From 29^th April to 3^rd May 2019, the counselling department at Verschilds High School hosted their Health and Wellness Week and we were delighted to have been invited to take part in two of their planned events.

On 29^th April, we spoke, bright and early, at the school’s assembly on the topic of stress management. During our 15 minute presentation, we talked about what stress is, what types of situations cause stress, the impact of stress and how we can manage stress.

We encouraged students to think about their own personal situations, especially during this exam period, to see how they can address any stressors that may be affecting their wellbeing and provided tips on managing these, which included – identifying stressors, elimination/delay of stressors, preparation, stress relief techniques, building resilience and getting support.

We had a great session with the student body and therefore were very happy to return on the 3^rd May for their health and wellness fair.

During their health and wellness fair, we set up a stall and promoted living a healthy lifestyle. We spoke to students and staff about the importance of children and teenagers getting enough exercise and physical activity (WHO recommends 60 minutes per day), drinking more water, eating 5-7 portions of fruit and vegetables per day and cutting down on sugary drinks.

We had information showing how much sugar is in many popular soft drinks and students and teachers were shocked to learn that one can of coke contains 8 teaspoons of sugar.

To encourage children to swap their unhealthy snacks for healthier snacks, we had some lovely mangoes for staff and students to sample and this included some dried mangoes. Dried mango is a great alternative to candy and chocolate and it tastes great –  the students (well…most of them) loved it.

We also held a competition where we asked students how many minutes of physical activity children and teenagers should take part in every day and three lucky students won a comic book – congratulations.

Finally, it was great to connect with the other stallholders, some of whom were familiar faces, such as the team behind Mother Becky Bush Tea and Sugar Town Organics. It was nice meeting the Gideon  Force Organic Agriculture  Cooperative, Close to Nature and the Drugs and Substance Misuse Team and learning about the great work they are all doing.

We had a great time at Verchilds High School and would like to thank the staff for their kind invitation and both staff and students for their warm welcome, visiting our stall and asking some great questions.

On 26^th April, we attended the Ministry of Health’s focus group on sugar-sweetened beverages (SSBs). This event was part of the Ministry’s consultation process to get feedback as well as inform the public and key stakeholders on the progress being made to develop a national SSB policy.

This event was a follow-up to the Ministry’s SSB National Consultation which took place in November 2018 and provided an update on the policy imperatives that were presented last year.

From the focus group we learnt that the updated policy recommendations are:

• A 32% excise only tax on SSBs
• The tax will apply to calorically sweetened beverages including carbonated drinks (sodas), sweetened carbonated water, sugar-sweetened juices, sports drinks, energy drinks, tea and coffee drinks, sweetened milk/milk alternatives, milk powdered blended drinks, powdered drink mixes and drink mix syrups
• Excluded from taxation would be fresh fruit juice (no sugar added), unsweetened milk/milk alternatives, infused water, unsweetened carbonated drinks and non-caloric sweetened drinks
• Alternatives to SSBs will be suggested to the public. These would include: fruit/vegetable infused water, plain water, unsweetened carbonated water, unsweetened herbal (bush) tea and fresh-poured coconut water (unsweetened coconut water)
• The tax revenue will be used to provide: a water infrastructure, water fountains in schools, reusable water bottles in schools, healthier school meals, public health campaigns, National Health Insurance, implementing a marketing ban to children, policy development for safe school zones and to improve agriculture education especially in primary schools

What About Artificially Sweetened Beverages?

One area still to consider, which is an interesting one, is whether to tax artificially sweetened beverages (ASBs).

ASBs are drinks that have been sweetened with non-nutritive sweeteners which include saccharin, acesulfame, aspartame, neotame, sucralose and stevia.

The field of ASBs is a confusing one. It has been hard to answer the simple question of whether they are beneficial or not. Therefore  WHO funded a large global study to answer this question, but this still didn’t answer the question with health officials stating the following:

“The inconclusive results of the review of the evidence suggest that we need to see better, bigger and longer-term studies of non-sugar sweetener use, to find out for sure their benefits and risks. The review suggests that there could be some benefits in terms of preventing weight gain, but the evidence so far is not strong and does not show consistent enough results to be sure.”

Whenever there is doubt, we recommend that the public keeps things simple and uses products where there are clear health benefits and there is no doubt. The best option at the moment is to consume unsweetened beverages.

In the meantime, the Ministry will evaluate whether ASBs should be taxed as part of their SSB policy.

 Why Tax SSBs?

