Saturday 24 August 2019

Eilis O'Hanlon: 'What our grandparents knew: whims of childhood should not be indulged'

When it comes to reducing worrying levels of childhood obesity, some new evidence suggests that the old ways are best, writes Eilis O'Hanlon

Figures presented to the European Congress on Obesity last week revealed that the northern English city of Leeds has become the first UK region to record a fall in the number of seriously overweight children. Stock Image
Figures presented to the European Congress on Obesity last week revealed that the northern English city of Leeds has become the first UK region to record a fall in the number of seriously overweight children. Stock Image

Eilis O'Hanlon

Figures presented to the European Congress on Obesity last week revealed that the northern English city of Leeds has become the first UK region to record a fall in the number of seriously overweight children, and it turns out that the reason for the drop is a return to traditional parenting.

Of course, it's not being described that way, but digging further, it's apparent that what Leeds has done is champion programmes where parents, particularly in deprived and low income areas, are encouraged to set boundaries for their children and not give them everything they want.

It's based on an approach known by the acronym Henry (Health, Exercise, Nutrition for the Really Young), which not only teaches stressed parents strategies to control what, when and how their children eat, but also looks at how families interact with one another and their routines (or lack of them).

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Who could have guessed that such an old-fashioned approach would work? Apart, that is, from anyone who ever gave the problem more than five minutes' thought?

It's difficult to discuss issues such as childhood obesity without straying into hyperbole. News headlines can make it appear as if everyone is eating themselves into an early grave when, in truth, we're living longer than ever. That's still no cause for complacency. The Irish consumption of fruit and vegetables is far too low; only one in four people eats the minimum daily requirement of five portions, and one in five doesn't eat any at all some days. Two thirds of people consume sugary snacks and drinks daily, and only 12pc of postprimary school children do the recommended amount of exercise.

It all leads to a range of health problems in later life such as heart disease, cancer, Type 2 diabetes, and respiratory problems. There is simply too much saturated fat, sugar and salt in our diets, and the challenge this presents can look so overwhelming that the solutions suggested to deal with them tend towards the overly complex when what Leeds proves is that sometimes simplicity is best.

Unfortunately, there's a reluctance to embrace simple ideas at government level. The Department of Health's landmark "obesity policy and action plan", entitled A Healthy Weight For Ireland 2016-2025, was one such example. That was clear from the outset, as health minister Simon Harris used his introduction to boast that it came about after "an extensive consultation with key stakeholders and meetings and submissions from a wide sector of organisations."

It's supposed to be reassuring, but one's heart can only sink at how they cling to that dreaded word "stakeholders", which was once listed among the top 10 worst examples of management speak. Stakeholders are just people who have an interest in a particular outcome, in this case, living longer and healthier. In other words, everybody. The report sets its sights more grandly on "healthcare professionals, academics, representatives from industry, relevant government departments and non-governmental organisations".

Politicians love this idea of the whole of government working together. The plan even envisages roping in the EU, UN and World Health Organisation. It's important that the work of different departments doesn't conflict, but making an issue such as obesity into a multi-agency, many-dimensional matrix just increases the chances of failure, creating more points at which the plan can break down.

On page 22 of the Healthy Weight For Ireland report, there is a table showing the most cost-effective interventions that could help reduce obesity. The raw data comes from the UK, but is obviously regarded by the Health department in Ireland as being locally relevant. The table shows "parental education" to be one of the most effective methods of reducing the social and economic cost of obesity, yet it barely gets a mention in the rest of the 84-page report, or indeed in government policy since. Instead it was a sugar tax, identified by the table as much less effective, which was introduced by the Government last May. How can this be considered evidence-based policy making?

"Public health campaigns" are also shown to be comparatively ineffective, but the Government remains obsessed with regulating advertising to push a media message that obesity is bad for the nation's health. As the creators of the Henry project point out, it's not that people don't know that being fat is bad for them, they just don't know what to do about it.

To be fair, the Irish report does talk about "individual choice", but not as much as it should, and it keeps returning to the slogan that the best way to go is to "make the healthy choice the easy choice".

That's not always possible. The easy choice is giving in to children's demands. It's also the wrong choice. Yet despite the fact that these "bottom up" methods are the most effective, the acknowledged need for "community-based health promotion programmes" soon gets buried under an avalanche of top-down initiatives, all stemming from the "Cabinet Committee on Social Policy and Public Sector Reform, supported by the Senior Officials' Group". Breaking out of this bureaucratic way of thinking has always proved impossible.

The country isn't doing as badly as it might. Headlines have warned for years now that Ireland is on course to become the fattest nation in Europe, but further figures from last week's European Congress on Obesity suggest those fears may have been exaggerated. Rates of what's categorised as "severe childhood obesity" in countries such as Greece, Italy and Spain are more than double the Irish rate. Having said that, the numbers aren't going down significantly either, so why not try what's been shown to work?

One explanation is surely that there's a reluctance to do anything which might be interpreted as criticising parents, especially those from socially disadvantaged communities, where childhood obesity is more concentrated. What the Leeds experience shows is that it's possible to help parents without nagging or attaching blame.

There's also a deep-seated resistance to the idea that the old rules-based method of parenting might have been the best all along. Philosopher Roger Scruton summed it up rather neatly. "People are unconsciously aware that the customs of society embody more wisdom than could emerge in a single generation," he once wrote. "They may struggle against this awareness, as liberals do. But it is far more reasonable, far more congenial, to acquiesce in it."

Certain ways of being have survived for a reason. That reason is generally because they work. Instead of constantly trying to reinvent the wheel, maybe we'd do better to acknowledge that our grandparents were right, and that we've gone too far in the opposite direction by giving in to children's whims, but also in so many other socially disruptive ways as well.

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