Healthy weight

Obesity rates in young children are showing no sign of improvement. Overweight children have increased chance of developing other health conditions, including heart disease, high blood pressure and diabetes.

Overweight at 4-5 years old: UK 24% | England 23% | Northern Ireland 26% | Scotland 23% | Wales 26%

Background

  • Childhood obesity is one of the biggest public health issues facing the UK. Obesity increases the risk of developing a range of health conditions in childhood and later life, including: heart disease; stroke; high blood pressure; diabetes and some cancers.1 Obese children are much more likely to be obese adults,2 which may lead to significant health risks.
  • There are various definitions of obesity in use. Body Mass Index (BMI) is one measure:
    • Underweight: BMI centile less than or equal to 2nd centile
    • Overweight: BMI centile greater than or equal to the 85th centile
    • Obese: BMI centile greater than or equal to the 95th centile.
    • Severely obese: BMI centile greater than or equal to 99.6
  • While all four nations routinely record and report the weight of children upon entry to primary school (aged 4-5), only the National Child Measurement Programme in England captures data upon exit of primary school (aged 10-11).
  • All four nations have published strategies committed to reducing childhood obesity:
    • England: Childhood Obesity: a plan for action includes the Soft Drinks Industry Levy (SDIL) and other measures to reduce sugar content and overall calories in food and drink often consumed by children. The Plan also pledges to halve childhood obesity by 2030.3
    • Scotland: A healthier future: Scotland’s diet and healthy weight delivery plan sets the same obesity reduction target, along with an explicit aim to reduce inequalities.4
    • Wales: Healthy Weight: healthy Wales is the Welsh strategy to reduce obesity, which is part of the Government’s obligation under the Public Health (Wales) Act 2017. A consultation was launched in 2019 to seek the views of the public on proposed strategic themes and actions, particularly focusing on the obesogenic environment.5
    • Northern Ireland: A Fitter Future for All is the regional framework for preventing and addressing overweight and obesity in Northern Ireland in 2012 to 2022. It takes a life course approach to tackling obesity.6

Key findings

  • The prevalence of children aged 4-5 who are overweight or obese has not changed significantly in any of the four nations since 2006/7.
  • While trends for 4-5 year olds are stable, trends for 10-11 years olds in England indicate that childhood obesity is increasing – add in trend.
    • In England in 2018/19, 22.6% of children aged 4-5 were either overweight, obese or severely obese, but much higher at 34.3% among children aged 10-11.
  • Childhood obesity is more prevalent among deprived areas. In England, the prevalence of severe obesity amongst 4-5 year olds was almost four times as high in the most deprived areas (3.8%) than the least deprived areas (1.0%) in 2017/18.7 Prevalence among the most deprived areas is also rising in Wales, 3.9% of the most deprived 4-5 year olds were severely obese in 2017/18, compared to 1.9% in 2013/14.8 In England and Scotland, the rate of overweight or obesity is increasing for the most deprived children at the same time as it is decreasing for those who are least deprived: therefore, the inequality gap is widening.

Northern Ireland: In 2018/19, children in Western Trust did not have height and weight measurements taken. Therefore 2018/19 is based on four out of five health trusts only. A small number of children were measured who were resident in WHSCT area and these children have been included in the data in the graph.

Northern Ireland: In 2018/19, children in Western Trust did not have height and weight measurements taken. Therefore 2018/19 is based on four out of five health trusts only. A small number of children were measured who were resident in WHSCT area and these children have been included in the data in the graph.

What does good look like?

Deliver and expand upon existing strategies to prevent childhood obesity. We welcome the development of obesity plans and strategies within Wales, Scotland, England and Northern Ireland, which aim to halve childhood obesity by 2030. We look forward to the urgent implementation of actions laid out within these strategies. This includes the targeting of the obesogenic environment, such as bans on price promotions and marketing of junk food, better nutritional labelling in shops and restaurants and improving nutrition in school foods. However, given the complexity of this issue, progress will require whole system action over a long time. Government strategies must be expanded to include more ambitious actions, particularly those which will positively impact upon disadvantaged children and young people.

Improved accessibility and availability of weight management services for children, young people and their families. Rising rates of overweight and obese children increases the demand for referrals to weight management services, to provide tailored support on diet and physical activity. Commissioning decisions should recognise that these services are delivered not just in health settings, but where access is easiest for children and young people and their families, such as within schools and colleges. These programmes should be rigorously evaluated to ensure they continue to confer sustainable improvements in weight for the child, young person and their family.

