Saturday, July 5, 2025

nutrition in children

When my son was in preschool while we were living in Dubai, he came home one day beaming with excitement. He had just learned about dinosaurs.

“Did you know the Stegosaurus had 17 bony plates along its spine, to help manage body temperature and for protection?” He spoke with the animated energy only a five-year-old can bring to the subject of ancient reptiles. This moment sparked a delightful chapter in our home – our “dinosaur era”.

A few months later, the topic shifted to space. Did you know you can remember the order of planets by saying “My Very Educated Mother Just Served Me Noodles,” he recited proudly. Then came the plant cycle.

I was proud of his curiosity and his love of learning. He was clearly absorbing the marvels of science, and school seemed to ignite a spark in him. But as the year progressed, I noticed something; he never once mentioned the human body. No organs. No bones. No systems. So one evening, I asked him: “Do you know where your liver is? Or your kidneys? Do you know what they do?” He looked at me with curiosity, wanting to learn – but unaware.

We moved to Singapore in 2022, and in the time since, I’ve noticed encouraging steps to make nutrition a bigger part of school life. But there’s still so much more we can do – especially in the early years – to connect kids with the science that matters most to their daily lives.

This feels even more urgent now, with processed foods and sugar-laden snacks and drinks so easily within reach and kids being inundated with ads and content promoting them online.

A public health imperative
The World Health Organisation estimates that 35 million children under the age of five were overweight in 2024, with almost half that number in Asia.

In Singapore, student obesity rates rose from 11 per cent in 2013 to 16 per cent in 2021. Chronic diseases such as type 2 diabetes – once seen only in adults – are increasingly diagnosed in children.

Initiatives like the Healthy Meals in Schools Programme (HMSP), which was launched in 2011, are commendable and a meaningful step in the right direction. They try to establish healthier cooking methods and promote balanced meals. In 2016, Singapore launched its “war on diabetes”, a nationwide initiative to promote healthy eating habits. In 2023, a new standard was launched to equip and support care centres and school canteens in preparing nutritious meals.

But food choices alone are not enough. Without understanding why these choices matter, the learning is superficial. Imagine teaching plant biology without explaining photosynthesis.

Nutrition is not just a health topic. It is biology, chemistry, economics, environmental science and psychology all rolled into one. And it needs to start earlier in the classrooms. 

To be clear, I’m not advocating a deep dive into methylation cycles, cytokines, immunoglobulins or the intricacies of autophagy in the classroom. But teaching nutrition is not merely lecturing children to eat their vegetables. Rather, it’s about empowerment and fostering understanding. It’s also about giving children – at every age of their development – a layered understanding of all the systems that sustain their lives and the tools to practice informed decision-making even at that early stage.

And we don’t have to reinvent the wheel. 

Integrating nutrition into education
In 2005, Japan formalised shokuiku (food and nutrition education) as a basic law. This involved school lunches being woven into the formal curriculum with opportunities for such education and building food literacy.

All students receive school lunches that are cooked onsite with fresh, whole food ingredients. Seasonal ingredients are sourced from local farms and many schools have their own farms, allowing students to experience the entire cycle from seed to plate. 

Nutrition education is taught by licensed nutrition educators to integrate food literacy into daily learning. These practices are linked – Japan has one of the most successful public food education systems and one of the lowest adult obesity rates worldwide.

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In Finland, the Basic Education Act (1998) mandates that every student receives a free school meal, and nutrition is woven into home economics, biology and health education. School meals follow strict nutritional standards and every school makes an action plan for food education individually taking health, nutrition and behavioural education into account.

In Singapore, there are efforts such as a recent initiative by NTUC First Campus’ My First Skool called Start Strong, Stay Strong for preschoolers. Students are introduced to different food groups and taught how to read nutrition labels and make better food choices. At the primary level, pupils use physical education journals to keep track of their food consumption.

While these efforts are promising, we can go further to embrace nutrition as a distinct pillar of health that deserves intentional integration into the fabric of daily school life. Let’s use nutrition education as a vehicle for learning, community connection and a lever in the public health strategy to tackle rising chronic disease rates.  

