Childhood Obesity: Webchat with Professor Paul Gately, Friday 6 July, 12-1pm

[RachelMumsnet]

Today one in three children are overweight or obese and research suggests that, if untreated, 85% of these children will become obese adults. To coincide with National Childhood Obesity Week Professor Paul Gately is joining us on Friday at 12 midday for a webchat about childhood obesity.

Professor Gately has over 20 years research experience in the field of childhood obesity and the study of weight loss programmes throughout the world. He formed the MoreLife programme which works across the country in partnership with the NHS to deliver specialist weight management services.

Paul has presented a number of television programmes on the subject of childhood obesity and is a spokesperson for Change4Life. He is also consultant to many government agencies, health organisations and corporations throughout the UK and internationally.

If you're worried your child is obese, or you have concerns about their diet or want advice on how to help them lose weight, join the webchat on Friday at midday or post a question in advance to Professor Gately.

[PaulGately]

@lastnerve

Would you agree or disagree that Child Obesity now, is more to do with the fact Children don't play enough and don't have the same levels of freedom they used to, rather than eating habits??? Its a rare opinion I wondered if you agreed.

I believe play is very important, but many people do not realise why it?s important, they often think it?s about the calories that kids burn, actually I don?t think the calories burned is the biggest benefit of play. I believe play has a range of benefits which include, developing relationships, learning to win and lose, interact with other kids, learning rules and developing social skills that are really important for young children?s development.

In terms of food and eating habits they are also very important, although eating and food intake has a greater direct impact on weight gain of children.

[PaulGately]

@StillSquiffy

I'm another one at my wits end. DS is not yet 9 but weighs 46kg (he is 142cm). He is constantly hungry and would eat like a horse given half a chance.

I've tried to regulate the quality of what goes in (scrambled eggs & bacon breakfast, healthy cooked school meal - private school and v high quality - and pretty healthy evening meal - roast/chicken & salad/salmon & greens). Water or milk (with one small glass of juice allowed a day). Generally lollies or yogurt for pudding. The problem is not quality, it is quantity - he is hungry, hungry, hungry.

Because GH and I have been low GL/low carb for years, we also limit the carbs and sugar quite a bit (not fully - he is allowed a bit of pasta here and there, pizza once a week, and desert once a day). We simply don't know what to do next. He is the most active child I know - 14.5 hours of hard sport a week (squash, swimming, rugby, footie, karate, tennis), and there is simply no more room in the day for him to do any more sport. He tries so hard and still he goes to sleep crying sometimes because his classmates call him 'tubs' and 'chubbers'. He's even asked his teachers at school to oversee his food selection instead of just diving in like the other boys

An 8YO boy shouldn't be wearing age 14 clothes with a 32" waist, but I really have no idea what I can possibly do.

This is a great example of the challenges that are faced by many parents out there. thanks for your question, you are clearly working very hard to address what you rightly see as an issue. I would take the information and work out the BMI of your son. Then i would look for some help, at his age and with secondarys school on its way now is a critical period.

Fundamentally you are doing many of the right things, but you proably need some help so that you can get the energy balance right.

First step is to begin monitoring your sons, food intake and physical activity levels, you have provided some information, but I think in more detail is a really important first step.

It is critical that you tackle this as a team a family team, where everyone is working together. Like any team, if it doesnt work together it wont be successful. This means that your son should be bought into the process as much as everyone else. If he feels on his own then it wont work. I mention this as i often see this situation, where many of the family members try really hard to help, but its overwhelming! whilst the child in question is thinking, why dont they just give me a hug!!!!!! So teamwork is key.

I also believe kids even as young as 8 should own their own journey, you have clearly put boundaries in place and created a positive physical activity and helathy eating environment, so how does he want to address some of the issues is an important element of your journey?

The real problem for many parents is that there are not the local services to help. MoreLife run weight management services across the UK but not everywhere. Look on our website to see if there is a free service in your area.

Good luck, remember like the development of a child, and the support parents provide is over the course of life not just a few weeks. Physical activity and healthy eating behaviorus are the same they are lifelong behaviours.

[PaulGately]

@ohforfoxsake

I'd like to know your views on the causes of the obesity epidemic, and how we can realistically implement change for the future. I don't mean rolling out government initiatives, but a fundamental understanding in how to take care of ourselves and our families.

It seems to me that in the last 3 decades we have seen a move towards faster, more processed foods, less activity, schools no longer teaching home economics, and many parents (through no fault of their own) who don't have the knowledge, time or inclination. Food is prepared for us, labelled 'good' or 'bad', and we take this as read. What about the calories v fat argument?

