Childhood obesity

Introduction

“Childhood obesity is one of the most serious global public health challenges of the 21st century” (World Health Organisation, 2013). The Foresight Report (2007) predicted that by 2050, 25% of children in the UK will be obese (accessed 4 January 2017).

Rising levels of childhood obesity has consequences for the health of children and young people in both the short and the longer term.

Obese children and adolescents are at an increased risk of developing various health problems (such as Type 2 diabetes, asthma, cardiovascular risk factors, obstructive sleep apnoea, psychosocial risks and mental health disorders and musculoskeletal problems) and are also more likely to become obese adults. (PHE Childhood Obesity Patterns and Trends).

Key inequalities and risk factors

Childhood Obesity

Deprivation – there is a strong relationship between deprivation and childhood obesity.  Obesity prevalence of the most deprived 10% of the population is approximately twice that of the least deprived 10%.  Socioeconomic  inequalities in obesity is stronger in girls than boys

Ethnicity – the National Child Measurement Programme reveals substantial variation in obesity prevalence by ethnic group for both Reception and Year 6 children:

• obesity prevalence among boys in Reception year is highest in the Black African, Black Other, and Bangladeshi groups, for girls in Reception obesity prevalence is highest among those from Black African, and Black Other ethnic groups
• boys in Year 6 from all minority groups are more likely to be obese than White British boys. For girls in Year 6, obesity prevalence is especially high for those from Black African and Black Other ethnic groups. Some of these differences may be due to the influence of factors such as deprivation and, possibly, physical differences such as height

Disability – children who have a limiting illness are more likely to be obese or overweight, particularly if they also have a learning disability.

Diet

Income – From a very young age, children’s diets are strongly influenced by household income and food and drink purchasing choices, which in turn have powerful social and cultural influences.  The general availability and affordability of healthy food may also be factor.

Deprivation – In general, dietary intake and eating behaviours in England are related to socioeconomic position.  The Living Costs and Food Survey (2011) reported that expenditure on fresh fruit and vegetables, as a proportion of all food and non-alcoholic drinks purchased, increases with household income levels.   The proportion of spend on fruit and vegetables is significantly lower in the poorest households than in the most affluent.  In contrast, the proportion of spend on processed meat and fish is significantly higher in the poorest households than in the most affluent ones.

Physical activity

Start Active, Stay Active – A report on physical activity for health set out a range of inequalities to address:

• gender – boys are more active than girls
• age – physical activity declines significantly with increasing age for both males and females
• income – physical activity is lower in low-income households
• ethnicity – certain ethnic groups have lower levels of physical activity. For example, in England, physical activity is lower for black or minority ethnic groups, with the exception of African-Caribbean and Irish populations
• girls are more likely than boys to reduce their activity levels as they move from childhood to adolescence

Children with disability engage in less physical activity compared to their typically developing peers. The percentage of children who are classified as either overweight or obese is highest where the child has a limiting illness. Where the child also has a learning difficulty, 27% are classified as overweight and a further 15% are classified as obese.

Nationally, the Health Survey for England 2015 report shows inequalities exist as a result of socio-economic status (measured by IMD score).

The environment and obesity

Facts, figures and trends

Obesity is a consequence of poor diet and a lack of physical activity. A range of socio-economic factors contribute to diet and activity such as the environment (road safety and air pollution), the food environment (availability and quality of fresh fruit and vegetables) and societal factors (the influence of media and culture).

Unlike most adults, many children and young people cannot choose the environment in which they live or the food they eat. They also may not understand the long-term consequences of their behaviour. They therefore warrant special attention in national and local strategies and plans to tackle the obesity epidemic.

According to the Health Survey for England 2015 report levels of obesity and being overweight have increased since 1995.

In 2015, overall 28% of children aged 2 to 15 were either overweight (14%) or obese (14%). The proportion of boys who were overweight, including obese (30%) was higher than the proportion of girls who were overweight, including obese (26%).

