Speakers: Kiruthika Rajeswaran and Dr. Chinnadorai Rajeswaran, Simplyweight; Jenny Caven, Slimming World; Phil Veasey, The Mayor of London’s Child Obesity Task Force
27 March 2019
All-Party Parliamentary Group on a Fit and Healthy Childhood
‘The Management of Obesity in Children and Young People’
Chair: Baroness Benjamin
Speakers: Kiruthika Rajeswaran – Co-Founder & CEO, Simplyweight; Dr. Chinnadorai Rajeswaran, Co-Founder & Medical Director, Simplyweight; Jenny Caven, Head of External Affairs, Slimming World; Phil Veasey, The Mayor of London’s Child Obesity Task Force.
Chair’s Opening Remarks:
Welcome everyone to the 42nd meeting of our group. Give yourselves a big hand! Ours is one of the best All-Party groups you could ever be part of, and tonight’s title is Management of Obesity in Children and Young people, so this evening we are returning once again to look at the vital issue of obesity and overweight in children and young people.
We all agree that this is an important and pressing issue that needs to be solved, and the sooner the better. This Group has consistently called for action since our very first report in 2014 and it is appropriate that the sponsors of that report, Slimming World, are on our panel of speakers this evening. Jenny Caven is here and, Jenny, you go right back to when we first started.
Since then we have seen Government introduce phase one and phase two of their Childhood Obesity Strategy.
Of course, still not enough is being done and we must keep up the pressure. The new measures are having some impact but still there needs to be more done as we are still known as the ‘fat man of Europe’ and obesity is costing the NHS £6.1 billion every year.
Usually, as regular members know, we focus on the big picture – what policies are needed to reverse the trend towards obesity? But tonight we will look at how best to help individual young people who are already affected. What can be done to help them? Have new strategies been developed that can help them to address their problem?
We will be helped to look at this by two organisations that have hands on experience, who face this challenge every day and work with those young people. It saddened me to hear from Jenny that some of the youngest members who come to Slimming World are ten. Can you imagine ten-year-olds needing help from Slimming World? We also have tonight Simplyweight, who face these challenges every day, working with young people. Also we are fortunate to have with us tonight a representative of The Mayor of London’s Child Obesity Task Force. Nearly 40 per cent of all London’s children are overweight or obese. The taskforce have set themselves a target of halving this by 2030.
Kiruthika Rajeswaran, Co-Founder & CEO, Simplyweight
Good evening ladies and gentleman. Thank you for joining us in discussing one of the most pressing issues in our society today. Currently the NHS estimates that around a third of children aged between 2-15 are overweight or obese. Now I can’t predict exactly what will happen with Brexit, but it is with certainty that we are heading for a healthcare crisis if we fail to manage obesity levels.
Overweight and obese children are more likely to face the same problem as adults, putting them at serious risk of developing type 2 diabetes, heart disease, stroke and certain cancers, to name a few. More importantly, they can grow up with serious damage to their psyche. Obesity is strongly linked to poor mental health, poor body image and lack of self-esteem. But how much worse is this to deal with as a child? During those crucial years where each experience helps shape our personalities, our perceptions of others and ourselves, we see more and more children and young people fall victim to bullying and marginalisation. And the idea to send letters home to parents informing that their children are overweight certainly doesn’t help.
Both the NHS and local councils are making consistent efforts to promote healthy eating and physical activity. Many programmes attempt to include parents, family members, schools, local eateries and the wider community. On a national level, initiatives to cut down sugar content and restrict advertising of junk food to children are all commendable, although slow to bear fruit. It’s evident that there is a lot of passion and dedication to solving this problem and yet if we’re really aiming to halve childhood obesity rates by 2030, we need to look deeper.
