Childhood obesity
July 2008
Childhood obesity
Introduction
Childhood health and nutrition are of great concern to the British Medical Association. Placing the needs of children at the centre of our thinking is vital, as this period is a crucial stage in development. Childhood obesity rates in the UK are soaring. This is extremely worrying as obesity can cause heart disease, osteoarthritis and some cancers.
The BMA released its report Preventing Childhood Obesity in 2005 (Reference 1) Its recommendations call for nutrition-based standards for schools meals, the removal of unhealthy foods from vending machines, improved food education in schools and the banning of advertising and marketing to children of unhealthy foods.
Other BMA reports include:
- Growing up in Britain: Ensuring a healthy future for our children (1999) (Reference 2) considered the nutritional needs of children aged 0 to 5 years.
- Eating disorders, body image and the media (2000) (Reference 3) considered the role the media can play in shaping young people’s attitudes to eating and body shape.
- Adolescent health (2003) (Reference 4) reviewed nutrition, exercise and obesity in adolescents
- Worldwide over 22 million children under five are severely overweight.
- In the UK there are around 1 million obese children under 16 years of age. These soaring rates in obesity have lead to an increase in childhood type II diabetes and will lead to more future cases of heart disease, osteoarthritis and some cancers.
- Estimates indicate that, if current trends continue, at least one fifth of boys and one third of girls will be obese by 2020.
- Every year the health service spends at least £2 billion on treating ill health caused by poor diet.
BMA policies
The following are a selection of the BMA’s policies for action to reduce the risks from obesity:
Nutrition
The BMA believes that cooking should be a compulsory part of the school curriculum.There should also be special emphasis on how to provide healthy meals on a low income.
Exercise
The BMA believes that the Government should increase funding and improve access to sport and recreation facilities within schools and communities.
Advertising
The BMA believes that there should be a ban on the advertising of unhealthy food and drink to school children.
Labelling
The BMA believes that accurate food labelling and clear information is imperative to encourage the public to make informed choices about their diet.
Health professionals
The BMA calls for funding to establish and sustain training programmes for those who are involved in the care of children with obesity.
Education, information and research
The BMA believes that the Government should mount a sustained and consistent public education campaign to improve parents’ and children’s understanding of the benefits of healthy living.
Nutrition
In general, children and adolescents are eating more salt, sugar and saturated fats than is recommended and not enough fruit and vegetables. Attention has also recently focussed on adolescents’ high consumption of fast food and soft drinks. The problem is most acute for those who are born into low-income families, with inadequate income and inadequate access to healthy food making it much more difficult to improve the diet (Reference 5). There is increasing evidence that adult susceptibility to disease is associated with nutrition in early childhood and adolescence, and therefore early intervention is vital (Reference 6).
The BMA has called for mandatory nutrient and compositional standards for school meals including maximum/minimum levels for fat, sugar, salt, vitamins and minerals. We welcome the fact that food standards guidelines based on recommendations by the School Meal Review Panel became a legal requirement in September 2006 in all primary and secondary schools. Nutritional standards will be introduced in primary schools by September 2008 and in secondary schools by September 2009. School meals will also be included in future Ofsted inspections.
The BMA has also called for the sale of unhealthy food and drink products from school vending machines to be banned in secondary and upper schools to continue the healthy eating message given in primary schools. We welcome the fact that since September 2006 healthier choices are being offered in vending machines based on recommendations by the School Food Trust.
The BMA welcomes the fact that free water is now freely available in all schools following School Meal Review Panel recommendations.
The BMA further recommends that:
- Food education and the acquisition of related practical skills should be compulsory. Food technology is currently an optional, rather than a compulsory part of the Key Stage 3 design and technology curriculum. It is appalling that so many young people leave school unable to prepare a simple meal. They will end up choosing to buy expensive, processed food that is high in fats, sugar and salt. If they have children in the future they will feed them similar unhealthy food and the pattern of obesity will not be broken. The Government announced 23/1/08 that food technology will be compulsory at key stage 3 for every 11 to 14-year-old from September 2011. Lessons will involve practical cooking lessons and classes on diet, nutrition and hygiene.
- There should also be special emphasis on how to provide healthy meals on a low income. In order to do this effectively, teachers should receive training on what constitutes a good, balanced diet and how to prepare food. Investment in facilities and effective curriculum development are needed.
- Primary and nursery schools should all provide free milk.
- The free fruit and vegetable scheme should be extended to all primary and nursery school children and the Government should subsidise the cost of fruit and vegetables to encourage health eating.
- All manufacturers should be legally obliged to reduce salt, sugar and fat in pre-prepared meals to an agreed level within a defined time frame. School food contractors should be encouraged to use different approaches to food preparation more frequently, such as boiling, grilling and baking.
The BMA recommends that:
- There should be increased access to subsidised sporting facilities for both children and their parents. Ready access for those from lower socio-economic groups is particularly important. ‘Exercise on prescription’ (eg reduced cost/free access to local authority sports centres) should be extended.
- Choice in the style of exercise offered to children is desirable, as not all children want to play competitive or mixed sports. The needs of disabled children should also be reflected in the choice available.
