policy-makers and the media are always talking about the question of "parental responsibility", says the IHF's head of advocacy, Chris Macey. "They don't understand the wider environmental drivers. We feel it is better for parents to answer that for themselves rather than for us as a charity speaking for parents. It is all around that pester power generated by advertising and how you resist it."

It’s so easy for those not in the throes of child-rearing to argue that parents should just say “no”. But, as Macey points out, since some of the world’s biggest and most successful companies are producing these unhealthy foods, families are up against the “best marketing brains in the world”.

Parents need help against these formidable forces, says marketing poacher-turned-gamekeeper Dan Parker, who quit working in advertising for multinationals after developing type-2 diabetes and formed a UK health promotion charity, Living Loud.

"Our first duty as human beings is towards raising the next generation, whether it's yours or society's," he tells Health + Family at the launch of the parents' campaign. "I think they have a right to innocence; a right to grow up from undue influence of advertising for products likely to be detrimental to their health and well-being."

Marie and Tomas McKeon from Blessington, Co Wicklow, do their best to keep their four children, aged two, four, six and eight, eating healthily. Working part-time in the charity sector, Marie has a business degree and marketing background and so is more aware than many of junk-food advertising tactics.

As their children are still very young, they as parents don’t have the online dimension of marketing to contend with yet but Marie believes many parents don’t realise the precision with which online advertisers can target children, never having had as much access to them as they do now.

In the past, she had wondered why nobody seemed to be asking parents for their views on these issues and so was very happy to sign up to this campaign.

Fizzy drinks

Fizzy drinks and high-sugar breakfast cereals are two product ranges she finds herself battling against most with her children at this stage.

Marie wishes GAA stars would not endorse sports drinks, which may have some benefit for those participating in prolonged, high-intensity exercise but can contribute to weight-gain in children for whom a more sporadic kickaround once or twice a week is the norm. But it’s very hard, when these guys are heroes to children, to try to explain to a child that a drink of water is better.

Take another sport and another hero – rugby and Joe Schmidt. At those sit-down, televised press conferences when he's announcing a team or dissecting a performance, a few bottles of a certain brand of sports drink linger on the table in front of him, despite no rehydrating athlete in sight. (Although to be fair, we should also note those IRFU stickers on packs of vegetables.)

There’s at least one point in every day, says Marie, when she is having to say to her children that, no, they can’t have some high-sugar item they’re asking for.

Children’s parties have moved from the portioned plates of sweet and savoury items in her childhood to free-for-all goody tables, she points out. “It’s the unlimitedness of it – how are they meant to control themselves?”

Like most parents, Marie strongly approves of the healthy lunch-box policy at her children’s primary school. It is a “relief” to be spared that particular battle as children accept it unquestioningly as the norm.

However, she would like to see Friday as the sole “treat day” scrapped too, because the chances are the children are going to get enough treats over the weekend, anyway. Primary-school teachers are a huge influence on children, she says, and, while we can’t expect them to do everything, they can be a strong force for good in terms of healthy eating and well-being.

The national school in Enniskerry, Co Wicklow, which Siobhán Donohoe’s children attend is, in fact, one that does require healthy lunch boxes all week. “They just accept they’re not allowed to bring in a treat or chocolate to school,” she says. It’s “not a battle, it’s normal”.

She joined the parents’ campaign against junk-food marketing primarily as a mother of three children aged 11, nine and five. But in her work as a GP, she has seen plenty of families struggling with weight issues – a difficulty she is all too familiar with herself.

Donohoe spent more than a decade, stretching from her late teens into her 30s, trying to get on top of her own weight problem, losing three or four stone in the process. Even now, if she doesn’t pay attention, “it is so easy for it to slide back”. This is definitely not something she wishes for her children.

It is not as if you can avoid food, she points out, so it is trying to find a way to be an informed eater and give children good habits – rather than letting them fall into bad habits that they will then struggle to break like she did.

But the "obesogenic environment" – a term coined by New Zealand public-health campaigner Boyd Swinburn – doesn't make it easy.

Complaints from parents

For instance, “it’s hard to eat something healthy in fast-food restaurants”, says Donohoe, who also mentions complaints from parents sitting in hospital waiting rooms that the only snacks available are high-sugar ones in a vending machine.

