Childhood obesity is a growing health and wellbeing issue.
Numbers can be surprising:
- Nearly 1 in 5 children are overweight or obese when the start primary school.
- 1 in 3 are overweight or obese by the time they start secondary education1.
The children of today are becoming obese earlier and staying that way for longer than previous generations2 .
Childhood obesity can lead to dyslipidaemia (deranged levels of fats in the blood), hyperinsulinaemia (high levels of insulin in the blood with the pancreas trying to keep up with the need) and hypertension (high blood pressure)3. Type 2 diabetes is becoming seen in children.
Not only is this a physical health issue, posing significant health risks, there are associated mental health problems including low self-esteem and poor body image4,5.
On a national level this becomes an economical hurdle to face – obesity is the largest human-generated economic burden facing the UK after smoking 1. In fact, in the UK the cost of treating obesity and diabetes is more than we spend on the police, judicial system and fire service combined6! In 2014-2015 the NHS in England spent £5.1 billon on ill-health related to obesity and being overweight6. Please note these figures are for all ages, not just childhood obesity.
With a rising proportion of the population, both adults and children, being obese what is considered “normal”. When does “puppy fat” become a concerning health issue? Do you know it’s normal to see some ribs in a child? I think these questions raise an interesting point. If a child is considered a ‘normal/healthy weight’ by their community yet is actually overweight, the drive for change could be lower, making interventions even more challenging to raise, let alone be successful.
Whilst I fully support the body positivity movement, I feel this shouldn’t be associated with obesity being thought of as healthy. One can be confident in their body, have self-esteem, but also want to change to improve their overall wellbeing.
One thing for sure we can say is this is not a child’s fault.
A concept I have come across repeatedly during my Public Health Masters is the Social Determinants of Health. Social determinants of Health are defined by the WHO as:
“the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems” 7.
In the UK there is a strong positive correlation between levels of deprivation and the prevalence of overweight and obese children8. In 2015-2016 in the most affluent areas of the country 27% of children were obese, whereas in the most deprived areas the figure was 40%8. This trend is gets worse over time with children from the poorest income families being twice as likely to be obese as those from the most affluent families at age 5, yet 3 times as likely to be obese by age 119. This is a reversal of the same relationship observed in the 1970s8.
So what can we do about it?
The causes of childhood obesity are so varied – the ‘obesogenic environment’ along with genetic and epigenetic factors. Whilst ultimately the end point is energy in being greater than energy out over time, the root causes are so multifaceted. This leads to a challenge from a public health perspective, as there is no single intervention or policy which could solve the problem.
The government has published a ‘plan for action’ with respect to childhood obesity 10.
Some implementations are going to be controversial – such as the introduction of the ‘sugar tax’ and banning advertising foods high in saturated fats, sugars and salt on TV before the 9pm watershed. Moreover, it is paramount that any intervention is regularly monitored and evaluated to ensure it is effective and delivering intended results.
There have been several studies into the effectiveness of interventions aimed at increasing physical activity, dietary advice and behavioural modifications either based in school, at home or both.
Ultimately a wide-pronged approach involving policy, public health campaigns and evidence-based weight-management services will be needed to address this growing health issue by tackling root causes through lifestyle change.
- About childhood obesity | RCPCH. Available at: https://www.rcpch.ac.uk/key-topics/nutrition-obesity/about-childhood-obesity. (Accessed: 20th March 2019)
- Johnson, W., Li, L., Kuh, D. & Hardy, R. How Has the Age-Related Process of Overweight or Obesity Development Changed over Time? Co-ordinated Analyses of Individual Participant Data from Five United Kingdom Birth Cohorts. PLOS Med. 12, e1001828 (2015).
- Freedman, D. S., Dietz, W. H., Srinivasan, S. R. & Berenson, G. S. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 103, 1175–82 (1999).
- Davison, K. K. & Birch, L. L. Weight status, parent reaction, and self-concept in five-year-old girls. Pediatrics 107, 46–53 (2001).
- Strauss, R. S. Childhood obesity and self-esteem. Pediatrics 105, e15 (2000).
- McKinsey Global Institute. Overcoming Obesity: An Initial Economic Analysis. (2014).
- WHO | Social determinants of health. WHO (2018).
- About childhood obesity | RCPCH. Available at: https://www.rcpch.ac.uk/key-topics/nutrition-obesity/about-childhood-obesity. (Accessed: 29th March 2019)
- Goisis, A., Sacker, A. & Kelly, Y. Why are poorer children at higher risk of obesity and overweight? A UK cohort study. Eur. J. Public Health 26, 7–13 (2016).
- Childhood obesity: a plan for action – GOV.UK. (2017). Available at: https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action/childhood-obesity-a-plan-for-action. (Accessed: 20th March 2019)