Childhood obesity is a significant challenge here in St Kitts and Nevis. A PAHO report revealed that 33% of secondary school children in the twin-island state were overweight and 14% were obese. More recently, in 2017, a UNICEF report published that 26% of children in St Kitts and Nevis are obese.

SSBs have been linked to weight gain and obesity. Therefore, the taxation of SSBs has been utilised throughout the world as a method of tackling obesity by creating a deterrent which leads to a reduction in the purchase and consumption of SSBs.

Taxation of SSBs has three important aims. The first it to incentivise manufacturers to reformulate or replace their products to create healthier options, the second is to deter the public from purchasing and consuming SSBs by making them unaffordable and the third is to raise funds from the tax revenue that can be used to support initiatives aimed at improving the health of the public.

Next Steps

The Ministry of Health will now take all the feedback from their consultation, focus group and other engagement activities to draft a policy which will be circulated to stakeholders for any final comments before it is sent to Cabinet for approval.

References

1. UNICEF, Situation Analysis of Children in the Federation of St Kitts and Nevis, UNICEF Office for the Eastern Caribbean Area and the Government of St Kitts and Nevis, Christ Church, Barbados, 2017
2. PAHO, Health in the Americas, 2012: St Kitts and Nevis, PAHO, 2012

At the end of last year, we started developing our two-year strategy after a year of exploring the public health landscape in St Kitts and Nevis, and the wider Caribbean region.

After careful consideration, we settled on focusing on women’s health and the prevention of childhood obesity.  In a previous blog we explained why we decided to focus on women’s health and today we’ll discuss why we’re also going to focus on childhood obesity.

 Why Childhood Obesity?

Childhood obesity is a major health issue in the Caribbean with 1 in 3 children being overweight or obese.  The rate of childhood obesity in the Caribbean is higher than the global average and is reported to be on the rise.

Being obese and overweight in childhood is linked to the development of several health issues such as type 2 diabetes and hypertension, and it also negatively impacts a child’s mental health. These health issues can follow children into adulthood with children affected by obesity, or who are overweight, having an increased risk of becoming overweight or obese adults and developing non-communicable diseases (NCDs) such as cancer and heart disease in later life.

Childhood Obesity in St Kitts and Nevis

Childhood obesity is a significant challenge here in St Kitts and Nevis. A PAHO report revealed that 33% of secondary school children in the twin-island state were overweight and 14% were obese. More recently, in 2017, a UNICEF report published that 26% of children in St Kitts and Nevis are obese.

Data has demonstrated that NCDs are becoming an epidemic in the Federation with 83% of deaths in St Kitts and Nevis being due to NCDs. We must do something about this to prevent our citizens from dying prematurely and one approach is to tackle childhood obesity.

To combat childhood obesity, we have to ensure that children adopt a healthy lifestyle and we also have to create a healthy environment at schools, in homes and within society so that children can make healthy choices.

Tackling Childhood Obesity in the Caribbean

The Healthy Caribbean Coalition (HCC) is a civil society member organisation that was established to combat NCDs and their associated risk factors.

One of their key focus areas is childhood obesity prevention and as part of their work, they published their Civil Society Action Plan for Preventing Childhood Obesity in the Caribbean. This plan provides guidance on how HCC members (we are a member) can strategically address this significant health challenge in their specific island states.

Lake Health and Wellbeing is thus aiming to align its strategy for childhood obesity prevention in St Kitts and Nevis with the following HCC priority areas:

• Trade and fiscal policy (taxation of unhealthy foods)
• Nutrition literacy (mandatory front-of-pack-labelling of foods)
• Early childhood nutrition (enacting legislation related to the International Code of Marketing of Breast Milk Substitutes)
• Marketing of healthy and unhealthy foods to children (Banning the marketing of unhealthy foods and beverages to children)
• School and community-based interventions (Banning the marketing and sale of unhealthy foods and beverages in and around schools, mandatory physical activity in schools)

What We’ve Done So Far

We’ll be taking our time and starting slowly with the implementation of our childhood obesity prevention strategy. We’re delighted to say that we have started making some progress and have achieved the following:

• We took part in the HCC’s regional campaign which aimed to raise awareness of childhood obesity in the Caribbean and influence the region’s leaders to champion and implement critical policies that will improve the health of our children and reduce childhood obesity. One of the key parts of this campaign was their childhood obesity prevention petition (call-to-action) which called on our Heads of Government to enact key policies and legislation which have been demonstrated as effective measures to combat childhood obesity. We got involved by gaining support for the HCC’s petition in St Kitts and raising awareness of this issue through a four-part podcast series. You can find out more about this here

• We’ve started advocating for front-of-pack nutrition labelling as this is an easy way for parents to assess the health of the foods they purchase. We submitted a response to the CARICOM Regional Organisation for Standards and Quality‘s consultation on pre-packaged food labelling which included front-of-pack food labelling and are now a member of the SKNBS Technical Committee for Labelling.

