The Times
London, UK
20 January, 2007


Half the boy I used to be

A scheme to fight childhood obesity is expanding fast — but does it work, asks Amanda Ursell


Slim, trim and confident, Paul Sacher, 35, a dietitian, was not always so. At 11, when he hit puberty, his weight began to spiral out of control. With it came loss of confidence and self-loathing. Diets given to him by doctors were of little help, and it wasn’t until he left home at 17 that he formulated ideas on how to tackle his weight effectively. His experience has not only informed his career choice — he is a specialist dietitian at Great Ormond Street Hospital and a clinical research fellow at the University College London Institute of Child Health — but made him determined that no child should experience the misery and frustration that being large can cause.

Six years ago, with a psychologist colleague, Dr Paul Chadwick, Sacher set up Mend (Mind, Exercise, Nutrition, Do It!), a nutrition and exercise programme aimed at helping overweight children between 7 and 13 to lose weight. So far more than 300 children have attended the 40 Mend centres around the country in community centres and town halls. This figure is likely to increase significantly with the announcement last month of lottery funding. On Monday, 40 Mend programmes are being launched nationwide.

“It was very confusing when my hormones kicked in,” Sacher recalls. “I remember watching my body change before my eyes. I started to shoot up in height and at the same time developed a voracious appetite.” He loved sweets and spending hours in front of the television. “I would buy crisps and chocolate on my way home from school with any spare pocket money and eat them without my parents’ knowledge in the privacy of my bedroom.

“As I grew bigger I developed health problems that were directly linked to my excessive weight. I had asthma and joint problems in my legs and feet that made exercise, which I loathed, even more difficult, and so the cycle continued. I became increasingly hostile towards my parents as a result of normal teenage rebellion combined with anger about my weight and lack of self-confidence.”

The prescribed low-calorie diets he was given at various clinics did not work because, Sacher says, they did not get to the root of the problem, which was that he was inactive and eating for emotional reasons including poor self-esteem. When he left home for university, at 17, he startedt to combine everything he had learnt from the various clinics he had attended to tackle his weight. He started swimming, going to yoga classes, and gradually realised the point of eating well and the importance of working on his own self-confidence.

According to government figures, we are hurtling towards the sad reality that in about 15 years one youngster in five will be obese; carrying the type of excess fat that puts their lives in danger. “Basically I wondered how I could help children learn these same skills, but at a much younger age. I never wanted another child to go through the difficulties that I experienced.” In setting up Mend, Sacher persuaded nutritionists and physical education teachers to come on board, and won funding from local health authorities and primary care centres. He devised a nine-week programme of two, two-hour evening sessions a week, to be attended by both the child and a chosen parent. The first hour focuses on understanding the psychological reasons for overeating (a child may be comfort-eating because of a family trauma) and food education (using specially designed games, supermarket trips and tastings). The second hour is devoted to getting the child active by playing games or going swimming.

If this sounds like a formal, stuffy, back-to- the-classroom approach, such an impression could not be farther from the truth. The word diet is avoided; weekly goals are set, such as eating breakfast daily or walking to school; and the emphasis is on teaching the children how to achieve and keep an acceptable body size for life; the body mass index (BMI) is used as a measure, instead of using scales.

But do the parents of obese children find Mend effective? Maria, whose nine-year-old son Alexander reduced his BMI significantly and completed the course last year, says she found it helpful that both parent and child attended together. “I think it’s important that your child doesn’t just think that it’s mummy being an ogre, but for them to see it for themselves why it’s good to eat healthily.”

Helen Ball, the mother of 15-year-old Mathew Williams, who completed the Mend programme four years ago and has maintained his healthy weight since, agrees. “Children need to be able to make healthy choices but they can’t make choices if they don’t know the whole picture,” she says. “Mend teaches them the implications of poor choices and explains the benefits of healthy ones.” It is all about children and parents working together.

"One of the main thrusts,” Sacher says, “is to assist parents in understandinghow to help their children change their behaviour without risking setting them up for failure and reducing their self-esteem and confidence.” :image:
Until now you would have been lucky to have found a Mend programme close to where you live. All this is about to change with funding from two vital sources, allowing the Mend organisation to extend its programmes nationwide. Last month the Big Lottery Fund announced a £8 million grant, which will provide most of the funding for local partners to run 1,610 Mend programmes at 230 sites across England over the next two years. This will make Mend the largest integrated childhood overweight and obesity treatment and prevention programme in the UK, probably even globally. Money from the funding will help to train local Mend teams.



Sainsbury’s has also recently pledged £3 million for another 450 programmes over the next three years. So things are looking good for the many thousands of children set to benefit from Mend. But Sacher’s dream does not end here. “Every child should have access to a Mend programme. Only once this happens can we realistically feel that we may be able to change the future course of obesity statistics.”


