Child's play? No way!

“I used to walk to school,” says Rodney Marsh, former international Australian cricketer and director of coaching at the ICC Global Cricket Academy in Dubai. “I didn’t have a bike, my family couldn’t afford a car, or even shoes for me to wear to school. We didn’t have television, and we had no entertainment. But we played football, a lot of games and climbed trees. We were always running around, and sometimes getting into trouble. We didn’t have fast food or fizzy drinks then, but we could have anything in moderation. There’s a lesson there for you!”

At 66, Marsh is fit enough to appear much younger. So are his colleagues Dayle Hadlee, former New Zealand player, and former international Pakistani star Mudassar Nazar. They are here to give a talk to the students about having a healthy lifestyle, which includes a nutritional diet.

This is an annual event at Jebel Ali Primary School. Each year the school dedicates a day, called Health Day, to promote a healthy lifestyle among schoolchildren. It is interesting to see the pupils responding to the cricketing legends. They don’t know them, but the fact that they are bonafide sports stars seems to lend weight to their words. They listen intently, and later seem to have absorbed enough to make them think about changing their dietary habits.

“I plan to stop eating so many chocolates, which I love! I’ll start eating more fruits and vegetables,” says fourth grader Lavinia Nouira.

“I’ll stop having too many fizzy drinks,” says Joois Middleton in Grade 6. “I love peanut butter and apples. I’ll eat more fresh fruits and vegetables, which my mom tells me to,” she promises with a toothy grin.

Cute. But it’s not a pretty picture when you look at the statistics that are causing the medical fraternity a lot of concern. There is a reason some schools like the Jebel Ali Primary School are trying to educate their students about a healthy lifestyle and the role diet and exercise play in their lives. At least one child in six, under the age of five, suffers from stunted growth as a result of poor nutrition in the UAE, according to doctors. There are also high rates of children with low birth weight and those who are severely underweight. According to health professionals, the problem stems from children not receiving
the nutrients they need.
The figures are based on a study by the National Centre for Health Statistics at the World Health Organisation in 2007. The numbers have gone up since. “The two extremes – obese children and severe cases of underweight children have become the norm in the present generation,” says Sufyan Ahmad Othman, head of development unit and senior clinical dietician of the Clinical Nutrition department at Rashid Hospital. “Because parents don’t know what they should and shouldn’t be eating and feeding
their kids.”

Processed food is the culprit
The problem is the processed food most children in the UAE consume, according to Dr Othman. They are high in calories, but not in micronutrients.

These observations are similar to the findings of two researchers, Dr Naz Awan, from the Faculty of Education and Maitha Bin Shahdoor, a research student, at
The British University in Dubai.

Dr Awan and Maitha conducted a pilot investigation into nutrition education and the development of a “Healthy Lifestyle Programme” for public schools in the UAE for the Emirates Foundation. The full-fledged study will begin next month.

“The aim of this study is to investigate issues associated with nutrition education and cafeteria food policy within public schools in Dubai,” says Dr Awan. “Research suggests that the changing lifestyle in the UAE has manifested itself in many ways including new eating habits.

The growing trend in obesity has become an issue of national concern.”
What they found in the pilot study that involved students of a Cycle 1 boys school and a Cycle 2 girls school was an eye-opener.

“The kids do know what’s good and what’s bad. They have an understanding of it, but they prefer snacks which are unhealthy. What we also found is that they have money to spend in cafeterias and that nutrition education is not formally represented in any part of the national curriculum,” says Maitha.

“But the school principals and teachers were aware of the importance of nutrition education and were keen to encourage the introduction of the subject into the curriculum.”

Checking lunch boxes for healthy food
Surveys of cafeteria facilities revealed that the food available to students was often high in fat and/or sugar and/or additives. “Schools were ill-equipped to provide students with healthy alternatives because of restricted food choices with suppliers, and a restriction in the suppliers that could be used by the schools,” says Dr Awan.

This is an issue faced by most schools in the UAE. Some schools have taken note of the problem and started scrutinising lunch boxes to ensure that students eat healthy.

“That’s why we regularly check students’ lunch boxes,” says Jane Beese, school nurse, Jebel Ali Primary School. “It gives us an idea of what our students eat, and how much
of an intervention is required from our end.”

Beese speaks to children regularly on what constitutes healthy eating. “It’s important to talk to them in their language,” she says. “If I tell them to eat more fruits and vegetables because they have more vitamins and minerals, it really doesn’t have the effect of telling them it will make them feel less tired when they are playing their favourite game.”

The idea is to make it as much fun as possible for children. “We have classes where we teach children how to make healthy snacks and sandwiches. We put on videos and generally have fun experimenting with food.”

One such activity is the outdoor barbecue where a teacher and an assistant are teaching a group of children how to barbecue fruits. Bits of strawberries, bananas, and other fruits skewered on sticks are being barbecued as the teacher explains the process. The children take the barbecued fruits with trepidation, but are soon enjoying the taste. “I like them!” exclaims Susie Shaw, a student in Grade 3. The assistant offers me a piece and I eat it with as much apprehension as the children did.And to my surprise, it’s tasty!

“This is what we try to teach them,” explains Beese. “We try to do that by Grade 3, which is the right age to start educating them about the wrong types of food and diet.”
“We have to get it across to children, and also parents, that heavily processed food, especially snacks heavy in saturated fats and animal fats (found in fast food), should be avoided,” says Dr Parviz Rashvand, of Synergy Integrated Medical Centre, Dubai. “A piece of chocolate will not do much harm; in fact, it can even stimulate the digestive system. The problem is when children don’t have breakfast, and take processed snacks in their lunch boxes. One way of circumventing this could be if the parents make the snacks, using less sugar and with better ingredients.”

