Feel Better, Live More with Dr Rangan Chatterjee - #9 Childhood Obesity and Fussy Eating with Dr Venita Patel

Episode Date: March 15, 2018

Dr Rangan Chatterjee meets Dr Venita Patel, paediatrician & nutritional therapist, to discuss the fight against childhood obesity, NHS-funded community projects and tips for fussy eaters. Show notes available at drchatterjee.com/venitapatel Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk Hosted on Acast. See acast.com/privacy for more information.

Hi, my name is Dr. Rangan Chatterjee, medical doctor, author of The Four Pillar Plan and BBC television presenter. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated. With this podcast, I aim to simplify it. I'm going to be having conversations with some of the most interesting and exciting people both within as well as outside the health space to hopefully inspire you as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe that when we are healthier, we are happier because when we feel better, we live more. better, we live more. I'm absolutely delighted to welcome onto the podcast today somebody who has got a real expertise in childhood nutrition, in childhood obesity, in child development, and someone with a very, very unique qualification. She is not only a paediatrician, she's also a nutritional therapist. Venita, welcome to the podcast. Thank you, Rangan.

nutritional therapist. Venita, welcome to the podcast. Thank you, Rangan. Venita, you have got an incredibly specialised qualification set. You know, you're a medical doctor, you work in paediatrics and you have done for what, over 20 years now? Over 20 years now. Yeah, but you're also a qualified nutritional therapist. And I'm not sure I know that many people who have got both of those qualifications. For people listening, I met Vinita, I'm going to guess now five or six years ago. I was on my own journey to learn more skills than I got at medical school to help me with my patients. And I'd been on some courses in America, I'd got back to the UK full of enthusiasm and I was looking for courses here and we both ended up at the same course in London that's right I remember meeting you and I think one of your friends there yes and um yeah I've been very very impressed with the work you've done that I've been watching since then so can you tell us Vanessa how did you

end up going from paediatrics to nutritional therapy and then back to paediatrics? Yes. So initially I did full training in paediatrics in this country and I specialised in something called community paediatrics, where we're looking at the whole child, we're looking at their development, we're looking at all aspects of a child's life. So education, school, and we're also assessing children for much longer. So we have about an hour with them. And I was thoroughly enjoying that. I then had my second child. And unfortunately, he became unwell at the age of one when I was returning to work. And so I decided to stay home and look after him. And unfortunately, while he was unwell, I also kind of put my own health issues to the

side. So I didn't really look after my own health. I was focusing on him. And luckily, after three or four years, he made a full recovery. And so I decided to, first of all, look at my own health, which I did, and see how children's health can be affected by nutrition. And a friend of mine, as you said said had just started the course in nutritional therapy. When I looked at her notes and when I saw that there's a lot of science behind it I realised that this was something I wanted to delve into much deeper and so I enrolled in the course and two years later were the best two years I ever did and I've never looked back because the information and knowledge which I gained has just transformed my whole approach to pediatrics, to children's health and to adult health as well.

Wow, that's phenomenal. So you started off in pediatrics looking after kids. And, you know, it's often a common story with people I've had on the podcast so far. There's often been a personal reason either with their own health or a family member's health. So you had to, you know, you felt as a mother, you had to take some time off and actually look after your son. But during that time that you were saying that you neglected your own health. I did, yes. And did you get sick because of that? I wasn't incredibly sick, but obviously I was feeling tired. I wasn't looking at my own nutrition properly. So just grabbing things when I could. And I realised that this couldn't carry on. So I first of all, went back into doing some regular exercise. And then that led into eating a bit more healthy. Right. And then you wanted to go back to paediatrics. But instead of doing that, you actually went to a nutritional therapy course yes that's right so instead of being able to finish my training very quickly I was faced with the option of doing

lots of hospital on calls and I didn't feel that I was able to commit to going back to that so when my friend happened to show me her notes that really just grabbed me and that's when I'd made the decision to start wow so as I say I say, you're very, very uniquely qualified. You've got this huge background in nutrition now, but also your medical training and your paediatrics training. Yeah. So how has getting an understanding and a qualification in nutritional therapy helps you as a paediatrician?