A 2020 study by researchers found that school-based interventions can promote healthy eating, improve dietary behaviour and attitudes among young children, especially when they are multi-component and involve the wider community.

The study suggests that schools – as trusted places of learning – can play a far bigger role in improving dietary practices and behaviour than previously thought.

Nutrition can be meaningfully interwoven into various subjects. Food labels can be used to teach percentages and proportions in maths, persuasive essays or food journals in languages. Classrooms can become “living labs” where activities become developmental tools to shape eating habits. 

Why it matters
Parents play an undeniable role in how we contribute to children’s eating behaviours. We serve as models and directly influence our children’s preferences by making certain foods available and through our own eating behaviour.

But too often, parents fall into the convenience trap of inexpensive, palatable, energy-dense foods that can promote overeating and inflammation.

Ask any first-time parent how much attention goes into a baby’s first food. But very quickly, after just a few months of solids, we seem to forget. 

We forget the diversity of the gut microbiota – the ecosystem of microbes in our intestines – only stabilises around the age of three. But even after three years, it still remains highly responsive to daily inputs: what we eat, what we drink, the medications we take and the stress we experience.

We forget that our gut is not merely a digestive organ but also acts like a gate keeper to our brain, so much so that it is commonly known as “the second brain”. 

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This dynamic ecosystem is being shaped every single day by the food our children consume – often without any awareness of its significance or risks. 

Evidence indicates early dietary patterns can track into adulthood and influence risks for obesity, diabetes, heart disease, cancer and even mental health conditions. These are not abstract risks but risks that are unfolding in paediatric clinics and even in my own practice. 

Our children’s meals aren’t just about today’s lunch – they’re shaping tomorrow’s health outcomes. By teaching nutrition early, consistently and joyfully, we give our children something far more valuable than a temporary grade: we give them life-long agency over their health. 

Today, with chronic diseases appearing in childhood and adolescence – conditions once common among adults – we cannot afford to ignore this. School meals serve an important learning opportunity that we don’t want to miss. 

The most important science our children can learn is happening inside their bodies. Let’s start teaching it early. 

Jieun Wrigley is a functional nutritionist and founder of nutrition consultancy Rapid Nutrition Therapy.

how long can I live

Mrs A, a 32-year-old woman with Stage IV uterine cancer, waited till her husband left my consultation room to take their three-year-old daughter to the restroom.

She then gingerly asked me: “How long do I have to live, Dr Val?” This has clearly been weighing heavily on her mind. Mrs A had decided that she was finally ready to hear the answer.

I took her hand and thanked her for asking. It must not have been easy to speak those words. Tears were shed. We discussed her reasons for asking and her fears. We also discussed her own expectations, how the answer to this question should rightly be used, and how we will fully support her no matter the trajectory.

Often, I find that our patients are more concerned for their loved ones than for themselves. And she is no exception.

“I want to be sure my family is ready and fully supported when I die,” she said.

The question of how long one has left is never easy to ask, let alone answer. Uncertainty hangs over it, and for many, the thought alone feels too heavy to face. Yet, amid this unknown, honest and open conversations provide the chance to draw loved ones closer during this time of difficulty. They are also necessary to provide the patient the best care possible.

Why the need for a prognosis?
Prognostication in cancer isn’t just about predicting survival – it is a foundational tool that informs nearly every aspect of care, from treatment planning to psychological support. Despite how it can be inaccurate, it helps ensure that patients receive care that aligns with both their clinical situation and personal values.

In simple terms, to prognosticate is to estimate the likely course and outcome of a patient. It is critically important for guiding treatment decisions, informed collective decision-making, psychological preparedness and even for end-of-life planning.

Prognostic information helps doctors to work with their patients to tailor treatment plans based on how aggressive or advanced the cancer is, and how specific treatments could change that trajectory.

Some patients with a better prognosis might avoid unnecessary toxic therapies with long-term side effects, while those with a poorer prognosis may benefit from more aggressive approaches. Others with an extremely poor prognosis may even choose to avoid treatments which are highly unlikely to bring meaningful benefit.

During my conversation with Mrs A, she asked what her final days would be like. “Will there be pain? Will it be sudden or slow?” I addressed each of these questions in turn.

