Childhood nutrition and obesity
An update from the BMA Board of Science
July 2008
Introduction
The British Medical Association (BMA) has a long term interest in the health of the public and believes that the increase in the levels of childhood obesity is a cause for great concern. Obesity at all stages of development is a growing problem, particularly in the United Kingdom (UK). Child obesity however, has significant implications for life-long health and needs to be tackled effectively. The health behaviour of children in the UK needs to be addressed immediately in order to ameliorate the long-term effects of poor nutrition and lack of exercise.
In 2005 the BMA Board of Science published ‘Preventing childhood obesity’ (2005) [Reference 1] which discusses childhood obesity and the impact it can have on children’s current and future health. The report considers nutrition and exercise levels in children, and the role of healthcare professionals in improving these. It also looks at the environmental barriers that need to be removed or adapted to halt the obesity epidemic. The report outlines a number of recommendations for action intended for Government, healthcare professionals, schools and stakeholders. These recommendations were devised to bring awareness to the many components required to respond to the current obesity epidemic. These include:
- promoting healthy eating
- access to exercise (ideally subsidised where possible)
- access to healthy foods, particularly in schools
- losing weight and maintaining weight-loss
- responsible advertising, when addressing both unhealthy foods and nutritional health claims
- clear, standardised product labelling.
The BMA previously published a number of relevant reports. ‘Adolescent health‘ (2003) [Reference 2] includes discussion on nutrition, exercise patterns and the prevalence of obesity in adolescents. ‘Eating disorders, body image and the media‘ (2000) [Reference 3] looks at the role the media plays in influencing young people’s attitudes to eating and body shape.
The BMA has produced briefings on childhood obesity for debate in both Westminster (2007) and the Scottish Parliament (2006).
Foresight project
Children’s Food Campaign
Food Advertising
School food
PorGrow
Guidance and resources for healthcare professionals
References
Sources of further information
Foresight project
The Foresight project 'Tackling obesities: future choices' was announced in 2005. The BMA was a key stakeholder and had an input particularly focused on systems mapping and scenario building. The outcomes report [Reference 4] was published in October 2007. It examines the scientific evidence base from across a wide range of disciplines in order to understand the relationships and importance of key factors influencing obesity. Using this evidence it aims to identify effective interventions, predict how obesity might change in the future and identify the most effective responses. The BMA welcomes the breadth of the analysis in the Foresight report. It offers a new way of viewing the problem of overweight and obesity and will help medical practitioners see how their particular contribution can have most impact within a much wider cultural and environmental picture. As well as the final report, this project produced a series of reviews of the current science and also models for future trends of obesity and policy options, and the likely impacts on health.The Foresight project was considered when the Quality and outcomes framework was updated recently.
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Children’s Food Campaign
The BMA supports the Children’s Food Campaign which is calling for:
- better food in schools
- protection for children from high fat, sugar and salt (HFSS) ‘junk’ food advertising
- every child to be taught about healthy food and cookery at school
- clear food labelling that everyone can understand, including children.
The Children’s Food Bill, organised by the campaign, won the support of approximately 300 Members of Parliament from all major parties, and raised the profile of children’s food. The Children’s Food Bill ran out of time at the end of the 2006 parliamentary session. A new private members Bill, seeking to prohibit the advertisement of HFSS foods before the 9pm watershed was presented to the House of Commons in December 2007 but the Bill failed to progress.
The report ‘Children’s Food Bill: why we need a new law, not more voluntary approaches’ (2005) [Reference 5] looks at the need for legislation to stop HFSS food being advertised to children. It highlights the ineffectiveness of voluntary codes of advertisement in competitive markets and rebuts the arguments used by the food and advertising industries to promote self-regulation rather than effective legislation.
In October 2007, the Campaign published ‘Missing the target’ (2007) [Reference 6], to which the BMA contributed. This report makes the case that more should be done to reduce the levels of childhood obesity and improve children’s health and wellbeing. The measures proposed include further restrictions to advertising via both television and other sources, such as the internet and mobile phones; making food technology a compulsory part of the national curriculum; and fully implementing the Traffic Light labelling system. The report states that ‘no public health expert now thinks the Government will meet its target to stop the growth of obesity among children under the age of 11 by 2010’ and that the ‘Government could have done far more to combat childhood obesity; and has failed to do so because of an unwillingness to take on the food industry’ [Reference 6].
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Food Advertising
Ofcom
In 2006 the Office of Communications (Ofcom) consulted on the television advertising of HFSS foods to children. The option to ban advertising of unhealthy food and drink products before the 9pm watershed was not included, much to the dismay of the BMA and other stakeholders.
The subsequent report, ‘Television advertising of food and drink products to children: final statement’ (2007) [Reference 7] outlines the standards for the advertisement of HFSS foods to children. These standards prohibit the advertisement of HFSS foods in or around programmes of particular appeal to both pre-school children and children aged four to 15 years. The standards set by Ofcom also restrict the use of celebrities and licensed characters, promotions, and nutritional and health claims for adverts aimed at school-aged children.
