Managing the childhood obesity crisis

by Alison Oliver, Youth Sport Trust's Chief Executive

This week is National Obesity Awareness Week - a time for action, undoubtedly, but also a time to reflect on a journey that has resulted in a third of young people in the UK entering secondary school overweight or obese. 

In the next few weeks the Government will release a childhood obesity strategy. Already it has received much media attention with widely publicised calls for a ‘sugar tax’ to be included. This discussion was given further fuel last autumn when the Commons Health Committee released the report of its childhood obesity inquiry. 

Whilst the larger part of this report focused on making the case to Government for behavioural health promotion, through a tax on sugary soft drinks and a centrally-led programme to reduce sugar in food and drink, there was key evidence submitted to the inquiry which everyone working with young people should be aware of.  

The first point to highlight was one made by Dr Jeanelle de Gruchy, Vice-President of the Association of Directors of Public Health, who explained to the Health Committee that both physical activity and food intake should be seen as ‘equally important in a very complex way’.

Delivering national-scale solutions to this complex problem demands local responses and multi-agency partnerships. It requires solutions that create healthy active habits for life, that are born out of high quality physical education in early-years settings. It must understand the array of pressures young people face, with scrutiny from peers, from the media and from school, can result in poor body confidence and fragile emotional wellbeing. It must meet the needs of young people and offer solutions to overcome socio-economic factors, such as poor diet and lack of understanding of how to keep healthy. With 20 years of experience of working with schools to improve physical activity the Youth Sport Trust understands the positive impact and transformational change PE can have on physical literacy, physical inactivity, body confidence and emotional wellbeing. 

We also understand that whilst childhood obesity is increasingly a priority of local-level health and wellbeing strategies, limited resources mean that the majority of local authorities are not able to offer services to help obese and overweight children. That is why we are supporting the strategic leadership of the sport delivery and healthcare providers of Northamptonshire with the development of an innovative approach to PE and sport that aims to tackle inactivity and the declining physical, social and emotional wellbeing of adolescents. We are also leading the National delivery of 10,000 Change4Life Sports Clubs in primary schools across England and working with local stakeholders to embed this school-based lifestyle programme into healthy weight pathways with many local authorities (reducing their investment in inefficient and ineffective tier one and two interventions).  Like all Youth Sport Trust programmes, it is informed by research that is furthering understanding in the field of childhood obesity and mental health and wellbeing. 

In most cases a large part of local authority funding for paediatric public health goes to support the National Child Measurement Programme (NCMP), which checks the height and weight (giving a Body Mass Index) of children as they join and leave primary school. Evidence presented to the Health Committee’s inquiry identified that where the measurement programme judges a child to be overweight or obese it is often not coupled with a treatment plan or supported by services for the child, or advice to parents, if indeed they even receive the results of the measurement of their child. When parents are informed it is in what has been dubbed by the media as ‘fat letters’, which indicate to parents if their child is overweight or obese. The letters represent one way in which the information from the measurement programme is being used as a tool to promote behaviour change. However, the Royal Society for Public Health (RSPH) says only half of parents understand why their child is being weighed, that few find the information in the letter useful and ultimately that parents need more support.

Without the inclusion of advice or links to services few parents, will do anything with the information they are given. The RSPH wants the letters to be the beginning of a dialogue with parents and calls for better integration of the National Child Measurement Programme with other public health initiatives, such as Change4Life.

Currently children fare worse than adults in meeting physical activity guidelines, and this situation seems to be worsening. Evidence shows that information campaigns aimed at promoting healthier choices generally tend to help those who are already engaged with improving their health, and may therefore only serve to widen health inequalities. A national-level campaign must be guided by strong evidence of effective intervention in order for restricted funds to have the greatest impact. 

There have been calls to extend the child measurement programme to include secondary school pupils and fitness testing. Developing a reliable and valid means of testing this in a population of young people maturing at different rates may be appropriate in times of plenty but in the current austerity climate, with November’s Spending Review resulting in further cuts both to public health spending and council budgets, local authorities must focus on the development of pragmatic solutions for managing the escalating childhood obesity problem. 

Whilst all remain hopeful that new money will be made available by the Department of Health’s forthcoming strategy, there is currently no ring-fenced funding for tackling childhood obesity and experts at the inquiry agreed that they would rather provide services to tackle childhood obesity in their communities than ‘doing another year’s survey’. 

As would be expected the inquiry looked at prevention, as well as cure. Public health experts called on the Government to increase provision for physical activity in schools, such as rolling out London's healthy schools programme across the country with national and local level support structures. 

To reverse the deepening obesity crisis, we need to see a physical activity offering and health and wellbeing strategy in schools that inspires fundamental and unchanging attitudes towards sport and physical activity from early in life, and inspires regular participation throughout life. As expressed in the NHS Five Year Forward View ‘the future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health’.

The Youth Sport Trust has long supported schools in encouraging children to be more active, not just in physical education and sports, but during lunch hours, through after-school activities and with a timetable tailored for an active school day.

In anticipation of the release of the childhood obesity strategy we can expect to hear more on the debate around what it is capable of achieving and what will actually be within its scope. This National Obesity Awareness Week the Youth Sport Trust is amplifying its call for physical activity to be a part of a blended response and included in national policies and government support of local services.

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