New guidance: how to prevent obese children from developing heart disease later in life

Experts are calling on decision-makers to create new policies which stop levels of childhood obesity and its associated problems from rising.

The guidance highlights the need to tackle obesity and the accompanying risk factors together, as having more than one problem compounds the likelihood of cardiovascular disease (CVD) in adulthood.

The document was produced by the Task Force for Childhood Health of the European Association of Preventive Cardiology (EAPC) of the ESC and the European Childhood Obesity Group (ECOG), and is published in the European Journal of Preventive Cardiology.

The importance of intervening during childhood

Levels of childhood obesity have risen significantly over the last few decades, rising from just 1% of 5-19-year-olds in 1975 to 7% in 2016, according to the World Health Organization (WHO).

Obese children are five times more likely to become obese adults than their healthy weight peers, leaving them vulnerable to a wide variety of health problems. Indeed, those with a high BMI are 40% more likely to develop cardiovascular disease in midlife.

Furthermore, children with a combination of risk factors including smoking and high BMI, blood pressure and blood lipids have a two- to nine-fold greater risk of heart attack and stroke in midlife.

Dietary habits and food preferences which are formed early in life are likely to continue into adulthood. This is why, the authors say, it is vital to intervene during childhood.

“The global rise in childhood obesity, to a large extent driven by more physical inactivity, has been linked with an increased prevalence of high blood pressure, blood lipids and blood glucose in childhood.

“This combination of factors is in turn linked with damage to the arteries and heart, which can be reversed with exercise in children but much less so in adults,” said first author Professor Henner Hanssen of the University of Basel, Switzerland.

Exercise and nutrition

There are a wide variety of health interventions school aged children should undertake to reduce the risk of obesity and its health-related consequences. This includes:

• Doing at least 60 minutes per day of moderate to vigorous aerobic physical activity
• Doing muscle strengthening activities at least three times per week
• Limiting sedentary time (including screen time)
• Eating three nutritious meals and no more than two snacks per day (avoiding energy-dense and nutrient-poor foods such as fruit juices or fast food, and increasing intake of unprocessed fruit, vegetables and fibre-rich cereals, and lowering fat and sugar intake.)

The guidance laid out in the scientific statement advises policy makers on how they can encourage children and adolescents to adhere to these recommendations.

This includes promoting physical activity and encouraging healthy eating habits, educating children on the need to reduce sedentary time, providing diet counselling and psychosocial support and promoting parenting styles that encourage physical activity and healthy eating.

Schools must take the lead to encourage healthy living

As well as teaching children and their families about the importance of physical activity and nutrition in particular, there is also an urgent need to reduce unhealthy food marketing, the experts say.

The document states that most children are exposed to promotion and marketing of products such as fast food and sugar-sweetened beverages up to about 200 times per week on social media.

Unhealthy food marketing can significantly influence children’s eating behaviours, while healthy food marketing appears to have no (or very little) affect.

Ultimately, Professor Hanssen says that instead of marketing simply telling people to eat healthily, a healthy lifestyle needs to be promoted as “fun and cool”, as this is likely to be far more effective.

To do this, schools should take the lead and offer healthy school meals, cooking classes, education about nutrition and activity, and sports clubs. Family and friends should be invited to take part, as both have an influence on a child’s lifestyle and weight.

Professor Hanssen said: “Healthy, affordable diets should start at the school canteen and physical activity can be promoted through active breaks at schools. Education about healthy lifestyles won’t have much of an impact if parents are not involved.”

Action plan needed to halt future health problems

Finally, the document stresses the need to avoid stigmatisation of overweight and obese children as this could push them towards eating disorders and inactivity. However, Professor Hanssen advises that this must be addressed “sensitively”.

“At school level, for example, all children and families may benefit from prevention strategies, from the healthy canteen to active breaks,” he said.

Ultimately, Professor Hanssen says addressing obesity and preventing CVD needs to start early, as this is when intervention efforts are likely to be most effective.

“Rather than wait and see whether or not today’s obese children become tomorrow’s heart attacks and strokes, an action plan is needed now to put a halt to future health problems. We already know that obesity is harming children’s health. What more proof do we need?” he asks.