The first part of this regulation came into effect in April 2007, with restrictions on advertisements for HFSS products in or around programmes aimed at children (including pre-school children), and in or around programmes that are likely to be of particular appeal to children aged four to nine years. From 1 January 2008, HFSS advertisements should not be shown in or around programmes with an audience index of 120 or more for children aged four to 15 years.
[A value of 100 denotes the viewing audience contains the same proportion of four to 15 year olds as are found in the general population. A value of 120 would mean that four to 15 year olds watching that programme are over-represented by 20%].
Under the new Ofcom regulations, dedicated children’s channels will be allowed a transitional period for implementation of the new scheduling restrictions until 31 December 2008. During this period they will be allowed to continue to broadcast a reduced proportion of HFSS food advertisements.
Food Standards Agency
The Food Standards Agency (FSA) produced a nutrient profiling model which was used in the development of Ofcom’s regulation of advertising HFSS foods to children. The BMA welcomes the model as a tool for use in defining ‘healthy’ and ‘unhealthy’ foods. The FSA is currently in the process of reviewing the nutrient profiling model.
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School food
Caroline Walker Trust
In September 2005, the Caroline Walker Trust (CWT) published ‘Eating well at school: nutritional and practical guidelines’ (2005) [Reference 8]. This report makes many recommendations about all aspects of school food including training and support for staff, provision in after-school clubs, appropriate marketing and education and linking food and nutrition into the whole-school environment. The report also sets out comprehensive nutrition-based standards for school meals and gives example menus for children of different ages.
Following this report CWT published ‘Eating well for under 5's in child care’ (2006) [Reference 9], which provides both nutritional and practical advice for use within this sector. This report is accompanied by additional training materials and food information.
School Food Trust
In 2005 the Department for Education and Schools (DfES) set up the School Food Trust (SFT) to improve the quality of food supplied and consumed in schools. Following the publication of ‘Turning the tables: transforming school food’ (2005) [Reference 10], the Trust, over the subsequent three years, aims to transform school food and food skills, improving health and education for children. As part of this responsibility the SFT has published ‘Eat better, do better: a guide to the Government’s new food-based standards for school lunches’ (2007) [Reference 11] which provides guidance on the new food-based and nutrient-based standards brought in by the Government.
Following consultation, DfES published ‘Nutritional standards for school lunches and other school food’ (2006) [Reference 12] which sets minimum nutritional and food standards for school food. These standards prohibit the sale of HFSS products including confectionary, crisps and fizzy drinks. They also require that high quality meat and fish are available on a regular basis; that a minimum of two portions of fruits and vegetables are available with every meal; and that deep-fried foods are restricted to no more than two portions per week.
Education and Inspections Act 2006
The ‘Education and Inspections Act 2006’ [Reference 13] provides legislative powers to effect changes to the nutritional standards of school foods. Under the Act the existing power to make regulations in connection with nutritional standards is extended to cover all foods and drinks provided to pupils by local education authorities (LEAs) and governing bodies. It also requires drinking water to be freely available, and gives LEAs and governing bodies the power to provide pupils with some or all meals/drinks/refreshments free of charge. The duty to ensure that these standards are met has been placed on LEAs and governing bodies. It is intended that the Act will allow further regulation to increase pupils’ access to healthier foods and reduce the amount of HFSS foods provided to pupils.
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PorGrow
The Europe-wide PorGrow project seeks to identify the policies that might provide the most effective means to reverse the rising trend in the prevalence of obesity. ‘Policy options for responding to obesity: UK national report of the PorGrow project’ (2006) [Reference 14] deals with findings at the national level in the UK. The report analyses the results from the UK survey, allowing the identification of promising policy initiatives. The BMA was involved in this project, analysing the relative benefits of different policies. ‘Policy options for responding to obesity: cross-national report of the PorGrow project’ (2006) [Reference 15] gives an EU-wide perspective of the challenge of obesity.
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Guidance and resources for healthcare professionals
Action for Obesity Resources (AFOR)
In 2005 the Action for Obesity Resources (AFOR) campaign emphasised the need to prevent as well as treat obesity and its related co-morbidities. The campaign called for obesity to be included in the General Medical Services (GMS) contract. Under the Quality and Outcomes Framework (QOF), currently eight points are awarded for producing a register of patients aged 16 and over with a body mass index (BMI) greater than or equal to 30. The evidence base for effectiveness of obesity interventions is not considered of sufficient strength to warrant further points within the GMS contract.
Department of Health
In January 2008, the Department of Health (DH) published ‘Healthy weight, healthy lives: a cross Government strategy for England’. This report outlines the immediate Governmental strategy to combat the obesity epidemic. This is aimed at five major areas – healthy growth and development of children, the promotion of healthier food choices, increasing physical activity, creating incentives for better health, and personalised advice and support.