Children aged 11 to 15

Despite a decline in prevalence from 2014 to 2015, levels of obesity among children aged 11 to 15 years over the last few years has remained relatively constant, particularly in boys:

Children aged 2 to 10

There has been a greater decrease in the proportion of children aged 2 to 10 years who were overweight or obese, with a more pronounced reduction in girls:

Whilst there has been little significant change in the levels of obesity over the last few years among children aged 11 to 15 years, there has been a significant decrease in the proportion of children aged 2 to 10 years who were obese. In 2005, 17% of both boys and girls were obese, compared to 13% of boys and 12% of girls in 2013 (Health Survey for England, 2013).

National Child Measurement Programme (NCMP)

The NCMP measures the weight and height of children in reception class (aged 4 to 5 years) and year 6 (aged 10 to 11 years) to assess the extent of overweight and obesity in primary schools.

A child’s Body Mass Index (BMI), sex and age is used to determine whether they are underweight, overweight or obese. The BMI definitions are different for children and adolescents – find out more on the Public Health England website.

The headline report for the NCMP programme for the 2015/16 school year revealed:

• over a fifth of reception children were overweight or obese. In year 6 it was over a third
• the prevalence of obesity has increased since 2014/15 in both reception and year 6
• in reception it increased to 9.3% from 9.1%, and in year 6 to 19.8% from 19.1%
• obesity prevalence was higher for boys than girls in both age groups
• obesity prevalence for children living in the most deprived areas in both age groups was more than double that of those living in the least deprived areas

Reception (ages 4 to 5)

NCMP data tables for 2013/14 to 2015/16 show levels of obesity in Bracknell Forest fell in 2015/16 and whilst prevalence is lower, it is statistically similar to the south east and England figures:

For context, compare the number of children of healthy weight at Reception where Bracknell Forest compares favourably against the south east and England averages:

Year 6 (ages 10 to 11)

The data tables also show that the rate of obesity increased slightly in 2015/16 compared to 2014/15.  Also that prevalence of obesity and being overweight are lower than the south east and England figures, however, rates are increasing at year 6:

For context, compares to the number of children of healthy weight at Year 6 where figures for Bracknell Forest are better than the south east and England averages despite a fall in the number of children of healthy weight recorded in 2015/16:

Perception of weight

The Health Survey for England 2015 report highlighted a concerning issue with regard to perception of weight by both children and parents. The danger here is that parents who underestimate the weight status of their overweight or obese children may be less likely to provide them with the support they need to achieve a healthy weight.

The majority of overweight and obese children were not aware that they were too heavy.

• only 26% of overweight (including obese) children aged 8 to 15 described themselves as too heavy
• compare this to the 41% who said that they were about the right weight

Parents of overweight and obese children often thought that their child was the right weight:

• the majority of overweight children were described as being about the right weight by their mothers (91%) and fathers (80%)
• for obese children, 48% of mothers and 43% of fathers said their child was about the right weight
• however, just over half of mothers (51%) and fathers (56%) of obese children described their child as too heavy

Physical activity

Physical activity includes all forms of activity, such as everyday walking or cycling, active play, work-related activity, active recreation (such as working out in a gym), dancing, gardening or playing active games, as well as organised and competitive sport.

The World Health Organisation (WHO) outlines the benefits of physical activity for young people to:

• develop healthy musculoskeletal tissues (i.e. bones, muscles and joints)
• develop a healthy cardiovascular system (i.e. heart and lungs)
• develop neuromuscular awareness (i.e. coordination and movement control)
• maintain a healthy body weight
• better control over symptoms of anxiety and depression
• opportunities for self-expression, building self-confidence, social interaction and integration
• more ready adoption of other healthy behaviours (e.g. tobacco, alcohol and drug mis-use avoidance)
• higher academic performance

WHO guidance recommends children and young people aged 5 to 17 should accumulate at least 60 minutes of moderate to vigorous intensity physical activity daily.

The Health Survey England 2015 report on physical activity compares levels for children aged 5 to 15 across three years. In 2015, levels of physical activity meeting guidelines (outside school lessons) were lower than in 2008 for boys (23% and 28% respectively) but at a similar level for girls (20% and 19% respectively).