Simplyweight believes that the best way to achieve successful, long-term weight loss is through holistic, personalised and medical intervention, meaning at a tier 3 level. Our primary clinic is The London Obesity Clinic at Harley Street. Our healthcare professionals have seen hundreds of patients both privately and within the NHS, many of whom have been children or teenagers. A large number of our patients typically come to us after trying various diets and weight loss programmes that haven’t worked for them. When we investigate further, it’s usually a similar story. They get well-informed about eating right and exercising more, especially at the start when they’re feeling motivated. Some of the better programmes include some psychological support in the form of cognitive behavioural therapy (CBT) for example, but this can be very labour intensive and difficult to extrapolate to the wider population. Despite all this support and intervention, why do people still regain weight?
The real issue is they never get to the root cause of the problem. All the while looking at their weight gain as the condition without going further to find out why. This is what we do. We ask the all-important “why?”. Most people have awareness of what is healthy and what isn’t. But despite that, we can all be prone to making bad choices. Why do people snack late at night even after having a heavy dinner? Are they just being greedy? Do they need to be educated that crisps aren’t good for you at 10pm? Or maybe, they know all of that but they’re experiencing reactive hypoglycemia and disturbed hunger patterns.
That is just one example. But it goes to show that there are many different causes for weight gain and even more causes for eating. We have developed a proprietary framework for studying individual hunger patterns known as WAISTT (which Dr.Raj will talk about). People don’t always eat due to feeling real hunger. Your hunger is influenced by numerous factors including your sleep schedule, time of eating, the lighting in the room, the number of previous weight loss attempts you’ve made and perhaps even the number of people who sit at the table with you!
Now think about an individual child and how many different touch points they have at school (with friends and teachers) and at home, on top of all other external influences. This is why it’s important to approach the problem holistically but also with medical support to find out the underlying cause specific to that individual. TLOC takes a neurohormonal, process (rather than goal) driven approach which includes the vital element of social integration. We don’t isolate children and young people who need help and neither do we play the blame game by pointing fingers at parents or failure of school systems. The truth is we are all collectively responsible but we can drive more significant change by working together. I’ll now hand over to Dr.Raj who will explain the complexity of the problem we’re facing and the science behind our approach.
Dr. Chinnadorai Rajeswaran, Co-Founder & Medical Director, Simplyweight
As Kiruthika said, it’s not the “what” as everybody knows – eat less and exercise more. This is not rocket science; you can ask a small child and he or she will know that it’s better to eat fruit than doughnuts. So telling people the same thing over and over is not going to work, so we have a completely different approach.
So I’m going to talk for two minutes on prevention and then three minutes on management.
So – prevention. At what age should prevention strategies of childhood obesity commence?
In a large study involving 50,000 German children, it was found that the greatest acceleration in weight occurred when children were between 2 and 6 years old, and the probability of obesity in adolescence was higher in children who had accelerated weight gain during their preschool years. These patterns were similar in girls and boys. Collectively, these data show that early childhood is a critical and relatively narrow window that predicts the establishment of sustained obesity down the road. So, the first opportunity to prevent childhood obesity is between the ages of 2 and 6.
In fact the very first opportunity is even before conception and in utero. An obese mother or a malnourished mother is more likely to have an obese child. Tackling obesity in parents is the key to prevention.
Prevention can be at several stages: perinatal, infancy, preschool, childhood and adolescence. However, if you really want to prevent obesity and improve the health of this country, we need to concentrate on adult obesity.
55-60% of obese children inherit or acquire the tendency to become obese from parents either due to hormones, microbiome, genetics or environmental factors. So, obese adults have obese children and most obese children end up as obese adults.
Everybody has a Basal Metabolic Rate (BMR) which is the amount of calories needed to sustain body weight. When weight decreases, the amount of calories needed for the new body is less. Unfortunately, if the weight goes back on, for some reason the rate doesn’t go back up. That’s why in subsequent weight loss plans, people fail. I often hear people say that the first time they lost weight it was easy and fantastic, but the second time was not so good. And then the third time, it didn’t work at all, despite doing exactly the same thing. So can you see that? We are driving people with short-term programmes towards failure and it is particularly bad when we do this to children.
Most of my adult patients have been overweight as children, and they invariably tell me how they were discriminated as children and had to follow the diet their mother was on. It is not just the discrimination which matters. What matters most is that these diets reset their BMR and they suffer lifelong. Every time they went on a crash diet, their BMR was pushed down and they found subsequent diets did not work.
