TT has the ninth highest percentage of overweight children under the age of five in the world, according to 2022 data from a World Health Organization report.
However, it is important to note there were gaps in the data as 41 countries provided no data at all.
The 2023 Levels and Trends in Child Malnutrition, Unicef (United Nations Children’s Fund) / WHO / World Bank Group Joint Child Malnutrition Estimates state that in 2022, 13.9 per cent or approximately 12,600 children under five years old were overweight in TT.
The report explained childhood overweight occurs when children’s caloric intake from food and beverages exceeds their energy requirements. And that since 2000 there had been an increase of about four million children under five living with overweight globally, taking the 2022 number to 37 million.
“To stop malnutrition before it starts, children and their families need access to nutritious diets, essential services and positive practises to set them on the path to survive and thrive.
“But today, these vital pathways to good nutrition are under growing threat, as many countries plunge deep into a global food and nutrition crisis fuelled by poverty, conflict, climate change and the enduring secondary effects of the covid19 pandemic.”
It added that childhood overweight and obesity increased the risk of obesity, noncommunicable diseases (NCDs), premature death and disability in adulthood.
For that reason, in 2017, the sale of sugar sweetened drinks, such as sports and energy drinks, and soft drinks were discontinued in government and government-assisted schools. Only water, 100 per cent fruit juices, and other milk, blended vegetables, and fruit drinks with no added sugars or artificial sweeteners are available for sale in cafeterias.
Commenting on the report, consultant paediatrician and adolescent health specialist Dr Asha Pemberton said data from several key countries were missing, making it difficult to draw accurate conclusions. She said just in the Caribbean region, the northern islands, like the Bahamas, usually had higher rates than TT.
“I wouldn’t rank it because too many other countries are missing. But what we can say is that, of those countries listed, TT’s numbers are in the higher range and we still need to look at how we could improve practise and policy around child nutrition.”
Sports and nutrition consultant Tracey Pierre was also concerned about the missing data but added that TT’s numbers painted a “very scary picture” for the country’s future adult population.
Both specialists stressed that nutrition education for parents and guardians was key to addressing the problem. They also said there was a psychological component to food that needed to be addressed and arrested before the situation escalated.
Pierre said, in general, people did not know about healthy intake ranges or how to read nutrition labels. And while they could get some information on the internet, she suggested parents speak to a paediatrician about developmental goals and norms.
Pemberton said in addition to feeding practises education for parents, promotion of breast feeding and easy access to nutritional foods and drinks were important. Focus should be on whole-based, non-processed foods, water, fruits and vegetables, and the reduction of sugar-sweetened drinks.
She encouraged breastfeeding for the first six months of a child’s life as babies who were breastfed longer had lower rates of obesity in childhood. After six months, breastfeeding should not be the child’s only nutrition and complimentary foods had to be added to the child’s diet. She added that up to two years of breastfeeding had benefits but there was no need for it developmentally.
Pierre said reasons for the high numbers of overweight children were varied but included socio-economic impact, types of foods and quantities, and the marketing of sugary drinks and unhealthy foods made them seem fun and attractive.
She admitted that some families did not have the financial flexibility to purchase healthier food items. She said a large pack of assorted snacks was $25, which was also the cost of one head of broccoli. And the child may not eat the broccoli or it may spoil before preparation.
But, she said, produce at markets were cheaper than supermarkets and was even cheaper when fruits were in season. Shopping at markets would also enable adults to purchase more variety and allow children to try new foods.
Pierre also suggested simple adjustments to meals to make them healthier such as smaller portions, cooking with less salt, oil and sugar, and trying different types of flour for bread or pasta such as multi grain, cassava, corn, oat, and almond flour.
“People hear ‘malnourished’ and, especially when it comes to children, they think about emaciated children they may have seen on advertisements in the past. But ‘mal’ means bad or poor.
“Poor nutrition also reveals itself in a surplus of calories and sugar. It could also be a lack of vitamins and minerals. So even if you have an overweight child, they may not be getting the amount of nutrients they need.”
Pierre said if healthy foods were not introduced at a young age, it was usually more difficult to get children to eat them when they were older. Therefore, parents had to find a way to make the time to introduce children to healthy foods.
She suggested taking them to the market and for them see the colourful fruits and vegetables. Parents should also talk to children about nutrition and the dangers of being obese in a tactful way so they did not develop body image issues.
“Even as it sounds like this advice is coming from a place of privilege, in many instances you really just have to make the time – to include them in cooking, talk to them about what healthy foods are so, even at a young age, they realise fruit is better or are willing to try vegetables.”
