The most beautiful day of the year at De Horizon Christian Primary School in Delft is Christmas Day. Then all parents, belonging to 28 countries, come to school from neighboring apartments, bringing food with them. All very much.
The tables are full of chicken legs, pancakes, baklava and other sweets. Children never complete it, so parents happily share in the meal.
Cheerful School Principal Mint Helder says “eating” is a good way to attract parents of 28 nationalities to school. We no longer give a farewell prom, these dads don’t know what to do with it. But everyone understands food.
At the same time, this presents Helder with a diabolical dilemma. Obesity is a big problem among his students. Horizon has a complex student base: people who live in the surrounding apartments are in debt, have low or no education at all, single mothers, there are drug problems, there are stresses about everyday life. All risk factors for an unhealthy lifestyle, for children who are overweight.
It has only gotten worse during the Corona crisis. “Thanks to online education, we suddenly got a view of the living rooms,” says director Helder. “We’ve seen oil on the table during lunch, and we’ve seen kids get fatter behind the scenes.”
Obvious increase in overweight and obesity
The numbers confirm Helder’s experiments. Epidemiologist Chantal Koolhaas looked at data from the South West Holland Youth Health Care Center last summer, which also includes Delft. The proportion of overweight children among 4-year-olds was stable for years before COVID-19 at around 7.3. In Corona’s first year, that rose to 9 percent. The proportion of children under the age of four who were obese increased from 1.4 to 2.2.
Same picture for 5.5-year-olds: overweight from 8 to 10.1 percent, obesity from about 2 to 3.2 percent. The increase in the number of obese children is also a concern among 10.5-year-olds.
The latest numbers from CBS? Same conclusion: In 2020 and 2021, more than 16 percent of people aged 12-18 were overweight, clearly higher than the previous five years. In 2021, the national obesity rate rose to 3.2%. Fits with the global trend. Researchers in China, Europe and the United States also found similar developments.
“What is striking about our personalities is that origin plays such a major role,” Koolhaas says. “Our advice may not be appropriate for all parents. In some cultures, for example, the idea is that a slightly chubby posture is a good thing.”
This is exactly why Principal Helder is using a large portion of the extra Corona money for education in order to educate about healthy nutrition and adequate exercise. Each class receives one hour per week on this topic, in addition to the regular school time. Today teacher Marloes studied in Group 5 about drinks and how much sugar they can actually contain.
A can of energy drink next to the bed
Children are given bits of orange, cucumber, lemon and ginger to make their own flavored water. Lots of lemon makes faces sour, and mint is a refreshing result. “I always have a bottle of water by my bed,” says a frail girl, still searching for the correct Dutch words. “I always have a can of energy drink,” Omran replies.
Well, those energy drinks, they’re full of sugar. The kids seem to be starting to drink it a lot during the lockdown and – even more worryingly – their consumption doesn’t go down when everything is open again. Anita Frogdenhill is Professor of Lifestyle Disorders in Maastricht, where she started a Childhood Overweight Expert Center. Immediately after the first shutdown was announced, she and her colleagues set up a number of research projects, because she had a feeling this would end badly for many children.
‘We have seen a deterioration in all areas of the lifestyle. The kids started eating more snacks, drinking more sugary drinks, and being drastically less mobile. The most shocking thing to me is that this lifestyle did not recover when the number of corona measures went down.
Shocking too: it’s particularly vulnerable children, those who are already obese, who have deteriorated the most. Surveys show that one in four children says they have gained weight during the pandemic. The proportion is two out of three for children treated at the Vreugdenhil department. On average, they gained 4.5 kilograms.
Vreugdenhil: ‘After the lockdown we saw kids again on the outpatient clinic and they were doing really well and then they gained 6, 7 and 8 kilos again in four months. Everything they worked so hard for was lost. It is sad to see the frustration among these children.
“You can clearly identify the consequences at primary school age.”
Being overweight (BMI between 25 and 30), but definitely obesity (BMI over 30) has serious consequences for the child. As early as primary school age, you can clearly identify the consequences under a microscope. Hypertension, lipid imbalance, hepatitis already due to fatty liver.
The psychological and social consequences are equally serious. Children report significantly lower quality of life. They often suffer from depression, anxiety problems, and eating disorders and do poorly in school. Vreugdenhil: ‘It’s also about basic things like never being invited to parties, or teachers reacting differently to students who are overweight. The kids in my office hours tell me that the physical education teacher ignores them with “fat ass” or “you have to work a little harder.”
All of these problems persist later in life. In fact, the earlier stages of pathology become diseases, it is more difficult to find a partner, it is more difficult to get pregnant, the pregnancy itself is more difficult, the sex life is less satisfactory and so on.
Frogdenhill: At such a difficult time, we should have done everything we could to protect this vulnerable group. But fighting extra pounds is just a side dish to all healthcare institutions, everyone has returned to their original mission. Because of these measures, we were also not able to receive children in the hospital or there was a need for health care staff to take care of Corona patients.
Sorry, apple juice has the most sugar
In the fifth set, teacher Marlowe placed five bottles. Students are required to rank water, apple juice, cola, diet cola, and energy drink from low to high in sugar. When Lishandro, to his pride, is asked to look at the posters, his face explodes in surprise. “Wow, whoop!” Screams throughout the class. Apple juice contains the most sugar.
In the sports field of the Krajicek Foundation next to the school, students run in a daze in a watery succession: back and forth as far as possible with a glass of water. After one round, Imram surrenders. Officially because his pants are wet, but his ability to take a breather on the seat doesn’t suit him either.
The worrying thing about obesity is that it doesn’t just go away. Erica van den Acker coordinates the pediatric department at the Healthy Weight Center at Erasmus MC in Rotterdam. There is a biological explanation for this: obesity is a disease. It changes your hormonal system. The feeling of hunger changes, weight regulation and burning change. Your body adjusts the thermostat differently, so it always tends to come back to a higher weight. This is why children who are already overweight are most affected.
Don’t focus on the number on the scale
Thus, says van den Acker, it is now important to reduce overweight and obesity as much as possible. Care organizations must work together to care for one child. The guideline for regulating the care of overweight children has just been completed. We must have time to do extensive research, and time to consult, so that we can find out exactly what is going on with the baby. What are the barriers to a healthy lifestyle? We have to address it, not focus on the number in the balance.
In practice, it appears that it is not possible to implement the guideline, says van den Acker. Ideally, youth health care would play a leading role, but there is also a staff shortage so great that more than a quarter of all JGZ regions cannot even perform their statutory duties, the inspectorate said. The municipality of The Hague, for example, actually reduced the aid for overweight, to the dismay of the same inspectorate.
Van den Acker: “Obesity is a complex problem and municipalities often want simple solutions. Remove the vending machines and be done. But it is a complex problem that simply cannot be solved. Healthcare providers need training, time and resources. She says it would be the sensible way to go. The Dutch partnership to increase Weight, a partnership of welfare and social care organizations from across the country, calculates that an overweight or obese person costs society an average of €11,000 per year in healthcare costs, and above all, job losses. People who are overweight: €79 billion per year So it pays to do everything you can to prevent obesity.
Helder, the school principal, says a week’s hour at Horizon Elementary isn’t going to make kids lose weight. “Of course this is never enough, but you have to start somewhere.”