The big issue

Fat is not just a feminist issue. It is now the most common
childhood disorder in Europe. 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 timebombs 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.

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.

Obesity is estimated to cost the economy at least £2.5bn 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 £450m 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.”

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

A lesson in healthy living

There have been startling changes to Padiham St Leonard’s C of E
primary school in Burnley, Lancashire, since Julie Bradley started
as head teacher 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.  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. 

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.”

Fat of the land 

• In 2001, 8.5 per cent of six year olds and 15 per cent of 15
  year olds were obese. 
• 60 per cent of 12 year olds have at least one modifiable risk
  factor for heart disease. 
• 30,000 deaths a year are attributable to obesity – 6 per cent
  of all deaths. 
• Obesity reduces life expectancy by nine years.