So, we need to come away from a goal-driven approach and go instead with a process-driven approach. For example, a child knows that they need to brush their teeth because they’ve been trained through a process so they know that is what they have to do. So we don’t say “go and lose one stone” or “go and eat vegetables” – that’s not right. We need to set a process so that it comes automatically, and we start with the adults, because 50/60% of adults are responsible for childhood obesity.
School programmes don’t work. For example, the Birmingham Schools programme cost a huge amount of money and it was a complete waste. You need to integrate parents, because parents are the key.
So how do we do it? We don’t have enough money, money is very tight, so what we do is we do a triage. We don’t follow BMI (body mass index, where above 30 is obese). That’s not right. Every rugby player is obese! You can’t lump everyone based on BMI, so we use something different called Edmonton Obesity Staging System. We triage children and find out who needs a psychologist, or an endoctrinologist – that’s how we need to do it, and that’s what works.
We use a programme called WAISTT as Kiruthika mentioned. W is for weight, A is ambience, I is internet, S is speed of eating, T is time management and the final T is thought. That’s what we work on.
Summary: Obesity is a chronic disease which arises due to a combination of medical, genetics and socioeconomic influences. Interventions which are low cost, personalised and multidimensional involving parents are the key to prevention and management.
Jenny Caven, Head of External Affairs, Slimming World
Children who struggle with weight problems are more like to experience bullying, low self-esteem and lower quality of life, making them more vulnerable to poor mental and physical health and wellbeing. They are more likely to become overweight adults and risk developing a range of health conditions. They are also disproportionately from low-income households.
Obesity is the greatest threat to the future physical and mental health of our children. We need to work together at every level to educate, communicate and promote health behaviours across families. We need to find ways to support families, especially those in deprived communities, to have access to healthy food and to be able to shop, prepare and enjoy balanced healthy meals. We need to help young people and families understand that being overweight is a chronic relapsing condition. Anyone who struggles with their weight knows that often managing weight becomes a lifetime battle. On the one hand we need to have the structure and support mechanisms in place to help those who struggle with weight to learn how to lose weight healthily and sustainably, but equally importantly we need to have the right system in place to ensure that children and families are equipped to prevent obesity.
For many years, we’ve been working together as members of this All-Party group to promote a fit and healthy childhood, and raise awareness of the threats to the health and wellbeing of our children caused by obesity. As a group we continue to work passionately and vigorously to present ways to improve the lives of children and families. In 2016 as Baroness Benjamin mentioned, the Government published its Childhood Obesity Strategy, and was criticised for a watered-down policy. Last year chapter two of that strategy, setting out how to cut sugar from our children’s diets and limit junk food marketing, was published. It still does not go far enough.
There is currently a Government consultation to restrict price and location-based promotions on the least-healthy foods, and Cancer Research UK, fellow members of this group and with whom Slimming World works both in fundraising and in policy-making, today published its response to that consultation. The four million young people who are overweight face developing type 2 diabetes, heart disease, liver disease or cancer – before they reach full adulthood. The Government has pledged to half the number of children who are overweight or obese by 2030, but the Child Obesity Strategy alone will not come close to achieving that.
Obesity is complex and it’s made worse by a range of factors. From busy working parents with less time to prepare meals, from easily accessible affordable processed foods being more available, from children spending more time indoors in front of a screen, from cuts to the number of hours spent teaching PE . . . Before the publication of the first chapter of the first Childhood Obesity Strategy Slimming World published a ground-breaking report along with the Royal Society for Public Health, asking young people for the first time for their views on the child obesity epidemic. They told us that it was too easy to order the delivery of takeaway food to their school using their smart phone, and that fast food companies should be banned from making such deliveries. They told us that soft drinks should show how many teaspoons of sugar they contained. They told us that supermarkets should give away free food to children, and that foods that are high in salt, fat or sugar should be put out of the eyeline of children in shops and supermarkets. They said that junk food should have a health warning – similar to cigarettes – on their packaging. They are crying out to us for their protection and help.
