Childhood obesity directly affects children’s physical and mental health, and often persists into adult life, causing significant morbidity and mortality. In England, a third of children aged 10 to 11 years in England have overweight or obesity. [1] In response the UK government has outlined a number of policies as part of a national plan to halve childhood obesity by 2030. [1,2,3]
There are some grounds for optimism. Overall levels of childhood obesity, whilst unacceptably high, are no longer rising, so with a sufficiently increased response by national and local politicians it should be possible to reduce the prevalence. Momentum for action is building; the public are rightly concerned and are increasingly willing to accept bold measures to tackle childhood obesity.
The Soft Drinks Industry Levy, or “sugar drinks tax,” has stimulated the soft drinks industry significantly to reduce the sugar content of many of their products.[4] Other important policies have been proposed, e.g. restrictions on advertising of unhealthy foods on television and the use of multi-buy discounts to sell unhealthy foods. Some local authorities are restricting the opening of new takeaway outlets, and the advertising of unhealthy foods, near schools.
But important grounds for concern remain. Inequalities in childhood obesity are stark and continue to grow. The prevalence of obesity for children aged 10 to 11 years continues to rise steeply for children living in the most deprived areas and is forecast to increase to one in three by 2030 if the present trend continues. [5] The number of takeaway food outlets continues to increase, with frequent promotion of very large portion sizes. Whilst existing plans should help to reduce childhood obesity, there is little if any prospect that they will achieve the Government’s ambition to halve childhood obesity by 2030. And major planks of those promised plans are yet to be implemented.
Solving Childhood Obesity, a report by Professor Dame Sally Davies, in her role as the previous Chief Medical Officer for England, outlines ten key principles that must underlie further actions to meet this goal.[5] The overwhelming focus is on primary prevention, with a clear message that the government needs to do much more to shape the environments that influence what children eat and determine the opportunities for them to be active.
Greater regulation of the food industry will be necessary to tackle childhood obesity. The voluntary responsibility deal failed to deliver meaningful change. Today, it is striking how legislation in the form of the levy on the soft drinks industry has led to a marked 22% reduction in the volume of sugar sold in soft drinks, while progress with the voluntary sugary reformulation programme has been poor. [4] The aim should be to set standards that protect children’s health, creating a level playing field so that businesses that act responsibly are not disadvantaged.
Similarly, much more needs to be done to protect children from the marketing of unhealthy food products, not just on TV and online, but also at public events, including major sports fixtures. Equally, the practice of using cartoon characters designed to appeal to children to sell sweets and other unhealthy products, and placement of these products at children’s eye-level in shops, needs to end.
Increasing physical activity will require a much stronger focus on creating safe and appealing places for children to walk, cycle, and play near their homes, through enhanced use and co-ordination of the planning process, and better design of the built environment.
Whilst effective prevention is essential, it is also important to provide help and support for children who have obesity. As many as 1.2 million children in England meet current NICE criteria for weight management or treatment, but there is significant under-provision of services for these children.[6] A major increase in investment will be required to meet this need. A recent Cochrane review concluded that weight management services are effective, at least in younger children, but concerns about effectiveness and value-for-money persist. [7]
It is only by changing the social, economic, policy and physical environments which frame all our dietary and activity decisions that we will see sustained, and sustainable change. Some of the proposals laid out in Dame Sally’s report are rightly bold; it is essential that we radically increase both the breadth and intensity of actions to tackle childhood obesity in these kinds of ways if we are to halve the prevalence by 2030.
Harry Rutter, Professor of Global Public Health, University of Bath, Claverton Down, Bath UK.
Emma Pawson, Office for the Chief Medical Officer, Department for Health and Social Care, UK.
Oliver Mytton, Office for the Chief Medical Officer, Department for Health and Social Care, UK and NIHR Academic Clinical Lecturer – Public Health, MRC Epidemiology Unit, University of Cambridge, UK.
Competing interests:
Oliver Mytton and Emma Pawson were editors in chief of the report by Prof Dame Sally Davies. Harry Rutter attended a round table meeting organized by the Chief Medical Officer prior to the writing of the report, and contributed advice during its drafting.
References:
- Childhood obesity: a plan for action. Department for Health and Social Care, 2017
- Childhood obesity: a plan for action, chapter 2. Department for Health and Social Care, 2018.
- Advancing our health: prevention in the 2020s. Department for Health and Social Care, 2019
- Sugar reduction: report on progress between 2015 and 2018. Public Health England, 2019
- Davies SC. Solving childhood obesity, an independent report by the Chief Medical Officer. Department for Health and Social Care, 2019
- Viner RM, Kinra S, Nicholls D, et al. Burden of child and adolescent obesity on health services in England. Archives of Disease in Childhood (2018).
- Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O’Malley C, Waters E, Summerbell CD. Do diet and physical activity strategies help prevent obesity in children (aged 0 to 18 years)? Cochrane (2019).