Policies towards the prevention of childhood obesity

The United Nations Convention on the Rights of the Child, specifically Article 24, requires that States do whatever is necessary to enable children attain the highest standards of health. The UK Government aims to stop the yearly rise in childhood obesity by 2010. Achieving this objective is the joint responsibility of three Departments – DOH^[1], DfES^[2], and DCMS^[3]. A multiplicity of strategies are being employed including school-based programmes, Sure-Start, Every Child Matters, Healthy Start, and other strategies (POST^[4], 2003). Healthy Start (DOH, 2004a) provides disadvantaged families with free vouchers to spend on milk, fresh fruit and vegetables, and other healthy foods. Launched in 1999, the Sure Start programme aims to improve health outcomes for children from disadvantaged backgrounds. In 2003 the Government published a Green Paper titled Every Child Matters (in response to the death of Victoria Climbie) aims to cater for the well-being of every child from birth to age 19 (DfES, 2003). Funded jointly by the DOH and DfES, and underpinned by the Children’s Act of 2004, this scheme sets out a 10 year plan of sustained improvement in health outcomes including healthier eating and reduced marketing of foods high in fat, sugar and salts. The National Health Schools Programme was launched in October 1999. Led by both the DOH and DfES, this initiative aims to tackle obesity through school-based programmes (e.g. the School Fruit and Vegetable Scheme). The Children’s Food Bill, ordered by The House of Commons, charges the Food Standards Agency (FSA) with accumulating scientific evidence on the problem and prohibits the marketing and sale of unhealthy foods to children.

Prevention of childhood obesity is hampered by various individual (i.e. person-based) and situational considerations. A recent study by three public watchdogs (NAO^[5]/HC^[6]/AC^[7], 2006) suggests that the efficacy of government initiatives may be hampered inaction, complexity, and uncertainty amongst organisations about their precise roles. Thus, the Public Service Agreement to halt the rise in obesity levels by 2010 may not be achieved. Public health groups, such as the NHF^[8], HET^[9], NAO, and the media, have long called for additional measures (POST, 2003), such as improved co-ordination amongst organisations, making it a statutory requirement for schools and other organisations to implement government nutritional policies, setting new nutritional goals that are more amenable to monitoring by Ofsted, reducing child poverty, and more stringent monitoring of TV advertising and programmes that may promote unhealthy diets. Media celebrity chefs such as Jamie Oliver and Gordon Ramsey have helped to raise public awareness of the problem. Mr. Oliver has promised to deliver healthy foods to almost 60 London-based schools, recognising that children in England have amongst the highest obesity rates in Europe. The Caroline Walker Trust and National Health Forum both recognise some of the challenges that schools might face in tackling the obesity problems (CWT^[10]/NHF^[11], 2005). For example, it may be necessary for schools to procure computer-based software to help catering authorities develop menus, which meet nutritional standards. Quite often children have limited control over what they eat at home and at school. While school-based initiatives ensure a healthy eating in this context it is essential to involve parents in such schemes (NHS Centre for Reviews & Dissemination, 2002), in order to ensure that children are also served healthy diets at home.

The importance of physical inactivity as a behavioural risk factor for childhood obesity is well established (DOH, 2004a, 2004b). An NHS review of research evidence in this area found that family-based programmes that increase physical activity levels and reduce sedentary behaviours could help to reduce childhood obesity (NHS Centre for Reviews & Dissemination, 2002). The National Healthy School Standards, part of the Healthy School Programme led by DfES and DOH, specifically identifies physical activity as one of four areas for intervention. In Chapter 3 of the governments 2004 White Paper Choosing Health: Making Healthier Choices (DOH, 2004b), it is noted practitioners, such as health visitors, school nurses, can play a key role for example by “reviewing children’s and young people’s health and supporting the use of children’s personal health guides” (DOH, 2004b, p.49). The BMA has highlighted the role of physical activity in preventing childhood obesity. In the recent policy report (BMA, 2005) the organisation called for the issues of diet and physical activity to be revisited. Practitioners are seen to play a central part in both the treatment and prevention of obesity. The BMA (2005, pp.18-19) lists specific forms of advice GPs in can offer. The government aims to support practitioners, for example by introducing ‘lead’ practitioners, and promoting information sharing (DfES, 2003; DOH, 2004a, 2004b).

