Childhood Obesity – The Silent Epidemic

Written by Niamh O’Connor BSc Dip RD MINDI, Consultant Dietitian & Clinical Nutritionist

© September 2012

Nutrition is a very ‘hot’ topic, especially when it comes to kids. This blog is aimed at parents, to give some insight into the world of nutrition, healthy eating for kids & the new ‘epidemic’ of the western world – childhood obesity. Despite the fact that millions of euro have been pumped into health promotion over the past 20 or more years, advising us to eat less fat, to take more exercise, to be a healthy weight and so on, the statistics show that our health has worsened significantly, our body weight has increased significantly, our diet it as high in fat as it has been for the past 10 years, and our knowledge our nutrition & healthy eating is appalling! So how confident can we be that our knowledge of children’s nutrition is up to scratch if we are so unsure and confused about what we, as adults, should be eating?

Did you know that if your child consumes a super-sized takeaway meal (such as a burger, large fries, large drink and a dessert/milkshake/ice-cream) they would have to run a full 26 mile marathon to burn off the calories in this meal? If not, then maybe you should read on!

 

Overweight & Obesity in Irish Children- the silent epidemic

Infants are meant to be plump! They have special fat called ‘Brown adipose tissue’ which is very metabolically active, and essentially is like a little furnace to keep babies warm. Babies should double their birth weight by 5 months old & they should weigh three times their birth weight by their first birthday. Percentage body fat should start to decrease after the first 12 months. Therefore a very plump 2 or 3 year old may be cause for concern. New guidelines suggest that a child should now be assessed for overweight/obesity at their 2nd birthday. There is a very fine line between a “Fine healthy child with puppy fat” and an obese child at risk of life threatening medical problems. At present, it is predicted by health experts that children may well die before their parents in this generation, from preventable chronic diseases.   Obesity is a very complex issue, with a very complex aetiology.  It is the end result of many factors such as genetics, underlying medical conditions, diet, physical activity level & other environmental factors. Organic or medical causes of obesity, such as hypothyroidism, are rare.  In fact 95% of cases of obesity in children are nutritional and lifestyle in origin. Obesity cannot occur unless there is nutritional abundance, i.e. too much food or calories. Lifestyle of adults and children has changed dramatically in the past few decades. TV/video viewing, computer games & the internet have taken over as the preferred pastimes for many children in preference to physical activity & organised exercise as hobbies. The apparent decrease in priority of physical education in schools has also compounded this problem. The psychological effect of obesity in children can be quite profound & should not be underestimated. Bullying of obese children is frequently reported. Obese children are more likely to be viewed by their peers as lazy & unfit, although this is wholly untrue. Research has revealed frightening statistics on the current overweight & obesity levels. In Ireland, over the past 20 years there has been a 127% increase in overweight and obesity, and Ireland now has the second highest rate of obesity in Europe. This unfortunately includes children living in Ireland, so our eating habits & lifestyle choices are certainly rubbing off on our kids.
  • 25% of three-year-olds are overweight
  • 20% of primary school children (aged 5-12 years) are overweight
  • 20% of teenagers are overweight
This equates to over 300,000 children and the epidemic is growing at a rate of 10,000 new cases every year. So that’s the equivalent of Croke Park Stadium, full, four times! That is most certainly a health problem of epidemic proportions. It would be very convenient to blame our “genes” or those of our ancestors, but this silent epidemic has numerous possible causes and far reaching consequences if not tackled seriously now. Last year I attended a childhood obesity conference and had the pleasure of listening to research results from consultant paediatricians based in Great Ormond St Childrens’ Hospital London. They have identified 15 different genes which may increase a person’s risk of obesity but even if a child had all the genes, it would only account for a 1 point change in Body Mass Index (BMI), which essentially means that the obesity epidemic is 99% related to nutrition & lifestyle factors. I could talk (write!) about this topic for hours and hours but lets just take a quick look at the main dietary factors that protect against childhood obesity and the factors that increase the risk Factors that protect your child against obesity
  1. Breast feeding
It is difficult to over-feed an infant who is breast-fed. The feed is the correct concentration, nothing has been added to it & the infant regulates their intake of milk at each feed. When they have enough they stop feeding! On the other hand, bottle-fed infants do not regulate their milk intake in quite the same way. The feed is often made up more concentrated than recommended (believe it or not!), and/or solids such as baby rice may are sometimes added to the bottle. Bottle fed infants may also be persuaded to drink more then they need!   2. Delay Weaning (the introduction of solid food) until aged 6 months Solids should not be introduced to your baby’s diet until the infant is 6 months old; these are the guidelines of the Irish Nutrition & Dietetic Institute & The Dept. of Health.  Research into weaning practices in Ireland has shown that many infants are weaned onto solid foods too early and this leads to a much higher risk of the child developing obesity. Research has also shown that an increasing number of women are overweight themselves at the time of conception, which seems to compound the entire issue further in terms of diet and lifestyle factors that the infant is subsequently exposed to. The final piece to this puzzle is that recent research has also shown that mothers are aware of the correct age to wean their babies onto solids, but make a personal decision to ignore the scientific recommendations. All in all, this constitutes a proverbial recipe for disaster.  If the infant cannot take the food from a spoon, then solids should be introduced at a later stage. Solids such as baby rice should NOT be added to the bottle. 3. Reduce the amount of energy (calories) in children’s diets by having a tailored diet prescribed by an experienced paediatric dietitian. You can search on www.indi.ie for a dietitian in your geographical area or log onto www.corknutrition.ie/sedi for a list of experienced consultant freelance dietitians in Ireland. 4. Set a good example to young children by eating healthily yourself. Easier said than done some days I hear you say! 5.  Control treats. Remember that treats do NOT have to edible! Why not look at non-food options as treats for your child especially if your child has a tendency to gain weight. 6.  Control portion sizes. Use child-friendly plates, bowls etc; Order children’s portion sizes in restaurants; watch out for the restaurants which offer and promote “Kids Size Me” menus (this is a recent initiative of The Restaurants Association of Ireland);  limit food treats to ‘mini or fun size’ instead of giving children large portions or adult servings. 7.  Encourage exercise. Children need to be active for at least 1 hour every day. This can be a formal sport or activity, or just playing with their friends, cycling, kicking a ball, playing rounders, chasing etc! The more fun it is the longer they will exercise for! Computer games can also play a role on the days when the weather is too bad to send kids out to play – Xbox, Wii Fit & dance mats are great indoor alternatives!  

