CHILDHOOD OBESITY PREVENTION
An interview with Prof. Jaap Seidell, of the Amsterdam Free University and chairman of the EEN committee on "Scientific Evaluation and Dissemination"
Prof. Jaap Seidell is currently Head of the Institute for Health Sciences and Head of the Department of Nutrition and Health at the Faculty of Earth and Life Sciences at the Free University and the Department of Internal Medicine of the VU Medical Center in Amsterdam. He is currently editor-in-chief of the "European Journal of Clinical Nutrition".
Community Based Interventions are the way forward
Professor Seidell's main research interest is the role of life-style factors in the prevention of chronic diseases, in particular the study of the causes and the consequences of obesity and body fat distribution. Over the last 10 years, he has shifted his focus away from the problem more towards finding solutions, particularly through "Community Based Interventions".
According to the interpretation of data, Prof. Seidell has noted that with just a relatively small increase in weight across a population (say an average of 3 kg or so over a 10 year period), the shape and spread of the Body Mass Index curve moves considerably. So while the lower BMI values will stay roughly the same, the higher values are much more spread out. It means that when the average BMI index increases by just a few units - from say an average of 21 to 23 or 24 - the number of obese people in the population at large increases significantly. He has observed that the bell curves are now flatter and longer, with the consequence that up to 1/3rd of the population in Western Europe can be classified as either overweight or obese.
The blame game
While every stakeholder in society agrees that obesity is a real issue, each distances itself from the problem. Each claims innocence in causing the epidemic.
The fact is society has radically changed.
The last 20 to 30 years have brought major lifestyle changes to almost everyone in Western Europe. Not only is food intake up, pre-packaged and pre-prepared food makes up a larger share of the diet. Fizzy sugared drink consumption has also continued to rise. Television has now become a round the clock phenomenon, and there are many more channels to choose from - and they are being watched! Schools, under pressure for academic performance, have done away with much of the physical exercise programmes of the past, and in many cases, playing fields have been sold for extra income. Parents too have been much more protective of their children letting them go out to play or ride a bike only under strict supervision.
Governments and local administrations have been slow to recognise these changes, and as a consequence certain infrastructure projects (play grounds, playing fields, bicycle lanes for example) have not received the investments required. Only now is there a gradual understanding that unsafe neighbourhoods have a knock-on effect within the community and the home, as parents become more reluctant to let their children go outside alone.
To conclude, instead of obesity being an unusual response to a normal environment, Prof. Seidell believes it is "a normal response to an abnormal environment."
Why has this happened, and what can be done about it?
Prof. Seidell says that while there have been many published studies about the problems and treatments of obesity, much of the research has been ignored by the scientific community as it has not been the subject of randomised control trials. Furthermore, drawing conclusions even from those studies with control samples has been difficult and the results have been less than conclusive. According to Prof. Seidell, this is for two reasons: on the one hand, research with randomised control trials run for only a relatively short period of time; and secondly the very fact that the control sample is selected and measured, means that the results are biased in their favour, as the recruited control sample is likely to behave differently than usual.
A much richer source of data has been the work done on communities as a whole, where the vast majority of interventions have had a profound effect on the levels of obesity in the society at large. The studies themselves have been going on for a much longer period of time (more than 15 years in some cases), and the results are conclusive.
There is no "silver bullet" to fighting obesity.
There is however no one thing to be done to reverse the trend for greater BMIs and more obesity. Just as the prevalence of being overweight is due to a combination of factors, so the resulting cure needs to be an integrated response.
Prof. Seidell is convinced that the integrated approach to fighting the problem is the only way forward. And this takes time, because there is a lot to get right.
Town planners need to be involved so as to create the right environment: for example exercise needs to be encouraged through the building of playgrounds and the creation of bicycle lanes.
Politicians too need to back the project so that the public at large feel good about letting their kids play outside safely. Bicycle lanes alone are not good enough; the public must feel good about using them. (There is a case of a city in Australia installing bicycle lanes that never got used - because the public felt unsafe in the surrounding traffic.)
Food and drink companies need to do their part and be an active part of the dialogue. (In this matter, Prof. Seidell is particularly pleased to see the 3 food sponsors, Nestlé, Ferrero and Mars working with and for the EPODE project).
The education system - including changing the curriculum - must back the movement. School meals with less fat and more fruit are just one example. Parents too need to be engaged and wooed, not only to provide healthy balanced meals but also to encourage their children to take more exercise.
To sum up, (and to quote the W.H.O.), we need to seduce people into doing the right thing, and so "make the healthy choice, the easy choice".
Developing signposts for successful implementation
Changing habits and behaviour does take time, often years, even decades. It is for this reason that Prof. Seidell and his team have been looking to create markers and signposts along the way of a successful roll out of the programme. They are also developing computer models that take into account ALL the factors contributing to obesity in society.
Prof. Seidell is adamant; the combined approach is the only way forward. He concludes by saying, "if you address just one of the causal factors, there will be no chance of success. We've got to work on each and every cause at the same time."