Tackling childhood obesity - a serious public health challenge for Birmingham

By Professor Jackie Blissett, Professor of Childhood Eating Behaviour, May 2019

Childhood obesity is one of the most serious global public health challenges of the 21st century. Birmingham has one of the highest rates of childhood obesity in England, with 25.6% of children having obesity in Year 6, and rates continue to rise. There is disparity in obesity rates based on socioeconomic status and ethnicity. In Handsworth, Birmingham, over 33% of children have obesity by the end of primary school, in contrast to around 10% in the affluent Sutton Trinity ward. The NHS Long Term Plan lays out proposals to address this, including an increase in the numbers of children receiving treatment of complications related to obesity, from cardiovascular conditions to mental health problems. Whilst we desperately need to invest in such services to support children with existing obesity, the Government’s ambition is to halve childhood obesity rates by 2030. To do this, we need to take drastic action.

The causes of obesity are complex. At the heart of it, the explanation is simple: individuals who take in more energy than they expend will gain weight over time. However, there are hundreds of factors that influence this balance, including the built environment, opportunities for physical activity, media influences, food production, availability and accessibility, and individual differences in physiology and psychology. These factors interact in complex ways to determine each individual’s tendency towards developing obesity. The challenge we face is determining which of these factors we can change, and intervening in a way that works for the specific social, geographical and cultural context. At Aston University, we are using computational modelling to predict children’s early diet quality which will be of use to councils and services to enable targeting of limited resources in places that will lead to effective change.

To date there has been much focus on individual responsibility for body weight, which has contributed to the stigma and discrimination around obesity. This has also led to a focus of interventions on individual behaviour change rather than system-wide transformation. This is problematic, particularly in the context of childhood obesity. Are we really expecting our children to take individual responsibility for managing their eating and physical activity, when the majority of adults do not regularly make healthy choices? Each individual has a different susceptibility to the influence of the food-rich, sedentary environment in which we live. For some individuals, small changes such as reducing portion sizes might be sufficient to reduce risk of obesity, but for others, multiple factors need to change to create a protective environment.

Even when we integrate behaviour change across multiple environments such as home, school and the community, we often fail to demonstrate significant reductions in childhood obesity. For example, a recent, well-designed, 12-month intervention in Birmingham involving almost 1500 primary school children had no significant effect on children’s BMI or on preventing obesity, despite incorporating increased daily school-based physical activity, involvement of Aston Villa Football Club in a six-week interactive programme, family healthy cooking workshops and signposting to local physical activities. The authors concluded that wider support across multiple environments and sectors is key to enabling change.  This requires a change to our thinking and our priorities in research, intervention design, policies and services.

Discussions with health professionals reveal a bleak picture of underfunded services, with limited capacity to deliver the necessary support. Staff must receive the backing they need to turn plans into action. It is not just NHS services that are stretched. Councils are spreading their limited public health funds thinly across multiple competing demands, and often cannot guarantee budgets to support services year-on-year. Furthermore, much of the funding for long term, large-scale studies of childhood obesity previously came from the EU, so if tackling childhood obesity is truly a priority for Government, it must create alternative funding streams for research. 

Whilst the Government’s childhood obesity plan for action has been accused of being weak, it did contain some welcome actions which included a consultation regarding a 9pm watershed on ‘junk-food’ adverts. There is increasing recognition of the need to take a whole systems approach and Birmingham’s recent Public Health green paper placed great emphasis on joint working of this kind. Birmingham City Council is one of 13 councils selected for the LGA Childhood Obesity Trailblazer Programme, to undertake a 12 week ‘discovery phase’ to engage with strategic stakeholders and develop a partnership approach to tackle childhood obesity across the city. Despite these positive steps, we have a crisis on our hands. We must be under no illusions that these actions are sufficient to achieve the Government’s goals for childhood obesity. Reliable funding streams for NHS, local authority services and childhood obesity research need to be established, expanded and protected. Government must adhere to its promise not to ‘shy away’ from mandating change and using fiscal levers if the food industry does not make the necessary voluntary changes. The plan and its actions must not be watered down. We need to alter the whole obesity system, based on good quality research evidence, and we need to start now.