Child obesity

If you only read four things:

1.  9.1% of reception age children and 17.6% of children in Year 6 in Suffolk are obese.
2.  70.3% of children in the county spend at least 7 hours a day sitting down.
3.  An obese child is more likely to become an obese adult, storing up health problems for the      future, such as type 2 diabetes, raised blood pressure and high cholesterol.
4.  Healthy weight children are more likely to be fitter, healthier, better able to learn and                more self-confident.

 

1.Key points

The numbers
  • In 2015/16 in England, nearly 1 in 10 children of Reception age and almost 1 in 5 children in Year 6 were measured as obese1.
  • Assessing the body mass index (BMI) of children is more complex compared to adults because it changes as they grow and mature, therefore thresholds that take into account a child's age and sex are used to assess whether their BMI is too high or too low. These are usually derived from a child growth reference (a reference population, with the data presented in BMI centile charts. In a clinical assessment, a child or young person on or above the 98th centile is classified as obese2.
  • The Health Survey for England indicates that the proportion of children meeting physical activity guidelines has been falling over time: in 2008 19% of girls and 28% of boys met the guidelines – by 2012 this had fallen to 16% and 21% respectively3.
  • Nationally, the consumption of five or more portions of fruit and vegetables is 10% higher in the least deprived areas than in the most deprived3.
  • Obesity levels are higher in the most deprived areas. National figures indicate that in reception year children 5.5% were obese in the least deprived decile compared to 12.5% in the most deprived decile.  In year 6 children this difference was even greater, 11.7% were obese in the least deprived decile compared to 26.0% in the most deprived decile1.
  • In Suffolk, the percentage of obese reception age children (aged 4 – 5 years) has fluctuated over recent years and is currently 9.1% (of children measured), while for Year 6 (aged 10 – 11 years) the figure has been slowly increasing to its current rate of 17.6%4.
  • 70.3% of children in Suffolk spend at least 7 hours a day sedentary4.
  • Results of the 2014 WAY (What About You) survey suggest that 46% of girls and 23% of boys aged 15 report that they are ‘too fat’; 34% of those reported being made fun of because of their weight4.
  • Only 13% of children in Suffolk are physically active for at least one hour per day seven days a week4.
  • In Suffolk, 50.7% of children report that they eat five or more portions of fruit and vegetables per day4.
  • 79.1% of Suffolk five year olds are tooth decay free, meaning 20.9% have one or more teeth that are decayed, missing or filled4.
  • Evidence suggests that breastfeeding can prevent child obesity5.  In Suffolk 76.6% of women started breastfeeding in 2014/15. Breastfeeding initiation percentages are not currently available for 2015/16.  However,  in 2015/16 47.0% of women were breastfeeding at 6 – 8 weeks after birth6.
The impact

Obesity is caused by too much energy being consumed in the form of calories, compared to what is burned off through physical activity. For children, these excess calories are often taken in the form of sugary or fatty foods. Today’s obese children are likely to become obese adults, suffering from a range of health conditions in adulthood, such as high blood pressure and raised cholesterol, which will impact on life expectancy.  Type 2 diabetes is becoming more prevalent in children, whereas previously it was a disease associated with adulthood7.  Obese children are also more likely to suffer from bullying because of their size, and may be affected by weight stigma, which may in turn lead to low self-esteem, body image issues, anxiety and depression.

Tackling childhood obesity effectively will require the development of a sustained ‘whole systems approach’, which seeks to link together many of the influencing factors on obesity and requires co-ordinated action and integration across multiple sectors. Action by health, education, social care, planning, housing, transport and business can bring about major change to combat obesity, making better use of resources and improving wellbeing and prosperity. Working across multiple disciplines, will help us to identify the opportunities to support individuals at key points throughout their lives to help reduce the occurrence and impact of obesity.

Levels of obesity in Suffolk children have varied over recent years. Figures from the National Childhood Measurement Programme (NCMP) (Figures 1 & 2 below), indicate that obesity in Reception age children is currently significantly higher than the East of England, and similar to England. Obesity in Year 6 children is  similar to the East of England and significantly lower than the England figure.  Compared to 2008/09 levels of year 6 obesity have increased.  

Figure 1: Percentage of Reception age children measured as obese – 2007/08 – 2015/16

Time lines showing % reception children obese in Suffolk is usually below East of England and England (2007/08 to 2012/13), but has increased recently

Data source: 1

Figure 2: Percentage of Year 6 children measured as obese – 2007/08 – 2015/16

Time line showing % year 6 obese in Suffolk was below East of England and England (2007/08-2011/12) and from 2012/13 has been in line with East of England and lower than England.

Data source: 1

For more data look below: 

2.What are the key inequalities in Suffolk?

Suffolk is a rural county and many people rely on their own transport to access education and employment opportunities.  Data from the Department for Transport shows Suffolk has the second lowest passenger journeys per head on local bus services compared to the other authorities in the East of England8. Children today are becoming increasingly more accustomed to being transported by parents/carers in cars than having to rely on either walking or cycling. 

