The Government recently revealed the second phase of its plans to address childhood obesity nationally. But what is happening at a local level? Léa Legraien reports
Once seen as a symbol of wealth, obesity is one of the biggest healthcare challenges of the 21st century.
In England, almost one in 10 children start primary school diagnosed as obese, according to data published by them Government in October as part of the National Child Measurement Programme.
By the time pupils leave primary school this figure has doubled; one in five of 10 and 11-year olds is obese. Despite the noticeable physical changes, obesity is a silent killer.
The charity Cancer Research UK estimates that obesity will overtake smoking as the biggest preventable cause of cancer for women by 2043.
Not only is obesity a risk factor for conditions such as stroke, it’s also a financial burden on the NHS. Obesity related ill health is estimated to cost the health service £6.1bn a year. To address this, the Government has embarked on an ambitious journey to halve childhood obesity by 2030.
But big changes start with small steps and the success of any anti-obesity measures will to a significant degree depend on the work done by local authorities.
Starting the conversation
Although obesity has been on the rise since the 1990s, it was only in 2016 that the problem received in-depth attention from the Government. It set out a bold vision to tackle the problem, starting from the first years of life and including a series of initiatives on sugar reduction.
A levy on soft drinks was introduced in April 2018. Before this, the Government reported that more than 50% of manufacturers had already changed their soft drinks formulas and removed the equivalent of 45 million kg of sugar per year.
In addition to the sugar tax, all sectors of the food and drinks industry, including retailers, manufacturers and restaurants, were challenged to reduce sugar in the products that contribute most to children’s sugar intake by 5% in the first year.
In the longer term, the objective is to achieve a 20% reduction by 2020. However, in May, the Government said sugar levels had only dropped by an average of 2%, commenting: ‘We’re already starting to embed change. However, we aren’t yet where we need to be.
‘The scale of the challenge means the Government, food and drinks industry, NHS, local authorities, schools and families all need to help tackle childhood obesity and be ambitious in doing so.’
Sheffield council public health director Greg Fell welcomes the sugar tax but believes the Government should be firmer with the food industry. ‘The Government is moving in the right direction, but probably not fast enough,’ Mr Fell says.
‘Ultimately, the food industry is there to make a profit and I understand that. One of the net effects of making a profit is selling more highly processed products high in salt and sugar. The effect of that is more obese kids. While the Government has a preference for voluntary agreement with the industry, regulation is needed.’
Mr Fell argues that ‘we need to do our piece locally. We definitely underinvest in childhood obesity but we also have an expectation that the Government helps us and does the right thing,’ he adds.
Think nationally, act locally
Public health is crucial in tackling major health issues, including obesity. Local authorities have a statutory responsibility to deliver public health services and there are many examples of good practice across the country. But in 2009/10, austerity prompted the Government to cut local authority budgets, threatening some public health services.
Shrinking budgets mean spending on public health will fall by at least £600m in real terms by 2020/21, on top of a £200m cut announced in the 2015/16 budget, according to healthcare think-tanks The King’s Fund, the Health Foundation and the Nuffield Trust.
In the early 2000s, the Government School Sport Partnerships Programme was implemented nationally in a bid to increase participation in physical education (PE) and sport activities within and outside of schools.
When funding for the scheme stopped in 2010, Stockport council lost around £300,000 a year, so it looked for a solution.
The council called a meeting with all the primary school head teachers and explained that a financial contribution would be needed to retain the programme. The vast majority of schools welcomed the idea and committed core funding to sustain it.
In 2013, the Government introduced a PE and sport premium grant to help primary schools improve the quality of PE lessons.
Under the initiative, a team of PE specialists working with Stockport council supports primary school teachers to deliver high quality PE to their pupils, particularly in primary schools where staff get little training.
‘We need to make sure children experience the highest quality of learning in PE because that’s where they’re given the skills, knowledge and enthusiasm to engage in physical activities outside schools and build these in as part of their lifestyles throughout adulthood,’ says Russ Boaler, PE, sport and physical activity consultant for Stockport council.
The programme has shown encouraging results. Data from the National Child Measurement Programme reveals that the proportion of Year 6 children considered overweight and obese dropped by 3 to 4% in the three years before 2016 compared to the three-year period before that.
‘With the current uncertainties around central and local finances, it’s an annual challenge. So far, we’ve met that challenge and we’re showing that we’re making a difference, Mr Boaler says. ‘While the schools want it and are willing to pay for it, our intention is to continue to support them.’
Obesity: society’s burden?
In November, the Government revealed that prevention will be at the heart of the NHS long-terwm plan. Health and social care secretary Matt Hancock said he wants people to take ‘greater personal responsibility for managing their health’.
Although Mr Fell agrees that taking personal responsibility is important, he believes people can only do so in an environment that supports healthy choices.
‘It’s not about blaming individuals for their poor choices. I’m a product of the environment in which I live and if this environment is full of cues to eat the wrong sort of food or drink too much, I will follow those cues,’ he says.
Ultimately, childhood obesity is not only a Stockport, Sheffield or UK problem but a global issue. Tackling the issue will take time and require a whole-system approach.
‘We need to go back to basics because from generation to generation we’re seeing a decrease in cooking skills,’ lead specialist dietitian and spokesperson for the British Dietetic Association Sioned Quirke says.
‘The other thing is thinking about families. As a clinician working to help people lose weight, I think we treat families in siloes.
‘We might treat an adult and then a child whereas in fact we know that if two parents are overweight or obese, there’s an 80% chance that the child will be. Everybody’s got to be involved.’
CASE STUDY: Stockport
Partnering with local schools
When funding for the School Sport Partnership Programme was cut in 2010, Stockport council decided to carry on with the scheme, seeing the positive impact it was having on children’s health. Russ Boaler, a PE, sport and physical activity consultant for the council, says:
‘When you’ve got a national strategy and you’re part of that, you’re a little bit restricted on what you can do because you have to fall in line with the national strategy. ‘But after 2010, we had the freedom to do what we wanted with the infrastructure we had managed to keep in place.’
At the moment, the viability of the service relies entirely on the money paid by schools. Mr Boaler argues that while primary schools have more flexibility, as they can use their PE and sport premium grant from the Government, secondary schools have to use their core budget. PE is a national curriculum subject that applies to all 12 years of compulsory education in England.
Despite its mandatory aspect, it can lack quality. With the partnership programme, the council has a team of PE specialists who work with schools to upskill staff.
‘In primary school, the average time a trainee teacher spends on PE training is around eight hours over four years. A lot of staff lack subject knowledge and confidence because there’s a health and safety aspect attached to PE,’ Mr Boaler says.
Training of staff takes place during the school year through a range of continued professional development programmes, which include one-to-one and group sessions.
So far, 88% of the 110 primary, secondary and special schools in Stockport have engaged with the council on a weekly basis. Last year, 629 staff attended training, while more than 34,000 pupils took part in the scheme.
‘The work we do in PE plays a significant part in reducing the levels of obesity mand the numbers of children who are overweight,’ Mr Boaler says.
‘If our data for the percentage of Reception pupils who are overweight and obese (22.2%) was to follow the trend in our 10 peer local authorities, it should be around 34% by the time pupils turn 10 or 11 years of age. But actually it’s around 32.8%.’