Expert Opinion

Within the UK, 20% of children starting school are already overweight or obese and by the time they leave primary school, this increases to 30%. There are significant inequalities as prevalence is twice as high in children from low income and some ethnic groups. These children are likely to remain obese into adulthood, with an elevated risk of developing heart disease, diabetes and some types of cancer. They may also develop psychological problems, as a result of low self-esteem and bullying at school.

The Government’s first Childhood Obesity Plan launched in August 2016 was deemed to be weak and unambitious by the public health community. Calls for curbing price promotions, marketing and advertising, improved labelling and providing local authorities with stronger regulatory planning powers were a major omission. Largely the focus was on the food and drink industry through encouraging reformulation of products and the sugar drinks industry levy (SDIL).

Public Health England (PHE) are charged with monitoring the impact of the Plan and have reported that some success has been achieved as drinks have been reformulated to avoid the levy before the introduction of the levy in April 2018. Compared to Treasury forecasts, this has resulted in the levy producing reduced funds that were earmarked to support physical activity programmes in schools.

The voluntary reformulation food high in sugar commonly consumed by children such as biscuits, cakes, yogurts have only achieved a 2% reduction compared to the target of 5% reduction in sugar content. At the outset we were informed that this Plan was the start of the conversation.

Hence The Obesity Plan: Chapter 2 has been eagerly awaited to see whether it includes the bold, and ambitious actions that we believe are needed to reverse the continuing increase in prevalence.

Chapter 2 has a more proactive and ambitious tone and states at the outset the government’s commitment in setting a national ambition to halve childhood obesity by 2030 and whilst not setting a specific target, it aims to significantly reduce the gap in obesity between children from the most and least deprived areas.

There is a commitment and a move towards a more co-ordinated approach in making healthier decisions, providing healthier options and creating healthier environments. However, embracing a whole systems approach would be of great benefit in the implementation process and therefore a focus on how best to apply this in practice across all organisations, agencies and the food industry is suggested.

The ambition of Chapter 2 is to empower parents to make informed decisions about the food they are buying for their families when eating out. It wants to mitigate pester power by preventing stores from promoting unhealthy food at checkouts and help make healthy food the default option for ‘buy one get one free’ deals.

It aims to protect children from advertising that encourages demand for unhealthy food and for the food and advertising industries to help all parents find the healthier choice the easier choice.

In order to realise these ambitions, Chapter 2 intends to continue with the sugar reduction programme and consider inclusion of sugary milk drinks as part of the (SDIL). In recognition that sugar is not only that is responsible for childhood obesity but it is about the whole diet, the plan aims to promote calorie labelling for the out of home food sector and consider simplification of food labelling post-Brexit; to  ban By one Get one Free (BOGOF) products plus free refills of high fat, sugar and salt (HFSS) products (as defined through the nutrient profiling programme); to end promotion of unhealthy food and drink by location e.g. end of aisles and checkouts; alignment of advertising and marketing regulations between broadcast and social media; introduce a 9pm watershed on TV and on-line advertising of HFSS products with the aim of reducing exposure to HFSS products and driving further product reformulation.

Chapter 2 states an intention to legislate in many of these areas with consultations due to start by the end of 2018.

Schools are recognised as an important health promotion setting and therefore it maintains the commitment to implementing the actions detailed in the first Plan i.e. providing high quality nutrition and 30 minutes physical activity per day in school. In addition, Chapter 2 aims to update the School Food Standards to reduce sugar consumption and primary schools to adopt The Daily Mile initiative.

In publishing Chapter 2, the government has taken on board some of the recommendations from public health campaigners, the evidence from the Health and Social Care Select Committee and the All Party Parliamentary Group on Obesity. It has included actions that were omitted and therefore heavily criticised for in the first Plan. The ambition to halve childhood obesity by 2030 is welcome as is the significant reduction of inequalities, even if there is no target for the latter. No further movement is seen improving weight management services; early years initiatives or increased planning powers for LA’s apart from a proposed ‘trailblaizer programme’.

The Plan is bolder and more ambitious however implementation is key if we are to realise the impact on childhood obesity levels. Therefore, the adoption of a whole systems approach would be of benefit in the implementation of the Plan. An approach that identifies and has involvement of all stakeholders, an operational plan with agreed and time bound actions, a robust evaluation plan with defined roles and agreed responsibilities including mandatory and fiscal levers, if for example industry is failing to face up to the scale of the problem

The requirement for sustained collaboration across the political divide, across society and across public and private sector organisations is a necessary characteristic for a whole systems approach and therefore provides greater likelihood of success. Finally and importantly strong leadership, political will and accountability are necessary requirements if the UK is to be the first nation to reverse the increasing prevalence of childhood obesity.

NHS 70 Years

Professor Pinki Sahota

Pinki Sahota is a former Professor of Nutrition and Childhood Obesity at Leeds Beckett and a Core Member of the Institute for Health and Wellbeing. Her expertise and research interests include the development, implementation and evaluation of interventions addressing nutrition.

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