A free fruit scheme in primary schools across Northern Ireland has been hailed as a success in the campaign to promote healthy eating among children.
By Jacqueline Hogge
BBC News Online Northern Ireland
The success of the Fresh Fruit in Schools pilot scheme comes amid rising rates of obesity with one in 20 children in the province showing signs of the condition by the age of 12.
A Belfast dietician told BBC News Online that she has treated children as young as four for the condition.
Grainne McMacken warned that more needed to be done to change people's eating habits.
Primary pupils receive free fresh fruit in some NI schools
"Most of the patients we deal with are referred to us by GPs but they normally have accompanying medical conditions," said the senior community dietician with the North and West Belfast Trust.
"It is hard to get children to change their eating habits. Their long-term perspective is non-existent and by the time they are teenagers, many have entered their rebellious phase and simply don't want to take the changes on board.
"By the age of eight, most children know what they like eating, what they enjoy, and it can be very hard for them to change."
She added that convincing parents that they also need to make changes to their diet to help their child adopt a healthier lifestyle could be difficult.
"It won't work if a child is told not to eat crisps, yet the parents are bringing multi-packs into the home for other family members," she said.
"So it is getting across the need for the whole family to eat more healthily and to cut down on fatty, salty foods.
"Most parents are eager to adopt the changes we recommend but some think they are doing all they can already."
The fresh fruit project has already shown impressive results in changing the eating habits of young children.
Introduced in October 2002, free fresh fruit is offered to Primary 1 and Primary 2 pupils at 89 schools within four Health Action Zones across the province.
The zones in north and west Belfast, Armagh and Dungannon, the Western region and Northern Neighbourhoods, involve partnerships between the NHS, local authorities, community groups and the voluntary and business sectors.
Their purpose is to target areas of disadvantage in the community to address public health issues.
The scheme was due to end in June, but because of its success, the Department of Health has confirmed it will continue to run and the possibility of extending it to other schools is being examined.
Initial analysis of the project has shown it to be overwhelmingly popular with children, parents and teachers, who found several way of integrating the fruit into the school lesson.
A majority of the schools involved said that staff had welcomed the scheme as a supplement to the pupils' diet and as a way of promoting healthy eating.
Several schools also said that the introduction of fruit on a daily basis had resulted in an improved atmosphere in the classroom with pupils' concentration levels improving and children settling down to class work a lot better.
Initial evaluation of the project has shown that its success was greatest in schools in areas of greatest social deprivation where children had previously not eaten significant levels of fresh fruit.
"One thing we did find was that children were eating more fruit out of school hours, as were older siblings who were not eligible for the scheme," said Naomi McKay of the Health Promotion Agency, which is monitoring the scheme.
A poor diet is blamed for the growing rate of childhood obesity
Grainne McMacken said that the enthusiasm and commitment of both staff and parents involved were the reasons for the project's success.
However, she warned the scheme was only a "small part" of the overall effort needed to tackle poor eating habits that was resulting in a growing number of obese children.
"We are definitely getting more referrals of children who are overweight and obese," she said.
"While I have not come across any cases where children are showing signs of the damage obesity can cause in later life, there are childhood illnesses such as asthma which are affected by the condition.
"Obese children would find it harder to breathe and are also put off exercise because of their asthma, so it is sometimes a vicious circle."
However, she concluded that the biggest battle would be to change people's behaviour and attitudes to food.
"Parents are generally very happy to support healthy eating, they want the best for their children," she said.
"So it is our job to facilitate people to make changes, to recognise the barriers faced by people and help them to overcome those whether it is a lack of cooking skills, or simply the costs associated with fresh fruit and vegetables."