These themes were picked up in a questionnaire that was given to students who were the subject of the study conducted by Dr Awan and Maitha, on the topic of attitudes towards food and exercise. “The results of this questionnaire revealed that while students were aware of what constituted a healthy diet, they often ate unhealthily,” says Dr Awan.

“An interesting finding revealed that many of the children have no contact with meal-making or cooking at home. The significant majority reported that maids were responsible for preparing meals. In addition, a large number of students reported
to eating out a great deal.”

What they appear to be doing is spending money in school cafeterias, which don’t stock much nutritional food. These findings were reinforced during an art workshop that the researchers conducted. Students were asked to create a daily food and exercise wall chart for another child. Students were allowed to create a visual montage of food/meals and exercises over a wall chart that represented one day in a ‘similar other’ child’s life. These wall charts were then used as a means for students to explain both the noted item on the wall chart and the reasons (rationale and beliefs) why certain foods should be consumed at certain times. They also had to note the types of exercise that the child would like to engage in. “The results again matched those generated by the questionnaire which showed that children are often aware of the distinction between ‘healthy’ and ‘unhealthy’ food,” says Dr Awan.

The balance for most children appeared to be between eating one healthy meal per day with the snacks that they purchased for themselves. Many of the children did not eat breakfast, therefore limiting a main meal to either lunch or dinner. Another important point that emerged was the high expendable income that children had that allowed them to consume food that wasn’t good for them.

‘Play’ factor in physical activity
There is also the issue of exercise and its place in the curriculum. “The preliminary study revealed that in the instances observed, the physical education classes did not engage students in physical activity,” says Maitha. Physical activity classes may be too closely associated with school work, so for some students this makes them feel like they are being made to do more work. Perhaps the key is to promote physical activity by getting children and adolescents to ‘play’ in ways that promote better fitness levels, while at the same time representing fun and adventurous activities, says Dr Awan.

The physical activities on offer to students during their physical education classes were limited due to the nature of the facilities and equipment available. “What we noted during these sessions was the general reluctance of students [particularly female students] to engage in physical exercise,” says Maitha.

Another fact that emerged was that the students did little exercise during their leisure time with the exception of those whose parents arranged an organised sporting activity, like swimming classes. The girls who were questioned, as part of the study, said that if there was more choice available like horseback riding, ice skating or skateboarding, they would be more likely to participate in exercise classes.

Dr Awan and Maitha will soon start a full-fledged study to explore the beliefs and behaviours of Dubai-based Emirati students to nutrition and exercise. They hope that the research findings will lead to recommendations on curriculum changes as well as help develop programmes to encourage children to “become more engaged with nutrition issues, the food cycle itself as well as improving attitudes and behaviours towards exercise.” Experts believe that any change should begin at home. Encouraging entire families to change their behaviour could help children lose weight and stay healthy.
“Which is why we try to involve parents in food activities,” says Bleese. “Only a combined effort can lead to success.”

“Family-based, lifestyle interventions that include a behavioural programme aimed at changing diet and physical activity provide significant and clinically meaningful decreases in both children and adolescents being obese and overweight compared with standard care or self-help regimes,” concurs Dr Rashvand.

Propensity for obesi ty

Several studies have been conducted on the nutritional status of children in the UAE in the last decade. What they have established, according to Sufya Ahmad Othman, head of development unit and senior clinical dietician of the Clinical Nutrition department at Rashid Hospital, is that while some children may suffer from nutrient deficiencies, others may be obese and malnourished at the same time. “A study in 2003 by Abdul Hamid Kerkadi found that about 19 per cent of 11 to 25-year-old females were overweight and 7 per cent of them were obese,” says Othman.

“Recent data showed that 21.5 per cent of 5 to17-year-old children are overweight and about 14 per cent of them are obese.”

“Furthermore, the comparison of body mass index (BMI) to international reference data revealed that UAE children are at increased risk to become overweight and obese,”
he adds.

“The frequency of obesity among UAE youth is two to three times greater than the recently published international standard. The prevalence of obesity is still high, which highlights the need for urgent action.”

A UNICEF report on UAE statistics shows that 14 per cent of under-fives (2003-2008) were moderate to severely underweight, 3 per cent were severely underweight, and 17 per cent had stunted growth (short stature). “What’s interesting is that this was mainly not related to lack of access to food or food shortage, but due to bad eating habits. There was a variety of junk foods that they consumed and empty calorie foods (foods high in calories from sugars and fats but very low in protein, vitamins, and minerals),” says Othman.
 

Dietary guidelines for school-age children

Vegetables 3-5 servings per day. A serving might be one cup of raw leafy vegetables, 3/4 cup of vegetable juice, or 1/2 cup of other vegetables, raw or cooked.
Fruits 2-4 servings per day. A serving may consist of 1/2 cup of sliced fruit, 3/4 cup of fruit juice, or a medium-size whole fruit, such as an apple, banana or pear.
Whole grains 6-11 servings per day. Each serving should equal one slice of bread, 1/2 cup of rice or 1 ounce of cereal.
Protein Four to six servings per day. A serving might be 1 ounce of cooked lean meat, poultry or fish, 1/2 cup of cooked dry beans, one egg, or 2 tablespoons of peanut butter for each ounce of lean meat.
Dairy products Two to three servings per day of low-fat milk or yoghurt (1 cup=one serving), or natural cheese (1 1/2 ounces=one serving).
Compiled by Sufya Ahmad Othman, head of development unit and senior clinical dietician of the Clinical Nutrition department at Rashid Hospital