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Cartoon shows an obese childWhat is a healthy weight for a child?

You may find it difficult to tell whether your child has temporary "puppy fat" or is genuinely overweight. In adults, a simple formula (the body mass index, or BMI) is used to work out whether a person is the right weight for their height.

However, BMI alone is not an appropriate measure for children, because they are still growing. Factors such as rate of growth, age and sex, and the BMI of other children of the same age must be taken into account when assessing your child's weight.

BMI is best interpreted with the help of your GP, health visitor, practice nurse or dietitian.
BUPA

Weight issues

British Bulldog
Speech by Alan Johnson
Teaching children at school to exercise
Stores promoting junk food
Nintendo Wii 'could prevent weight gain'
Tories shun regulation in obesity fight
Madness - Tories think that fat is a political issue
Being heavy may be protective in heart disease
The other side: Under-Nutrition
See also

Bring back British Bulldog to prevent obesity in children,
council leaders say

By Jessica Salter 01 Sep 2008

Children should be allowed to play banned playground games such as British Bulldog as a way of tackling obesity and encouraging a better understanding of the world, council leaders claim.
 
Many traditional playground games have been outlawed by schools because of fears they are too dangerous and may lead to compensation claims.

Pastimes such as skipping have been stopped after pupils fell over when they tied their legs together, while one school issued pupils with safety goggles before allowing them to play conkers.

British Bulldog - where children try to stop one another from running across a pitch - is banned in many schools for being too violent.

However the Local Government Association (LGA), which represents town halls, claims schools must balance these worries with concern for children's overall welfare and a need to keep them physically active.

Councillor Les Lawrence, from the LGA, said: "Children benefit from physical activity and even some rough and tumble. We do our youngsters no favours by wrapping them up in cotton-wool, which can prevent them from developing skills they'll need in their adult life.

"It's time to take a stand against many aspects of the compensation culture and accept there are going to be a few scratches and grazed knees because that's part of growing up."

If current trends continue, it is estimated that nearly 60 per cent of the UK population will be obese by 2050. To stay healthy, children need to do 60 minutes of physical activity a day, but many simply stay inside and watch television.

Cllr Lawrence said: "While children used to play regularly on their bikes or kick a ball, they're now more likely to spend their free time in front of a television or round a computer console. That makes it even more important they do some running around during the school day."

The LGA, which represents more than 400 councils in England and Wales, has issued local authorities with a list of its top 10 activities for breaktimes before the start of the new school year, including British Bulldog, Tag and Stuck in the Mud.

Sue Palmer, an education consultant and the author of the book Toxic Childhood, said she was delighted that children were being encouraged to play more.

She said: "While we do everything we sensibly can to make sure that children are safe, we've got to balance that with the opportunity for children to engage in safe risks through unstructured play. They've got to learn how to be resilient and how to take care of themselves.

"Playtime not only helps children develop physically, it also gives them an understanding of the world. When you fall out of a tree you learn a lot about gravity and the human body."

A spokesman for the Department for Children, Schools and Families said it was happy for schools and local councils to decide on what playtime games are allowed.

He said: "If they want to, let them crack on with it."

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Speech by Alan Johnson


Source: Department of Health. 1 September, 2008


Thank you very much for hosting this event today.

I wanted to ensure that I made a speech to the Fabian Society in this, the 60th anniversary year of the NHS, recognising the crucial role that the society played in its establishment.

The introduction in 1948 of universal healthcare, free at the point of need, is without question my party’s finest achievement.

It was first proposed nearly 40 years earlier, by Beatrice Webb, in her minority report to the Poor Law Inquiry of 1909.

And it was Beatrice and Sydney Webb who were responsible for introducing William Beveridge to Winston Churchill, leading eventually to what at first seemed the relatively insignificant appointment of Beveridge as chair of a committee on social insurance in 1941. The rest, as they say, is history.

In more recent years, the Fabian Society has continued its campaign for better health for all – leading in the debate on tackling health inequalities, and focusing particularly on the importance of early intervention in infancy and childhood.

The NHS is in the rudest of health as it becomes eligible for its bus pass and winter fuel allowance. The decades of chronic underinvestment, perilously long waiting times for life-saving operations and a crisis every winter are becoming a distant memory. Nothing better reflects this transformation than the Conservative Government’s Patient’s Charter, signed by the then Secretary of State Virginia Bottomley in 1995 - sixteen years into their period of office, the Tories made a virtue of its promise that: 'For hip or knee replacements and cataract operations, a waiting time guarantee of 18 months'.  That, incidentally, was just for inpatient waiting. By December, the maximum patients will wait for surgery or any other treatment will be 18 weeks from referral by their GP - including all appointments and diagnostic tests.

With the resources and capacity in place, we are now ready to move to the next stage in the service’s evolution. Ara Darzi’s Review set out how we will make quality the guiding principle in all we do, and how we will tackle prevention, as one Strategic Health Authority puts it, on an industrial scale.

The Review was shaped not by central dictation, but by the vision and expertise of thousands of clinicians across the country, who identified the challenges they face locally and what they needed to do to address them. Whilst none of the resultant regional plans are exactly the same, all are emphatic about the need to give people more control over their own health and greater protection from the risks of chronic and lifestyle diseases, which, if left unchecked, threaten to reverse the extraordinary achievements of the NHS over the last 60 years.

Context : Obesity
I want to focus this evening on obesity, which is the biggest health challenge we face. The Foresight report published last October looked at the question of how we could deliver a sustainable response to obesity over the next 40 years. It assembled the expertise from academic disciplines as diverse as epidemiology, food science, genetics, psychology and sociology. Its conclusions are stark.

Today, two thirds of all adults and one third of all children are either overweight or obese. By 2050, on current trends these figures will rise to almost nine in ten adults and two thirds of all children. By then, obesity, which is already responsible for 9000  premature deaths each year, 58 per cent of all type 2 diabetes, 21 per cent of heart disease and a 9 year reduction in life expectancy, will lead to a seven-fold increase in direct health costs with wider costs to society of around £50 billion.
 
The increase in the number of children who are obese is a particular cause for concern. Obesity is not something that children tend to grow out of. Fifty-five per cent of 6-9 year olds and 79 per cent of 10-14 year olds who are obese will remains so into adulthood.