So I've been fortunate to be able to go back into paediatrics and in fact certain areas were looking for a community paediatrician who had an interest in nutrition because I'm sure you are aware that childhood obesity rates are on the increase and certain areas have very high rates and the area which I was going back to work in had already set up a pilot project. And it was actually a very whole child approach, which I liked. So it was based from mental health, family therapy. And they were looking at the child's resources, the family's resources, to see where and how to help them on their own terms, rather than being didactic and saying, this is what you need to eat and this is what exercise you need to do.

They're going to see what can the family manage, what are the barriers to doing it, and actually going into people's homes, going to schools, rather than just calling people to clinics. So it's a very different approach. And I was able to bring my nutritional therapy knowledge into that to say, well, hang on, these families are from diverse backgrounds. Why don't we look at their culture? And why don't we look at their traditional diets? Because a lot of them have very healthy traditional diets, but they'd moved away from it,

partly because they'd moved to this country. And they may have a lack of resources or just partly a lack of knowledge. And so by supporting them to go back to their traditional diets, which on the whole were eating much more vegetables and foods which they were used to and enjoyed, they actually benefited from that. And the other way that nutritional therapy helps is that you're looking at the root cause of what's going on with a child rather than just giving some symptom relief so if a child presents with constipation yes of course we're going to say okay they need more fiber they need more fluid but then going back a stage to say is there an underlying cause to that so that's really where it

helped me wow so if anisa just so everyone's clear you work in london i do and you work as a community pediatrician so you're not in the hospital no we're not based in the hospital you're out with people in their homes you're saying we're actually we are based in a child development center but my team, which consists of a dietician, a fitness specialist and a family therapist are able to go and visit families in their homes. So that's where they really get an understanding of how people live and what they're able to manage really day to day. Well, I mean, you know, just hearing that is incredible because you write sometimes that the public health messaging that is given out is quite didactic. It's overly simplistic some of the time.

I get sometimes, you know, for public health messaging, you know, people are trying to deliver a simple solution so that there's uptake in the general population. But often that simple solution isn't working for people. Yes. And actually something you just said really, on one level, deeply resonated with me. And I've done some BBC documentaries before, and in the last series of Doctor in the House, I had a childhood obesity case,

and it was in a family's house in North London. had a childhood obesity case and it was in a family's house in north london and you know these guys were trying to do what they thought they were meant to do you know eat relatively healthily and be active yeah and actually this this young lad was doing that despite that he was extremely overweight but it was only by going into his house only by getting an understanding of the dynamics at home and you know taking that whole child approach was I able to get such fantastic results with him and I imagine that's a real opportunity for you guys when you can see children in their family environments is that right? It really helps so obviously we only are only seeing a very small percentage we're seeing the

children who are above a certain percentile of BMI and also who have another diagnosis. So they may have a learning difficulty or they may be diagnosed with autism or ADHD or there may be some other issues going on which mean that they aren't able to access other group approaches such as MEND which is something which is going on countrywide. So they need much more of an individual approach and by seeing what's happening with them at home our team are able to then really pinpoint how to help them and how to support them. Can you give us or share with us any insights at all that you know when you or your team are in someone's house how does that potentially alter the advice

that you're giving to those families and if you were just seeing them in clinic? So first of all we're able to have a look at their kitchens to see do they have good cooking facilities do they have ability to store things in cupboards do they have a fridge that's that's a very first start then we're looking at whether there's any space indoors for the child to do any movement, any activity, just to see what are the dynamics. Is it a safe environment or are they at risk of hurting themselves if we're asking them to do some exercise indoors? Are they having to go up several flights of stairs to navigate? So if we're asking them to do a big shop of vegetables, they're then having to get them up the stairs. So there are lots of sort of practical issues which we can then give solutions around. So it's a lot more personalised. It is. Yeah. Okay. And this is something that is funded

by the National Health Service. Yes, it is. Okay. So you've got this project that the NHS are funding for people who, well, children who are above a certain BMI. So is this sort of what category of obesity would you say? So it's four to 12 year olds to start with, because it's a family approach rather than just looking at the child themselves. And we know that the family approach works much better for that age group. Can you just clarify for people listening, what do you mean when you say a family approach? So rather than focusing on just what should we do with the child, we're saying what can the family do together? How can they cook and eat together?

