Childhood obesity - a growing health problem. Episode 61

Monika Rachtan
Hi, good morning, Monika Rachtan. I would like to welcome you to another episode of the programme "First Patient". It turns out that up to 60% school-aged children have a physical education exemption, and only 30% kids have a normal body weight. I will be talking to Dr Hanna Stolinska about this problem today. Hi, Hania, a very warm welcome to you. Hania, you are a clinical dietitian, but you also work with patients. You see them in your office.

Hanna Stolińska
Yes, I am first and foremost a theoretician, because I worked for seven years at the Institute of Food and Nutrition, where I also worked on my PhD. However, I believe that the greatest knowledge is gained by working with another human being, on a living organism.

Monika Rachtan
Your practice receives many patients, including children.

Monika Rachtan
But let's go back to the problem of teenagers. In fact, children at the age of 5, 7, 8, 9, 10, 15 have a problem with overweight and obesity. This problem is very widespread and as we walk down the street and look at these young people, we see that the problem of overweight and obesity is widespread.

Hanna Stolińska
It's common, it's become normal in our country, like in the United States. I remember when I went to school, there was a very small percentage of children in the class who were overweight or obese and they were actually harassed more, attention was drawn to it. Now, I talk to parents about other children's attitudes towards my young patients who have a problem with overweight and obesity. Parents and these children say, "I don't have a problem, my colleague, my friend doesn't say anything to me because it's already normal because there are a lot of us like that in the class."

Monika Rachtan
Well, exactly, but tell me, how do parents approach this problem? You already know parents who have realised that their child has a problem, that they are the ones who have a problem too and they come to see a specialist. But what happens is that people allow a child to be obese at the age of 5, not overweight, just obese?

Hanna Stolińska
Working with a child is very difficult. Building eating habits is difficult even among parents who eat healthily themselves. I hear from patients that when their child was young and ate with a spoon, there was no problem with blended vegetables. Later, at the age of 3-4 years, the child starts to have food selectivity, sometimes there is food neophobia, which is a fear of different foods. This is very common and this is when parents start to let go. I myself have a nephew aged four. He used to eat everything, but now he won't eat anything. I remind him, "After all, you loved carrots and now you don't want to eat them?" - "No." This is normal. During this time, parents do not have the strength or time to work on this child. The child starts to go to kindergarten, makes interpersonal contacts and watches how other children eat. I think we will talk a lot today about nutrition in schools and kindergartens, what a terrible system it is. Even parents who eat healthily find it hard to introduce healthy eating habits permanently in their children.

Monika Rachtan
Yes, because it's the child at a certain point, when he or she doesn't want to eat anything and only eats chips, it's the mum who worries about her son or daughter not having had breakfast or lunch all day, when Zosia, Tosia or Tom says: 'Mum, I want chips', the mum goes to a restaurant, shop or prepares them herself and is happy that the child has eaten something at all.

Hanna Stolińska
That's the point, because parents often explain that they don't have the heart not to give them food, sometimes to starve them. I think it's impossible to overfeed a child, because if they were hungry they would ultimately eat everything. Although I know there are some children who, even when they are very hungry, protest and the parents don't have the heart and give the child what they know they will eat so they won't be hungry.

Monika Rachtan
But what do you think in such a situation? We make these feeding mistakes towards our children, we justify ourselves a little bit by saying that it's good that they ate whatever. But on the other hand we are aware of our actions and we have eyes, we see what is happening to the child. Well, because at a certain point, if it's chips once a week, let's be honest, it's not a problem.

Hanna Stolińska
Of course, but once there's chips, once there's ice, lollipops, jelly beans, pork chops, cola - every day something. It's not that a child is eating well every day and getting chips once a week, absolutely not. The problem is that we adults have a very high percentage of overweight and obesity and we don't see the problem ourselves, which results in us not seeing our child's problem.

Monika Rachtan
It's incomprehensible to me all the time how we can't see this problem. I recently heard an opinion from an adult who had significant obesity that she was not aware that she was ill, that obesity was a disease. It's hard to call it a disease because I don't want to call it that in terms of treatment, pills and so on. I think it's a more complex problem that starts in the head, but on the other hand it's such a visible health problem that you have to deceive yourself to say I didn't know my child was obese, fat, overweight. How can you not notice that from a size 38 before pregnancy I now wear a 46?