• We have also started advocating for the introduction of a sugar-sweetened beverage tax in St Kitts and Nevis. As part of this process, we attended the Ministry of Health’s National SSB Consultation, have prepared a position statement of SSB taxation in St Kitts and will be attending an SSB focus group, at the end of April 2019, organised by the Ministry of Health.

• We launched a childhood obesity social media campaign for World Cancer Day

Next Steps

We’ll be continuing with the above and exploring the development of resources to encourage children to get active.

We’re really excited about this work and are looking forward to making a difference in this area.

References

1. UNICEF, Situation Analysis of Children in the Federation of St Kitts and Nevis, UNICEF Office for the Eastern Caribbean Area and the Government of St Kitts and Nevis, Christ Church, Barbados, 2017
2. PAHO, Health in the Americas, 2012: St Kitts and Nevis, PAHO, 2012

Childhood obesity is a major health issue in the Caribbean with 1 in 3 children being overweight or obese. Being obese and overweight in childhood is linked to the development of a number of health issues such as diabetes and hypertension, and it also negatively impacts a child’s mental health. These health issues can follow children into adulthood with children affected by obesity, or who are overweight, having an increased risk of becoming overweight or obese adults and developing non-communicable diseases such as cancer and heart disease in later life.

Childhood obesity is a significant challenge here in St Kitts and Nevis. A PAHO report revealed that 33% of secondary school children in the twin island state were overweight and 14% were obese. More recently, in 2017, a UNICEF report published that 26% of children in St Kitts and Nevis are obese.

Childhood Obesity Solutions

To combat childhood obesity we have to ensure that children adopt a healthy lifestyle and one approach is to explore how we can reduce the consumption of products that are high in sugar, salt and saturated fat. One strategy is to focus on nutrition education and making it easier for to parents identify which foods are high in these components, so they can easily make healthy choices when they purchase groceries.

Front-of-Pack Nutrition Labelling

Front-of-pack nutrition labelling has been introduced in many countries to provide a quick and easy way for consumers to assess the health of the foods they purchase. Currently there are several front-of-pack nutrition labelling systems with the main options being:

Summary indicators. These include the Health Star Rating developed by Food Standards Australia New Zealand which gives foods a 1 to 5-star rating based on their healthfulness and France’s Nutri-score which puts foods into five categories, A to E, based on how healthy they are deemed to be.

The traffic light system. This uses the colour code green, amber and red to communicate whether products have a low, medium or high level of salt, sugar and saturated fat based on daily intake references.

Warning labels. This uses a ‘high-in’ label to inform consumers that foods are high in certain nutrients

Front-of-Pack Nutrition Labelling Consultation in the Caribbean

Caribbean countries are starting to explore the introduction of front-of-pack nutrition labels. The CARICOM Regional Organisation for Standards and Quality held a consultation from 15^th October 2018 to 31^st January 2019 on pre-packaged food labelling which included front-of-pack food labelling. The labelling system being explored is warning labels and we were pleased to have been able to submit a response to their consultation.

Our Views

• We support the introduction of front-of-pack nutrition labels in the Caribbean
• We believe that front-of-pack nutrition labels present a quick, easy and useful way of communicating the healthiness of pre-packaged foods
• We believe that front-of-pack labelling provides information in a way that is easier to understand, with respect to healthiness, than back-of-pack nutrition labelling
• We believe more work is needed to determine which front-of pack  labelling system would be most effective in the Caribbean
• We believe that a full assessment is required to determine if front-of-pack food labels will influence consumer behaviour in the Caribbean and if not, why not
• We feel that if the ‘high-in’ labels are to be used, the colour of the labels should be reconsidered, from black to red. This is important so that we begin to steer dialogue away from black always being seen as a negative, which has a wider societal context with regards to race and ethnicity
• We believe a standard international front-of-pack nutrition label is required to ensure consistency and to prevent confusion

Next Steps

CARICOM Regional Organisation for Standards and Quality will review all the comments it has received from throughout the region and decide on a way forward with respect to nutrition labelling of pre-packaged foods.

We look forward to seeing how the strategy for FOP labelling in the Caribbean develops and are pleased to see this action being taken on this matter.