How can they incorporate activity and movement into their day-to-day routine? Because as you know, everybody's busy. People really are limited on how much extra time they can give to doing activity so if we can see what is their school run like we can perhaps give advice on where they can add in some movement some activity maybe taking the long route round so that they're getting more steps in on the way or the way back and rather than just saying okay you need to move this much every day, you're saying this is what's practical for you.

Let's start at this stage and then we can build on that. Yeah. I mean, something we said off air before we got here today was that you found that actually making small changes consistently can often lead to the big outcomes and the big results. Can you just sort of expand on that? Rather than trying to incorporate a whole new eating plan and movement plan, if you just look at what the family are doing and saying, where can we capitalise? Where can we just improve or change a small thing so that that will then lead to further changes because small changes are more likely to be sustained and we know we see

that happening every week. Because it's a bit more achievable isn't it for them so what sorts of things might you ask them to do? So for example we had a child who had a very common habit of when they got on the bus with mum they would ask for some crisps or they would ask for some chocolate and so as parents do we sort of say okay you can have crisps but it became quite a regular habit so that whenever they went on the bus it was a reaction for him to say, give me crisps. And so we explored about what are the things he liked. And we found out that he loves carrots. So he said, why don't we have bus carrots? So mum had little pot of carrots in her bag. And we made it a big deal that he would go on the bus and have his bus carrots. So that was an example of very small change, but a very positive change

for them. So that he's getting another of his five a day in, and he's not asking for the foods which are not helping him in the long term. Yeah, what's great about that is that he's already, presumably, and obviously I don't know the ins and outs of what was going on in that particular case, but as you say, we're often conditioned to having certain treats or certain things in certain situations so you know he's on the bus with mummy that's his time to get his treats correct and so you're using that you're you're keeping that framework there but you're just tweaking it so when he's having that treat he's having bus carrots and he likes carrots absolutely so you know I guess if we're talking about small changes leading to big outcomes, let's say he was taking the bus five times a week.

Yes. Then instead of five packets of crisps, he's getting five portions of carrots. And not only is he getting those carrots, he's not actually having those crisps either. Exactly. You know, that's a much smaller thing than saying you've got to try and have... Five a day or seven a day. Yeah, it's just a small thing and meeting them where they're at and you know that that is the thing that i think both of us as doctors realize the more patients we see is that the guidelines can be very useful but we need the autonomy to be able to personalize those

in the context of that patient in front of us and their families it is yeah yeah so we have the opportunity to do that within our project but as we said it's a small project but we can extend that to just taking these ideas and and supporting other people in doing them so it doesn't have to be a medical team that's doing it it could be someone who's just supporting the family so that would be an idea of how to spread this message to make it go further and when we see that families make changes together we also see that the benefits are that often the parents are improving their health as well and that can only have a good effect for the child so parents often do reduce

their weight when their child comes to our project and they're feeling much better they're looking much better they can't say you know much more than that that they're so happy their child is happy and they're happy yeah that's it's I love this whole family approach because you know whether we're talking about adults or children but particularly children I'd guess it's very hard to make behavioral change in isolation and when i'm dealing with adult patients i often say look let's say the let's say the mother is in with me for something and i want them to make some changes if the husband's not on board or their partner's not on boards actually you know what if you're trying to eat a healthy salad in the

