Child obesity: leveraging a sweet spot for crucial action

YOUNG Australians now face an escalating health crisis. In 2016, almost one in every four children growing up in Australia is either overweight or obese – a 21% increase since 1995. A staggering statistic that means this is not a health concern for a marginal few, but a society-wide challenge that threatens the wellbeing and welfare of our young people now, and throughout their future lifespans.

As clinicians, it is easy to feel disempowered or even overwhelmed by the scale and gravity of the obesity crisis gripping our nation. We know that overweight, in many ways, is a devastating externality of our modern economic, food and urban systems, and that child obesity follows an inverse economic gradient; obesity is both a risk factor for and predictor of economic disadvantage.

Many of the drivers of child and adolescent obesity are beyond our control as clinicians – indeed even beyond the control of the health sector – and our tools to treat child and adolescent overweight seem lacking and ineffectual. Our consultations, lasting often just a few moments, are strongly juxtaposed to the ubiquitous and unrelenting exposures to advertising for unhealthy food products in what many would now regard as an obesogenic society.

To suggest that there is a single panacea to child and adolescent overweight and obesity would be misleading. To solve this challenge will take many actions from a range of actors – in particular strong government policy. But as clinicians with an influential, trusted and unparalleled window into the lives and health of our young patients, there are things that we can do today.

One such important opportunity is in reducing or eliminating sugary drinks.

According to the 2012 Australian Health Survey, just under half (42%), or 9 million Australians aged 2 years and over, consumed sugary drinks on the day prior to interview, while consumption increased with age across childhood, peaking among teenagers aged 14–18 years. Of the approximately 10 million Australians who were overweight or obese, almost half (47%) consumed sugary drinks – significantly higher than among normal weight populations. Australians living in areas with the highest levels of socio-economic disadvantage were more likely to drink sugary drinks than those living in areas of least disadvantage, and Australians were estimated to consume a staggering 76 litres of sugary drinks annually, according to a recent national report.

The result is that Australian children are consuming far more free sugars than is recommended by the world’s leading health agencies. “Free sugars” are those added to, or concentrated in, food and drink products – sugars in whole, intact fruits and vegetables continue to be safe and consumption should be encouraged.

For a range of health reasons, the World Health Organization recommends that just 5% of the daily calories come from free sugars. For a fully grown man or woman, this equates to a recommended limit of roughly 25 grams, or 6 teaspoons. For children, though, this might be a third, or less. Yet with 16 teaspoons of sugar in a “single” bottle serving – or more than 64 grams – sugary drinks can easily take children far beyond their recommended sugar intake.

Evidence also suggests that when we drink calories in the form of sugary drinks, our brains are unable to recognise these calories in the same way as with solid foods. Sugary drinks fail to cause satiety or “fullness” and could even make the consumer hungrier. This results in drinking, but also eating, more calories, making liquid calories even more troubling than other forms of junk food. Combined then with studies suggesting that the pleasure provided by sugary drinks may be difficult to give up or cut back, the result is children drinking larger amounts, more often.

Including all carbonated drinks, flavoured milks and energy drinks with any added sugars, as well as fruit drinks and juices, sugary drinks provide very little nutritional value to our diets.

Strong evidence does however link their consumption to weight gain, obesity, type 2 diabetes, cardiovascular disease and dental caries. Multiple, high-quality meta-analyses evaluating change in weight per increase in sugary drink consumption found significant positive associations.

Moreover, a growing number of studies have also highlighted the weight-loss and health opportunities of reducing consumption, even in children, with increasing water intake in place of sugary drinks (including fruit juices) associated with lower long term weight gain, and a reduction in liquid calories having a stronger effect on weight loss than a reduction in solid calorie intake.

Finally, the good news. Recent evidence reminded us that even brief advice and interventions delivered in a primary care setting by clinicians focused on clear, diet-based recommendations for weight loss, can be effective in achieving healthier outcomes in patients. This supports previous evidence on the effectiveness of clinicians in delivering health-promoting messages aimed at similar metabolic diseases and their risk factors.

In summary, Australian children face real and growing health threats from overweight and obesity and as clinicians, we should never underestimate our role in providing clear and strong health guidance. Regardless of weight or socio-economic status, reminding our young patients and their families of the harms associated with sugary drink consumption could be an appropriate and important part of any consultation, with wide-reaching health benefits.

While policy action on sugary drinks is needed to address the systemic determinants of obesity, including true pricing and limitations on advertising of unhealthy foods, this shouldn’t delay action in the consultation room. Whether simply having a conversation about the risks and benefits of sugary drinks, reminding your patients that they are best kept as an occasional treat while water is the staple, or providing advice on considerations to eliminate consumption altogether, the powerful and important role of the clinician in reducing unhealthy sugar consumption in young Australians should not be overlooked, nor ever underestimated.

Dr Alessandro Demaio works for the World Health Organization in Geneva. This article was written by him in his personal capacity. The views, opinions and positions expressed in this article are the author’s own and do not reflect the views of any third party. Additionally, those providing comments on this article are doing so in their personal capacity, and do not necessarily reflect the views, opinions or positions of the author. Dr Demaio is co-founder of the not-for-profit project NCDFREE.org

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