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No role models?

With an obesity crisis weighing on the small shoulders of the UK’s children and teens, can community pharmacies help parents demonstrate healthy habits for better futures?

Food habits play a vital role in helping an individual to maintain a healthy weight, as well as a functioning immune system, healthy skin and a happy mind.

Instilling habits in children from a young age will play a significant role in ensuring they preserve their health as they enter adult life. 

Unfortunately, the current situation in the UK isn’t good, with more than one in four children aged four to five years, and four in 10 aged 10-11 years, being overweight or obese, according to the National Child Measurement Programme (NCMP). Indeed, the NCMP consistently indicates that the prevalence of obesity in children doubles between reception and year six. 

“We’re seeing worrying levels of childhood obesity,” says Bridget Benelam, nutrition communications manager at the British Nutrition Foundation (BNF). Speaking on the Training Matters Category Insight podcast in April, Bridget added: “We know that obesity in childhood can lead to obesity in adulthood, so this is a real concern when we’re looking at people’s health throughout their lives.” 

Of course, a lot of this responsibility is placed in the hands of parents, but pharmacy teams can be on hand to offer information on what makes a healthy diet and some top tips on how to keep a child engaged with eating well. 

So, what is need to make a nutritious meal?

Looking at the whole plate

Carbohydrates are one of the key diet components for all ages, with meals often being based around foods from this group. For a growing child, starchy carbohydrates are the best source of energy. Children should be offered a variety of these, including wholegrain versions and potatoes with their skins on as these contain more fibre. 

Protein is another key dietary component, excellent for growth, maintenance and repair of the body. Children should eat a variety of protein rich goods at least twice a day, according to the British Dietetic Association (BDA), which could include lean meat, fish, dairy products, beans and eggs.

When it comes to overall nutrition, some fat is necessary. Too much saturated fat, however, can increase a child’s risk of developing serious health conditions, such as heart disease later in life. Due to this, saturated fat such as fatty meat, butter and processed foods (e.g., cakes and biscuits) should be replaced with unsaturated fats (olive, rapeseed and sunflower oil or nuts and seeds). 

Calcium is vital for maintaining healthy bones and teeth. The BDA states that children should aim for three servings of calcium-rich food every day, for example, a 150ml glass of milk, a small pot of yoghurt or a matchbox sized piece of cheese. Additionally, the BDA recommends that children under two years have full fat milk and dairy foods. 

Iron is not only important for younger children but is also vital for teenagers, particularly teenage girls as they begin menstruation. It keeps the blood healthy and supports the transportation of oxygen around the body. Asides from supplements, iron can be found in foods such as lean meat, wholegrain cereals, dark green leafy vegetables (such as spinach) and dried fruit. 

Vitamin A is crucial for healthy skin and eyes as well as maintaining the function of the immune system. Sources include milk, eggs and orange, red and green leafy vegetables such as carrots, sweet potato and spinach.

Vitamin C is perhaps most famously obtained from citrus fruits and is essential for the healing process – maintaining healthy body tissues including the skin and gums. It also aids the absorption of iron from plant sources. The BNF’s has tips for parents trying to encourage their children to eat more fruit containing vitamin C, including having a fruit bowl which is easily accessible.

The body uses vitamin D for growth, development and maintenance of bones and teeth as well as keeping muscles and the immune system healthy. Worldwide, the main source of vitamin D is the action of sunlight on skin. In the UK, the sun is only strong enough to do this between April and October, thus a vitamin D supplement of 10mcg is recommend outside of these months for children aged four and over. Other food sources include eggs, oily fish and fortified breakfast cereals. 

Long chain omega 3 fatty acids are essential for normal brain development. As the human body cannot create this type of fat, it is especially important that it is obtained from our diets. The most common source is oily fish such as salmon, mackerel and sardines. A healthy, balanced diet should include at least two portions of fish a week, including one of oily fish. Girls and women, however, should have no more than two portions of oily fish a week due to toxins present which can build up in the body and may be passed to future unborn children. Additionally, all children under the age of 15 should avoid eating fish such as shark or swordfish due to potential mercury levels which can affect the nervous system. 

Vegan and vegetarian diets

Some customers may be choosing to raise their children on a vegetarian or vegan diet. Their wishes should, of course, be respected, but it’s important for pharmacy teams to emphasise to them that they have to ensure their children are still getting all the nutrients they need. 

For children on a vegan diet, foods that are nutrient dense are necessary to provide them with enough energy, protein, vitamins and minerals. The British Nutrition Foundation (BNF) recommends avocados, tofu, bananas and nut butters as well as vegetable oils or vegan fat spreads. 