Informed decision-making can collectively be done between the patient, their loved ones and their doctor. Best choices can be made about care, quality of life and goals, based on realistic and aligned expectations. Knowing the likely course of the disease also helps all involved in the patient’s care to be prepared mentally and emotionally.

Additionally, prognostication is often used to determine whether one is eligible for specific clinical trials. In healthcare systems with limited resources, prognostic data may even be used to prioritise interventions for those most likely to benefit.

Oncologists use a combination of clinical judgment, diagnostic tools and validated models to prognosticate. Many patients are also discussed in multidisciplinary tumour boards for input from surgeons, pathologists, radiologists and radiation specialists.

It’s not a countdown
Prognostication in cancer has improved significantly, but again, it is not perfectly accurate.

This is because every patient and every tumour is unique. There is biological variability between patient tumours even with the same histology, or even in different locations within the same patient – every cell within a tumour is also different.

In addition to the cancer itself, dynamic changes in a patient’s physiology, including their performance status and immune status, may not always follow a gradual trajectory and can even change suddenly. Prognostic tools and models are also limited.

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Even the best models are probabilistic, not deterministic – they give ranges or chances, not certainties. Lastly, new therapies (for example, immunotherapy) may also shift outcomes, sometimes for the better, in unpredictable ways.

It is important to recognise that prognostication in cancer is reasonably accurate at a population level (that is, predicting outcomes across groups), but less precise at the individual level. This therefore provides useful guidance but should always be used alongside clinical judgment and ongoing reassessment for change.

Prognosis should therefore be used as a guide, not a guarantee. It offers a range of possible outcomes and while it can help guide decisions, it does not define one’s future.

Navigating the uncertainty
A first step for patients and family members would be to ask for honest but balanced information. Ask your doctor to explain typical outcomes, best-case and worst-case scenarios and the factors that may shift your personal outlook.

Understand that prognosis can change. It’s something we reassess over time. Prognosis evolves with how one responds to treatment and even advances in therapy. Stay open to updates, especially in fast-moving fields like immunotherapy and targeted therapy.

Balance hope with planning. Hope and realism can live side by side. It is possible to hope for the best while preparing for all possibilities. Consider discussing advance care planning – not as a sign of giving up, but as a way of maintaining control (even with unexpected and sudden changes) and dignity.

Preparation can come in the way of wills, bank accounts, lasting power of attorneys (LPAs), advance care plans (ACPs), memories or legacies for loved ones. We may prepare for the worst but we hope for the best. There is no harm in preparing.

Focus on what you can control. No one can fully control the biology of cancer, but we can control: how we live our days, how we make our decisions, how we express our values and goals, and how we express our love and connect with our loved ones. Prognosis may be about numbers – our life is about meaning.

Seek support – medical, emotional, practical. Navigating uncertainty is extremely tough. We can use our care team, supportive and palliative care team (not just for end-of-life), support groups, and counselling to stay grounded. One does not have to carry this alone.

Having frank conversations with loved ones is encouraged. Often in our Asian society, some consider it “pantang” or bad luck to broach this topic. In reality, talking about it does not curse or doom anyone. Addressing the elephant in the room will instead facilitate open conversations and bring about a closeness with loved ones.

Prognosis is a tool, not a verdict. It serves to inform, not limit, one’s choices. The goal isn’t just to survive – it’s to live meaningfully, regardless of the timeline.

To Mrs A, I explained how my answer is a mere estimate, how these are seldom accurate and that these estimates can also change over time. It should not be taken as a hard truth and certainly should not lead to a “doomsday calendar countdown”.

We then spoke about what brings her meaning in life and what she would want for her young daughter and husband.

“I want my daughter to remember her mother for her strength, so that she may remember this when she faces her own storms. I want my husband to remarry, to find a good woman and live a full life that I cannot give. In the meantime, I want to live the rest of my days with them to the fullest.”

Dr Valerie Shiwen Yang is a senior medical oncologist at OncoCare Cancer Centre and visiting consultant at the National Cancer Centre. She is also an adjunct assistant professor at Duke-NUS Medical School.
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