We need healthier food classes to teach you and to make both children and parents more aware of issues.

Young person speaking to RCPCH &Us

Policy recommendations

  • UK Government should implement in full the actions from chapters 2 and 3 of ‘Childhood obesity: a plan for action’ including:
    • Introduction of a 21:00 watershed for broadcasting restrictions of products high in fat, sugar and salt (HFSS), which should apply to TV, online advertising and within public spaces or family events. This would restrict all HFSS advertising between 5:30 and 21:00. There should be no exemptions to this advertising restriction.
    • Maintenance and monitoring of the Soft Drinks Industry Levy, which should be expanded to include other products with high sugar content (e.g. natural sugars in infant foods).
  • UK Government should resource Local Authorities to review planning and licensing arrangements to ban fast food outlets (FFOs) from within 400 metres (approximately five minutes walking time) of schools and other locations with a high child footfall (e.g. leisure centres, parks, hospitals).
  • UK Government should resource Local Authorities to maintain and expand on current sports and leisure facilities available for children and young people to exercise at.
  • We welcome the Department for Education’s commitment to provide greater access to physical activity within their 2019 ‘School sport and activity action plan’; this should ensure children have a minimum of two hours of physical activity per week within primary education. Physical activity could include: The Daily Mile, after school sports offers, physical education within the curriculum.
    • Physical education or activity should be in line with the UK Chief Medical Officers’ 2019 Physical Activity Guidelines.
    • The quality of physical education, or other physical activity, provided should be monitored by Ofsted.
  • The Department for Education should continue to provide the Primary PE and Sport Premium at the doubled rate (£320 million) for 2020-21. UK Government should outline plans for funding beyond 2021.
  • The Department for Education should expand school curriculum to incorporate nutrition and healthy diet education, within the Relationships and Health Education curricula. The quality of nutrition / healthy diet education should be monitored by Ofsted.
  • UK Government should review and evaluate the School Fruit and Vegetable Scheme to ensure all children in England are receiving daily fruit and vegetables, that is fresh and to a certain quality standard.
  • National Child Measurement Programme (NCMP) should be maintained across England, ensuring data collection upon entry and exit of primary school. NCMP data should be embedded within electronic health records.
  • Local Authorities should review planning and licensing arrangements to ban fast food outlets (FFOs) from within 400 metres (approximately five minutes walking time) of schools and other locations with a high child footfall (e.g. leisure centres, parks, hospitals).
  • Scottish Government should provide funding for Local Authorities to maintain and expand on current sports and leisure facilities available for children and young people to exercise at.
  • Physical education or activity should be in line with the UK Chief Medical Officers’ 2019 Physical Activity Guidelines. Scottish Government should introduce measures of the quality of physical education, in line with the resources recently published by Education Scotland, ‘Quality learning, teaching and assessment in physical education’ (2020) and report on them annually.
  • We welcome the inclusion of nutrition and healthy diet education within the 2010-11 Scottish Government Curriculum for Excellence, which should be reviewed to ensure it is up to date. The quality of nutrition and healthy diet education should be monitored by Education Scotland.
  • We welcome Scottish Government’s commitment to provide healthier food within primary schools in 2020, including: a minimum of two portions of fruit or vegetables within each school lunch, a maximum amount of red meat served within each school lunch, removal of fruit juices and smoothies. Scottish Government should monitor the implementation of this and consider expanding this to all school children.
  • National Child Measurement Programme (NCMP) should be maintained in Scotland. Scottish Government should consult on expanding their Programme to collect data upon exit of primary school, which also provides an intervention for this age group who are more likely to be overweight or obese. NCMP data should be embedded within electronic health records.
  • We welcome and support Welsh Government’s ‘Healthy Weight, Healthy Wales’ strategy, to prevent and reduce childhood obesity in Wales. Welsh Government should ensure full implementation of the delivery plan, which provides a roadmap of necessary actions for the first two years of implementation. The following actions should be delivered at pace and subsequently evaluated:
    • A ban on advertising, sponsorship and promotion of products high in fat, sugar and salt HFSS products in public spaces including sporting events, family attractions and leisure centres should be implemented by 2030 and subsequently evaluated, starting with the transport network in the first delivery phase.
    • A review of planning and licensing opportunities and the creation of healthier environments, including limiting hot food takeaways near schools (within 400 metres). There should be consideration of expanding this to other locations with a high child footfall (e.g. leisure centres, parks, hospitals).
    • Build daily physical activity into the school day in line with the UK Chief Medical Officers’ 2019 Physical Activity Guidelines. The quality of physical education, or other physical activity, provided should be monitored by Estyn. We welcome Estyn’s commitment to a Whole School Approach, considering physical activity.
    • Create active environments, by providing funding for Local Authorities to maintain and expand on current sports and leisure facilities available for children and young people.
    • Maintain and expand provision for free breakfast within primary schools, including access to fruit or vegetables. Welsh Government should publish revisions to the Healthy Eating in Schools (Nutritional Standards and Requirements) (Wales) Regulations and deliver an effective framework for monitoring compliance and intervening where the regulations are not being met.
    • Advocate and lobby the UK Government to further restrict advertising of products HFSS in broadcast and on-line settings, which are non-devolved. All HFSS advertising between 17:30 and 21:00 should be restricted, with no exemptions.
    • Set out expectations of the pace of reformulation of HFSS products, with a view to using Welsh taxation powers to bring about further change.
  • The National Child Measurement Programme (NCMP) should be maintained across Wales. Welsh Government should consult on expanding their programmes to collect data at exit of primary school, which also provides an intervention for this age group who are more likely to be overweight or obese. NCMP data should be embedded within electronic health records.
  • Local Councils and, where appropriate, the Department of Infrastructure should review planning arrangements to ban fast food outlets (FFOs) from within 400 metres (approximately five minutes walking time) of schools and other locations with a high child footfall (e.g. leisure centres, parks, hospitals).
  • The Department of Education should ensure that physical education or activity is in line with the UK Chief Medical Officers’ 2019 Physical Activity Guidelines.
  • Northern Ireland Executive should prioritise the development of the ‘2020-2030 Strategy for Physical Activity and Sport’. The predecessor strategy ‘Sport Matters Northern Ireland’ consolidated the importance of play opportunities for pre-school children through its objectives to develop and deliver physical literacy skills for very young children and to encourage and sustain those skills into the physical education curriculum in key stages 1 & 2.
  • Primary school children should have access to free fruit and vegetables in school. Northern Ireland Executive should consider implementation of a School Fruit and Vegetable Scheme to ensure all children are receiving daily fruit and vegetables, that is fresh and to a certain quality standard.
  • National Child Measurement Programme (NCMP) should be maintained across Northern Ireland. NCMP data should be embedded within electronic health records.

