Need for nutritionists

Starting them young: Dr Hazreen said schools should look into activities such as inculcating the habit of planting vegetables among their students. – Filepic

Proper diet and conducive environment as crucial as BMI checks in weight management, experts say

KNOWING what encompasses a healthy lifestyle should start from a young age.

Educating schoolchildren on its importance is vital if we are to raise a healthy and active generation of youths.

The Education Ministry’s recently announced BMI 5-9T (see infobox), which focuses on tackling obesity among pupils aged five to nine by measuring their body mass indices (BMIs), is important but Nutrition Society of Malaysia president Dr Tee E. Siong cautioned that if not handled properly, it could backfire, causing children to ridicule each other over their weight.

“For this reason, it has to be properly implemented by nutritionists instead of teachers, with the participation of parents, as nutritionists are professionally trained to carry out the measurements.

“This is especially important for young children, where errors in measurement can make the BMI value invalid,” he told StarEdu.

Having nutritionists in schools to conduct the checks, which will be done twice a year on an annual basis for children of that age group, will allow the process to be done in a more professional manner as these professionals are trained to use their discretion in handling BMI data, he said.

Nutritionists do not publicly name children who are not within the healthy range; are trained to do follow-ups for children who are out of the healthy range, such as those who are underweight, overweight and obese; and can provide the necessary advice to parents in helping these children attain and maintain a healthy body weight, he explained.

“This includes healthy eating messages and doing physical activities. In severe cases, nutritionists can even make a referral to the relevant professionals for additional treatment.

“If BMI 5-9T is properly carried out with nutritionists handling the activities, our children will benefit greatly. Nutritionists can conduct a number of other food and nutrition-related activities, as well as simple nutrition messages,” he said, adding that these messages can have a lasting impact on children well into adulthood.

Get parents involved

Parents, Dr Tee said, must be kept informed of their children’s BMI measurements and other nutrition-related matters, stressing that they should also familiarise themselves with BMI measurements and learn how to carry them out by themselves.

Universiti Malaya Assoc Prof Dr Hazreen Abdul Majid said if programmes like the BMI 5-9T are to be done effectively, parents should be informed of the outcome so as to enable them to plan their next steps.

Dr Hazreen is the Medicine Faculty’s Centre for Population Health, Social and Preventive Medicine Department head.

It’s extremely important to carry out BMI checks correctly, he said.

“Monitoring their weight and height is a good start because that is how you want to monitor whether they are in the healthy weight range.

“But bear in mind that during this period, children are growing so we should not only look at their BMIs for age, but we should also monitor their weight circumference.

Dr Tee: Having nutritionists in schools to conduct BMI checks will allow the process to be done in a more professional manner as they are trained to use their discretion in handling BMI data.Dr Tee: Having nutritionists in schools to conduct BMI checks will allow the process to be done in a more professional manner as they are trained to use their discretion in handling BMI data.

“The weight circumference for older children will be able to tell if they have more composition of fat in their abdomens,” said Dr Hazreen, who is also an adjunct professor at Universitas Airlangga, Indonesia, and a Universiti Malaya Medical Centre consultant dietitian.

Other methods to effectively implement the BMI 5-9T programme include educating the pupils on why their BMIs are being checked, as well as changing parents’ perception that their overweight children are “cute”.

He also emphasised that collaboration is key, stating that there must be cooperation between schools, parents and parent-teacher associations.

Schools should look into activities such as inculcating the habit of planting vegetables among their students, he added.

“The ministry could work with universities which have done studies to show evidence of unhealthy lifestyle practices, as well.

“These are important steps because it’s easy to come up with such plans but often, we do not follow up properly.

“We say we want our children to eat healthier, but how are we educating them? What kind of knowledge are we giving them? What if they want to bring food from home? Are they given ideas of what they can bring?

“How healthy is the food that’s being sold in school canteens? We must ensure there are healthy options for students, while reducing items like sweet drinks and foods like sausages, as well as implementing strict guidelines and regulations (on canteen operators).”

Some parents may contend that their children are small eaters despite being overweight so it is crucial to take note of the latter’s eating habits, said Dr Hazreen.

