BRITISH BROADCASTING CORPORATION
RADIO FOUR
CHECK UP Programme No. 6 - Obesity
TX. DATE: 27TH DECEMBER 2007 1500-1530
PRESENTER: BARBARA MYERS
CONTRIBUTORS: PAUL SACHER
NICOLA DAVEY
GARY BIRD
PRODUCER: BETH EASTWOOD
NOT CHECKED AS BROADCAST
MYERS
Hello and just for a change we're taking questions today, not on the phone as we normally do, but in person, direct from a group of children and their parents who I have come to meet here in West London.
They are all here taking part in the MEND programme. MEND stands for Mind Exercise Nutrition - Do it!
And the MEND programme began in 2002, there are now over 150 MEND groups up and running all around the country and another hundred or so about to start. And their mission is to tackle childhood obesity. And with one in three children now classified as obese and overweight that's a big challenge.
But its not one that daunts our experts today. They're Nicola Davey, she's a nurse and a MEND trainer here in Fulham and Paul Sacher is from the Institute of Child Health, he's a dietician and one of the people who devised the MEND approach to weight control.
Now Paul, I say weight control rather than weight loss because this is not about crash dieting is it?
SACHER
Well Barbara the whole thing about children is they're still growing and so children need to get a balanced diet in order to grow properly, develop properly, their brains are developing very rapidly and so we don't recommend dieting for children. If a child doesn't gain any weight, sometimes that can be a sign that they're not getting everything they need. So what we do on MEND is we recommend that the children either stay the same weight as they grow taller or possibly for some of the children, who are maybe a little bit more overweight, losing weight slowly.
MYERS
More about the MEND programme in a minute but it's fair to say that everyone here is a little bit concerned about their weight. Let's go to the floor and see if there are any questions. There's a young man over there, give me your name and what's your question?
MOHAMMED
My name's Mohammed and my question is that because I love junk food and all them stuff how can I cut it down?
MYERS
Paul, there is a tendency to eat junk food, it's really cheap, really available, quick and easy, it saves everyone having to go home and cook, is there anything actually wrong with eating junk food, takeaway meals and so on?
SACHER
Junk food is generally high in fats, sugar and salts - all the things that block our arteries, give us cancer and diabetes and all those other kind of nasty illnesses. A lot of people think junk food's cheap, it's not cheap - if you add up all the money you spend on junk food and you buy proper food at the supermarket you'll be amazed at what you can get for your money. And that's one of the things we teach families on the MEND programme, we give them loads of recipes. All the recipes are costed, so they actually have the prices, so you can actually see that to make a turkey burger with tomato salsa on wholemeal bread at home is about a quarter or a fifth of the price it would cost if you got it from a fast food joint. And again with fast food it's like sweets, we're not saying never have fast food but if you have it everyday maybe try and cut it down and have every second day and slowly try and reduce the amount of food you're eating. Another good thing to do is before you go out say you normally have some chips on the way home from school, make sure you have an extra bit of food in your packed lunch so you can have that just when school finishes so you're not starving when you walk past the chip shop, it's much easier to say no to these things when you aren't starving.
MYERS
I guess there are not many people here in this room, prove me wrong, that really would like to see a giant heaping portion of - well let's shall we say broccoli or cabbage or carrot. Who hates vegetables? Yes, let's bring the microphone to this young lady, tell us what your problem is about vegetables.
CHILD
I don't like courgettes or tomatoes.
MYERS
If someone has particular dislikes and they happen to be vegetables should you force vegetables on children, we know they're good for you - lots of vitamin C, lots of fibre?
SACHER
Well it is a problem, children are growing very quickly so they need all their vitamins and minerals and nutrients to grow up to be strong and healthy but I think in many cases what we find is that many kids actually haven't tasted the full range of fruit and vegetables out there and as a dietician I've had many parents bringing their children to me and saying my son or daughter doesn't eat any fruit and vegetables. My first question is always do you eat fruit and vegetables and very often they'll say no. So the first thing you can start to do as a parent is to actually eat fruit and vegetables yourself and generally children will copy you. But again it's not sort of trying some and going ooh but forcing yourself to eat it but actually enjoying it. The other thing to say is it does take children up to 15 tries of a vegetable before they begin to like it, so any child who just puts vegetable in their mouth once, tries it and goes ooh I hate that, we don't accept that, try a small bit everyday for two weeks and at the end of the two weeks I guarantee you will not hate it as much as you hated it to start off with. And again it's about small steps.
