Obesity is one of the biggest public health threats facing the UK and the biggest human-generated burden on the economy after smoking. Our 2017 State of Child Health report explored some of the challenges and potential solutions.
The nature of obesity is such that it increases your risk of a range of health conditions, including heart disease, stroke, high blood pressure, diabetes and some cancers, and prematurely doubles the risk of dying. Already, the NHS spends over £5.1 billion a year treating conditions relating to obesity.
Deprivation and obesity
There is also a strong relationship between deprivation and overweight/obesity prevalence. In 2015/2016, 40% of children in England’s most deprived areas were overweight or obese, compared to 27% in the most affluent areas.
As deprivation increases the number of children at a healthy weight decreases, and the number of children measured as overweight or obese increases. The most recent data show that overweight and obesity prevalence for children living in the most deprived areas is greater than it is for those living in the least deprived areas: in England, 25.8% compared to 18.0%; in Scotland, 25.1% compared to 17.1%; and in Wales, 28.5% compared to 22.2%. This pattern is in contrast to the early 1970s where obesity prevalence was greater in children from the most affluent areas than in the most deprived.
What can we do about it?
Our recent State of Child Health report illustrates the need for continued efforts by government and partners to reduce childhood obesity, starting with maternal health and wellbeing and continuing once children are born and grow into adulthood.
We also need better data on the obesity epidemic. Currently, two indicators are included on obesity – healthy weight at the start of school and healthy weight at the end of primary school. For the latter the only data available is for England. Much better data is needed to address the obesity epidemic, including additional weight measures across childhood and adolescence.
How can we improve?
The causes of obesity in childhood are multifaceted, with contributions from multiple aspects of environmental change (leading to the so-called 'obesogenic' modern environment) together with genetic and likely epigenetic factors. There is therefore no single intervention or policy approach that can be implemented to deal with the issue.
When implementing initiatives it is important to consider the multitude of stakeholders involved, including parents, children, businesses and civil society actors, in addition to government. It is also important to consider the social and cultural context of childhood obesity and, in particular, address the growing inequality in childhood obesity.
The WHO Report on Ending Childhood Obesity 2016 emphasised the need for coordinated cross-sectoral action and a strong focus on actions in pregnancy and early life. A full set of policy recommendations is set out in the RCPCH 2015 report Tackling England’s Childhood Obesity Crisis.
The recent introduction of a sugar levy in the UK is welcomed. However, we must ensure that this new tax is robustly evaluated and if successful, consideration should be given to extending this levy to other sugar-sweetened products. The government in England has recently introduced a Childhood Obesity Plan. Whilst disappointing in its reach, it is one of the few international cross-government strategies to specifically and strategically address childhood obesity. Robust evidence-based childhood obesity strategies are needed across all countries, involving government departments and including rigorous evaluation.
Additionally, we must ensure that children who have significant obesity have timely access to evidence-based weight-management services and the support and treatment they need to reduce their weight. One of the young people involved in our Voice Bank in 2016 told us that “Many young people don’t realise how fun sport can be.”.
What are we calling for?
- Enact cross-government childhood obesity strategies across all countries, including rigorous evaluation and quality improvement plans
- Robust evaluation to monitor the effectiveness of the proposed sugar levy and other sugar-reduction initiatives on sugar sweetened beverages in all countries
- Expand nutritional standards to all schools. Make school-based health education a statutory subject in all schools, with schools focusing on the importance of both physical activity and nutrition
- Introduce a ban across the UK on the advertising of foods high in saturated fats, sugar and salt before 9pm, and evaluate the impact of online food marketing on children
- Extend the reach and effectiveness of universal measurement programmes in different countries to include an increase in the number of measurement points and longitudinal tracking of children, starting much earlier in childhood. There should be sharing of data with general practitioners, school nurses and parents. Introduce Year 6 and P6 cohorts in child measurement programmes in Scotland, Wales and Northern Ireland
- Support a research environment that enables sustained, long-term expansion of basic science and applied research to identify the causes of obesity and effective interventions to tackle it
- Ensure that overweight and obese children have timely access and support to attend evidence-based programmes, via prescriptions or referrals by their GP
- Ensure children with significant underweight have timely access to specialist child health service
- Help all healthcare professionals make every contact count by having that difficult conversation with their patients (whatever their age) who are overweight.
Take a look at the NHS Choices interactive Eat Well Guide with tips on how to achieve a healthy, balanced diet
The RCPCH is a steering group member of the Obesity Health Alliance - read about the Alliance’s campaigns.