There is a very real danger that significant numbers of today’s children will live shorter lives than their parents and spend more of their years in poor health.

In response to the Foresight report, we launched the Government’s obesity strategy: Healthy Weight, Healthy Lives, in February. The strategy set out how we could support parents and very young children with targeted advice and breast-feeding promotion schemes, how in schools and communities, we would promote healthy food and how, by working with employers, we would make it easier for people to build exercise into their lives. Healthy Weight, Health Lives is the first strategy of its kind in the world and as Foresight pointed out, the UK is well-placed to be a global leader in tackling a problem that is challenging policy-makers across the globe.

Changing Lives
Obesity is the product of a simple imbalance between energy intake and energy expenditure. Because it is a lifestyle disease, it requires us to change the way we live. Human beings evolved in a world of relative food scarcity and hard physical work – now energy dense food is abundant and labour saving devices abound.

Even the Fabians will have been affected. William Beveridge and Beatrice Webb discussed the future of the welfare state during two long walks over the Hampshire Downs – it was these discussion which greatly influenced Beveridge’s report. Today’s blue skies thinkers ponder over e-mail, or in interminable meetings, fuelled by an endless supply of caffeine.
 
Low-skilled manual jobs have shrunk in the factories, the farms, the docks and the shipyards. They are now more likely to be found in call centres and in the retail and services industry.

When Nye Bevan introduced the NHS, less than one in ten households had a television and less than a third owned a car – now one, if not two or three television sets are found in 98 per cent of all households and 19.5 million households own a car – 8.4 million have two or more.

Over the last twenty years, the number of children being driven to school has doubled - the majority of primary school children live less than a mile from their school, yet 41 per cent are driven by their parents, and this figure is rising.

Despite the abundance of information about how to protect our health, the straight-forward advice about what to eat, how often to exercise, how much we should drink, is easy to ignore and frequently lost in a cacophony of conflicting messages. To use Arthur C Clarke’s analogy, it is like trying to get a glass of water from Niagra Falls.

As the Know your units campaign pointed out, the vast majority of people underestimate how much alcohol is in a glass of wine or a pint of beer and thus have little awareness of whether they are drinking too much. While many are probably aware that they should be exercising for half an hour, five times a week, only one in three actually does this in practice.

While most would be shocked by a newspaper story about a nine year old who weighs 14 stone, the distinction between being a bit overweight and obese is not always so obvious.

Research shows that only 17 per cent of parents with an obese child identified that child as having a serious weight problem, and the majority of parents overestimate the amount of exercise their child engages in and underestimate the amount of food they eat.

Many are discouraged or confused by over-medicalized terminology such as BMI and the clinically obese and worry about the stigma that is attached to this subject. Messages about the importance of healthy living often don’t reach those most at risk.


Not Nanny State, Not Neglectful State
So how should a serious political party of the 21st century faced with these acute and growing problems react? The Foresight scientists highlighted the fact that for an increasing number of people, weight gain is inevitable and largely involuntary as a consequence of exposure to a modern lifestyle. They used the term passive obesity, and pointed out that it particularly effects the socially and economically disadvantaged.

Not every child is lucky enough to live in an environment that promotes good health. Not every family has a leafy back garden for their kids to play in. Not every family can afford to buy fresh organic produce from the local farmer’s market, or to put food on the table that their children will refuse to eat.

Our strategy made clear that in approaching this problem, we reject both the nanny state, which polices shopping trolleys and institutes exercise regimes and the neglectful state, which wipes its hands of the problem, and wags the finger in the direction of the most vulnerable families in the vague hope that they will do as they are told.

The Conservative Party have apparently chosen this approach. Reading David Cameron’s Glasgow speech, I was struck not by how much the Tories have changed, but by how little. Cameron is following a Tory tradition which would have been familiar to the Fabian progressives of the 20s and 30s, and which was distilled to create pure Thatcherism in the 80s. He delivered Tebbit’s 'Get on your bike' speech, refined by PR experts. Chingford meets Notting Hill. It attracted predictable support in the pages of the Spectator, where, in an article headed: 'Shouting abuse at fat people is not just fun, it’s socially useful,' Rod Liddle congratulates Cameron for 'telling these awful people it’s all their own fault that they are hideous, poor and stupid.' He goes on to fantasise about setting a fat mother on fire with his Zippo lighter. For Liddle and others, permission to be cruel and nasty about the obese has been granted by the Leader of the Opposition.

It’s easy for politicians to stand on the sidelines accusing the impoverished, the fat and the excluded of only having themselves to blame. But before we evoke the Victorian notion of the deserving and undeserving poor – the very concept that Fabians have battled against over the years - we should take a moment to consider how complex these issues really are.

Academics and medical experts do not say that children are at risk of obesity or poverty because of political correctness – they say this because it’s an accurate assessment of the situation. A child who grows up in poverty, and whose parents have little or no aspiration for them, who doesn’t get to go to the best school, who isn’t blessed with an inspirational teacher, is by any definition at risk of becoming a poor adult. It’s not inevitable, but without some help and support, it’s highly likely.

It is simply wrong to suggest that the only solution to deep-rooted problems such as obesity is for people to be more responsible. Of course people must take personal responsibility for their own actions. Nobody in their right mind would argue for personal irresponsibility.

But rather than engage in oversimplification, government has to develop and implement a sustained response to a problem that will have profound and long-term consequences for health and well-being and major costs to the health budget and the wider economy.

Just as the government has a moral duty to tackle poverty and exclusion, so it also has a duty to address obesity. But this is not a licence to hector and lecture people on how they should spend their lives – not least because that approach simply won’t work.

Tackling obesity requires a much broader partnership, not only with families, but with employers, retailers, the leisure industry, the media, local government and the voluntary sector. We need a national movement that will bring about a fundamental change in the way we live our lives.

National Movement for Change
Our obesity strategy sets out how we aim to create a climate more conducive to promoting good health.

We are clear that this is not something that government can do on its own. The state cannot and should not micromanage the choices that people make in their daily lives.

Many local community clubs, groups and organisations are already supporting people to lead healthier lives and be more active – particularly those people most at risk of poor health. From breakfast clubs to activity sessions in the local park to cycling initiatives and health checks. Industry groups and charities are also working nationally to promote better diets and more exercise.

