P U T T I N G

C H I L D R E N

F I R S T

Sport Nutrition Health Education

A Glimmer of Light:

Eating Habits of Children in Liverpool

EATING HABITS OF CHILDREN IN LIVERPOOL

The state of play

The dietary habits of children have been scrutinised as never before over the last few years. Many studies have commented on the poor eating habits of British children (Gregory et al, 2000), including Liverpool (Johnson & Hackett, 1997), which have been amongst the worst in Europe (Vereecken & Maes, 2000). A recent survey in nine European countries (Yngve et al, 2005) showed that children were only eating between 2-3 portions of fruits and vegetables a day.
The same report showed that only a fifth of boys and girls were eating the recommended five portions a day. In particular, food consumed in schools has come under the spotlight and there have been many fine words on the subject. SportsLinx from its inception has had improving the eating habits of children firmly on its agenda and believes that healthy eating cannot be divorced from other aspects of healthy lifestyle such as being more active. SportsLinx data has identified that far too many Liverpool 9 and 10-year-old boys and girls are overweight (22.8% & 23.8% respectively) or actually obese (12.1% & 10.3% respectively) SportsLinx (2004). This was a very large increase from 1998-99 when the project began. The last SportsLinx report of the dietary habits of Liverpool children highlighted the prominence of undesirable foods (for example sugary and fatty foods) and the very small numbers of children consuming vegetables (33%) and even fruit was only consumed by about 70% of children (SportsLinx, 2004; Hackett et al, 2002). Clearly there was a major task facing the city. The Governments response to these problems, which are most definitely not unique to Liverpool, has slowly gathered pace and is encapsulated in Choosing a Better Diet - a food and health action plan (DH, 2005). The findings presented here show that Liverpool has been leading the way in caring for the nutritional needs of its children and can offer much support to other areas that wish to do the same. This report presents unique data of the dietary habits of a succession of cohorts of year 5 (9 & 10 year old) children across an entire city and how these have been changing year on year for the last 5 years.

Summary

Research has identified the poor eating habits of British children, including children in Liverpool. SportsLinx has found 22.8% and 23.8% of 9-10 year old boys and girls respectively to be overweight, and that 12.1% of boys and 10.3% of girls are obese. The eating habits of children in conjunction with physical activity are key factors in the development of obesity and the current overweight epidemic. Previous SportsLinx reports have shown poor levels of fruit and vegetables consumption. The most recent SportsLinx data suggest that improvements in diet are occurring; shown by a reduction in mean negative food marker scores, and an increase in the mean positive food marker scores between 2000 and 2005. Consumption of chips, crisps, fried vegetables, meat pies, sugary cereals, sugar in foods, and sugar in drinks has fluctuated over the years of the project.

Fizzy drinks, chocolate biscuit and pudding consumption has declined over the years of the study. Boys and girls have shown a substantial increases in fruit, vegetables and salad consumption when comparing the 2004-2005 and 2000-2001 cohorts. SportsLinx and partners invest heavily in promoting healthy eating across Liverpool through the delivery of after school clubs, packed lunch schemes, taster sessions and training. This investment, in conjunction with other healthy eating initiatives appears to be paying off. The Liverpool Taste For Health food and health action plan identifies the promotion of healthy eating at its core: SportsLinx and our partners provide many services aimed at improving the eating habits of individuals across the city but strategic decisions are needed to enable such activities as a right of passage for every child in Liverpool.

EATING HABITS OF CHILDREN IN LIVERPOOL

Intake of selected foods: Year on year data for boys & girls
Table one and Charts one and two report the mean positive and negative marker scores for boys and girls over the study period. Negative marker foods are those which children would normally be discouraged from eating often or in large amounts. A positive marker food is one which children would be encouraged to eat in greater quantities or more often. Individuals are assigned a positive and a negative marker score by counting the number of individual negative foods (to find negative marker score) and positive foods (to find positive marker score) that they have reported consuming.

Chart One Mean Negative Marker Foods Score: Y5 Boys and Girls 2000-2005
Boys Girls

Mean Negative Marker Food Score

EATING HABITS OF CHILDREN IN LIVERPOOL

Chart Two Mean Positive Marker Food Score: Y5 Boys and Girls 2000-2005
Boys Girls

Table one and charts one and two show an overall decrease in mean negative marker scores over the study period for the girls, there is little change in boys negative marker scores but there was a downward trend for the last three years. Perhaps more encouragingly, there is a substantial increase in mean positive marker score for both boys and girls year on year. This means that girls involved in SportsLinx are consuming fewer negative foods (albeit by a small amount) and boys and girls are now consuming substantially more positive foods.