MYERS
Let me bring Nicola Davey into this because I know you're very much involved in attitudes to food, getting motivation right and so on. From your point of view how can all of us change our approach so that we actually find time to go home and make good meals and time to sit down and perhaps share family meals so that the fast food, you know the instant gratification, isn't such a strong motivator?
DAVEY
Well it is really difficult because we all have such busy lives these days and when people participate in the MEND programme, the children and their families, it's a whole life change to a healthier lifestyle that we are asking them to make and them being there is saying that they want to make the change as well. And like Paul was saying it's little things that you can do, say like starting to eat together and making families meals a social time, sitting there and eating a meal with your children demonstrates to them that food is important as they're growing up really.
MYERS
We've got another MEND trainer with us in the audience today - Gary Bird - you're involved in helping the youngsters get some exercise, what would you say about encouraging people to get out there, do something, play sport, not everyone likes to or feels they're good about sport, so how can you get people moving?
BIRD
Well I think they can do it anytime in the day, going to school, maybe coming home from school, walk the extra bus stop or get off at the bus stop before and gradually build it up everyday. Might be walking halfway to school or halfway from school. And when they do get home go down to the park have a kick about. There's loads of ways we can exercise.
MYERS
Is there anybody here who has problems getting out there, running around?
SAM
Well when I first started I didn't do sport, I just sat down played my Playstation, watched TV, liked drinking coke and eating chocolate. I'm glued to the computer like my dad. But what I want to do is I want to try and find of a way of getting off and like mixing with other kids.
MYERS
And your name is?
SAM
My name's Sam and I'm nine.
MYERS
What's made you get more active and perhaps thinking again about how much junk food you're eating?
SAM
What I do now is I've cut down on my portions, I'm getting more fit and when I used to go to school I used to get taken the mickey out of but now when I go to school I don't get taken the mickey out of because they really know I've started.
MYERS
Paul, what do you reckon to Sam's approach?
SACHER
I mean we know bullying's a huge problem and it's on the increase. One of the things that MEND does, one of the fundamental things it does, is it helps to improve children's self-esteem and confidence because kids pick on the weakest kids and the minute they see you feeling more confident, you're a bit fitter, you're not coming last in PE, you can run a bit faster, you're just looking a bit more comfortable in your shoes, often they tend to leave you alone and move on. And for some kids on the MEND programme they've never had a friend before or they don't have many friends at school so suddenly you've got your own little gang, your own group and the whole programme is about improving children's self-esteem and confidence. I'm quite sure that before the programme many of the kids we're hearing from today probably wouldn't have had the confidence to speak in this type of forum.
MYERS
Any parents out there who think that they are seeing really positive changes and see how their kids are actually getting to grips with weight and their self-esteem.
SAM'S MOTHER
Well basically since Sam started there's an outlook, everyone's seen the weight loss, basically he's more self confident, more worried about what he's eating and basically it's not just what actually in the MEND programme it's people outside - his head teacher and everything - it's the motivation that has basically helped him as well. And he's not sitting down because as you were just saying if you've got a child and they're getting picked on, children do say nasty things the way they look - if they wear glasses or so forth - but yeah it's built up his self-confidence and everything else.
MYERS
And how as a mum are you making or helping make those changes around the diet? Sam mentioned portion control - what sizes are we talking about now?
SAM'S MOTHER
Basically that's what I wanted to ask, is you've got three children, I've got a child of two, a girl of 11 and Sam who's nine. Now portion control, you've got my daughter that don't hardly eat anything, so how can you help that when you've got a boy that eats everything and then you've got the two year old - so how can you say about portion sizes when the family eat all different?