Research tells us that people want practical support and information, not just from GP surgeries, but from the nurseries and schools their children attend. They want clear and consistent messages on what’s best to eat and how to stay healthy, delivered in a way that relates to the problems they face in their daily lives.

Earlier today, I met with leaders from major health charities, retailers, the health profession and community action groups to discuss how we could form a national campaign that would help us change the way we live.

I have also written to 220,000 local activists who are already doing excellent work in their communities to promote good health to ask them to help shape this movement.

We are calling on everyone - from the smallest community keep fit class to the biggest retailers in the land - to join in this campaign to change the way we live our lives.

Retailers have extraordinary influence over the food people buy and they have a clear role to play, through the incentives they are able to provide, in encouraging healthy choices in the supermarket and on the high street.

As ITV and others have recognised, the media also has a role in reframing how we think about obesity, challenging instead of reinforcing the prejudices and extreme images that can prevent people from seeking help.  Research shows us that vilifying the extremely fat doesn't make people change their behaviour. Commentators who point and shout at pictures of the morbidly obese simply fuel the problem. Those whose seriously unhealthy lifestyles are not advertised by their waste lines will simply say: 'Well that's not me. I don't need to change what I do.' But if you present the message more intelligently - if you explain to parents that many children, regardless of their size, have dangerous levels of fat in their arteries or around their organs, and this may reduce their life expectancy by up to 11 years - then people respond.

And as employers such as BT, Royal Mail and GlaxoSmithKline have shown, it is possible to promote health and wellbeing among employees.

Conclusion
In its infancy, the NHS grappled with acute and infectious diseases that could be treated or vaccinated against. But the Government cannot vaccinate against obesity, anymore than it can reverse the ageing process to relieve the burden on the NHS of demographic change.

The gravity of the obesity challenge demands that we grasp the true nature and complexity of its causes, and enable people to adapt their lifestyles in order to avoid the damage that obesity can cause.

The government commissioned the Foresight report because we wanted our best scientists to turn their minds to one of the most intractable problems of the developed world.

In the political battle between modern science and Tory prejudice, I’m with the scientists.

To follow any other path wouldn’t just put our society at risk of obesity, it would put our health service at risk of decline.

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Teaching children at school to exercise can cut obesity rates by a third
By Jenny Hope 1st September 2008

Teaching children at school to be physically active every day can cut the rate of overweight pupils by a third, say researchers.

Lessons in healthy eating and encouraging children to watch less TV curbs weight gain in just a year, according to new studies presented at the European Society of Cardiology congress in Munich.

Children in primary school who had daily reminders about healthy living gained 260g less body fat - the equivalent of a pack of butter - compared with those doing standard PE lessons.

Studies show children who are offered a daily diet of physical activity and healthy eating at school are less likely to be obese

Researchers claim the success of school-based programmes could halt the epidemic of obesity among youngsters, with teachers becoming new role models.

Around one in three schoolchildren in the UK is overweight or obese.

In a study of almost 300 pupils aged around 12, daily exercise lessons had a dramatic effect on their fitness and weight.

Half the children were given extra exercise in classes lasting about an hour, while the remainder continued with regular school sports of just two hours a week.

After a year, the percentage of overweight schoolchildren having exercise classes dropped from 13 to nine per cent.

There was no change among the other children, while a comparison with a specialist school doing 12 hours of high level exercise and competitive sports a week showed just two per cent were overweight.

There was also a significant improvement in physical fitness and lung function in pupils taking daily exercise, said researchers at the University of Leipzig, Germany.

A separate study looked at an obesity intervention programme for 1,000 primary schoolchildren aged seven to eight years.

Half were asked to cut down TV and computer viewing, and consumption of sugary drinks, while having extra tuition about healthy living at school.

They had 'key messages' about diet and exercise included in a range of lessons including maths and music, along with two five-to-seven minute sessions of exercise a day.

Their parents were sent letters about helping to prevent weight gain and the family was given homework, said Professor Martin Wabitsch, of the University of Ulm, Germany, who headed the study.

He said the findings showed less weight gain after a year among the children getting healthy living lessons, a reduction of 260g compared with similar children having normal lessons.

He said findings from the study were still being analysed but the 'active' children watched less TV, drank fewer sugary drinks and had slimmer waists.

'These interventions had a small but significant effect that's sustainable' he said.

Prof Wabitsh said preventive health for children had shifted from medicine to schools.

He said 'Vaccination is medical history, children spend a lot of time in school where we can change their eating and physical behaviour.

'It's not a duty so far for schools, but there could be a new role for teachers.

'They can be role models and guide children's behaviour as parents should do but don't do anymore.'

Currently, schools in England must cover healthy diets and lifestyles but only in science lessons.

PSHE (personal, social and health education), where teachers could cover the subject in more detail and give guidance on healthy eating, is not compulsory.

While the vast majority of schools include PSHE on their curriculum, they have discretion over the content of the lessons.

Tam Fry, from the National Obesity Forum, said the studies were very well conducted and intervened at key times in child development.

He said: 'Traditionally the ages of six to eight are seen as a risk point for later overweight and obesity. It is key that the school interventions are followed up with the parents as all the gains made at school can be negated if not followed at home as well.

'In the UK we have precious little education for parents about parenthood. Quite often parents don't know what to teach their children because weren't taught it in the first place.'

Dr Jeremy Pearson, assistant medical director of the British Heart Foundation charity, said involving teachers and parents was critical.

He said 'We have to intregrate lessons for the rest of your life into the school curriculum.

'We have to start early. I'm not sure how good the UK is at this and whether just planning more periods for games or running tracks is enough.

'The BHF does individual projects in schools but we need a nationwide approach from the Government that would lead to the take-up of programmes proven to be of some use.'

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Stores promoting junk food despite warnings on obesity
Valerie Elliott September 1, 2008

Promotions for items high in fat, sugar and salt make up more than half

Supermarkets have almost doubled the number of “junk food” items they promote, despite warnings of an obesity crisis, an official watchdog has found.

The National Consumer Council accuses supermarkets of using “buy one, get one free” or “three for the price of two” offers on savoury snacks, sweets, chocolate, biscuits, cakes and fizzy drinks to entice shoppers during the credit crunch – and names Morrisons and Waitrose as the worst offenders.

