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Childhood obesity

Green paper on prevention response

10 October 2019

Our response to the Department of Health and Social Care

Question

Currently 18% of boys and 21% of girls aged 2 to 4 years are overweight or obese; therefore, we need to look at  what we can do in the early years to help give children the healthiest start in life.

We know that 3 in 4 children aged 4 to 18 months have energy intakes that exceed their daily requirements.  This figure increases with age following the introduction of solids. Data shows that sugar levels in some commercial baby foods and drinks can be very high.

Around 9 in 10 children aged 1.5 to 3 years old exceed recommended daily sugar intake levels.  Consuming too much sugar, and too many foods and drinks high in sugar can lead to weight gain, which in turn increases the risk of heart disease, type 2 diabetes, stroke and some cancers in adulthood.

Added sugar in foods can have a negative effect on babies and young children’s health by putting them on this trajectory. High levels of sugar intake also increase the risk of tooth decay. Just under a quarter of 5 year olds in England have tooth decay  and almost 9 out of 10 hospital tooth extractions among children aged 0 to 5 could have been avoided.

How can we better support families with children aged 0 to 5 years to eat well?

Answer

Whilst we are pleased to see the government publishing further commitments on childhood obesity, the policy suggestions do not go far enough to safeguard our children’s health and achieve the government’s stated goal of halving childhood obesity by 2030.

To achieve this goal, the government will need to use the full range of its regulatory and political power to create a fairer playing field for children, no matter where they live.

Fortunately, the Chief Medical Officers’ recent independent report on child obesity (Time to Solve Childhood Obesity, 10.10.19) sets out a very clear framework for action. We would encourage the government to be bold in implementing the recommendations in the report. At its core are two fundamental principles based on evidence we’re seeing in our own work tackling childhood obesity in South London: that inequality is at the heart of the problem and that the spaces where families and children spend their time, especially in inner cities, are often flooded with cheap, unhealthy food options.

Policy areas

In addition, we would prioritise five policy areas for further action. Based on our work these practical initiatives are vital if government is to achieve its goal of halving childhood obesity by 2030:

Give Ofsted the remit to enforce School Food Standards and Physical Activity Guidelines as part of their rating process – While the paper lays claim to wanting all government departments to “pull in the same direction”, it fails to acknowledge the leverage school environments have in providing opportunities for promoting good health.  Schools should be provided with clear policies on how to reach the standards, including advice on choice architecture in canteens, packed lunch policies and making drinks provision water-only.

Stronger regulation to set an even playing field – recommendations here around Infant feeding, clear labelling and improving the nutritional content of food and drink should be stronger and carry greater commitment. Government should lead the way in mandating calorie reduction targets, banning advertising by fast food outlets and unhealthy food products targeted at children, stronger advertising regulation and ensuring that all Local Authority controlled contracts and events are health maximising.

Invest in shifting public perception on childhood obesity – Public understanding of childhood obesity is a key barrier to evidence-based childhood obesity solutions.  Through research undertaken by the FrameWorks Institute we have identified a significant disconnect between the evidence and public opinion.  This means responsibility for the problem is placed squarely with parents and weak individual willpower – rather than understanding how environment and context shapes food options. This is a key barrier to evidence-based childhood obesity solutions. Government can play a leading role in helping change the conversation and shift public perception on this critical issue through proactive application of the recommendations from this research. 

Maximise the potential of National Child Measurement Programme – current plans set out make a good start.  We’d recommend government go further and expand the programme to a wider age range and include other biometrics such as strength and balance (as achieved in Amsterdam), to make it a more holistic report targeted towards intervention as well as detection and encourage greater parental involvement with NCMP.

Take action to implement early years nutrition initiatives better designed around parents’ needs: The paper rightly acknowledges the importance of breastfeeding in terms of reducing future childhood obesity, and the UK’s extremely low figures relative to other countries, and we urge concrete plans to tackle this. Alongside industry actions listed above, more could be done to implement global initiatives aimed at building a supportive culture around breastfeeding – including increased support for local areas to achieve baby friendly city accreditation. Secondly, we know that take up of Healthy Start Vouchers is low, and there is existing research as to why.  Barriers exist for both eligible families and voucher distribution points. Voucher schemes such as the Alexandra Rose Voucher schemes present real examples of how this process could be designed in a way that is much more suited to user-need. We call on Government to implement pilots that test a new process for distributing these vouchers, based on the existing research, and to hold itself accountable to increasing take up and impact of this scheme within the next 2 years.

Finally, as a funder we are running the UK’s largest philanthropic programme to tackle childhood obesity. As food environments are influenced by businesses, statutory authorities and communities, creating change requires working with a wide range of partners. In practice, this means we layer up different activities and work with a range of organisations – locally, nationally and internationally – to test and run projects that can tackle the issue from many angles. Given the clear link between an area’s average income and obesity, we focus our efforts in the areas with lower average incomes, where childhood obesity rates are highest.

We are investing in a number of projects that could be ripe for national replication – many of which could be funded through existing government funds, and without the need for extra spend. We would be delighted to meet to discuss these in greater depth.