We also produced a report last year on the practice of upselling, where customers are encourage to “go large” or add additional items when buying food. That report showed that young people aged 18 to 24 were most vulnerable to being upsold to, and were likely to consume an additional 750 calories a week as a result. Impressionable younger children who lack the confidence to say “just this, thanks” are at even greater risk.
A key constituent of the Government’s Childhood Obesity Strategy is a campaign to promote calorie labelling, particularly on out of home products. While helping families to understand calories, it is also important the help children and families how to enjoy a healthy balanced and sustainable diet. After all, it is possible to eat crisps and a chocolate bar for breakfast, have a sausage roll for lunch, get pizza for tea, throw in a fizzy drink – and still be below a calorie count for gaining weight. That is clearly not a healthy or balanced diet, so calorie counting alone is not enough. In fact, it may even be counter-productive.
At Slimming World we reach around a million people every week and we’ve recently looked at data for people who attend our weekly groups over the course of a year. 30% of people who attend are aged between 18 and 34, and a further 20% are aged 35 to 44. That means that half of our members are at the age where they are most likely to be parents and we are reaching and supporting young women to develop healthy habits before they consider starting a family. Analysis that looks at indices of multiple deprivation shows that more than half of our members come from the top five areas of highest deprivation. We are the only weight loss organisation that supports women to manage their weight in pregnancy, which is one of the times in life when they are most prone to gaining weight. Our programme is designed to support the whole family to develop sustainable healthy living habits.
We also reach 20,000 young people between the ages of 11 and 16 each week. They discover not how to count calories but how to feel empowered to make a choice between a burger and fries and a baked potato and beans, and to understand why the potato is the healthier option. Without doubt, we are encouraging more families to learn about healthy sustainable eating as well as encouraging them to become more active, than more than any other organisation focussed on healthy weight loss. Some of you may have heard our young members Thomas and Izzy speaking to this group a while ago.
But Slimming World and this group alone are not enough. As well as the four million children in England more than 14 million adults in the UK are overweight or obese. If we are to ensure the future health of our children, we need to work across every sector to prevent as well as tackle to consequences of obesity. We need to promote healthy lifestyles for the whole family. We need to educate parents and children about healthy food rather than calories. We need to equip families and young people to be able to prepare healthy and delicious meals, and provide safe opportunities for families and children to be active outdoors. We need to put health warnings on junk food and limit access to fast food establishments, especially in close proximity to schools. We need to listen to our children’s please to protect them.
For years in this group we’ve been working to promote a fit and healthy childhood. We’ve produced reports, lobbied ministers, we’ve talked to the media, we’ve made our voices heard. We’ve called for a Minister for Children. We cannot do this along, and we cannot afford to compete or vie for resources. Whether we are educationalists, health experts, physical activity professionals, policy makers, academic researchers, whether we are parents, grandparents, family or friends – we all have a part to play.
Phil Veasey, The Mayor of London’s Child Obesity Task Force
What’s the situation? Children in Tower Hamlets – where I am currently writing the Physical Activity and Sports Strategy – have worse than average levels of obesity:
- 7% of children aged 4-5 years and 26.9% of children aged 10-11 years are classified as obese
- And its linked to poverty – as 39.2% of children up to age 16 live in poverty in Tower Hamlets (compared with 23.4% in London and 20.1% nationally
In Newham, where I work 3 days per week in the Public Health team, we are actively encouraging Councillors to steer away from percentages and instead talk in actual numbers – so its 14 of a typical class of 30 year 6 children in some of our communities are overweight or obese – every child’s life is important and sometimes I think we forget this when we are throwing out percentages.
So, with nearly 4 in 10 of London’s children being overweight or obese; and with the highest rates occurring in the areas of greatest deprivation – the Mayor of London has been so concerned that he announced in The London Health Inequalities Strategy in September 2018 that he was forming a Child Obesity Taskforce.