Table One Mean Positive and Negative Marker Scores: Boys and Girls 2000-2005 Mean Score
Negative Marker Foods Boys Girls Positive Marker Foods Boys Girls 2000-2001 9.5 9.4 2000-2001 3.4 3.6 2001-2002 9.3 9.3 2001-2002 3.6 3.9 2002-2003 9.7 9.3 2002-2003 4.2 4.2 2003-2004 9.6 8.9 2003-2004 4.5 4.5 2004-2005 9.4 8.4 2004-2005 5.4 5.5

Mean Positive Marker Food Score

EATING HABITS OF CHILDREN IN LIVERPOOL

Charts three to eight display the percentage of boys and girls consuming a selection of negative marker foods.

Chart Three Proportion of Boys (%) who claimed to have eaten Chips, Crisps, Meat Pies and Fried Vegetables: 2000-2005
Chips

% of Subjects Consuming Selected Food

Crisps Fried Veg Meat pie

Chart three shows reported intake of some common fatty foods. It shows fluctuating intakes of chips, crisps, fried vegetables and meat pies over the study period. In the case of chips and meat pies, consumption shows a welcome downward trend from 2002-2003.

Chart Four Proportion of girls (%) who claimed to have eaten Chips, Crisps, Meat Pies and Fried Vegetables: 2000-2005
% of Subjects Consuming Selected Food
Chips Crisps Fried Veg Meat pie

Chart four displays fluctuating intakes of the selected foods in girls from 2000-2005. Consumption of chips has remained relatively constant over the study period, with consumption of crisps showing increases up to 2003-2004, followed by a decrease in reported consumption. Consumption of fried vegetables displays a downward trend from 2002-2003. Clearly, crisps and chips, from the proportion of boys and girls claiming to have eaten them, are very popular foods.

EATING HABITS OF CHILDREN IN LIVERPOOL

Charts five and six show the intake of some sugary foods by boys and girls. Sugary foods were very popular with children, and most children reported consuming a soft drink (containing sugar) and a regular cordial (containing sugar). Sugared breakfast cereals were consumed by a high proportion of children (typically 35-40%).

Chart five Proportion of boys (%) who claimed to have eaten sugar on food, sugar in drinks, sugary cereals and fizzy drinks: 2000-2005

% of Subjects Consuming Selected Food

Sugared Cereals Regular Cordial Sugar on Food Fizzy drinks plus sugar Regular Cordial

Chart five shows a declining percentage consumption of fizzy drinks in boys annually. Consumption of regular cordial has declined since 2000-2001, but has fluctuated over the last three years. Consumption of sugary cereals, sugar in drinks and sugar on food has fluctuated over the study period

Chart six Proportion of girls (%) who claimed to have consumed sugar on food, sugar in drinks, sugary cereals and fizzy drinks: 2000-2005
% of Subjects Consuming Selected Food
Sugared Cereals Regular Cordial Sugar on Food Fizzy drinks plus sugar Regular Cordial

Chart six shows an annual decline in consumption of fizzy drinks, with a similar reduction in consumption of regular cordial, and sugar in drinks. Consumption of sugary cereals and sugar on food has fluctuated over the study period.

EATING HABITS OF CHILDREN IN LIVERPOOL

Charts seven and eight show the intake of biscuits and puddings. Chocolate biscuits are very popular with the children.

Chart Seven Proportion of boys (%) who claimed to have consumed Biscuits, Cakes, and Puddings: 2000-2005
Plain biscuits

% of Subjects Consuming Selected Food

Chocolate biscuits Cakes /pastries Puddings

Chart seven shows a fluctuating consumption of biscuits, cakes, and puddings, although consumption of chocolate biscuits has declined over the study period.

Chart Eight Proportion of girls (%) who claimed to have consumed Biscuits, Cakes, and Puddings: 2000-2005
Plain biscuits

% of Subjects Consuming Selected Food

Chocolate biscuits Cakes /pastries Puddings

Chart eight shows an annual decline in chocolate biscuit consumption, with fluctuating intakes of plain biscuits, cakes and puddings from 2000-2005. Cake and pudding consumption has declined from 2002-2003.

EATING HABITS OF CHILDREN IN LIVERPOOL

Intake of fruit, vegetables & salad: year on year data for boys and girls
Charts nine to eleven display the percentage of children consuming fruit, vegetables, and salad, from 20002001 through to 2004-2005. Fruit has almost always been the food reported to have been eaten by most children wherever this survey method has been used (over the last 15 years). The proportion of children reportedly eating fruit has never exceeded 75%, ideally all children would eat fruit every day.