There is a paucity of research on the impact of caregiver’s feeding style on obesity. Some evidence suggests that a caregiver’s feeding styles can reduce the risk of obesity, by facilitating the consumption of healthier foods. For example Patrick et al (2005) found that an ‘authoritative’ feeding style increases the probability that children will eat fruits, vegetables, and other healthy foods. This suggests that government initiatives should focus on increasing the powers of caregivers to be more authoritative when feeding children. The impact of caregiver characteristics and behaviour is unclear. For example, is a lack of research on whether the age of a caregiver or their dietary habits significantly affects what children eat, and hence their risk of obesity. What seems more evident is that parental feeding styles (e.g. breastfeeding, prompting children to eat) and attitudes/belief may constitute risk factors for childhood obesity. A study by public health experts at the University College London (Wardle et al, 2002) considered this issue. Obese mothers were compared with ‘normal’ mothers on four feeding styles - emotional feeding, instrumental feeding (in which food is used as a reward), encouragement to eat, and control over eating. Obese mothers exercised less control over the child’s food intake, which in turn may increase obesity risk. Other research suggests that breastfeeding method may also be a factor in childhood obesity (von Kries et al, 1999). Finally, children appear to model their parents dietary behaviours, so children have a reduced risk of obesity if their parents eat healthily, incorporate healthy dietary habits within the family, and teach their kids about the importance of a healthy diet and being physically active (Kids Health, 2005).

BIBLIOGRAPHY

BMA (2005) Preventing Childhood Obesity. London: British Medical Association,

Board of Science.

CWT/NHF (2005) Nutrition-Based Standards for School Foods. Abbots-Langley:

Caroline Walker Trust.

DfES (2003) Every Child Matters. London: Department for Education & Skills.

DOH (2004a) Healthy Start. London: Department of Health.

DOH (2004b) Choosing Health: Making Healthy Choices Easier. London:

Department of Health.

Kids Health (2005) Overweight and Obesity [online], Nemours Foundation, Available

from: http://kidshealth.org/parent/nutrition_fit/nutrition/overweight_obesity.html [Accessed 8 July 2006].

NAO/HC/AC (2006) Tackling Childhood Obesity. London: National Audit Office,

Healthcare Commission, Audit Commission.

NHS Centre for Reviews and Dissemination (2002) The prevention and treatment of

childhood obesity. Effective Health Care, 7, 1-12.

Patrick, H., Nicklas, T.A., Hughes, S.O. & Morales, M. (2005) The benefits of

authoritative feeding style: caregiver feeding styles and children's food

consumption patterns. Appetite, 44, pp.243-249. POST (2003) Childhood Obesity. London: Parliamentary Office of Science &

Technology.

Von Kries, R., Koletzko, B., Sauerwald, T., von Mutius, E., Barnert, D., Grunert, V.

& von Voss, H. (1999) Breast feeding and obesity: cross sectional study.

British Medical Journal. 319, 147-150.

Wardle, J., Sanderson, S., Guthrie, C.A., Rapoport, L. & Plomin, R. (2002) Parental

feeding style and the intergenerational transmission of obesity risk. Obesity

Research, 10, pp.453-462

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Footnotes

^[1] Department of Health

^[2] Department for Education and Skills

^[3] Department for Culture, Media and Sports

^[4] Parliamentary Office of Science and Technology

^[5] National Audit Office

^[6] Healthcare Commission

^[7] Audit Commission

^[8] National Heart Foundation

^[9] Health Education Trust

^[10] Caroline Walker Trust

^[11]National Heart Forum