The PASOS study has become a reference when evaluating the lifestyles and health of Spanish children and adolescents. The latter showed a notable deterioration in the emotional and physical health of the population between 8 and 16 years of age since the pandemic. The percentage of children who feel sad, worried or unhappy has gone from 19.5 to 32.2% between 2019 and 2022. In addition, their adherence to the Mediterranean diet has decreased, the practice of physical activity has decreased, they have increased addictions to screens and there are more and more children, especially adolescents, who go to bed too late.
And that children today lead less healthy lives is surprising because never before has there been so much information on what is or is not healthy, on how to prevent diseases or on emotional education. For this reason we have asked the coordinator of these investigations, Santi F. Gómez (Cornellà de Llobregat, 1983), what is happening. Do families fail? Does education fail? Is the health system failing?
And the first thing that he made clear in the interview held at the headquarters of the Gasol Foundation, of which he is director of programs and research, is that families must be blamed, that it is not "a voluntary decision" of parents who children eat poorly, sleep worse, or exercise less. And it is not a matter of blaming everything on the covid pandemic either "because between 2000 and 2019 we had already seen a deterioration, and what the pandemic has done is accelerate it."
So what's wrong?
Mainly - and this is also pointed out by the WHO - it is society: children live in obesogenic environments, more and more.
What does it mean?
That they live in environments where going out to do physical activity or simply to play outside is increasingly unlikely. Which are environments where they are increasingly exposed to ads for unhealthy foods that encourage them to eat that. That, especially those of a low socioeconomic level, live in environments where there are fewer and fewer establishments such as greengrocers and greengrocers and more sales of ultra-processed and plastic-packaged products. And they are environments in which having a pleasant rest is less and less likely because the apartments are increasingly crowded, there are more families that share apartments with others or that have to live in a single room...
And in these environments, families receive many stressors and few activities that contribute to their psychological well-being, and that stress ends up cascading from parents to children.
Is it a socioeconomic problem then?
Undoubtedly, the deterioration of children's lifestyles is associated with the increase in social inequalities, because the environment in which many families live increasingly limits their ability to discover what it means to live in a healthy way. A few decades ago it was natural to live healthy; now it is less easy, you have to look for it, you have to have the intention to achieve it.
And what would you say is the most serious problem affecting children's lifestyle and health?
At the Gasol Foundation we work with the metaphor of the healthy galaxy, a galaxy that has four planets: physical activity, diet, sleep and emotional well-being. And we believe (although we have not yet been able to scientifically prove it) that what has a greater influence on the whole of that galaxy is emotional well-being.
Because?
The fact that children grow up happy, with good self-esteem, wanting to have fun, to play, to discover... pushes them to do physical activity, allows them to sleep adequately at night and eat more balanced during the day. Because human beings tend to compensate for many dissatisfactions with what we eat and, the greater the dissatisfaction, the more we eat products high in sugar and fat because they manage to awaken pleasure in our brain.
That is why we are concerned about the deterioration of emotional well-being in the comparison between the PASOS 2019 and 2022 study, because we do not know how long it will take to harm the rest of the lifestyle factors and cause profound damage to the health of that generation. but we know it will.
Another of the contradictions that attracts attention when lifestyles are analyzed is that we live in a time of great concern for health and image, but also of very high rates of obesity. Because?
Aesthetic pressure has grown a lot in the last 15 years and this growing stigma around weight does not contribute to less childhood obesity, on the contrary. The fact that it is more difficult for us to accept our body makes us have less healthy behaviors. We see how boys and girls who are obese tend to hide more in physical education classes for fear that the rest will judge them, or they have less desire to go play in the park so they don't laugh at them... That takes to prioritize sedentary activities, at home, which is a safe environment where they do not receive accusing glances or are judged... And they tend to feel worse about themselves and the pleasure they do not find in having fun with other children they go to seek through video games or food.
Does this mean that weight concerns are behind the rise in obesity?
We should relax and subject the community less to that aesthetic pressure and that judgment around weight. Aesthetic pressure goes against the well-being of children, and we should prioritize well-being over weight, because focusing so much on obesity may be causing negative consequences.
I don't know if this message will be very well received by pediatricians...
Obesity is a relevant indicator at the epidemiological level, but when we interact with the child or the family we should never focus on weight. If a child is obese, his parents already know it and so does he, and focusing on that can only cause his psychological well-being to deteriorate further. Therefore, it is not a matter of focusing on his weight but on discovering and exciting them with what a healthy lifestyle means. All bodies are healthy if they follow healthy habits, regardless of the genetic load with which one has come into the world.
And how is this change of focus achieved?
Childhood obesity is a social disease. It is a disease because it affects people's health, but it is not solved in primary care centers or hospitals, it does not depend only on the health sector. It is the whole of society, from political leaders to architects, urban planners, journalists, food stores, the primary sector, schools, sports and social entities, community organizations... who can and should contribute to promote a lifestyle. The baker who sees you in the morning and asks you when you are a child how you are doing influences your psychological well-being, because you identify that there is an adult in your community who is interested in your well-being... And that that baker gives you a piece of bread or a lollipop also affects your lifestyle.
For that healthy lifestyle, one of the legs that fails is physical activity. How is it justified that in Spain, despite its good climate and reputation for being sociable, children are more sedentary than in the Nordic countries?
There are many factors, with different levels of influence. One is the environment that surrounds the place where we live. We have seen that the population between the ages of 8 and 16 who live in less walkable environments do less physical activity. So how we design cities is a very clear factor. Then, there is the irruption of the use of screens: if the child prioritizes being in front of the TV or the video console, it means that he is not in the park playing or jumping. The lack of time and conciliation is another factor, and cultural changes too, because before it was typical to participate in a community of neighbors and go on excursions on the weekend. Now families go to the mall, which in addition to being sedentary leisure promotes the desire to buy a soft drink, fast food or a video game console.
If it were in your power to implement measures to solve children's health problems, what would be the first? What is the most urgent?
The national plan to reduce childhood obesity that was approved last year contemplates 200 measures and, of these, we believe that the structural ones must be prioritized. For example, the tax authorities: put taxes on unhealthy products, such as sugary drinks. There is scientific evidence that this reduces its consumption, and it affects above all the population with a lower economic level, which is the one in which the lifestyle is more deteriorated.
Any other priority measures?
Protect children from advertisements that promote the consumption of products that science has already shown do not benefit their growth but deteriorate it. And then favor that the environments where children grow up are promoters of physical activity.
As?
With parks that really motivate them to play, sidewalks that allow them to go to school safely on foot or by bike, improving the perception of safety so that children can go out without parents worrying about something happening to them... And noise and environmental pollutants should also be reduced, because this contributes to better sleep and a healthier lifestyle. To this we must add measures so that families discover the benefits and well-being that a healthy lifestyle can bring about, which is what we try to do with our foundation's programs.
(During the interview, Santi F. Gómez always refers to the child population as boys, girls and adolescents, although La Vanguardia has opted for the generic masculine when transcribing it)
