Adam Fletcher, Head of British Heart Foundation (BHF) Cymru tells us exactly what the key ingredients are for improving the health of the next generation during the childhood obesity challenge
In just a few decades, childhood and family life have changed beyond recognition. Children now typically spend more time indoors and in front of a screen than ever before. Combined with major changes in how food is produced, marketed and sold, this has had a significant impact on children’s weight.
Today in the UK, nearly 30% of children are obese or overweight. Overweight or obese children are five times more likely to become obese adults and the progress that has been made in reducing mortality from heart and circulatory diseases, such as heart attacks and stroke, is beginning to stall because of these trends.
BHF-funded research has helped understand the connections between obesity, diabetes and heart and circulatory diseases. Adults with diabetes are two to three times more likely to develop heart or circulatory diseases. This is because high levels of glucose in the blood can damage artery walls. This can lead to a build-up of fatty deposits increasing the risk of heart attacks and stroke.
A range of actions are now urgently needed to improve children’s diet, as well as changes to our schools and communities to support children and families to be more active.
Improving children’s diets
As a member of the Obesity Health Alliance, the British Heart Foundation is advocating for the introduction of a new 9 pm ‘watershed’ for the advertising of high fat, salt and sugar products across all media that children are exposed to. This would protect children not just from adverts in print and broadcast on the TV and radio but also from digital advertising online and via social media, apps, games and in public spaces. The evidence supports limiting the power of advertising, which can lead children to pester their parents to buy certain products as well as influencing the total amount they eat.
Changing school settings to restrict the sales of less healthy food is also an effective approach, although the effectiveness of these ‘junk food bans’ within schools is limited where local supermarkets and other retailers close to schools are promoting unhealthy products and using buy-one-get-one-free and multi-buy offers. For this reason, it is vital that the government’s commitment to further restrict promotions in the retail sector is implemented fully.
Families can also be supported to make healthier choices through better nutritional information. We have recently seen an important government pledge to make calorie labelling on the menus in restaurants, cafes, pubs, coffee shops and takeaways mandatory. This is an important commitment and must apply as widely as possible to have an effect. ‘Traffic light labelling,’ showing the sugar, salt and saturated fat content of foods, should also be widely available for foods we eat both at home and on the move.
We also need to see greater progress in reducing the sugar, salt and calorie content of food and drink. Increasing the current levy on sugary drinks and extending this levy to other products may be necessary to bring forward this progress. The Chief Medical Officer for England has suggested widening the current levy to include sweetened milk-based drinks and baby foods with added sugar. As well as changing consumer behaviour, ‘sugar taxes’ can be important in encouraging manufacturers to change their products.
More active childhoods
Most schoolchildren do not meet the Chief Medical Officer’s guidelines of 60 minutes or more physical activity a day, every day of the week. Low levels of physical activity compound the problem of poor diets and contribute to the overall burden of childhood obesity.
One promising approach for encouraging greater physical activity in schools is the ‘Daily Mile’ – this is a simple and free way of getting all children out of the classroom for about fifteen minutes every day to run or jog, at their own pace, with their classmates. ‘Active lessons’ in which pupils spend time in the classroom being active while learning is also a popular and effective way to improve both students’ education and health together.
In addition, we need to focus on how built environments can facilitate more active lifestyles for children, including through investment in the active travel infrastructure. Local authorities who want to use their powers to promote active travel should be supported to do so. At a national level, to ensure healthy community environments, policy areas such as urban planning and transport should be ‘health proofed’ more effectively.
Ending health inequalities
While increasingly prevalent nationally, that is not to say obesity is evenly distributed: children growing up in poor areas are even more likely to be overweight. By age 11, obesity rates are twice as high in the most deprived areas compared to the least deprived. This will reinforce current inequalities in heart and circulatory diseases later in life.
Reducing the number of children growing up in poverty is vital for improving all aspects of child health, including reducing the number of children who are overweight or obese. Policies such as free healthy breakfasts and lunches and school-holiday food and fitness clubs can also help to mitigate some of the impact of childhood poverty on diet and ill health in deprived communities.
Another way to try and address these massive inequalities is to target more intensive and costly programmes at the most deprived communities, such as family-focused weight loss interventions for children who are overweight and annual child measurement as recommended by the Royal College of Paediatrics and Child Health (RCPCH). However, such approaches should be trialed before being rolled out due to uncertain benefits and the high costs involved.
Obesity during childhood and youth has now reached epidemic proportions and represents a potential time bomb for the future burden of heart and circulatory disease, especially in the poorest communities. Only through a new mix of evidence-based approaches will the challenge of childhood obesity be addressed effectively.
1. BHF analysis of UK health surveys, 2018.
2. Simmonds et al. (2016) Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obesity Review 17(2):95-107.
3. British Heart Foundation UK Factsheet, November 2018. Available at: www.bhf.org.uk/what-we-do/our-research/heart-statistics
4. Obesity Health Alliance (2017) A ‘Watershed’ Moment: Why it’s Prime Time to Protect Children from Junk Food Adverts.
5. Perkins & DeSousa (2018) Trends in childhood height and weight, and socioeconomic inequalities. The Lancet Public Health 3(4): e160-161.
Head of BHF Cymru
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