evening get your partner's got some chips or a donut it's going to be very limited at how far you can go and the other thing i've learned from being a parent now for seven years is children's children generally i i feel respond to what they see you actually do not what you tell them to do yeah so you know for many of us as parents if we want our children to adopt healthier habits then actually we need to adopt healthier habits and actually model that behavior in front of them i know it's you know i'm not preaching i get it's hard you know it can be very challenging for some people um but that's certainly something that me as a as a father we very much prioritize involving our kids in the

conversation about food in the chopping off vegetables you know my my daughter's just turned five but she's chopping mushrooms for us you know several times a week um i think actually you know there's an argument you know what age are they safe to use a knife yeah but you know i don't know you know i mean the context of my own home, I kind of feel that, you know, children are pretty smart. You know, you teach them, they learn pretty quickly. They can do this stuff. Yeah. You know, I don't know.

What do you do as a mother? Well, definitely what we do is and what they see is what they become. So children become their parents. We become our parents. We know that. And it's what they're being exposed to in the home environment is what they're seeing. And particularly in the first few years of life, that's all they're seeing. So whatever you're doing, they're watching you. Be careful. Whatever we say, they copy, they use our words, they copy

our actions. So it is really important for us to think are we spending a lot of time on our phone while we're eating because that's what we're going to be showing our children that is for me that's an absolute cast iron don't break rule at home at the dinner table yeah no one's on their phone that's like myself it's not my wife's not and and i'm in fact it winds me up with people who are on their phone. Myself, it's not. My wife's not. And I'm, in fact, it winds me up with people who are on their phone at my dinner table because I just, you know, rightly or wrongly, I'm trying to protect my kids from that. I don't know if I'm, you know, as parents, we're all trying to do the best that we can, right? We don't, I don't know if this will result in the outcome

that I want. I really don't know. Well, every parent just wants a healthy and happy child at the end of the day. That is our first wish for our children. And if we realise that what we're doing and what we're showing them is having such a huge effect, then that will change how they respond to us and how they respond to the world. So we're teaching them how to respond to cues as well. Yeah, absolutely. I wonder, as part of this project that you're involved with, Vinita, are you seeing families from poorer families and from lower socioeconomic groups? Is that fair to say? It is fair to say. So in the area that I work, which is Lambeth, we have a hugely diverse population and there are large areas of deprivation. So we're seeing families who are facing financial issues, social issues, and they're not able to come out from that so easily.

So by supporting them through that, we're actually helping them in many more ways rather than just with the health of their child. Yeah absolutely. Is your approach for those families different from more affluent families? I wouldn't necessarily say so. It may be that we need to make more home visits for those families because it's hard for them to actually even come to a clinic but the approach and the advice is actually quite similar yes with more affluent families they have more access to things so we're just pointing them in the direction of perhaps your child would enjoy doing this after-school club whereas for other families they may not be able to afford the after-school club so in that way we're slightly different in that we're just pointing and directing people. But for the families who are able to, yes, they can access things. But for the families who aren't, there are lots of things they can access for free.

So we're lucky in our borough that they can do that. So, Vanessa, we're here in 2018. lucky in our borough that where they can do that so venita we're here in 2018 and the last time i checked the statistics one in five children when they start primary school are either overweight or obese and by the time they leave primary to start secondary school at the age of 11 one in three are either overweight or obese now that is shocking, that is worrying. Can we beat the childhood obesity epidemic? It certainly needs a long-term approach and that's what's been missing to date and it is very difficult to have a public health approach which works for everyone. However, there are so many fantastic projects which are running, which individually, if they came together, would actually create a sustained and long term benefit for all of these types of families.

So possible, but we need a longer term strategy. Support the projects which are already running. So there are lots of small individual voluntary agencies and charities which are doing such great work with children. There are community kitchens where they're inviting families to come and cook and to learn basic recipes. However, they're all struggling financially. And so just by supporting them, giving them that boost, we will be able to help so many more families. People hear health messaging all the time on the news, on the radio. What is the difficulty in actually hearing that messaging and converting it into action? You know, what do you commonly see? Yeah. So often people know what they should be doing, but it's the translation of that into behavioural change, which is where the barriers are.