Hanna Stolińska
This stems from the belief that a child has to look good, that a child is due, that a child is a child so they should get what they want to eat, that they will grow up, that they will stretch right out.

Monika Rachtan
Yes, it was said that he would go to middle school, then it would be drawn out that the boy needed to be a bit bigger at the beginning, because then he would grow quickly and so that he wouldn't accidentally be too dry or too skinny.

Hanna Stolińska
This is a common belief, and even as parents fight to keep their child from eating sweets, under the care of grandparents or others, these people secretly give them sweets.
Monika Rachtan
If you had to advise a young mum, the kind of mum of just a 5-year-old who is often left in the care of her grandmother, because it's a very common situation that after kindergarten the parents work and send the child to the care of the grandmother, and the grandmothers secretly give chocolates. I'm a mum myself, so I know what it's like. I can talk and ask, but how do I talk to get it across? What arguments to use with these older people? How do I explain it to them? This is a different generation.

Hanna Stolińska
Very difficult. I have a patient who came to me with an overweight daughter, the girl had a big problem, she cried a lot, she didn't accept herself. They have already changed their eating habits a lot, although it was difficult, and I see it not only in one patient. I saw it in restaurants in Warsaw. When I was young, my parents never took me out for sushi, and now there are children who eat sushi, shrimp, pork knuckle and Bao buns for dinner. That's the signal from the big cities. We have been successful, the girl has lost weight, she is cheerful, she accepts herself, she herself understood after my visits and discussions with her mum that eating habits needed to be changed. She had been to another specialist before, she had a very restrictive diet and at the very thought of vegetables she cried because the diet was very restrictive. Mum had to talk to her grandparents at Christmas very firmly, put conditions. But the results only came when the seven-year-old girl herself said please don't give me this because it's unhealthy. Education and talking to the child is the key.

Monika Rachtan
I shudder when you say that. This programme was created to solve the problems of people like us, normal people who face health problems that are supported by a social and family background. It is very often said that vegetarians don't eat meat at home, and when they go to their grandmother's for dinner, they have to eat a pork chop?

Hanna Stolińska
All that is needed is to set clear boundaries. They are by their side, of course. And on the other hand, don't do anything by force. If someone doesn't want to cooperate, you need to step back for a while and let them know that you don't like their behaviour. In the context of children, this is important, because if an adult can say no and nothing happens, a child on holiday at grandma's is out of our control.

Monika Rachtan
He is there for a fortnight, then he gets used to the sweet cola, the lollipops, and all our work for a whole year is wasted. It's not even that the child will significantly increase in weight, they just come back with a different head.

Hanna Stolińska
Yes, that's why I explain to parents that you have to work very intensively at home with the child, show what should be on the plate and talk about why these health habits are important. Children are guided by their sense of taste, they are not interested in being overweight up to a certain point. Then they start to pay attention to how they look in a swimming costume, whether something is spilling out of the sides. I've had a lot of nutrition workshops with young children in schools and more than once, after a healthy eating lesson where we were making smoothies, making healthy sweets, at break the children would eat their unhealthy food. On the steps the mum says to the child: "Eat a chocolate bar now because you can't at school because you don't eat sweets at school." In my opinion, all the time this process of changing eating habits is a battle between good and evil, both among children and adults in society as a whole. We say not to negate overweight and obese people, and we make fun of fitness freaks. I can be a fitness freak if it's good for my health. We should meet in the middle and not accept extremes, but speak with one voice. We don't open a newspaper with an article "How to lose weight" and on the next page "How to bake a meringue cake". There is a lack of uniformity in the world, no political struggle, no top-down recommendations. Yesterday I was talking on TV about the harmfulness of xylitol. Why are we looking into such a product and not investigating fast food? Xylitol is important because it replaces sugar, but the research has not been good. The sponsors of the research are one big machine. Dietetics is an unregulated medical profession, anyone can be a dietitian. A person who weighs 150 kg and loses weight is an internet star because they can now slim other people down, tell them how to do it, rather than a person who has been doing it every day for years.

