Chapter 4 Chapter four HELPING CHILDREN ACHIEVE ENERGY BALANCE Key messages School-based programmes should Family-based guidance should A healthy active childhood: giving children the best chance of a cancer-free future 29
C Population-based programmes 30 World Cancer Campaign 2009
Chapter 4 Micro-environments Intrapersonal (eg individual) Interpersonal (eg family and friends) Institutional (eg school or workplace) Community Macro-environments Food processing industries Local government Mass media Non- governmental organizations Political pressure groups Legislators International environments Trade agreements Food marketing Figure 7. Examples of micro- and macro-environments for action Opportunities for effective prevention policy A healthy active childhood: giving children the best chance of a cancer-free future 31
Include food and health education in the school curriculum Control the provision and sale of fatty snacks, confectionery and sweet drinks in public institutions such as schools and hospitals Control the advertising and promotion of food and drink products Provide public subsidies on healthy foods to improve patterns of food consumption Encourage more physical activity by changing planning and transport policies Improve provision of sports and recreational facilities in schools and communities Improve training for health professionals in obesity prevention and diagnosing and counselling those at risk of obesity Improve health education to enable citizens to make informed choices Reform the EU s common agricultural policy to help achieve nutritional targets Make nutritional information labelling mandatory for all processed food, for example using an energy density traffic light system, with high energy density products labelled in red, low density products labelled in green, and intermediate products labelled yellow Figure 8. Policy options to prevent childhood obesity (European Heart Network 2007) Evidence for effective prevention programmes 32 World Cancer Campaign 2009
Chapter 4 Overall educational message Children told that decreasing sugar consumption would improve overall well-being and benefit dental health 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 Opportunities for effective prevention programmes Figure 9. CHOPPS: a successful school-based obesity reduction programme (James et al 2004) A healthy active childhood: giving children the best chance of a cancer-free future 33
School policies and school environment Ensure school policies and school environments encourage 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 training on how to implement healthy school policies Links with relevant organizations Establish links with health professionals and those involved in local strategies and professional partnerships to promote sports for children and young people Interventions Introduce sustained interventions to encourage pupils to develop life-long healthy habits. Short term, oneoff events are not effective on their own Take pupils views into account including differences between boys and girls and barriers such as cost or concerns about the taste of healthy food PE/sport staff should promote activities that children enjoy and can take part in outside school and continue into adulthood Children should eat meals in a pleasant sociable environment free from distractions Younger ones should be supervised; if possible, staff should eat with them Involve parents where possible; for example through special events, newsletters and information about lunch menus Figure 10. Recommendations for school settings (NICE 2006) The family context 34 World Cancer Campaign 2009
Chapter 4 Figure 11. YES SELECT WITH CARE NO Drinking water must be available: Free drinking water must be available in schools at all times Drinks that are allowed to be provided: Mineral water (still or carbonated) Semi-skimmed, skimmed milk or lower-fat milks There is a range of other drinks permitted by the regulations but these drinks must be carefully selected (see the SELECT WITH CARE column Other drinks that are allowed to be provided if specific criteria are met: Milk drinks (hot or cold) containing: no more than 1.8g of total fat per 100ml no more than 10g of total sugars per 100ml and no more than 20g of total sugars per portion size. Drinking yoghurts containing: no more than 1.8g of total fat per 100ml no more than 10g of total sugars per 100ml and no more than 20g of total sugars per portion size. Soya, rice or oat drinks enriched with calcium containing: no more than 1.8g of total fat per 100ml no more than 5g of total sugars per 100ml and no more than 10g of total sugars per portion size. Any variety of fruit juice or vegetable juice (including fruit juice made from concentrate or partially made from concentrate) 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 vegetable fruit 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 sugar no more than 20g of sugar per portion size 50% or more fruit or vegetable juice and no more than 200ml fruit or vegetable juice. Tea and coffee the use of any milk in these drinks should be restricted to semi-skimmed, skimmed milk and other lower-fat milks. Examples of drinks that are no longer allowed: No soft drinks (still or carbonated) including flavoured waters (the only exception is the combination drinks that meet the criteria set out int the SELECT WITH CARE column). No sugar-free soft drinks (still or carbonated) including flavoured waters No sweetened fruit juice No sweetened or salted vegetable juice No squashes/cordials including lower sugar and no added sugar versions No whole milk No sport drinks www.scotland.gov.uk/publications/2008/09/12090355/ A healthy active childhood: giving children the best chance of a cancer-free future 35
If you eat KJ Kcal Sitting still Walking (5.6km/hr) Food Running (12km/hr) Swimming (freestyle) 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) Food and drink weights sourced from www.calorieking.com.au Diet Children and young adults should eat regular meals, including breakfast, in a pleasant, sociable environment without distractions (such as watching television) Parents and carers should eat with children with all family members eating the same foods Activity Encourage active play for example, dancing and skipping Try to be more active as a family for example, walking and cycling to school and shops, going to the park or swimming Gradually reduce sedentary activities such as watching television or playing video games and consider active alternatives such as dance, football or walking Encourage children to participate in sport or other active recreation, and make the most of opportunities for exercise at school Conclusion Figure 11. Recommendations for parents and carers (NICE 2006) 36 World Cancer Campaign 2009