MYERS
It's a good point and we're a bit confused, it seems to me Paul, about what makes a portion because it depends what it is of course and what else you're eating it with but is there a kind of rule of thumb, I mean take a typical, I don't know, dinner plate?
SACHER
Well a third of the plate should be carbohydrate and on MEND we say slow release or unrefined carbohydrates, so that's things like pasta, brown rice, if you're having bread sort of wholemeal or whole grain or granary bread no white bread. A third of the plate should be maybe a couple of vegetables or salad and then protein, sort of meat, fish, chicken, or vegetarian alternatives. But the main thing is really - there's two issues really - it's the type of foods you eat and it's how much you eat. The other thing is kids are growing, they need loads of energy, they're at school in the morning, so they need to have three meals a day and up to two snacks per day. So the minute you leave a child without food for too long they can't control what they eat, so keeping children regularly topped up, if you like, with fuel really helps them.
MYERS
Thank you. There's a mum over here with a question.
PARENT
I didn't realise the crisps and other daily things that children eat are really, really fatty, so that was an eye opener for me when I actually looked at the label, I just didn't realise that but I'm fully aware of it now and quite conscious, so hopefully I'll be able to help my son as well.
MYERS
Paul, can you comment about the food labelling because certainly some items you buy it's not at all clear whether they're going to be good for you or bad for you, they may be very high in certain fats, for example, and yet they're still advertised as being healthy options, how can that be?
SACHER
This is a huge problem. The first issue is lots of different supermarkets label in different ways and you have to be some sort of scientist to be able to understand how they all work. Even I can't get my head around all the different systems. What we do at MEND is we just look at the back of pack and that's what has to be there by law and we just look at very simple things - how much sugar, how much fat, does it have any fruit in. A lot of food manufacturers will make claims like low fat, the minute you see something low fat generally it'll be high in sugar. So it's all very confusing and the only way to actually find out if something is sort of healthy or not is to actually look at the label, the back, yourself and not believe anything that's written on the front.
MYERS
But if you look at the pack Paul you still don't entirely know what it means, even if some figures and facts are given there do you?
SACHER
It's very easy actually, we always look per 100 grams, so you can pick up any food and compare - so you pick up two pizzas you can immediately tell which has more fat by looking at how much fat per 100 grams. And the cut offs during MEND are to have less than 5 grams of total sugar per 100 grams and less than 5 grams total fat per 100 grams. There are exceptions to this rule, for example if the food contains fruit or has lots of dairy products, those are sort of MEND friendly or healthy versions of sugar. But it is a very easy way just to see what's inside food and to make healthier choices when you are shopping.
MYERS
You are listening to Check up with me Barbara Myers. No phone calls today - we are taking questions instead from families who are here at a MEND training course, we're in Fulham in London.
Another question from one of the parents, yes lady over here.
PARENT
It was just that I had one child that was quite overweight from young and I didn't want to put her on a diet, so I was looking for something with healthy eating using the nutrients and not missing out on the healthy stuff.
MYERS
And why didn't you want to put her on a diet?
PARENT
I was just scared of anorexia basically and food fads and stuff like that.
MYERS
And that is a very fair point, we hear a lot about girls particularly getting over obsessed with their weight and becoming very thin and possibly becoming anorexic. So there's a challenge - we're making these children very conscious of their weight, so how can we avoid these kind of psychological problems? Nicola, perhaps that's your department.
DAVEY
It's obviously yes very important not to put children on a diet from the nutrition side that we've said before but psychologically you want to be demonstrating to your children a healthy lifestyle, you're acting as a role model as such and if you're eating healthily and as a family as well and showing to your children that this is normal, it's normal to have a good healthy breakfast in the morning, to have an apple as a snack and so on and so forth and gradually install this healthy lifestyle.
SACHER
I just want to say about the eating disorder. There is research that has been done looking at children who've been through healthy lifestyle programmes and whether they have any increased incidence of developing eating disorders and there isn't a link. I think a lot of parents think well I'm not going to raise the issue of my child being overweight because I'm scared they might go the other way, that doesn't happen, it's really important that you do speak to your child about their weight and your own weight, if you happen to be overweight. And often many children will be concerned about it, they might not be telling you about it but they might be being bullied at school or having other issues. So it's very important as a family that you are able to talk about these issues.
