Finished your Easter chocolate? How do you feel when you see a large empty box that once contained what looked like a month’s supply of chocolate?
Embarrassed? Ashamed? Obese?
According to Ruby Tandoh, writing in the Guardian, you shouldn’t feel any of these, and you wouldn’t feel these things if we – as a society – had a healthier relationship with food in general.
https://www.theguardian.com/commentisfree/2017/apr/17/enjoy-food-nourishes-mind-body-eating-disorder
“No more clean eating fads, no more “dirty” burgers – let’s remove the moral judgments from the food we eat. We need to teach young people that food – and cooking – are joyous, transformative things. Rather than marching into schools with Jamie Oliver’s school dinner reform or imposing sugar tax and health imperatives from above, we need to completely overhaul the way that we, as a society, approach food. Our food is what becomes the fabric of our minds and bodies: we deserve to eat plenty, and eat well.”
But what of our chronic problems with obesity, particularly in young people? Surely we can’t encourage them to eat large amounts of chocolate?
As with so many complicated issues in life, it’s about balance.
Healthy eating is all about balance. As is healthy exercise. Do more exercise, eat more sensibly, and the rewards are apparent. There’s no such thing as “bad food”. It’s about moderation. And this message evidently isn’t getting through to many of our children and young people.
Well over a decade ago, we knew that the epidemic of childhood obesity was happening and it was bound to produce long-term health issues for our young people. Not only that – a lack of preventative work was going to create huge financial implications for the NHS.
We also knew that there is a significant link between mental wellbeing and eating – be that under-eating with illnesses such as anorexia and bulimia or overeating as a form of self-mutilation.
And what did we do?
We measured children’s weight at the age of five and eleven, confirmed that there was a problem and then indulged in all manner of one-off uncoordinated fads in response.
The result – we still have a huge obesity problem (for children and adults), the prospect of an enormous bill for the NHS in decades to come, and overweight, under-exercised and mentally unwell young people.
Amsterdam also had a problem with childhood obesity, and, like the UK, they had a range of preventative measures that weren’t necessarily dealing with the issue. However, unlike the UK, they did something about it and the results are extremely positive.
“The programme appears to be succeeding by hitting multiple targets at the same time – from promoting tap water to after-school activities to the city refusing sponsorship to events that take money from Coca Cola or McDonalds. . . . . . . From 2012 to 2015, the number of overweight and obese children has dropped by 12%. Even more impressive, Amsterdam has done what nobody else has managed, because the biggest fall has been amongst the lowest socio-economic groups.”
The coordinated approach to the obesity problem included
- A ban on fruit juices to targeted schools
- A ban on birthday cakes and sweets in schools
- More water fountains in the city
- Cooking classes for children and families
- Families encouraged to eat dinner together
- City refusal to sponsor events jointly funded by fast-food companies
- Sports centre membership and activities subsidised for low-income families
- Focus on the first 1000 days of life – including counselling for parents
- Children put on pedal-free bicycles instead of wheeling them in buggies
The important point about these interventions is that they were coordinated. They’re part of a complex and carefully planned programme of intervention that continues today.
This is all very positive but what’s particularly galling is that these are all interventions that we – in local authority health and education programmes – considered and implemented over a decade ago, all of which petered out due to a lack of funding, and lack of support from those in the higher reaches of local government and indeed national government. All of the proposed and implemented initiatives we introduced would have had a significant impact on the lives of children, young people and their families had they been continued . . . . . if they had been properly coordinated and supported.
Jamie Oliver stuck his neck out regarding the poor quality of school meals. He spoke with politicians, many of whom recognised there was a significant problem. He was, however, mightily disturbed when given the go-ahead to drastically alter the meals to more healthy options . . . the children wouldn’t eat them.
Flummoxed and baffled by their response, he wondered what to do. The school involved then realised they needed more than ‘healthy options’. The young people needed educating in their food choices. The curriculum needed to reiterate the healthy eating message in every subject. Teachers, parents, senior managers all had to work together to support the changes. A whole school approach was needed. And once that happened, bingo! The children chose the healthier options.
In one local authority we targeted the poorest families who needed (and wanted) direct intervention. A Mind, Exercise, Nutrition and Diet (MEND) programme was established whereby children and their families had twice weekly meetings which included education on cooking, encouragement to eat together as a family, provision of cost-free exercise for the whole family, and counselling.
We joined forces with the local health team and the recreation department to provide greater access to health improvement information and to make swimming pools more accessible. We employed a range of different activities, including yoga, taekwondo, healthier cooking classes, etc. We even worked with the housing department to look at ways that our most deprived families could have space to sit and eat together. We were also one of the first local authorities to introduce free school meals for all under 7s. (Sadly, by the time this was introduced, the austerity measures of the coalition government meant that all those who’d been working on such interventions were made redundant, and the whole school/community approach was lost).
It could have worked. It needed more funding and more understanding of the long-term positive outcomes.
But local authorities operate on financial short-termism, not projected long-termism. Immediate results are seemingly needed to justify spending, and the important work we were doing wasn’t quantifiable in the short term.
The report on the work in Amsterdam proves that such interventions can work.
We’re now into a period of electioneering. Labour has promised free school meals for all primary school children – a noteworthy and positive suggestion.
Our caution on this policy comes from the experiences of the last decade. Such an intervention will only make a significant impact on the health and wellbeing of our children if there’s a coordinated approach to learning about healthier living – mentally and physically – with parents, carers and children all learning how to choose healthier options in their lives. It has to be sustainable and it has to be given time.
And it has to include, as Ruby Tandoh says, a completely different approach to how we respond and react to food (and exercise).
“To solve problems like this we can’t just patch up the current flawed system. To challenge the stereotypes, misdiagnoses and stigma that those with eating disorders face, we need a revolution.”
3D Eye 