Childhood obesity is a global public health challenge. The alarming rise noted in the 1990s may have levelled off in the past 10 years, but still one in 10 kids in England are obese by the time they start primary school. By the time they leave, one in five is obese and a third are overweight. The UK is rapidly catching up with the US, is level pegging with Australia and has the dubious distinction of having the fattest kids in Europe.

A fat child is at risk of health problems throughout life and is more likely to become an obese adult. In a review of surveys from 1970-92, about half of obese school-age children remained obese in adulthood. Yet parents are often in denial, rejoicing in their child’s “healthy appetite”. So what can be done? The best advice is to treat every child according to the following evidence-based guidance.

Start when you’re pregnant

The food a woman eats when pregnant can be detected in the amniotic fluid surrounding the baby in the womb – as early as 15 weeks a foetus responds to the flavour, swallowing more if the fluid tastes sweet and less if it tastes “bitter”. Food eaten while breastfeeding also flavours the milk. This early exposure makes the baby receptive to that taste when weaned. So it is important for women to eat a range of healthy foods when pregnant or breastfeeding. In addition, women who are slim themselves, don’t smoke, or gain too much weight when pregnant and have normal vitamin D levels are less likely to have obese children.

Breastfeeding

Breastmilk is less sweet than formula milk – and both the milk itself and the way the baby feeds may help in developing healthy eating patterns. Breastfed babies seem to be able to better regulate their food intake, and are probably at lower risk of obesity, though studies are fraught with confounding factors, as mothers in developed countries who breastfeed are also those least likely to be obese themselves. However, one study that looked at siblings where one was breastfed and the other formula fed, found that by the age of 14, on average the breastfed children were 13lb (5.9kg) lighter than their bottle-fed siblings. But whether it’s breast or bottle, as soon as a baby shows signs of satiety, feeding can stop. Tracking weight gain is the best measure of whether it is getting enough.



Crying is not always about hunger

Babies cry and children winge and say they are hungry; but they don’t always need feeding. Babies cry for lots of reasons – tiredness, a dirty nappy, wind, being too hot or cold, wanting a cuddle, being bored or overstimulated. Distraction is legitimate and it’s a good habit not to respond to every sign of distress by putting something in a child’s mouth.

Wean on bitter foods

If the first solid a child is exposed to is sweet fruit, it is less likely to be receptive to bitter artichoke. But there is a window of opportunity between four to seven months when infants are very receptive to all flavours. “You can get a five-month-old to eat almost anything,” says Clare Llewellyn, lecturer in behavioural obesity research at University College London. The World Health Organisation recommends not introducing solids before six months, but, in reality, lots of parents do. Certainly, solids before four months old are firmly discouraged – and there is some, albeit contested, evidence that early weaning may increase the risk of obesity.



Persevere

Research shows that it takes five to 10 exposures to a new taste before a baby will accept it. Professor Marion Hetherington at the University of Leeds, who co-authored research on the subject, says that repeatedly exposing young children, particularly those under two, to a range of vegetables, will increase the chance that they will eat their greens later in childhood.

Baby-led feeding

Dr Michelle Lee from Swansea University’s College of Human and Health Sciences says babies should be encouraged to feed themselves with appropriate bits of food from the age of six months rather than just being spoon-fed. “With a baby-led approach, parents report that their children are more likely to stop eating when they feel full and may, therefore, be less likely to overeat and be overweight in the long run.”



Stay aware

Stay aware of your child’s weight and growth. In the UK, there is no fixed timetable, but guidelines from the National Institute for Health and Care Excellence state that “once feeding is established, if parents wish, or if there is professional concern, babies can be weighed at six, 12 and 16 weeks” and then again at about a year. Further measurements will depend on whether there is any concern. The National Child Measurement programme measures and weighs children when they enter and leave primary school. Parents who get feedback from a health professional or school that their child is overweight often get upset or don’t believe it, says Llewellyn – but they need to get to grips with what it is about the family’s lifestyle and eating that is contributing.

Eat well, move lots

There is a strong case for government intervention to limit sales of sugary drinks, improve school meals and consider taxing unhealthy foods and subsidising healthy ones. But parents are responsible for what goes on in the home. The message from health experts is clear; no TV or screens before age two and control what children eat. Toddlers should be generally active at least three hours a day, as well as doing activities such as running, chasing a ball and using climbing frames. Kids over five should spend at least an hour a day cycling or running round, as well as doing some vigorous exercise such as running fast. On three days a week, they should do some muscle-strengthening exercise such as push-ups or gymnastics.