Monika Rachtan
I saw a lady stylist yesterday on Instagram who had lost weight and was showing pictures of herself from 10 years ago. She wrote: "I thought this is how I must always look. I changed other people's wardrobes, I changed other people's lives, and I couldn't change my own." Of course, she's releasing a course on how to lose weight and change yourself to feel better, to listen to yourself. I wonder if you would do a course like that and release it online, on Instagram, so that people listen to you. Or another influencer, once a put-upon girl weighing about 90kg, she was body positive. She did wedding dress sessions for body positive girls, she said: "Stand in front of the mirror, even if you have flaws, love your body. It's your body. I've given birth to two children, I can't have a normal body weight." Then she got a divorce, changed her life, lost weight, now weighing 60kg. She did skin reduction surgery and now says being skinny is great, she's proud of it. Her number of followers has increased by 100,000. I remember what she used to say. It's great that she's now showing healthy attitudes, but it's contradictory that we say body positive and then when we get rid of the problem we make it a marketing product.

Hanna Stolińska
I haven't done such a course, although I have had the opportunity, rather I try to appear in the media, podcasts. Working with the other person is the most important thing, focusing on the individual, getting the person to say what health problems they have, difficulties, lifestyle. That way we can help individually, rather than recording a course for everyone and no one really. I work with a live person, I see them every day, sometimes through the webcam, as we are separated by miles. It gives me satisfaction and feedback from these people, that's important. It's also possible to work with children without restrictive diets, because children grow, they develop. You have to impose norms. It can't be that the child says 'I don't want this', I talk to him and we come to a consensus. Later he sends me a picture: "Please see, I ate a carrot." It's positive, but the parent has to be positive to act. If the mother in the study says: "After all, it's not good, he won't eat it", then automatically he won't eat it anymore.
Monika Rachtan
But if a parent comes to you, they spend money. Because dietary advice, dietetics is not particularly clinical, it's not likely to be written into the National Health Fund provision. I mean it is, but it is known that it is not so widely available. And yet it negates you the specialist. It comes to you?

Hanna Stolińska
I think it's more not that I'm just what this child can do.

Monika Rachtan
But this child can do anything.
Hanna Stolińska
Of course they do. And these are you know, they often come with their kids and these kids are great because once they get into the topic they eat so perfectly and they have such fantastic results with me that I'm turbo proud of them for educating their friends that he's not going to go into McDonald's because he's got his food on the trip, but also parents come with their teenagers and these are two groups as well. One is that fit mums want this girl to be fit too, and she doesn't need to be slimmed down at all, because this is the teenage puberty period of 12 13 years, where every body changes. It's hormones, it's a different build and these girls don't accept that because that's often what mums tell them.

Monika Rachtan
Afterwards, the problem of, for example, anorexia, an eating disorder, may arise.

Hanna Stolińska
Of course, this is also very common. And on the other hand, there is just something about this child being carried out by force and then there are no further visits. So here there is also a fashion such that all the kids at break time fly to the shop and buy hot dogs.

Monika Rachtan
Shops should not be in the area. In general, children can leave the school. That is a different problem. But after all, in my time, it was not allowed to leave the school walls.

Hanna Stolińska
Because everybody buys there. That's me wanting that hot dog too, so is that particular ice cream that's in vogue now and it's, you know, judging. I also hear the situation that there are weight loss competitions among such teenage girls. These are really terrible things.

Monika Rachtan
You think Instagram is destroying our heads like that.

Hanna Stolińska
I think Instagram tiktok, all those, I don't know about these modern platforms and so actually that could be a problem.

Monika Rachtan
A Back to social media come to you parents who have been tempted to send their child on a keto diet.Do you hear of such cases?

Hanna Stolińska
This case of a girl who lost weight so nicely and is now enjoying life and eating everything. It was just that she was on a keto diet with one ala famous nutritionists.

Monika Rachtan
Obviously a diet is, with certain medical indications, it has an effect there. what research there is, but I am concerned precisely with such extreme diets in children.

Monika Rachtan
You cannot do something like that. This is an organism that is developing. If we do something like that, we spoil the child's metabolism for life.

Monika Rachtan
And if the parents are vegan. So now say there's a child comes into the family, the parents are vegan, they don't eat meat, they don't eat zoonotic products, And what? and introduce meat into that child's diet at the beginning. What do you do here?

