Laurence Gruer - The importance of food in children's health - 06/19/2007

Patrick Holden: It's my pleasure to introduce our first speaker who is Laurence Gruer. Laurence Gruer is Director of Public Health Science, NHS Scotland. Laurence is well known for his dedication to improving the health of Scotland's people and for his work on drug misuse, and he has a long standing professional interest in food with a recent focus on obesity.

I was lucky enough to spend some time in his company last night – we had dinner together and got to know each other a bit. We're very lucky to have him with us and I'd like you to welcome Laurence who will speak on the importance of food in children's health.

Laurence Gruer: Thanks very much Patrick and I must say you're the first person who has said publicly he has been inspired by the smell of the cowshed, that's impressive stuff! Now, most of you don't know much about me so I thought I'd give you just a couple of details that are relevant to what I'm going to say. I've been a doctor for 29 years and a public health specialist focusing on the health of the population for 18.

But also relevant is the fact I've been a father of three kids in total for 23 years. Through my interests and family circumstances I've ended up being both the principal shopper and the cook for my household for a staggering total of 32 years. So I'm putting together over 100 years of experience for you in this talk today!

I've also lived and eaten around the world. Most of my life has been spent in Scotland but also I've lived in Ireland, Wales and England. I've spent some time in the United States and a lot of time in France, and Ghana is a place that's very close to my heart because I married a beautiful Ghanaian woman, and so Ghana's had a lot of influence on my tastes in various respects.

These are my three kids as they were back in 1989, eating some freshly prepared homemade popcorn, and as you can see they're obviously thriving on it at that time! So let's get down to the business of the importance of food for children's health. Good nutrition starts in the womb, and I think we now know just how important a mother's diet during pregnancy is, and how profound an impact that can actually have on her child's future health.

A good example of where there's quite a lot of focus at the moment is folate and folic acid deficiency leading to spina bifida. And also, there's so many other things that can be consumed in pregnancy such as tobacco, alcohol and other drugs that can have a very damaging effect on the baby. So a good start in life starts in the womb.

We now know and we've known really for a long time the great benefits of human breastmilk in protecting babies against infection, giving them the best chance for good physical and mental development. It's really very sad that the great majority of children in this country do not get the optimum amount of breastfeeding, and I'm pretty sure that the children in North West India, that the inspirers of the Soil Association would have met, would all have been 100% breastfed.

Breastfeeding rates in Scotland have been gradually improving, but still less than 40% of babies in Scotland are breastfed for even 6-8 weeks. The World Health Organisation's targets are six months and in fact recommended for up to two years. As it happens, this area of Parkhead is one of the worst in Scotland, with only 6% of babies being breastfed at eight weeks in this very neighbourhood.

Toddlers are at that crucial stage when tastes are developed and patterns of eating are established. Unfortunately again in the UK millions of toddlers very quickly get used to eating foods that are high in sugar, salt and fat and low in nutrient value. Once that happens, many of us know to our cost how difficult it is to change their ways and the struggle that you can have to try and introduce new tastes later on.

The results are depressingly inevitable. Many children in this country develop tooth decay, like this, and it's entirely preventable through reducing the amount of sugar they eat, and brushing their teeth regularly with fluoride toothpaste. In Scotland at the moment only 45% of five year old kids have no tooth decay, and many of the others have got lots of teeth that are really falling apart.

As we all know the levels of childhood obesity have been rising fast throughout the UK – the proportion of children who are overweight in Scotland is among the highest in Europe. In 2003 the Scottish Health Survey found that 18% of boys and 14% of girls were classified as obese.

The most important cause of this type of health problem is the type and quantity of the food that young children are eating. Becoming obese then sets children on a pathway towards a host of health problems, including diabetes, heart disease and cancer. It's a pathway from which it is very hard to escape once you're on it.

There is also growing evidence that some additives in our children's food are contributing to the epidemic of Attention Deficit and Hyperactivity Disorder. Yet everywhere our kids go there are assailed with images and offers of soft drinks laden with sugar, of fat and sugar-laden snacks.

By the time that they're into their teens, when they should not only be well set on a healthy pattern of eating, they should also now be learning about nutrition and how to prepare their own healthy food themselves. And yet, sadly in this country the great majority of young people are not able to do this. Most of our teenagers are set in a very limited diet of processed food with few if any fruit and vegetables and little if any ability for preparing their own nutritious and tasty meals.

Instead, what they have to contend with is an environment which creates huge pressures to eat too much. Supermarkets and other retailers tempt us with an extraordinary array of energy-dense processed products, a disproportionate amount of advertising of nutritionally poor food, and much of it still aimed at children. Although I think we have to welcome the changes that are being brought in now in terms of advertising, particularly on television.

We've got this increasing trend to eat out or eat ready meals of dubious nutritional value at home, and a tendency for retailers to try to sell us and our children ever bigger sizes or helpings of their products, whether it's chocolate bars, muffins or soft drinks. So, many of our children subsist on a diet that's based on cereals full of sugar, white bread and chips. They live in houses well stocked with sugared fizzy drinks, crisps, biscuits and cakes. They become used to receiving, as a matter of course, presents or rewards for good behaviour in the form of sweets, chocolates or ice cream.

What has happened over this past century, as Patrick was saying, is that we've forgotten our origins as human beings. How most of us eat now is a very, very long way from how human beings have eaten throughout history until very recently. We've forgotten that our digestive systems evolved over several millions of years to enable us to survive on a mixed diet of bulky unprocessed foods – mainly grains and root vegetables, some meat or fish and fruit when we could get it. On such a diet, when our stomachs are full we no longer feel hungry and we stop eating. Our control mechanisms are gauged and set up to do that. These natural foods are generally digested slowly and enable us to keep going for many hours without feeling hungry.

