- 11 October 2018
Following the Royal College of Paediatrics and Child Health summit on childhood obesity, RSPH PR and Campaigns Manager Ed Morrow, looks at how and why we should be creating a less obesogenic environment
Ordinarily, any discussion of obesity as a public health issue starts with the recitation of terrifying statistics. X number of adults and X number of children overweight or obese by year X, causing X number of preventable deaths and costing the public purse X number of pounds. But let’s take that as read. We all know the stakes. We all know it’s the weight of obesity that could finally crush the life out of the NHS.
What there is more confusion and debate over is the causes, and the potential solutions. On that front, last week I was fortunate enough to attend a summit on childhood obesity organised by the Royal College of Paediatrics and Child Health (RCPCH) for a crash course in the issue. The summit brought an impressive array of expertise together in the same room, and proved a source of great insight.
The focus on childhood obesity, in particular, is vital. Obese children usually go on to become obese adults. The behaviours and trends that set someone on a trajectory to obesity are programmed at the earliest ages, and can be nigh on impossible to overturn later in the day. It is clear that, in obesity as in much else, early years interventions offer the greatest opportunity to shape a different future.
However, before we fall over ourselves in a rush to blame the parents for setting their offspring on a calamitous course, we should remember that more often than not, childhood obesity is the result of a gradual accumulation from an early age. It requires only a small calorie surplus each day to have big consequences in the long run; it doesn’t require parental responsibility over diet and exercise to go totally absent without leave. Obesity, then, is a matter of fine margins.
If we cannot blame the parents, then there are important implications for how we attempt to tackle childhood obesity. We must accept that interventions based purely on educating parents simply do not work – a fact backed up by the evidence presented at the RCPCH summit. Indeed, interventions based on guilt can be positively unhelpful. Even where educational messages are taken on board, it is often only by easier to reach demographic groups that stand least to benefit from them, amplifying health inequalities.
Instead, we need to do what we can to create a less obesogenic environment – an environment, both physical and financial, that makes healthy choices easier and unhealthy choices harder. This may be unpalatable to some, but it is what we have to do if we are serious about tackling our obesity epidemic and averting a public health catastrophe.
So what does a less obesogenic environment look like in practice, and what environmental interventions are best evidenced to work, especially for children? These are among the questions the Royal Society for Public Health, alongside others, will be addressing as we look to feed into the government’s forthcoming childhood obesity strategy, which is theoretically due for publication before the end of the year.
Measures suggested and evidenced at the summit include changes to the school environment, such as wider provision of free school meals and increased mandatory activity time. The big headline intervention could be a sugar tax – evidence on this front is largely modelled and therefore uncertain, but there are some positive signs on the ground from such a tax in Mexico. Perhaps most interestingly, studies have demonstrated the power or larger plate sizes to generate higher food consumption, so measures to reverse this trend are certainly worth exploring.
What I left the summit in no doubt of is that childhood obesity is not a problem for which there is a silver bullet. Tackling it is going to take a holistic approach that encompasses both diet and physical activity across a range of settings. Most of all, it’s going to need us to stop bashing the parents, and start making the healthy choice the easy choice.