Hanna Stolińska
No, it is a question here of good balance. The world consensus is that we can be on a plant-based diet at any stage of life, it's just that you actually have to take care of the details, and that's already difficult among a toddler from birth. But I also guide children on vegan diets myself. And you can? You can. And these are the children who have those best eating habits.

Monika Rachtan
I think of such cool kids coming to this clinical nutritionist. Hopefully a clinical one. And we remind you that if you're going to a dietitian with your child with you, check that this person has graduated, because they could have finished a two-day course on the internet and call themselves a dietitian. On the other hand, we are looking for a dietician who has graduated and asking about it. Hania, I wouldn't be offended by your practice and we wouldn't know each other. And I would be weak on the internet and not search who you are if I asked you. Ms Dietitian and are you a REAL dietitian or one from the internet? Or have you graduated from university? Would she be offended by such questions?

Hanna Stolińska
Sure it's not absolutely often that people ring up and actually ask who I am? They got a number, they heard about me somewhere, they saw me somewhere. But how do I work? Who am I? These are normal questions. I don't take offence at this, because I also go to other doctors and specialists.

Monika Rachtan
And you also check out Competence. I think of such cool kids who have such an interest in cooking. There have been cooking programmes, also with children on TV, and I thought it would push in such a cool direction, that we can also cook as children, that we can take care of what we eat, that it can be healthy, colourful, fresh. We're talking June, so I can already see my stall. Where there's delicious green beans and broad beans that have a high glycaemic index, which you told me about and I can't live with that. But you know, I think it can be so cool to impress your peers, for example.

Monika Rachtan
You know it's fun. It's just that you have to have time for it. Maybe it's a bit so brutal. And I think if you decide to have children, you have to have the time to do it, to raise them well and take care of them. But if parents don't cook for themselves, how are they supposed to cook with their children? I also know of cases where it is the children who cook for the parents. But these are the cool kids, I mean all the kids are cool, but these are the kids who have been educated somewhere, who have got involved in the kitchen, so to speak, and they cook for their parents, for the whole family. And how do you look at school and what school teaches?

Hanna Stolińska
School doesn't teach, you know, health habits. There are food pyramids discussed, but they're not quite what they should be. Something there in biology doesn't emphasise nutrition education in schools. There is no one to do it. The biology lady or what? An educator or a PE master? There are no such people employed to do it sensibly and there are no adapted breaks in school to have a normal meal. Often I'm standing on my head because the children are talking, but we're running at break time from room to room we've got five minutes. It's so crowded on those stairs that I can't even open my smoothie bottle because it's flooded, let alone take a spoon and eat a yoghurt, it's like there's no space. It's completely different abroad than in Poland.

Monika Rachtan
And when you look at the school shops, I remember that there were some activities there.

Monika Rachtan
Yes, I was also involved in this when I worked at the Institute of Food and Nutrition, and there was a campaign to change the shops. It lasted a very short time. After that, nobody controlled it anymore.

Monika Rachtan
Because it is a business. Well, and we're not looking at health, we're looking at getting someone to sell to you, to make money. But on the other hand, again, I imagine cool school shops, the kind with smoothies.

Hanna Stolińska
It's just that someone would have to buy it like that. And kids don't think about it, because they're not educated, they're not shown how much sugar there is in particular products. I often deal with the parents of my charges in such a way that they send me a menu every week, often there is a menu to choose from and then I ask the mother and child to sit down at home and choose things that are suitable. They send it to me, I check if it's ok or if we would choose something else though, or we do it at the visit. We talk afterwards. Over time, 3, 4 weeks later they can do it themselves. They don't have to refer back to me because they know that their choice is ok. But it's also work, it's time commitment.

Monika Rachtan
You have to have the time to do it. How do you look at these menus that school canteens offer? I don't know what it looks like now in most of them.

Monika Rachtan
They are very different, some canteens are so totally simple, it's meat, potatoes, salad, and someone who doesn't eat meat will get dumplings or pancakes. But there are also caterers that are almost restaurant-like, I can say.

