To tackle the ‘wicked problem’ of childhood overweight and obesity, one needs a long term approach that reaches into every domain of a child’s life. That is what the council and health department of Amsterdam set out to do, four years ago. The council members awarded the programme with a sizeable, structural budget, reaching as far as 2033, when children of the first ‘healthy generation’ will celebrate their 18th birthday.
From the start, a healthy life for children has been viewed, not just as a responsibility of the parents, but as a shared responsibility, shared by everyone who plays a part in the life of children, be it close by and personal (neighbours, teachers) or from a impersonal distance (legislators, food industry). The programme has steadily been working on building a coalition of partners, all working in their own domain on this issue, sending out the same message: healthy behaviour is normal behaviour. Three simple lifestyle rules form the basis of this message: healthy food and drink, exercise, and sleep. The measures include:
- Primary schools have changed their policies: only tap water is drunken during breaks, no more sugary soft drinks or juices. Packed lunches must be healthy, as well as birthday treats. Extra PE for all kids – not just the overweight ones – by a trained teacher. Active outdoor play, also after school is out. Education on healthy choices for parents.
- (Medical) care professionals, meanwhile, have been trained to talk to parents on healthy choices – not the easiest of subjects as it touches on parenting skills and personal lifestyle. They have agreed to work together, keeping every child that is overweight or obese, in sight and in care. That care can stretch outside the traditional medical domain and even past the usual ‘diet and exercise’ interventions. Such things as debts or poor language skills can be obstacles first to be tackled in families, before healthy choices can even come into focus. A large health insurance company is on board to – by way of experiment – finance this rather unusual type of care coordination for (morbidly) obese children.
- Prevention is everything, and the first few years of life form the foundation for health later on. Therefore an extra programme focused on the ‘first one thousand days’ of a child’s life, from the point of conception to the second birthday, sets out to encourage women to live healthily in pregnancy and offer their baby a healthy lifestyle from birth.
- Volunteers, in neighbourhoods that are most effected by this health issue, are encouraged to take this subject to hand and run with it, always asking the question: what can YOU do to take responsibility for a healthy environment for children? Different migrant and neighbourhood communities have taken initiative to organize healthy cooking classes with kids or to start exercising themselves, to set an example for their own kids.
- The same goes for food entrepreneurs: from the local supermarket owner to the big food corporations: they are all invited to share in the responsibility, play their part and offer healthier choices. Kids marketing for unhealthy foods is increasingly criticized and several companies have taken steps to take kids idols off of their packaging. The national government has recently decided to shift supervision on marketing rules from the industry itself to an independent body.
- City planners are exploring the possibilities of a ‘healthy city’: a city that, by design, invites children and adults to walk, run, cycle on an everyday basis. The bicycle, already Hollands favorite means of transportation, is given even more priority in Amsterdam. Sport clubs are on board to make their courses available also to inactive kids from poorer families. Sports events for children and municipal sports locations such as swimming pools must be free of marketing of unhealthy food and drink.
Figures for childhood overweight and obesity in Amsterdam went down by 12% in three years time, from 21% to 18,5%, while the national average remained the same at 13%. This decline is also visible among the lowest classes: children from poor, mostly immigrant families show healthier behaviour and more of them have a healthy weight. No conclusion can yet be drawn about cause and effect. While much more time and research is needed, the figures give a sense of being on the right track.