However, since 2012, the proportion of children aged 5 to 15 who met the physical activity guidelines has increased (18% in 2012 compared with 22% in 2015). In 2012, 21% of boys aged 5 to 15 met the recommendations, compared with 23% in 2015. Among girls, 16% met the recommendations in 2012, compared with 20% in 2015.

What’s a parent to do?

A 2016 Canadian study of just under 23,000 young people over three years found that adolescents were more likely to engage in physical activity if they reported more parental encouragement (such as role modelling), parental instrumental support (e.g. enabling through transportation and equipment), and facilitating the formation and maintenance of a physically active friendship network.

Active travel

Figures for active travel remain relatively constant over the three periods:

• 61% of children had walked to or from school on at least one day in the last week
• children of this age walked to school on an average (median) of three days in the last week
• just under two-fifths (37%) walked to/from school every day

The proportion of both boys and girls who had walked and/or cycled to or from school on at least one occasion in the last week had been very similar in 2008 and 2012.

The environment and obesity

Obesity is a complex problem that requires action from individuals and society across multiple sectors. One important action is to modify the environment so that it does not promote sedentary behaviour or provide easy access to energy-dense food. The aim is to help make the healthy choice the easy choice via environmental change and action at population and individual levels. This provides the opportunity to build the partnerships that are important for creating healthier places, and around which local leaders and communities can engage. Planning authorities can influence the built environment to improve health and reduce the extent to which it promotes obesity, the details of which should be set out in the area’s Local Plan.

Sense of place

In the widest sense, a “sense of place” is a desirable planning outcome because it sets out those things that people recognise as being distinctive to that place. The implication is that this ‘specialness’ is also desirable. (LGiU, 2017)

Therefore creating a sense of place can facilitate a range of planning-related outcomes:  Researchers have found that the risk of developing depression for city residents can be reduced by designing green space, active space and social space into cities. There are opportunities to create a sense of place through planning environments that address these three elements.  A partnership of agencies in Scotland has published the Place Standard (also see the LGiU Scotland briefing on the standard), which is a simple question and answer tool to help evaluate the quality of a place. This includes a question on identity and belonging; housing organisations need to demonstrate that they are using the standard to engage local people as a criteria for receiving government funding.

School sport

The government 2010 PE and Sport Survey surveyed all schools in England to identify participation rates in PE and school sport.  A smaller but representative survey was carried out by the Youth Sport Trust in January 2015. Whilst the results cannot be directly compared to the 2010 survey, it suggests that there may be levels of decline in certain areas, includuding the average minutes of PE ofered to pupils per week and the average number of club links.

The survey presented the percentage of children that took part in at least 3 hours of curriculum PE in a typical week. The rate of children doing this level of PE falls for each school year with 100% of children in year 1 and 2 taking part in two hours of PE and falling to 38% in years 12 and 13:

At that time, participation was lower than the average of all English schools surveyed.

The National Child and Maternal Health Intelligence Network School Age Children Profile 2014 (accessed 27 April 2016) indicates that the percentage of children participating in at least 3 hours of high quality PE and sport at school age (5 to 18 years) per week in Bracknell Forest for 2009/2010 was significantly lower than participation rates for England and the south east:

The 2013 Bracknell Forest survey of children and young people provided a unique insight into the lives of 2,500 children and young people aged 8 to 18 in years 5 to 11.  Almost 2,500 children and young people in 12 primary schools, five secondary schools and one special school participated in the survey.

Figures showed almost two-thirds (64%) said that they take part in sport or exercise at least twice a week, but over one in ten (11%) said that they never do.

There were significant age and gender differences in response to this question, with year 10s (19%) and girls (13%) more likely to say that they never take part in exercise or sport. The top two reasons for not taking part in exercise or sport – apart from ‘other’ -were not having the time and not liking the activities on offer.

Treatment Costs

Diagnosis data from 2014-15 hospital admissions data states 661 hospital admision of young people aged 0-18 with a main diagnosis related to obesity, 44.5% of whom were aged 10-14.  This compared with 675 in 2013-14 when 46% were in the 11-15 age category.