The Taskforce came together under the leadership of Chair – Paul Lindley and Vice Chair Professor Corinna Hawkes – for the first time as a formal group in October 2018 and in the mid-summer of this year we are set to publish our first action plan. This will be underpinned by Our Statement of Intent that sets out to frame the challenge of Child Obesity in London through the eyes of children, young people and their families.
The Statement of Intent outlines six commitments for how the Taskforce will approach this challenge:
- Drive and stimulate action
- To learn by listening to London’s children and their families
- Unleash leadership
- To communicate and champion
- Learn from and share with other cities
- Mobilise finance and resources
One of my roles in the Taskforce is to lead on the children, young people and families workstrand, and I wanted to focus on this for a moment.
The Taskforce is absolutely committed to listening to children, young people and their families and co-designing solutions to reduce levels of overweight and obesity. It’s vital therefore that we try as best we can to understand how children live their lives in London.
To help our initial thinking we have created four fictional ‘composite’ children – a 2 year old, a reception pupil, a year 6 pupil and a teenager. These children represent what we see as typical or the normal lives of many children living in London. Basically – there are many good reasons why having a healthy diet, drinking water and taking exercise may be a challenge for children and their parents. This is especially the case in London’s most disadvantaged communities. And we will be mindful of the realities of daily life when we publish our first action plan and begin implementation.
Going back to the 4 profiles – Our year 6 pupil was profiled in January of this year from an interview with mothers at Cubitt Town Junior School on the Isle of Dogs, and from my extensive work in the public health teams in TH and Newham. Let’s just list some of the barriers to this young boy living a healthy life:
- He lives on a second floor flat with no outside space.
- He would like to learn to swim but lessons are thought to be too expensive.
- He enjoys going to the park, but Mum doesn’t consider it safe.
- Mum always cooks dinner, though there isn’t enough space in the flat for a table for the family to all sit together to eat.
- On school days she makes him a big breakfast and a packed lunch too.
- At weekends they visit relatives where there are always ready access to crisps and fizzy drinks.
Across all 4 profiles we see:
- The community leading very local geographical lives and variations depending on:
- How old the children are
- where they live
- who their caregivers are
- if their parents work and what they do
- family income and how it is spent
- the space and assets the household has access to
- the public and private spaces they frequent
- access to affordable healthier food options
- the content and amount of advertising they are exposed to
- perceptions and realities of community safety
- the social networks the family participates in
- other influences, including their online world
In terms of taking action, the taskforce is meeting for a 2 day away session this week – where we will begin to prioritise the actions we plan to take. At the same time, we are planning to procure an expert agency to lead the consultation process with children, young people and families.
In terms of what sorts of actions we can expect to see – we have all been given a fantastic lift by the implementation of the Mayor’s ban on junk food advertising on the TfL network, and the related work in Lewisham with another significant company who own those huge advertising boards in our communities.
For my part, I will be pushing for actions that join things up and make the most of efforts, that are around doing things with the community and not to them , and that connect children, young people and families from some of our most disadvantaged communities to local positive things that they can get involved in . So, as I hope you have heard, we have been busy forming, but what’s really exciting is that we are on the fast-tracked journey to performing!
Questions and Comments:
Paul Wright, Health Edco: I used to work with smoking prevention and cessation services and I wonder if we need to look at some of the strategies there, where essentially there was a team in a city or town that brought all these things together, did the brief intervention training, got the nurses, etc. to be able to see this as a positive quick nudge to talk to people, but then had the services easily to hand to bring about the changes, rather than have lots of fixing piecemeal and, in some areas, not a lot available.
Jenny Caven: Raising the issue through that first conversation is a really important thing, and, yes, then being able to signpost people to the most effective support. There’s a difference between smoking cessation and obesity, but I think the support services, the signposting and having the initial conversation are all really important. It’s about scale though, isn’t it?
Paul Wright, Health Edco: Do you think if there was a national service . . . that’s what I mean really.