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References

1. UNICEF, Situation Analysis of Children in the Federation of St Kitts and Nevis, UNICEF Office for the Eastern Caribbean Area and the Government of St Kitts and Nevis, Christ Church, Barbados, 2017
2. PAHO, Health in the Americas, 2012: St Kitts and Nevis, PAHO, 2012
3. Kanter, R., Vanderlee, L., & Vandevijvere, S. (2018). Front-of-package nutrition labelling policy: Global progress and future directions. Public Health Nutrition, 21(8), 1399-1408. doi:10.1017/S1368980018000010

World Cancer Day is on 4^th February and it  gives the world the opportunity to come together to raise awareness and campaign on key issues to improve the care, support and treatment given to patients.

Organisers, the UICC,  announced that the theme for World Cancer Day is #IAmAndIWill and this theme highlights that fact that whoever you are, you have the power to reduce the impact of cancer for yourself, the people you love and for the world.

The campaign therefore encourages everyone to make a commitment by using the hashtag and sharing who you are and what you will commit to in order to tackle cancer.

Our #IamAndIWill Commitment for 2019-2021

Our World Cancer Day commitment is to focus on children and raise awareness of the fact that overweight or obese children are more likely to become overweight or obese adults, and being overweight as an adult increases a person’s risk of developing cancer. In  fact, the World Cancer Research Fund has found that being overweight or obese throughout adulthood is linked to an increased risk of developing 12 types of cancer.

Our campaign appeals to parents to reduce their children’s future cancer risk by ensuring they’re a healthy weight now, and this can be achieved by ensuring that children:

• Are physically active and take part in 60 minutes of physical activity every day
• Eat a healthy diet

Childhood obesity is a significant challenge here in St Kitts and Nevis. A PAHO report revealed that 33% of secondary school children in the twin island state were overweight and 14% were obese. More recently, in 2017, a UNICEF report stated that 26% of children in St Kitts and Nevis are obese.  We have to tackle childhood obesity to improve the health of our children to ensure they become happy, healthy adults.

We believe that by beating childhood obesity we can also contribute to beating cancer, and other non-communicable diseases (NCDs).

“I am Lake Health and Wellbeing and I will make an impact by spreading the word

about childhood obesity increasing a child’s future cancer risk” – #IamAndIWill

What We’re Doing Beyond World Cancer Day

Our work doesn’t stop after World Cancer Day, we’re working to beat childhood obesity all year round through our new childhood obesity prevention project. 

We’re currently working on developing innovative resources to get children active so they can easily get to and maintain a healthy weight.

How You Can Get Involved

You can get involved by raising awareness on social media and sharing your thoughts on this issue. You can use any of the images below or the short video clips below.

                                                               

                                                               

Also, we’d love it if you could support us by making a donation, which will go towards our childhood obesity prevention project.

You can make a donation below:

[asp_product id=”5804″]

Thank you for any support you’re able to provide and we hope you’ll join us for World Cancer Day to #BeatChildhoodObesity and #BeatCancer

References

1. UNICEF, Situation Analysis of Children in the Federation of St Kitts and Nevis, UNICEF Office for the Eastern Caribbean Area and the Government of St Kitts and Nevis, Christ Church, Barbados, 2017
2. PAHO, Health in the Americas, 2012: St Kitts and Nevis, PAHO, 2012
3.  World Cancer Research Fund, Diet, Nutrition, Physical Activity and Cancer: A Global Perspective,  World Cancer Research Fund International, London, UK, 2018.

On 20^th November 2018, we were on the beautiful island of Barbados for the Healthy Caribbean Coalition’s ‘Beyond the Call to Action Event: Towards School Policies in Support of Childhood Obesity Prevention.’

This event marked the end of the HCC’s childhood obesity prevention campaign. One of the key parts of this campaign was the HCC’s childhood obesity prevention petition (Call to Action) which called on Heads of Government to enact any of the following policies and legislation which have been demonstrated as effective measures to combat childhood  obesity:

• Imposition of a tax of not less than 20% on Sugar Sweetened Beverages (SSBs) and use tax revenue for NCD prevention and control.
• Banning the sale, promotion and marketing of SSBs, and unhealthy foods and beverages in and around schools.
• Mandatory physical activity in all primary and secondary schools
• Adoption and application of regional standards for nutritional and front of package labelling of foods and beverages.
• Banning the marketing of unhealthy foods and beverages to children (includes non-school environments)
• Enacting legislation related to The International Code of Marketing of Breast-milk Substitutes.