Also, in you opinion, should an influential parenting website be promoting fast food brands?

Wow what a tough question how long have I got?!

We do need lots of changes to the system; it is very complicated and involves a range of factors. We know that obesity is linked with a number of issues and I would say we need government commitment and action. I think public opinion is also important and I think that should be lead by much more empathy for overweight obese people and children. The negative attitudes I see and hear about are unfair and unhelpful, if people realised the negative impact they had on obese children and adults I don?t believe they would continue to have such negative views.

Food brands and fast food brands are interesting question, my view is that they are here to stay although over the last decade they have been making changes and will continue to make changes as customers change their preferences. A key factor is no food company is going to make and try to sell poor tasting food so it isn?t easy for them to change. I will be controversial now and say that the organic panic that has been created doesn?t help either. The problem for many companies is that the ?consumer is asking for natural foods? which limits what food companies can do to reduce the energy content of foods without limiting taste.

[PaulGately]

@JugglingWithTangentialOranges

I'm very interested in the idea that breast-feeding can help regulate a baby and child's appetite, and this can have a continued effect throughout life.

I BF my two children for an extended (or natural term) time, (up to 4 and 6 years respectively)

I feel they've always been good at regulating their own nutritional intake, though I don't go out of my way to give them sweets, and puddings and cakes etc. are more of an occasional than everyday occurrence. We have a fairly healthy vegetarian diet. We have positive attitudes to food, enjoying it as a sociable and enjoyable part of life. My son said just today that his favourite fruits were pineapple, mango, and lychee in that order ( as we shared a tin of lychee with pineapple) I thought "good call DS" - (but what about bananas ? He said apples are pretty nice too )

Anyway, questions would be ....

How important do you feel breast-feeding is in helping to regulate children's appetites ?

How important do you feel a positive approach to food is within the family, in combating obesity ?

And I'm also interested to see what you feel about the role of exercise and active, outdoor lifestyles in children's lives ( as lastnerve has asked )

I have worked with young children and their families throughout my working life, as well as my experience with my own two children.

Sounds like you are doing really well already
We think breastfeeding is important, however as you can appreciate it is very complicated and the behaviour of breastfeeding and what children learn from it will be part of a complicated mix of other genetic and environmental factors and what we call programming factors (i.e. what goes on during pregnancy).
Feeding and the establishment of behaviours at home is critical, don?t let food become a battleground. I would say the parents should provide the environment (what is available to eat etc) and the child should choose what they eat. If these roles are changed it will become hard and conflict will ensue.

[PaulGately]

@lovelydogs

Nicolamary I have the same problem, my 10yr old DD is overweight but she loves food. It's getting worse though. I try to make sure everything is healthy but as a vegetarian I struggle to find foods that contain enough protein to fill her up. I have only very recently discovered (within the last couple of weeks) that her high carb (she loves a jacket spud) diet could be the problem. The last webchat and posts from BWIW(hope I got that right)have been real eye openers. She also has a lot of fruits (high sugar?) These were all the things I believed to be healthy.

I dont know her height or how much she currently weighs she is just above average for height and well over 7 stone, absolutely none of her clothes fit for her age group and i often buy her s/m aduts wear. I really worry about diabetes.

I have been concentrating on her diet for the last year and nothing has changed, just got worse. She's fairly active so dont think it's that although I'm shocked that a lot of people say it's not much to do with exercise.

She'll have breakfast, which could be scrambled eggs on toast, porridge, normal full fat yogurt with berries drizzled with agave necter that kind of thing. A snack (!) at school at break time often fruit. Lunch, again struggle with the vegetarian issue so could be Quorn chicken slices with green leaves on seeded bread sarnie. Bunch of grapes, some berries, maybe the healthiest looking cereal bar and small yogurt. She'll come out of school STARVING (her words!!) and raid the fridge, usually fruit or choc spread sarnie or peanut butter. Then have dinner. (Normal veggie dinner)

Where am I going wrong??!!

Its hard to do a dietary analysis in real time, so I would suggest you spend some time recording food intake and physical activity. Also, what are your daughters views on the issue? have you talked about it? We find many parents who are scared to talk about weight issues with their kids. Unfortunately the message the kids are getting is that thier parents dont want to talk about it and are uhappy with them. Of course this is not the case and that is why communication is critical.

Parents are concerned they will do more harm than good and the kids just want someone to talk to about how they are feeling.

