The Big Read: Tackling the Bay's growing child obesity problem

Otumoetai College students can buy healthy food from the canteen. The principal says 3/4 of students do sport. Manaaki Mason-Lowe (left), and Kennedy Singh, play basketball. Photo/Andrew Warner

Bay of Plenty Times Weekend reporter Dawn Picken set out to learn what our community is doing to address the growing problem of childhood obesity.

Whether you and your family are fat, thin or in-between, stemming the obesity epidemic rests on all our shoulders, according to a new report. And experts say failure to address the issue could threaten everyone's health care. The first-ever detailed data by local health officials shows how big some of our smallest neighbours have become.

BIG NUMBERS

A new study shows one in five Bay of Plenty 4-year-olds are overweight, some severely so.

The Toi Te Ora Public Health Service B4 School Check data body size technical report states 21.4 per cent of 4800 4-year-old children checked in 2013 and 2014 in the Bay of Plenty District Health Board area were overweight, obese or extremely obese (a 4-year-old girl and boy of average height weighing 20.9kg and 20.5kg, respectively, would be considered extremely obese).

The proportion of extremely obese children was nine times what was expected from the World Health Organization's growth standard.

The phenomenon is illustrated in a graphic (see figure, "Distribution of Body Mass Index z-scores") which shows a black curved line indicating what is expected in a healthy population. Bay of Plenty 4-year-olds' weight scores are shifted to the right, showing high numbers of children identified as overweight to extremely obese. The data also shows a large proportion of children who, while not overweight, still have a BMI above average. In other words, our community's preschoolers are heavier than what's expected in a healthy population.

Report co-author, BOPDHB Medical Officer of Health Dr Neil de Wet, writes, "The fact the entire curve shifted to the right without any real change in shape is good evidence that the problem is not about a small group of children that has become overweight or obese through poor lifestyle choices or poor parenting."

Rather, he writes, the data strongly suggests causes relate to the physical, social and economic environment children experience, including the food environment. "This includes, for example, the types of food and drink products that are being produced and how they are marketed."

BIG FOOD

Tauranga registered dietitian Fiona Boyle of Food Solutions says weight issues are multi-factorial, but believes a lot of people are confused about food.

"Nutrition messages seem to change constantly, which doesn't help. I think it's packaged foods that are easy to access, and don't tend to be the best for us."

Kidz Nutrition paediatric dietitian Rebecca Bruce says one in three New Zealand children are overweight or obese, a reality she says is more likely if they have an overweight parent. "High fat and sugar convenience foods with low nutritional value as well as high sugar beverages are a huge problem. Coupled with increasing sedentary behaviours such as use of phones, computers and TV, obesity rates are at their highest. Unfortunately it can often be cheaper making poor nutritional choices."

Matua mum Katja Brown (see sidebar, "Family, Food and Fitness") says she often sees children at seven-thirty in the morning walking to school holding pies. While she wonders whether mum or dad is being neglectful, she says poverty plays a role. "For a lot of families I think it's hard to buy fresh food because it costs so much more. Four dollars for a head of broccoli or cauliflower - it's crazy money and a lot of people can't afford it."

The Toi Te Ora report shows the most socio-economically deprived 4-year-olds, those in the bottom quintile (20 per cent), are much more likely to be overweight or obese than less disadvantaged peers. Nearly 30 per cent (29.8 per cent) of children studied in the bottom quintile were overweight, obese or extremely obese, compared with 19.4 per cent of children in the top quintile.

Cartier McGreal makes her way through the obstacle course at Arataki Kindergarten.

Pacific and Maori children were found to be proportionally heavier than NZ European children. Dr de Wet says, "To turn the obesity epidemic around in all age groups, the strategies for intervention must broaden the focus from individuals and groups at risk to changing the environment that puts them at risk."

BIG RISKS

The Ministry of Health reports excess body weight is one of the most important modifiable risk factors for diseases including type 2 diabetes, heart disease, stroke and several common cancers. The World Health Organization says overweight and obese children are at higher risk of developing asthma, high blood pressure, sleep disorders and liver disease. They may also suffer from psychological effects such as depression. The ministry says New Zealand has the third highest adult obesity rate in the OECD, and that extremely obese individuals have a life expectancy shortened by an estimated 8-10 years.

It says obese 4-year-olds have a 50 per cent chance of growing into obese adults. About two-thirds of Kiwi adults are overweight or obese.

BIG COSTS

A study from University of Auckland researchers in 2012 showed overweight and obesity in New Zealand costs the country up to $849 million a year in health costs and lost productivity. The Ministry of Health says about a quarter of a million Kiwis have type 2 diabetes, a disease often associated with excess weight. Diabetes Youth New Zealand reports more than 200 children have type 2. Dr de Wet says it's a "long-term condition associated with complications, many of which become long term themselves, often resulting in frequent hospital admissions. Over a lifetime it can be very expensive for the health service". Related conditions include heart disease, circulatory problems resulting in amputations, kidney failure and eye problems.

Dr de Wet says the obesity epidemic is a global phenomenon that's emerged in the past 30 years. "Given the high prevalence of childhood obesity and earlier onset of diseases such as type 2 diabetes and heart disease, it could become a crisis in terms of providing health services in future decades. That's going to affect everyone, not just people who are overweight and obese."

