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The now famous Eat My Lunch, lunchbox.
The now famous Eat My Lunch, lunchbox.

SocietyJuly 16, 2018

Lunchbox shaming matters – but combatting childhood obesity matters more

The now famous Eat My Lunch, lunchbox.
The now famous Eat My Lunch, lunchbox.

The debate about lunchbox shaming risks leaving us powerless to combat a far greater health emergency, writes public health consultant Victoria Mulligan.

Dr Rebekah Graham last week called to end food policing and “lunchbox shaming”, claiming that it’s hurting our most vulnerable families.

Her research uncovered the challenges that some families face in providing food for their children. She started a conversation that New Zealanders need to have: about the health of our children and how families are best supported to protect it. But though she raised plenty of questions, her piece was short on answers.

My concern is that it’s counterproductive to focus on so-called “shaming”, when it forms a comparatively minor story in what is the number one health issue facing New Zealand: obesity. New Zealand has the third highest obesity rate in the OECD. Instead of fixating on whether or not a Le Snak should be on the banned list, we should be discussing what we can do right now to make change happen, who should have responsibility for what and how we can best support the families and communities that are struggling.

The biggest problem with overweight children is that excess weight continues into adulthood; obesity has now overtaken tobacco as the greatest risk driving death and disability in New Zealand. Diseases associated with obesity – type 2 diabetes, cancers, strokes, cardiovascular disease and hypertension – are set to cripple our health system.

We see these medical terms so often now that we forget what they mean – New Zealanders with type 2 diabetes going blind before the age of 40, having limbs amputated in the prime of their life, our youngest members of society going under general anaesthetic to have rotten and infected teeth removed. Yet all of this is entirely preventable, and childhood is where we do the preventing.

Dr Graham is right that fighting obesity is harder for disadvantaged communities, who work long minimum-wage hours, returning to substandard living conditions with little time or money to prepare healthy meals. There has been an uneven growth of fast food outlets compared to grocery stores and fruit and vegetable shops in these communities, and this greater availability of high energy, low nutrient food matches a drop in physical activity. Even those lucky enough to have money for food have little choice but to spend it on the products of poison and disease that surround them.

But labelling as “shamers” anybody who tries to address these problems risks undermining the few positive attempts we’re making to fight back against this health crisis. Research shows that, as children age, the control that we as parents have over their access to unhealthy food and drink declines. For now we can control what goes into their lunchboxes five days a week so, yes, any shaming over what’s in there is unacceptable, but we need to ask what is acceptable?

Obesity is disproportionately a disease of poverty. But poor people are obese due to lack of options, not a lack of will power. We live in an incredibly unhealthy food environment; fatty, salty, and sugar-laden foods have become the norm. Families buy bad food because it’s cheap, it’s fast, it’s tasty and it’s heavily promoted with bright colours and cartoons – it’s what children learn to prefer. And if you want to ensure you’re kids are eating when they’re away from you, it’s what you put in their lunchboxes.

In Dr Graham’s interview on RNZ she said that healthy food is a class construct. I don’t agree. Yes inequity is a huge problem in New Zealand, and the burdens of an unhealthy diet fall much harder on people in disadvantaged situations, but there is little debate across populations as to what unhealthy means. If you want to put fizzy drinks in the “subjectively unhealthy” category then you have to put cigarettes in there too.

Most alarmingly she said that she wasn’t convinced education was a solution, and that obesity wasn’t caused by unhealthy food but by stress brought on by food insecurity. I agree that more cash is part of the answer, but though that would solve the short term hunger (and this is priority number one) we create more problems if we’re not equipping parents with the knowledge to know good food from junk. There’s more than one way to educate of course, and given the unhealthy environments our poorest families are trapped in we need to reach beyond them to the decision makers – central and local government, school principals, Boards of Trustees, church leaders – to help spread and support the message.

Parents need to encourage healthy lifestyles by providing our children with healthy food and drink options, and they need to know what those looks like. It’s incredibly sad that guidelines on healthy lunchboxes provided by schools, or notes sent home are regarded as shaming, and because individual responses to those notes are subjective, I can’t argue about how something is making you feel. But I can confidently state that schools are doing this with the intention of helping, not shaming. With a couple of exceptions highlighted by Dr Graham, schools are on track with these guidelines – let’s not throw them out because of they make us feel upset.

As to shaming by other parents, does this happen? I’d be against this if it’s a real problem but as a parent I don’t think I’ve ever seen inside the lunchbox of a child who wasn’t my own. Are some parents coming back to school at lunchtime, hanging around the quad taking photos of unhealthy food then instagramming them with critical comments? If so then yes, I am against that too.

If lunchbox notes are imperfect is there a more collaborative option? If so, let’s work on that.

Glenview School in Cannon’s Creek has shown how schools can shift the culture of nutrition. Glenview has prioritised good nutrition for 20 years, since formalising a healthy eating programme in response to poor health outcomes in the community. What began with careful lunchbox inspections became a major culture shift around food. Students at the school now routinely arrive with sandwiches and low sugar snacks –  it’s become the new normal, as has rejecting unhealthy food. Charitable support has ensured children without access to healthy lunches receive them, and nobody goes hungry.

But the obesity crisis that New Zealand faces is mammoth and complex, and it can’t be tackled effectively at home or school without structural change. It is incredibly difficult to change unhealthy behaviours when you live in an unhealthy environment, and efforts to prevent the diseases of obesity must go up against the money and power of the sugar industry. Government needs to show leadership and implement WHO-recommended policies without industry interference, or at the very least hold them to account when they are involved.

We need to legislate around the advertising and marketing of unhealthy food, and urgently introduce a health levy on sugary drinks, with money going to prevention. Evidence is starting to emerge from countries brave enough to bring in such a levy, that it effectively changes behavior and consumption.  Polls show the public supports taxes on unhealthy foods if the funds are used to subsidise healthy options or promote health.

Legislative change is not a fix-all – social inequalities will still remain, but what we are learning is that regulation helps. If we want to make meaningful inroads into relieving childhood obesity such structural change is essential.

A comprehensive approach to addressing obesity is required, tackling the environment that we live in, and supporting family and community efforts to provide healthy food. It’s easy when debating health policy to forget the very human effects of the decisions making – in this case, that what we’re feeding our tamariki right now is creating the first generation of children who will die younger than their parents. How do we stop this, effectively and urgently? Lunchbox police may not be the answer, but until we have something better let’s ease up on the schools who care enough to try and make a difference.

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