And the barriers could be all sorts of different barriers. It could be just a practical barrier that they don't actually know what does that translate to having on my plate. So just by showing them a very simple plate of how the proportions of vegetables and fruits should be to other foods. That can help a family transform their diet. The other barrier I find is that we're much more used to seeing children with a larger BMI. So parents aren't actually aware that their child is of a higher weight. And I think researchers have showed that about 50% of children above the 91st centile their mothers or fathers thought that they were a healthy weight so we're so used to seeing children of a different demographic and weight. Is that partly because society has

well is changing and we have you know more overweight and obese adults and children that therefore our perception of what is normal might be shifting as well so a lot of these parents are seeing their children and they're not realizing they're not consciously registering that actually my child is overweight or obese yeah i think that's true we know that a lot of shifts have been happening over the last few decades and one of them is that people are growing much bigger we know that a lot of shifts have been happening over the last few decades and one of them is that people are growing much bigger we know that height is also going up and so our shift to seeing what's normal has changed as well and it's a case of just reminding ourselves that there are consequences if we allow that to continue in children because there is a window

of opportunity for helping them and then reducing the likelihood of complications. One of the difficulties that often gets spoken about is if a child is overweight or obese, is it difficult as a healthcare professional to bring that up with a family? Are there, you know, are there issues there? Because we've been conditioned with the media for many years now to think that obesity is a blame issue. It's a lack of willpower when we, it's clearly not the case. And so, you know, is that a challenge? challenge you know how do you bring that up with a family in a very productive and constructive way yeah so it's obviously a sensitive issue and what we do is we rather than focusing on weight we focus on the child's overall health are they fit are they happy

do they have energy and so looking at the whole child rather than just focusing on weight, are they able to go to school? Or are there issues meaning they're bullied at school and they're not wanting to attend school? And so rather than looking at just weight, we're looking at all the aspects of the child. And so parents do want their children to be happy they want them to learn they want them to be able to enjoy life and rather than talking about weight that's why where we can actually get them on board i mean i think that every single parent wants the best for their child within their capabilities within their life within their you know their jobs and you know that everyone's trying to do the best that they can and i think how we bring this up with people uh makes a huge

difference it certainly does because you know ultimately i think parents would welcome the help if it's done in a kind compassionate and helpful way yes rather than someone being told off what they're not doing with their child exactly and you mentioned bullying there's one thing i mean if a child is being bullied at school and they've got that emotional pain to be dealing with yes you know like just the same with adults often we turn to food they do to sort of numb and feed that emotional pain yeah and you know just telling that child that five a day is really important it's not going to you know it's just going to almost be on deaf ears right because the food is serving a different role that's right so the family therapist is able to really explore that with the family and to help

the child build their self-esteem build their confidence and from that platform we can then work on the other aspects so the physical and the dietary aspects yeah fantastic it's so great to hear that these sort of projects are out there and are being funded by the national health service which is brilliant yeah but I know you've also got an expertise in gut health and you know how does the importance of gut health play into your role as a community paediatrician who's trying to help children with weight issues? So we do see children who have gastrointestinal problems. So I mentioned constipation. They may

have non-specific stomach aches or other vague symptoms, just feeling sick at certain times of the day. And that can affect what they're eating, when they're eating. And so rather than just giving them an anti-sickness tablet or giving them lactulose or treatment for constipation, it's always good if we can look at how we can support their diet to improve the gut microbiome or their gut health overall. And has that changed since before you did nutritional therapy and after you'd done nutritional therapy? So that same child, before you had the knowledge that you gleaned on that

course, would you have treated those problems a different way, do you think? I think I probably would. I would have talked about increasing their water intake increasing fibre intake but I think I would also have relied on some medication and now being able to offer many other modalities rather than just medication it's so helpful for families to not have to rely on it. Yeah it is helpful it's also very rewarding as a as a healthcare professional i think if we can if we've got that bigger toolbox we can try and figure out what is causing this constipation issue rather than giving a you know a um uh you know like lactulose liquid let's say to to help that person you know sort of go to the toilets if we can actually prevent

