The numbers are getting frightening, says Professor Barry Taylor, head of paediatrics at
the University of Otago’s Dunedin School of Medicine and founder of Dunedin’s Childhood Obesity Clinic.
Around 10 per cent of New Zealand children are now obese – topping the 98th percentile in BMI (body mass index) growth charts and about 5 per cent of those have extreme obesity (a BMI of 35 or higher), with extreme obesity a particular concern among Pacific people and Māori.
The reasons are complex and multiple but easy access to cheap, energy-dense, nutrient-poor foods at the same time as increasing screen time is definitely taking a toll on our children’s waistlines. And an obese child is very likely to be an obese adult.
Obesity can now also start very early. Taylor says about 70 per cent of children aged between six months and two years are gaining weight too fast. But the whole nation has been getting heavier in the past three decades, so we are starting to see overweight children as the
Results from the 2013–14 New Zealand Health Survey highlighted this, with nearly 90 per cent of parents of obese two- to four-year-olds saying their child was a normal weight and more than half the parents of obese five- to nine-year-olds.
It is the consequences of this normalising child obesity that worries Taylor.
A study of New Zealand obese children, just published in September, for the first time showed how prevalent the risk factors for developing serious weight-related illness were amongst Kiwi obese children. And how young these risk factors were emerging.
The study looked at 200 Taranaki obese children and teenagers involved in a 12-month multi-disciplinary, weight management intervention in Taranaki called Whānau Pakari.
Dr Yvonne Anderson, the study’s co-author and a paediatrician, says children as young as five were found to have risk factors for type 2 diabetes and signs suggestive of obstructive sleep apnoea.
Tests found that overall 40 per cent of the children involved had high risk signs for type 2 diabetes, 75 per cent had signs of inflammation (increasing long-term heart disease risk) and 50 per cent snored four or more nights a week. Anderson said the children in the study were not just “carrying a bit of extra weight” – they had health indicators that could be life-limiting if not addressed.
Heads in the sand?
Knowing that obesity in childhood could be life-limiting is one thing. Knowing and feeling confident that you can help make a difference is another.
When Dee Repko set out to survey fellow paediatric nurses for her master’s thesis, she found she was not alone in providing limited obesity interventions to overweight or obese children they worked with.
The Hawke’s Bay nurse’s survey two years ago was prompted by her own experience of seeing a lot of large children in her hospital work but few conversations being started with families about the long-term health implications of their children’s weight or referrals made.
“Basically nothing was being done … it was put into the too-hard basket.”
Her survey found the majority of paediatric nurse respondents were aware of programmes like Active Families in their own region but few referred families largely due to their workload, lack of time and the perception that families were not open to referrals. But the vast majority were keen in receiving education on obesity interventions.
As a paediatric nurse, Repko says she is expected to screen all families on immunisations to being smokefree and questions why such a major public health issue as child obesity isn’t added as a fifth screening requirement.
She, for one, sees a vital need for national guidelines in BMI measurements and training in effective obesity interventions that paediatric nurses like herself and other nurses can use in their daily practice and not just during the B4 School Check.
Screening for children’s BMI
From 1 July this year screening and referring obese four-year-olds at the B4 School Check is a national health target as part of the Government’s Childhood Obesity Plan.
But should we be routinely screening earlier and more often than just at four years old?
Since the first Plunket book, measuring, charting and monitoring children’s growth has been part and parcel of nursing in New Zealand.
Barry Taylor thinks it is time for a culture change to shift the focus from children failing to thrive to children growing too fast. Taylor, chair
of the combined South Island district health boards’ childhood obesity plan strategy, says ideally that we should not only screen for obesity at age four but much earlier and at least once again at age 11.
“It would be really good to know whether children are growing excessively at age two,” he says. If height and weight measurements and BMI calculations were routine and regular through a child’s life, nurses and others could pick up if the trajectory of growth started to accelerate too fast and then show parents objectively what was happening on their child’s BMI chart.
Taylor is pushing for the Ministry of Health to adopt a standardised online child BMI
calculator that leads through to the Be Smarter resources (see corresponding article) if a child’s BMI is too high.
Natalie Parkes, psychologist for Waikato’s Bodywise child weight management intervention, agrees “absolutely” that in an ideal world the more routinely and regularly all children’s growth was measured and charted the more natural it would be.
Likewise Barbara Docherty, who specialises in offering behavioural training to health professionals, says why not continue measuring growth milestones beyond baby and toddlerhood. But only if regular BMI screening was universal and not just targeting certain people or groups.
“Once we are targeting people they know they are being judged … we don’t want overweight kids to be targeted at school, and at their general practice and for them to keep feeling targeted over and over again.”
Because, as physical education researcher Professor Lisette Burrows points out, it is not automatic that all overweight children will go on to be obese and have weight-related diseases; they may instead feel stigmatised and end up with poor body images and relationships with food.
“And some [fat acceptance advocates] would say the way they are regarded and treated by society is much more damaging to their mental health and wellbeing than any damage done by physical disease.”
SEE ALSO RELATED STORY: Childhood obesity: empathy not judgement
Don’t blame the kids: tax fizzy drinks and stop the ads
Many argue that the biggest driver of childhood obesity is the modern world we live in.
Kiwi kids, unlike their grandparents, are growing up surrounded by heavily promoted, easily available, cheap food and drinks that are high energy and nutrient poor. And the addictive lure of screen options sees kids spending more sedentary hours.
Making the healthy choice the easy choice is a growing call from the World Health Organization (WHO) to the New Zealand Medical Association. The ideal, says Professor Barry Taylor, is to have an environment where resisting temptation is just not so hard.
Frustrated anti-obesity campaigner Dr Robyn Toomath, in her 2016 book Fat Science, argues overweight people are entitled to an environment that makes it easier, not harder, to remain healthy and slim, and government policy is key. “Eating healthy food and getting enough exercise should be the default, not something we have to battle for.”
Recommendations from WHO’s 2015 Ending Childhood Obesity report – backed by most New Zealand obesity advocates – include the following:
- Implementing an effective tax on sugar-sweetened drinks.
- Restrictions on the marketing of junk food to children and adolescents.
- Eliminating the provision or sale of unhealthy food and drinks in schools.
STOP PRESS: Recommendations released on October 20 for changes to current voluntary Children’s Code for Advertising Food including increasing age coverage to young people under 18 years and for “occasional” (junk) food and drink ads “not to be screened, broadcast, published or displayed in any media or setting where more than 25% of the expected audience are children”.
Obesity Plan target seeks to raise referrals from 28% to 95%
Since 1 July this year the new childhood obesity target ‘Raising healthy kids’ is one of the Government’s six national health targets. The target, one of the initiatives in the Government’s Childhood Obesity Plan, is to have 95 per cent of obese children identified in the B4 School Check programme offered a referral to a health professional for clinical assessment and family-based nutrition, activity and lifestyle interventions by December 2017.
A child is defined as clinically obese if their BMI is above the 98th percentile (using the NZ-WHO Growth Charts – see resources below).
In the 2015–16 year B4 School Checks were delivered to 57,985 four-year-olds, of which about 9 per cent were identified as clinically obese. About 28 per cent of these children and their families were recorded as being referred on for further assessment and an intervention programme.
Ministry of Health: Childhood Obesity Plan
Agencies for Nutrition Action (ANA)
Research and resources on improving nutrition and physical activity in Aotearoa
Weight: A parent’s guide
Paediatric Society of New Zealand and Starship Foundation joint website
BMI for children
UK’s NHS BMI healthy weight online calculator
NZ’s Weight-Height to BMI conversion chart
Some Māori and Pacifika weight management research projects