News

Fat is not just a feminist issue. It is now the most common childhood disorder in Europe, writes Natalis Valios.

Between 1996 and 2001 the proportion of overweight children increased by 7 per cent and of obese children by 3.5 per cent. If these trends continue, by 2020 one-fifth of boys and one-third of girls will be obese.

Obesity, diabetes and smoking, are the biggest health time bombs in society. For the first time, according to the British Medical Association’s adolescent health report, medical professionals are seeing non-insulin diabetes in children under 10 as a direct result of obesity.¹ Poor nutrition, obesity and little exercise as a child will only add to their susceptibility as an adult to diseases such as coronary heart disease.

Food “deserts” and poverty play a significant role in obesity. Food deserts are densely populated urban areas where residents do not have access to an affordable, healthy diet. They are often on benefits and if they do not have a car they cannot easily get to out-of-town superstores where food is cheaper and there is more choice. Instead they rely on the more expensive local convenience stores and takeaways.

Other reasons for more children becoming obese – the rise of sedentary pursuits such as playing computer games and watching TV, and the decline in outside play and sport – are well documented.

Children who are neglected, depressed or have other social problems are more likely to become obese as they grow older, as are those with obese parents.

Low self-esteem

Psychological effects of obesity leave children with low self-esteem and eating disorders as well as feelings of sadness, loneliness and anxiety. Many are bullied.

Obesity has become the latest burning issue in the media, yet paradoxically the rising number of obese children suggests a laissez-faire attitude towards their health and physical education. So what is being done to tackle it?

According to Ian Campbell, chairperson of the National Obesity Forum, the answer is… not nearly enough. He says: “The majority of my colleagues are paying scant regard to the problem of rising numbers of obese children. Everyone is interested, but few people are doing anything about it.”

The forum, which has been running for five years, established the first guidelines for professionals on weight management for children. It began as a network for health professionals and is now also a pressure group involved with the all-party parliamentary group on obesity, campaigning for preventive measures.

Campbell believes there is a failure to recognise that obesity in children exists, coupled with a lack of strength in the system to diagnose it. “Even if it is diagnosed, what would we do about it? There are no resources available and little support. There are only about six paediatric clinics in the country that deal with it,” he says.

The Carnegie International Weightloss Camp is the UK’s only residential programme for overweight and obese children, and is in its sixth year. For the first time, the six-week summer camp is being reinforced with a two-week Easter programme.

About two-thirds of attendees are self-referrals, either from the children themselves or their parents. Eighty-five per cent are funded by their family, the rest by social services or health. Rather than a “fat camp”,  it is a health camp teaching children skills to lead a more active and healthier lifestyle, says director Paul Gately. It has impressive outcomes: one-year follow-ups show that the weight loss of 60-80 per cent of participants will be permanent. They may even continue to shed pounds.

Coach potato culture

Obesity is estimated to cost the economy at least £2.5 billion a year. So no wonder the government is saying it wants to tackle the problem. Culture secretary Tessa Jowell said recently: “Tackling the couch potato culture among young people is important for us. Children need to know they aren’t just the passive victims of an epidemic.”

The government has set up the Activity Co-ordination Team (ACT) to produce a national physical activity strategy for England. The first three-year plan is due to be published this spring.

As well as promoting healthy eating and exercise in schools, the government launched a national strategy for PE in October 2002 so that everyone can take part in high-quality physical education and sport. It is backing it with a £450 million investment between 2003-6 to transform PE in schools. The target is for 75 per cent of 5-16 year olds to have at least two hours a week of PE and school sport by 2006.

But what sort of target is this? “Pathetic,” says Gately, who is also principal lecturer in exercise physiology and health at Leeds Metropolitan University.

“The government doesn’t know what to do about the problem of obese children and isn’t willing to tackle it by moving it up the public agenda. Its strategy and vision is to align it to other things that have been successful, for example the five-a-day programme (vegetable and fruit portions).

“The government talks about evidence-based information, but there’s no evidence that five portions of fruit and vegetables a day tackles obesity. It has a positive effect on heart disease and cancer, but you can’t align one issue with another.”

Gately’s main criticism is that PE lessons and school meals are under-resourced. “There is no nutritional education in schools. If the government was serious about obesity, it would address these issues.”

"Water pistol rather than tidal wave"

He says: “It’s like trying to turn a supertanker around but the government is using a water pistol to do it rather than a tidal wave. Government and policy makers talk about obesity as a big problem but when it comes down to it they are doing nothing to tackle it seriously.”

The recently published Wanless report envisages a crucial role for primary care trusts and local government in tackling obesity.² 

The report is a follow-up to Derek Wanless’s report two years ago which looked at long-term health trends. The latest study recommends that the government set a clear national framework of objectives for the key risk factors to our future health, such as smoking and obesity. Primary care trusts and local authorities should agree joint local targets which should be reinforced through the NHS and local government performance management and inspection systems. Wanless expects the public health white paper due in July to propose plans to achieve this.

The warnings are loud and clear. It’s time for policy makers and practitioners to start doing something about the problem, rather than just chewing the fat.

¹ BMA Board of Science and Education, Adolescent Health, BMA, 2003
² D Wanless, Securing Good Health for the Whole Population, HM Treasury, 2004

Case study

There have been startling changes to Padiham St Leonard’s C of E primary school in Burnley, Lancashire, since Julie Bradley started as headteacher nearly four years ago. She inherited a school with “various educational weaknesses”, as she puts it. SAT results were about 30 per cent, there were low expectations of children and a lack of self-esteem and motivation.

Padiham is an area of high social deprivation – 55 per cent of pupils at the school receive free school meals. There was no physical activity programme at the school when Bradley arrived, but she was keen to introduce one and develop health education. The result is a programme that prevents obesity, helps concentration and keeps pupils healthy and active.

82 per cent not eating breakfast

A survey revealed that 82 per cent of pupils were not eating breakfast, and those who did often ate biscuits and crisps. Now children can arrive at school at 8.15 for breakfast for a nominal fee. Before lessons start at nine, pupils have five minutes of aerobic exercise in the classroom with their teacher to give them an energy boost.

During lessons there are one-minute “brain breaks” every 10 to 15 minutes where they do some sort of physical activity such as rolling their head or touching their toes to aid concentration. At mid-morning break a healthy eating club provides toast, fruit and smoothies, each 10p.

During breaks the pupils can take part in structured play, including football, netball, circuit training and tennis on a playground with multi-sport markings. All this activity left some children on too much of a high after lunch so five minutes of yoga-type stretching exercises follow the lunch break to calm them.

Improved results

Bradley says: “We do a lot of work around healthy eating and living. We talk to children about eating five portions of fruit and vegetables a day and we send flyers to parents about healthy eating and going to bed early.”

Bradley’s philosophy that “an unhealthy child can’t think to full capacity” has been borne out. Standards have risen and the school now has 80 per cent SAT results despite one-third of pupils having special needs.

She believes that schools have to start as early as possible to teach children about eating well. “We have to realise that we have to do it and make an effort. Schools have a huge part to play.”

Bradley herself seems to have boundless energy and enthusiasm for the work and has no time for those who are not prepared to do something about the problem: “I get really agitated with people who sit back and say ‘what other initiative can we throw money at?’. I have done this on £5,000. If it can work in my school, it can work anywhere.”