Rising obesity rates are widely viewed as the biggest health crisis facing the Western world. Prevention is better than cure, so doctors are focused on stopping children from getting overweight.
But how to do it? Many countries have programme aimed at parents of young children, such as healthy eating sessions, exercise groups, and advice on weaning foods and screen time.
There’s just one problem: none of it is effective, a review of 17 child obesity prevention programmes from around the world has concluded.
“Trying to prevent obesity very early on at the family level doesn’t really seem to work,” said Professor Anna Lene Seidler, a child health researcher at the University of Rostock in Germany, who was involved with the review, published in The Lancet.
The focus on children has come because it is hard for adults to lose weight and keep it off, without medical intervention.
And once children get overweight, they tend to become overweight adults.
“A child that develops obesity early on, it’s really hard to get rid of,” said Professor Seidler. “Usually children that have obesity become adults that have obesity, with lifelong health implications.”
But we don’t yet know how to stop young children from getting overweight. Healthy eating advice for parents abounds. But structured advice programmes fail to make much difference when tested in randomised trials, the gold standard of medical evidence.
None of the programmes in the review, whether in the UK, America or Australia, significantly changed the trajectory of children’s weight as they grew up.
Children are less physically active than they used to be (Photo: Getty)In the UK programmes, parents of children up to five years old were targeted, with weekly group sessions on healthy eating, mealtime strategies and boosting activity levels.
Similar programmes have been tried in older children, focusing on either parents or children themselves through schools – and nothing has yet been found to work.
Such results support the idea that, rather than blaming parents of overweight children, we need to look at wider society, said Lucy Upton, a paediatric dietitian who has written The Ultimate Guide to Children’s Nutrition.
The food industry promotes meals high in fat and sugar, as well as encouraging snacking, said Upton. “From the hundreds of diet histories I’ve done over the years, constantly snacking is definitely more prevalent. It can be every hour sometimes.”
Children are also less active than they used to be, partly because parents may be reluctant to let their kids play on the street or get themselves to school by walking or cycling. Doctors say such factors add up to an “obesogenic environment”.
One approach to improving diet is a drinks sugar tax, to discourage people from sugary sodas.
The UK was among the first countries to introduce such a tax in 2018, with a levy that nudged firms into reformulating some of their drinks with sweeteners.
Whether it has been successful is in the eye of the beholder. Supporters point out that when the tax came in, sugar intake fell by about 11g a day in adults and 5g in children.
But it’s debatable if this had any impact on weight. According to one analysis, it was linked with a slight fall in one group of children, 10- to 11-year-old girls. But it didn’t in boys the same age, or in younger age groups.
And the dip in older girls has since been dwarfed by a rise in childhood obesity levels that happened during the Covid pandemic. Realistically, a fall in sugar equivalent to one teaspoon per day was unlikely to do much.
Campaigners have long called for stronger measures – for instance, extending the sugar tax to fruit juices and milkshakes (which are exempt) and foods like sweets and biscuits. And they want subsidies for cheaper fruit and veg, healthier school dinners and restrictions on food advertising.
As a first step, a ban on advertising unhealthy foods online and on TV before 9pm is due next year.
For now, we should be less judgemental about parents whose children are overweight if even the experts don’t know how to stop it from happening, said Upton.
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“Some people are at higher genetic risk, however, if we manage to create better environments, that would help those people,” said Professor Seidler.
We also can’t ignore the fact that poorer families can find it harder to follow the healthy eating messages, for instance, because they can’t afford healthier foods or have less time to cook from scratch, said Upton.
“There’s an oversimplification of how easy it should be for parents,” said Upton. “But preventing childhood obesity is exceptionally complex.”
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