Childhood obesity came under scrutiny again last week when the Government published its green paper, Advancing our health: prevention in the 2020s, and admitted that it had limited success in tackling this major health challenge.
Current UK statistics show that one in three children aged 10 to 11 are overweight or obese. A worrying statistic given that obese children are five times more likely to become obese adults. Being overweight or obese is also a major risk factor for a number of conditions, including diabetes, heart disease and stroke.
New figures from Cancer Research UK show that people who are obese now outnumber people who smoke two to one in the UK, and excess weight causes more cases of certain cancers than smoking.
In response, the government says it wants to take 'bold action' and aims to reduce obesity in children by 50% by 2030. It wants to build upon actions within Chapters 1 and 2 of the Childhood Obesity Plan as well as publishing a third chapter that will aim to tackle the root causes of obesity.
This includes supporting families by making the healthier choice the easier choice. Something that will be welcomed after a Public Health England survey published last year found around nine in 10 people support the work Government is doing with the food industry to make food healthier.
The scale of the obesity problem
Figures from the Royal College of Paediatrics and Child Health (RCPCH) state that almost one in five children are overweight or obese when they start primary school, rising to one in three when they start secondary school. By 2020 it’s estimated half of all children will be overweight or obese.
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.
Mental health is also affected, according to the British Dietetic Association (BDA), as overweight children are reported to have reduced self-esteem and are more likely to be bullied compared with their normal weight peers as a consequence of weight stigma. This has potential long-term consequences through adverse effects on educational attainment and lifetime achievement. It is therefore important that action is taken to tackle weight stigma as well as to help children to lose weight.
A report by the Royal Society of Public Health also found that almost half of young people (49%) blame fast food takeaways as the companies or brands most at fault for childhood obesity. Yet, half of young people (50%) have ordered a takeaway via their smartphone. More than two in five (42%) also said that they can walk from their school to somewhere selling unhealthy food in under two minutes.
How to make progress?
The government says it will be consulting on making calorie labeling mandatory in the out-of-home sector, such as restaurants, takeaways and cafes. It will also end the sale of energy drinks to children under the age of 16 and has recommitted to considering extending the sugar levy to high sugar milk drinks.
As part of Chapter 2 of the childhood obesity plan, it has also selected five Childhood Obesity Trailblazer authorities, who together will have access to £1.5 million of funding and support over the next three years. They are: Blackburn with Darwen, Birmingham, Bradford, Lewisham and Nottinghamshire.
Across the five areas, Trailblazer activity will support and create opportunities for future generations, from supporting families and children in the early years through to upskilling adolescents and young adults. Between them, they will test the potential for existing local levers to:
- restrict out-of-home advertising of foods and drinks high in fat, sugar and salt
- create healthier food environments through the planning system
- use community and faith assets
- incentivise businesses to improve their retail offer
- improve accessibility and affordability of healthier foods
- improve job opportunities and growth in health, food and physical activity sectors.
The Obesity Health Alliance said that the green paper proposals address important areas, however, real progress won't be made without structural changes that address the way less healthy food is marketed, promoted and sold.
It added: "That’s why we need the Government to swiftly and fully implement plans announced over a year ago to introduce calorie labelling on menus, restrict unhealthy promotions and introduce a 9pm watershed on junk food adverts on TV and online.”
What can GPs do to tackle childhood obesity?
The Royal College of General Practitioners (GP) said that childhood obesity is one of the most serious health challenges of our time and one that mustn't be swept under the carpet.
Chair Professor Helen Stokes-Lampard said that GPs and their teams will routinely talk to parents about simple lifestyle changes that can have a positive impact on their children's health but this is a society-wide responsibility and GPs need to work with parents, healthcare professionals, teachers, advertisers, food manufacturers, retailers, public health officials and others, in order to evoke genuine change.
She added: "Nobody wants to think of themselves or their child as overweight or unhealthy, but the stark truth is that overweight and obese children face numerous, serious health-related problems – both physical and mental – in the years ahead, if their weight is not addressed.
"Underestimation is prevalent across the board – including among healthcare professionals – and highlights the importance of taking accurate measurements, so that appropriate and consistent interventions can be implemented to support a child to lose weight and live a healthier lifestyle.
"It would be useful to see some research into the reasons why people are more likely to underestimate children's weight, so that we can start properly and effectively addressing the problem."
A recent article published in BJFM on tackling childhood obesity in primary care, looked at practical considerations for GPs. It highlighted that once a diagnosis of obesity or overweight has been established, it is important to gauge how willing the child and the family is to make lifestyle changes.
Statements such as ‘eat less and do more exercise’ are usually too broad and a specific tailored problem-solving approach is usually required. Despite having been advocated by NICE, accessing local weight management pathways is extremely difficult. Despite this lack of widespread provision, there is simple information and support that GPs can offer families.
Specific advice can include:
- Reinforcing the 5-day concept
- Encouraging children’s meals to include starchy foods
- Limiting sugary drinks and saving high-calorie foods for treats.
Dr Jessica Garner, a GP, added: "Obviously, the answer to childhood obesity does not solely lie at the feet of general practitioners. Yet by discussing and promoting lifestyle changes, we have an opportunity to improve health outcomes for today’s young people and subsequent generations."