Children Eat Their Weight In Sugar: What Can Be Done?

sugar-1482196Introduction

The first recommendations on carbohydrate intake were proposed in the 1980’s and 90’s by COMA which has since disbanded. Since then overwhelming evidence has mounted which shows carbohydrate consumption to be associated with many of today’s current health problems. More specifically, the type of carbohydrate and the consumption of simple sugars and refined carbohydrates has become an increasing concern. High sugar intake is implicated as a significant risk factor for diabetes, fatty liver disease and obesity and receives a large amount of focus for current health initiatives and government policy on the recommendations for sugar intake.

Prevalence of weight related disease

In the UK 57% of adults are overweight and obese which is predicted to reach around 70% by 2034 (Public Health England Obesity Knowledge and Intelligence team, 2016). Children in the UK are following a similar trend with 25% of them being over weight and obese. The prevalence of doctor-diagnosed diabetes in adults increased between 1994 and 2014 from 2.9% to 7.1% and 1.9% to 5.3% for men and women respectively. The cost of obesity to the NHS is £5.1 billion (Scarborough et al., 2011) and the cost of treating diabetes and the complications that result from it in 2010/11 was £9.8 billion a year which is projected to be over £16.9 billion by 2035/36 (Hex et al., 2012). However, the NHS has refuted claims about potential bankruptcy in the future (Nhs.uk, 2012) despite such claims circulating in the media (Google.co.uk, 2015).

Sugar consumption

Actual sugar consumption has fallen over the past 40 years while consumption of sugar-sweetened beverages and foods have risen. Children ages 4-10 are said to consume on average just over 60g of sugar a day, equating to 5,543 sugar cubes or 22kg of sugar in one year (Gov.uk, 2016). Sugar consumption is highest among school age children and low income families. However, a high consumption of sugary foods is not justified by a low income when you consider a bag of bananas or apples can be purchased at a lower price which contains natural sugars, as well as vitamins and minerals. The biggest source of sugar for kids are juices and soft drinks, although for ages 19-64 one of the biggest sources of sugar comes from table sugar. However, this may be attributed to Britain’s cultural obsession with Tea.

Parents perception of child weight status and health

The fact that 42% of parents do not recognise their children to be overweight or obese when they are (Public Health England, 2015) also contributes to the problem. A study showed parents of overweight and obese children considered happiness, diet and activity level to be more important than body weight as an indicator of health, despite the physical and mental health implications of being overweight or obese (Syrad et al., 2014). The same study found that parents also didn’t find the BMI scale to be a credible indicator of a child’s health, because according to parents it didn’t take into consideration the child’s lifestyle. This shows that despite the implicated health risks of being over weight or obese, parents do not acknowledge body weight to be a significant risk factor to their child’s health. This is a dangerous misperception that needs to be immediately corrected. A strategy to give parents a more accurate perception of ‘overweight’ as well as education on the diverse effects that being overweight or obese has on their children, must be part of the health initiative. Failure to do so will not address the wider context of the problem

Current health initiatives

Health initiatives are currently in place across Britain to reduce sugar intake.
Public Health England compiled an evidence based report called “Sugar consumption: The evidence for action” (Public Health England., 2015) which expresses the need to drastically reduce sugar intake across the population, which even the British Dental Association stated would be reckless to ignore (BDJ Team., 2015).
Change4Life has issued a new campaign that focuses on educating parents to be “sugar smart” and even encourages parents to download the new Sugar Smart app that measures the sugar content of every day food and drink (Nhs.uk., 2016).
Action on Sugar have also proposed an evidence based, six point sugar reduction plan to David Cameron (Cameron’s Plan: A comprehensive approach to prevent obesity, 2015) and are also backing TV chef Jamie Oliver’s obesity plan too (Actiononsugar.org, 2015). Some of the actions proposed by Action on Sugar involve a 50% sugar reduction within the next five years starting with soft drinks, ceasing the promotion and all types of marketing of unhealthy food to children and adolescents and a 20% duty on all sugar sweetened soft drinks and confectionery. They also began promoting sugar awareness week between the 30thNov-6thDec (Actiononsugar.org, 2015). All health initiatives proposed involve the proposal of a sugar tax with 53% of the public being for it.

Educational behavioural strategies

In review of five educational school intervention programmes that aim to reduce sugar-sweetened beverage consumption and investigate changes in body mass, three showed long term success (Avery et al., 2014). After 12 months, one of which found the percentage of overweight and obese children decreased while the control group increased by 7.5% (Stockman., 2006). Sugar tax doesn’t address the root causes or take into context the bigger picture. Research has also suggested calorie intake has dropped but activity levels have dropped further (Prentice et al., 1995). Evidence investigating marketing strategies such as the four P’s (promotion, price, product, place) framework is shown to influence consumption and purchase of sugar (Sugar Reduction: The evidence for action Annexe 3, 2015). These same principles can be applied to the marketing of healthy foods, but need to be marketed with equal if not more vigour than the marketing strategies used to promote unhealthy foods.