MYERS
Does that mean Paul, would you suggest, that parents should know at anytime what their child weighs and in keeping an eye on it again is there a rule of thumb - do we always quite appreciate that the pounds are being piled on, what is a proper normal weight at any given age?
SACHER
Well you can't just look at a child and tell whether they're overweight, obese or a healthy weight, even I can't and I've been doing this work for 11 years now. The only way to do it is to have your child weighed and have their height measured and then calculate their BMI. There's loads of websites where you can just enter their weight and height and it will tell you whether they're a healthy weight, overweight or obese. And I think it's important that you are aware of that because as all children are getting bigger - you know a third of all children in the UK are overweight or obese - they don't stand out as much anymore. When I was at school I was obese and everyone knew I was the fat kid at school because there were so few kids who were overweight. I was taken to see a dietician at the age of 12, I was put on a really strict diet, I was told I couldn't eat any of my favourite foods, I felt the whole world was ganging up on me. I used to, you know, eat these things behind my mum's back, I was told I couldn't eat it so I used to buy them on the way back from school. And it was only until I decided for myself that actually I wasn't happy with how I looked and the fact that I was coming last in PE that I actually started reading up on nutrition, so I lost a lot of weight but mainly through exercise but also through healthy eating.
MYERS
Excellent. Another question from perhaps one of the parents. Yes, lady over here.
PARENT
I just wondered why you advocated aspartame, there's been a lot of bad press about that as an artificial sweetener, over honey. You know I'd prefer to give something natural to sweeten say a breakfast cereal.
SACHER
Yeah I mean how it works is many of the kids before they go on the programme in the research we've done are having anywhere from a 100, all the way up to 180 added teaspoons of sugar per day, that's in all their food and drinks. So children are used to eating a very sweet diet. Now what we've done in the past is we've taken them from a sweet diet and said right no more sugar, not artificial sweeteners and what happens is the children feel like they're on a diet, they're craving sweet things and they don't last more than a week. So we recommend them during the programme, while the kids are getting used to a less sweet diet, and then we tell you by the end of the programme to start reducing those foods yourselves containing that. But a few teaspoons of artificial sweetener per day, a few drinks, will do no harm to anyone, there's tonnes and tonnes of research. A lot of the stories you might have heard are basically studies that were done in rats where they gave them the equivalent of hundreds of cans of fizzy drink a day. And so there is really no risk for the kids. The biggest danger to these children is their weight and not the miniscule potential harmful effect that artificial sweeteners might do. So really we need to keep it all in perspective, these kids need to do enough exercise, they need to eat healthily, they need to make sure they don't grow up to become really overweight adults because we all know a. how hard it is to lose weight when you're an adult and b. we all know people who've had health problems because of their weight.
MYERS
And I don't want to scare our young audience but I mean those health risks are really quite considerable. Just run through them if you will Paul, the kind of things that can go wrong with your body if you carry too much weight from an early age through into adulthood.
SACHER
Well obesity has been linked to almost everything now, it causes cancer, it causes heart diseases, it causes diabetes, it causes depression, it causes increased rates of suicide. I mean you name it there's a link to obesity. And we also know that children - an obese child has between a 40-70% chance of growing up to be an obese adult if they don't do anything about it. The good thing to say is you guys are in a unique position, you're actually addressing the problem, you're learning about all the stuff while you're young and for many of you I think the biggest thing is you're learning that exercise can be fun. I saw you all racing around earlier, I wonder whether you would have done that four or five weeks ago if we'd put you in an empty hall?
MYERS
Who's enjoying the exercise side of things? Again all the hands go up. Why are you enjoying it, what are you enjoying about it, someone we haven't spoken to, this young chap over here, yes tell us a little bit about it?
CHILD
Because before when I never used to do a lot of exercise I wasn't very experienced in exercise and I wasn't very fit and ever since I started doing a lot of exercise I've found it quite fun.