This event brought together a wide cross section of national and regional stakeholders to celebrate the achievements of the campaign and to showcase all the great work being conducted across the Caribbean to tackle childhood obesity. We heard from speakers from the Bahamas, Bermuda, Jamaica and Trinidad. It was particularly interesting listening to Dr Simone Spence’s presentation explaining Jamaica Moves’ new initiative targeting schools.

Youth Involvement

It was also very nice to see young people actively participating in this event. Young people took part in a parallel youth session led by Krystal Boyea, the HCC’s Youth Advocate. In this session young people discussed the solutions and barriers to creating a healthy school environment and also explored the types of products sold in schools and how the school environment influences behaviour and health.

We Took Part in a Panel Discussion

We had the pleasure of taking part in a panel discussion with other CSOs including the Antigua and Barbuda Diabetes Association,  the Heart and Stroke Foundation of Barbados,  the Grenada NCD Commission, the St Lucia Diabetes and Hypertension Association and the Heart Foundation of Jamaica about the importance of coalitions and collaborations in addressing critical issues such as childhood obesity. We had an interesting discussion, facilitated by Sir Trevor Hassell.

We really enjoyed this event and would like to thank the HCC for inviting us to take part in the panel discussion. We look forward to hearing more about the work being conducted across the Caribbean to tackle childhood obesity and making our own small contribution to this effort.

On 1^st November, we attended the national consultation on the impact of sugar sweetened beverages (SSBs). This event was organised by the Ministry of Health in collaboration with the Pan American Health Organisation (PAHO) as an early step towards the development of the nation’s strategy for reducing the public’s consumption of SSBs.

The Ministry’s strategy for SSBs forms just a small part of their non-communicable disease (NCD) prevention plan which outlines actions that are needed to create a healthy environment and promote exercise.

Speakers Set the Scene

During the consultation we heard from an excellent panel of speakers which included:

• Mrs Delores Stapleton-Harris, Permanent Secretary, Ministry of Health
• Hon Wendy Phipps, Minister of State with Responsibility for Health, Community Development, Social Services and Gender Affairs
• Dr Godrey Xuereb, PAHO/WHO Representative for Barbados and the Eastern Caribbean
• Dr Keisha Liddie, District Medical Officer
• Dr Lisa Powell, Professor and Director of Health Policy and Administration, School of Public Health, University of Illinois
• Dr Marissa Carty, NCD Coordinator, Ministry of Health

Together the panel outlined the need for the development of a strategy on SSBs, reminding the audience that in St Kitts and Nevis NCDs, such as diabetes, cancer, heart disease and high blood pressure, are a major health challenge with 83% of deaths in the Federation being attributed to these conditions.

Hon Phipps described how NCDs are not only a threat to the health of the nation but are a significant socio-economic issue. Whilst Dr Xuereb provided information on the need for a SSB policy stating that it is just one of many strategies to improve the health of a nation and help countries achieve the sustainable development goal (SDG) on health. He stated that in order to achieve the SDG on health it is important to focus on improving the health of children as currently, in the Caribbean, childhood obesity is very common and is a major factor in children developing NCDs. He explained that what is driving NCDs is the increased consumption of sugar, and the major source of sugar is SSBs – SSBs make up 40% of children’s sugar intake with 70% of children in the Caribbean drinking one or more SSBs per day. He stated that data from Barbados, Mexico and Chile has shown that increasing the cost of SSBs through taxation has reduced the consumption of SSBs and therefore this is an effective strategy in tackling NCDs.

We also heard from Dr Keisha Liddie who presented a very in-depth and comprehensive situational analysis of St Kitts and Nevis. Dr Liddie described the data and trends for NCDs in the Federation showing the increase in the incidence of specific NCDs year on year and their impact on the nation. Finally, Dr Powell explored the economics, practicalities and important considerations when introducing a tax on SSBs and provided a number of recommendations which included:

• Implement a 20% SSB tax
• Include all forms of SSBs in the taxation strategy e.g: soda, energy drinks, sports drinks, fruit drinks, sweetened teas/coffees, sweetened water and beverage powders/syrups). Exclude zero calorie beverages
• Apply the tax to all imported and domestically produced SSBs
• Earmark the tax revenue for public health initiatives with an emphasis on nutrition and physical activity
• Carry out public awareness and education to inform the public about the SSB tax and its objectives
• Ban the sale of SSBs in schools
• Ban the sale of SSBs in hospitals and government buildings
• Regulate the marketing of SSBs in and around schools
• Develop a drinking water infrastructure in schools that provide reusable water bottles to school children
• Provide local agricultural products as snacks in schools
• Promote the implementation of school gardens as a learning tool and to improve access to fruits and vegetables
• Explore appropriate sponsors for youth sports that align with the objectives of improving health
• Provide funding to increase activity spaces

