Helen O’Callaghan learns about the challenges facing children today in keeping fit and healthy.
Hannah Nolan’s 11-year-old son has always struggled with weight and at the beginning of lockdown told his mum he felt really miserable about it.
“William gains weight very quickly,” says the Co Wicklow-based mum of three, who thinks her impetus to “build him up and make him strong” as a baby may have contributed.
“He arrived early and during his first week was losing weight. The nurse said ‘if he keeps losing weight by Monday, he’ll have to go to hospital’, so I was really feeding him. By three months, he was in the 95th percentile for his weight and he stayed there. So, even when he was little, he was big – he has a large build. Once in the supermarket, a lady said ‘oh, what a very healthy baby!’ Culturally, being a big baby is often seen as a good thing.”
It was difficult for Hannah to see her eldest child unhappy with himself. “It’s a very delicate balance, between saying ‘maybe you could do with losing a bit of weight’ and not causing your child stress. They have to want to do it. I asked William ‘would you like me to help you?’” says Hannah, who coincidentally runs a fitness studio .
On a friend’s advice, Hannah got the whole family – including husband Gerry, 10-year-old Chloe and two-year-old Kyle – doing the Daily Mile every day since March. Promoted by Athletics Ireland in association with Local Sports Partnerships, the Daily Mile sees children walking, jogging or running at their own pace for 15 minutes every day. Just before lockdown, almost 1,000 primary schools had signed up to make it part of their school day.
Doing it with his family was William’s first encounter with the Daily Mile and it really clicked with him, says Hannah. “Because we were focused on doing it every day, it was our minimum achievement, our daily goal. We all jumped on board.
While William has lost weight during lockdown, many children countrywide won’t have. With schools closed for three months, they’ve missed out on so much built-in physical activity: playing in the yard at break, PE, participation in sports.
Dr Grace O’Malley, CORU-registered physiotherapist and clinical lead of the W82GO Child and Adolescent Weight Management Service in Children’s Health Ireland at Temple Street, says when schools are out, the main childhood population usually gains weight. “From US-data we see that during summer holidays children gain more weight compared to school-time and children who are overweight tend to gain more.”
This can be for any number of reasons, says O’Malley. Families relying on schools for healthy meals will eat less nutritious food when schools are closed or with a lack of routine, the way children eat or what they eat can change.
W82GO sees around 120 new patients a year on top of 200 existing patients – in 2019, the service offered over 1,700 appointments. Since lockdown started, O’Malley has heard patients describe challenges around accessing physical space to play and exercise. “Some live where there are no footpaths or parks.
Others live in apartment blocks with only one small patch of public space and everybody’s trying to use it. Some live in industrialised areas with too few places to play safely outside.”
Anxiety has increased too, she says, and children, absorbing parental stress and without opportunity for play with friends, may eat for comfort – just as adults do.
Born to Move
Professor Niall Moyna, clinical exercise physiologist at DCU’s School of Health and Human Performance, says we’re genetically programmed to be active. “The body mal-adapts very quickly if we’re not.”
With only 10% of Irish teens currently getting the recommended 60 minutes daily of moderate-to-vigorous physical activity, Moyna reiterates a stark WHO warning: if current trends continue, this generation of young people will be the first in the history of humanity not to outlive their parents.
Between 20-25% of Irish children are either overweight or obese, which Moyna says dovetails with other European countries – and we’re catching up on the US.
“Technology is engineering physical activity out of children’s lives. They just don’t get the unstructured play previous generations had access to. Parents say ‘sure, they’re only kids – they’re not going to become unhealthy as children’. That’s nonsense,” he says, pointing to research that finds inactive eight to 12-year-olds at increased likelihood of developing risk factors for diabetes, heart disease, high blood pressure and obesity.
DCU research, currently in review for publication, which investigated 15-year-old boys, found 87% of those least active -and in the lowest 25% fitness range- had a vascular age of between 55 and 60. Some 64% were obese or overweight, 75% had high blood pressure and 62% were insulin-resistant and on their way to developing diabetes.
