Obesity is a complex problem, affected by factors that encompass dietary, environmental, behavioural and physiological factors. Our norms within society and culture also interact with and compound the impact of these determinants. For this reason, a system-wide approach is needed that makes obesity everybody’s business and is tailored to local needs and works across the life course.
This section describes the local picture and drivers of overweight and obesity in each life stage.
Parental health
Healthy weight before, during and after pregnancy is identified as a high impact area for promoting health in children, young people and families. This is due to a strong relationship between maternal obesity and the birth of babies above a normal weight range, and the subsequent development of childhood obesity.
The prevalence of obesity in early pregnancy in 2023/24 is 27% in Bracknell Forest, higher than both the national and South-East prevalence of 26.2% and 25.1% respectively.
NICE guidelines (NG247) highlights the importance of healthy eating and physical activity during pregnancy. Pregnant women who have a BMI of 40kg/m2 should be referred to a specialist obesity service or practitioner who can provide tailored advice.
Evidence also points to the positive impact of engaging parents and taking a whole family approach such as the HENRY programme.
School-aged children and young people
Physical activity
Schools play a central role in providing a healthy and safe environment for children. They have the opportunity to embed the knowledge that children and young people need to make healthy choices for their overall wellbeing.
For example, schools provide opportunities to participate in physical activity through structured physical education, school sports and any other physical activity initiatives (e.g. Daily mile, Active travel).
Data from Active Lives Survey (Figure 6) suggest that the percentage of ‘less active’ children and young people in Bracknell Forest have declined since 2021/22. These are children and young people who engage in less than 30 minutes of physical activity a day. Conversely, the percentage of physically active children and young people have increased since 2021/22.
Despite the increase in activity levels however, findings from the national survey highlights that inequalities persist particularly among children and young people from Black and Asian ethnic groups as well as those from the least affluent families. Girls are also less likely to be active than boys.
Schools in Bracknell Forest offer varying levels of activities and initiatives to increase physical activity outside of the curriculum, such as the Daily Mile and extra curricular sports activities. Professionals working with school aged children highlighted that there is a potential gap in supporting adolescents who are going through puberty. It was discussed that sports activities can be an engaging way to encourage physical activity but can also be intimidating for someone who has existing weight or body-image issues.
Young people highlighted a number of factors including confidence to engage in activities, access to safe spaces where they can exercise (e.g. gyms cost money or don’t want to be with stranger adults), lack of young people-friendly information about how to keep themselves healthy, lack of awareness of services, and services not being young people friendly or welcoming.
It should be emphasised that physical activity can also have a positive impact on mental health. There is evidence that mental health is associated with obesity in instances when food becomes a coping mechanism, or conditions such as that linked to body image leading to an individual adopting a poor diet, becoming physically inactive or does not adhere to weight management programmes. This highlights the importance of preventing and addressing mental health and emotional wellbeing concerns early. In Bracknell Forest, Sport in Mind offers youth led sessions using sport and physical activity to promote mental health. They also attend and deliver assemblies in schools however these have been limited due to funding and capacity.
Diet
Local data on dietary patterns of children and young people is limited. Nationally, children from lower-income households are significantly less likely to consume the recommended five portions of fruit and vegetables daily, and more likely to consume high levels of Ultra-Processed Foods (UPF). A 2023 analysis of National Diet and Nutrition Survey (NDNS) data found that UPFs account for around 65% of energy intake in children aged 4 to 18 in the UK, with the highest consumption among older adolescents and those from lower socioeconomic backgrounds.
Food insecurity is a significant and growing driver of poor dietary quality in children. Children eligible for Free School Meals (FSM) are at elevated risk of food insecurity, particularly during school holiday periods when access to subsidised meals is lost. The Holiday Activities and Food (HAF) programme, as cited in the National Food Strategy, provides an important mitigating offer during school holidays. Understanding the reach and coverage of HAF provision is an important intelligence gap for this chapter.
The school food environment also plays a significant role. Schools are required to meet the School Food Standards, which set minimum requirements for food and drink provided. However, compliance and consistency of implementation can vary. There is scope to work with local schools to assess the quality of the food environment beyond statutory compliance, including access to healthy food options, water, and the nutritional quality of school meals and tuck shop provision.
Screen time, sedentary behaviour and sleep
Sedentary behaviour or time spent sitting or lying down with low energy expenditure is associated with increased risk of overweight and obesity in children and young people. Evidence consistently links excessive recreational screen time (including television viewing, gaming and social media use) with higher BMI, poorer dietary quality, disrupted sleep and reduced physical activity in children aged 5 to 17.
The relationship between screen time and weight is partly mediated through sleep. Young children who do not get enough sleep are at increased risk of becoming overweight.
Evidence gap Future JSNA updates should seek to address an understanding of screen time, sleep and sedentary behaviour of young people in Bracknell Forest, potentially through inclusion in local school health and wellbeing surveys.
Weight stigma
Weight stigma is increasingly recognised as a significant barrier to effective intervention and a driver of poor health outcomes in its own right. Children and young people who experience weight stigma report higher rates of depression, anxiety, social isolation and disordered eating, and are less likely to engage with physical activity or seek help for weight-related concerns.
Weight stigma can occur in a range of settings encountered by children and young people, including schools, healthcare consultations, and online and social media environments.
In Bracknell Forest, feedback from young people highlights body image concerns and fear of stigma as barriers to adolescents engaging with sports activities and weight management support. This underscores the importance of ensuring that any provision for children and young people is co-designed with young people, uses inclusive and affirming approaches, and explicitly addresses confidence and psychological wellbeing alongside physical health.
Wider environment
The food environment including the density, placement and marketing of food outlets and products shapes dietary behaviours in ways that go beyond individual choice. Evidence consistently shows that greater exposure to fast food outlets is associated with higher rates of obesity, particularly in more deprived communities.
The e-food desert index map presented in this chapter (see Figure 8) demonstrates variation in food access across Bracknell Forest wards, with worse access in the north-east of the borough and pockets of food desert in the west. This geographic inequality in the food environment is an important structural driver of inequalities in healthy weight outcomes.
Local authorities have a range of planning and licensing powers that can be used to shape the food environment, including policies in Local Plans to restrict the density of hot food takeaways (high fat, salt and sugar, or HFSS, outlets) in certain areas, particularly near schools, and conditions on planning applications. Bracknell Forest’s whole-systems approach work has identified mapping and improving the food environment as a strategic action and this should include an assessment of the current distribution of HFSS outlets relative to areas of highest obesity prevalence and deprivation.
