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Tuesday, 17 April 2012

Childhood obesity (Παιδική παχυσαρκία)

Throughout my blog, I have shown to be highly critical of parents who do not teach the value of good nutrition to their children. I am especially saddened by what I see or hear through my children about what goes into some chidlren's school lunchboxes, especially since Crete reputedly has Greece's fattest children and Greece is apparently the fattest nation in Europe (the UK often competes with us on this one). It seems incredulous to hear of packaged goods being brought daily into a primary school (that has no canteen or tuck shop) which is located in an agricultural region where chickens and sheep, fruit and vegetables, orange, avocado and olive treees surround the general area. I would think it would cost much more in time, labour and money to go to a supermarket to buy so many packaged products, instead of using the resources that these children are surrounded by!

Greek people's ideas about good nutrition often hinge on some fallacies, such as:

- preparing copious quantities of food (hence, portions are always large, and there are second helpings)
- bulk buying of food items (so there is always too much food in the house)
- the belief that young children's bulging stomachs will magically turn into height at a later age
- preparing different meals for fussy eaters (it's now standard practice to see the menu heading 'Children's Meals' at tavernas, which was once quite rare)
- the belief that children deserve to be given sweet treats (eg regular servings of ice-cream in the summer, etc)
- the lack of knowledge about what packaged convenience food contains (eg few people realise that soft drinks contain not just sugar but also salt)
- the lack of critical self-awareness: few people acknowledge that their chidlren are overweight (in their eyes, their chidlren look 'normal', while other people may view the same child as 'fat'). 

Some of these problems sound like global ones, but they also have an inherently Greek twist to them: during WW2, many Greeks starved to death in urban areas (while the rural populations had to resort to foraging to survive) because of the confiscation of food by the Nazis for their troops, and many people still remember those times, hence they have an image of fat healthy chidlren, which they pass on to their family members. The doting tender care, love and affection expounded on children is also a contributing factor to Greek children's bad dietary habits. When the parent is not looking after their child's nutrition needs, it's usually the grandparent who takes care of it, and grandparents are often too relaxed in their methods of raising their grandchildren, which they may not have been with their own children. Greek women who like to keep up with fashion are also not shy about wearing clothes that seem to accentuate their fatness. This peculiar trait is quite revealing in terms of identity: it rings tunes of smugness: "I eat what I like, I wear what I like, and I know I am beautiful." 

Most Greeks still prepare, cook and prefer to eat Greek traditional meals, but the large portions, coupled with junk food added to the daily menu, are probably what causes obesity in Greeks, not to mention a more sedentary lifestyle and less physical field work - the average Cretan farmer used to walk 20 kilometres a day on average, whereas he now drives that much instead, and walks only about 2 kilometres a day.
Obesity survey in Greek schools, 2012
Just recently, my children bought home a large envelope containing a 20-page questionnaire for the purposes of discovering the eating and physical activity patterns of Greek chidlren. The research is being carried out as part of a nationwide survey on childhood obesity, touted as the first of its kind ever to be conducted in Greece. The cover letter states that this is an attempt to chronicle the changes in Greek society in the way we eat and keep active. The questionnaire is to be answered anonymously, and only if the parents/caregivers wish to take part. Having worked with questionnaires and other such research work, I know how difficult it is to gauge accuracy using only such tools, because it's difficult to know how honestly people answer the questions. But this survey is also going to be backed up with physical measurements of the chidlren (whose parents have signed a written agreement to allow them to take part), which include: weight, height, waistline, neck perimeter, blood pressure, strength (with a hand-dynamometer) and endurance (through a running test).

The questionnaire asks parents about the dietary habits of the household, but there is a clear main interest throughout the survey in junk food. Parents are asked to check boxes (with a cross: Greeks aren't used to using a tick!) to show which food items they allow to be found in the house and/or give to their chidlren for morning/afternoon snacks: chocolate, croissant, 'tost' (which means 'ham and cheese toasted sandwich' in Greece), pizza and packaged juice are found among the choices, including yoghurt and milk (with separate entries for low-fat, full-fat and 0%), egg and fruit. There is also a section that asks parents how often they order food from a fast-food restaurant, pizzeria, souvlaki shop or taverna (note that 'fast food' and 'souvlaki shop' are kept separate). No actual Greek food name has been used, only generic ideas.

The physical activity sections focus on what sports activities children take part in (eg basketball, football, etc), as well as dance. People are also asked to state what they believe about physical activity in children, eg "How likely are you to send your child to a sports activity rather than a frontistirio?" Most if not all Greek children spend many hours outside the state school system, sitting at desks in private school, doing more school work, mainly in learning foreign languages when they are primary school, and adding preparatory lessons in school subjects when they are in high school. 

The economic crisis is touched on with six questions concerning the affordability of eating balanced meals, eg "Do you believe that in the last 12 months you have been unable to afford to eat balanced meals?" and "In the last 12 months, have you felt hungry because there was not enough food in the house?" But I was surprised that absolutely no mention of olive oil was made, whereas there were specific references made to sugar and salt, eg "How much do you agree with the statement that too much salt is bad for you?". Salt, sugar and fat in combination are regarded as the main culprits for the rise in obesity around the world, as discussed in obesity literature, along with the sedentary lifestyle. Olive oil is propounded by experts as a superfood for good health, well-being and longevity, as well as one being one of the most marketable products Greece produces. Greeks consume the highest  amount per capita int he whole world, while Cretans supposedly use more than any other Greek (we go through 150kg of olive oil in a year, among 5 people).

The questionnnaire also asks parents to provide basic demographic details, including their chidlren's birth history and present weight and height (apart from the physical measurements which will be conducted by the researchers at a later stage). My children were both surprised to see that their weight matched the centimetres in their height (after 1m/100cm was subtracted). So if you weigh about 70 kilos, you should be about 1.70m tall. That's what I've always used to gauge a balanced weight and height.

It will be interesting to hear the results of the survey. I will keep you posted.

You can see how I answered the questionnaire (and test your knowledge of the Greek language at the same time) in this photo set.