St Kitts and Nevis’ Proposed Approach to SSBs 

Dr Marissa Carty outlined the Ministry’s initial ideas on their approach to reducing the consumption of SSBs and gave the audience the opportunity to provide feedback on all the policy areas. The Ministry’s proposed policy imperatives include:

• A 40% tax on SSBs (update: the proposed tax is now 32%)
• The tax will apply to calorically sweetened beverages including carbonated drinks (sodas), sweetened carbonated water, sugar sweetened juices, sports drinks, energy drinks, tea and coffee drinks, sweetened milk/milk alternatives, milk powdered blended drinks, powdered drink mixes and drink mix syrups
• Sugar would no longer be zero rated when it comes to tax
• Excluded from the tax would be: fresh fruit juice (no sugar added), unsweetened milk/milk alternatives, infused water, unsweetened carbonated drinks and non-caloric sweetened drinks
• Alternatives to SSBs will be suggested to the public. These would include: fruit/vegetable infused water unsweetened water, plain water, unsweetened carbonated water, unsweetened herbal (bush) tea and artificially non-caloric sweetened beverages
• The tax revenue will be used to provide: a water infrastructure, water fountains in schools, reusable water bottles in schools, healthier school meals, public health campaigns, National Health Insurance, implementing a marketing ban to children and policy development for safe school zones.

Our Thoughts

We 100% support the government’s approach to SSBs as there is a need to tackle childhood obesity in St Kitts and Nevis and by reducing SSB consumption this can be achieved.

We believe a 40% (or 32%) tax is sufficiently high enough to deter consumption of all SSBs, anything lower than this could lead to consumers simply replacing expensive SSBs for more affordable SSBs. There was some evidence of this in Barbados where the tax is 10% and this suggested that this level of taxation wasn’t high enough to deter consumers from buying the lower priced SSBs.

We think it is important that the revenue raised from the SSB tax should fund public health initiatives particularly those that are aimed at childhood obesity and so we applaud the Ministry’s suggestions on the use of the tax revenue. We would also like to see the tax revenue being used to make healthy foods more affordable to ensure that parents and guardians don’t encounter any barriers to adopting healthy eating practices. It is also important for there to be full transparency on the expenditure of the tax revenue so that the public can be confident that the funds have been used to benefit the public’s health.

Next Steps

The Ministry of Health will collate the feedback received from this consultation as well as the consultation conducted in Nevis and continue to engage with key stakeholders to develop their SSB policy. This will then have to be approved by Cabinet.

We look forward to seeing this policy develop and will support the Ministry in any way that we can to see this policy developed, approved and implemented.

The Body Mass Index (BMI) is a method used throughout the world to determine whether a person is at a healthy weight for their height. It is calculated by dividing a person’s weight by the square of their height giving a value that is expressed in kg/m². It tends to be used as a measure of a person’s total body fat.

People are assigned to one of four BMI categories (shown below) which helps to identify whether they are overweight or obese.

• Underweight – less than 18.5
• Normal weight – 18.5 to 24.9
• Overweight – 25 to 30
• Obese – 30  and over

It has been a useful, easy method of exploring weight and body fat, but its limitations are well known. Criticisms of it include:

• It doesn’t take into account factors such as age, sex and ethnicity
• It doesn’t look at the type of fat a person has
• It doesn’t differentiate between excess fat, muscle mass or bone mass

This means that the BMI may overestimate the amount of body fat athletes and body builders possess and underestimate harmful body fat in people who have a normal BMI.

Children and BMI

When looking at children, a different scale is used that takes into account the fact that children are constantly growing, and that boys and girls develop differently, so the BMI scale for children takes into account age and sex.

Researchers in the UK have found that the scale for children doesn’t accurately reflect the obesity levels in black and Asian children living in the UK. This is a problem as we can’t accurately identify children who will be at higher risk of health conditions such as diabetes and heart disease later in life.

Research into Children, BMI and Ethnicity

Researchers in St Georges and University College London, funded by the British Heart Foundation started work in this area a few years ago and published their work in March 2017.

Having identified that BMI may not be providing accurate measurements for ethnic minority children they sought to develop a method to adjust BMI values based on ethnicity.

In order to create the BMI adjustments they had to go back to basics and look at the actual body fat measurements of children. They identified 1,728 children aged 4 to 12 years old. They then explored the relationship between  BMI and body fat in each ethnic group (White European, Black African and South Asian). Using this data they were able to calculate the BMI adjustment needed for each ethnic group.