In its analysis of more than 4,300 cheap deals, the council found that promotions for items high in fat, sugar and salt made up more than half – 54 per cent – of all instore promotions. Yet advice from the Food Standards Agency suggests that such foods form only 7 per cent of a person’s diet. Only 12 per cent of cheap deals were for fresh fruit and vegetables or other healthy staple items.

The last time the council conducted a similar survey was in July 2006, when junk food promotions accounted for 37 per cent of cut-price deals. The council is concerned that retailers are using these offers to increase their market share during a difficult trading period. It is anxious, too, that low prices might be encouraging those on lowest incomes who are more likely to feel the pinch.

The findings, in a report entitled Cut-price, What Cost?, are particularly alarming as the latest government figures predict that without healthier lifestyles two thirds of all adults and a third of children will be obese by 2050, putting them at severe risk of heart disease, diabetes and cancer.

Of the promotions in Morrisons, 63 per cent were in the junk food category, up from the 39 per cent it had in 2006. Fifty-seven per cent of Waitrose’s special offers were for treats and other “guilt” foods.

The survey found that 65 per cent of the prime selling points in Waitrose stores – known as gondola ends – were used to display products high in sugar and fat. Morrisons used 62 per cent of the same sites for these items.

Even the lowest-scoring stores, Coop and Marks & Spencer, still had a high proportion of junk foods on special offer, with the Coop displaying 41 per cent and Marks & Spencer 48 per cent, up from 27 per cent and 24 per cent in 2006.

The council praised Marks & Spencer for offering the most fresh fruit and vegetables in its deals, but criticised it for continuing to promote sweets and chocolates on low check-out shelves, which tempt children and encourage “pester power”.

The council also criticised Morrisons for unhealthy pitches at all its checkouts, which displayed fatty and sugary confectionery, drinks and crisps, with some items at child height.

Lucy Yates, senior policy advocate at the council, who compiled the report, said that the volume of promotions for fatty and sugary foods was staggering.

The survey took place during March in Sheffield because the city offered shoppers a choice of each of the leading companies.

Ms Yates was disappointed by the lack of progress towards promoting healthy eating and is calling for all supermarkets to ensure that 33 per cent of promotions are dedicated to fresh fruit and vegetables.

The British Retail Consortium condemns the survey for failing to recognise that promotions are balanced throughout the year. Fruit and vegetables are promoted all year, though more heavily in spring and summer, when supplies are more plentiful, while “treat” promotions are more common at Easter and Christmas.

Andrew Opie, the consortium’s food director, said: “This one-off March snapshot is misleading. Customers will have seen for themselves the current high-profile supermarket price war centred on fruit and vegetables. Thanks to retailers, customers have more information available to them, including on pack fronts, to help them make healthier eating choices.”

Supermarket sweets

• 63% of Morrisons promotions were high in sugar and fat. They included McVitie’s HobNobs and Häagen-Dazs ice cream

• 57% of Waitrose’s special offers involved products such as Doritos, Toblerone and Walkers crisps
 

• 56% of Tesco promotions featured Mr Kipling jam tarts, McVitie’s Ginger Nuts, Walkers crisps and other high-fat and sugar products

• 52% of Asda’s special deals caused concern. Among the cheap items were Cadbury Chocolate Fingers, Walkers crisps and Tango drinks
 

• 52% of Sainsbury’s offers involved products such as KitKats, Fox’s chocolate biscuits and Fanta

• 52% of Somerfield promotional offers were deemed to be unhealthy, including Pringles, Magnum ice-creams and multipacks of McVitie’s Penguins

• 48% of the goods on special promotion at Marks & Spencer were found to be high in fat and sugar. They included the store’s own-brand flapjacks, family-size ice cream packs and mixed bags of children’s sweets

• 41% of special offer goods at Coop were high in sugar and fat, such as Kettle Chips, Fox’s Glacier Fruits and McVitie’s Digestives

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Nintendo Wii 'could prevent weight gain'
By Kate Devlin 01 Sep 2008

Playing active computer games such as those for the Nintendo Wii for just half an hour a day could prevent weight gain, a new study suggests.
 
Taking part in games like tennis, golf or bowling on consoles such as the Wii can burn four times as many calories as playing more traditional computer games, enough to keep waistlines in check, they claim.

Computer games have long been blamed for the growing obesity crisis, which has left almost one in four British adults extremely overweight.

Critics claim that the games encourage sedentary lifestyles and divert children away from playing more physically demanding games like football or rounders.

But now scientists say the new games, in which players holding joysticks mimic the actions involved in sports to control an on screen character, are a good way of keeping fit.

Players can burn up to 150 calories in 35 minutes while imitating the motions of their favourite sport stars in order to "hit" tennis balls or "swing" golf clubs, scientists found, roughly the same amount as a brisk walk.

Previous studies have suggested that expending a similar amount of energy every day could be enough to help most people avoid gaining weight.

"Preventing weight gain requires an energy adjustment of approximately 150 [calories] per day," according to the authors of the study, Robin Mellecker and Alison McManus, from the University of Hong Kong.

"The four-fold increase in energy expenditure when playing the (active game) would fill the proposed energy gap, if this game were played for 35 minutes a day."

The study, which looked at 18 children with an average age of 9 years old, also found that the new type of game could significantly raise a player's heart rate.

Details of the study are published in the journal Archives of Pediatrics & Adolescent Medicine.

Doctors classify obesity based on a person's Body Mass Index (BMI), a measurement of their weight compared to their height.

A BMI of between 20 and 25 is considered normal, while a BMI of more than 30 is obese.

Earlier this year Nintendo launched the Wii Fit, designed to keep players in shape.

The researchers now want to see whether the new games will encourage children to exercise more as they become adults.

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Tories shun regulation in obesity fight
By Jean Eaglesham, August 27 2008

A Conservative government will seek to tackle obesity and binge drinking through voluntary agreements with industry, rather than fresh regulation, the party will signal today.

Andrew Lansley, the shadow health secretary, will set out the terms of a proposed "responsibility deal" with business on public health. The voluntary deal will be drawn up by a working group chaired by Dave Lewis, chairman of Unilever UK and Ireland, the consumer goods group.