Iron is essential for growing children and is usually most present in meat, so parents need to ensure their child is still able to obtain this. Vegan or vegetarian children should regularly consume wholegrain cereals, dark green leafy vegetables, lentils and dried apricots or figs. Additionally, calcium is essential to growing bones and teeth, lots of dairy alternatives have added calcium but remind parents to check the label to make sure. 

Lend a helping hand  

As well as outlining key dietary components and their importance, pharmacy teams can offer a range of advice
to help parent’s keep their child eating healthily. One of the best ways to do this is to ensure they are having child-size portions. 

According to the NHS, parents should try to start meals with smaller servings and wait for their children to ask for more food if they’re still hungry. The organisation also recommends that parents not use adult-size plates for young children as it encourages them to eat oversized portions. Children should be offered three meals per day with two small snacks in between, according to the BDA. It should be recommended that parents offer different foods each mealtime as eating a variety of foods will ensure that children are able to obtain a range of different nutrients. 

It may also help to encourage children to eat slowly and have set mealtimes. Advise parents to discourage sugary or high-fat foods such as sweets, biscuits and fizzy drinks, as these processed foods tend be high in calories and low in nutrients. Children should instead obtain the large majority of their calories from healthier foods like fruit and starchy foods like bread and potatoes. 

It’s also important to highlight to parents that they set a good precedence to their children who learn by example. Advise them that any changes they make to their child’s diet are much more likely to be accepted if they involve the whole family. 

For more information on this, teams can signpost parents to the NHS Better Health site.

Physically fit

Of course, diet is not the only thing that can help the obesity crisis facing UK children. Getting active can make a real difference. 

It is recommended that all children spend at least 60 minutes doing physical activity every day. This does not have to be all at once, in fact the NHS recommends that short 10-minute bursts of activity during the day can be just as impactful as a full hour in one go. Exercise can range from playing in a park for younger children, to walking to school or swimming for older children. 

As with diet, children often follow an example, so pharmacy teams could recommend that parents try to reserve time as a family to take part in exercise. “Keep trying different ideas until something clicks,” says Eric Small, specialist in paediatric and adolescent sports medicine. “It’s important to get non-athletic kids motivated and moving so they can enjoy a lifelong habit of physical activity.”

Tackling eating disorders

When it comes to food and diet, obesity is not the only health issue that customers of all ages may be suffering from. According to charity, Beat, approximately 1.25 million people in the UK suffer from an eating disorder. Stereotypically, many disorders develop during adolescence, but the charity states that they are aware of cases of anorexia in children as young as six. The most common types of eating disorder are: 

  • Anorexia nervosa – trying to control weight by not eating enough food, exercising too much or doing both
  • Binge eating disorder (BED) – eating large portions of food until you feel uncomfortably full
  • Bulimia – binge eating and then forcing regurgitation, using laxatives or excessive exercise, or a combination of these, to avoid weight gain
  • Physical signs of an eating disorder can include feeling cold, tingling in the arms and legs, problems with digestion and not getting a period. 

“Eating disorders affect everyone differently and there are many different signs,” says Umairah Malik, clinical advice coordinator for Beat. Some of these include people saying they have already eaten or will eat later, or that they have eaten more than they have. Sufferers may display anxiety around food, avoid specific foods or engage in strict dieting behaviours. They may also eat large quantities of food without feeling like they are in control, or purge after bingeing.

Symptoms may not always be visible. Umairah says: “Looking out for changes in mood is important, such as increased isolation or irritability, low confidence, difficulty concentrating, or a distorted perception of body shape or weight.”

There are some indications, however, that pharmacy teams can particularly look out for when it comes to spotting customers that may be suffering. According to Umairah, staff should watch out for: 

  • People who may enquire about weight loss medications or interventions and, in particular, might be showing higher than usual levels of concern about weight gain as a side effect
  • Someone who may be frequently using the scales in the pharmacy
  • Some who is excessively using or misusing medications such as those which suppress appetite, laxatives or diuretics
  • Someone who is displaying high levels of anxiety and stress, or seem low in mood, distracted or may struggle remembering information. 

When it comes to supporting customers that may be suffering, Umairah offers these key do’s and don’ts: 

  • Communicate sensitively by listening and providing a safe space to discuss concerns
  • For teenagers, discuss with them whether there is a trusted adult who is aware of what they’ve been experiencing, and whether they’d feel comfortable sharing it with someone
  • Pharmacy teams may also liaise with the care team where appropriate and should seek safeguarding support if needed
  • Recognise that someone with an eating disorder may not be fully aware or accept that they have problems with eating, and so raising your concerns in a caring and non-judgemental way is important
  • Don’t minimise someone’s experience, and don’t reinforce stereotypes about who can be affected
  • Avoid being critical, suggesting quick fixes or commenting on the person’s weight or appearance in general
  • Carefully consider the quantity and reason for purchasing laxatives or weight loss pills.
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