Chart Nine The Percentage of Boys and Girls Consuming Fruit: 2000-2005
Boys Girls

There has been a steady year-on-year increase in the number of girls who reported eating fruit over the last five years. The trend for boys shows a different picture. Between 2000 and 2002 there was a small decrease in fruit intake, however the trend since 2003 has been a positive one. There have been increases each year over the last three years. In general, girls were more likely to report eating fruit than boys. These positive changes predate the introduction of free pieces of fruit for children of this age group in schools, which was introduced in June 2005. The proportion of children reporting eating vegetables has always been very low. The results here show the highest proportion of children consuming vegetable ever seen.

% of Children Consuming Fruit

EATING HABITS OF CHILDREN IN LIVERPOOL

Chart Ten The Percentage of Boys and Girls Consuming Vegetables: 2000-2005
Boys Girls

The number of boys and girls eating vegetables between 2000 and 2002 was similar. During 2003-2004 and 20042005, there was a dramatic increase in the numbers of boys and girls who reported eating vegetables compared to previous years. In 2003-2004 38.6% of boys and 43.6% of girls reported eating vegetables. There was a similar upward trend for 2004-2005, with 37.5% of boys and 44.3% of girls reporting that they had eaten vegetables. Overall there was a 24% increase in vegetable intake in boys and 44% increase in girls over the five year period.

Chart Eleven The Percentage of Boys and Girls Consuming Salad: 2000-2005
Boys Girls

There was a clear upward trend in the intake of salad vegetables over the five year period in both boys and girls, although more girls reported that they had eaten salad vegetables than boys, in all years. Over the five year period there was a 25% increase in the number of boys eating salad. In girls the trend was more dramatic, the results show a 49.5% increase over five years.

% of Children Consuming Salad

% of Children Consuming Vegetables

EATING HABITS OF CHILDREN IN LIVERPOOL

Current SportsLinx and related activities in Liverpool

SportsLinx delivers a range of activities to promote healthy eating within schools, from fruit taster sessions and after school clubs to supporting healthy eating weeks. During 2005 forty three after school clubs were delivered across Liverpool schools by the SportsLinx Nutrition Team, including our partners: the Liverpool Community Food Workers. SportsLinx will run 50 after school nutrition clubs in 2006, reaching over 500 children by delivering healthy eating messages, nutritional knowledge, and food skills. The SportsLinx messages will cascade out to many other children, siblings and parents. One hundred and fifty nine fruit tasting sessions were delivered to primary schools in 2005 across Liverpool. SportsLinx fruit taster sessions supported and formed part of healthy schools weeks in numerous Primary schools, helping to promote the 5-a-Day message. The Pack it in: Whats in your lunchbox? campaign, jointly organised by Taste for Health, SportsLinx, public health, and community dietitians, will provide a leaflet packed with information and tips for healthy lunchboxes. The leaflet will be supported by a local road show to parents and schools demonstrating alternative lunchbox ideas. The SportsLinx nutrition team, and community food workers will be visiting schools to support the campaign, offering top tips on packing healthier lunchboxes with tasters and recipe ideas. A healthy eating fun sheet is being prepared which will be given to Year 5 children. The fun sheet will allow children and their parents/carers to discuss food and health. A comprehensive package of training has been developed by SportsLinx and LJMU in food hygiene, nutrition, and food skills. The training is targeted at teachers, classroom assistants, and PHSE co-ordinators and aims to ensure the delivery of effective after-school nutrition clubs, breakfast clubs, healthy tuck shops and healthy packed lunches. This training was introduced to ensure that quality, consistent messages are delivered throughout our schools and to ensure the sustainability of current and emerging after-school cookery/nutrition clubs and other initiatives. This training supports the City of Liverpool Sports and Recreation Service Food and Fitness Pack. Thirty free places will be given to schools in 2006, and during 2005 SportsLinx provided food worker training for 60 workers and representatives from early years settings and schools across the city.

