Hot on the heels of Sport New Zealand’s survey of young people’s activity choices (released in October 2012) comes the Ministry of Health’s report on children’ health (released in December 2012). The report highlights a number of salient issues.
Whilst the link between low socio-economic level and poor health has been widely documented, the recent health survey acknowledges that asthma, obesity and emotional/behavioural problems are increasing for New Zealand children. Regardless of gender, ethnicity and age, children in the most deprived areas suffer most from these health conditions the most. In trying to determine why, the health survey followed on from the previous 2006/2007 health survey and presented several health behaviours and risk indicators that are known influences on children’s health. These indicators included: the introduction of solid food to infants at four months (rather than the recommended six months), skipping breakfast, the amount of time viewing television, and changes to obesity status.
Since the last health survey, the obesity rate in children has increased eight percent. The rise in obesity in both Maori and Pacifica (one in four for both groups) children has increased.
Public health messages about obesity management after the 2006/2007 health survey focused on eating breakfast and daily physical activity. On the whole, the breakfast message is working: Nine out of 10 children eat breakfast at home every day. However, 78 percent of girls aged 10 -14 years were less likely to eat breakfast compared with boys of the same age.
Nutritionists throughout the country know that the consumption of fizzy drinks has a huge influence on caloric intake. High in sugar and low in nutrients, fizzy drinks have been denigrated by nutritionists and dental practitioners. The health survey reports that older children’s consumption of fizzy drinks, hasn’t changed since the last survey in 2006/2007.
Neither has the amount of time watching television, which averaged two to three hours per day in all age-groups. Fifty-nine percent of Pacific children were watching two or more hours per day. This was a higher rate than for non-Pacific children.
The recent health survey did not report on physical activity participation, only active transport to school, i.e. walking, biking and skate boarding. For an overview of physical activity participation, one has to turn to Sport New Zealand’s (previously SPARC) Young People’s survey results from September 2012. In contrast to the doom and gloom of the health survey, it reports that most Kiwi kids are actively engaged in sports. Interestingly, most young people from different ethnic backgrounds said that they liked playing sport a lot.
More challenges
However, a conundrum emerges when the definition of “enjoyable sport” meant different things to different genders and ethnicities. For example, young Maori boys (11-14 years) enjoyed skate-boarding and rugby league more than the average boy. Rugby league and walking were more popular with Pacific boys, and badminton and walking were more popular with Asian boys. Activity preferences also differed in girls. Touch and Maori activities (e.g. kapa-haka) were more popular with Maori girls, compared with basketball, touch and volleyball being more popular for Pacific girls. Badminton was most popular with Asian girls. Kids of all ages also stated that they enjoyed swimming, athletics, rugby, football, running/jogging and cycling.
Obesity is a complex health problem. Most health behaviour researchers acknowledge that obesity is caused by environment (e.g. availability of healthy food; access to safe activity areas within a community etc.), behaviour (e.g. daily activity or sedentary habits, emotional status, discipline and food-triggers) and biology (e.g. genetic links such as hormonal status) components. These three components interact and make up what is known in health behaviour as “an ecological model” of obesity. As all teachers know, changes to lifestyle are not easy, even more so when the majority of children rely on parents and care-givers for a healthy lifestyle.
The United States National Weight Control Registry places nutrition above exercise for starting to manage obesity. This makes sense because it’s difficult for an obese person to exercise in an intense way. In the early stages of obesity management, the purpose of physical activity is not just for energy expenditure. The idea is for the individual to consistently allocate time for exercising so that it becomes a daily habit. As obese children exercise daily as well as increase their energy from changing their diet, we hope they gain more energy to partake in a preferred activity.
Supporting children to develop healthful daily habits is a constant challenge for teachers. The teacher becomes the motivator and moderator of behaviour change strategies. Knowledge of behaviour change strategies is therefore an important tool in a teacher’s tool box. Systematic reviews of behaviour change techniques indicate that a number of strategies are necessary. Some of these strategies include: self-monitoring by the obese individual, i.e., keeping an activity and/ or eating diary or log-book and having a health professional check up on the recorded information, making adjustments and offering advice as required) and motivational interviewing, i.e., asking questions in such a way as to empower the person to make their own decisions about their daily habits). Perhaps the most salient technique for enabling behaviour change: Ensure that the obese child is surrounded by the right support people. They are known to have a positive and long-lasting effect. It is the motivational and educational support that each teacher provides that will have the most impact on a child’ ability to sustain the discipline and motivation necessary to undertake and stay engaged in healthful behaviours “for life.”