Conclusion

Overall the dynamics of sugar consumption and its effects on the health of the population is complex. As such, this surely warrants an equal response and an approach that mirrors it’s complexity. The food industry needs to become a part of the solution and not part of the problem to shift the favour towards the goals of the initiatives. Whilst the government needs to do its part in enforcing change and aggressively working towards fulfilling the goals of the initiatives. However, reducing sugar consumption is just one step towards tackling a multi faceted problem. There are many other factors affecting the health of the public besides sugar. Significant, long term improvements in public health and reductions in dietary related diseases will ultimately be accomplished at an individual level without tactics of coercion. This change will come from parents having; realistic nutrition and bodyweight perceptions, better food awareness, practical guidance on calorie balance and portion control and education on the effects of overnutrition. This all of course needs to be followed up with parents putting knowledge into practice and implementing long term positive behaviour changes such as moderating portion sizes or increasing purchases of foods that contain natural sugars such as fruit, whilst decreasing or eliminating the purchase of foods that contain ‘free sugars’.

References

Actiononsugar.org. (2015). ACTION ON SUGAR BACKS JAMIE OLIVER’S OBESITY STRATEGY AND LAUNCHES ITS OWN EVIDENCE-BASED ACTION PLAN TO SAVE LIVES AND THE NHS. [online] Available at: http://www.actiononsugar.org/News%20Centre/Press%20Releases%20/2015/167492.html [Accessed 17 Mar. 2016].

Actiononsugar.org. (2015). Sugar Awareness Week. [online] Available at: http://www.actiononsugar.org/sugar-awareness-week/Sugar%20Awareness%20Week%202015/167198.html [Accessed 15 Mar. 2016].

Avery, A., Bostock, L. and McCullough, F. (2014). A systematic review investigating interventions that can help reduce consumption of sugar-sweetened beverages in children leading to changes in body fatness. Journal of Human Nutrition and Dietetics, 28, pp.52-64.


BDJ Team (2015) 2, Article number: 15157. Ignoring Public Health England report on sugar reduction would be reckless. BDJ Team, 2(10), p.15157.


Butland B, Jebb S, Kopelman P. (2007).
Tackling obesities: future choices – project report 2nd Ed. London: Foresight Programme of the Government Office for Science, 2007.


Cameron’s Plan: A comprehensive approach to prevent obesity. (2015). [pdf]. UK: Action on Sugar. Available at: http://www.actiononsugar.org/News%20Centre/Press%20Releases%20/2015/167492.html [Accessed 16 Mar. 2016].

Google.co.uk. (2015). diabetes threatens bankrupt NHS UK 2015. [online] Available at: https://www.google.co.uk/gfe_rd=cr&ei=e3PpVo_DEenS8AesxIKIDg&gws_rd=ssl#q=diabetes+threatens+bankrupt+NHS+UK+2015 [Accessed 16 Mar. 2016].

GOV.UK. (2016). 5 year olds eat and drink their body weight in sugar every year – Press releases – GOV.UK. [online] Available at: https://www.gov.uk/government/news/5-year-olds-eat-and-drink-their-body-weight-in-sugar-every-year [Accessed 15 Mar. 2016].

Hex, N., Bartlett, C., Wright, D., Taylor, M. and Varley, D. (2012). Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine, 29(7), pp.855-862.

Nhs.uk. (2012). Massive rise in diabetes costs predicted – Health News – NHS Choices. [online] Available at: http://www.nhs.uk/news/2012/04april/Pages/nhs-diabetes-costs-cases-rising.aspx [Accessed 16 Mar. 2016].

Nhs.uk. (2016). Let’s get Sugar Smart! Download the Change4Life Sugar Smart app for free today. [online] Available at: https://www.nhs.uk/change4life-beta/campaigns/sugar-smart/sugar-facts [Accessed 15 Mar. 2016].

Obesity Knowledge and Intelligence team. (2016). Public Health England. [online] Noo.org.uk. Available at: http://www.noo.org.uk/slide_sets [Accessed 4 Mar. 2016].

Prentice, A. and Jebb, S. (1995). Obesity in Britain: gluttony or sloth?. BMJ, 311(7002), pp.437-439.

Public Health England. (2015). [pdf]. Sugar Reduction: The evidence for action. Available at: https://www.gov.uk/government/publications/sugar-reduction-from-evidence-into-action [Accessed 15 Mar. 2016].

Scarborough, P., Bhatnagar, P., Wickramasinghe, K., Allender, S., Foster, C. and Rayner, M. (2011). The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs. Journal of Public Health, 33(4), pp.527-535.

Sugar Reduction: The evidence for action Annexe 3: A mixed method review of behaviour changes resulting from marketing strategies targeted at high sugar food and non-alcoholic drink. (2015). 1st ed. England: Public Health England, pp.pg 7-8.


Stockman, J. (2006). Preventing Childhood Obesity by Reducing Consumption of Carbonated Drinks: Cluster Randomised Controlled Trial. Yearbook of Pediatrics, 2006, pp.407-408.

Syrad, H., Falconer, C., Cooke, L., Saxena, S., Kessel, A., Viner, R., Kinra, S., Wardle, J. and Croker, H. (2014). ‘Health and happiness is more important than weight’: a qualitative investigation of the views of parents receiving written feedback on their child’s weight as part of the National Child Measurement Programme. Journal of Human Nutrition and Dietetics, 28(1), pp.47-55.

