I’ve just been woken up on Halloween night at 3am by a dirty faced 2 year old pirate hanging out of his cot looking to see more fireworks. This pirate may have over indulged in the spirit of Halloween in the hours before hand. And as I’m emptying the bins in the early hours of the next morning I wonder whether Haribo had any involvement in the recent reinvention of Halloween and indeed in my 2 year olds early morning antics. I also realise that the main culprit responsible for the mound of sweet wrappers spilling out of the bin may not have been my little pirate. It was probably me.
In a recent radio interview with Clem Ryan on KFM I was asked my opinion about exercise and children and are they doing too much for their immature skeletal structures. I was caught on the hop slightly with this, as the main body of discussion was supposed to be about running and running related injuries. But such is live radio. My answer, and I stick with it, was along the lines of this: Kids shouldn’t really need a structured exercise programme as ‘play’ should be their exercise. However due to rising levels of inactivity amongst kids for all sorts of reasons unfortunately there may well be a need for structured programmes. Of course there are some kids that do too much being chauffeured from one activity to the other. There is a chance of some overuse injury here but the solution is simple, or at least more simple than if doing too little; reduce the load, i.e. rest for a short period and typically the problem will settle. The risks here are far outweighed by those at the other end of the scale who do too little, if anything at all.
So lets looks at some of the statistics. In 1980 3% of Irish kids were overweight and 0% obese. None. Obesity in children did not even exist in 1980. Fast-forward 35 years. In Ireland in 2015 20% of 9 year olds are overweight and 7% obese. Think about that. Think back to the 1980’s and 90’s or if you were born post this period or can’t remember think of a film from that era: The Snapper, Into The West, War of the Buttons. I can’t recall any obese children in any of these films. There were other issues for sure and of course they’re only films but films that depicted Ireland better than any Hollywood Blockbuster did then or has since. The children ran, cycled, got up to mischief, played. They just played. And when we compare the stats with our EU counterparts we don’t come out great. They are the type of rankings our national football teams aspire to reach. We’re above the EU average. 26.5% of Irish girls and 16% of Irish boys are overweight. The lowest in the EU is The Netherlands at 4%. Between adult and childhood obesity this problem of epidemic proportions costs us €398 million annually. Yes almost half a BILLION! Did they not metion that in the recent budget? So of all the cruel, unavoidable, horrible conditions people and families have to suffer like cancer, motor neuron disease and multiple sclerosis here lies a problem that is very preventable, reversible and manageable. The solution? Move more, eat less.
The Snapper by Roddy Doyle [in a pub, after Sharon’s delivery]
-“7 pounds 12 ounces.”
-“Is that a baby, or a turkey?”
-“That’s a good-sized baby.”
-“Small turkey, though.”
Now before the body image brigade get on my case here slating me saying children shouldn’t be concerned about how they look and eating disorders etc just stop. This is not an article about eating disorders, body image or the psychology behind both. I’m not saying they should be concerned with how they look. Far from it. They’re kids for god sake. They should just be expending more calories than they’re consuming and for a child that should be a piece of cake very easy.
There is a pilot programme being rolled out in the USA this year of standing desks in the classroom, a really interesting idea that I actually think will take off (https://www.facebook.com/NowThisNews/videos/927824177307707/?fref=nf). The idea is to get kids more active and not become lethargic or restless sitting for the majority of the day. It’s an idea that is already growing legs in the office space too. But what are the factors that cause a child to become obese? Lets looks at some of the facts. A child with obese parents is 3 times more likely to become obese. That makes sense. The child sees Mam and Dad not moving a whole lot, eating more than they should and this becomes the norm. No surprise there. Those children that are obese are ten times more likely to remain obese as adults. Right so maybe its not that treatable. In theory it should be but of course there’s motivational, sometimes social, and psychological barriers to overcome as well as the physical task of eating less and exercising more. And then there’s the other problems that spiral as a result of obesity: increased risk of type 2 diabetes, cardiovascular disease, increased forces through joints leading to back, hip and knee pain, respiratory problems. And now we start to see where that earlier figure of €398 million comes from. It is clear parents and adults play a key role in the child’s activity and dietary habits so maybe the intervention required isn’t to target the children at all. Maybe the population to be targeted are the role models that play such an influential role in the child’s life, i.e. parents.
How do we determine if someone is obese or not? Several methods are used. There is Body Mass Index (BMI), a score based on height and weight classifying where we sit on a scale ranging from <20 (underweight) to >35 (severely obese). This becomes essentially null and void with athletic populations as based on this system every middle to long distance runner would be underweight and every rugby player would be obese but for the majority of people in between it gives a general idea where we lie on the scale. Body fat percentage is slightly more complex based on skin fold readings from different parts around the body giving a total score which is then represented as a percentage. The most practical and clinically relevant measure for obesity is waist circumference. Abdominal fat is most closely associated with metabolic risk factors for vascular disease and metabolic disease. So what’s the cut off numbers here? We get dressed every day and if when you’re pulling up your jeans in the morning the label on the back reads 40 inches for men or 35 for women then it may be time to start making some lifestyle changes.
And in the case of obesity its more than just physical activity. It needs to be combined with dieting but in a structured realistic goal orientated manner. We’ve all seen the extreme dieting techniques come and go and wondrous claims of losing a stone in 2 weeks. If you’ve been that soldier take a bow. That takes serious determination. Unfortunately history will tell us that fast weight loss like this is not sustainable and usually results in relapse. The initial goal should be a 10% decrease in body weight achieved within 6 months. For someone who is borderline obese that’s just one pound per week. Doesn’t sound like much does it but over a 6 month period? And a loss of one pound per week really is achievable. Lets ditch the magic shakes and unrealistic extreme weight loss targets and replace them with just a fraction of that determination it took to lose a stone in 2 weeks 5 years ago, some family support, some good sound practical advice, and a pinch of common sense. And if motivation is a factor then think of the next generation and how you could be saving them too. Lets also think how some of that €398 million could be put towards helping some of those other horrible conditions.
Rob McCabe MISCP
MSc Physiotherapy, BSc Sport Science and Health, MSc Sports Physiotherapy, Post Grad Dip Orthopaedic Medicine
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