What can health professionals do about this?

  • Provide weight management advice. Child health professionals should be trained to provide treatment and advice for obese children and young people, including how to sensitively engage in motivational conversations to support behaviour change in children, young people and their families.
  • Make every contact count. Children, young people and their families may see an encounter with a trusted health professional as an opportunity to discuss issues beyond their immediate, physical complaint. Professionals should make every healthcare contact count by proactively exploring weight management issues sensitively and where appropriate.
  • Recognise the impact of social determinants of health and support families in need. Families living in difficult circumstances are at higher risk of obesity. Professionals should act as advocates for vulnerable families, and signpost referrals if appropriate to other agencies for help with poverty and adversity.

Contributing authors

  • Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
  • Gethin Matthews-Jones, RCPCH Policy & External Affairs Division
  • Rachael McKeown, RCPCH State of Child Health Project Manager
  • Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor

Royal College of Paediatrics and Child Health (2020) State of Child Health. London: RCPCH. [Available at: stateofchildhealth.rcpch.ac.uk]

References

(1)

Reilly, J. et al. 2003. Health consequences of obesity. Archives of Disease in Childhood.

(2)

Simmonds, M. et al. 2016. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obesity Reviews.

(3)

Department of Health and Social Care, Cabinet Office, HM Treasury and Prime Minister’s Office. 2017. Childhood obesity: a plan for action.

(4)

Scottish Government. 2018. A healthier future: Scotland’s diet and healthy weight delivery plan.

(5)

Welsh Government. 2019. Health weight: healthy Wales.

(6)

Northern Ireland Department of Health, Social Services and Public Safety. 2012. A Fitter Future for All: Framework for Preventing and Addressing Overweight and Obesity in Northern Ireland 2012-2022.

(8)

Public Health Wales. 2019. Every Child: Child Measurement Programme 2017/18. Supplementary report: Severe Obesity.