Once you have the information then you can start to look at ways to change things. But the plan should be long term. I think it is very sensible that you have been looking at the issue for the last year. You have outlined the last years efforts have not had an impact but the reality is the situation could have been much worse. so keep positive.

I would also check out her bmi as this will give you some indication of what to do next. We have a bmi calculator on our website www.more-life.co.uk If she is in the overweight range, then dont worry to much just carry on monitroing and supporting. If she is in the obese range then you proably need to look for some specialist help. This will help you get on the right track.

[vezzie]

Hi Paul - looking at your 12.32 reply - do you really think that fake food is the answer? when you say "reduce energy content without limiting taste" do you mean artificially low fat? But as our food has become more artificially constructed, we have all got fatter. And "taste" is not what it is about. People don't eat 2500 calories a day because they like the taste, it is because they feel physically hungry (although they are putting fat on). the more low cal junk you eat, the hungrier you feel. I am terrified that views like yours have so much influence.
the mistake is thinking that it is possible or desirable to create foods you can eat all the time. The answer is to empower people - physically (by good food) and pyschologically (a very complicated thing) not to eat all the time, not to feel so hungry

[PaulGately]

@Indith

Why are we so obsessed with lowering our fat intake to the detriment of other things and how do you think we can change this attitude when children as young as 5 are being told "fat is bad" in school?

For example fat free yoghurts etc that simply have other rubbish pumped into them to make them just as creamy and tasty as a perfectly healthy whole milk natural yoghurt yet the additive filled one is seen as the healthier option. My 5 year old comes home freom school saying he mustn't eat this that or the other. He has started fussing about fat on meat and refusing to eat it and I have to try to undo the teaching done by school to let him know that a healthy diet needs to have some fat etc in it and that as a growing child he needs a bit of everything. Have we completely lost sight of what a normal healthy diet actually is?

You raise an important question about knowledge and education. Unfortunately, there is limited nutritional education for teachers and other health and educational professionals so poor information is found everywhere. We spend a lot of time in our programmes trying to re-educate children and parents. This is because there is a lot of poor information out there that confuses many people.

[PaulGately]

@SittingBull

Question: at a very real level, what is the best way to ensure our children are a healthy weight?

My daughter is 6 and we encourage healthy eating and exercise and try to model this behavior also - however - there is a fine line between encouraging healthy living and being obsessive and actually causing a problem or a weight obsession. How do you know where the line is? How do I know I am not causing the problem?

Thanks in advance

This is a really important question. I think we often make food and weight such negative issues that it is no wonder children and parents are confused about what to do.

Many people are concerned about the development of poor eating behaviours of their kids or eating disorders.  The reality is that the development of eating disorders is very complex and influenced by a variety of factors. There is still a lot to be understood about them.  There are concerns of course but the research evidence shows that good quality information on healthy eating and physical activity delivered in a supportive environment and in a positive way are unlikely to be contributing factors.

[PaulGately]

@vezzie

Do you believe that there is a connection between increased commercialisation of our diets (more things in packets, fewer unbranded, unprocessed foods, more and more foods marketed specifically as snacks when 50 years ago people ate meals only) and rising obesity?
If so, what do you think the government's role in this should be? Is it really ok to let "food" manufacturers do what they need to do to turn their profits at the expense of the health of the population?
My personal view (as you may have guessed) is that this is one of those areas where the market is not the mechanism that can bring about the best possible outcome. However, anything that says the market is not always right seems to be very unpopular politically. What do you think about this?

I am concerned that placing the burden of "healthy eating" (whatever that is - a can of low-fat worms I won't open) entirely upon individuals, in an unhealthy commercial environment, is actively counterproductive (as well as being unfair) because it adds to the problematisation of food. I think the holy grail of healthy eating is a blithe indifference to food for most of the day when you are not actually eating a meal; and going on and on and on about it, creating this tension between what people should be eating and what is constantly being thrust in their faces, makes people more anxious about food (and more anxious in general) and this will always, in the medium and long term, lead to problems with diets: eating disorders at both ends of the spectrum.

Shouldn't the market be curbed in the interests of our health?

Love this question, very considered!! I think there is a lot that needs to be done; attempts to do this have not been as effective as they can be. My own personal view on this is that the government and the food industry seem to take adversarial positions and I don?t think that is helpful. I think the responsibility deal in the UK has had limited impact because the questions you are asking are also unclear at that level. There is an awful lot to consider.
I think we must be realistic and we must move forward and not look to move backwards. I mean, the food industry is in business to make money, and government are in place to look after the interests of our whole society. But consumers/voters are very powerful and can influence both government (particularly in these days) and companies by what they buy.
This debate will continue for a long time, I believe the companies that invest in this agenda for the future will be more successful. Those that don?t change with the times will become extinct!!!

