1. Suzanne Fletcher Founder and Registered Nutritionist (Public Health)
How does POOR diet impact the lives and education of children and young people?
Suzanne Fletcher Founder and Registered Nutritionist (Public Health)
@nutritionscot

2. Overview Nutrition and child development
Food-related health inequalities
How malnutrition affects HWB
Why is food and health education important?
What can we do?
References and further information

3. NUTRITION AND CHILD DEVELOPMENT

4. Nutrition and child development
Critical time for growth and development
Establishing physical and mental abilities
Nutrition affects development from the very beginning
Certain periods more vulnerable than others
Differ depending on type of deficiency
Now considerable research to show associations between nutritional deficiencies and children’s development and cognition
Neural tube defects in early pregnancy
Relatively higher energy needs of children
Iron calcium
Varied, balanced diet throughout ensures nutritional requirements are met and normal growth and development

5. FOOD-RELATED HEALTH INEQUALITIES

6. Coexisting social inequalities
Undernutrition
Overnutrition
Strongly associated with social deprivation
Glasgow remains the most deprived city and local authority area in Scotland
Associated with poor quality diets and physical inactivity
Overfed and undernourished
Glasgow Centre for Population Health (GCPH)

7. The Eatwell Guide
A policy tool used to define government recommendations
Outlines a diet that meets population nutrient needs.
Recommendations and guidelines based on analysis of scientific data
Challenge to translate this into behaviours that fit with peoples daily lives
Time, Cost, Knowledge – main barriers to eating a healthy diet
Lifestyle, taste preferences, food environment, cultural values, health…
Food and health education involves much more than leaning about specific nutrients.

8. Affordable Eatwell Guide?
The Food Foundation is an independent think tank that tackles the growing challenges facing the UK’s food system in the interests of the UK public.
This research was funded by the Children and Young People’s Commissioner, Scotland.
UK Department for Environment, Food and Rural Affairs (DEFRA) cites figures as evidence that food is affordable in the UK but don’t consider the healthfulness or sufficiency of food purchased.
The results point to the need to ensure the incomes and resources of low-income households are adequate for purchasing a healthy diet, and to take measures to support these households in affording the foods contained within the Eatwell Guide.
The Food Foundation Report, 2018

9. Food Poverty Impact Physical Social Psychological
Growing up in poverty:
Associated with chronic stress
Prolonged excessive stress hormone levels can inhibit normal brain and physical development
More susceptible to learning and behaviour problems and physical and mental illness in later life
ACEs more common in children living in poverty

10. Food poverty impact
“Poverty can hinder parents from providing a supportive and enriching environment for their children to grow up in. This may be, for example, due to parents undergoing continued stress.”

11. THE EFFECTS OF MALNUTRITION ON HEALTH AND WELLBEING

12. Effects of overnutrition
Childhood obesity can affect:
Social e.g. more isolated
Emotional wellbeing
Self-esteem
Physical health
Linked to obesity in later life and poor health outcomes as an adult (increased risk of T2D, CVD, stroke and cancer)
Poor academic performance
Lower quality of life
Many co-morbid conditions like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity
Sahoo et al., 2015

13. Effects of undernutrition
Childhood undernutrition:
Low birth weight associated with poor health outcomes and associated with deprivation
Low birth weight babies usually have period of catch up growth in first 2 yrs
BUT social conditions important to allow catch up growth and prevent undernutrition persisting into later years.
National Food Surveys show:
Diets in low-income households have less variety – associated with poor nutrient profiles
Children living in socially deprived areas showed lower levels of vitamins and minerals in blood.

14. Common nutrient deficiencies
Iron deficiency anaemia associated with:
Poor cognitive and motor development
Behavioural problems (anxiety, depression and increased social and attention problems)
Can have long-term impact
Iodine deficiency associated with:
Poor mental and motor development
Some UK populations mild to moderately deficient
Risks to child cognitive health
Inadequate iodine during pregnancy associated with poor child cognitive development
Common in all communities including those overfed and undernourished
Studies traditionally focused on motor and cognitive development
Much less information on social and emotional development and mental health.
Bath et al., 2013

15. Aiming for Optimal Nutrition
Optimal nutrition includes factors such as quality, quantity, nutrient components and timing of meals
Epigenetics – new and ongoing reseearch

