Childhood obesity crisis: a comprehensive strategy with high-level political support is needed.
Dear Editor
The Institute of Health Promotion and Education fully agrees, co-ordinated bold and decisive action is needed to tackle the childhood obesity crisis.(1) During the covid-19 pandemic there has been a lack of government impetus in relation to obesity, and in addition the lockdown is likely to have inhibited physical activity for some children potentially leading to increases in weight.
There is a considerable body of evidence demonstrating the impact and burden of diet related ill health and the need for action.(2-11) Poor diet is not only a significant cause of ill health and premature mortality but is also a considerable drain on the NHS. Moreover, obesity and linked conditions are now associated with worse covid-19 outcomes.(12-14) We urgently need a well-structured multifaceted campaign to tackle overweight and obesity.
Campaigns to tackle obesity have previously focused heavily on personal responsibility and some in the media have been involved in victim blaming and shaming. This is not the type of approach that we advocate. Isolated interventions including: altering portion size, increasing taxation on certain foods, reformulation, and banning junk food in some settings can bring about some improvements but this is not always the same as improving health. We strongly believe that a comprehensive strategy will be more effective.(15-17) Children and their families need to be supported to make sustained behaviour change and at the same time obesogenic environments need to be tackled so that healthier options are more likely to be chosen.
In the NHS doctors and nurses could have a more proactive role in health promotion.(18,19) Here we recommend a whole systems approach where for example there are heathier food options on the menu and in onsite shops; for patients, visitors and staff. Hospitals should be exemplars of good practice for the local community.(19) Such approaches could be facilitated by public health specialists who have the knowledge and skills to create health promoting hospitals.
Similarly, whole school approaches are likely to be more effective than isolated education.(20-22) Providing healthier food and drink options in school should be used to support education in the classroom. At a national level, mandatory school food standards could be introduced to assist all schools. Physical activity also needs promoting. At a local level, public health specialists could galvanise, train and coordinate the actions of teachers, school nurses and catering staff to further drive improvements.
Multidisciplinary local authority public health teams led by directors of public health have been underutilised.(23-27) They should have a key role in driving action across a range of settings including hospitals, schools and the local community. However, if we are to truly address this epidemic then they must be provided with adequate resources and strong long-term national support.
The scale, impact and costs of the childhood obesity epidemic should not be underestimated and real improvements in positive health will take time to achieve. We believe it is crucial to act now not only for the health of future generations but also for our overburdened NHS. We urge the government to significantly increase activity and to produce a multifaceted positive healthy eating strategy.
References
1) Wise J. Government must “stop dithering” and tackle childhood obesity crisis, says Labour. BMJ 2020;370:m2881 http://dx.doi.org/10.1136/bmj.m2881
2) Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obesity Reviews, 2004, 5(Suppl 1):4–104.
3) Foresight. Tackling Obesities: Future Choices – Project Report. Government Office for Science: London 2007.
4) World Health Organization. Population-based approaches to Childhood Obesity Prevention. Geneva: World Health Organization, 2012.
5) World Health Organization. Prioritizing areas for action in the field of population-based prevention of childhood obesity. A set of tools for Member states to determine and identify priority areas for action. Geneva: World Health Organization 2012.
10) Mytton O, Fenton-Glynn C, Pawson E, Viner R and Davies S. Protecting children's rights: why governments must be bold to tackle childhood obesity. The Lancet, 2019.DOI:doi.org/10.1016/S0140-6736(19)32274-3 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32274-3/fulltext#articleInformation
12) Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ2020;369:m1985 https://www.bmj.com/content/369/bmj.m1985
16) Watson M C, Theaker T. Re: Fight childhood obesity with multiple methods, not just more taxes, MPs hear. BMJ Rapid Response. 7th May 2018. https://www.bmj.com/content/361/bmj.k1963/rr
17) Watson M C and Lloyd J. Obesity epidemic: bold and decisive action needed. BMJ 2019;367:l6396
doi: https://doi.org/10.1136/bmj.l6396
20) Campbell C (Editor) New Directions in Health Education. London: The Falmer Press, 1985.
21) Boddington N, King A and McWhirter J. Understanding Personal, Social, Health and Economic Education in Primary Schools. London: Sage Publications, 2014.
Rapid Response:
Childhood obesity crisis: a comprehensive strategy with high-level political support is needed.
Dear Editor
The Institute of Health Promotion and Education fully agrees, co-ordinated bold and decisive action is needed to tackle the childhood obesity crisis.(1) During the covid-19 pandemic there has been a lack of government impetus in relation to obesity, and in addition the lockdown is likely to have inhibited physical activity for some children potentially leading to increases in weight.
There is a considerable body of evidence demonstrating the impact and burden of diet related ill health and the need for action.(2-11) Poor diet is not only a significant cause of ill health and premature mortality but is also a considerable drain on the NHS. Moreover, obesity and linked conditions are now associated with worse covid-19 outcomes.(12-14) We urgently need a well-structured multifaceted campaign to tackle overweight and obesity.
Campaigns to tackle obesity have previously focused heavily on personal responsibility and some in the media have been involved in victim blaming and shaming. This is not the type of approach that we advocate. Isolated interventions including: altering portion size, increasing taxation on certain foods, reformulation, and banning junk food in some settings can bring about some improvements but this is not always the same as improving health. We strongly believe that a comprehensive strategy will be more effective.(15-17) Children and their families need to be supported to make sustained behaviour change and at the same time obesogenic environments need to be tackled so that healthier options are more likely to be chosen.