Make it a family affair
According to Pemberton, if young children were already overweight, there needed to be family-based lifestyle changes.
“There is little value or success in attempting to place a child on a specific regime that the entire family does not adopt. It makes no sense for parents to have all sorts of treats and snacks in the house and then ask the child why they are eating it.
“As a child you are going to eat what tastes good and what you have access to. So parents have to be mindful of what they bring into the environment of the child and what they allow them to purchase on the outside.”
She suggested returning to the practise of eating meals together as a family. She recognised that people were busy but making time for family meals had multiple benefits such as the opportunity for family members to bond and communicate, and individuals would eat more mindfully and be less likely to overeat.
“If you are sitting in front of a device watching Netflix or playing a game, you actually eat automatically without thinking about it because your mind is not focussed on what you are doing.”
She also encouraged parents to stop connecting food and mood. She said food or snacks should not be used as rewards or punishments. Parents should not offer certain types of food if a child did something “good" or have certain foods withheld from them if they did something “bad.” This may cause children to view certain foods as “good” or “bad.”
And just as many adults gravitate to alcohol, cake or ice-cream when they had a difficult or stressful day, or to celebrate or reward themselves, children should not be encouraged to associate feelings with food or snacks so as they often had less self control than adults.
“Food/mood mind mapping starts very young. We have been raised in a culture where different types of food are treated as a reward. That should not be. It should be, ‘On Saturdays we have pizza.’ Food should not have to come with a (non-financial) price.”
Pierre added that parents encouraging children to “eat everything on that plate” was negative as it altered the child’s psychology. Instead of interpreting the signals the body sends to the brain to tell them they were full, they would rely on the parent or the plate of food in front of them.
For picky eaters, she suggested involving them in the preparation or cooking process, make it fun, and to try to encourage them to try foods.
“If you have a very stubborn, picky eater, you might want to try a child psychologist to break that conversation barrier with your child around food. Also, children are sponges so if the adult in their lives eat healthy foods begrudgingly, they are not going to see it as something positive.”
Pemberton also recommended parents and children cook and prepare meals together because it was cost effective and a good time to bond.
“As a society we need to re-examine our family-based gender roles. The role of a parent is to usher, protect and raise a child into adulthood. That is the same for parents of both genders.
“With that framework in mind, teaching a male or female child to cook or be a part of their feeding process is an essential life skill. As adults we all have to be able to manage and feed ourselves.”
She said supermarkets sold pre-chopped vegetables to save preparation time or a trip to the market.
“Yes, they are more expensive but what you don’t pay for now in cash, you pay for in health later.”
For those who may not have much time to shop for and prepare meals, she encouraged them to make good choices with convenient food. They food could be non-fried, plant-based, or whole foods, and people could choose to drink water rather than soft drinks.
Pemberton said physical activity in the form of unstructured play was also important, even as she recognised there were issues of safety and access. She said it was important, not only for physical health, but mental well being and socialisation as children who spent most of their time on devices usually had poor communication skills.
She said if a child was already overweight, they also needed structured physical activity with an instructor to make them exert themselves more. She suggested swimming, football, dancing, tennis, karate or any physical activity they enjoyed. It should never be a punishment.
For those who could not afford such activities, there should be family-based activity. She said many people lived near or had access to green spaces so they should invest their time and take their children. She also suggested hiking, walking around the Queen’s Park Savannah, or other physical outdoor activities.
Culture of child's family
President of the Diabetes Association of TT Andrew Dhanoo believed one of the reasons for these concerning statistics was related to the culture of the child's family.
“A lot of these children who fall into this category are children whose families are also overweight or obese. They grow up eating very fatty foods, salty snacks, sugary beverages and being sedentary. Here is where we want to intervene and target the families.”
He also noticed many pregnant women getting diabetes during pregnancy, called gestational diabetes.
According to the American Diabetes website, gestational diabetes affects the baby causing its pancreas to make extra insulin to get rid of the blood glucose. The extra energy is stored as fat and those big babies could damage their shoulders during birth.
“Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies born with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.”
Dhanoo said since an intervention could not be had with a five-year-old, it had to be with the family, and the family had to work together.
The top ten countries with the highest prevalence of overweight babies, toddlers and preschoolers in 2022 were:
1. Libya – 28.7 per cent
2. Australia – 21.8 per cent
3. Tunisia – 19 per cent
4. Egypt – 18.8 per cent
5. Turks and Caicos Islands – 17.6 per cent
6. Papua New Guinea – 16 per cent
7. Greece – 14.6 per cent
8. Paraguay – 14.6 per cent
9. Trinidad and Tobago – 13.9 per cent
10. Ukraine – 13.6 per cent