Data from the national travel survey highlights the different travel to school methods for 5-16 year olds (figure 3).  Those living in rural locations are more likely to use motorised transports (cars / buses) to get to school compared to those in more urban locations.

Figure 3: Trips to and from school by main mode, region and Rural-Urban Classification: England, 2014/15
  Walk Cycle Car/van Private bus public bus other
England 42% 2% 36% 4% 13% 3%
Urban conurbation 42% 2% 33% 3% 17% 4%
Urban city & town 47% 3% 36% 3% 9% 2%
Rural town & fringe 41% 2% 37% 7% 12% 3%
Rural village, hamlet & isolated dwelling 13% 1% 50% 13% 20% 3%

Source: 9 (Table NTS9908)

There are variations in levels of child obesity between the seven local authorities in Suffolk with the lowest seen in the less deprived local authorities (Mid Suffolk and Suffolk Coastal) and the highest in the most deprived (Ipswich and Waveney)10, in line with the national picture. 

Figure 4:  Percentage of children measured as obese, 2015/16 and average Index of Multiple Deprivation score 2015, Suffolk

Chart comparing deprivation by Suffolk local authority and deprivation.

Data source: 1, 11

3.Costs

It is difficult to assess the cost of child obesity, although George Osborne, in his last Budget as Chancellor of the Exchequer, proposing a tax on sugary drinks, stated that obesity overall costs the NHS £27 billion a year12.   The full costs of childhood obesity would most likely be incurred in adulthood, for example triggering health conditions requiring life-long medical treatment, or resulting in lower earnings/ worklessness.

4.What are we doing?

There is a wealth of advice and guidance available, with the focus on healthy eating and being physical active. NHS Choices offer advice to parents and carers on managing their children’s weight, not just with increased physical activity, but through healthy eating, ensuring that children consume child -sized portions of food, as well as limiting screen time and ensuring children get enough sleep. More local initiatives include the following:

  • OneLife Suffolk offers support to families and young people, running free interactive programmes combining physical activity and games for children and young people aged 2 -18, to educate them about healthy eating and maintaining a healthy weight and lifestyle. Sessions run at the same time as those for adults, so the whole family can benefit.
  • Suffolk Sport – a source of information for all schools in Suffolk on school sport and school games. Suffolk Sport also administers the Suffolk Sporting Ambassador Scheme, where schools, clubs and community groups can request a visit from an elite Suffolk sportsperson as inspiration for children and young people.
  • Ipswich Junior Park Run – operating in a similar way to the adult Park Run, this scheme provides a free weekly 2km run for children aged 4 – 14 years.
  • Change4Life – provides advice to parents on managing their children’s weight, including physical activity, healthy eating and portion size.
  • Most Active County -  operates various initiatives to get young people more active, including Doorstep Sports Clubs, aimed at young people in disadvantaged communities.
  • The Healthy Child Programme - a national initiative provided by local authorities who commission public health services for children and young people, bringing together health, and education and offering early intervention in a range of issues such as healthy eating and obesity, speech and language therapy, special educational needs and wellbeing.

5.What else could we do?

The Joint Health and Well Being Strategy for Suffolk 2012-2022 has identified “Every child in Suffolk has the best start in life” as one of its priorities.  Adopting a whole system approach to tackle childhood obesity will help achieve the long term aims of reducing the prevalence of overweight and obese children and young people, improving health and decreasing health inequalities.

Tackling childhood obesity effectively will require the development of a sustained ‘whole systems approach’, which seeks to link together many of the influencing factors on obesity and requires co-ordinated action and integration across multiple sectors. Action by health, education, social care, planning, housing, transport and business can bring about major change to combat obesity, making better use of resources and improving wellbeing and prosperity. Working across multiple disciplines, will help to identify the opportunities to support individuals at key points throughout their lives to help reduce the occurrence and impact of obesity.

In March 2017, the government published a planning document aimed at reducing the number of hot food takeaways in areas with high levels of child obesity in Gateshead13.  This is the sort of initiative that could be rolled out nationally; quite often secondary school age children prefer to purchase food eaten during the school day at fast-food outlets, rather than school canteens14

Although schools are increasingly under pressure to provide value for money meals, there is a greater role they could be playing in the education of children around healthy eating. Public Health England’s Health matters: obesity and the food environment14  suggests several steps schools could undertake to encourage children to make better choices, including:

  • School nutrition action groups and consulting with children around the food on offer
  • Making school canteens more inviting, with better décor, music and shorter queues
  • Adopting a cashless system to speed up queues and remove the need for children to be given cash which could be spent at fast food outlets
  • Closed gate/on-site policies to remove the temptation of children leaving school premises to but fast food
  • Meal deals in school canteens or subsidised/free meals
  • Letting children analyse local food outlet offers and develop and trial healthier, tastier food options

As information available shows, there is a correlation between obesity levels and deprivation; more could be done to increase the take up of free school meals. Data from the school census taken in January 2016 shows that on the day of the census, 2,337 children in state-funded mainstream schools in Suffolk did not take up the free school meal they were entitled to15. This equates to almost 21% of those eligible.  More work could be done to establish why so many do not take up their entitlement; it could be that there is a stigma attached to free school meals that could be removed by introducing smart cards for all children which can be preloaded either with the child’s entitlement to free school meals or cash, if the child is not entitled.