In the NHS doctors and nurses could have a more proactive role in health promotion.(18,19) Here we recommend a whole systems approach where for example there are heathier food options on the menu and in onsite shops; for patients, visitors and staff. Hospitals should be exemplars of good practice for the local community.(19) Such approaches could be facilitated by public health specialists who have the knowledge and skills to create health promoting hospitals.
Similarly, whole school approaches are likely to be more effective than isolated education.(20-22) Providing healthier food and drink options in school should be used to support education in the classroom. At a national level, mandatory school food standards could be introduced to assist all schools. Physical activity also needs promoting. At a local level, public health specialists could galvanise, train and coordinate the actions of teachers, school nurses and catering staff to further drive improvements.
Multidisciplinary local authority public health teams led by directors of public health have been underutilised.(23-27) They should have a key role in driving action across a range of settings including hospitals, schools and the local community. However, if we are to truly address this epidemic then they must be provided with adequate resources and strong long-term national support.
The scale, impact and costs of the childhood obesity epidemic should not be underestimated and real improvements in positive health will take time to achieve. We believe it is crucial to act now not only for the health of future generations but also for our overburdened NHS. We urge the government to significantly increase activity and to produce a multifaceted positive healthy eating strategy.
References
1) Wise J. Government must “stop dithering” and tackle childhood obesity crisis, says Labour. BMJ 2020;370:m2881
http://dx.doi.org/10.1136/bmj.m2881
2) Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obesity Reviews, 2004, 5(Suppl 1):4–104.
3) Foresight. Tackling Obesities: Future Choices – Project Report. Government Office for Science: London 2007.
4) World Health Organization. Population-based approaches to Childhood Obesity Prevention. Geneva: World Health Organization, 2012.
5) World Health Organization. Prioritizing areas for action in the field of population-based prevention of childhood obesity. A set of tools for Member states to determine and identify priority areas for action. Geneva: World Health Organization 2012.
6)House of Commons Health Committee. Childhood obesity: follow-up. 27 Mar 2017. www.parliament.uk/business/committees/committees-a-z/commons-select/heal...
7) World Health Organization. Taking Action on Childhood Obesity. Geneva: World Health Organization, 2018.
https://www.who.int/end-childhood-obesity/publications/taking-action-chi...
8) Davies S. Time to Solve Childhood Obesity. London: Department of Health Social Care 2019.
https://www.gov.uk/government/publications/time-to-solve-childhood-obesi...
9) OECD The Heavy Burden of Obesity: The Economics of Prevention. OECD Publishing: Paris, 2019.
http://www.oecd.org/health/tackling-obesity-would-boost-economic-and-soc...
10) Mytton O, Fenton-Glynn C, Pawson E, Viner R and Davies S. Protecting children's rights: why governments must be bold to tackle childhood obesity. The Lancet, 2019.DOI:doi.org/10.1016/S0140-6736(19)32274-3
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32274-3/fulltext#articleInformation
11) Royal College of Paediatrics and Child Health. State of child health 2020. March 2020. www.rcpch.ac.uk/state-of-child-health.
12) Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ2020;369:m1985
https://www.bmj.com/content/369/bmj.m1985
13) Syed A, Soran H, Adam S. Obesity and covid-19: the unseen risks. BMJ 2020;370:m2823
https://www.bmj.com/content/370/bmj.m2823
14) Tan M, He FJ, MacGregor GA. Obesity and covid-19: the role of the food industry. BMJ 2020;369:m2237.
https://www.bmj.com/content/369/bmj.m2237
15) Watson M and Lloyd J. Taxing sugar should be just one element of a multifaceted campaign BMJ 2015;351:h4388
https://www.bmj.com/content/351/bmj.h4388
16) Watson M C, Theaker T. Re: Fight childhood obesity with multiple methods, not just more taxes, MPs hear. BMJ Rapid Response. 7th May 2018. https://www.bmj.com/content/361/bmj.k1963/rr
17) Watson M C and Lloyd J. Obesity epidemic: bold and decisive action needed. BMJ 2019;367:l6396
doi: https://doi.org/10.1136/bmj.l6396
18) Academy of Medical Royal Colleges. Measuring Up: The Medical Profession’s Prescription for the Nations Obesity Crisis. London: Academy of Medical Royal Colleges 2013.
https://www.aomrc.org.uk/reports-guidance/measuring-up-0213/
19) BMA Food for thought: promoting healthy diets among children and young people. London: BMA 2015.
https://www.bma.org.uk/collective-voice/policy-and-research/public-and-p...
20) Campbell C (Editor) New Directions in Health Education. London: The Falmer Press, 1985.
21) Boddington N, King A and McWhirter J. Understanding Personal, Social, Health and Economic Education in Primary Schools. London: Sage Publications, 2014.
22) Lloyd J, Watson M. IHPE Position Statement: PSHE. Lichfield: IHPE, 2019.
https://ihpe.org.uk/wp-content/uploads/2019/10/IHPE-Position-Statement-P...
23) Watson M C and Lloyd J. Need for increased investment in public health BMJ 2016;352:i761.
https://www.bmj.com/content/352/bmj.i761
24) BMA. Funding for ill-health prevention and public health in the UK. May 2017. http://bit.ly/2quLN3K
25) House of Commons Health Committee. Public health post-2013: second report of session 2016-17. House of Commons Paper No 140, 2016-17.
26) Watson M C and Thompson S. Government must get serious about prevention. BMJ 2018;360:k1279.
https://www.bmj.com/content/360/bmj.k1279
27) Scally G, Jacobson B and Abbasi K. The UK’s public health response to covid-19. BMJ 2020;369:m1932
https://www.bmj.com/content/369/bmj.m1932
Competing interests: No competing interests