Government agencies, community organisations and schools are entrenched in efforts to raise fit children. But those efforts compete with cheap, quick, fatty and sugary foods and a tech-rich culture where indoor screen time trumps outdoor play time.

BIG MOVES AT SCHOOL

It's Wednesday morning when the Bay of Plenty Times Weekend visits Arataki Kindergarten in Mount Maunganui. Kids from ages 2 to 5 take part in making vegetable soup with produce brought from home. They play on the obstacle course. The school also includes a vege garden, worm farm and chickens. Teacher Amy Garrity says the Enviroschool focuses on wellbeing throughout the curriculum, and in forming lifelong habits. "It's imperative for their learning. Children move to learn. The food we put into our bodies affects our behaviour and their development."

Garrity says her kids love running and riding scooters. They also compare prices of healthy and unhealthy lunches and learn about sugar content.

I teach in some low-decile schools and some kids are 80, 90 kilos and we try to get them running around. But there has to be a change of habits and a change in nutrition

Christine Young

The focus on health continues at primary school and beyond. Bay of Plenty District Health Board child and youth, oral health and pharmacy portfolio manager Tim Slow says 34 schools in the BOPDHB area are part of the government's Health Promoting Schools programme designed to counter childhood obesity. One area of concern is sugary drinks.
A recent survey showed 46 per cent of schools in the Bay of Plenty do not sell sugary drinks, shown to cause tooth decay and put a child at risk for being overweight and developing type 2 diabetes. World Health Organization guidelines recommend a child have no more than three or four teaspoons of sugar a day.

Slow says, "We all recognise that lollies, confectionary and chocolate have lots of sugar but it's not that obvious that a 600ml bottle of fizzy drink may contain as much as 16 teaspoons of sugar."

Schools and the health system are facing a never-ending battle where a bottle of 1.5-litre fizzy can be 99 cents. It's hugely high in sugar. Parents are facing misleading information around food that's fat-free and salt-free, but extremely high in sugar.

Dane Robertson

Gate Pa Primary is a decile 2 school (the lower the decile, the more economically disadvantaged the school zone) that recently joined the Health Promoting Schools programme. Children at this Tauranga school get free fruit and elective martial arts education once a week through the The Martial Arts Academy (TMAA). Director and instructor Christine Young also volunteers at Merivale Primary (a decile 1 school) and says she wishes she could do more. "I teach in some low-decile schools and some kids are 80, 90 kilos and we try to get them running around. But there has to be a change of habits and a change in nutrition."

Students at Gate Pa are learning jiu-jitsu Friday mornings. Young says training works when it's fun. " ... but if I say, 'Do star jumps and press-ups, that's difficult for them, so we play agility games or racing games they can cope with and they forget they're exercising." Young says up to 40 families attend martial arts classes at TMAA studios, which gets children and parents moving together. "Some kids pick it up on their own and are self-motivated, but it's different at home if they have fish and chips for dinner or pies, pizza and fizzy drink."

Dane Robertson, president of the Western Bay of Plenty Principals' Association and Kaimai School principal, says schools are increasingly adopting healthy eating policies, but our food environment doesn't help. "Schools and the health system are facing a never-ending battle where a bottle of 1.5-litre fizzy can be 99 cents. It's hugely high in sugar. Parents are facing misleading information around food that's fat-free and salt-free, but extremely high in sugar."

Given the high prevalence of childhood obesity and earlier onset of diseases such as type 2 diabetes and heart disease, it could become a crisis in terms of providing health services in future decades. That's going to affect everyone, not just people who are overweight and obese

Dr de Wet

Otumoetai College principal Dave Randell says the school's canteen stocks healthy options like sushi and fish, hasn't sold fizzy drinks for years and is building a new gym. "Sports science and outdoor education are very popular at our school. Three-quarters of our students - 1300 - play sport. We have 75 sports teams this term alone."

Randell says it concerns him to see students returning from the dairy across the street with pies and energy drink, but he doesn't support banning unhealthy foods on campus. "If you think I'm standing at the gate to check 2000 bags, dream on."

BIG EFFORTS

There's no shortage of government organisations, community groups and businesses in the Bay offering to help us shape up. Sport Bay of Plenty runs Active Families to link children and their parents to sport. In addition, Nga Mataapuna Oranga runs four clinics in the Western Bay targeting high-need Maori. Dr de Wet says longlasting transformation requires leadership across society. "Until we focus on changing the food environment, I don't think we're going to make real progress with reducing obesity for children and adults."

RECOMMENDATIONS FOR CHANGE

*Sugary drink-free policies and healthy food initiatives led by schools, early childhood education centres, councils and workplaces
*Food product reformulation that progressively reduces hidden sugar content
*Policies that increase local availability and affordability of fresh and whole foods
*Council planning approaches that reduce children's exposure to unhealthy food environments (such as the high density of fast food outlets and dairies that often seem to surround schools)
*Regulation of the marketing of unhealthy food and drink products
- Excerpted from Medical Officer of Health Report, June 2016 by Dr Neil de Wet