Want to know more?

A whole family, early life stage approach integrated approach across schools, colleges, children’s centres and childminders.

The UK Chief Medical Officers’ 2011 physical activity guidelines recommends:

• a lifecourse approach
• a stronger recognition of the role of vigorous intensity activity
• the flexibility to combine moderate and vigorous intensity activity
• an emphasis upon daily activity
• new guidelines on sedentary behaviour

Building the foundations – tackling obesity through planning and development (Local Government Association & Public Health England, 2016) – a report which identifies a series of themes and more specific elements that help to create healthy-weight environments.

Change4Life (Department of Health – campaign to raise awareness about diet and physical activity for 0 to 5 year olds.

Childhood Obesity Plan (Department of Health, 2016) – sets out a range of measures to tackle childhood obesity, including introducing a soft drinks industry levy.  The revenue raised from the levy will be invested in programmes to reduce obesity and encourage school-aged children to be more physically active. A further £10m a year is earmarked to set up healthy breakfast clubs in schools to improve children’s diet.

Other measures outlined include working with producers to remove 20% of sugar in products, refreshing the Healthy Start voucher scheme to support  families on low incomes, introducing a voluntary healthy rating scheme in primary schools and guidelines for early years settings.

Early Years Statutory Framework (Department of Education, 2012) – sets out requirements upon early years providers to promote good health and balanced, healthy and nutritious meals, snacks or drinks

Evidence on Physical Education and Sport in schools (Department of Education 2013) – Key findings report highlights levels of participation, effective practice, pupil attitude, barriers and benefits of sport and physical activity.

Local Action on Health Inequalities: Improving access to green spaces (Public Health England, 2014) – a summary of evidence about the positive impact of access to green spaces on self-rated health, wellbeing, obesity and overweight levels, reduced social isolation and independence.

Making sense of a ‘sense of place’: a planning perspective (LGiU, 2017) – A briefing on calls for change within the planning system to focus more on a sense of place, with the aim of achieving development that is more accepted by local communities going beyond economic vitality to wider wellbeing outcomes.

Obesity prevention (NICE, updated 2015) –updated guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children recommending parents and carers help children to establish healthy diet and activity behaviours and maintain or work towards a healthy weight.

Physical Activity for Children and Young People (NICE, 2009) – advice to all those who are involved in promoting physical activity to children and young people in a range of settings, on how to plan to provide opportunities and promote the health benefits of physical activity.

School Food Standards (2015) – sets out mandatory standards for food provided in all maintained schools and new academies and free schools from January 2015.  The standards aim to help children develop healthy eating habits and ensure they get the energy and nutrition they need across the whole school day.

Social and economic inequalities in diet and physical activity (Public Health England, 2013) – a briefing paper which describes social and economic inequalities associated with two of the main determinants of obesity – diet and physical activity – and explores explanations for these inequalities. The PHE Obesity Knowledge and Intelligence team has also produced factsheets that describe the relationship between obesity and various measures of socioeconomic position for both adults and children.

Start4Life (Department of Health) – birth to early years campaign to raise awareness about diet and physical activity.

Supporting public health; children, young people and families (PHE, updated 2016) – guidance to support local authorities and providers in the commissioning and delivery of services across the highest impact health and wellbeing outcomes for children and young people through the 0 to 19 healthy child programme.

Weight management: lifestyle services for overweight or obese children and young people (NICE, 2013) – a lifestyle approach to helping children and young people to manage their weight.

National Child and Maternal Health Intelligence Network – Dynamic Report for Bracknell Forest gives high level statistical data and analysis on healthy weight (excess weight at 4 to 5 years) and tooth decay in children aged 5 years old.

This page was created on 27 February 2014 and updated on 11 January 2017. Next update due February 2017.

Cite this page:

Bracknell Forest Council. (2017). JSNA – Childhood Obesity. Available at: jsna.bracknell-forest.gov.uk/developing-well/children-and-young-peoples-health/childhood-obesity (Accessed: dd Mmmm yyyy)

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