From their work they were able to confirm that BMI underestimated body fat levels in South Asians and overestimated body fat levels in Black Africans.

Based on their findings the research team developed a BMI calculator for children with an adjustment for ethnicity. Parents, teachers and healthcare professionals can use this simple tool to obtain accurate BMI readings for black and Asian children.

The research team followed up this work with research that they published in November 2017. This was a larger piece of work to explore the extent of the problem of using BMI in assessing the body fat of children.

They used data from the National Institute of Health Research’s National Child Measurement Programme.  Every year this programme assesses the weight of children in the UK who are aged 4-5 years old and 10-11, and attend a state-funded primary school.

The research team applied their new BMI adjustment to the weight measurements for children weighed between 2012 and 2013. This included 583,899 children aged 4-5 years old and 485,362 children aged 10-11. Their findings are summarised in the tables below.

Percentage of boys who were overweight or obese

Ethnicity	% Overweight and Obese
	Without Ethnicity Adjustment		With Ethnicity Adjustment
	4-5 years old	10-11 years old	4-5  years old	10-11 years old
Black African	31%	42%	11%	32%
South Asian	19%	42%	39%	52%
White European	23%	33%	–	–

Percentage of girls who were overweight or obese

Ethnicity	% Overweight and Obese
	Without Ethnicity Adjustment		With Ethnicity Adjustment
	4-5 years old	10-11 years old	4-5  years old	10-11 years old
Black African	29%	45%	12%	35%
South Asian	19%	34%	35%	44%
White European	21%	30%	–	–

Their results showed that the BMI overestimated the percentage of black children who were overweight or obese by 10-20% (depending on age and sex) so a significant number of black children are being misclassified in the government’s national weight assessment programme.

They concluded that BMI does not accurately reflect body fat in ethnic minorities and by using adjustments a more accurate measurement of the body fat can be determined.

Our Thoughts

This body of work highlighted the gaps that exist in medical research and the problem of using one ethnic group as a standard for health. This work clearly shows the need to explore ethnicity and health, it demonstrates that by not taking race and ethnicity into account key differences are being masked and we therefore don’t have a true picture of the health of our community.

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Sources

1. Body mass index adjustments to increase the validity of body fatness assessment in UK Black African and South Asian children (22^nd March 2017)
2. Patterns of childhood body mass index (BMI), overweight and obesity in South Asian and black participants in the English National child measurement programme: Effect of applying BMI adjustments standardizing for ethnic differences in BMI-body fatness associations (2^nd November 2017)
3. New BMI readings for children of different ethnicities (March 2017)
4. BMI Adjust (March 2017)
5. Body Mass Index Considerations for Practitioners
6. Body Mass Index Advantages and Disadvantages (July 2017)
7. BMI failing to reflect childhood obesity levels in ethnic minorities (Nov 2017)
8. Children from ethnic minorities may have been wrongly labelled obese, according to new research (Nov 2017)

Last week was World Obesity Day and to mark the occasion researchers released global estimates of childhood and adolescent obesity levels. The publication of this data aimed to give a flavour of where we are with the health of children throughout the world and initiate action on tackling childhood obesity. The study pulled together data from 2,416 sources and this covered information on the height and weight of 128.9 million people aged 5 and over from 1975 to 2016.

Overall the data showed that globally the number of obese children increased by a factor of 10 from 1975 to 2016. If we put that into numbers the number of obese girls (aged 5 to 19) rose from 5 million in 1975 to 50 million in 2016, whilst the number of obese boys increased from 6 million to 74 million.

Interestingly, when we look at specific regions across the world, we see that Polynesia and Micronesia have the highest childhood obesity levels and the lowest levels are seen in south Asia and east Africa.

It was also noted that whilst there are high levels of obesity amongst children worldwide a significant number of children are moderately or severely underweight – 75 million girls and 117 million boys. The majority of these children are in South Asia, specifically India.

What’s happening in the Caribbean?

The Caribbean is also included in this study with 18 countries explored. This included Antigua & Barbuda, the Bahamas, Belize, Barbados, Bermuda, Cuba, Dominica, Dominican Republic, Grenada, Guyana, Haiti, Jamaica, Puerto Rico, St Kitts and Nevis, St Lucia,  St Vincent and the Grenadines, Trinidad and Tobago and Suriname.