Phil Veasey: I think it’s about everyone being on-message. In Newham there’s no shortage of effort and enthusiasm in health workers, midwives, community neighbours team, GPs – but we all need to be sending the same message. There’s a huge need for a joined-up effort. The other day I was at the London Food Board and someone stood up from Healthy Sports London followed by someone from Water in Schools London and then someone from somewhere else . . . and I thought, well, if I were a Head Teacher how would I make sense of all of those activities?
Chinnadorai Rajeswaran: I completely agree. I feel there are similarities between smoking and eating in that they are both hand-mouth reflexes. In Yorkshire they are using a similar pathway, using health care assistants to try to get into the community. To save money they are using the smoking cessation team to deliver weight management.
Baroness Benjamin: A lot of what you’ve been saying about movement is true. David Beckham as a child kicked a ball day in, day out. We’ve got to train children how to put the food in, how many times to chew, put knife and fork down in between – so that it becomes automatic.
Marie Williams, Dream Networks: I’m CEO of a social enterprise, and a play academic. I’ve got a personal question. When I was younger I was clinically obese, and I skipped sports in school. But what helped me personally was that my friends challenged me to diet, which I hadn’t tried before, and that’s how I lost weight. But the key thing for me was that I had to learn to cook. My family ate significantly later than me, so I had to start cooking for myself and learn all about food. What interventions have you done to co-design with children or teenagers who could cook for themselves to enable them to bring about the changes themselves, especially where the parents aren’t supportive?
Jenny Caven: Part of what we do is to encourage the whole family to cook together. In sessions it’s all about people coming together to learn from each other about healthy food and healthy cooking. We have a programme called “free foods” which are foods that are low in energy density but high in satiety – and these are the things to create meals from. They learn about that. Sometimes there is conflict in families and one of things that happens in group is that that kind of thing can get worked out through the group.
Marie Williams, Dream Networks: What about the parents who don’t have time for the group? Have you got anything to co-design with the child? There are many children in that situation.
Baroness Benjamin: Do you think it starts at school?
Marie Williams, Dream Networks: Not necessarily, but children need to be empowered to do things themselves.
Baroness Benjamin: If you start in school, childhood lasts a lifetime, and if the child understands about diet, intake, rhythm of the body, what happens is that it almost becomes like how you tie your shoelaces. But I don’t think we treat eating and our bodies the way that we should be. Because I run marathons, I understood about my body. Once you understand that, it’s great, and I think the earlier you start learning that, the better. I think we are missing a trick in schools at the moment, not teaching children about their bodies.
Chinnadorai Rajeswaran: Understanding your body and your hunger is key. That is what should be taught in schools.
Kiruthika Rajeswaran: We’ve seen children in those situations, where the parents haven’t been supportive, and you’re right that we have to look at it holistically. You have to look at the family as a whole but we can’t underestimate the influence of environment. Even as adults, we commit to doing something but we are so easily swayed. It’s hard for adults but even harder for children.
Baroness Benjamin: Remember, parents were children once so if you get them when they are children, they will remember what to do as parents. What’s happening now is that parents haven’t been educated enough to understand the influences that are coming into their lives about what they should and shouldn’t do – financial, social, peer pressure, environment, etc. (To Marie) You’re a perfect example of what used to be, what can be and what should be. What job do you do?
Marie Williams, Dream Networks: I’m a senior engineer but I co-design playgrounds round the world.
Baroness Benjamin: And do you tell them your story?
Marie Williams, Dream Networks: Yes, I used to be an aerospace engineer and I was in a school today talking about engineering to encourage the children to think about engineering, and I put up a picture of my school in Peckham when I was six years old and very obese and I was able to say “I’ve lost weight”. It’s also important to convey the message that even after losing weight, it’s still a daily challenge afterwards.
Sascha Colgan, Consultant GP: The difficulty that I find working as a GP is that when a clearly overweight child comes into surgery, I find it really hard to have that initial conversation. I don’t want to get into fat-shaming and my concern is that while my intention is to make them much healthier, I could unintentionally create a massive amount of psychological damage by singling them out and making them feel devalued because of their physical appearance.