The opposition party will risk accusations of caving in to corporate influence. Its proposed deal rejects the "traffic light" system of labelling foods for fat, sugar and salt content, favoured by the Food Standards Agency and used by some supermarket chains.

The Tories will commit to stopping government promotion of such traffic light labelling. Today's deal backs the rival "guideline daily amounts" (GDA) system championed by, among others, Unilever. The Tories say they will back European proposals for mandatory GDA labelling and "will not add UK regulation to this".

The Tories' new deal will also rule out further restrictions on food advertising, beyond those already implemented by Ofcom, the broadcasting regulator. Instead, the party will aim to get a "voluntary agreement, extending across all media, which balances freedom to advertise products with specific cross-industry and government action to promote improved diet".

On alcohol, the deal places a similar emphasis on self-regulation, saying the party will "work with the drinks industry to improve labelling" and consider ways to encourage industry-funded promotion of "the message of responsible drinking".

The Tory stance contrasts with recent ministerial warnings of impending legislation if more is not done by retailers, alcohol producers and pubs to tackle binge drinking.

David Cameron has made concerns over binge drinking an important element of his political message that a change of government is needed to mend Britain's "broken society". The Tory leader warned this month of a "wild west" culture of excess "taking over our streets".

Labour yesterday accused the opposition party of failing to back up such concerns with the potentially difficult measures needed to address them. "Once again the Tories offer lots of warm words but with very little policy substance," Ann Keen, the health minister, said. "Everyone believes that individual responsibility matters. But the Tories are using individual responsibility as an excuse for their lack of effective policies in this area."

But the Conservatives rejected criticism of the industry deal, saying it was consistent with their approach of seeking to minimise red tape, particularly in areas - such as food labelling - where Brussels was considering mandatory controls. "The whole approach of the responsibility deals is to use regulation only where necessary," a party official said.

Mr Lansley will today flesh out this philosophy in a speech to the Reform think-tank. He will reiterate the Tory leadership's enthusiasm for changing behaviour by "nudging" people towards social norms, rather than using regulation.

"People who see more fat people around them may themselves be more likely to gain weight. Young people who think many of their friends binge-drink are likely to do so themselves," Mr Lansley will said. "Peer pressure and social norms are powerful influences on behaviour."

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What madness makes Tories think that fat is a political issue?

Even as they preach against the evils of obesity, some Conservatives
are not exactly setting a good example

Catherine Bennett August 31 2008

Is it too late to save Eric Pickles from himself? By rights, the popular architect of the Tory victory in Crewe and Nantwich should not have much longer to wait before he becomes chairman of his party, replacing Caroline Spelman (victim of unfortunate mix-up involving public money and her children's nanny). When they were invited to pick a fantasy chairman to preside over the party conference, visitors to the Conservative Home website recently offered Pickles their overwhelming support, with 52 per cent of the vote.

What possessed them? Although the poll was held a few weeks before shadow health spokesman Andrew Lansley declared that fat people have no excuses for their behaviour, that does not exonerate the Pickleites, who must already have been well aware of David Cameron's engagement with fat politics, from his concerns about chocolate oranges and undisguised disgust for those who eat too many of them.

'We talk too much about people being "at risk of obesity" instead of talking about people who eat too much and take too little exercise,' he said, in his celebrated attack on moral failure in the broken (except for Boris Johnson's bit) society.

So the time has long passed since Pickles could claim that he is just big-boned. Did his supporters not consider, in their enthusiasm, what message the choice of an obese-looking party chairman would send out to fat people who must learn, as Lansley re-emphasised, last week, that 'the buck stops with them. They can't shuffle off the responsibility'?

Although his party has not, as yet, completed the downloadable table which will tell us, at a glance, the body mass index of every sitting Tory MP, it must be clear, even to non-dieticians, that Pickles's figure betrays him as exactly the type of person whose slack, self-deluding, ultimately irresponsible behaviour must cease, before the country is flattened by their collective weight.

'Changing our culture is not easy or quick,' Cameron warned. 'You cannot do it top-down. But you can give a lead.' The wonder is that Pickles has not followed it already. But conference is still four weeks away. That leaves ample time, on the No Excuses diet, for him to rediscover his bikini body.

Week One. Goal: re-education. This is when Pickles should completely undress and take a good, hard look at himself in the mirror. How did he get here? It's not good enough to blame lack of tone on the influence of obese friends and colleagues, such as Nicholas Soames or Lord Strathclyde. 'Peer pressure and social norms are powerful influences on behaviour,' says top dietician Lansley, 'and they are classic excuses.'

Week Two. Goal: healthy eating. And where better to find nutritious inspiration than in the fantastic Unilever range of products? In his No Excuses speech, Lansley announced that Dave Lewis, chairman of Unilever UK, is to chair the Tories' new 'Responsibility Deal' on public health.

For breakfast, Dave, who graduated in something or other from Trent Polytechnic, recommends a yummy Magnum, as advertised by slender Hollywood actress Eva Longoria. 'Did you know,' he says, 'that, eaten sensibly, ice cream can be part of a healthy balanced diet?' Yet another reason, as the food industry has been arguing, to abandon the stigmatising traffic light labelling system. Isn't it much fairer on ice cream to stigmatise people instead?

Lunch: Eric should choose from Unilever's range of tasty Pot Noodles; just one will supply around 25 per cent of his daily recommended sodium allowance! His light evening meal could be anything from the Unilever list, from a delicious bowlful of Hellman's mayonnaise to a comforting cup of Bovril (assuming the source of the recent salmonella outbreak has now been identified).

Week Three. Goal: enjoy exercise! Eric will find out how fun and exciting this can be if he tunes into CBeebies' LazyTown, featuring the Tories' favourite keep-fit instructor, Sportacus. This character is mentioned so often in connection with Tory health plans that you might easily get the impression that Sportacus, Cameron and Lansley are collaborators. But that would mean helping fat people, and as Sportacus creator Magnus Scheving says: 'LazyTown does not align itself with political parties.'

Week Four. Goal: developing self-esteem. By now, Eric will be admiring his new curves and wondering how he could ever have fallen for the line, promulgated by the authors of last year's Foresight survey, that the UK's adiposity explosion is related to conditions in the 'obesogenic society'.

