Childhood obesity: a bolder new plan but still lacking in ambition

With the second chapter of the childhood obesity plan recently published, Dr Rakhee Shah argues it’s a step in the right direction but rues its failure to go further.

Blog post

Published: 26/07/2018

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

Today almost a quarter of children in reception in England are obese or overweight, which increases to one in three children by the end of primary school. With the percentage of obese children in year 6 rising constantly over the past decade, inequalities have also been widening, with obesity rates for children living in the poorest areas now double those living in the richest.

Childhood obesity is associated with a wide range of serious health complications when children become older, and is also associated with the premature onset of illnesses such as diabetes and heart disease. So without bold strategic action – addressing both the rapid rise in obesity rates and the widening obesity gap between poor and rich children – most obese children will continue to be obese when they become adults.

The Government has recently published new measures to tackle these problems in the second chapter of the Childhood Obesity Plan. The first action plan was criticised for not addressing the more corporate determinants of why children overconsume unhealthy food – such as price promotions, advertising and calorie labelling. But one success from the first plan was the introduction of the sugar tax on soft drinks, which has led to several soft drinks being reformulated.

So how does the second chapter fare?

The second chapter has bolder actions to tackle the advertising, pricing and promotion of unhealthy foods. They include:

  • consulting on a proposal to ban TV advertising for high fat, salt and sugar products before a 9pm watershed
  • calorie labelling for the out-of-home sector (restaurants, cafes and takeaways)
  • banning promotions such as buy one get one free, multi-buy offers or unlimited refills of unhealthy foods and drinks
  • removing unhealthy products from the end of aisles.

But some gaps in action are still evident. No new action has been taken on the use of cartoon characters to advertise unhealthy food products, and there is nothing about advertising unhealthy food on billboards near schools.

A missed opportunity

Childhood obesity in England follows a socioeconomic gradient. Mothers from lower socioeconomic status groups are more likely to be overweight and less likely to breastfeed. Infants who are not breastfed are more likely to be overweight, and this is then later transferred to subsequent generations.

So it’s clear that obesity is increasingly related to poverty, and the target of halving childhood obesity by 2030 is a welcome one. However, the lack of a specific target and strategy to reduce the inequalities in obesity between children from the richest and poorest backgrounds – other than to do so “significantly” – is somewhat disappointing.

Recent data from Public Health England indicates that poorer areas have five times more fast food outlets than richer areas. Yet there is no specific mention in the new chapter about providing local authorities (especially in those deprived areas) with any new powers to help combat the competing interests of improving local people's health and wellbeing and the need for economic gains from livelier high streets. And while there is a reference to investing in a ‘trailblazer’ programme to maximise local authorities' existing powers, this won’t be sufficient to tackle the scale of the problem.

Breastfeeding at birth has also been shown to help reduce childhood obesity and the health gap between children from the richest and poorest backgrounds. The UK has one of the lowest breastfeeding rates in the world, with only 32% of babies receiving any breast milk until six months. But there is no mention of new targets on breastfeeding in this new chapter, which is another missed opportunity.

New initiatives can widen the gap

Certain interventions that help enable people to make better health choices – such as calorie labelling in restaurants – have a different impact on people from different backgrounds.

For example, a 12-year-old boy living in a deprived area – exposed to a higher number of fast food outlets on the way home from school, with a smaller budget to fill himself for dinner – is going to be less influenced by calorie labelling in the local chicken shop than a 12-year-old boy living in a richer area who is exposed to fewer fast food outlets, and who is more likely to have educated parents on a higher income who have educated him on the ‘correct’ calorie intake per day.

There is also evidence from smoking cessation education programmes that those who did better academically are more likely to take on the information and quit smoking. That is not to say that such interventions should not be implemented, but it is important to evaluate them to make sure they are not extending the health gap.

One way to ensure that educational interventions aimed at reducing obesity do not actually widen the gap between the rich and poor is by improving the health literacy of all school pupils, which would be helped by making personal social and health education (PSHE) compulsory and ensuring that the curriculum covers healthy eating.

In conclusion: more clarity and ambition needed

Take two of the Childhood Obesity Plan is significantly bolder, particularly in how it targets the advertising and pricing of unhealthy foods. The new target to halve the number of obese children by 2030 is welcome, but the plan lacks clarity and ambition to reduce the inequality gap in childhood obesity.

A lack of new targets on breastfeeding, a lack of new powers given to local authorities and a lack of a plan to evaluate whether obesity prevention interventions widen inequalities are all missed opportunities.

Dr Rakhee Shah (@shahrakhee) is a paediatric registrar and a research assistant at the Association for Young People’s Health.

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

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