Monika Rachtan
Because in my day, there was a canteen at school and there was a kitchen and there the cooks prepared the lunches every day, plus each class was on duty in the canteen. I'm talking to the kids now how you're not on canteen duty? But do you remember those times? It was just great. It also really taught us as kids just how to eat healthy, how to prepare meals. You could get to like it.

Hanna Stolińska
You know, I often see on the Internet that there are various memes from the 90s, 80s, that I ate a turbo gum or a Ham, and these are such pearls that were in our childhood, and I posted them somewhere and was heckled, and that's how obesity was born. It wasn't born obesity then, because there wasn't such availability of that food, because there were maybe those sweets once in a while, not every day. Now there's a problem with the availability of this food and the child goes into the shop and is just loaded with all this stuff and the parents can't say no.

Monika Rachtan
But on the other hand you have a 10 12 year old who already goes to school on his own, who you no longer drive. You don't drive him? You're the one who has no control over what he eats, because if he has pocket money, he goes into that shop and he chooses for himself there what he wants to eat on the way home or eat on the way to school, you don't even know what your child eats. When you talk to parents you get that light that goes on that actually maybe it's not that there's bad food at home. Maybe it's not that we're the ones cooking badly, we're the ones eating badly, it's just that there are times that the parents are not in control and that this is where you need to take care.

Hanna Stolińska
It's all got to be balanced very strongly, because if it's the other way around the bias is too much, restrictive at home and pure let's say it's food, well then such a child is let off the leash and goes crazy, and it's even worse and we find papers behind the sofa from sweets, so everything has to be very strongly balanced. And I think everyone should go to a nutritionist and talk to them about child nutrition. How should that make sense?

Monika Rachtan
I think to myself that taking care of a child's feeding model is for the parents, for those children. Such a policy for the future.

Hanna Stolińska
Obviously, an obese child will be obese in the future.

Monika Rachtan
I think we forget a bit about that, that ok, what matters is aesthetics, what matters is how this child looks, but we don't think about the fact that a child who from the age of five or seven is overweight, then obese, that this, that heart, that liver, that this stomach, that this whole skeleton is all mega stressed And then that thirty year old will have type two diabetes, will have a non-alcoholic liver contusion, will have joint pain, and will have a heart attack at the age of 50.

Hanna Stolińska
You know Children as young as school age have elevated cholesterol. It's already starting to happen, it's been happening for a long time and we have to look at it that way. Also if we don't see the disease, it doesn't mean it's not there.

Monika Rachtan
And when you have such a small patient who comes to you, do you establish what the problem is? Such at first glance let's say then you still ask for some additional laboratory tests.

Hanna Stolińska
Of course, yes. We work on an ongoing basis there are food diaries. The children like it very much. The diaries are colourful, very positive and we work in this way and change the recommendations on an ongoing basis.
Monika Rachtan
The advice of a dietician, as we said clinical, involves paying for it. Today life is expensive, healthy food. Someone will say it is expensive. I think any is expensive. It doesn't matter whether you eat healthy or unhealthy. On the other hand, tell me, if you change this eating pattern, does it take a long time? Is it a costly investment for parents? Do 4, 5, 7 visits suffice and the matter is settled? Do you go to this nutritionist afterwards for 3 years?

Hanna Stolińska
No, absolutely that's it. It's a couple of meetings most of the time. But I also work in such a way with the patient that I have contact on a regular basis.

Monika Rachtan
That is, you call each other by text message.

Hanna Stolińska
As the need arises, I am always available.
Monika Rachtan
Tell me, how do you look at the problem? Because I think it's a societal problem - obesity in children and the fact that over 60% children don't exercise in PE.

Hanna Stolińska
I didn't do P.E. myself because I had a cyst and varicose veins under my knee, which I had cut out three times. I had surgery on my leg and my mother was worried about me. It turned out at the end of the day that the activity even needed to be there to make the circulation in my leg better.

Monika Rachtan
Yes, I had Hashimoto's again as a little girl, it wasn't so popular then. Think to yourself, 25 years ago someone had Hashimoto's, it was some horrible disease. When my paediatrician found out I had the disease, we did all the diagnostics, and absolutely to be safe she exempted me from P.E. because she said I couldn't do exercise. The PE teacher asked, what kind of exercise is exercise? Every exercise is some kind of exertion. So she gave me an exemption. And I was on that exemption. It turned out that people with hypothyroidism should move all the more. Moderate physical activity should be. But I don't think 60% children in Poland have indications for exemption.

