Childhood obesity

Childhood obesity has been a local priority for a number of years. In May 2015 the Health Secretary announced that childhood obesity was a national priority and that work was underway to develop a new national childhood obesity strategy.

Figures for 2014/15 show that in England by age 4-5 (Reception Year) over one in five children are either overweight or obese (21.9%). By age 10-11 (Year 6) that rises to one in three children overweight or obese, and of those one in three, two thirds are classified as obese.

What do we know?

Risk factors

Weight gain is due to an imbalance in the energy that you take in (i.e. food and drinks you consume) and the energy that you expend e.g. through being active. Therefore, households where children are sedentary, tend to have longer screen times, watching television and computer games and eating/snacking while watching TV are at greater risk of childhood obesity.

Though factors in older children are well-known to be associated with weight gain, many children entering Reception year are already overweight. This highlights the importance of taking a “lifecourse” approach to obesity and looking at early life factors such as breastfeeding as protecting against childhood overweight and even prenatal factors such as smoking during pregnancy as a risk factor for childhood obesity.

Health-related consequences

Children who are overweight or obese are at greater risk of developing health problems in childhood including type 2 diabetes, problems with breathing including obstructive sleep apnoea (OSA) and problems with joints and bones including joint pain and slipped upper fermoral epiphysis (SUFE). Due to this greater risk of illness, children who are obese are more likely to be absent from school due to illness.

Childhood obesity is also associated with longer term health problems. Overweight and obese children are more likely to become obese adults, and are more likely to develop related diseases such as type 2 diabetes and heart disease.
The resulting NHS costs attributable to overweight and obesity (in adults and children) are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year (Foresight 2007). These factors combine to make the prevention of obesity a major public health challenge.

Facts, Figures, Trends

The proportion of 4 and 5 year olds in Slough who are overweight (including those who are obese) has come down slightly from 20.2% in 2013/14 to 19.9% in 2014/15. This is measured according to the postcode of the primary school. When measured according to child’s postcode the figure is 19.6%. In this age group, Slough children are less overweight than the England average (Figure 1).

Figure 1. Prevalence of overweight and obesity in Reception Year in Slough

Figure 1 shows percentage of children who are obese in reception.

Source: National Child Measurement Programme 

In terms of those aged 10 and 11 years in Slough, however, the proportion overweight has increased from 36.5% in 2013/14 to 38% in 2014/15 so that now it is significantly higher than the average for England (Figure 2). Again, these figures are according to Slough school postcode; the corresponding figure according to the child’s postcode is 38.8%.

While for the younger age group, there was also a reduction in the proportion of overweight children that were obese, in those in Year 6 (aged 10 and 11), the proportion of obese children increased over the same period.

Figure 2. Prevalence of overweight and obesity in Year 6 in Slough

Figure 2 shows percentage of children who are obese in year 6.

 (Source: HSCIC National Child Measurement Programme)

 We can also look at the rates of overweight children according to the ward they live in (Figure 3). While there is some variation across the borough, in fact levels of child obesity in 10 and 11 year olds is similarly high in all wards. The highest levels of obesity in children of this age are seen in Colnbrook with Poyle and Wexham Lea.

Figure 3. Child Obesity for Slough at ward level map (11/12 and 13/14 for year 6)

(highest rates of obesity shaded dark red)

Figure 3 shows Slough wards with the highest and lowest rates of childhood obesity.

Source: National Child Measurement Programme

Slough School Food Survey

The school food survey for Slough 2014/15 visited all but two primary schools in Slough and found positive results in that the uptake of school meals had risen to 49% from 32% in the previous year (though the national target is for 70% of children to be eating school meals).

The survey also found that 86% of school meals provided were balanced and complied with guidelines while only 39% of packed lunches were healthy and balanced. This finding is consistent with national evidence on packed lunches and reflects the governments aim to encourage more pupils to eat school meals.

National & Local Strategies (Current best practices)

National strategies

A new National Childhood Obesity strategy is expected to be published by the government in early 2016. Existing strategies and policy papers are described below.