Chinnadorai Rajeswaran: That’s exactly the same in our case as well. Someone can go to a doctor with an ingrowing toenail and be told that they’re overweight. So what we do is not go for the opportunistic. We normally give a leaflet in amongst other leaflets. We have a nurse and I always find that people don’t completely confess everything to me as the doctor – they’re not open enough – but with health care assistants they are more open and will have a chat. That’s how we open up. We’re not patronising but we just show people the doors that are open to them.
Jenny Caven: The Royal Society of Public Health does some interesting work around motivational interviewing and raising the issue, so it might be worthwhile getting in touch with them to see if they do training courses for health professionals.
Phil Veasey: Guy’s and St Thomas’s charity have funded the framework institute to frame this whole issue and work out what’s going to resonate best. I can put you in touch. As GPs you’re got to have some of the answers, to know where to signpost and so on.
Sascha Colgan, Consultant GP: Yes, I think that’s true very much for adults but it’s a different conversation for children. It’s all well and good raising the problem but there need to be solutions too.
Sharon Smith, University of Northampton: I’m an Early Years Lecturer and I’m always interested to hear about early years, pre-conception and pregnancy. I was interested in what people were saying about listening to the child because the voice of the child and the rights of the child to not grow up with obesity is really important. I wonder how we can get the voice of the child in a more meaningful way? How can we really listen and act on the voice of the child?
Chinnadorai Rajeswaran: You’re absolutely right. We completely focus on non weight-related goals (maybe socialising, going out, meeting people) and that’s the way we get people in.
Kiruthika Rajeswaran: I draw on personal experience because I was very obese as a child and being in school sometimes teachers, who were really only trying to help, made me feel different and isolated from a really early age. When you are a child and you’ve been obese for as long as you can remember you can’t perceive that you are obese and different from other children. This is one of the reasons why we focus on non weight-related goals – because we don’t want children to feel that they are different. It really works for us to focus on being healthy, their dreams and what they want to achieve, same for all children.
Phil Veasey: In terms of play areas it can be productive to take parents round to look at them so that we can start co-designing. All the play areas look the same and they are a prime example of a community having things done to them instead of with them.
Brian Jarrett, The People’s Supermarket: There was one related point I want to raise. At the People’s Supermarket we look at the children that are downstream. The supermarkets, fast food outlets, etc. are upstream, and to some extent, we have to stem that flow. What we believe at the People’s Supermarket is we choose not to increase our turnover through promotions around sugar and unhealthy food. We took our numbers and, similar to the gender pay gap, we broke them down by fat, salt and sugar to show how much we were making out of those products – and it was shameful! I think if we took that to the High Street and insisted that big companies had to start publishing how much they are making off the nation by selling fat, salt and sugary products, it would change behaviour. It would stem the flow as it would shame them.
At the People’s Supermarket we have to pay the bills, of course, but we have to strike a balance.
In terms of knife crime and food one thing we’ve identified is the problem of how do we get them to listen? We could start in the House of Commons but how do we get that down to the street? They don’t listen to teachers or parents but they do listen to their peer group and their siblings. So how do parents get their children to sit down and listen and communicate? It’s dinner time. Once a week we need to sit down, get round a table, turn off the TV and talk. Parents will find out so much about their children in this way, but it doesn’t happen any more and that break down in family communication is contributing greatly to a lot of society breakdowns as well. Getting together once a week to break bread is so important to society and the Turkish, Italian, Spanish, Jewish . . . any societies that do that have more stable societies.
Baroness Benjamin: You’re absolutely right and everything you’ve said is what we’ve been saying as a group and trying to get out: the principles that families build their lives around so that their children don’t suffer.
Estelle Mackay, Public Health Nutritionist: To Phil: I have huge admiration particularly for the work that Corinna (Hawkes) has been doing. Could you say something about the banning of junk food adverts on the tube, which has recently started in London?
Phil Veasey: It was in the consultation strategy within health inequalities way back. It went through a consultation process and the public loved it. It’s one of those things that the Mayor has power over and it’s 40% of London’s advertising space, so it’s a brilliant step forward.
