Obesity in children is a global epidemic, and in Malta the situation appears particularly grave. In the ‘Health Behaviour in School-aged Children’ study by the World Health Organisation (2020), it was reported that Maltese children aged 11, 13 and 15 had the highest rates of obesity among all the countries surveyed (45 in total).
The cause of childhood obesity is multifactorial but likely boils down to family lifestyle choices combined with the modern obesogenic (tending to cause obesity) environment. Essentially, there is an increase in the amount of energy dense foods consumed (processed foods), an increase in the time spent watching television and playing video games, and a reduction in physical activity.
The WHO survey, in fact, found that Maltese children had a low consumption of vegetables, a high consumption of sweets and high rates of problematic social media use.
The following approach to tackling obesity varies according to the age group.
Infants and preschool children
While it is difficult to overfeed a breastfed infant, a bottle-fed infant can indeed be persuaded to drink greater volumes than they require. It is, therefore, important for the parent of a bottle-fed infant to not always assume that crying signals hunger.
The infant can simply be bored, tired or uncomfortable. It is also essential that formula is made up exactly as per manufacturer’s directions, and that volumes provided are appropriate for age.
Infants should be introduced to a cup from about seven to eight months of age and bottles should omitted completely by one year of age as there is a tendency to consume larger quantities of milk when feeding from a bottle.
Primary schoolchildren
For younger primary schoolchildren, responsibility of the issue needs to be taken solely by the parents/carers. On the other hand, for older primary schoolchildren, the carers and children should be engaged jointly.
The parents are the gatekeepers of the child’s food and it is up to them to ensure that the appropriate quality and quantity is being provided. The intervention will have the highest chances of success if the whole family adopts healthy eating patterns, and parents should strive to be good role models for the child.
The main changes recommended are for the family to reduce the intake of foods high in fat and sugar, replacing them with healthier options such as fruits and vegetables, and ensuring that age-appropriate portions are being consumed.
Goals should be set with the child and rewards for achieving these goals can be motivating. Rewards should be inexpensive non-food items such as a book or a family excursion.
It is also helpful to remove temptations that encourage unhealthy behaviours while providing more opportunities for the child to engage in the desired behaviours. Examples would include not having sugary drinks around the house, going for family walks on the weekends and always having fruit available as a quick snack.
It is important, however, to avoid extreme dietary restriction or unbalanced diets since these could impair the child’s growth and development. It should go without saying that weight loss supplements are not appropriate in children.
Adolescents
Adolescents are a challenging group and the intervention will only be successful if the teenager acknowledges the need for change and is ready to commit to it.
Parents should ‘only’ play a supporting role. The main issue at this age is peer pressure for the consumption of fast foods and high-calorie snack foods.
Strategies used in this age group involve negotiating acceptable food swaps, portion control and an increase in physical activity.
Physical activity guidelines
Children under five who can walk on their own should partake in at least three hours of physical activity per day. This includes both light activity such as moving around and playing, and more energetic activity such as running and jumping.
Children and young people aged five to 18 years should aim for at least one hour of moderate-intensity physical activity each day, such as fast walking, playground activities, cycling and organised sports.
Screen time
Screen time (watching television, using computers or mobile phones) has become an increasingly insidious problem, and for a lot of children (and their parents) reducing screen time can be the most challenging change to make.
According to WHO recommendations (2019), screen time should be avoided in children under one, while children between two to four years should be allowed not more than one hour of screen time per day. It is recommended that parents designate media-free times for all the family (e.g. meal times), as well as media-free locations at home, such as bedrooms.
Manuel Attard is a registered dietitian and nutritionist.
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