MYERS
Anyone else want to say something about that, yes girl at the end?
CHILD
I found it quite fun because it's not just that it's exercise, Gary makes us feel much welcomed here and nothing goes wrong here.
MYERS
And Sam again.
SAM
We get to do more team games, we get to play dodge ball and we're getting more fit.
MYERS
Part of this is about setting goals for yourself if you're going to try and control your weight and doing it through exercise and obviously doing it through what you eat. Some of you have already set some goals, give us some idea of what you are wanting to do, let's go to this young chap again, what's your goal?
CHILD
Now I'm cutting down on fizzy drinks and I do exercise twice a week in the park for 20 minutes.
MYERS
And when you achieve your goals you give yourself a reward don't you?
CHILD
I haven't decided yet.
MYERS
Alright, who else has got a goal and has set themselves a reward?
CHILD
My achievement is to cut down on chips and for my exercise one it was running up and down the stairs three times a week and my reward was a magazine.
MYERS
What's interesting Nicola is that the children are breaking their goals down, so they are very precise - eat less chips, don't eat school puddings, run up stairs a couple of times and there's a reward attached - tell us a little bit about how important it is to help children set goals.
DAVEY
Well with the children on the MEND programme they set a nutrition goal and an exercise goal and this is reviewed weekly and we give a sticker as to whether they've achieved those every week. So it's like a normal behavioural management chart that parents might have used beforehand. And if they achieve those goals they have a weekly reward that comes from their parents. As we heard a magazine or a piece of Lego or getting to go and spend time with mum swimming on a Saturday afternoon. And it works very well. I think it's, for children, it brings things down to their level as well, it makes - it makes their achievements really tangible, if they know by the time we get to Thursday, which is when we do them, that they're going to have this time set aside for them, they can really look forward to it and it makes them stick to what they're trying to achieve - the healthy lifestyle in the long run.
MYERS
Is there a principle here do you think Nicola that's applicable to all of us not just for children - breaking things down into small steps?
DAVEY
It makes you feel really good if you - if you achieve something, if you can see a difference in yourself, if you feel healthier in yourself then actually that gives you a bit of a buzz as well. And also other people start to comment on it and I think that's really important.
MYERS
So are there any parents here today who are taking this advice for themselves - things that their children are learning that they've been able to adopt for themselves and for the rest of the family, maybe even about breaking things down into small steps, setting goals? Yes this lady.
PARENT
We never ate brown bread before, we never had brown cereal - I'd see them on the shelves and sometimes we buy the shredded wheat, sometimes we buy the wheat - now it's all bran flakes, shredded wheat, weetabix and sultana bran - that's all we've got now. And even the three year old is eating brown bread and she would not eat it before and I wouldn't eat brown bread, I didn't like it, now I don't like white bread, I've really gone off it.
MYERS
And this lady?
PARENT
What was good is that we learnt to set realistic goals, so rather than banning chocolate forever, which for me would be impossible, at least to maybe have one piece at the weekend instead of one piece a day. So that's been useful really.
MYERS
A very good comment. Perhaps I could get you Paul just to leave us with a few more top tips to mull over, something perhaps to bear in mind as we make our New Year resolutions. If you said nothing else what would you want to say about this?
SACHER
Well I think the top tip probably would be don't - if you don't want to eat junk, don't buy junk, don't keep it home. Eat as a family, the more you eat as a family the more kids will copy you and learn from you. Go back to cooking, it's much cheaper than buying fast food and all that kind of stuff. Do all of it but do it in moderation. And you know no matter what the weather is make sure you get out there and do some exercise, even if it's just walking up the stairs or going for a walk around the block.
MYERS
Thank you very much. Thank you to Paul Sacher, to Nicola Davey, to Gary Bird and to all of you who have joined us to share your experiences and to help us think a bit more about some practical and positive ways that we can control our weight and improve our health. There's more information on our website, that's bbc.co.uk/radio4 follow the trail to Check Up. Or you can phone our free and confidential help line, that's 0800 044 044. And join me again next week please when we'll be back in the studio and ready to take your calls about problems with your voice.
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