It is important that adequate support is available to children and parents/carers if a child is identified as obese.  Health professionals should be able to advise and provide information relevant to all the family, not just the child. It is important that all members of the family are engaged in creating a healthy lifestyle.

There are also opportunities for prevention of obesity during pregnancy; midwives in contact with women who are overweight or obese should be able to advise them on how to eat more healthily during the pregnancy, and promote the benefits for both mother and child.

Too often healthy food is more expensive than cheaper, fatty food. Evidence for this was produced in a study by the University of Cambridge and the University of East Anglia, based on the price of foods per 1,000 calories (the standard method of assessing food poverty).  Healthy (lower calorie) foods, including fruit and vegetables, were assessed as being expensive as more were required to make up the 1,000 calories16.  If there could be more done to promote the fact that healthy eating is not as costly as is perceived, families might find it easier to make better food choices and follow healthier lifestyles.  Additionally, food cooking programmes in school and for parents may promote healthier lifestyle choices.

6.Recommendations

More needs to be done to educate families in the need to eat healthily and undertake sufficient physical activity to maintain a healthy weight, ensuring good health in the future.   There is a proven link between active mothers and active children. A recent Southampton based study found a direct and significant association between physical activity levels and sedentary time in British children (at 4 years) and their mothers17. Although the study was primarily looking at mother and child activity it notes that health promotion efforts should consider inclusion by the whole family i.e. dads and siblings. The study found that only 53% of mothers engaged in 30 minutes of moderate-to-vigorous activity (at least once a week).

Children should be given the opportunity to follow a healthy lifestyle. Schools also have a role in encouraging healthy eating on a day-to-day basis and provide meals that encourage healthy food choices.

Clearer information about food content and cost would enable parents to better understand the impact of high calorie foods, especially those which are fatty or sugary, not only their children’s health, but on their own.

Children and their families need to be supported to be more physically active through active recreation, active travel and active play.   The increasingly earlier disengagement of girls from participation in sport and PA needs to be tackled. Physical activity programmes should support the needs of children with excess weight, and sedentary behaviour both in school and at home needs to be reduced.

7.Useful links

8.References

1.           Public Health England. NCMP Fingertips Profile (July 2017). http://fingertips.phe.org.uk/profile/national-child-measurement-programme/data#page/0/gid/8000011/pat/6/par/E12000006/ati/102/are/E10000029/iid/90319/age/200/sex/4. Published 2017.

2.           NICE. Weight management: lifestyle services for overweight or obese children and young people  | Guidance and guidelines | NICE. https://www.nice.org.uk/guidance/ph47/chapter/1-recommendations. Published 2013. Accessed July 20, 2017.

3.           Statistics on Obesity, Physical Activity and Diet, England.; 2016.

4.           Public Health England Child Health Profiles 2017.

5.           World Health Organization. WHO | Exclusive breastfeeding to reduce the risk of childhood overweight and obesity. WHO. http://www.who.int/elena/titles/bbc/breastfeeding_childhood_obesity/en/. Published 2014. Accessed July 20, 2017.

6.           Public Health England. Fingertips - Child Health and Breastfeeding Profile - June 2017. https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-pregnancy/data#page/0/gid/1938133035/pat/6/par/E12000006/ati/102/are/E10000029. Published 2017. Accessed June 9, 2017.

7.           Public Health England - National Obesity Observatory.

8.           Department for Transport. Passenger journeys on local bus services per head of population by local authority: England: BUS0110. https://www.gov.uk/government/statistical-data-sets/bus01-local-bus-passenger-journeys. Published 2017.

9.           Department for Transport. Travel by region and area type of residence (NTS99). https://www.gov.uk/government/statistical-data-sets/nts99-travel-by-region-and-area-type-of-residence. Published 2016.

10.         IMD 2015 - Ranking within Suffolk - Suffolk Observatory.

11.         Department for Communities and Local Government. English indices of deprivation 2015. 2015. https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015.

12.         Chancellor of the Exchequer’s 2016 Budget Speech.

13.         Planning Document to Limit the Proliferation of Takeaways - March 2017.

14.         Public Health England - Health matters: obesity and the food environment - 2017.

15.         Department for Education: Schools, pupils and their characteristics (school census data) January 2016.

16.         NHS Choices - “Healthy foods expensive” claim is unreasonable - 9th October 2014.

17.         Suffolk County Council. 2014 - Start Here, Suffolk Annual Public Health Report. 2014. http://www.healthysuffolk.org.uk/assets/JSNA/Annual-Report/2014-Public-Health-Annual-Report-Interactive-LR.pdf.