Overweight to obesity

Recent Irish statistics have shown high levels of overweight and obesity in children under the age of 3 years in Ireland^1,2. The National Pre-School Nutrition Survey¹ found that whilst 23% of Irish toddlers are classified as either overweight or obese, 90% of parents perceived their child to be a normal weight. When broken down into different age groups, higher levels of overweight and obesity were observed amongst 2 year olds (27%) and 3 year olds (32%) compared to 8% of 4 year olds.

For the Growing up in Ireland infant cohort, the families of 11,100 children were initially interviewed in 2008/2009 when the Study Child was nine months old². They were re-interviewed between January and August 2011, when the children were three years old. The child’s height and weight measurements were recorded to calculate their Body Mass Index (BMI), which is a widely used way to determine if children have a healthy body weight. Some of the key findings on infants’ physical growth from birth to three years of age were:

• The majority of children in Ireland are very healthy and experiencing patterns of physical growth that are similar to those of children in other affluent nations such as Britain and the US.
• However, 76% of three-year-olds were classified as non-overweight, 19% as overweight and 6% as obese.
• Therefore, almost a quarter of all three-year-olds had a BMI beyond the range that is considered healthy for this age group, according to the International Obesity Task Force thresholds.
• Girls and boys are equally likely to be overweight (19% v 18%).
• Children’s weight was related to household social class. 5% of children in families in the professional/managerial group were classified as obese at three years of age compared with 9% of those in the most disadvantaged social class group.
• At least one-fifth of children in every social class were overweight.

An unhealthy diet, lack of exercise and socioeconomic background all play a role in Irish childhood obesity levels. Children who are obese between six months and five years of age have a 25% chance of becoming obese adults. Over the age of six years, this likelihood increases to 50% and obese adolescents are 80% more likely to develop obesity in adulthood³. This is a cause for concern when future health implications for the individual are taken into consideration. Also worrying is the future financial burden that this will have on the Irish health service, which is estimated to be €0.4 billion a year⁴.

Assessing overweight and obesity in pre-school children is complex since BMI changes substantially during normal growth. Ideally, a child’s growth and development should be monitored over time; however, prevalence of overweight and obesity can also be assessed by applying cut-offs to age and gender specific BMI charts^5,6. These charts compare a child’s BMI to the BMI distribution of a reference sample of children of the same age. Cut-offs are then used to define the weight status of the child.

New growth charts have been introduced for babies born in Ireland since January 1st 2013. The new charts have been adopted as policy by the Department of Health and have been adapted for Ireland from materials originally developed by the WHO and Royal College of Paediatrics and Child Health in the UK.

The new charts include a suite of new 9-centile growth charts for children in Ireland to be used for all newborns from 1st January 2013. Existing growth charts will continue to be used for children born before January 1st 2013. For more information, click here to visit the HSE website.

• Support parents/guardians to recognise and become aware of what constitutes a healthy/unhealthy weight for themselves and also their children.
• Encourage breastfeeding as it has been shown to decrease the risk of obesity and being overweight in later life^8-10.
• Ensure parents to not begin weaning infants until at least 4 months of age (17 weeks)¹¹.
• Understand the components of an optimal diet for infants from weaning onwards, and communicate these to parents, helping them to make the best possible choices for their infant¹¹.
• Encourage parents to consider childhood eating habits, types of food available at home, attitudes towards food and to identify if certain foods are used as rewards.
• Provide practical advice to parents on healthy eating, with emphasis on fruit and vegetable intakes, and substituting less nutritious choices for healthier options e.g. brown bread for white bread, lean meats for processed meats.
• Encourage parents to act as role models.