helping children achieve energy balance

Chapter four

HELPING CHILDREN ACHIEVE ENERGY BALANCE

Key messages

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School-based programmes should

Family-based guidance should

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A healthy active childhood: giving children the best chance of a cancer-free future

C

Population-based programmes

World Cancer Campaign 200930

Opportunities for effective prevention policy

Food marketing

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Micro-environments Macro-environments

• Intrapersonal (eg individual)

• Food processing industries

• Interpersonal (eg family and friends)

• Local government

• Institutional (eg school or workplace)

• Mass media

• Community • Non- governmental organizations

• Political pressure groups

• Legislators

• International environments

• Trade agreements

Figure 7. Examples of micro- and macro-environments for action

Evidence for effective prevention programmes


• Include food and health education in the school curri-culum

• Control the provision and sale of fatty snacks, confec-tionery and sweet drinks in public institutions such asschools and hospitals

• Control the advertising and promotion of food anddrink products

• Provide public subsidies on healthy foods to improvepatterns of food consumption

• Encourage more physical activity by changing plan-ning and transport policies

• Improve provision of sports and recreational facilitiesin schools and communities

• Improve training for health professionals in obesityprevention and diagnosing and counselling those atrisk of obesity

• Improve health education to enable citizens to makeinformed choices

• Reform the EU’s common agricultural policy to helpachieve nutritional targets

• Make nutritional information labelling mandatory forall processed food, for example using an energy den-sity “traffic light” system, with high energy densityproducts labelled in red, low density products labelledin green, and intermediate products labelled yellow

Figure 8. Policy options to prevent childhood obesity (EuropeanHeart Network 2007)

Opportunities for effective prevention pro-grammes

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Overall educational message

• Children told that decreasing sugar consumptionwould improve overall well-being and benefit dentalhealth

Class room delivery activities: One class (1 hour) per term

• First session �Focused on balance of good health �Promoted water intake�Tasted fruit to learn about the natural sweetness of

products �Gave each class a tooth immersed in a sweetened

carbonated cola

• Second and third sessions �Music competition to produce a song or a rap with

a healthy message.

• Final session �Presentations of art work related to theme�Interactive approaches (quiz)

Wider educational involvement

• Encouraged to access information on project’s website

Figure 9. CHOPPS: a successful school-based obesity reductionprogramme (James et al 2004)

The family context


School policies and school environment

• Ensure school policies and school environments en-courage physical activity and a healthy diet. Consider�building layout�provision of recreational spaces�catering, including vending machines�food brought into school by children�the curriculum, including PE (physical education)�school travel plans, including provision for cycling�extended schools

Staff training

• Teaching, support and catering staff should have trai-ning on how to implement healthy school policies

Links with relevant organizations

• Establish links with health professionals and those in-volved in local strategies and professional partnershipsto promote sports for children and young people

Interventions

• Introduce sustained interventions to encourage pupilsto develop life-long healthy habits. Short term, one-off events are not effective on their own

• Take pupils’ views into account – including differencesbetween boys and girls and barriers such as cost orconcerns about the taste of healthy food

• PE/sport staff should promote activities that childrenenjoy and can take part in outside school and conti-nue into adulthood

• Children should eat meals in a pleasant sociable envi-ronment free from distractions

• Younger ones should be supervised; if possible, staffshould eat with them

• Involve parents where possible; for example through spe-cial events, newsletters and information about lunch menus

Figure 10. Recommendations for school settings (NICE 2006)

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YES SELECT WITH CARE NO

Drinking water must be avail-able:

�Free drinking water mustbe available in schools atall times

Drinks that are allowed to beprovided:

�Mineral water (still or carbonated)

�Semi-skimmed, skimmedmilk or lower-fat milks

There is a range of otherdrinks permitted by the regulations but these drinksmust be carefully selected(see the “SELECT WITHCARE” column

Other drinks that are allowed to be provided if specificcriteria are met:

Milk drinks (hot or cold) containing:no more than 1.8g of total fat per 100mlno more than 10g of total sugars per 100ml andno more than 20g of total sugars per portion size.