[PaulGately]

@vezzie

Hi Paul - looking at your 12.32 reply - do you really think that fake food is the answer? when you say "reduce energy content without limiting taste" do you mean artificially low fat? But as our food has become more artificially constructed, we have all got fatter. And "taste" is not what it is about. People don't eat 2500 calories a day because they like the taste, it is because they feel physically hungry (although they are putting fat on). the more low cal junk you eat, the hungrier you feel. I am terrified that views like yours have so much influence.
the mistake is thinking that it is possible or desirable to create foods you can eat all the time. The answer is to empower people - physically (by good food) and pyschologically (a very complicated thing) not to eat all the time, not to feel so hungry

It depends what the objective is. I agree the way food is processed has had an influence on our nations weight. But this is not the only factor. Food availablity (including "natural food") has increased, the fact that food can be stored in friddges or freezers, supermarkets are open 24 hours all contribute to our consumption of food. Portions have increased. We drink more fruit jucie which has the same calories as soft drinks!!!

At the end of the day calories are key, we have to look at this big picture. I spend lots of my time working with families and children, often they are so confused about what they should and should not do, that they give up as whatever they do is wrong in their eyes. We do need to empower them, but in my view that does not mean we can do away with the food industry and change our food system!! I believe we need to work with all tools and if that includes continued food develoment or as you put it "fake food" then I believe this will be necessary for many people that will be unable for a variety of reasons to eat a "healthy diet"

[PaulGately]

A lot of people have asked questions about snacking. The evidence on snacking shows that it does contribute to weight gain, probably more than anything else. But what does snacking mean and when does it become a problem are also important questions.
I was interested to see how many mumsnetters are informed about the range of issues that exist. All of the comments are important and show just how complicated it is. We are clear that snacks are important in weight gain, but we are unclear what types of snacks in what proportions, as part of what diet or lifestyle, for what age group. Therefore we have to rely on informed opinion, which includes things like healthy snacks.
It should be noted though that the calories in fruit is pretty much the same as the calories in sweets or the sugars in snacks. So from an energy balance perspective we need to make sure that overall total calories are considered. The evidence on the impact of 5 a day as a way of managing weight is disappointing and shows that people don?t tend to substitute their more energy dense snacks (chocolate, sweets, crisps, cake) for less energy dense snacks (fruit, veg); they just add it on top. Therefore everything in moderation especially those energy dense snacks!!

[PaulGately]

@nicolamary

SpringGoddess I watched the diet doctor video and had a look at the site last night, so interesting and the theory seemed sound. However, my question is this, do children need some carbs to maintain healthy development? Today I have sent my daughter to school with cooked chicken, ham and cheese in her lunchbox and no carbs. She had porridge for breakfast.

A lot of people have asked about the necessity of carbs in diet. The last decade has seen real debate about carbs and how good or bad they are. Often this debate is badly described which confuses many people and leads to a variety of poor eating practices. We need to consider what we are talking about. There are different types of carbs and they are not all good or all bad. We need carbohydrates in our diet full stop. We of course need protein and fat too. The issue is about the balance of them. The research does show that protein has an effect on appetite and that is why a higher protein and/or low carb diet is promoted. Of course fat comes into play too.
We use the Eat Well Plate as a way of helping children balance their food intake. This includes a mixture of carbohydrate, fat and protein in appropriate portions. I would argue we don?t get the basics of this right, before we move to weird and wonderful diets that include no or low carbs.
The issue of carbs is important; there are many different type of carbs or sugars. Simple Carbs, like the sugar we have in soft drinks or table sugar, are different to complex carbs like pasta, rice, fruit, veg and bread. Our bodies respond differently to these different types of carbs, in addition, even within the complex carbs there can be big differences, for example wholemeal bread contains more fibre than white bread. These differences are important as they relate to the way the body uses these carbs.
We could do a whole webchat just on this topic, basically, carbs are good and not bad. Simple sugars should be used or consumed sparingly, and carbs that include fibre are the best forms.