A top priority in Lansley's No Excuses programme is to keep the public away from that kind of damaging misinformation. 'Tell people that biology and the environment cause obesity,' he warns, 'and they are offered the one thing we have to avoid: an excuse.' So even if Pickles already knows about the dire consequences of dietary abundance, human biology and a sedentary lifestyle, please don't mention this to any other Tory MPs who might use it as an excuse not to shed pounds of unattractive flab.

It's hard to judge, at this early stage, how the Cameron anti-fat campaign compares, in hostage-to-fortune terms, with John Major's back to basics. Even supposing there are fewer extremely fat Tories than priapic and/or corrupt ones, there could still be morale implications for his plumper backbenchers, struggling for survival in the party of the thin. How long before some sobbing junior minister describes the horror of the constant weighing and hurtful criticism from party whips? At least fashion's size zeros get to be supermodels.

Far riskier, however, is the possible impact of insulting one quarter - the obese section - of the adult population. Last week's map of obesity 'hot spots' suggests that not all of these potentially offended people are the deprived inhabitants of guaranteed Labour seats (supposing such places still exist). There are quite a few inexcusably obese people, it turns out, in Tory seats like Kensington and Chelsea. And, as much as the careers of Gillian McKeith and Anne Diamond reveal a surprising tolerance, on the public's part, for dietary advisers who may be unqualified, unhinged or five stone overweight, it seems to draw the line at abuse.

Jamie Oliver is unlikely, ever, to regain the popularity he enjoyed before he put on a fat suit and advertised his moral superiority over the 'fucking arseholes' and 'tossers' who feed their children badly. And Oliver, at least, offered recipes with this analysis. The Tories' intentionally arm's-length initiatives amount to Cameron's rebukes, Lansley's 'no excuses', the promotion of Unilever's Mr Pot Noodle, and an end to traffic light food labelling.

Of course, while obese people remain a minority, their demonisation might turn out to be a terrific vote winner. Easy to spot and fun to tease, they are also the perfect guinea pigs for Cameron's new, bottom-up approach to governance. It might just work. And if it doesn't, there's a perfectly good excuse: it's the fat people's fault, with knobs on. That's something to think about, Eric Pickles.

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Being heavy may be protective in heart disease

By Megan Rauscher Jun. 29, 2007

The "obesity paradox" lives on: In a look-back at a group of adults with suspected or known coronary artery disease, underweight adults had an increased risk of death, whereas overweight and obese adults had a lower risk of death, compared with normal-weight adults.

The paradoxical relation of higher body mass index (BMI) with lower mortality has been observed recently in other patient groups, including those with chronic heart failure and renal disease. At the moment, the reason for this is not understood.

In their study, Dr. Don Poldermans from Erasmus Medical Center, Rotterdam, the Netherlands, and colleagues examined data on 5,950 coronary artery disease patients seen at the center between 1993 and 2005.

Over an average of 6 years, mortality was highest in underweight individuals (39 percent), followed by normal-weight (35 percent), overweight (24 percent) and obese individuals (20 percent), the team reports in the American Journal of Cardiology.

In analyses taking into account potentially confounding factors, underweight patients had a greater than twofold increased risk of dying during the study period compared with normal-weight patients, while overweight and obese patients had significantly lower risks of dying.

"The explanation of the underweight patients and adverse outcome might be the prevalence of chronic obstructive pulmonary disease in this population, or (still unknown) malignancies," Poldermans told Reuters Health.

SOURCE: American Journal of Cardiology, May 2007.


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Undernutrition

merck.com

Undernutrition is a deficiency of calories or of one or more essential nutrients.

Undernutrition is usually thought of as a deficiency primarily of calories (that is, overall food consumption) or of protein. Deficiencies of vitamins and minerals are usually considered separate disorders. However, when calories are deficient, vitamins and minerals are likely to be also. Undernutrition, which is often used interchangeably with malnutrition, is actually a type of malnutrition. Malnutrition is an imbalance between the nutrients the body needs and the nutrients it gets. Thus, malnutrition also includes overnutrition (consumption of too many calories or too much of any specific nutrient—protein, fat, vitamin, mineral, or other dietary supplement).

In developed countries, undernutrition is usually far less common than overnutrition. However, undernutrition does occur, especially in people who are very poor, such as the homeless, and in those who have psychiatric disorders. Also, people who are very ill may be unable to eat enough food because they have lost their appetite or because their body's need for nutrients is greatly increased. Infants, children, and adolescents are at risk of undernutrition because they are growing and thus need a lot of calories and nutrients.

Undernutrition also occurs in older people. About 1 of 7 older people who live in the community consume fewer than 1,000 calories a day—not enough for adequate nutrition. As many as half of older people in hospitals and long-term care facilities do not consume enough calories.

  
Did You Know...

- About 1 of 7 older people who live in the community and about half of older people in long-term care facilities have undernutrition.

- Drinking too much alcohol can cause undernutrition.
 
- When not enough calories are consumed, the body first breaks down its own fat and uses it for calories—much like burning the furniture to keep a house warm. After fat stores are used up, the body may break down its other tissues, such as muscle and tissues in internal organs, leading to serious problems, including death.

- A severe deficiency of protein and calories (called protein-energy undernutrition or protein-energy malnutrition) results when people do not consume enough protein and calories for a long time.

- In developing countries, protein-energy undernutrition often occurs in children. It contributes to death in more than half of children who die (for example, by increasing the risk of developing life-threatening infections and, if they develop, increasing their severity). However, this disorder can affect anyone, regardless of age, if food supplies are inadequate. Protein-energy undernutrition has two main forms:

Marasmus:
Marasmus is a severe deficiency of calories and protein. It tends to develop in infants and very young children. It typically results in weight loss and dehydration. Breastfeeding usually protects against marasmus.

Starvation is the most extreme form of marasmus (and undernutrition). It results from a partial or total lack of essential nutrients for a long time.

Kwashiorkor:
Kwashiorkor is a severe deficiency more of protein than of calories. Kwashiorkor is less common than marasmus. The term is derived from an African word meaning “first child-second child” because a first-born child often develops kwashiorkor when the second child is born and replaces the first-born child at the mother's breast. Because children tend to develop kwashiorkor after they are weaned, they are usually older than those who have marasmus. Kwashiorkor tends to be confined to certain areas of the world where staple foods and foods used to wean babies are deficient in protein even though they provide enough calories as carbohydrates.

