We were delighted to e-attend the Healthy Caribbean Coalition’s Civil Society Action Team’s inaugural meeting on 20th April .  The main objective of the action team is to ensure that the Caribbean public becomes aware of the challenges of childhood obesity and supports the call for policy changes and other educational approaches that will create a supportive environment for the reduction of this growing problem which places children at risk of developing diabetes and hypertension as well as  cancer and heart disease in their adult life

During this inaugural meeting of the action team, the HCC shared its communication plan for their childhood obesity prevention petition and discussed ways in which organisations could play a part in their local area. This included liaising with the media and encouraging  members, corporate partners and other social and parenting groups to sign the petition at www.toomuchjunk.org.

This was a really interesting meeting and we were delighted to meet representatives from a number of Caribbean organisations and we look forward to implementing the ideas discussed in the meeting in our local area here in St Kitts.

Wednesday 4th April, 2018

Today, we touch on the Healthy Caribbean Coalition’s new childhood obesity prevention campaign, why this campaign is important, what policies the HCC is encouraging governments in the Caribbean to introduce to tackle childhood obesity and how you can get involved.

The Healthy Caribbean Coalition has launched their Childhood Obesity Prevention Petition as part of their Civil Society Action Plan for 2017-2019.

The aim of the petition is to raise awareness of childhood obesity in the Caribbean and to influence the region’s leaders to champion and implement critical policies that will improve the health of our children, reduce childhood obesity and prevent the associated non-communicable diseases.

The Healthy Caribbean Coalition plans to present their petition at the CARICOM Heads of Governments Conference in Jamaica in July, which presents the perfect opportunity to raise this issue.

With 1 in 3 children in the Caribbean being overweight or obese urgent action is needed and therefore the HCC needs your help. Please add your voice to the HCC’s call for action to be taken on childhood obesity by signing their petition and encouraging your contacts to do so too.

We can all make a difference and improve our children’s health, and this petition is just the first step.

Thank you for your support. For more information on this campaign and to sign the petition, please visit: www.healthycaribbean.org/yourvoicematters

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)

Sadiq Khan, the Mayor of London, in a bid to tackle childhood obesity and its related health problems, has announced a ban on new fast-food outlets being located within 400m of existing or proposed primary and secondary schools.  The Mayor’s office has said that currently a quarter of fast-food outlets are within five minutes of schools.

In addition, the Mayor is proposing that when planning permission is granted to fast-food outlets, that they be required to sign up to the Healthier Catering Commitment for London. This is a scheme that recognises businesses in London that demonstrate a commitment to providing their customers with a healthier option by reducing saturated fat, salt and sugar in their dishes.

This ban is much-needed in London where there are 8,000 fast-food outlets throughout London with 2,000 of these being within five minutes of schools. This gives children quick and easy access to unhealthy foods, that are very cheap.  The Mayor’s office said that just one of these meals  contains 60% of our recommended daily calorie intake, half of our recommended salt and saturated fat intake and  no fruits and vegetables.

We know that many school children consume the unhealthy meals prepared by these outlets every day contributing to the childhood obesity crisis.

In London, a staggering 40% of children are overweight or obese when they finish primary school. This puts them at an increased risk of developing type 2 diabetes, heart disease and a number of other diseases.

The Mayor of London, Sadiq Khan said:

“Takeaway restaurants are a vibrant part of London life, but it’s important that they are not encouraging our children to make poor food choices.

 

“I am working hard to create a healthier London and this must start with the food that our children eat. As promised in my manifesto, I am using all of my powers through my new London Plan to prevent new takeaways from being built just down the road from schools as part of a package of measures to tackle the ticking time bomb of childhood obesity and help us all lead healthier lives.”

This scheme is very promising and if successful should ensure that we improve young Londoner’s health. There is also a need to ensure that existing fast-food outlets are targeted so that the 8,000 outlets in London play their role in improving the health of Londoners.

The Healthy Caribbean Coalition in collaboration with the NCD Alliance have released an  action plan for preventing childhood obesity in the Caribbean. This action plan is based on a number of frameworks developed by organisations around the world to ensure consistency. The plan aims to foster a collaborative approach to tackling childhood obesity with recommendations for civil society working in partnership with governments and the private sector.

This action plan is of utmost importance as a third of children in the Caribbean are overweight or obese. Children who are overweight or obese are at an increased risk of being overweight or obese adults and of developing a non-communicable disease (NCD) later in life.