[vezzie]

Paul, thank you for your answers. I disagree though because I think we do need to change our "food system" - I think we need to do exactly that, because at the moment we are sacrificing human beings by placing business first. I think it is defeatist to say, oh well, the food industry have to make money so let everyone else struggle and maybe die, except a few lucky individuals with the will and the education and the metabolism to somehow get through.
Also I think it is very sad that you say "many people that will be unable for a variety of reasons to eat a "healthy diet"" - really? What reasons? Why accept that many - not some, many - can't just eat normally, modestly, healthily?

[PaulGately]

@nicolamary

Thanks SpringGoddess I will take a look. Going high fat does go against all your instincts but I'm open to anything.

Hi it goes against instincts as it is not the right way to go!!! The issue is not high carb and low fat vs low carb. It is obviously more complicated than that. The evidence base and the guidance from government and organisations like the British Dietetic Assocation is sound. It's the implmentation of this guidance that is not done well, thats the problem. In addition, there are plenty of people out there that are trying to look for a magic bullet!!! Unfortunately one doesnt exist! That doesn't mean we need to change what we and the wealth of evidence we have tells us to do!

The work we do at MoreLife tries to understand how we put the guidance into practice! When we do this we find that people are not putting into practice what they think they are! When we work with them and give them the skills to change their bheaviours they are effective at weight loss and weight loss maintenance.

try refining what you are doing, dont look for a completely new path is my view!!

[StillSquiffy]

Surely the biggest problem with snacks is that it is impossible to have healthy 'on the hoof' snacks and mums are forever bussing the kids from one activity to the next? It's easy enough to give my kids cucumber sticks and hummous when they are at home, but you can't pick up this kind of stuff in cafes and garages.

Are packs of nuts the answer? I am on the fence about nuts for kids - even though I am mostly convinced by the low carb argument, I still get worried about the very high calorie load and also the salt.... what's your view?

[vezzie]

Paul, I know time is tight but I would love you to answer PostBellumBugsy's questions

[SpringGoddess]

Interesting view on white pasta - which Dr Briffa described in his webchat yesterday as having almost the same affect on the blood and insulin as sugar. Who is right?

[StillSquiffy]

Sorry, should have said low net carb content in that post, am well aware unadjusted carb content v high.

[PaulGately]

@vezzie

Paul, thank you for your answers. I disagree though because I think we do need to change our "food system" - I think we need to do exactly that, because at the moment we are sacrificing human beings by placing business first. I think it is defeatist to say, oh well, the food industry have to make money so let everyone else struggle and maybe die, except a few lucky individuals with the will and the education and the metabolism to somehow get through.
Also I think it is very sad that you say "many people that will be unable for a variety of reasons to eat a "healthy diet"" - really? What reasons? Why accept that many - not some, many - can't just eat normally, modestly, healthily?

I do believe the we need to change the food system, but this will take a long time to do, and the drivers to do it must be considered!!! I work with lots of children and adults. Changing the food system will not help him.

We know that finances, education, mental health, social circumstances all have an influence on peoples ability to eat a healthy diet. This is well established by the evidence base.!!

I certainly dont sit and accept the status quo, I work hard to contribute to changing these systems but it takes times!! I'm not a defeatist, just a realist !!

[PaulGately]

There are some great questions that have gone unanswered for which we will put some answers together and add to our blog next week. In the meantime, you can like us on facebook at facebook.com/morelifeuk or follow us on twitter @team_morelife for regular MoreLife updates.

[SpringGoddess]

So carbs have no effect on insulin levels and consequently fat storage, massively fluctuating blood sugar levels and consequently increased appetite - really?

[vezzie]

Thankyou again Paul

[PaulGately]

@StillSquiffy

Surely the biggest problem with snacks is that it is impossible to have healthy 'on the hoof' snacks and mums are forever bussing the kids from one activity to the next? It's easy enough to give my kids cucumber sticks and hummous when they are at home, but you can't pick up this kind of stuff in cafes and garages.

Are packs of nuts the answer? I am on the fence about nuts for kids - even though I am mostly convinced by the low carb argument, I still get worried about the very high calorie load and also the salt.... what's your view?

There are lots of snack options out there, i think they will continue to be provided by many retail outlets, the greater the demand the greater the supply!!! Nuts are great, but they are highly energy dense so should be considered as part of the overall energy balance!!

[PaulGately]

thanks everyone!!

[SpringGoddess]

To sum up - eat less, move more and attend a Morelife activity - has anyone learned anything new? If that's all we've got why would a parent with an overweight child see a specialist - what exactly are they going to do - measure the child, work out their BMI, then ...... what? oh yes eat less move more - right back to where we started.....am I missing something?