Moyna says some of this generation may well live longer than their parents – because of drugs and medical intervention – but asks what percentage of their life span will be a healthy one. “It will be reduced dramatically because the earlier we’re exposed to risk factors, the earlier clinical conditions will manifest.”
A paper published in Irish Medical Journal in 2019 that looked at retrospective HSE data found, in 2013, 61% of Irish men and 67% of Irish women aged 45 and over were on poly-pharmacy – receiving five or more medicines in one month.
“If we think we have a problem now with poly-pharmacy, can you imagine what it’ll be like when these children are that age? Who are we kidding,” asks Moyna.
He points to certain lifestyle health risk factors we have total control over – alcohol consumption, drug abuse, stress, sleep, diet and physical activity. In relation to the last two, he warns: physical exercise will help if diet is poor – but you can’t out-exercise a bad diet.
Moyna says most kids develop their health behaviours by mid-teens and bring these with them into adulthood and onto midlife. “Rather than getting them to change their behaviours in midlife, why not encourage healthy behaviours in early life and sustain that,” says the man who started running at a young age, played sport, never smoked and didn’t drink despite growing up in a pub.
He cites the HELENA pan-European study of adolescents that found boys, who met the criteria for optimum fitness for their age, six and a half times more likely to have a healthier cardiovascular health index than boys who didn’t meet that fitness level. And girls who met the minimum fitness standard for their age were three times more likely to have a healthier cardiovascular index than girls who didn’t meet that fitness standard.
“We have a window of opportunity up to age 30. That’s when we start to age. Prior to that, we can reverse many of the ill-effects of inactivity on our health. And because children are so adaptable, when they start any form of physical activity, the result is immediate and substantial health benefits,” says Moyna, who’s a strong advocate of the Daily Mile.
In April, Sport Ireland research showed a surge in numbers of adults walking, cycling and running since Covid-19 restrictions were implemented in March. “Parents’ example is very important. Children will adopt many of the practices of their parents,” says Moyna, who recommends every child in Ireland be taught to swim and cycle, because these – along with walking – exercise large muscle groups and “can be done up to age 90”.
O’Malley, who also leads a childhood obesity research team at RCSI University of Medicine and Health Sciences, says obesity can challenge one or more of a child’s organs and body systems. “Breathing can be difficult, or body posture and the way a child’s bones grow can be affected.
This means it takes greater effort to play actively or participate in PE. It can be a barrier to performance – the child moves more slowly, gets breathless quicker or is more uncomfortable with movement compared to friends. Some children will be teased because of this and may be less keen to get involved in PE or sports.”
She says we all need to expand our understanding of weight gain and obesity. “Very often huge blame is put on parents, yet families are doing their best. Sometimes illness, grief, trauma or financial distress within the household impacts the kinds of meals and food eaten, how meals are eaten (e.g. slowly versus fast, at a table or in front of a screen) or the time meals are eaten.”
She urges everyone to reflect on how they reacted in first weeks of lockdown and whether their patterns of eating, sleep or physical activity changed. “More often than not, many of us were eating in a very different way – eating more, grazing more – than we had pre-Covid.
Our daily physical activity level or usual sleep patterns were affected. The lifestyle changes we experienced provide good insight into how we, as humans deal with anxiety, financial stress, movement restrictions and being apart from friends and family.”
Meanwhile, in Tinahely, Hannah Nolan recently came across a bag of William’s clothes she’d been intending to give away because they hadn’t been fitting him. “I said why not try these on – and they fit him. He feels much better about himself now, more confident. He’s more aware of his feelings around food and is eating more fruit, salad and vegetables with every meal. Most days he wants to do more than just the daily mile – he’ll say ‘Mom, do you want to go for another walk?’”
And with schools out for another two months, Athletics Ireland Daily Mile ambassador Frank Greally urges kids countrywide to keep up their daily mile at home. “Get back on the runners and get out for your daily dose of exercise.”