Childhood Obesity: A Plan for Action
Big, brave and bold?
Weak, wan and weedy?
How should we respond?
On his re-election in May 2015 David Cameron rightly made tackling the childhood obesity epidemic a flagship issue, putting number 10 in charge, rather than the Department of Health, in order to tackle the wider non-NHS issues. Draconian action in a "game changing moment" was promised by Jeremy Hunt to tackle obesity, which currently costs the NHS at least £4 billion annually and may eventually bankrupt the NHS if action is not taken now.
Then on 13 July Theresa May, in her inaugural speech, promised that her government will do everything to give back people control over their lives and not merely attend to the interests of the powerful in society.
Professional expectations for the obesity strategy were high. The back story, prior to the obesity plan, is interesting. Public Health England published “Sugar Reduction Responding to the Challenge” in 2014 and “Sugar Reduction the Evidence Base" in 2015. The Health Select Committee then produced a publication entitled "Childhood Obesity - Brave and Bold Action" which endorsed the majority of the PHE conclusions.
The report concluded that there is no single solution equally applicable to all areas and that we should experiment with solutions rather than working for perfect proof of what works, especially where the risks of the intervention are low.
Neither the Public Health England nor the Health Select Committee reports were mandated by government or supported by resources as these were expected to be contained within the childhood obesity plan.
The Spring budget 2016 saw the introduction of a soft drinks sugar tax to be introduced in 2018, which will be a levy on producers and importers rather than on consumers. There will be two bands: one for total sugar content above 5g per 100ml with the second higher band for drinks with more than 8g per 100ml. Pure fruit juices and milk-based drinks will be excluded.
Then August 2016 saw the long awaited launch of the "Childhood Obesity - a Plan for Action".
Responses to be Obesity Plan.
The plan has been greeted with virtually universal condemnation, from ex-ministers, through professional alliances and concerned celebrities.
“This is certainly not the ‘game changing’ plan for reducing childhood obesity that it had been built up to be. This policy has over-promised, but I fear that the reality will be under-delivery” Dr Dan Poulter ex Conservative Minister for Health
"The disappointing watering down of the childhood obesity strategy demonstrates the gap in joined-up evidence-based policy to improve health and wellbeing. Government must match the rhetoric on reducing health inequality with a resolve to take on big industry interests and will need to be prepared to go further if it is serious about achieving its stated aims." Dr. Sarah Wollaston, Conservative Chair of the Health Select Committee
"Disappointingly short of what is needed", with some anticipated measures "significantly watered down or removed entirely". The Obesity Health Alliance
“Where are the actions on the irresponsible advertising targeted at our children, and the restrictions on junk food promotions? With this disappointing and, frankly, underwhelming strategy, the health of our future generations remains at stake” Jamie Oliver, Celebrity Chef
Tackling Obesity : Plans from the 4 Nations
Each nation in the United Kingdom has their own childhood obesity plan or strategy.
- Preventing Overweight and Obesity in Scotland
- Turning the Curve on Childhood Obesity in Wales
- A Fitter Future for All. A Framework for Preventing and Addressing Overweight and Obesity in Northern Ireland 2012-2022
- Childhood Obesity: A Plan for Action (England)
The same themes appear in each report. A recent systematic review of national obesity policies concluded that "the policies are often written in general terms and frequently identify sets of actions which could be pursued without making commitment to carrying them out. Interventions in schools and the workplace are the well-developed. Many countries have created active transport strategies to increase both cycling and walking. Apart from these, there are few specific proposals for tackling obesity. Those countries with obesity polices highlight the need to tackle the problem among socially disadvantaged people. Fiscal and legislative interventions are almost completely absent from policy documents. There is also little mention of funding for the range of proposed interventions”.
BACAPH will be producing six interrelated short briefing papers:
- Overview of obesity
- Obesity prevention - nutrition - national advocacy,
- Obesity prevention - nutrition - local strategy,
- Obesity prevention - exercise - national advocacy,
- Obesity prevention - exercise - local strategy,
- Obesity management – a service pathway.
Obesity prevention interventions are therefore orientated towards:
Diet ('eat well')
- Reducing exposure (protection) to known dietary hazards such as refined sugars, particularly in drinks, and excessive sugar and fats in processed food.
- Increasing exposure (promotion) to a healthy diet rich in unprocessed nutrients especially fruit and vegetables.
Exercise ('move more')
- Increasing exposure (promotion) of healthy levels of exercise and activity.
- Decreasing exposure (protection) from excessive inactivity particularly "screen time".
These interventions can be orientated directly towards children, their families or the communities in which they live, which in turn provides a framework for local action.
What should we do next? Local action
When facing a global epidemic is often difficult to know where to start! I would suggest
- gather together local stakeholders to ascertain commitment to prevent obesity. Then assuming willingness to take local action.
- Review current local obesity prevention strategies and their impact.
- Review the evidence on what works.
- Prioritise those interventions most likely to be effective in your local community.
- Plan and implement, decide on meaningful measures by which to judge the success.
BACAPH is a membership organisation which exists to promote public health in order to achieve better outcomes throughout the United Kingdom. Please report your experience in order to promote discussion and effective working.
Community paediatrician, co-chair BACAPH