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The complex problem of childhood obesity

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Children eating, tasting pizza in kitchen

Credit: Andriichenko

There’s more to addressing childhood obesity than taking away the lollies and getting children to do laps of the oval.

Obesity happens when more energy (food) is consumed than expended, but the reasons for this are complex, as are the solutions which involve more than taking away lollies and getting children to do laps of the oval.

A report from the Australian Institute of Health and Welfare (AIHW) highlights the growing problem of childhood obesity in Australia, where one in four children and adolescents are overweight or obese.

Boyd Swinburn, Professor of Population Nutrition and Global Health at the University of Auckland explains that the factors contributing to childhood obesity are multi-levelled.

“The key causes are processed foods in their diet,” he says.

“The intermediate causes are family rules and routines which should place constraints on consumption of junk food and establish family mealtime routines and sensible roles around food.

“For example, it is the parent’s role to decide for their young children what to eat and when to eat, while the children decide if they’d like to eat and how much food to consume during mealtimes.

“While food routines are the most important, the rules and routines around sleep and screen time are also contributing factors to childhood obesity.

“Finally, there are also factors like lower socio-economic neighbourhoods being filled with fast food outlets, parents from those neighbourhoods being occupied with survival due to poor wages and inadequate social protection systems, and weak or non-existent government policies to make the food systems healthier.

“For example, there are no restrictions on junk food marketing to children nor any taxes on sugary drinks.”

While food routines are the most important, the rules and routines around sleep and screen time are also contributing factors to childhood obesity.
Professor Boyd Swinburn

Professor Swinburn explains that in addition to the physical health complications, obesity carries a high social stigma that has the potential to set up a child for a lifetime of weight bias and all the doors that this bias closes for reaching their potential.

“While there tends to be a focus on the first 1000 days of a child’s life, and those days are the most critical in setting up healthy habits, the whole 1000 weeks of childhood and adolescence are very important,” he says.

“Children keep growing and food environments need to be healthy throughout their life.”

Individual factors contributing to obesity

Parents and carers who set the rules and expectations within the child’s immediate surroundings influence a child’s likelihood of obesity, not only while they are young, but also as a foundation to learn from as they grow up and become more independent.

When it comes to food intake, the report notes that parents and carers are the key as the home is the main place for children to consume their meals.

“Family rules and routines around food are critical,” emphasises Professor Swinburn.

“Authoritative parenting is associated with the best child outcomes.

“By that I mean being responsive to a child’s needs but with clear boundaries.

“Understandably, this requires effort and many families around the breadline just do not have that bandwidth because all of their effort is just getting through day-to-day survival.”

The Australian Dietary Guidelines provide clear advice on eating to promote overall health and wellbeing, however the report found there are some areas that parents and carers are missing the mark.

Parents are serving adult-sized portions to children, which the report says can result in children consuming on average 20 per cent more food than recommended.

Parents who pressure their children to eat after they are full, may disrupt a child’s ability to interpret and listen to their fullness cues, highlighting the importance of equipping children to self-regulate their intake.

For children aged between two and three years old, 30 per cent of their daily energy intake was from discretionary foods while most children under five were only meeting recommended daily servings in fruit, grains and dairy.

When it came to physical activity, only 61 per cent of children aged between two and five met the recommendations by the 24-Hour Movement Guidelines for the Early Years (birth to 5 years).

As for screen time, only 25 per cent of children between two and five were meeting the guideline of no more than 60 minutes per day.

The report also notes that there is strong evidence between childhood obesity and a child not getting enough sleep or having inconsistent routines around bedtime.

Children who had a disability were also more likely to be overweight than those without.

Finally, the report found that self-esteem and mental health contributed to childhood obesity, showing children with low self-esteem, an indicator of depression, more likely to report being overweight or obese.

Family habits and the community’s impact on obesity

Families who eat together at mealtimes are more likely to eat healthier food and reduce the likelihood of being overweight or obese.

However, the report says that only 43 per cent of children aged six months to six years ate family dinner together every night.

The cost of food and access to takeaway meals also impacted a family’s ability to eat healthily.

The report found that low-income households spent 19 per cent of their household budget on the groceries, while for high-income households it was only 14 per cent.

While healthy diets in line with the Australian Dietary Guidelines is the cheaper option, families are spending 58 per cent of their food budget on discretionary food choices, and only 10 to 15 per cent on fruits and vegetables (when it should be at 29 per cent).

This can be attributed to marketing.

The report found that discretionary food was advertised 2.3 times per hour during children’s peak television viewing time, while healthy food was only advertised once within the hour.

Professor Swinburn notes that the broader environment that a child lives in affects their options with low socio-economic, rural and regional areas bearing the brunt of poor food environments.

“A neighbourhood which is safe with good play areas, accessible day care, healthy food outlets, access to green spaces etc, is highly influential on family behaviours,” he says.

“The food swamps of junk food outlets are also highly influential on family behaviours which is why these outlets are concentrated in money-poor, time-poor neighbourhoods.”

The report emphasises that to adequately tackle childhood obesity, initiatives need to consider individual, social and environmental factors that contribute to the growing problem.

Professor Swinburn’s 5 strategies for parents:

  1. Try to have consistent rules and routines around food, screen time and sleep.
  2. When it comes to eating, lead by example as much as possible.
  3. Keep under-fives away from processed food as much as possible – they create a lifelong taste for sugar, salt and fat.
  4. When it comes to drink, water and milk only, and you can never have too much fresh fruit and vegetables.
  5. Build their taste buds with different natural flavours – remember many children will need to try something multiple times before they enjoy them.