When all the data for the Caribbean was pooled together, the data was somewhat promising in 5-9 year olds with the average BMI (Body Mass Index) for Caribbean boys and girls being on the lower end when compared to other countries. For example, the average BMI for girls aged 5-9 in the Caribbean was found to be about 16kg/m². This was the 6^th lowest out of 21 countries. The highest being about 20 kg/m² in Polynesia and Micronesia, the lowest being 14.5kg/m² in East Africa and South Asia.

When looking at the older age group of 10-19 year olds, the data is not so promising with Caribbean children being on the higher end of the scale. For example, the average BMI for Caribbean boys aged 10-19 was about 21.5 kg/m², the 6^th highest out of 21 countries. The highest being almost 24 kg/m² in Polynesia and Micronesia, the lowest being 18 kg/m2 in South Asia

As well as looking at the average BMI, the researchers explored the prevalence of obesity in different countries and again some countries in the Caribbean are ranked amongst the highest with countries like Bermuda and Puerto Rico having an obesity prevalence in girls of over 20%.

Conclusion

This work confirms what is widely known in the Caribbean and other countries, childhood obesity is a problem and needs to be tackled with some urgency. On paper the solution is easy: get children active and improve their diet, but in reality due to a number of factors such as culture, income, motivation and opportunity the solution is difficult and complex.

We all need to work together to determine how best we can address this problem by encouraging the Caribbean to see the benefits of their traditional way of life before Western culture and food were embraced. We have to make physical activity a part of life and turn back to home-grown, unrefined, home-made food.

Over the past month or so we’ve had the opportunity to attend a number of interesting events to discuss a range of health issues and in today’s blog, we’ll give you a quick summary of a childhood obesity event we attended a few weeks ago.

Reducing Childhood Obesity

On 18^th January, we attended the Croydon Children, Young People and Families’ Network reducing childhood obesity event. This event brought together organisations in Croydon who are tackling childhood obesity to share experiences and also to understand Croydon’s new childhood obesity strategy.

The main speaker on the day was Bernadette Alves, Consultant in Public Health at Croydon Council, who took us through the Croydon Healthy Weight Action Plan for Children and Young People which aims to cover their plans from 2017 to 2020.

The Scale of the Problem

Bernadette Alves started by setting the scene with some background information stating that childhood obesity is a major priority for Croydon being one of their five main priorities for children in the borough. She explained that obesity causes children harm impacting their physical health, mental health, behaviour and day-to-day life (such as school attendance). She explained the extent of the problem telling us that 20.3% of children in reception (4-5-year-olds) are overweight or obese and 39% in year 6 (10-11-year-olds). When we look across the borough there is a lot of variation with Broad Green, New Addington, Selhurst and Thornton Heath having the highest levels of year 6 obesity levels and Sanderstead having the lowest year 6 obesity rate.

Croydon’s Action Plan for Childhood Obesity

We then heard how Croydon Council aims to tackle childhood obesity with their new strategy. Bernadette explained that their core priorities would be :

• Sugar: to sign a sugar declaration and develop a borough wide sugar smart approach
• Targeting and Integration: they will ensure that services are targeted to those most in need and develop an integrated interactive pathway of all services that are available to support children to reach and maintain a healthy weight
• Physical activity: roll out the Daily Mile campaign to schools
• Engagement of residents and the community: they will raise awareness of the impact of childhood obesity and support and empower residents to make behaviour changes.

The Council’s action plan, at the time, was in a draft phase and going forward they were conducting a consultation on the plan; the deadline for this was the end of January.  We also learnt that a Healthy Weight Steering Group was set up and is being led by Croydon Clinical Commissioning Group and Croydon Council; they will monitor the implementation of the action plan.

Unhealthy High Streets

Following Bernadette’s presentation there was time for questions and one of the issues raised was the large number of unhealthy takeaway restaurants in close proximity to schools.  In response to this Bernadette stated that there is a lot of work being conducted to create healthier high streets. She acknowledged that there is a major issue with fast food chains being placed near schools that target children with very cheap deals on their products.  Even data from the Royal Society of Public Health has shown that  Croydon has a particular problem with Central Parade in New Addington being the second most unhealthy high street in London.

Developing Better Relationships Between Local Government and Charities

Another issue that was raised during the Q&A was the lack of communication between small groups and the Council. It was felt that there needs to be a better working relationship between community groups and the Council that would enable all organisations working in this field to work effectively together, reduce duplication and align their objectives with the local approach. It was felt that the Council could provide more support to community organisations that goes beyond providing funding through their grants programmes but promoting projects and working in collaboration to ensure that projects are successful.

The event ended with a networking session where we could learn about the work being conducted by local community groups and charities.

This was a really interesting event and provided some good insight into local plans for tackling childhood obesity.