Drinking yoghurts containing:no more than 1.8g of total fat per 100mlno more than 10g of total sugars per 100ml andno more than 20g of total sugars per portion size.

Soya, rice or oat drinks enriched with calciumcontaining:no more than 1.8g of total fat per 100mlno more than 5g of total sugars per 100ml andno more than 10g of total sugars per portion size.

Any variety of fruit juice or vegetable juice (includingfruit juice made from concentrate or partially made fromconcentrate) that meets the following criteria:unsweetened a portion size of no more and unsalted than 200 ml.

A blend containing any of the following ingredients, either singly or combination:fruit vegetablefruit juice vegetable juice

and with no added sugar or salt and a maximum portion size of 200ml

Drinks made with a combination of water (still or carbonated) and fruit and/or vegetable juice that contain:no added sugarno more than 20g of sugar per portion size50% or more fruit or vegetable juice andno more than 200ml fruit or vegetable juice.

Tea and coffee – the use of any milk in these drinksshould be restricted to semi-skimmed, skimmed milkand other lower-fat milks.

Examples of drinks that areno longer allowed:

�No soft drinks (still or carbonated) includingflavoured waters (the onlyexception is the combina-tion drinks that meet thecriteria set out int the “SELECT WITH CARE”column).

�No sugar-free soft drinks(still or carbonated) includ-ing flavoured waters

�No sweetened fruit juice

�No sweetened or saltedvegetable juice

�No squashes/cordials in-cluding lower sugar and“no added sugar versions

�No whole milk

�No sport drinks

www.scotland.gov.uk/Publi-cations/2008/09/12090355/

Figure 11.

Conclusion


Diet

• Children and young adults should eat regular meals,including breakfast, in a pleasant, sociable environ-ment without distractions (such as watching televi-sion)

• Parents and carers should eat with children – with allfamily members eating the same foods

Activity

• Encourage active play – for example, dancing andskipping

• Try to be more active as a family – for example, wal-king and cycling to school and shops, going to thepark or swimming

• Gradually reduce sedentary activities – such as wat-ching television or playing video games – and consideractive alternatives such as dance, football or walking

• Encourage children to participate in sport or other ac-tive recreation, and make the most of opportunitiesfor exercise at school

Figure 11. Recommendations for parents and carers (NICE 2006)

If you eat… KJ Kcal Sitting still Walking(5.6km/hr)

Running(12km/hr)

Swimming(freestyle)

Food

1 small apple (106g) 230 55 57 min 19 min 7 min 10 min

Muesli bar – fruit (35g) 531 127 2hr 12min 45 min 16 min 22 min

Chocolate - Mars bar (60g) 1152 276 4hr 46min 1hr 37 min 35 min 48 min

Luxury ice-cream (91g) 1185 283 4hr 53min 1hr 39 min 35 min 50 min

Meat pie (200g) 1989 476 8hr 13min 2hr 47 min 59 min 1hr 23 min

Big Mac (200g) 2010 481 8hr 18min 2hr 49 min 1 hr 1hr 24 min

Drink

40% fruit juice/cordial (200ml) 302 72 1hr 14min 25 min 9 min 13 min

No-added- sugar orange juice (300ml) 480 115 1hr 59min 40 min 14 min 22 min

Can of cola (375ml) 675 161 2hr 47min 57 min 20 min 28 min

Large juice bar low-fat smoothie (650ml) 1723 412 7hr 7 min 2hr 25min 51min 1hr 12 min

Table 4. : Energy balance: time taken in different kinds of activity to burn off some common foods. (McArdle et al 2001; Stewart 2007)Reference child: 10 year old boy. Height 150cm (~50th percentile) Weight 40 kg (~50th percentile) BMI 17.77 (50th percentile) Foodand drink weights sourced from www.calorieking.com.au

helping children achieve energy balance

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