When a child is born in Amsterdam, a midwifery assistant visits the mother for six hours every day for just over a week, offering guidance and support. A nurse then checks on the mother and baby a further 10 times before the child’s second birthday.
This system is at the core of Amsterdam’s new campaign against obesity in preschool children. The city cut the number of overweight and obese under-18s by 12% from 2012 to 2015. But this overall success hasn’t been matched for the youngest children: obesity amongst toddlers has barely changed, and in 2017 the number of overweight two-year-olds in the city even increased.
With Amsterdam pursuing an ambitious aim of having no overweight kids by 2033, the city must improve the health of preschoolers. Its new First 1000 Days program, launched in summer 2017, aims to do just that. But will it go far enough?
The web of support
Most previous city anti-obesity interventions have focused on school children aged between four and 12, said Marianne Mahieu, Project Manager for First 1,000 Days. But obesity in later childhood is associated with several factors from early childhood, such as the quality of a baby’s sleep, and whether a mother smokes during pregnancy.
Since 2012 much of the city’s anti-obesity drive has involved working with 25,000 children in schools. Amsterdam has helped kids to join exercise classes, taught them to eat healthily and concentrated extra support in the poorest parts of the city.
For a child’s first 1,000 days, though, home-visiting nurses provide the main chance for the city to reach them.
In the last couple of years, efforts have been stepped up to make preventing obesity a central part of the home-visiting system. The key to the city’s new approach is intervening early: stopping obesity before it develops. Midwives and nurses are trained to identify risk factors for obesity, such as a mother's health and financial situation, and are in close contact with one another.
“We want all the grandmothers, grandfathers, the aunties and everyone to know how important a healthy lifestyle is during this period”
“Sometimes the midwife calls me to say she has a pregnant mother who’s obese,” said Siegnella Concincion, a child nurse in Amsterdam. She will then cycle over to the mother’s house to offer guidance on diet, exercise or other issues. Just giving advice doesn’t tend to work, she said. She asks mothers what they find difficult and they talk through solutions together.
Pre-natal targeting and screening is just one of several new changes aimed at boosting children’s early health. For example, the city has created a popular app to give parents information about healthy lifestyles and child growth. Medical professionals can refer future parents to customised coaching programs, while nurses can refer young children and their parents to dieticians and physiotherapists.
A community effort
As well as formal support, relationships in the community are central to the city’s strategy. The Amsterdam Healthy Weight Program as a whole works with around 200 trained health ambassadors in Amsterdam neighbourhoods, who provide informal support to families and organise healthy activities. “We want all the grandmothers, grandfathers, the aunties and everyone to know how important a healthy lifestyle is during this period,” said Maheiu.
Young kids in poor immigrant communities tend to be the most vulnerable to obesity, especially in south eastern Amsterdam which has a large Ghanaian population. This makes it even more important to engage with community leaders who help to translate their messaging into local cultural contexts.
"I’m making changes for the rest of our lives, and that takes time"
For example, despite the fact that breast milk is best for a new-born infant’s health, some Ghanaian mothers think “breastfeeding is something for poor people”, said Concincion, and that buying milk shows you have money and status.
The annual budget allocated specifically to the First 1,000 Days project is €230,000 ($270,000), with the Healthy Weight Program overall allocated €5.5 million ($6.4 million) each year. The new city council has announced its intention to invest more in the first 1,000 days in the near future, said Mahieu.
Amsterdam’s progress against childhood obesity — which has risen ten-fold in the last four decades around the world — has been rapid and impressive. But to create more lasting improvements, they need to boost the health of kids in their early years.
Fighting childhood obesity means encouraging significant lifestyle changes, said Concincion, which means they have to be patient. “I’m making changes for the rest of our lives,” one mother said to her. “And that takes time."
(Picture credit: Flickr/Merlijn Hoek)
Jack Graham
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