Management of childhood obesity

If your child becomes overweight, do not embark on a DIY dietary regime as this may be totally unsuitable & nutritionally inadequate for a growing child. Strict dietary regimes are unsuitable in very young children especially the under fives. Babies and young children do not have access to food, that can’t reach it buy it, cook it or feed themselves, so an obese baby or young child has not done that to themselves! Consequently babies and young children will rely totally on parents / carers for treatment of the condition. Everyone who has responsibility for feeding the young child MUST be consistent – eg parents, guardians, child minders, creche staff, grandparents, siblings, aunts/uncles, babysitters, teachers etc. Women are gatekeepers for men’s nutritional health, but parents are gatekeepers for the nutritional health of their children. In the older child, where they probably do have access to food, and may also have plenty money to buy endless amounts of ‘unsuitable’ food, then treatment can be far more challenging.  The child themselves must want to lose weight, or at least maintain their weight or “grow into it”. Assessment of your child’s condition by your GP is crucial at the initial stages to diagnose or rule out any organic or medical reason for the obesity. Referral to a qualified (MINDI) dietitian/clinical nutritionist is the next step, where your child’s weight problem can be dealt with in a sensitive & professional manner. In some cases the advice of a child psychologist may also be necessary & beneficial. Parents, be advised to resist the temptation of bringing your child to any other therapist or practitioner, or any type of slimming club as this can significantly  increase the risk of your child developing an eating disorder later on.  Any such “diet” prescribed by anyone who is not a qualified dietitian, may not understand the complexity of the problem is likely to advise on a very restrictive and grossly inappropriate dietary regime, which may adversely affect your child’s growth and development. Thankfully, qualified healthcare professionals & their titles will soon be protected, registered and regulated - See http://www.coru.ie/ for details. There are only 600 qualified dietitians / clinical nutritionists in Ireland. If your child is an inpatient in a hospital, you may be referred (or may ask to be referred) to a dietitian. However, in the community there is very limited access to HSE dietitians and long waiting lists are common. Ongoing HSE cutbacks are likely to further limit availability to such free services, and/or result in unacceptable long waiting lists. Furthermore, there are only 17 are full-time freelance dietitians in private practice (see the ‘SEDI’ section of my website www.corknutrition.ie/sedi/ for details of these dietitians throughout Ireland). If you have private health insurance, you may claim back between €13 and €45 per visit to a private qualified dietitian who carries the initials MINDI after their name. The sad reality is that a child with one overweight parent has a 40% risk of becoming overweight an overweight adult themselves, and a child with 2 overweight parents has an 80% risk of becoming an overweight adult with an increased risk of cardiac problems, diabetes, arthritis, skin disorders, respiratory disorders & psychological problems. Childhood obesity is a very serious, sensitive & complex issue that should be assessed & treated by qualified medical & health professionals only.   Then next blog will be "Calories on Menus" ............. followed by "All about Nuts", for Halloween!   © Niamh O’Connor, 30th September 2012

