06/25/2024

Dr Antonis Kafatos, Professor of Preventive Medicine and Nutrition, University of Crete

Obesity in our country has reached epidemic proportions in the recent decades. Excess weight and obesity are accompanied by many factors, leading to cardiovascular diseases, cancer, type II diabetes, osteoarthritis, thrombophlebitis and other chronic diseases. A recent study, funded by the Regional Administration of Heraklion in a representative sample of 505 people aged 20 to 65 years old in the area of Messara (6 municipalities with a population of 42.000 citizens), showed that 87% of the sample was overweight or obese. This percentage exceeds even the relative samples of the U.S and Western Europe. A representative sample of children aged 9-17 years from the Heraklion region, which was examined in 1982, showed that 20% of the children were overweight or obese. An examination of children of the same age group in 2002 showed that the percentage had doubled (40%).

Undoubtedly, the consumption of food with high energy density such as biscuits, chocolate, chips, pizza, ice cream, fast food, along with a sedentary lifestyle and lack of adequate physical activity has led to this situation. Various factors contribute to the rapid expansion of this epidemic such as the lack of bike lanes and even sidewalks, lack of adequate sports facilities, television programs which constantly advertise unhealthy food and beverages and a general lack of national policy on prevention, nutrition and physical activity. A crucial factor that plays a major role in child obesity is the lack of breastfeeding. The composition of cow's milk is sufficient to ensure the rapid growth of calves, which complete their development until the age of 18 months. On the contrary, breast milk has a different composition for a child’s development which is completed in the age of 18 years old.

It is observed that 80% of women who give birth in public or private maternity hospitals in Heraklion don’t even try to breastfeed their children. On the contrary, in Scandinavian countries, 80% of the mothers breastfeed their infants exclusively for 6 months and continue breastfeeding along with other foods until the 12th month.

One of the main reasons that mothers in our country don’t breastfeed their new-borns is due to the baby food companies, which have branched out to all private and public maternity hospitals. These companies very often offer gifts like cow’s milk and feeding bottles to the mothers as well as approach the nurses which in return, without asking, feed the newly born with their products. This is the main reason for the lack of breastfeeding in our country. This way it is easier for an infant to accept milk from the feeding bottle rather than attempting to breastfeed which is more complicated. In addition, once the baby has tested the sweetness of the bottled milk, it is unlikely to accept or attempt to breastfeed.

In the rare case where a mother manages to breastfeed after her baby has tried bottle feeding, it is observed that the infant does not increase its body weight as much as it would if it was fed with other types of milk. Breastfeeding is the right way of feeding the newly born because they should have low weight in that age in order to prevent or reduce future danger of obesity. Unfortunately, baby food companies exploit this fact and find different ways of sending false messages to the mothers, making mother’s milk appear "weak" and inappropriate, prompting them to replace it with their company’s milk.

These companies even reach to the point of advertising that children who feed with their milk will become more intelligence in comparison to the ones who breastfeed because their milk contains omega-3 fatty acid. This is completely absurd and is without any scientific basis because mother’s milk has the ideal composition and the necessary amount of omega-3 fatty acids that ensures optimal brain development for the infant. Too much omega-3 fatty acids is detrimental because it is susceptible to oxidation, resulting free radicals to form peroxides of fatty acids that increase oxidative stress very early in life. Oxidative stress is responsible for all chronic diseases such as cardiovascular and nervous system, various cancers, leukaemia, etc. This is the reason why all mothers should demand to have their newborns to be next to them during their stay at the clinic, if the babies are healthy, in order to ensure that the clinic staff won’t feed them with any bottled milk. In addition they shouldn’t accept gifts from baby food companies. In order to do so, a mother should be prepared and accept from the last trimester of her pregnancy that she is going to breastfeed her baby exclusively without any other type of baby food. This is the best method to ensure that the infant will have excellent physical and mental development. As long as the mother has a sheer will and determination, there is no way of failing with breastfeeding. Furthermore, before the 50's and 60’s all mothers breastfed their infants. In rare cases where a mother could not breastfeed her child, she would have found another woman to do so for her.

It was recently observed that the lack of breastfeeding and the use of cow’s milk from a bottle continues after the 12th month even during kindergarten and first grade classes.

A recent study by the University of Crete in collaboration with the paediatric clinic of the general hospital of Chania and the Chania Regional Administration showed that 40% of children aged 4 to 7 years who attend nurseries and kindergartens in Chania continue to drink milk from a feeding bottle.

This phenomenon has bad consequences for their teeth and the fact that they receive large quantities of energy, will lead to high rates of obesity in the future. Obesity rates are even higher for children who drink milk from a feeding bottle or even a glass.

While these children have increased weight or are obese, they also have deficiencies due to the lack of received nutrients from other types of food (apart from dairy products).

The other food categories are:

• Meat, fish, eggs, legumes
• Cereals, bread-rice-pasta-corn-peas etc.
• Raw and cooked vegetables
• Fruits
• Extra virgin olive oil should be the only fat, even better if it’s organic.

In the cases where an infant has received artificial food, bottle feeding should be cessed until the 12th month. In case the child refuses to drink milk from a glass, the mother should not insist on doing so. Milk is not necessary after the age of 12 months because the child can easily eat yogurt or cheese. The arguments between mothers and children about drinking a glass of milk before going to kindergarten or school in the morning should be avoided.

The child should have a full breakfast like the rest of the family. This should include whole bran cereal like ground wheat or oat flakes with a bit of milk, yogurt or rice pudding, one to two fruits and an egg 4-5 times a week. Corn flakes are not recommended because of their high sugar volume and lack of fibres. The parents can have coffee or tea.
An alternative breakfast can include olives with whole wheat bread or toast bread with olive oil, tomato or a vegetable omelette.

The University of Crete and the Nutrition and Preventive Medicine Clinic has published two books:

The first is dedicated to the health and nutrition during pregnancy, which includes instructions for a successful breastfeeding.

The second relates to health and nutrition for infants and preschool children and has recently been reissued with improved growth curves by the Chania Regional Administration. 

In addition, the Ministry of Health has recently assigned to the University of Crete and the Department of Preventive Medicine and Nutrition to upgrade the health booklet that is provided to new mothers. This task was completed and delivered to the Ministry of Health and is expected to be published and distributed to all mothers.

The new book emphasizes on breastfeeding, obesity treatment by avoiding food with high energy density, high saturated fat, salt and sugar. In addition it provides guidance for achieving a diet largely based on traditional Greek food.  

Furthermore, it emphasizes on the importance of exercise as well as how to avoid passive and active smoking at home, especially in the presence of children. The book also includes colour illustrations of the growth curve, waist circumference and information about the body mass index. It makes it easier for mothers to distinguish deviations from normal development.

The Ministry of Health is congratulated for deciding to improve the child’s health booklet. In the next step, it would be extremely useful if the Ministry of Health took the initiative of publishing books on health and nutrition in pregnancy and provide them for free to all pregnant women in the country.

Dr. Antonis Kafatos
Professor of Preventive Medicine and Nutrition at the University of Crete
Director of Social Medicine