Melaine McLean | National School Nutrition Policy is urgent hope for children

The National School Nutrition Policy, which is currently awaiting Cabinet approval, signifies a national commitment to improve and prioritise the health of children in Jamaica. The policy provides a national framework that encourages and facilitates healthy eating habits through nutritious and cost-effective meals in schools for students. It also restricts access to, and marketing of, unhealthy foods in and around the school environment.

With the implementation of this policy, students will be offered food options that meet nutritional standards and guidelines, improving their nutritional status and, consequently, their physical, mental, and social health as they grow.

Similar to many low-income and middle-income countries, Jamaica suffers from the double burden of malnutrition, where undernutrition that causes stunted growth and wasting from inadequate nutritional intake, coexists with overweight and obesity. The Jamaican Youth Risk and Resiliency Behaviour Survey 2005 found that “25-33 per cent of the school-age population arrives at school hungry or without having eaten anything on a given schoolday” (Fox & Gordon-Strachan, 2007). Studies have long corroborated what we know intuitively — a hungry child cannot learn optimally.

Children who are undernourished have been shown to have impairments in learning, development, and behaviour, resulting in poor concentration, difficulty focusing and low academic performance. The National School Nutrition Policy aims to address this inequity by tackling short-term hunger, particularly in low-income and vulnerable students.

Over the past three decades, increasing urbanisation, economic growth and globalisation have ushered in a dietary shift away from the consumption of unprocessed and minimally processed indigenous staples like grains, legumes (peas and beans), fruits and vegetables. Globally, we are eating more calorie-dense, highly processed, and nutrient-poor foods, typically high in sugars, salts, saturated fat and trans fats, and low in dietary fibre. This dietary change, coupled with a more sedentary lifestyle with decreased physical activity, has driven the global obesity epidemic, with global obesity nearly tripling since 1975 (World Health Organization, 2018).

NUTRITIONAL TRANSITION

The COVID-19 pandemic has not helped this situation. Jamaica, too, has undergone this nutritional transition, with more children and adults eating unhealthy foods and sugar-sweetened beverages, leading to an increase in people at unhealthy weights. In fact, the 2016-2017 Jamaica Health and Lifestyle Survey (III) revealed that one in two Jamaicans 15 years and older is overweight or obese, a worrying 76 per cent increase from 2000.

This rise is concerning because obesity is a major risk factor for the group of predominantly diet and lifestyle-driven and largely preventable diseases known as non-communicable diseases (NCDs). Non-communicable diseases include such chronic diseases as hypertension, heart disease, Type 2 diabetes mellitus, kidney disease, as well as multiple types of cancers. Jamaica has experienced a precipitous increase in the prevalence of NCDs, with 80 per cent of preventable deaths in adults attributable to NCDs. And most of these deaths are diet-induced.

Unfortunately, the childhood obesity picture in Jamaica mirrors what is currently being seen in the adult population. The 2017 Global School-based Student Health Survey report on students in Jamaica revealed that 23 per cent of students ages 13-17 years were overweight and/or obese. That’s nearly one out of every four students. The survey also shows an almost doubling of obesity rates in boys (94 per cent) and a 47 per cent increase in girls, when compared with 2010. These are troubling statistics because many studies have shown that overweight children have a higher likelihood of becoming overweight adults with an increased risk of developing NCDs. Even more worrisome is the fact that children and adolescents can develop the same obesity-related conditions as adults, like hypertension, Type 2 diabetes, and high cholesterol. I have, unfortunately, seen this first-hand in my paediatric patients while practising in New York City.

Jamaica is special to me because I was born and raised here. From my own experience growing up, I know that parents and families want the best for their children — they want them to be healthy and they are prepared to do whatever it takes to accomplish that goal. This is why the National School Nutrition Policy is so vitally important — it can be an integral part of a multi-layered and multi-pronged approach to reversing the current upward obesity trends in our children, so they can live long, healthy and productive lives. The school environment is an ideal setting to promote and facilitate healthy eating habits, since a large number of children can be reached for potentially wider and deeper impact. Children will eat tasty, nutritious foods, and at the same time be educated about healthy food choices, and perhaps begin to make some of those dishes themselves in home economics classes at school or when they return home.

Fortunately, there is reason for hope. Other countries have wrestled with the health consequences of rising obesity rates on their populations and seen some positive results. In the early 2000s, for example, in New York City, the rising rates of obesity prompted an urgent response by local government and other stakeholders, with the goal of devising innovative and creative ways to meet this health challenge.

REGULATE FOOD ENVIRONMENT

As a result, New York City (NYC) became the first major city in the United States to regulate its food environment by setting nutrition standards for all foods and meals purchased and served by all city agencies. New policies and initiatives were enacted to ensure that nutritious foods were served in NYC public schools, with its 1.1 million students: a wider variety of fruit and vegetable offerings, banning soda from school vending machines, limiting sugar-sweetened beverages in schools by regulating the number of calories allowable in an 8oz serving, substituting whole milk with low-fat milk, and installing water fountains in all NYC schools.

These standards were further strengthened in 2010 with the passing of the Healthy, Hunger-Free Kids Act (HHFKA), a piece of legislation that required schools to offer increased servings and varieties of fruits and vegetables, more whole grain-rich foods, and decreased saturated fat and sodium. Another initiative, called Grow to Learn NYC, targeted the childhood obesity problem by creating vegetable gardens in NYC public schools, giving students the opportunity to grow, harvest and taste their own foods, while teaching them about healthy foods. While there is still significant concern around childhood obesity levels in NYC, sustained improvements in obesity trends are being seen (Day, et al., 2020). Jamaica has the opportunity to act even more quickly to halt or even reverse the negative trends in its children.

Children are every nation’s future. Having seen the pain and fear of families whose children are diagnosed with Type 2 Diabetes or hypertension, and knowing that this can be prevented through intentional policy shifts, I am eagerly awaiting the implementation of the pioneering National School Nutrition Policy. By itself, the policy may not lead to the complete elimination of the obesity and NCD challenges Jamaica currently faces, but it is a proven and necessary starting point in fulfilling our collective responsibility for every child in Jamaica to have the best possible health and reach their full potential.

- Dr Melaine McLean is a Jamaica-born, New York-based public health practitioner and paediatrician. Send feedback to ghapjm@gmail.com or columns@gleanerjm.com