Use awareness as a weapon against childhood obesity

By Emile Hollman

How do you convince children to eat healthier? “This is a complex issue,” says Edgar van Mil, pediatric endocrinologist and professor of Maastricht University’s Youth, Nutrition and Health program at Brightlands Campus Greenport Venlo. “Complex problems demand customization.”

As a child, Edgar van Mil once picked turnip cabbage from a farmer’s field near his hometown of Waalwijk. He peeled it with his knife and sampled the vegetable he hadn’t known existed until then. “I will never forget how it tasted, and every time I eat turnip cabbage, I am reminded of that moment.”

There is a good reason he shares this anecdote. The chair at Brightlands Campus Greenport Venlo aims to study how we can help children eat a healthier diet. And it’s not just to help young people with obesity, like the patients Van Mil sees every week at the Jeroen Bosch Hospital in Den Bosch, but all children. Experiencing what you eat, much like Edgar van Mil’s “turnip cabbage adventure,” can help. “When you take kids to see a vegetable grower’s farm – something we do here at Kokkerelli Kids University – they get excited. Vegetables are about much more than just nutrition; there’s a story behind them. This makes them taste good and possibly more palatable.”

Wrong stimulus

Born in Waalwijk, Edgar van Mil (1969) trained as a physician in Maastricht, and has always been interested in nutrition. Not only because it’s something we are always studying, but also because his father, Gerard van Mil, was a renowned pastry chef. “As a child, I really used to think I would follow in my father’s footsteps and have the same career. He wasn’t concerned as much about making healthy products as he was about creating a tasty product that triggered your sense of taste so much that one of these pastries would be enough. These days, there are products you can easily eat ten of. And this is where the problem actually lies. After all, it encourages people to eat even more.”

He sees the consequences of this in his medical practice. “Initially, I concentrated on pediatric endocrinology and medical research, but so much involves eating habits, taste development and what this does to young children’s metabolism. We still don’t know enough about this, which is what makes this chair so interesting, and is the reason behavioral psychologist Remco Havermans is now involved as an associate professor.”

We see kids weighing 150 kilos, which makes you wonder where on earth it all went wrong

Edgar van Mil

Refreshing

Van Mil is an authority when it comes to childhood obesity. He wrote a book on the subject, and was involved in the creation of the National Prevention Agreement. The chair is the next step, and came about primarily thanks to the support of the business community. “What makes me really happy is the direct contact with the companies here in Venlo. The things you see happening here in practice are only being paid lip service to in other places. We are actually doing something about it here, and the entrepreneurial spirit is very refreshing. When you come from the medical field, you often feel like you’re fighting a losing battle. We see kids weighing 150 kilos, which makes you wonder where on earth it all went wrong. How did it come to this? Not that we have a ready-made solution here, but at Brightlands Campus Greenport Venlo we can at least research how to make healthy choices easier.”

Taste sensations

It will be a struggle though, Edgar van Mil admits. “All those high-calorie products have gotten very inexpensive. People are busy, so it’s easier to give children something quick to placate them. It may sound hackneyed, but when I was young, even though we had plenty of candy, we didn’t keep it in the house. Not even in a pastry shop. Whenever I was given a pastry, I couldn’t even finish it because of all the taste sensations it triggered. These days, the flavor is much blander. Natural products often have many more taste sensations that have an effect on satiety. The thing is you have to put more effort into it to get this result; cooking or creating is required. Grabbing something from the refrigerator is obviously faster.”

This is the problem Van Mil and Havermans are trying to find a solution for at the Brightlands campus in Venlo. “We understand how choices are made. However, what are the biological and behavioral factors that play a role in this, and how can you respond to them with healthy nutrition? It’s interesting to see how you can influence behavior. We are constantly falling prey to stimuli, part of this is because of our biology, but part is also learned.”

Obesity

There are a few points of departure, of course. “For example, we know that children who were breastfed are more likely to choose healthy and varied nutrition. When they are fed with a level scoop of formula, you might be cultivating monotonous taste development.” The fact that children eat fewer potatoes, vegetables and fruit, and spend less time playing outdoors also plays a role. Between 15 and 20 percent of children are overweight, and three to four percent of all Dutch children are obese. Van Mil: “We focus on all children because healthy eating is vital for everyone. You can’t just tell overweight children to do this or that, while the rest can eat whatever they want.”

If only just for the record, can you tell us why being overweight is so dangerous? “If you look at it very simply, obesity leads to accelerated aging. This also means all of the medical complications that go with this such as diabetes, cardiovascular disease, and problems that affect the brain. We are seeing children with adult-onset diabetes, something that was considered impossible until recently.”

Lifestyle

And this in spite of all the food gurus, diets and media coverage on the topic. “It’s a complex issue: there isn’t one single answer,” says Van Mil. “Being overweight is the result of a lot of factors combined: environment, predisposition, and lifestyle. And these elements interact with each other. Everyone is looking for an easy solution, a quick fix. Eat less and exercise more is such a cliché; people already know this. What’s key is customization and professional supervision. Doctors often find it very difficult to do anything about lifestyle. They have to ask so many questions as it is, and explain things; they hardly have time for a lifestyle consultation. To make this easier, we have all sorts of lifestyle help centers at the Jeroen Bosch Hospital. People are referred by the specialist, complete with accurate information; in other words, details on what exactly is going on with the patient.”

How wonderful it would be if products were developed at the front end of the supply chain that would help consumers make healthy choices

Edgar van Mil

Vegetable queen

Edgar van Mil is at the Brightlands campus one day a week and devotes one other day each week to his part-time position as a professor.

“Products are developed at the campus that we can really use. We shouldn’t only be talking about health; we need to tell the whole story and bring experience back to the mix: where does our food come from, and how are we preparing it? How wonderful it would be if products were developed at the front end of the supply chain that would help consumers make healthy choices. At this campus, we introduce children to fruit and vegetables, healthy products. There’s also a company based here that combines a lot of fruit and vegetables in a shake. A project with vegetable boxes proved very educational for this age group. The children tasted a different vegetable from the box each time. We have seen that when children do this with their peers, they like it. The child who ate the most of the vegetable was crowned vegetable king or queen. It might seem so simple, but our PhD student Britt van Belkom actually made the front page of the UK Times with the program. The next goal is to use technology to scale up this knowledge so that more children can reap the benefits and for a longer period of time. How great would it be for this region to be the one to take the theme of health to the next level? It’s really all about value.”

Other Brightlands campuses join in

Fast food is, of course, always within reach. Van Mil: “We have to remain vigilant about all of the results our work produces. Healthy products are always more expensive, and the extra cost will ultimately have to be translated into health gains.”

Van Mil and Havermans also work closely with the Healthy Elementary School of the Future, a project Maastricht professor Onno van Schayck runs at Brightlands Maastricht Health Campus. An app is also being developed that young people can use to keep up their desired eating habits. The data could be interesting to research further at Brightlands Smart Services Campus in Heerlen, where the information can be studied. “In this regard, we are constantly looking for technological developments that can support these efforts.”

Edgar van Mil is a classically trained scientist, and by his own admission, says that he doesn’t know much about data science. “Health is a very complex field, and if the problems were easy to solve we would have already done so. Complex problems demand complex approaches. All of the expertise available at the different campuses can be very helpful.”