If you are interested in joining a Mend programme visit www.mendprogramme.org. If your area is not listed, complete the form on the website as 200 sites will start this year.


'It changed my life'

Matthew Williams, 15, from North London, went on the Mend programme in 2002

“I began to put on weight at the same time that I started being bullied at school. I used to comfort eat. I’d eat everything. I’d finish dinner and go straight to the biscuit tin and carry on eating. I put on about 3st and the bullying became worse. Then my mother found out about Mend from the school nurse and suggested that I go.

“I attended two nights a week for nine weeks and was taught what foods are healthy. I was given things to taste, so that

I could work out what I liked. Going to Mend was fun at a time when I was feeling bad about myself. There were also psychology classes, which were held with other children. They made me realise that I was just as good as everyone else. In the class we were encouraged to say nice things about each other and to write down the comments so that we could remind ourselves of them later.

“I also went swimming with Mend twice a week and because the centre was away from my local area I felt OK about being myself. Now, if I feel down, instead of eating I play my guitar. And now that I have lost weight I have found that I’m less clumsy and more confident. I don’t get out of breath or sweat like I used to and my asthma has improved.

“Mend is definitely worth going to, not just for kids but their families too, it changed my life and Mum’s even eating healthier, too.”


Go by the book to keep them slim

Junk-Free Children’s Eating Plan, by Lorraine Kelly, with Carina Norris, a nutritionist (Virgin Books)
A six-week eating plan designed to de-junk your family’s diet, thereby weeding junk from your children’s school lunchboxes. This book is designed to help parents set a model of healthy eating at home. There is advice about getting more activity into family life and a chapter of simple healthy recipes, including omelettes, turkey burgers and berry pancakes. It is sensible, practical and easy to use.

Super Foods for Babies and Children, by Annabel Karmel (Ebury Press)
Designed for children up to 3 years, Karmel helps parents to learn how to feed youngsters well from the word go. “What we feed our children today will determine their future tomorrow. A well-stocked larder is the best form of preventive medicine,” she says. There is plenty of basic information about nutrition and what makes a healthy diet from the moment you begin to wean your child through the toddler stage. Recipes such as noodle soup and fajitas are suitable for the whole family.

They Are What You Feed Them, by Dr Alex Richardson (Thorsons)
Dr Richardson is a research fellow at Oxford University working in nutrition and brain health, and specialising in helping children with learning difficulties. She shows how a few simple changes to how you feed your children can make a huge difference to their behaviour. She explains the effects of specific nutrients such as omega-3 fats on brain health. There is also a small chapter of recipes. This is a dense, photograph-free book, not for the faint-hearted.


Dumping the junk

Dr Paul Sacher, the founder of Mend, the nutrition and exercise programme for overweight kids, answers your questions

How do I deal with my child’s inevitable trips to fast-food places with his friends?

If you have helped your children to understand the way different foods affect them, the chances are they may make healthier choices when presented with burgers, fries and drinks. In fast-food restaurants, a straightforward burger with a juice is better than a double cheese burger with large fries and a vat of cola.

My ten-year-old daughter is invited to a lot of parties. Should I send her with her own healthy party food? This is likely to make her feel the odd one out. Mend recommends that a child eats a healthy meal before going so that he or he is less likely to fall on the party food. Find a time to discuss with her how sandwiches, jelly and ice-cream are better than pastry-based food and biscuits and cakes. This way she can join in without feeling guilty.

My mother will not accept that my 11 and 13-year-old boys are overweight and insists on giving them treats behind my back. How do I make her understand that she is doing the wrong thing? This is a tricky situation. The best advice is to have a word in private. Explain that if you don’t work together to help your sons they could have serious medical problems later in life. Also, give your mother suggestions for healthy treats so that she still feels she is indulging her grandchildren.

I have one overweight child and one thin one. I don’t want to deny the thin one treats; how do I do this without exacerbating the other’s problem? Healthy eating practices at home for all of your children will help them to maintain a healthy weight throughout life. Just because a child is skinny and you can’t see the damage junk food is doing doesn’t mean that the damage is not being done.

My daughter is becoming independent and making her own snacks and meals. How can I steer her to healthy choices without turning into the food police? Make sure that your cupboards, fridge and freezer are stocked with healthy foods from which she can make her meals and snacks, and buy cookery books that are full of naturally healthy balanced recipes.

My child is putting on weight, but doesn’t seem to be growing in height as fast. How do I know whether it is puppy fat or if he is becoming overweight? You can’t judge just by looking at your child so it is important to measure his height and weight and work out his body mass index (there is a calculator on the Mend website, mendprogramme.org, to help you do this). It’s also a good idea to have your GP measure his growth rate every six months.



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