The Priorities of the Plan

Rates of childhood obesity are increasing in the Caribbean; this needs to be addressed to improve the health of the Caribbean community. If left unchecked the Caribbean will see a huge increase in NCDs leading to avoidable ill-health and premature death. The Healthy Caribbean Coalition’s action plan aims to address this. Their plan focuses on seven priority areas. These include:

Trade and fiscal policies e.g. taxation of unhealthy food

Nutrition literacy e.g. mandatory front-of-package nutrition labelling

Early childhood nutrition e.g. interventions related to breastfeeding and complementary foods

Marketing of healthy and unhealthy foods and drinks e.g. banning of marketing of unhealthy foods and drinks to children

School and community based interventions e.g. mandatory physical activity in schools  

Resource mobilisation for interventions addressing childhood obesity

Strategic planning, monitoring and evaluation: e.g monitoring progress through the use of the CSO Childhood Obesity Prevention Scorecard

Next Steps

The Healthy Caribbean Coalition team, based in Barbados, will take the lead on implementing this action plan and will form a regional Steering Committee with members coming from the around the Caribbean representing the private sector, government and civil society organisations. They will also form a civil society organisation action network for childhood obesity prevention who will work on promoting relevant policies and interventions.

We’re really happy to see this action plan published. It provides a good foundation on which to start work on the prevention of childhood obesity in the Caribbean and we look forward to getting involved in this work.

More Information

For more information please visit the HCC website here, download the action plan below or email  hcc@healthycaribbean.org

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.

 

Yesterday, the UK Government published its childhood obesity action plan which sets out its strategy to significantly reduce obesity levels in children over the next ten years.

Childhood obesity is a major problem in the UK with nearly a third of children being obese or overweight. There are a number of factors that have contributed to this and these include behaviour, our environment, culture and genetics.

The government’s action plan makes an important observation which is that obesity levels are highest in children from low-income families.  Research has shown that 5 year olds in the poorest  families are twice as likely to be obese than their affluent counterparts and by the age of 11 they are three times more likely to be obese. We need to address this inequality.

The government’s action plan aims to provide a good balance of reducing childhood obesity whilst respecting the public’s freedom of choice when it comes to food selection. They also clearly state that this action plan is a starting point rather than a complete final plan.

A Summary of the Action Plan

Introducing a sugar levy (the sugar tax)

Soft drinks companies will pay a levy on drinks with added sugar. This will apply to drinks with a total sugar content above 5 grams per 100 ml. A higher rate will be applied to drinks with more than 8 grams per 100 ml.  The levy won’t be applied to milk-based drinks or fruit juices.  The levy will come into effect from April 2018.

Soft drinks manufacturers will have two years to reduce the sugar content of their drinks so they won’t be taxed if they are successful. The government states that there has already been some success with some manufacturers already reducing sugar in their drinks.

The money raised from the sugar levy will be used to double the funding available to primary schools for PE and sports programmes. The government has estimated the sugar levy will raise £320 million a year for primary schools to support healthier more active lifestyles in children. The funding will not only go towards expanding PE and sports programmes but to also expand breakfast clubs in primary schools ensuring that children have access to a healthy breakfast every week day.

The idea behind the sugar levy is a good one. It’s hoped that the levy will incentivise the soft drinks industry to reduce the amount of sugar in their products, helping the public consume less sugar. The money raised will go towards helping children get more active and healthy and thus tackle our high rates of childhood obesity.  So, from a public health point of view the sugar levy is a win-win.

Taking out 20% of sugar in products

The government will be slowly reducing the sugar content in everyday products  and will launch a sugar reduction programme to reduce sugar in products that are popular with children.  All sectors in the food and drinks industry will be challenged to reduce the sugar in their products by 20% by 2020, this will include a 5% reduction in year one. Their recommendations to the food and drinks industry are to:

• Reduce sugar in their products
• Reduce portion sizes
• Use lower sugar alternatives

The sugar reduction programme will focus on nine areas: breakfast cereals, yoghurts, biscuits, cakes, confectionery, morning goods (such as pastries), ice cream and sweet spreads. They will then move on to other foods and drinks such as milk-based drinks and they will ensure that they focus on ranges that target babies and young children.

The government will monitor progress and publish reports every six months to determine if manufacturers are on track to achieve the 20% reduction.

The action plan also makes the point that sugar reduction should also mean calorie reduction and manufacturers should not increase the saturated fat content of their products.

We like the sugar reduction programme with its clear targets and hope that the manufacturers will comply and work with the government to achieve this. The issue we see is that manufacturers have no strong incentive to take part in this programme and may continue as is.  Also, we know some manufacturers don’t appreciate the government interference in the way they do business and may not comply out of principle – they think it will set a nanny state precedent.