‘Healthy Lives, Healthy People: A call to action on obesity in England’ outlines the main components of the governments new approach to obesity as including:

  1. Empowering people and communities
  2. Giving partners (including business) the opportunity to play their full part
  3. Giving local government the lead role in driving health improvement and harnessing partners at local level
  4. Building the evidence base.

In the paper ‘2010 to 2015 government policy: obesity and healthy eating’, the government sets out its actions on obesity as:

  • giving people advice on a healthy diet and physical activity through the Change4Life programme
  • improving labelling on food and drink to help people make healthy choices
  • encouraging businesses on the high street to include calorie information on their menus so that people can make healthy choices
  • giving people guidance on how much physical activity they should be doing

Change4Life

Change4life is a public health campaign that aims to use marketing techniques to encourage people to adopt healthy behaviours. The 'sugar smart' campaign is the current focus of C4L activity.

The Public Health Responsibility Deal

The responsibility deal was launched in 2011 and aimed to get businesses and other influential organisations to create healthier environments by offering healthier food and opportunities for more physical activity through signing voluntary pledges.

National recommendations

Recommendations for physical activity for children and young people can be found at NHS Choices. Guidelines for a balanced diet are represented using the ‘eatwell plate’ while more specific and detailed advice on weaning and infant feeding can be found at NHS choices pregnancy and babies pages

Local strategies

Children and young people’s plan 2015-2016
‘Physical and nutritional wellbeing’ is a key aspect of priority 3 of the CYPP, encompassing both childhood obesity and, more broadly, diet and nutrition.

Slough Youth Offer
Slough’s youth offer includes offers to provide support for young people to make informed choices about any aspect of their lives and to support young people in leading healthy lifestyles.

Get Active Slough: a leisure strategy
This strategy outlines the plans for encouraging physical activity is adopted as a habit for life for all making ”more people, more active, more often”.

What is this telling us?

There have been improvements in obesity rates for younger children (aged 4 and 5), reflecting good work in promoting breastfeeding and good infant feeding practice locally, however, the rates of obesity for older children (aged 10 and 11) continues to rise.

School meal uptake is improving though is still not achieving the national target, and while school meals in Slough are providing healthy and balanced options for children, the quality of packed lunches remains poor.

What are the key inequalities?

Socioeconomically deprived areas Levels of childhood obesity are, on average, higher in deprived areas than they are in less deprived areas. The obesity prevalence among reception year children attending schools in areas in the most deprived decile is double that of the least deprived decile (NCMP 2013/2014). Similarly, levels of childhood obesity are associated with the proportion of children eligible for free school meals.

Children with disabilities
Though there is limited data available on children with disabilities specifically, we do know that adults with disabilities are more likely to be obese and to be less physically active than the general population (National Obesity Observatory).

Black and Minority Ethnic Groups
Child obesity prevalence varies significantly between ethnic groups. Children from Asian and Black Groups are more likely to be obese than white ethnic groups (National Obesity Observatory), though there is limited data exploring these associations in any depth and methods of measuring obesity are unhelpfully based only on Caucasian population.

What are the unmet needs/ service gaps?

  • Through work with school caterers there have been improvements in uptake of school meals, and through continued work of PSHE leads there is a good awareness of healthy foods among children, the quality of packed lunches remains poor.
  • Some sessions on healthy eating on a budget, specifically aimed at people out of work are provided locally, more could be done to improve healthy eating awareness and cooking skills of parents.
  • Though much work has been done to shape the physical, social and cultural environment in Slough to encourage physical activity, less large-scale community level work has been done in terms of modifying the food environment.

Recommendations:

  • To refer to recommendations proposed by the new National Childhood Obesity Strategy 2016 once published
  • Schools to continue work to raise awareness of importance of healthy eating and physical activity, particularly engaging with parents e.g. through Family FUNs
  • Incorporating measures to tackle obesity into strategic town planning and place shaping initiatives
  • For multi-agency collaboration on childhood obesity to continue at a regional level and for obesity care pathways to be shaped in order to treat children who are obese

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