Questions like “What are they consuming – is it a drink that is high in sugar? Is the cheese high in fat? Will it fill their stomachs?” are important.

Dr Hazreen: It’s important to educate pupils on why their BMIs are being checked, as well as change parents’ perception that their overweight children are ‘cute’.Dr Hazreen: It’s important to educate pupils on why their BMIs are being checked, as well as change parents’ perception that their overweight children are ‘cute’.

“There are many aspects to leading a healthy lifestyle. Simply monitoring one’s weight alone is not enough.

“We cannot just tell pupils to reduce their weight based on their BMIs without providing them with an environment that’s conducive to do it.”

Dr Hazreen and his team are conducting an ongoing study, titled “Malaysian Health and Adolescents Longitudinal Research Team”, on 13-year-olds who had their blood samples, diet practices and physical activity levels measured.

Involving 1,361 Form One students, their health status was monitored until they turned 17.

The team was led by Dr Hazreen as the principal investigator.

Upon examination and the subsequent follow-ups, he found that 25% of the students surveyed were obese and overweight and that about 13% of overweight students maintained their weight until they were 17.

This shows that educating children early on about maintaining a healthy lifestyle until they complete their secondary education is vital.

Only then, he said, will they feel empowered to make a change.

“Overweight children are at a higher risk of contracting non-communicable diseases like diabetes.

“The number of younger people developing non-communicable diseases, according to the Health Ministry’s national health and morbidity surveys, has increased. We have to do more.

“Having said this, it doesn’t mean that an overweight child will definitely be diagnosed with diabetes but it’s crucial to take action now while the person is still young to save him or her from contracting any diseases later on in life.”

Having the right knowledge, being willing to try different options and having more healthy food choices are other important factors that can create a healthy domino effect.

While he agreed that the recent increase in prices of vegetables and poultry may make it harder to eat healthy, Dr Hazreen suggested buying locally produced groceries as a more affordable and nutritious alternative.

“Why do we always buy healthy food as defined by the Western culture, such as salads and quinoa, instead of buying local produce which have extremely high nutritional value and may even be cheaper?

“Local foods like pegaga and pucuk ubi have very high nutrients and can be planted in our homes.


“Instead of buying imported fruits, why not go for locally produced ones like papayas and guavas? Guavas have richer Vitamin C than oranges,” he said.

Beware of body shaming

Developing best practice recommendations in tackling obesity among schoolchildren, said counsellor Bawany Chinapan, should be based on a systematic approach.

Such recommendations must be developed in accordance with critically appraised research findings.

Biological, cultural, environmental, socioeconomic and community factors, lifestyle, and living conditions should be considered in drawing up long-term solutions.

Commenting on the BMI 5-9T programme, Bawany, who is a senior lecturer at HELP University, cautioned that teachers taking the BMI measurements must be mindful of making seemingly innocuous phrases that can cause a deep psychological impact on children.

Phrases like “healthy body composition” should be used instead of “ideal body composition”, she suggested.

“It’s important how a statement is phrased and what words are used as these can influence how a child views his or her peers.

“We need to address childhood obesity holistically instead of targeting obese individuals as this may be detrimental to their psychological well-being.

“Some may be more prone to mental health issues in later years,” said Bawany.

Citing a study carried out in Singapore during the implementation of the Trim and Fit programme in the country’s schools between 1992 and 2007 as an example, she said the study which targeted child obesity left psychological effects on the students as it gave rise to eating disorders.

“Children can feel sidelined, and lose their self-esteem and self-confidence if targeted.

“So any programme targeting obesity among children must be done carefully to prevent them from feeling stigmatised and developing body image issues later in life.”

Body weight or size, which comes with a set of stigmas, stressed Dr Tee, can potentially cause psychological distress for pupils.

While Dr Tee emphasised the importance of having nutritionists involved to ensure proper implementation, National Union of the Teaching Profession secretary-general Wang Heng Suan said measuring pupils’ BMIs is not new to teachers.

Wang said this has always been part of their administrative tasks.

“We’ve been measuring the BMIs of students from Year One to Form Five for years. It is just that the recently announced BMI 5-9T programme is more targeted at a particular age group.”

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