- The BMA remains deeply concerned by the sale of school playing fields, even when this is regarded as the last resort. The protection offered to school playing fields should be strengthened.
The BMA is concerned that children receive a huge amount of attention from food advertisers, with a marked discrepancy between the foods marketed at children and the nutritional quality of that food (Reference 7). The media has an important role to play in forming attitudes to nutrition and there is scope to harness this potential and further regulate its more harmful impact (Reference 8).
The BMA recommends that:
- There should be a ban on the advertising of unhealthy foodstuffs, including inappropriate sponsorship programmes, targeted at school children.
- Celebrities and children’s television characters should only endorse healthy products that meet nutritional criteria laid down by the Food Standards Agency (FSA). The media has a role to play in encouraging improvements in children’s diet and exercise. Supermarkets should consider price promotions for healthy food instead of chocolates, sweets and crisps. The BMA recognises that the Ofcom announcement (17/11/06) recommending a ban on junk food ads during TV programmes that are relatively popular with under-16s goes further than expected. However, the BMA is concerned that the proposals will exclude some programmes which are watched by the highest number of under-16s. If there is not going to be a complete ban, the BMA believes that a ban on advertising of unhealthy foods before the 9pm watershed will afford the most protection to children of all ages
The National Consumer Council found that logos on food labels are more likely to confuse and mislead consumers, than help them make informed choices (Reference 9). Research into the dietary knowledge of adolescents aged 14 to 16 years found that they did not tend to check nutritional labelling or weigh up the nutritional content of food that they chose. (Reference 10)
- The BMA believes that accurate food labelling and clear information is imperative to encourage the public to make informed choices about their diet. Nutritional labelling must be clear, simple and easy to understand. Health claims made on food must also be addressed. Both nutritional and content claims on labels, and functional claims on packaging and in advertising, must be accurate and verifiable.
- The BMA welcomes the government’s initiative to make nutrition labelling on all foods mandatory, and moves toward having labelling which indicates whether the product is high, medium or low in fat, sugar and salt (Reference 11). We welcome the recently developed Nutrient Profiling Model or ‘traffic light’ system of labelling from the Food Standards Agency which is an appropriate tool for determining which foods are ‘unhealthy’. We hope that it will be used to set new standards in nutritional content, food labelling, and food marketing and promotion for mandatory adoption by the food industry. The BMA believes that that it should be more widely and forcefully applied.
- The BMA strongly advocates that nutritional labelling and health claims should be regulated. Regulations must apply to all traders, suppliers, manufacturers, caterers, agencies, retailers and importers of foods. They must be adequately policed and monitored by a board such as the FSA.
Existing primary care health professionals are not well placed to meet the needs of obese children. The International Consensus document (Reference 12) gives very specific recommendations that need to be addressed when planning services. Staff with time and motivational skills are urgently needed.
- There needs to be funding to establish and sustain training programmes for those who are involved in the care of children with obesity. This includes specialist school nurses, health visitors and GPs.
- This should be complemented by resources to allow children from any region within the UK to gain access to specialist regional obesity services.
- There needs to be clearer guidance and advice as to the most effective ways of losing weight and maintaining weight loss.
Families should be educated and empowered through guidance that recognises the impact they have on their children’s development of life-long habits of eating and activity. Information and advice should appeal to ‘positives’ where possible.
- The BMA strongly supports and calls for a ‘National Obesity Institute’ or ‘Nutrition Council’ to improve collaboration between stakeholder groups.
- There should be UK-wide surveillance of factors that lead to childhood obesity, developed by the public health observatories.
- There is very little evidence about the effectiveness of interventions and therefore research is
needed on the effectiveness of weight management and treatment programmes, the longitudinal
impact of obesity on individuals and society, the impact of physical activity (by type) on obesity
and co-morbidities, and the relationship between environmental factors and obesity prevalence.
E-mail: parliamentaryunit@bma.org.uk.
- British Medical Association Preventing Childhood Obesity London: BMA 2005
- British Medical Association. Growing up in Britain: Ensuring a healthy future for our children. London: BMJ Books 1999
- British Medical Association. Eating disorders, body image & the media. London: BMA 2000.
- British Medical Association. Adolescent health. London: BMA 2003.
- (2) British Medical Association. Growing up in Britain: Ensuring a healthy future for our children. London: BMJ Books 1999.
- Public Health Nutrition 4 (6A) 1335-6 Early nutrition and risk of disease in the adult
- British Medical Association. Growing up in Britain: Ensuring a healthy future for our children. London: BMJ Books 1999
- British Medical Association. Adolescent health. London: BMA 2003
- NCC annual review 2001
- Food Standards Agency (2003) Food Standards Agency role in school based initiatives. London: Consumer Committee Meeting 18 June 2003. In Adolescent Health (2003).
- HL Deb 1 April 2004 c182WA
- Speiser P, Rudolf MCJ et al (2005) Consensus statement: childhood obesity. Journal of Clinical Endocrinology and Metabolism 90(3): 1871-87.