Examples of such foods are yams, cassava, rice, sweet potatoes, and green bananas. However, anyone can develop kwashiorkor if their diet consists mainly of carbohydrates. People with kwashiorkor retain fluid, making them appear puffy and swollen. If kwashiorkor is severe, the abdomen may protrude.

  
How Starvation Affects the Body
 
Digestive system
Decreased production of stomach acid
Shrinking of the stomach
Frequent, often fatal, diarrhea
 
Cardiovascular system (heart and blood vessels)
Reduced heart size, reduced amount of blood pumped, slow heart rate, and low blood pressure
Ultimately, heart failure
 
Respiratory system
Slow breathing and reduced lung capacity
Ultimately, respiratory failure
 
Reproductive system
Reduced size of ovaries and testes
Loss of sex drive (libido)
Cessation of menstrual periods
 
Nervous system
Apathy and irritability
In children, mental retardation (sometimes)
Mental dysfunction, particularly in older people
 
Muscles
Reduced muscle size and strength, imparing the ability to exercise or work
 
Blood
Anemia
 
Metabolism (body processes to convert food into energy or to synthesize needed substances)
Low body temperature (hypothermia)
Fluid accumulation in the arms, legs, and abdomen
Disappearance of fat
 
Skin and hair
Thin, dry, inelastic skin
Dry, sparse hair that falls out easily
 
Immune system
Impaired ability to fight infections and repair wounds
 
Causes

Undernutrition may result from the following:

Lack of access to food
Disorders or drugs that interfere with the intake, metabolism or absorption of nutrients
A greatly increased need for calories

Taking certain drugs may contribute to undernutrition. Many drugs decrease appetite. Examples are drugs used to treat high blood pressure (such as diuretics), heart failure (such as digoxin LANOXIN),  or cancer (such as cisplatin,  PLATINOL). Some drugs cause nausea, which decreases appetite.

Others (such as thyroxine and theophylline
BRONKODYL THEOLAIR increase metabolism, and still others may interfere with the absorption of certain nutrients in the intestine. Also, stopping certain drugs (such as antianxiety drugs and antipsychotics) or alcohol may lead to weight loss.

Drinking too much alcohol, which has calories but little nutritional value, decreases the appetite. Because alcohol damages the liver, it can also interfere with the absorption and use of nutrients. Smoking dulls taste and smell, making food less appealing. Smoking also seems to cause other changes in the body that contribute to a low body weight. For example, smoking stimulates the sympathetic nervous system, which increases the body's use of energy.

In older people, many factors, including age-related changes in the body, work together to cause undernutrition.

Causes of Undernutrition
Lack of access to food
Poverty
Famine
Inability to obtain food (for example, due to lack of transportation or physical impairment)
Voluntary restriction of calories (as for a strict reducing diet or a fast)
Disorders that interfere with the intake, metabolism, or absorption of nutrients
Vomiting
Diarrhea
AIDS
Cancer
Diabetes
Kidney failure
Malabsorption disorders
Inflammatory bowel disorders (such as Crohn's disease and ulcerative colitis)
Liver disorders
Anorexia nervosa
Depression
Alcoholism
Drug abuse
Drugs that interfere with the intake, metabolism, or absorption of nutrients
Drugs used to treat anxiety, high blood pressure, heart failure, an underactive thyroid gland, asthma, and cancer
Conditions that greatly increase the need for calories
Injury, such as burns
Surgery
An overactive thyroid gland (hyperthyroidism)
Infections that are widespread or severe
High fever
Demanding exercise, such as rehabilitation or training for athletic competition
Pregnancy and breastfeeding
Growth and development in infants, children, and adolescents

Symptoms

The most obvious sign of a calorie deficiency is loss of body fat (adipose tissue).

If the calorie deficiency is severe, adults can lose up to half of their body weight, and children can lose even more. Bones protrude, and the skin becomes thin, dry, inelastic, pale, and cold. Eventually, fat in the face is lost, causing the cheeks to look hollow and the eyes to seem sunken. The hair becomes dry and sparse, falling out easily. Severe wasting away of muscle and fat tissue is called cachexia. Cachexia is thought to result from excess production of substances called cytokines, which are produced by the immune system in response to a disorder, such as cancer or AIDS.

Other symptoms include fatigue, an inability to stay warm, diarrhea, loss of appetite, irritability, and apathy, sometimes leading to unresponsiveness (stupor). People feel weak, unable to do their normal activities. The number of some types of white blood cells decreases, resembling what happens in people who have AIDS. As a result, the immune system is weakened, increasing the risk of infections. If the calorie deficiency continues for a long time, liver, heart, and respiratory failure may develop. Total starvation (when no food is consumed) is fatal in 8 to 12 weeks.

In children who are severely undernourished, behavioral development may be markedly slow, and mental retardation may occur. Undernutrition, even when treated, may have long-lasting effects in children. Impairments in mental function and digestive problems may persist, sometimes throughout life. With treatment, most adults recover fully.

Diagnosis
Doctors can usually diagnose severe, long-standing undernutrition based on the person's appearance. They also ask questions about diet, weight loss, the ability to shop for and prepare food, the presence of other disorders, and the use of drugs. These questions may help confirm the diagnosis, particularly when undernutrition is less obvious, and identify a cause. Identifying the cause is particularly important in children.

Blood tests may be done to measure the level of albumin (which decreases when people do not consume enough protein) and the number of certain types of white blood cells. A physical examination, x-rays, and skin tests may be done to determine the severity and effects of undernutrition. If doctors suspect the cause is another disorder, other tests may be done to help identify the cause.

Undernutrition in older people is serious because it increases the risk and severity of fractures, problems after surgery, pressure sores, and infections.

Older people are at risk of undernutrition for many reasons:

Age-related changes in the body: In the aging body, production of and sensitivity to hormones (such as growth hormone, insulin, and androgens) change. As a result, the percentage of fat in the body increases. How the body produces and uses energy also changes. Older people tend to feel full sooner and have less of an appetite. Thus, they may eat less. They may also eat less because the ability to taste and smell decreases, reducing the enjoyment of food. The ability to absorb some nutrients is reduced.