Claim back up to 50% of your dietetic consultation fees (per visit!)

Private health insurers in the Irish market now realise more and more that it’s far more prudent to allow their members to claim back a significant portion of day-to-day medical expenses for consultations with a wide variety of health care professionals who intervention has proven benefits. This means lower heath care costs for the insurer in the long run if diseases or potentially serious conditions are diagnosed and treated as early as possible, and there is obviously a better short-term and longer-term outcome for the patients too. You can now claim back up to 50% of the fee (per visit) to a qualified dietitian through your private health insurance. See FEES section of the site for full details on all health insurance policies, number of annual visits allowed, reimbursement amount & annual excess deductable/payable under each policy (which is zero in many cases). Remember, you can also claim 20% of the remaining non-reimbursed portion of private dietetic fees through the tax relief via the Med. 1 form, which you can download here: http://www.revenue.ie/en/tax/it/claim-forms.html Example 1: Weight Management Programme Comprises 7 private consultations. Usual cost €390. Special offer Fee: €340 (including ‘bundle’ saving of €50) Gross cost per visit: €48.57 Claim 50% back on Simply Health Suite with Quinn Healthcare (5 visits are covered per year, less policy excess of just €1 per policy member) Total saving/claim from Quinn healthcare for 5 visits @ 50%= €120.43 (incl. €1 excess) Claim a further 20% tax back (for every visit) on the balance of €219.57 (= €43.91) Net cost is €175.66 for the entire programme of 7 consultations Net cost= €25.09 per visit Total saving: €214.34 (including special offer ‘bundle’ saving of €50)                                            Example 2: Single once-off consultation First visit (1 hour), Fee €90 Claim €35 back on VHI Family plan level 2, Net cost ‘so far’ €55 Claim a further 20% tax back on the balance (€11) Net cost for initial visit = €44 Total saving €46     Example 3:  Diabetes Bundle (5 consultations) Fee: €250 (including special offer ‘bundle’ saving of €40) Gross cost per visit: €50 Claim €25 back on Aviva Health “We plan level 1 Day-to-day 50” (up to 8 visits per member per year, with No policy excess payable). Net cost ‘so far’ = €25 Claim a further 20% tax back (per visit) on the balance (€5) Net cost = €100 for the full Diabetes Bundle (5 private consultations) Net cost = €20 per visit Total saving €190 (including special offer ‘bundle’ saving of €40)     **NOTE** You can only claim back on fees paid to qualified dietitians (clinical nutritionists) who are members of INDI and carry the initials MINDI after their name. You cannot claim back any portion of fees (through private health insurance or the 20% tax-back via the Med. 1 form) for self-professed nutritionists or nutrition consultants or nutritional therapists who have not attained recognised honours degree, Post graduate honours diplomas, Masters or PhD qualifications from a recognised University in Ireland. Dietitians who obtain their qualification outside Ireland are subject to a rigorous validation process by the Irish Nutrition & Dietetic Institute, and the Department of Health.

