Growing up overweight or obese can help to lock in health inequalities

Growing up overweight or obese is a pervasive and—importantly—preventable disadvantage. It worsens physical and mental health and reduces social and economic success. It can trap people in a cycle of sedentary activity, overeating, and escalating weight. This leads to poor wellbeing and, ultimately, shortens lives.

And while the overall increase in obesity is modest—at least according to the dataset underpinning the chapter in our latest State of Child Health report—the gap between the most and least deprived people is widening. As obesity increasingly impacts disadvantaged communities, it also becomes an effective mechanism for locking in health inequalities.

Healthy weight should be easy to address. The equation is, after all, simple—burn more calories than you consume. Better still, consume fewer calories on a miracle diet while burning extra fat at the gym. Why, then, isn’t it as simple as measuring a child’s BMI and suggesting this advice when it’s needed?

It’s not, generally, that people don’t know that they should eat more healthily to lose weight, but unhealthy food is often cheaper, easier, and quicker to prepare. For families that work long shifts and have access to limited cooking facilities, ‘eating more greens’ isn’t so simple.

The first problem is that many parents and carers are not aware that their child even has a high BMI. Of course, BMI has limitations. It doesn’t, for instance, distinguish fat from muscle mass. But it is a useful yardstick—particularly when dispelling damaging myths about ‘puppy fat’.

Once we have established that there is a problem, we have to show empathy for patients and their families. In the case of healthy weight, this means understanding the barriers that stop families from addressing caloric imbalance—especially in low income settings.

It’s not, generally, that people don’t know that they should eat more healthily to lose weight, but unhealthy food is often cheaper, easier, and quicker to prepare. For families that work long shifts and have access to limited cooking facilities, ‘eating more greens’ isn’t so simple.

Likewise, trying to encourage more exercise can be difficult. Depending on where families live in relation to school, walking and cycling may be inviable commuting options. And playing fields are under pressure from housing demands and are increasingly being commercialised—inevitably excluding low-income families.

Regardless, the facts remain—obese children are less active, sleep poorly, and have worse mental health. These are all factors that can trap them in a self-fulfilling cycle of inactivity and poor diet well into adulthood. We have to focus on solutions, even against the gloomy backdrop working against us.

As paediatricians, we can have sensitive conversations with families about what they can do in their own situation. Without taking the time to understand the family’s context, however, these conversations will likely lead to misunderstandings and resentment. It is important that we have these conversations properly if we choose to have them at all.

We can also point families to healthy weight programmes—which many families find difficult to access. By explaining why these groups are valuable, and helping families to connect with the teams, we can make that journey easier. Locally, we can take actions to reduce obesogenic environments, including supporting councils to limit fast food near schools and widen access to swimming pools. Nationally, we need to act on poverty, road infrastructure, and food pricing.

Above all, we need to challenge the oversimplified narratives too often peddled by the mainstream media and political establishment. In other words, personal responsibility is not to blame. The issue of healthy weight is among the trickiest in our report—we must approach it with compassion and understanding as we tease apart the institutional hitches that have helped to create it. Families deserve nothing less.