“So, wherever you go, you’re backed into a corner where it is next to impossible, unless you have brought something with you, to have a healthy thing to eat. It’s a constant battle.

"Parents shouldn't have to be the ones to take on this fight," she continues. "If the Government was really serious about doing something on childhood obesity, they would take the junk food industry on. It's a move that would be in their interest purely from the health budget perspective, as most children who become overweight or obese carry this into adulthood, accumulating health problems and using health service resources as they go.

“We know the evidence is there that voluntary codes don’t work,” Donohoe adds. “We need a strong statement from Government to show their intent to be serious about this and put something in place that would actually have teeth.”

It's clear that some politicians agree. Five of the 20 recommendations in the Report on Tackling Childhood Obesity, published by the Joint Committee on Children and Youth Affairs this month, after the IHF launch of the parents' campaign, relate to tighter controls on the advertising and marketing of unhealthy foods to children.

The thrust of them is a call for the statutory regulations which currently apply to children’s broadcast media be extended to “other programmes where there may be a significant number of children watching”. It also suggests a statutory code for the advertising and marketing of food and non-alcoholic beverages in the context of non-broadcast media as well.

The committee is “inclined to agree” that weak definitions of “unhealthy food” and ambiguity about “children’s media” in the code governing non-broadcast media, not to mention its voluntary nature, mean “the efforts to limit advertising in this context may be largely meaningless”.

Back to the womb

The battle against childhood obesity and junk food goes right back to pre-conception, when women planning a pregnancy would ideally make sure they were a healthy weight and mindful of eating a nutritionally balanced diet.

In the Coombe maternity hospital, one in two mothers attending for a 12-week appointment is overweight or obese, says Kathy Whyte, a nurse and midwife by training and founder of Nurture Mum, which promotes pregnancy wellness in the workplace. As one in two babies in Ireland is planned, she believes there is a huge opportunity to tackle this issue in the promotion of pre-conception health.

Then, once women are pregnant, gestational weight-gain is very significant for the health of both her and her baby. Yet it can be a time when it’s comforting for the image-conscious to think that the “bump” will camouflage any evidence of over-indulgence on “treats”.

“Think for two,” rather than “eat for two”, advises Whyte. “It is only in the last trimester that mum needs a few extra calories – that is really 200 calories, which equates to two slices of brown bread and a banana.”

There are also your child's future food preferences to think about. At just 13-15 weeks into pregnancy, the baby is beginning to sample different flavours from the mother's diet as the taste buds begin to develop.

“In the last month of a healthy pregnancy, there’s two litres of amniotic fluid and the baby drinks one litre of that every day,” she explains.

So, if you want your future toddler to happily eat his kale, you now know what to do. The science is there to prove it.

Whyte reports that a randomised controlled study found that babies whose mothers ate carrots during pregnancy weaned much quicker on this particular vegetable. It has also been shown that babies in India, who get plenty of exposure to spicy food in utero, only have to be offered the smell of spices after birth and they want to suckle and feed.

Breastfeeding is obviously another significant factor in cultivating babies’ tastes. Breastmilk, apart from being the best nutritionally for babies, is also giving them a variety of flavours depending on what Mum has eaten that day, whereas formula always tastes exactly the same – day after day for the first six months.

However, what really riles Whyte is the totally unnecessary “follow-on” toddler milk, which she characterises as “liquid cream” and would like to see banned. It is so sweet, she says, a child who has tasted that is unlikely to want cow’s milk from the age of one year on, and so the parents continue with the artificial, sweetened product.

The massive marketing behind formula continues into weaning foods. If parents buy food products that are geared towards children, yogurts for example, “they automatically have 10-20 per cent more sugar in them”, she points out. It underlines why we have to start talking “earlier and earlier”, she adds, about the pushing of unhealthy foods to children.

The numbers

– 22 per cent of nine-year-olds in Ireland are overweight, and 5 per cent of these are obese
– 1,000+ TV ads a year for "less healthy" food are seen by pre-school children in Ireland
– One exposure to an ad for unhealthy food/drink increases a child's food intake by 30-50 calories
Sources: Growing Up in Ireland; UCD-led research on food marketing and pre-school children; Dr Mimi-Tatlow Golden of the Open University