Parents’ lack of money, time for cooking, and motivation are some of the important barriers to achieving a healthy diet in children. Similarly, lack of sports facilities, intolerant neighbours, and not having a garden can act as barriers to being more physically active. These are the first results of the European IDEFICS study (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants).

Contributing to the prevention of childhood obesity in Europe

Childhood obesity and its related health problems are an increasing phenomenon in Europe. Consequently, the IDEFICS study was set up to improve knowledge about dietary factors, social environment, and lifestyle affecting children’s health in Europe. This knowledge will be used to develop, implement, evaluate, and validate specific interventions for reducing the prevalence of diet- and lifestyle-related diseases.

As part of the IDEFICS study, focus groups were held at the child and parent level in eight countries to gain insight into the factors that affect children’s nutrition and physical activity. The focus groups’ participants comprised:

• 155 children aged 6-8 years (81 boys, 74 girls) - split into 20 groups of 5-17 participants
• 106 parents of 2-4 year old and 83 parents of 6-8 year old children (28 men, 161 women) - split into 36 groups of 5-12 participants

Barriers to a healthy diet

Not enough time for cooking, lack of money, limited motivation, little time available to spend with the children (to control what they are eating), grandparents breaking food rules, and the wide availability of energy-dense, nutrient-poor foods were among the factors mentioned that can hamper children eating healthily. Low-income families are more likely to have diets that are less healthy, where shopping is more influenced by price and taste preferences of the children and food choice rules are less strict. There are large differences between countries in school rules on food consumption. Sweden has strict and clear rules, nutritious meals are provided to children and vending machines are regulated. The absence of clear rules is, however, common in other countries. Generally, there is a lack of nutrition education (except for Belgium and Spain), and eating fruit at school is not facilitated.

Barriers to physical activity

Common environmental barriers include the lack of facilities, such as playgrounds, gyms, sporting grounds, swimming pools, green spaces or cycle lanes, as well as safety issues that include too much traffic, the presence of teenage gangs, no or unclear traffic signs and bad condition of cycle lanes and footpaths. Conditions at school, although variable from country to country, are not optimal either, due to too short breaks and lack of space to play.

Lack of organised activities for younger children and lack of sports organisations contribute to children doing little physical activity. Low-income families regarded the price of doing sports in a sports club as a major obstacle, although they would see the participation of their children in organised activities as a way to keep them in a safe environment. Generally, the children were more active during spring and summer.

Tearing down the barriers

Parents most often perceive school as an important facilitator for healthy diet and lifestyles. This is due to the fact that children spend a significant amount of daytime at school. Nutrition education should thus be included since children from all socio-economic classes could be reached this way. It is also necessary to have a well elaborated and consistent school food policy that is endorsed by the parents. This is important as parents need to become more aware of their responsibility for improving their children’s diet and lifestyle.

Environmental changes like the creation of traffic-free zones, or safe streets with footpaths and cycle lanes will help increase physical activity in children. Organising affordable activities for children will not only take them away from sedentary lifestyles, but also keep them out of trouble, especially in low-income families. Schools should make appropriate accommodation and sports materials available, include active breaks, organise extracurricular activities, and motivate teachers to act as role models. In Sweden, day care schools already offer such activities for younger children during and after school hours, and in Hungary schools open their playgrounds for families to do sports activities together. Playing together is highly motivating for children to go outdoors and be active.

The IDEFICS study continues

The results of the focus groups have been used to develop a community-based lifestyle strategy that addresses nutrition and physical activity interventions and is centred around primary and nursery schools. The nutrition intervention will include education as well as training to develop cooking and shopping skills. For the intervention on physical activity, structured activities and an environment that supports activity both at school and in the community will be necessary. Improving safety in the neighbourhood, and large-scale actions such as increasing the number of playgrounds or parks or family days, should be part of a community programme and the focus of negotiations with community leaders. Finally, a healthy parental lifestyle supporting physical activity and the availability of healthy foods will contribute to a healthier diet and higher activity levels in their children.

Further information: www.ideficsstudy.eu

References

1. Ahrens W, Bammann K, de Henauw S, Halford J, Palou A, Pigeot I, Siani A, Sjostrom M. (2006) Understanding and preventing childhood obesity and related disorders—IDEFICS: A European multilevel epidemiological approach. Nutrition, Metabolism and Cardiovascular Diseases 16(4):302-308.
2. Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS). European Commission Sixth Framework Programme. Contract n° 016181 (FOOD) http://www.ideficsstudy.eu.
3. Haerens L, De Bourdeaudhuij I, Barba G, Eiben G, Fernandez J, Hebestreit A, Konstabel K, Kovács É, Lasn H, Regber S, Shiakou M, De Henauw S, on behalf of the IDEFICS consortium (in press). Developing the IDEFICS community based intervention program to enhance eating behaviors in 2-8 year old children: findings from focus groups with children and parents. Health Education Research.
4. Haerens L, De Bourdeaudhuij I, Eiben G, Barba G, Bel S, Keimer K, Kovács E, Lasn H, Regber S, Shiakou M, Maes L on behalf of the IDEFICS consortium (submitted). Formative research to develop the IDEFICS physical activity intervention component: findings from focus groups with children and parents. IJBNPA.
5. EUFIC Food Today n°58 (May 2007) Learning Healthy Living – Development of a European Prevention Strategy.
   Available at: www.eufic.org/article/en/artid/Learn-healthy-living-european-intervention-strategy/

FOOD TODAY 07/2008