Instead, most people young and old, but especially the young, are eating highly processed, energy-dense food and drink that mislead our stomachs and our control systems into thinking we're eating less energy than we in fact are. This food is also rapidly digested, which means we feel hungry again sooner with an intense desire to eat.

On top of that, many of us eat not so much because our bodies need the food, but because eating helps to satisfy our emotional and social needs. At worst eating can become a disorder, just like drug addiction, where we have an unstoppable desire to eat even though we're seriously overweight.

At the same time, lots of what the food industry is doing to enable us to eat the way we are is having a seriously damaging effect on the global environment. In tropical countries, forests are being destroyed to enable palm oil trees to be grown or cattle raised. We're rapidly emptying the seas of fish. Agricultural production and food transport are making a major contribution to greenhouse gases, leading to global warming, desertification and the flooding of low-lying coastal lands or islands.

So as well as being concerned about what food is doing to our children's health now, we need to be deeply worried about the damage global food production is doing to the world they are growing up into. But let's be positive, we know what our children and ourselves should be eating – it's all here on this huge plate.

It's a diet based on wholegrain cereals and other complex carbohydrates such as pasta, rice, brown bread and root vegetables, with a wide range of fruit and vegetables and - unless you're a vegetarian - fish and lean meat, dairy products in moderation and small amounts of fried foods, confectionery, sweet biscuits and cakes from time to time.

What's available today in our shops and supermarkets even on a very limited budget gives boundless opportunities for tasty, healthy eating, provided you know what to do and are prepared to put in the time and the effort. But how many of us actually do?

So what have I learned from my time in other countries abroad? Although it's possible to eat very healthily in the United States if you know where to go and what to get, the average diet is actually an object lesson in how not to eat. As I think you all know most Americans eat far too much of the wrong sort of food, and many of our habits, I think, are very much along that sort of model. It's no surprise that they're leading the world in childhood obesity and some of the highest rates of adult obesity as well.

In Ghana I found that they prepare a wide range of traditional vegetable based dishes, with small amounts of fish if you live on the coast and meat more inland. And what's amazing is to see for example my Ghanaian nieces and nephews enjoying hot chilli pepper stews at the age of three, and coming back for more, because they've gradually been introduced to those tastes right from square one. Unfortunately one is seeing, particularly in Akra, the capital, that things are changing and fast food joints are opening up and Western style diets are coming in.

I now want to spend a little bit of time sharing with you my admiration of French women. This started off at the age of 12, when we went on holiday in the south of France and I encountered delectable girls such as these who fuelled my adolescent fantasies! As I've grown older my admiration has extended to the more mature French woman, and particularly from a professional perspective noticing that French women live on average several years longer than women in Scotland.

I've concluded that a large part of the explanation for this lies in the food that millions of French women are cooking for their families every day. So what are the French secrets of healthy eating? It's a focus principally on three meals a day, generally very few snacks in between and balanced courses with, if the food is rich, small portions. It's very impressive that over the last 30 years or so the French I think recognise this issue of obesity. There's been a major push towards smaller portion sizes and resisting the efforts to supersize things.

Often British people when they go to French restaurants complain 'there's not enough food on my plate, this nouvelle cuisine stuff is nonsense'. But in fact it's a very appropriate approach to food for the 21st century. Lots of tasty vegetables built into the recipes and fruit, and of course meals are very much a social occasion for all the family.

This is a scene of a family that we know very well, in the south of France just last summer, outside, eating this delicious meal of steamed salmon with stuffed tomatoes, hard boiled eggs and prawns. You can see a bowl of salad there at the front, bread in the background and a little bit of wine and water to wash it down.

Later in the evening the family assembled round the table inside. They're just finishing off a green salad there with vinaigrette, you can see the apples and peaches in the foreground and some delicious local cheese to be washed down with a little bit of wine as well. Everything in moderation, delicious tastes, small amounts and you come back from the table feeling as though you've had a really good experience.

How do we move from where most of us in Scotland are at the moment to a healthier way of eating like this French family? I think we have made great progress as we'll be hearing about more today in our schools in Scotland in the last few years. As far as good examples and learning about food can come from the school, it is still only a small part of our eating lives.

We've still got a huge job to persuade, to support and enable parents to set their children on the path to a lifetime of healthier eating. But if we are to achieve a healthier balance for our bodies and our lives, the food industry also needs to change all the way from the field to our plates. For example, agriculture should be producing less animal fat. Our food manufacturers need to reformulate many products so they have more fibre, less sugar, less saturated fat and less salt. Our retailers must do much better, in making the healthier choice the obvious choice or indeed, ideally the only choice. Our caterers have to think much more about portion sizes and the calorie content of their menus and advertisers need to lay off the kids.

All this won't happen overnight and won't be easy – it will need a combination of consumer pressure, voluntary changes by the industry and where needed more financial incentives, legislation and regulation from governments and the international community.

And so to conclude, good food is of fundamental importance to good health from conception to old age. We do understand the principles of good eating, but what we need to do is to put these principles actively into practice in our schools, but also in our homes across the land and around the world.

And finally you might be wondering what's happened to my three kids after over 20 years of me feeding them, well here they are a couple of years ago. I hope you will agree that my recipe does seem to have worked, at least superficially. Thank you very much.

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