and get rid of the problem in the first place it's much more satisfying and one thing I have noticed over the past few years and again until I until I sort of went out with my medical training to get more knowledge I don't think I was quite as aware of this but often it's not only you know what you put into the diet it's also what you can take out sometimes and i see a lot of patients particularly um when i'm seeing patients of different ethnicities and it's not uncommon to see people who let's say don't tolerate dairy very well but they've never considered a trial without and sometimes not all the time but sometimes i've seen

constipation issues completely resolve when you know a child eliminates dairy for a period of time and then you know clearly at that point and they can have a conversation with a nutritional professional necessary to work out how they can go forward with their diet if it doesn't contain dairy um but you know certainly for me that was a big change uh, you know, my conventional medical training. But then before I sort of went out with to get some more skills. Yeah. The barrier to changing children's diet is that children can be fussy about what they want to eat and they can have quite a limited number of foods. And that's a really big difficulty for parents.

So we're sitting here saying you have to eat this number of vegetables but their child isn't even eating one vegetable so what we can do is then explain and support parents into how to very very gradually increase that and it's all about very tiny exposures and doing it often the actual window of opportunity for children to get their food taste preference is very, very early. And I think that we didn't know this until recently, how early. So most people wean at around six months. And the traditional foods to wean used to be some baby rice and some fruit. And then we now realize that actually this is the time where we need to be introducing other tastes rather than the sweeter tastes so we should be actually offering a really wide variety of vegetables at that stage and that will mean it is more likely

later on that they're not going to have this fussy eater issue yeah that's a really good point i think for people listening if they have got young babies or someone's pregnant and you know you're thinking that this is going to be relevant for you i think that's really important early on to to expose your child to as many different flavors as possible and the other thing is is that often they don't like it first time but i've read some some really good research said you have to get it at least maybe seven or seven or eight times eight times before that taste starts registering. So it's about patience and perseverance.

You have to keep offering it. And this can be done at any age, but it just takes a lot longer in an older child. So by doing it at a much earlier age, it's actually a very short time, six months if you like, where you can get those taste preferences and increase them yeah i think what's what's really interesting about what you're saying venice at the moment is i think sometimes uh we can many of us depending on you know what world we live in and what social media world we inhabit you know we think that it's normal to have these plates full of colorful vibrant uh plant foods and vegetables um but actually for some families you know you're saying moving from zero fruit and veggie day to one is a big shift have you got any sort of

strategies for people that if if if any mothers are listening to this or any fathers or you know anyone who interacts with children and they are struggling to get their children to actually eat some colourful fruit and veg do you have any any tips at all? So first of all as we talked about before leading by example so if they see you eating things even from from a very young age, that does influence their choices. And also what's available in the home. So if there are fruit available ready for them to eat and there are no other foods available, such as crisps or biscuits, then obviously they're going to make that choice more easily. So it's about making choices for children much more easy rather than making it a difficult choice. And we all suffer from decision fatigue after a while when we're

offered a cake and then we're offered it again. The third and fourth time, we definitely will eat that cake. However, if there's no cake in the house, we're probably not even going to think about the cake. So it's by having your home environment to make it easier for them to say okay i'm going to have this healthy snack rather than going for something which is not going to be healthy in the long run yeah i think that's a great tip and i know we're talking because of your speciality about children this applies to adults it really does applies to everyone yeah and what i often say to people is control the environment you can control. Because as soon as you step outside the front door, there's temptation everywhere these days.