Supporting innovation to help businesses make healthier products

The action plan summarises how the government is supporting businesses in making healthier products. This includes: a £10millon investment to support research that explores new processes and products to increase the availability of healthy food choices; the formation of the Agri-Food Technology Council to provide leadership in health, nutrition and consumer acceptability; and the formation of the Food and Drink Innovation Network which brings together the food and drinks industry, researchers and innovation support to enable greater take up of world-leading R&D.

Updating the nutrient profile

The current nutrient profile which gives foods a score based on their sugar, fat, salt, vegetables, nuts, fibre and protein content is 10 years old and needs updating. It does give parents a view on how healthy their food is and enables them to make healthier choices, but work is needed to update it so it is in line with today’s scientific advice.

The government will therefore work with academics, the food and drinks industry, charities and other stakeholders to update the nutrient profile.

Making healthy options available

The action plan talks about the potential of the public sector to make a significant contribution to reducing childhood obesity.  They state that every public space from leisure centres to hospitals should serve healthy food.  The government has committed to working with their local government colleagues to ensure that this will happen.

Helping low-income families in purchasing healthy foods

The government will continue with their Healthy Start Scheme which provide vouchers to low-income families, these can be exchanged for fruit, vegetables and milk. The scheme also provides vitamins during pregnancy and early years.

Encouraging children to take part in one hour of physical activity every day

The government aims to support schools in using the funding raised by the sugar levy on sports programmes that have the maximum impact possible and guidance will be developed on how best to implement school PE, sports and healthy lifestyle programmes. Support will also be given to schools to ensure they have access to high quality sports and physical activity programmes. Additionally the government will continue to invest in making it safe for children to walk and cycle to school.

Encouraging healthy eating in schools

The government will introduce a voluntary healthy rating scheme to recognise the work being done in schools to ensure that children are eating healthy and getting active. There will be a focus on continuing to improve school meals through the School Food Standards and breakfast clubs will continue to provide children with a healthy start to the day.

Other measures

Other areas the government will focus on are:  clearer food labels, making use of technology in the form of apps and other digital resources, for example the sugar smart app and exploring how health professionals can support families.

Conclusions

We are very happy to see the government publish its childhood obesity action plan, and we see it for what it is: a starting point.

We believe that it is a good starting point and are particularly happy to see the sugar levy; the sugar reduction plan; the investment being made in research and development to support businesses in making their food healthier; the support given to schools to ensure kids are active and healthy during school time; and the support given to low-income families.

We hope that everyone will play their part so that this plan is successful and we hope that the government will continue to develop its strategy to ensure that all areas are addressed.

You can download the full report below.

This week the UK’s Health Committee published their report on childhood obesity setting out what action needs to be taken to tackle this ever increasing problem.  The report states that the scale of the problem requires “bold and urgent action from the Government.”

From the report we learn that a fifth of children in the UK are overweight or obese when they begin school and by the time they leave primary school a third will be overweight or obese. They also noted that deprived children are twice as likely to be obese than the least deprived children and therefore obesity is a significant contributor to health inequality.

The report also highlights the cost of obesity. Treating obesity and its consequences costs the NHS £5.1bn every year. Obesity is the main risk factor for a number of disease including diabetes and the cost of diabetes to the NHS is  £8.8bn a year.

Through their research into this area, the committee found that there are very few interventions aimed at overweight or obese children. They state that the evidence shows that healthy living campaigns tend to help those who are already making healthy choices and are not reaching those that need them.

The health committee have made a number of recommendations that focus on changing our food environment because evidence suggests this is where the most attention is needed. Their nine recommendations include:
–  Strong controls on price promotions of unhealthy food and drink
–  Tougher controls on marketing and advertising of unhealthy food and drink
–  A centrally led reformulation programme to reduce sugar in food and drink
–  A sugary drinks tax on full sugar soft drinks, in order to help change behaviour, with all proceeds targeted to help those children at greatest risk of obesity
–  Labelling of single portions of products with added sugar to show sugar content in teaspoons
–  Improved education and information about diet
–  Universal school food standards
–  Greater powers for local authorities to tackle the environment leading to obesity
–   Early intervention to offer help to families of children affected by obesity and further research into the most effective interventions

We are in support of the above recommendations as obesity is a significant problem in the black community and by taking these actions we can begin to change our community’s behaviour and improve our health.

You can download the full report below.