Wrong to teach kids about nutrition?

Parents, kids and food education
This article was inspired by an unfortunate disagreement that had arisen between me and someone I know. This disagreement was sadly over my efforts to encourage healthy eating in my Daughter (who was a very aware and conscious 5 year old at the time) and from the education I had provided her regarding the benefits and the potential dangers of unhealthy food. My efforts with my daughter and with many other people whose lives and healths I have helped improve over the years, have never been based on exaggerations, or scare tactics. My efforts, identical to my articles, views, values and philosophies in nutrition, have always been influenced and supported by scientifically validated facts and evidence as well as logical rationale.

This is an important point to note. I don’t believe in lying to my child in the same way I don’t expect my child to lie to me. In fact I have a real hard time with the whole Santa thing and just avoid the question when she asks me. I don’t believe in discouraging them from eating crisps by telling them, “if you eat crisps you’ll get cancer”. I don’t agree with scaring them into eating healthy food. In contrast I disagree with saying things like “if you eat your vegetables you can have dessert” as I also don’t agree with bribing them to eat healthy food with the reward of eating unhealthy food afterwards either. In fact it completely contradicts my point of promoting healthy food over unhealthy food. I don’t agree with distorting the truth in any way or promoting unhealthy eating habits to promote healthy eating to kids, at all.

Sometimes the best way to teach a child, is to teach a child. Sometimes a child needs to learn and know instead of being told what to do or what not to do. If you can educate a child on why they should be eating healthy food, why they should only eat chocolate sparingly, then that’s half the battle. Once a child is aware of the effect on health food can have, based solely on facts, it’s human nature and instinct to avoid or at least reduce contact with things that we know could be harmful to us through behavioural change. This works particularly well in children, more so than in adults because children function through more primal instincts and emotions. Where as with maturity, comes the complex advancement in attitudes, willful ignorance, pride and stubborn behaviours which can of course have a negative effect on one’s on health.

Ignorance is far more common in adults especially with regards to health. Ignorant not just about nutrition, but willfully ignorant to acknowledge anything that may challenge their current paradigm, regardless of logic or fact. But that’s a discussion for another article. Children’s instincts and emotions are far simpler. They are more instinctive in nature in the respect that they show less ignorance to dangers in general. This instinctive nature can guide children in making healthier food choices. Based on this they can potentially show much more enthusiasm in being healthy, particularly when they understand and are aware of the negative effects such things can have on their health. In the same way a child can learn to associate strangers or say a wasp with negative connotations you can also create a negative association with unhealthy food.

This brings me swiftly to my point. This is how I have educated my daughter. I’ve made her aware of facts and educated her on how to be healthy. She can tell the difference between refined and wholegrain carbohydrates, with a fairly good understanding of which ones can lead to sharp rise and falls in blood sugar and which ones don’t. Some kids her age are still learning the alphabet or their months, but my Daughter has been able to distinguish all the major muscles on the body from gastronemus to trapezius with near perfect pronunciation from the age of 4. What’s great is that she generally enjoys learning about food and is always quizzing me for information and then randomly recites information back to me two weeks later, much to my surprise and satisfaction. I would say she is the epitome and vision of what many public health professionals including myself want for the future of children in this country.

 It’s now becoming more common for children to get diagnosed with adult onset type II diabetes despite the fact its usually diagnosed in adults over the age of 40, children that are now on medication because of an adopted, family drawn perception that has been perpetuated by clever food marketing in the media, that certain refined and processed foods are normal foods to eat and are part of our staple diet. But yet my daughter knows what diabetes is. Not only does she know what it is she’s aware of what foods are potential promoters of it and she limits her intake of them foods. Given that there are more children now obese and overweight with diet related diseases than ever before, the importance of this can’t be down-played or shrugged off.

Chocolate is NOT food. Crisps are NOT food. Refined, processed, chemically altered, artificially made, aggressively manufactured, contaminated man made junk is NOT food. If it does not grow from natural vegetation teach your child to limit their intake of it and educate them about why.

So what age is the right age to tell a child fruit offers many nutrients that help you learn better at school? when is the right time to tell a child a diet high in sugar will decay their teeth and can lead to health problems? when is the right time to tell them that having crisps for lunch will only provide empty calories that will not give them lots of long lasting energy to play with their friends at break? when is the right time to tell a child the saturated fat in McDonald’s burgers is not good for their heart and to be weary of marketing ploys designed to appeal to a child’s immediate desires? The main point of being a parent is to look after and protect your child. It’s to provide them with the best quality of life possible. Then surely wouldn’t the right answer to the question; when is the right time to teach kids about health? be at the very least, sooner, rather than later?

I may be criticised for teaching my daughter things she “doesn’t need to know about at her age” but at least I know with confidence my Daughter is not part of the huge public health crisis where many of today’s kids will grow up unhealthy, over weight, nutrient deficient and lacking fundamental food education to protect them from diet related diseases in the future. Now that for me, is a comforting thought and well worth the criticism.