A childhood obesity strategy

25/11/2015 - 07:37
The government, claiming it is “one of the major priorities”, is now closing in on its objective of creating an action plan to tackle obesity in children. David Foad reports.

For those involved in child welfare, particularly health workers and school caterers, the figures are quite chilling. Simply put: one child in ten is obese on joining school at five. By the time they reach 11 and are ready to move on to secondary school, that has doubled to one in five.

It is bad enough that nearly 10% of all five-year-olds are starting school with their health potentially compromised but hugely disappointing for all concerned when twice as many children are in the same position six years later.

Health Secretary Jeremy Hunt said recently: “Tackling obesity, particularly in children, is one of this government’s major priorities.

“Progress has been made in recent years, but we know we have much further to go. We will put forward our plans for action in this area in our childhood obesity strategy in the coming months.

“Obesity is a leading cause of serious diseases such as type 2 diabetes, heart disease and cancer. Obesity is also a major risk factor for non-alcoholic fatty liver disease. This represents a huge cost to the health and well-being of the individual, the NHS and the wider economy.”

The Department of Health (DoH) has charged Public Health England (PHE) with pulling together the evidence base, and then translating that into practical measures and support for local and national health improvement initiatives.

National Child Measurement Programme data for 2014/15 will be published before the end of the year but is unlikely to show much change on the figures from 2013/14, when it was found one in five children in reception (four to five years old) is overweight or obese (boys 23.4%, girls 21.6%). Of these, around one in ten children is obese (boys 9.9%, girls 9.0%).

We also know that one in three children in Year 6 (ten and 11 years old) is overweight or obese (boys 35.2%, girls 31.7%) and, of these, around one in five is obese (boys 20.8%, girls 17.3%).

The House of Commons Health Select Committee has been hearing evidence to help guide government priorities in the planned childhood obesity strategy.

This has been supported by the DoH, with Hunt saying: “We welcome the committee’s decision to hold an inquiry on childhood obesity and this opportunity to further explore the challenges and build consensus on actions needed.

“The government is fully committed to this process, working closely with our partners to develop and deliver a national strategy to tackle childhood obesity.”

The DoH supplied a written update to the committee saying: “We know there is a link between obesity and lower-income groups, but that does not mean everyone who is overweight is from this group.

“For example, though obesity prevalence among Year 6 children attending schools in areas in the most deprived decile is 24.6%, in more affluent areas, it is 11.8%.”

Among those giving evidence at the Health Select Committee hearings was TV chef, restaurateur and children’s food campaigner Jamie Oliver, whose proposal for a tax on sugary drinks to limit consumption achieved high-profile media coverage.

 “Calorie reduction, including sugar reduction, will form part of our work on tackling childhood obesity,” said the DoH. “We requested that PHE, as an executive agency to the Department of Health, prepare evidence for the government on reducing sugar consumption.

“We are currently working very closely with PHE, and its evidence is integral to our ongoing policy development. We will publish our childhood obesity strategy and the PHE evidence supporting it simultaneously.”

Alongside this, the government has also accepted the recommendations of the Scientific Advisory Committee on Nutrition (SACN) report on ‘Carbohydrates and Health’, published in July, which will also inform the strategy.

The DoH sees exercise as playing an important, and it continues to work with partners such as the Change4Life 10 Minute Shake Up with Disney, which aims to inspire and support children from aged between five and 11 to be more active and meet the physical activity guideline of 60 minutes a day of moderate-to-vigorous physical activity. More than 385,000 families signed up, with around 700,000 children requesting packs.

This is in addition to work with the Department of Culture Media and Sport on a new strategy for participation designed to ensure sport is as inclusive as possible, and the Prime Minister’s recent announcement on a deal with the Premier League to expand its school sports programme to every primary school in the country.

The Department for Education is also making key contributions, in particular through the implementation of School Food Standards.

The role of PHE is seen as core to any childhood obesity strategy because, although it is a Department of Health executive agency, its remit runs to local authorities, which are responsible for running many of the country’s schools.

PHE also supplied evidence to the Health Select Committee, describing its review of the evidence around interventions to reduce sugar intake, “including mixed-method reviews of the impact of marketing and fiscal measures targeted at high-sugar products on health and behaviour changes’.

Its various programmes include Start4Life, the National Child Measurement Programme and support for schools in implementing a whole-school approach around food and diet.

Dr Alison Tedstone, director of diet and obesity with PHE, told the committee that any strategy needed to look at the whole environment in which children are brought up and not focus too much on schools

“What we need to acknowledge is that the biggest risk factor for being an overweight child is living in a family where one of your carers is overweight or obese.

“I absolutely support the idea of focusing on primary-school-aged children, but we have to think of the drivers of excess energy consumption and low levels of physical activity, which are primarily environmental.

“Those may be the environment we live in – if you walk down any high street, there are constant nudges to consume more food – the home and society more broadly.

“There is also a bit of a danger that too much of a focus on primary-school-aged children puts the focus on schools; we know that schools have improved immensely.

“Most schoolchildren in England now do not have access to unhealthy food while at school. A lot is being done. Children now learn to cook. They learn to cook savoury food as well as sweet food. Diet is embedded in a whole-school approach.”

Professor Susan Jebb, who runs the diet and population health unit at the University of Oxford and is a government adviser on obesity, backed up these points when she gave evidence to the Health Select Committee.

“Early infancy is a critical time, and the protein intake of very young children is extraordinarily high. We know that that is associated with increased risk of excess weight gain.

“There are lots of issues in early infancy. The statistics that you pointed out earlier show that many children are arriving at school already overweight and obese.

“We absolutely have to look at those early years at home, when lots of their taste preferences and their understanding about food are already shaped.

“We are asking school to pick up the pieces, when actually we could be doing much more in the early years, through health visitors and early-years support through the healthcare system and through childcare settings,” Jebb said.

“I was involved in developing the voluntary guidance for pre-school years on food, but that has not had anything like the kind of ‘oomph’ behind it that we have put in relation to food that is served in schools.

“As more children have more childcare outside the home, there are probably opportunities to intervene there.”

Among the ideas being proposed to help prevent children piling on the pounds in infancy, and between Reception and Year 6 at school, is that they undergo a ‘yearly obesity MOT’ at school.

The suggestion comes from the National Obesity Forum, with the organisation’s Tam Fry saying it should be part of the government’s childhood obesity strategy.

He said: “We monitor our cars yearly by law to ensure that they are ticking over nicely; we weigh chimps at the zoo every 12 months to ensure that they are in good health; yet we don’t afford our children routine check-ups that would alert us to the need to take action.”

He said the current system meant that advice and help was usually not offered to families until children had a major obesity problem, when it was far more difficult to tackle.

Professor John Wass, the Royal College of Physicians special adviser on obesity, has backed the idea: “Children should be measured regularly before they start school and during their childhood years, and we also need joined-up measurement across the National Child Measurement Programme, health visitors and GPs.”

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