Quotes from Parents and Children

Research investigating the SportsLinx after school nutrition clubs has generated some very positive preliminary results. Quotes from children (taken from focus groups held with children) asked what have you enjoyed the most? I liked eating more fruit and vegetables and I liked learning how to make more food. I liked learning about a balanced diet Quotes from Parents (taken from parental focus group) I think its something the children should be learning He will try more things at home He realises he can do things himself and that he can cook for his family

EATING HABITS OF CHILDREN IN LIVERPOOL

Conclusions & Recommendations

The findings presented in this report are very exciting. They suggest that sustained improvements have been taking place in key aspects of the diets of Year 5 children over the last five years. Furthermore these improvements correspond exactly with the emphasis that has been given to childrens diets particularly the promotion of fruit and vegetable consumption. It is not being claimed that SportsLinx is solely responsible for these improvements. Liverpool is fortunate in having several programmes aimed at improving the diets of children (especially fruit & vegetables): 5-a-Day teams, Heal 8, Community Dietetics and the Community Food Workers and the Taste for Health group. These programmes are complementary, and together, are delivering very valuable outcomes. It is vital that this input is maintained to ensure that this success is continued and the children of Liverpool benefit.

Bibliography and References

Department of Health (2005) Choosing a Better Diet: a food and health action plan. London: Department of Health. Gregory JR, Lowe S. Bates CJ, Prentice A, Jackson LV, Smithers G, Wenlock R, Farron M (2000) National Diet and Nutrition Survey: young people aged 4-18 years - volume 1: Report of the diet and nutrition survey. SO: London. Hackett AF, Gibbon M, Stratton G & Hamill L (2002) Dietary intake of 9-10 year old and 11-12 year old children in Liverpool. Public Health Nutrition, 5(3), 449-455. Johnson B & Hackett AF (1997) Eating habits of 11-14 year old schoolchildren living in less affluent areas of Liverpool. Journal of Human Nutrition & Dietetics, 10, 125 -144 SportsLinx (2003) SportsLinx Project 01-03. report on the health & fitness of Liverpool primary and secondary school children. Liverpool: SportsLinx. SportsLinx (2004) Childhood Obesity in Liverpool: where do we go from here? Liverpool: SportsLinx. Taylor S, Hackett A, Stratton G & Lamb L (2004) SportsLinx: improving the health and fitness of Liverpools youth. Education and Health, 22(1), 3-7. Vereecken C & Maes L (2000) Eating habits, dental care and dieting. Chapter 8: 83-89. In Health and Health B ehaviour among Young People. Copenhagen: WHO Europe. Yngve A, Wolf A, Poortvliet E, Elmadfa I, Brug J, Ehrenblad B, Franchini B, Haraldsdottir J, Krolner R, Maes L, Perez-Rodrigo C, Sjostrom M, Thorsdottis I, Klepp K. (2005) Fruit and vegetable intake in a sample of 22-year old children in 9 European countries, Annals of Nutrition and Metabolism, 49: 236-245.

Acknowledgements
Liz Lamb. Health & Physical Activity Officer (Liverpool City Council) Lynne Boddy. Research Officer (Liverpool City Council & Liverpool John Moores Universtity) Dr. Allan Hackett. Reader in Community Nutrition (Liverpool John Moores University) Dr. Gareth Stratton. Reader in Paedaitric Exercise Science (Liverpool John Moores Universtity) Dr. Sue Taylor. Senior Lecturer (North East Wales Institute of Higher Education) Paula Watson. Principal Researcher, G.O.A.Ls Project (Liverpool City Council & Liverpool John Moores Universtity) Dr Brian Johnson, Community Food Worker Manager (Liverpool PCT) Shirley Judd, Head of Community Nutrition (Liverpool PCT) Lindsey Dugdill. Reader in Exercise and Health (University of Salford) Richard Johnson. Sport Development Manager (Liverpool City Council) Chris Briggs. Sport & Recreation Manager (Liverpool City Council) Gordon Dacre. Policy Development Officer (Liverpool City Council) Hazel Cheung. Nutrition Co-ordinator (Liverpool City Council) Glen Groves & Jenny Claque. Fitness Officers (Liverpool City Council) James McGinn. After School Clubs (Liverpool City Council) Stephen Tiffany. Health & Well-being Officer (Liverpool City Council) John Marsden. Liverpool Active City

Food & Fitness for Kids

This health related exercise and healthy eating resource pack is aimed at children aged 9-13 years, although the ideas can be adapted to suit other age groups. The pack consists of 3 teacher booklets, related pupil activity cards and large colour posters. To enquire about obtaining a copy contact us for further information.

Liz Lamb Health and Physical Activity Officer Liverpool Education, Library and Sports Services 1st Floor Millennium House 60 Victoria Street Liverpool L1 6JH Tel: Mobile: email: 0151 233 6335 07764 855003 liz.lamb@liverpool.gov.uk