16. Epigenetics
Disadvantage starts before birth and accumulates throughout life
Early intervention important
Is Epigenetics inherited?
Johnathan Shaw, 2017

17. Epigenetics

18. WHY IS FOOD AND HEALTH EDUCATION IMPORTANT?

19. Physical Health Focus
Food and health education is important for children to understand the qualities and disadvantages of the food they choose and the impact it has on their body.
Often the main messages are around physical health and the benefits / problems of specific nutrients
The CfE includes some learning around nutrients, culture, the food system, sustainability, nurturing, growing and social aspect
Schools provide an ideal learning environment for food education, universal, peer support, open to new experiences and provides learning opportunities to all children.

20. Food preferences can be influenced
Nature - Innate preference for sweet foods and dislike for bitter foods / genetic preference
Nurture – Taste learning / repeated exposure / flavour acceptance
Exposure to a variety of healthy foods from the very start can influence later acceptance of these foods.
Eating behaviour and habits are formed from a young age, and (alongside parents and carers), school settings across the Early Years and beyond offer an environment that can help positively shape how children think about food and eating.
* Including prenatal period, breast-feeding and weaning period.

21. Food environment
Behavioural science has evidenced that children’s food choices can be swayed by what is most visible and accessible
Changes to the food environment can have significant effects on food choices and bring positive behaviour change.

22. Importance of food Twitter https://t.co/KNPKtyoFsi
Everyone eats and everyone can have an impact.
No one organisation can make the change required
Changing a culture
Prevention better than a cure
Twitter

23. What can we do?

24. Whole system approach Population level change requires this approach
Policy – laws, policies, rules, regulations
Food environment – promotions, school lunches, vans
Organisations and institutions – schools, healthcare, businesses, faith organisations, voluntary sector
Social environment – individual relationships, families, social networks
Individual – capabilities, motivations, opportunities, knowledge, needs and behaviours

25. Whole system approach Collaboration Partnership working Multi-level
Multi-system
Co-ordinated
Holistic approach
Collaboration/partnerships key
Using our strengths in our different areas of expertise to come up with new and innovative ways of improving food related health and reducing the inequalities.
Supporting and involving various groups and individuals in finding solutions – not passive recipients of our advice and information.
Community led – requires serious and longer term support from Gov.
A preventative approach and innovative solutions
Working with the food industry to encourage change whilst being mindful of their bottom line priority

26. Why is food education important?
Time, cost and knowledge biggest barriers to healthy diet
Those living in poverty hugely disadvantaged and inequalities growing
Continued through the generations
Disadvantaged communities continue to be disadvantaged and it starts even before pregnancy
Feedback from parents of infants is that they use social media for ideas and information on child feeding but are uncertain if it’s reliable or evidence-based
Social media offers a lot of dubious information…..

27. Suzanne Fletcher suzanne@nutritionscotland
Suzanne Fletcher

28. Additional resources
Eatbetter Feel Better website Healthy Schools website Free resources for teaching young people aged 3-16 years about where food comes from, cooking and healthy eating. A campaign from Food Active which aims to raise awareness of the health harms associated with over consumption of sugary drinks NHS Change 4 life site aimed at children and healthy eating The Food Foundation – Food poverty and children’s future food inquiry report

29. References
The Eatwell Guide – Gov. recommendations on eating a healthy balanced diet Understanding Glasgow, The Glasgow Indicators Project Food and Agriculture Organization of the United Nations – Infographic; why is food and nutrition education needed? A Healthier Future – Scotland’s Diet and Healthy Weight Strategy

30. References
The Food Foundation - Affordability of the UK’s Eatwell Guide (Sept, 2018) Childhood obesity, causes and consequences. Sahoo et al., (2015)J family Med Pri care Bath et al., Effect of inadequate iodine status in UK pregnancy women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC) Lancet (2013) 382: Is epigenetics inherited, Jonathan Shaw NHS Health Scotland – Food poverty file:///C:/Users/local.admin/Downloads/food-poverty%20(1).pdf Health at a price, reducing the impact of poverty. BMA, 2017 file:///C:/Users/local.admin/Downloads/Health-at-a-Price-2017.pdf