Childhood obesity has become a serious public health problem in the UK, with children facing both increased ill-health and psychological problems as a consequence. An estimated one in three children are overweight and one in ten are obese (see box). Eighty per cent of obese children will become obese adults.
Children's weight problems arise from a chronic imbalance between energy intake and energy needs. Today's children tend to be less active than former generations. As they spend more time watching television and their parents worry more about their safety, children have become more sedentary.
Larger food portions, changes in food manufacturing practices and fast-food advertising aimed at children are also factors.
'We need to tackle the perception that childhood obesity is insignificant in health terms,' warns Dr John Reilly from the department of human nutrition at the University of Glasgow. Speaking at the UK's first major conference on the subject, 'Issues and Actions in Childhood Obesity', he said, 'It is not purely a cosmetic problem. In fact there are strong associations between obesity in childhood and future consequences for health.'
Alarmingly, over half (58 per cent) of obese children aged five to ten show some early warning signs of heart disease. In childhood they can also develop respiratory difficulties, diabetes and orthopaedic problems.
Obesity can also cause or exacerbate asthma. On top of the health risks, an overweight child may also have to deal with the psychological effects of being bigger than their peers.
These negative effects can start in early childhood, with children becoming aware that being overweight is not the norm. Dr Laurel Edmunds from the Institute of Health Sciences in Oxford says, 'I spoke to the mother of a four-year-old daughter who was overweight and she was aware something was wrong. She could not verbalise those feelings but was picking up the message that she was different from other children. A five-year-old actually begged his mother to take him to a doctor because he was being bullied about his weight.'
Dr Edmunds adds, 'I am beginning to wonder whether we are born with a recognition of what is normal, rather than it just being societal influences. Children become aware when they reach a certain fatness level, because no matter what age they are, the teasing and name-calling begins.
'A study in Scotland gave children aged two to five shapes of people who are normal and overweight, and asked them to make choices. Even the two-year-olds chose the normal size shape, not the big one.'
Words that young children use to describe the silhouette of an obese child include lazy, unhygienic and unhealthy. These attitudes often colour how an overweight child feels about themselves, and their self-esteem may plummet.
But low self-esteem can also be the cause of obesity, says Hessel Willemsen, clinical psychologist at the Tavistock Clinic's child and family department. 'For young children, food can become a substitute for something missing from their life, such as the death of a parent, or the absence of a loving relationship,' he says.
'They can learn to retreat to a substitute and this can lead them to finding it difficult to form friendships and relationships which can continue into later life. They may end up in relationships that do not give the love they need.'
Feeling self-conscious
Dr Edmunds has found that children who have always been big can often handle the psychological effects better, because they have always had to deal with it. But children lacking confidence after they have put on weight can find it harder to stand up to negativity. This lack of confidence can lead to the child being bullied, which increases as the child gets fatter.
Bullying can affect a child's education, which often leads to a lack of achievement, with both social and psychological consequences.
'The psychological impact can vary,' says child psychologist Jennie Lindon, 'but a lot more weight can slow children down and make them a lot less keen or able to take part in play and physical activities. Overweight children may feel it is not worth bothering, which can make them passive and worsen the problem.
'Children can feel self-conscious in activities where they have to strip off, such as swimming, and if a child carries a lot of weight it can mean they're less speedy and unable to join in team games, forcing them into the sidelines.'
Feeling self-conscious can make children want to keep a low profile and hide their figure in baggier clothes. The need for young children to wear larger clothes can also have side-effects. 'Children wearing clothes intended for those older than them get treated as older and they tend to get told off for being immature, even though they are only acting their age,' says Laurel Edmunds.
'One boy, a five-year-old in an eight-year-old's body, was always in trouble for breaking things. But the furniture was not geared up for him and was made for small bodies.'
Sensitive subject
Problems linked to obesity can be lessened by seeking advice. But parents are often reluctant to discuss what they see as a sensitive issue. A big barrier to parents seeking help is their worry about how they will be viewed by health professionals.
Dr Edmunds adds, 'Parents are also worried that if they do something about their child's food intake it will tip them over into anorexia. But for that to happen, the children need a clinical pre-disposition to anorexia. We need to get the message across that this is an unrealistic fear.'
Jennie Lindon says early years professionals have a duty to address sensitively a child's weight problem with the parents. 'Like any other health issue, it shouldn't be ignored but raised delicately. Staff should be supportive, because some parents may feel they are being blamed.
'If other children in the setting are making rude remarks, staff should address it in the way they would any hurtful comment - explain that it is a very personal remark that hurts feelings and that here we do not do that.'
At Whitehill Parent and Child Centre in Hamilton, Lanarkshire, the staff are consciously trying to improve the health and lifestyles of the children and their parents by encouraging healthy eating, physical activity and, importantly, improved self-image through the STEPS Excellence for Personal Success course.
'The course looks at issues of self-esteem, attitude, beliefs and goal setting,' explains project co-ordinator Anne Marie Stevenson. 'We hope to empower people to make changes. Parents have a strong influence over their children and if we can get to parents and help them to be positive and confident in their choices, then this can have a positive effect on their children too.'
Healthy eating is incorporated into the 80-place nursery's day and parents are involved in what their child is eating and why. 'We encourage children to play outside every day and be active. They also receive a balanced diet, which does include crisps on occasion, but also crackers, cheese and fruit, which is now commonplace to the children. They participate in making snacks, and carers sit and eat with the children, so they are good role models. The food is presented in an attractive way to make it appealing, and children are given a variety of food to allow them to make informed choices.'
Ms Stevenson adds, 'If we introduce children to healthy eating at an early age, it is hoped that they will establish good eating habits which will carry on into school and adulthood. We hope the nursery will help children take healthy living as a norm and this will prevent weight and health problems from occurring.'
Facts and figures
* According to the 'Health Survey for England 1995-1997' by the Department of Health, 10 per cent of six-year-olds and 17 per cent of 15-year-olds are classed as obese.
* Excess body weight is the commonest childhood disorder in Europe and North America, according to the International Obesity Task Force. An estimated 22 million children aged under five are overweight.
* Results of the National Diet and Nutrition Survey, done jointly for the Department of Health and the Ministry of Agriculture, Fisheries and Food, showed that 17 per cent of children aged three and a half ate no vegetables and 16 per cent no fruit.
* Children consume 30 times as many soft drinks and 25 times more confectionery than they did in 1950, the Avon Longitudinal Study of Parents and Children (ALSPAC) found.
* ALSPAC also found that a mother's educational level is a factor in a child's diet. A study found that 11 per cent of seven-year-olds whose mothers had a low educational level were obese, compared with 4.8 per cent of those whose mothers had degrees.