The results of this study showed greater incidence of overweight, obesity and morbid
obesity in English children than in the French children. It also indicated a number of
underweight French children in this study. A difference was also seen in waist
circumferences, being larger in the English children, although the mean age and mean
height of the English children were very slightly higher than those of the French children,
and this may have played a role in the higher BMIs seen in this study.
Low levels of physical exercise were observed in the English children and high levels
seen in the French children in this study. High levels of sedentary activity (TV and
computer use) were seen in the English children and low levels seen in the French children
in this study. Certainly there are plenty of studies that have investigated the role ofsedentary activities including TV and computer use on diet, body fatness and physical
activity levels. Grund et al. (2001) showed that the number of hours of TV viewing was
related to fatness, although they found no effect of TV viewing on overall energy
expenditure, muscle strength or diet. It is likely that sedentary behaviour may also be
associated with increased snacking, and it has been reported that TV viewing has often
been associated with passive eating and the consumption of fast foods and confectionary
(Jeffery et al. 2006). Alternatively, it has been suggested that TV viewing is a consequence
not a cause of obesity (Robinson 2001). However, it is likely that sedentary activities
including TV viewing may be indicative of an unhealthy lifestyle in general and thus
contribute to overweight and obesity in this way. Time spent outdoors has been used as an
indicator of a healthy lifestyle, spending less than an hour outdoors and hence more time in
front of TV and computer screens can have serious implications for obesity risk (Wen et al.
2009). The French children in this study spent considerably greater time doing outside
activities than the English. Increasing physical activities and reducing TV viewing has also
been seen as an effective obesity prevention measure.
The method of getting to school can also be related to physical activity levels and even
body weight (Faulkner et al. 2009). Children who walk to school may have lower BMIs,
although it is not clear whether it is the walking that contributes to preventing weight gain
or whether simply leaner children walk to school (Rosenberg et al. 2006). Although both
the French and English children in this study walked to school, the French children walked
a considerably greater distance.
In both England and France, the quality of the diet has been linked to nutritional
knowledge, education and socio-economic status (Robinson et al. 2004, Vernay et al.
2009). The French have a history of dietary awareness dating back to the year 1904 when
the French Health Public Health Act was introduced and the emergence of Puericulture.
The point of puericulture was to encourage and teach parents to behave responsibly and
consider the quality and quantity of the diet, the legacy of which is still alleged to exist
today (Borgenicht and Borgenicht 2003). The nutritional knowledge of the French
children in this study was certainly superior to that of the English and this will also have
positively influenced dietary intake.
All the French children in this study went home for lunch, whereas the English either
had a school dinner or a packed lunch. Both school dinners and packed lunches in the UK
have been noted as being poor (Rogers et al. 2007) and could certainly be a key area for
improvement.
Several studies (Jeffery et al. 2006, Crawford et al. 2008) have failed to show an
association between fast food outlet proximity to schools and BMI, most finding that it is
the frequency of visits that is key. However if there are no fast food outlets in the area being
studied, then there is no opportunity for visits and hence consumption. The difference
between the distribution of fast food outlets in the studied area of France and London could
be a further reason for differences between the two sample groups.
It is recognized that this study is a cross-sectional snapshot, that number of subjects
were limited and that the locations from where the subjects were recruited may not be
wholly representative of the nations they represent. There is also risk of measurement bias
for self-report questions regarding the reported physical activity patterns and food
preferences of the children. Future studies should endeavour to make detailed dietary
analysis to examine differences in the food composition of these two northern European
countries. Nonetheless this study identifies some factors that may be indicative of the
differences between incidence of obesity in England and incidence of obesity in France.In summary the French children in this study were thinner, more active, walked farther
to school and were not involved in long periods of sedentary activity. Whereas a third of
the English children were overweight or obese, they were extremely physically inactive
and spent long periods of time viewing TV or on a computer outside of school. The French
children also appeared to be more nutritionally aware. The lifestyle differences between
the two groups are striking and may help to explain the differences in BMI between these
two nations.