Schools and childhood obesity
The statistics are sobering – according to the Australian Institute of Health and Welfare, as many as 25 per cent of Australian children and adolescents are overweight or obese, and rates continue to grow.
Many experts say the community-wide public health effects of obesity are dire. Obesity has been linked with an increased likelihood of chronic conditions such as cardiovascular disease and type 2 diabetes. The economic cost is difficult to calculate, but according to the Australian Bureau of Statistics, the healthcare costs, loss of productivity and carers’ costs could exceed $58 billion.
But what is the best course of action to reduce obesity in our communities? The Global Obesity Centre (GLOBE), a research group based in the Centre for Population Health Research at Deakin University, thinks they have the answer. In a proposal made to a Senate committee, GLOBE’s Steven Allender said that weighing children at school every two years could map childhood obesity in order to better target problem areas.
The proposal comes after the success of a pilot scheme in Britain after which it looks likely schools around the country will be routinely weighing their students in a bid to better manage their weight.
During the trial, over the past three years, children at St Mary’s Primary School in Moss Side, Manchester, were weighed yearly by school nurses. The results were sent to parents and carers via text message along with an invitation to visit an online portal that provides information about maintaining a healthy lifestyle.
Speaking to The Times, St Mary’s principal Jenny McGarry said that the information was very helpful for parents. “You can normalise the size of your children because you see them every day,” she said. “It’s when you actually look at how they compare nationally or to what is desirable that the information is very powerful.”
On the surface, the scheme appeared to achieve positive results. Children at St Mary’s were less likely to increase their body mass index (BMI) than children outside the scheme. The Royal College of Paediatrics and Child Health has recommended that the scheme be rolled out across Britain.
In a statement last weekend, Australia’s health minister, Greg Hunt, said he will be referring GLOBE’s proposal to the Australian Health Ministers’ Advisory Council for consideration. A Change.org petition was launched within hours of Hunt’s statement.
At present, the Coalition government says it is taking a multi-pronged approach to obesity prevention. Speaking to The Saturday Paper, the minister for sport, Senator Bridget McKenzie, said that the Coalition government invests in a number of initiatives that include providing tools and information to consumers to help them make healthier, more informed choices.
At the moment these initiatives include the Health Star Rating on packaged foods, the government’s Healthy Weight Guide website, and the Healthy Food Partnership, an alliance of food industry and public health groups that aims to help the public make healthier food and drink choices.
The government has also invested $230 million in sport and physical activity, McKenzie says.
“[This will] enable more Australians to be more active, more often,” she says. “National and community sporting organisations, schools and physical activity organisations have a huge role to play in getting us more active, and will all share in new funding to support them in this endeavour.”
While McKenzie doesn’t specifically rule out the weighing of schoolchildren, the emphasis and investment in physical activity shows that promoting active lifestyles is Australia’s preferred strategy in dealing with the health risks posed by the growing obesity problem.
But if weighing children in school is shown to be working in Britain, should Australia adopt the scheme? Miriam Raleigh is a paediatric dietitian. She is emphatic when she says that she would not support the weighing of children in schools and warns that the measurement process can cause more harm than good. “Many children who are overweight or underweight are well aware that their bodies are different to some of their peers,” she says.
“Sometimes there have been comments from other children in a classroom or in the playground which have already left the child feeling very emotional about their body. Children need to feel supported and encouraged and not shamed about their weight.”
Raleigh says there are better methods of combating obesity than schools recording children’s weight as they grow. “How is their school uniform fitting? Do they still fit into their pants or dresses around the waist, but just need hems taken down?”
In fact, as well as being against weighing in general, Raleigh doesn’t support any sort of weight-loss initiative aimed at children. “We should never aim for weight loss as a success outcome,” she says.
“Children are in a constant state of growth and the risk of weight loss in a child is that they might not achieve their full height potential. We usually aim for a child to keep their weight stable while giving their height a chance to catch up.”
What role should schools play in reducing obesity among pupils? For Raleigh it comes down to better education about healthy eating and physical activity.
“Teach children, particularly young children, about what a healthy diet looks like. Teach them about the core food groups and why it is important to consume lots of different foods from each core food group each day or each week.”
In terms of exercise, Raleigh notes that there are already some fantastic initiatives being adopted in Australian schools. “Initiatives that encourage anywhere between 15 to 30 minutes of physical activity time that fit in within school hours … Students are walking or running around school ovals and grounds to help them achieve their daily physical activity goals.”
Raleigh also notes that the responsibility for delivering this type of education is often outsourced to third-party organisations. Life Education, Australia’s largest preventive health organisation, is one such group. They have been delivering health and wellbeing workshops for nearly 40 years.
Life Education spokesperson Kellie Sloane says obesity is a complex issue that requires intervention at every level. “It is important to recognise that a number of factors affect a person’s weight: the food we eat and the physical activity we do; genetics, family and social factors also play a role,” she says.
Life Education doesn’t talk to children about obesity specifically. Instead, educators, along with the Healthy Harold mascot, focus on prevention. “We don’t usually cover medical conditions and diseases in detail. We would use the term ‘overweight’ or an ‘unhealthy weight’ in a general sense only when discussing the possible long-term consequences of an ongoing poor diet and a person’s lack of regular physical activity,” Sloane says.
But while the British trial shows weighing children does reduce obesity, is there a terrible price to pay for promoting smaller BMIs? Critics of the scheme fear weighing children in the school environment could lead to fat shaming, a type of bullying that has been linked with eating disorders such as anorexia and bulimia.
According to the National Eating Disorders Collaboration, about one in 20 Australians has an eating disorder and the rate is increasing. Alarmingly, recent data from the New South Wales Hunter region showed that children as young as six have been presenting with eating disorders.
The effects of eating disorders should not be underestimated: health consequences include long-term heart problems, kidney failure, anaemia and osteoporosis. Women with anorexia nervosa are six to 12 times more likely to die a premature death, including through suicide.
The chief executive of the Butterfly Foundation, Christine Morgan, says that although the causes of eating disorders are very complex, fat shaming could definitely be seen as a contributing factor. Could weighing children at school lead to bullying? Morgan thinks so. “A concern with weighing children in schools is the body shaming between peers that may follow and the emphasis on body shape and size at such a young and vulnerable age.”
Rather than weighing children, Morgan says she would like to see schools doing more to build young people’s emotional awareness, communication skills, resilience and help-seeking behaviours. “Establishing these skills in young people can in turn create positive environments and management skills to prevent concerns from escalating into dieting behaviours and disordered eating and exercise.
“The most important thing a school can do is to create a supportive environment that encourages open conversation and role-models appropriate behaviour.”
This article was first published in the print edition of The Saturday Paper on Jul 28, 2018 as "A weigh-in a danger?". Subscribe here.