The DH has recently established a Directorate of Obesity to coordinate the work in this area and in particular to deliver Public Services Agreements (PSAs). The DH website contains a range of information relating to obesity and nutrition, including information and statistics, care pathways, and other guidance documents. The DH has updated ‘Forecasting obesity to 2010’ (updated 2006), [Reference 16] which analyses the current levels and trends in obesity, in order to estimate the prevalence of obesity in the future.
The DH and the Department for Children, Schools and Families (DCSF) are jointly involved in the operation of the National Child Measurement Programme (NCMP) established in 2005. This programme collects data on the height and weight of five and 11 year olds during the school year. It intends to track the prevalence and trends of childhood obesity, and to direct future policy and guidance decisions on obesity and nutrition, as well as local planning and delivery of services for children.
The NCMP study in 2005/06 produced ‘Analysis of the National Childhood Obesity Database 2005-06’ (2006) [Reference 17].
The ‘National child measurement programme: guide for PCTs – 2007-08 school year’ (2007) [Reference 18] provides guidance for Primary Care Trusts (PCTs) on methodology and explains the rationale for this programme.
The DH has produced a collection of obesity care pathways and a supporting booklet for healthcare professionals to use with patients. There is also advice on how to approach this sensitive area with both adults and children.
National Institute for Health and Clinical Excellence
The National Institute for Health and Clinical Excellence (NICE) published ‘Guidance on the prevention, identification, assessment and management of overweight and obesity in both adults and children’ (2006) [Reference 19] which outlines clinical guidance on obesity for healthcare professionals. The guidance includes information on lifestyle changes, drug treatments and surgery.
National Heart Forum
‘Lightening the load: tackling overweight and obesity’ (updated 2007) [Reference 20] has been updated by the National Heart Forum (NHF). This toolkit provides information for healthcare professionals and policy makers in both the NHS and Local Government, which can form the basis for the development of a local obesity strategy. The toolkit includes practical initiatives, evidence of effectiveness, frameworks and examples of good practice, and incorporates guidance from many relevant organisations to develop and implement strategies to meet the challenge of obesity.
Intercollegiate Group on Nutrition
The Intercollegiate Group on Nutrition (ICGN) is a group of the Academy of Medical Royal Colleges in collaboration with the British Dietetic Association, and the British Dental Association.
The ICGN provide courses and education on nutrition, primarily for medical professionals to complement the present level of education in human nutrition across all the specialties and disciplines.
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References
- British Medical Association (2005) ‘Preventing childhood obesity’. London: British Medical Association.
- British Medical Association (2003) ‘Adolescent health’. London: British Medical Association.
- British Medical Association (2000) ‘Eating disorders, body image and the media’. London: British Medical Association.
- Government Office for Science (2007) ‘Tackling obesity: future choices – project report’. London: Department for Innovation, Universities and Skills.
- Children’s Food Campaign (2005) ‘Children’s Food Bill: why we need a new law, not more voluntary approaches’.
- Children’s Food Campaign (2007) ‘Missing the target’.
- Office of Communications (2007) ‘Television advertising of food and drink products to children: final statement’.
- Crawley H (2005) ‘Eating well at school – nutritional and practical guidelines’. Hertfordshire: Caroline Walker Trust.
- Caroline Walker Trust (2006) ‘Eating well for under 5's in child care’. Hertfordshire: Caroline Walker Trust.
- Department for Education and Schools (2006) ‘Turning the tables: transforming school food’.
- School Food Trust (2007) ‘Eat better, do better: a guide to the Government’s new food-based standards for school lunches’. Sheffield: School Food Trust.
- Department for Education and Schools (2006) ‘Nutritional standards for school lunches and other school food: final decisions on the report of the school meals review panel on school lunches and the advice of the School Food Trust on other school food’
- The Stationery Office (2006) ‘Education and inspections Act 2006’. London: The Stationery Office.
- University of Sussex & New and Emerging Science and Technology (2006) ‘Policy options for responding to obesity: UK national report of the PorGrow project’. Brighton: University of Sussex Science and Technology Policy Research.
- University of Sussex & New and Emerging Science and Technology (2006) ‘Policy options for responding to obesity: cross-national report of the PorGrow project’. Brighton: University of Sussex Science and Technology Policy Research.
- National Centre for Social Research & University College London (2006) ‘Forecasting obesity to 2010’.
- Crowther R, Dinsdale H, Rutter H et al (2006) ‘Analysis of the National Childhood Obesity Database 2005-06’.
- Department for Children, Schools and Families & Department of Health (2007) ‘National child measurement programme: guide for PCTs – 2007-08 school year’.
- National Institute for Health and Clinical Excellence (2006) ‘Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children’.
- National Heart Forum (2007) ‘Lightening the Load: tackling overweight and obesity’. London: Department of Health.
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