Hanna Stolińska
Absolutely. When a girl gets her period, this is not an indication of indisposition either.

Monika Rachtan
Well yes, menstruation here, of course there are extreme cases where a girl menstruates very painfully, very profusely and then it's clear and you can talk about it. But on the other hand, these 60% is a bit scary for me, because these children, apart from not moving in P.E., they don't move in general. They generally spend most of their time in front of the phone, in front of the computer.

Hanna Stolińska
These little kids like to move too. I even hear a bit of exaggeration, that one day I'm at karate, the next day I'm at dance, the third day I'm playing football. Well that's not to exaggerate either, because a child needs to have that kind of slack to go out in the yard and run around with the other kids, not some super sports activities. We didn't have that in my day.

Monika Rachtan
For mine too. But you know what, we discuss this often, watching neighbours who drive their children to small estates from the motorway. These children are constantly just being driven to different activities. It seems to me that this is a bit of a way for parents to get their children out of the house because they don't have time.

Hanna Stolińska
A little bit, yes, but also the postponement of their ambitions, because they didn't do it and they want the child to achieve the unknown. And on the other hand, later on there comes a time in the teenage years when that teenager actually doesn't want to move anymore.

Monika Rachtan
He's also tired and a bit overstimulated, it seems to me, in a situation like this where he has ball, karate and tennis.

Hanna Stolińska
That's on top of English, maths and other things. There is such a fashion among teenage girls now, because the canons of beauty are changing a lot. Now it is the canon of beauty: a big bottom, a narrow waist, a muscular body. Very many girls go to the gym and go in that direction. In such an even dangerous sexuality, which later translates into other aspects of life.

Monika Rachtan
Me I think somewhere at some point in our conversation it came up that it's the internet, Instagram, that we're watching, it's called viral. Something out there is viral, shoes are viral, the body can be viral, breakfasts can be viral. It would be nice if they were just viral in the context of a healthy lifestyle. If you could go into the Ministry of Education, the Ministry of Health today and have a real impact on what you can do to get these kids to adopt this healthy eating model. Do you have any tools? Ms Hania, please, a free hand. What would you suggest to them?

Hanna Stolińska
This is a difficult question. You would have to go in many directions. I would, in spite of everything, put more emphasis on nutritional education in schools. Not just for a while, but on the basis of a sounding board - repeat, repeat, repeat. I would go even further into taxing various unhealthy foods and also into educating parents. We can't do anything by force, but we can just educate, educate. That is the basis.

Monika Rachtan
I think this health education subject, which is due to appear in schools from September 2025, is the answer to childhood obesity, because it is the most visible.

Hanna Stolińska
Yes, only who will run it, how it will be run and what effect it will have - I don't know.

Monika Rachtan
I have my doubts too, because if this is to be carried out by a teacher, an educator who has these lessons as part of family life education, it will have absolutely no effect. You have to do it comprehensively, hire specialists. Tell me, you are a nutritionist, you rotate among nutritionists. Do you think there is a chance to convince the community to run such activities in schools for children, to address this part related to nutrition? Is there any space here?

Hanna Stolińska
Clearly, this is how it should be. For the time being, these are nevertheless some private meetings.

Monika Rachtan
I believe that this health education and this subject is a great opportunity, as long as it is well organised and looked after. I would like to leave our audience with the message that taking care of your child's health, taking care of healthy eating is such a life-long policy for your child's future.

Hanna Stolińska
We want a child to go to a good school, to have a good job. Health is fundamental.

Monika Rachtan
Yes, we invest in English, but what if our child as an adult, a young adult, 27 years old, speaks beautiful English, plays great football, but will still be overweight and embarrassed by public speaking? The money we have spent on education will not be well spent because there will be a problem he will face. If our audience has children, we urge them to take care of their eating pattern. Even if there is nothing worrying going on yet, it is worth going to a nutritionist and talking about what our child is eating. Thank you very much Hania for our conversation today and thank you for your attention. This has been a patient-first programme and my name is Monika Rachtan and I invite you to subscribe to our channel.