British Dietetic Association Urges Awareness of the difference Between Dietitians and Nutritional Therapists

Have you ever asked yourself or have you ever wanted to know: What Is The Difference Between a Qualified Dietitian (also known as Clinical Nutritionist) & a “Nutritional therapist”? To try to describe the difference between these titles and qualifications is futile, as essentially there is NO COMPARISON at all between a real dietitian (with a 4-5 year honours degree, post graduate qualification or PhD from a recognised University) and the training of a nutritional therapist. Follow this link to read the warning issued by the British Dietetic Association http://www.bda.uk.com/news/120116NutTherapists.html Check out this blog post by Canadian registered dietitian Kate Park RD, CDE, MAN, BASc http://thesensiblefoodie.weebly.com/1/post/2011/4/first-post.html In the words of the infamous stand-up comedian Dara O’Briain (who studied mathematics and theoretical physics at University College Dublin, before embarking on his TV presenting & stand-up career) “A Dietitian is to a Nutritionist, what a Dentist is to a Toothiologist!” Or why not check out Dara O’Briain’s Youtube video here on the topic of credentials of health professionals versus quacks! (*Warning/disclaimer: This clip is not for the faint hearted! Viewer discretion is strongly advised. The views and opinions of Dara O’Briain are not the views and opinion of Niamh O’Connor and/or Cork Nutrition Consultancy) http://www.youtube.com/watch?v=uDYba0m6ztE

New Low-FODMAPs diet for treatment of IBS & other functional gut disorders

The new revolutionary Low-FODMAPs diet which was developed by a team of researchers in Monash University, Melbourne Australia, is now available in Ireland. The diet has been shown to give major symptomatic relief in people with Crohns Disease & up to 75% of people with IBS. FODMAPs are found in the foods we eat. FODMAPs is an acronym for Fermentable Oligosaccharides (eg. Fructans and Galactans) Disaccharides (eg. Lactose), Monosaccharides (eg. excess Fructose) and Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt) In Ireland, this new diet is only available from qualified registered dietitians (MINDI accredited). In November 2012, Niamh was one of 25 dietitians who attended & completed the first Fodmap training course for dietitians in Ireland. Niamh now offers the low-Fodmap diet to patients at her private clinics, located at Elmwood Medical Centre, Frankfield Douglas Cork & also the new Mater Private Hospital, City Gate, Mahon, Cork. Check out this link to Kings College London for Fodmap FAQs. http://www.kcl.ac.uk/medicine/research/divisions/dns/projects/fodmaps/faq.aspx   Here is a list of other freelance FODMAP-trained dietitians in Ireland: List of SEDI dietitians who are FODMAP trained_updated January 2014 All Dietitians listed are members of the Irish Nutrition & Dietetic Institute (INDI)  &  Self-Employed Dietitians of Ireland (SEDI)  

Vitamin D supplementation recommended for all newborn babies living in Ireland, from birth to their 1st birthday

Vitamin D deficiency leads to a serious bone condition called Rickets, which is now re-emerging in Irish children and is fast becoming as a serious public health concern. Vitamin D deficiency was thought to have been eradicated in Ireland after the Second World War, due to better nutrition. However, over 20 cases of rickets in infants and toddlers have been reported at two Dublin hospitals in the last five years.   Infants obtain around 50% of their vitamin D stores from their mother at birth, but research has found that maternal Vitamin D status in Ireland is low. Most of our Vitamin D is produced by the action of the sun’s UV rays on our skin. However, due to the fact that Ireland is 51 – 55 degrees north of the equator, little or no Vitamin D can be produced from sunlight between October & March/April as the angle of the sun is too low! Furthermore, poor summers & use of sun protections factors to reduce the risk of skin cancer also have a role to play in our declining vitamin D status. The final piece of information to complete this jigsaw is that very little Vitamin D is derived from food! All of these factors, coupled with the strong advice that infants should never be exposed to direct sunlight, means we find ourselves in a proverbial ‘catch 22’ situation!   The HSE & The Food Safety Authority of Ireland (www.fsai.ie) now recommend that all babies be given a Vitamin D supplement until their first birthday. The single supplementation should contain Vitamin D only, and no other vitamins. Several preparations are available (e.g.  Baby Vit D3). Ask your GP or pharmacist for further information and advice on specific “Vitamin D only” brands & appropriate dosage.   http://www.fsai.ie/faq/vitamin_d.html http://www.irishhealth.com/article.html?id=19830