Some older people produce less saliva, resulting in dental problems and difficulty swallowing.

Disorders: Many disorders that contribute to undernutrition are common among older people. Depression can cause loss of appetite. A stroke or tremors may make chewing, swallowing, or preparing food difficult. Arthritis or other physical impairments, which reduce the ability to move, may make shopping for and preparing food more difficult. Malabsorption disorders interfere with the absorption of nutrients. Cancer can reduce the appetite and increase the body's need for calories. People with dementia may forget to eat and so lose weight. People with advanced dementia cannot feed themselves and may resist attempts by others to feed them. Dental problems (such as ill-fitting dentures or gum disease) may make chewing and thus digesting food more difficult. Anorexia nervosa that has been present for a long time may be made worse by an event late in life, such as death of a partner or fear of aging.

Drugs: Many of the drugs used to treat disorders common among older people (such as depression, cancer, heart failure, and high blood pressure) can contribute to undernutrition. Drugs can increase the body's need for nutrients, change how the body uses nutrients, or decrease the appetite. Some drugs have side effects that interfere with eating, such as nausea, diarrhea, and constipation.

Living situation: Older people who live alone may be less motivated to prepare and eat meals. They may have limited funds, causing them to buy cheap, less nutritious food or less total food. They may be physically unable or afraid to go out to buy food or may not have transportation to a grocery store.

Older people who live in institutions have even more obstacles to adequate nutrition.

• They may be confused and unable to say when they are hungry or what they would like to eat.
• They may be unable to choose foods they like.
• They may be unable to feed themselves.
• If they eat slowly, especially if they need to be fed by a staff member, the staff member may not allow enough time to feed them adequately.

Older people who are hospitalized sometimes have the same problems.

Prevention and treatment: Older people can be encouraged to eat more, and food can be made more appealing. For example, strongly flavored or favorite foods, rather than low-salt or low-fat foods, can be served. Older people who need help with feeding should be given more help. Depression and other disorders, if present, should be treated. For older people living in institutions, making the dining room more attractive and giving them more time to eat may enable them to eat more.
 
Treatment
For most people, treatment involves gradually increasing the number of calories consumed. Eating several small, nutritious meals each day is the best way. For people who have been starving, foods are reintroduced carefully. People who have difficulty digesting solid food may need liquid supplements. If undernutrition is severe, people may need to be hospitalized. Multivitamin supplements are also given.

Nutrients are given by mouth whenever possible. If they cannot be given by mouth, nutrients may be given through a tube inserted into the digestive tract or into a vein (intravenously).

Tube Feeding: This method may be used to feed people whose digestive tract is functioning normally but who cannot eat enough to meet their nutritional needs (such as people with severe burns) or who cannot swallow (such as some people who have had a stroke). For tube feeding, a thin plastic tube (a nasogastric tube) is passed through the nose and down the throat until it reaches the stomach or small intestine. If tube feeding is needed for a long time, the tube can be inserted directly into the stomach or small intestine through a small incision in the abdomen.

Food given through a tube (enteral nutrition) should contain all the nutrients a person needs. Special solutions, including some for people with specific needs (such as restriction of fluid intake), are available. Or, solid foods may be processed and given through a nasogastric tube. Tube feedings may be given slowly and continuously or in a larger amount (called a bolus) every few hours.

Tube feeding causes many problems, and the problems may be life threatening:

Inhalation (aspiration) of food into the lungs:
For older people, aspiration is the most common problem caused by tube feeding. Aspiration of food can lead to pneumonia. Food is less likely to be aspirated when the head of the bed is elevated for 1 to 2 hours after tube feeding, reducing the risk of spitting food up (regurgitation), and when the solution is given slowly.

Diarrhea and abdominal discomfort: Changing the solution or giving it more slowly may lessen these problems.

Irritation of tissues: The tube may irritate and erode tissues of the nose, throat, or esophagus. If tissues become irritated, the feeding tube can usually be removed, and feedings can be continued using a different type of tube.

Intravenous Feeding: This method is used when the digestive tract cannot adequately absorb nutrients (for example, in people with a malabsorption disorder). It is also used when the digestive tract must be temporarily kept free of food (for example, in people with ulcerative colitis or severe pancreatitis). Food given intravenously (parenteral nutrition) can supply part of a person's nutritional requirements (partial parenteral nutrition) or all of them (total parenteral nutrition). Because total parenteral nutrition requires a large intravenous tube (catheter), it is inserted into a large vein, such as the subclavian vein, located under the collarbone.

Intravenous feeding can also cause problems:

Infection: Infection is a constant risk because the catheter is usually left in place for a long time and the solutions that pass through it contain a lot of glucose—a sugar—which promotes the growth of bacteria. People receiving total parenteral nutrition are closely monitored for signs of infection.

Too much water (volume overload): Giving too much water can cause fluid to collect in the lungs, making breathing difficult. Thus, doctors monitor the person's weight and the amount of urine excreted regularly. They can sometimes reduce the risk by calculating the amount of water required before starting feedings.

Nutritional imbalances and deficiencies: Rarely, deficiencies of certain vitamins and minerals occur. Doctors measure the blood levels of dissolved minerals (electrolytes), sugar (glucose), and urea (a measure of kidney function) to identify certain nutritional imbalances. They can then adjust the solution accordingly. They periodically monitor the levels.

Decreased bone density: In some people, total parenteral nutrition causes bone density to decrease. The reason is unknown, and the best treatment is to temporarily or permanently stop this type of feeding.

Liver problems: Total parenteral nutrition can cause liver malfunction, most commonly in premature infants. Blood tests are done to monitor liver function.

Gallbladder problems: Gallstones may develop. Treatment involves adjusting the solution, stopping feedings for a few hours a day, and, if possible, providing food by mouth or feeding tube.

Drugs: People who are very undernourished are sometimes given drugs to increase appetite, such as dronabinol or drugs to increase muscle mass, such as growth hormone or an anabolic steroid (for example, nandrolone or testosterone)

Underweight teenagers  (292KB PDF)

See also
Cash to tackle childhood obesity
Obesity the crusade
Doctors: 'Put obese children into care'

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