So I say if you're really serious about making behavioural change, try and make your house a safe zone. And one thing we've started doing at home, I say we, my wife and I, is when the kids come home after school and they want a snack, what I've started doing is keeping out colourful fruit and veg on the counter. So they're walking past it. They're seeing it. So, you know, if they're hungry, if they're genuinely hungry, which is, that's a separate issue. they're hungry if they're genuinely hungry which is that's it that's a separate issue actually if there isn't anything else and that's there ultimately you know you do that day after day that's what they're going to have that's right and that's what they'll then start getting used to having um the other if you ask most parents when is your child most hungry it's at the end of school

so between finishing school and getting home, that's when they're the most hungry. So depending on your school run, how you're picking them up, have those healthy snacks with you and offer them first. They are actually going to eat them at that stage because they're so hungry. And then later on, they'll have less hunger for the other foods. And it could be that you're in the car, it could be that you're on the bus, as the other foods. And it could be that you're in the car. It could be that you're on the bus, as we talked about. Or it could be that when you get home, the first thing they're eating, as you said, are those healthier options. Yeah, that's a great tip.

Do you find that some families say to you and your team, look, we want to make healthy food choices. But, you know, I sell my kids to school and there's all this junk available at school and actually there's only so much I can do because that's what they've been exposed to and that's what they want is that something that your team hear much about we do hear parents talking about school as being one of the main areas where they can't really control and so what we say to them is actually that's only five meals out of your week. So you're having three meals a day. If you're having one of them at lunch at school, and they may be having a main meal, a hot meal, followed by a pudding, that's actually

probably okay. And schools are trying as hard as they can within their resources to offer healthier main meals at lunchtime. And so you'll probably find if you look at menus across the country, they are changing, they are improving. And that one meal, if they're eating a certain amount of sugar at that stage, it's actually probably going to fuel them for the rest of the afternoon, particularly if they're doing something like sports. So we shouldn't get too worried or worked up about what they're having at school. Yes, it changes once they become a certain age. So once they're past 11 and they go into secondary school, that's a whole other ballgame because they have their own choices, they have their own money money and they have access to eating all sorts

of foods depending on where their school is and what their school offers so we're talking about the primary age children where families and parents have a lot more influence yeah vanisa it's a really interesting perspective and i think it's very important for us to remember that that you know you're there in the trenches working with children with you know children who are wanting help with their weight and they might have some quite challenging circumstances around that and it's about making pragmatic choices for these people and actually putting things in perspective you know yes of course we'd love every child in this country to have a home-cooked meal with healthy nutritious ingredients three times a day but culture and society is not allowing that and it's not likely to anytime soon so just hearing you say

that actually that's only five meals out of what potentially 21 meals a week absolutely you know that that's a really good perspective and quite a refreshing perspective to hear yeah the other thing that we focus on is breakfast so So many children say they're not hungry in the morning or they have to get up and it's too early or they don't have time. But we really reinforce the fact that if they're having a decent breakfast at home, they're not going to then feel hungry at break time and then be looking for high sugar foods. And they're also going to have a better balance of their blood sugar through the day and most children that we speak to would be having a bowl of cereal with milk that's a fairly standard breakfast or some toast but just by making a tweak to that and saying can we add some

fruit in or can we change the toast to being a scrambled egg with toast then you're increasing the protein you're increasing the nutrient content of that breakfast and then obviously you can build on that further so it's about just supporting parents to make those changes and showing them that it may not take that much more time and they actually do respond very well when we help them understand yeah so really about meeting people where they're at. It is. Actually seeing, well, what is the breakfast that your child is having already? And how can I subtly change that rather than trying to overhaul everything?

Absolutely. Of course, some families will be very receptive to a complete overhaul. And they'll have the time and the energy to put behind that. But, you know I think that's what I'm enjoying most about this conversation Vanessa is that you know we can't assume that everybody has the same life situation the same access and ultimately we need to tweak things for for those people and actually alter the advice that we give. It's finding what works.