Estelle Mackay, Public Health Nutritionist: Mind you, at the top of escalator at Westminster Station, McDonald’s still have their big advert!
Sara Keel, Babycup: I’m interested not just in what you eat and drink but also how you do it. How you chew, having real food and not just pureed food. In particular, this point about the length of meal time and actually taking time to have a meal. With everything being so fast-moving and the pressure to achieve so much in a day, it can be very difficult at home and at school. Are there any examples from other countries where mealtimes in workplaces or schools are seen as a special, important social time, as well as a healthy time? Are there any studies that we could learn from?
Phil Veasey: If you google “Tower Hamlets Food Poverty Action Plan”, we wrote extensively about school lunches and the experience. What was happening there was that because all the teachers weren’t being given free school meals, they weren’t there to interact and talk with the children, so there was no quality control. The lunchtime supervisors were not part of the Head Teacher’s responsibility because they were outsourced, and there could be chaos going on in dining rooms and the Head Teacher couldn’t do anything about it.
In the Food Poverty Action Plan we encourage assistant teachers to earn some extra money if they want to, to have better influence over the lunchtime experience. They we found that the Procurement Manager was just choosing the menu himself, and he was not of a healthy weight, and so we put in a co-production process where parents, teachers and children came together to choose the menu for the next term. It’s an eighth of a school day so it needs to be a time to reflect, learn and socialise.
Baroness Benjamin: In one school I visited, 10 children were chosen each week to have lunch with the Head Teacher and discuss the school week and so on. Children who were chosen to take part in this activity felt a real sense of responsibility.
Stuart Flint, Leeds Beckett University: I am a Senior Research Fellow in Public Health and Obesity and part of HOOP (Helping Overcome Obesity Problems ) which is a charitable foundation set up to provide support for adults and children with obesity. There are two things I’d like to talk about. Firstly in terms of language, there is a need to raise a discussion around weight, and the key is how we communicate about it in a non-stigmatising way. Unfortunately what we do know is that in many services that are designed around obesity we are using stigmatising languages and unfortunately we know that people respond maladaptively to that. Contrary to popular opinion, people do not start eating healthy food when we stigmatise them.
I do also take the point from the front that in the general population you should be focussing more on behaviour than on outcome because we can control our behaviour more, so we shouldn’t be focussing on weight but instead on behaviour like physical activities, healthy eating etc.
There are some lessons we can learn from smoking cessation but I would also be very cautions. We are talking a lot about obesity being the new smoking, but smoking is a behaviour and obesity is an outcome, so whilst there might be some learning in terms of how we approach the problem, the two things are very different and I don’t think we should be delivering health care services in the same way.
How are we addressing stigma? How are we addressing education for health care professionals? In 2007 the Foresight Report told us that there are over 100 different causes of obesity, but all we ever hear is that we eat too much.
Baroness Benjamin: Unfortunately with only a few minutes left for our meeting, can the panel please respond very briefly to Dr Flint’s question.
Phil Veasey: If we look at the mainstream media, it’s all the parents fault. Every autumn after the National Child Measurement Programme results come out we see the same outcry. How we frame it is really, really important.
Jenny Caven: For me, it’s about raising people’s self-esteem and empowering them to make healthy choices and to understand the consequences of their behaviour.
Chinnadorai Rajeswaran: Educating health care professionals is really important because they are not taught about obesity in medical school, so we have started to develop education programmes. We’re also trying to introduce knowledge to children through video games.
Kiruthika Rajeswaran: We work with some NHS Trusts currently and we go to hospitals to train the health care professionals and they can subsequently deliver our programme. We’re looking to do more of this as it’s the only way we can get to the population as a whole rather than looking at individual people as private customers.
Baroness Benjamin: The BBC are doing some research about children with overweight, and part of the problem seems to be that parents don’t see the child as overweight as long as they are happy and comfortable. They don’t think about the problems that come later down the line. We need to re-educate the brain on how to stay healthy and fit and learn about the rhythm of our bodies, because once we understand that we know what to do.
After some further discussion, questions and comments, the meeting closed at 5.30 pm.