Childhood obesity: A problem that only gets worse as we fail to address it

Observer Newsco: There has never been a more appropriate time for urgent attention to be paid to preventing childhood obesity, not only in developed countries like Canada, the UK and the US, but also in less-developed countries like Antigua and Barbuda (A&B) where “one in four children is overweight or obese”, according to the Healthy Caribbean Coalition (HCC).

The Covid-19 pandemic has disrupted social and economic systems across the world, with several territories reporting a massive increase in the prevalence of childhood obesity.

A report from the UK government’s National Child Measurement Programme late last year revealed that childhood obesity rates have increased substantially over the past year – the largest single-year increase since the programme started 15 years ago, according to the Lancet Diabetes & Endocrinology journal.

Similarly, a study by the US Centers for Disease Control and Prevention (CDC) showed that “American children and teenagers have seen a significant increase in weight gain since the pandemic began, with the biggest jumps occurring in younger school-aged children and those who were already prone to obesity”.

As it pertains to the twin islands of A&B, the Caribbean Island Urinary Iodine Survey (2018) – a school-based study with focus on primary schools – revealed that, of 200 6-12-year-olds reviewed in Antigua who were healthy with no known medical illnesses, 16.2 percent were living with obesity and 37.6 percent were overweight.

That data is from 2018, but no significant policy changes have been made since then, so it is safe to say the situation is not likely to have improved much, and the pandemic has likely erased any gains made.

A global school-based health survey conducted in 2009 revealed that 59 percent of A&B’s students between the ages of 13 and 15 drank carbonated soft drinks one or more times per day during the previous 30 days.

A&B’s Health Ministry revealed that focus group discussions conducted in 2021 among young children found that 70 percent consumed Sugar Sweetened Beverages (SSBs) more often than water.

Furthermore, constant school closures, the shift toward online learning and the need to social distance, due to the ongoing pandemic, have drastically reduced the amount of physical activity that children engage in.

At the same time, food insecurity, socio-economic hardship and psychological strain have pushed some families, including the children, toward unhealthy diets; this was concerning even before the pandemic.

The government’s Food and Nutrition Security Policy from 2012 noted that A&B is experiencing a period of nutritional transition, where diets have shifted “away from indigenous staples, locally-grown fruits, vegetables, legumes…to diets consisting of more processed foods, more added sugars [and] more foods high in fats/oils and sodium”.

Nurse Valerie Williams, the Non-Communicable Disease (NCD) Coordinator in the Health Ministry, says the situation in the country’s schools has become untenable.

“If you take a walk around these schools in the morning, you’ll find all these vendors are selling is everything that’s sweet [and] why are children having hotdogs, pizza and fried chicken for breakfast?

“Then, they are buying the same thing for lunch and, after school, some of them are going down to KFC,” she said.

This reality, though scary to face, proves that there is an urgent need for policies to be put in place to mitigate the increasing prevalence of childhood obesity and encourage healthier lifestyle practices among the nation’s youth.

Dr Shivon Belle-Jarvis, Head of the Paediatric Department at the Sir Lester Bird Medical Centre, certainly agrees.

“Curbing obesity is everyone’s business. Now more than ever, governments, civil society, communities, households, families and individuals need to come together to ensure that – where obesity is concerned – Antigua and Barbuda is not left behind.

“The implementation of national policies, nutritional guidelines for schools, regulating the marketing of sugar sweetened beverages, subsidising local fruits and vegetables, ensuring a baby-friendly hospital (where breast milk is THE feed of choice) and ensuring that each child is physically active are some methods that will prevent Antigua and Barbuda from plunging deeper into this global crisis,” she explained.

Despite these glaring concerns though, it’s not all ‘doom and gloom’, as there are viable actions that can be taken to rectify the situation, and schools are the perfect starting point.

Organisations like the Caribbean Public Health Agency (CARPHA) and the World Health Organization (WHO), as well as the Pan-American Health Organization (PAHO), have conceptualised and/or promote specific policies aimed at decreasing childhood obesity levels.

For example, CARPHA’s plan of action to prevent and control childhood obesity involves six policy areas, including food labelling, nutrition standards and guidelines for schools and other institutions, food marketing, nutritional quality of food supply, trade and fiscal policies, and food chain incentives – which have become known as CARPHA’s 6-Point Policy Package.

The WHO recommends that children aged 5-17 years take part in at least 60 minutes of physical activity per day, and this is one policy that is partially in effect in A&B.

Physical Education (PE) is only mandatory in government schools up to second form, however, some students are choosing to continue it further and some private schools have mandated PE in all forms.

In 2010, 78.3 percent of children in Antigua and Barbuda between 11 and 17 were said to be attaining less than 60 minutes of moderate to vigorous-intensity physical activity daily.

This is due partly to the influence of social media and electronic devices. They have become increasingly attractive alternatives to children to ‘playing outside’.

Antigua and Barbuda also has a National School Meals programme through which children are provided daily meals, but these meals consist mainly of protein and starch, with very little vegetable content.

The Health Ministry recently launched a campaign – dubbed “Less Sugar, Longer Life” – aimed at reducing the intake of sweetened beverages, and while this is a good start to tackling the issue, there is a need for more radical policy-driven action.

President of the Antigua and Barbuda Diabetes Association, Juanita James, believes that while education is fundamental to addressing the issue, “There is no point doing education…asking the children to make healthy choices in an environment that does not really support healthy choices, so this is why you need a policy framework.”

The government, therefore, needs to provide balanced and nutritious foods in its school meals programme, and also regulate unhealthy foods and beverages sold in and around school compounds, place an excise tax on SSBs, make PE mandatory at all levels of schooling, integrate physical activity throughout the school day and facilitate inclusive afterschool physical activity programmes.

The results of a microsimulation analysis published in 2014 by the US National Center for Biotechnology Information predicted that an afterschool programme would reduce obesity among 6-to-12-year-olds by 1.8 percent and taxing SSBs would do the same among 13-to-18-year-olds by 2.4 percent.

And the proof is in the pudding – in 2015, Barbados placed a 10 percent excise tax on SSBs; as a result, the sale of sugary drinks declined by 4.3 percent and bottled water became 7.5 percent more popular in the first year of implementation. This is according to a Vital Strategies article from 2019.

In addition, added taxes mean revenue generation, and these monies can in turn be used to advance efforts to reduce the obesity epidemic, like through the introduction of subsidies on fruit and vegetables, increasing spaces for physical activity, providing metal drinking water bottles for school-aged children, implementing supportive health promotion campaigns and funding obesity management programmes for overweight and obese children.

Bearing all this in mind, it should be clear that everyone involved in the lives of children has a part to play to reduce childhood obesity.

As Dr Belle-Jarvis rightfully says, “Parents should also lead by example. ‘Do as I say and not as I do’ no longer works where nutrition and physical activity are concerned.”

So, if you’re a parent or guardian, it is your responsibility to monitor your child’s diet to ensure that they eat healthy foods, to ensure that they engage in adequate physical activity and to advocate for their right to healthy and nourishing food options and safe environments for physical activity.

If you’re a legislator or administrator, it is your responsibility to put laws in place and enforce those laws that create healthy environments, that encourage healthy eating and physical activity in order to secure a healthy future for the children.

And even if you’re just a concerned citizen, your voice counts in the campaign for a healthier Antigua and Barbuda.

No matter which side of the fence you stand, it should be obvious at this point how bad the childhood obesity situation is and how much worse the Covid-19 pandemic has made it, so the time for serious action is now.

If not you, then who? And if not now, then when? (By Latrishka Thomas)

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