Every family works in a different way. We have our own routines. We have our own preferences. And it's about just working with those and building on them. by you know let's say you go through the sugar content of some cereals with your families that you're talking with yeah do you find that some of them are quite shocked with how much sugar is in their healthy breakfast cereals yeah so we our dietician works with the family to help them read labels and that is one of the things which they often say is that we didn't realize we thought this was a healthy cereal but well in fact we're not doing our

children any favors by giving them this and that's the crux of the matter isn't it yeah there is this hidden um sugar content in so much of the processed food that we're now eating and as we both sort of said is that we generally believe that most parents are trying to do the best that they can for their children and once they understand what's in those cereals often actually they they don't want to give it any more once they understand what's in it absolutely and marketing is very clever so that a lot of foods will come across as very healthy and when you're in a rush you're rushing up and down the supermarket you just grab what you're used to grabbing and you think it's healthy without realizing that actually there's a lot of uncovered sugars in there yeah

absolutely is there any so i mean so that's one thing that you know surprises you but how i don't know it's tricky you you know you we see all these big uh media headlines and these articles that get shared lots on social media and i think some of us can start making the assumption that everyone knows this stuff but you're out there in the trenches and you're actually realizing that actually that information has not got to where it needs to get to. I mean, we've still got a long way to go to educate as many families as possible about what they can do to improve their overall health. Well, I think there certainly is a place for the social media and the groups who are linked into these. Oh, no question. However, I think that this can work by them spreading their message further.

So someone who has this knowledge could then take it to a wider audience. And that's where we can really help these families. Yeah, absolutely. Have you seen a significant change in the way that childhood obesity is being tackled now in 2018 compared to when you started your career about 20 years ago? Well there certainly seems to be an acceleration in a focus on childhood obesity. I think we may be looking at the US and saying that we don't want our population to follow and so there's certainly been a lot more talk, a lot more media coverage, and government input as well. So Public Health England are trying different campaigns to help people who may not understand some basic principles. But there's always going to be controversies around what you tell the whole

country to do, because you can't have one size fits all. So yes, we can take that message and then work it for those people and see how can it work on an individual situation rather than saying everybody has to do the same thing. Sure. So if I need to look what I try and give my listeners in this podcast is some simple actionable achievable tips that they can apply in their own life hopefully immediately you know do you have four top tips that you can give the listeners in terms of what they can do in the context of their children and their families in terms of how to improve their health yes i would say that um there are sort of four things which i could group together which help children to increase how much they're eating in terms of vegetables and how they're getting

involved with cooking so first of of all, engaging your child. So let them play with the vegetables, let them wash the vegetables, let them be involved in cutting when they're at a developmental age, that they can do that. And by exposing them to all different vegetables, so trying something new that you haven't tried before, bringing it home, allowing everybody to taste it and keep repeating that so that it's not an unusual thing to have something new on the table

and then we talked before about leading by example so you need to be the example for your children and even when they're teenagers they are still watching and looking so just be aware of that I've got all that to come you have yeah I'm already there and then lastly just to enjoy doing things with your child being enthusiastic getting some movement through playing you know connecting them with them when you're cooking all of those opportunities doesn't have to be a whole hour taken out of your time. You could be doing something else like walking to the shops, take them along with you, make it an exciting thing for them, a route where they're going to get some activity done. And so those are the sort of areas which I think that people can focus on.

Vanessa, thank you for that. That's incredibly useful. Look, I'm so happy that you've managed to spare some of your time to come onto the podcast today to share your expertise in this area. Thank you. If people want to stay in touch with what you're doing, I know you've got some big plans and you're helping talk about wider strategies in terms of how we can really make a an impact on childhood obesity how can they stay in touch with you so i am on social media myself and it's a health via nutrition okay and people can contact me through there fantastic well thank

you very much for your time i wish you all the best thank you for your work going forward and hope to have you back on the podcast soon. Thank you very much. That's the end of this week's Feel Better Live More podcast. Thank you so much for listening. And I really hope you found the conversation useful, but also enjoyable. If you're not already, I'd highly recommend that you subscribe to this podcast so that you can be notified when the latest episode of my podcast comes out. I'd also be incredibly grateful if you consider going onto iTunes and giving this a five-star rating so that I can get

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