23 Jul 2020
In anticipation of the government’s latest strategy for obesity and weight management, BDA Paediatric Specialist Group (PSG) Co-Chair Dr Julie Lanigan Ph.D. RD discusses some recent challenges and why a preventative approach, particularly targeting early years, is what is needed. Julie also sets out what PSG are doing to help address this challenge.
The BDA Paediatric Specialist Group (PSG) aims to help provide every child the healthiest start in life. Early life has a major influence on a child’s lifelong health but there are many obstacles along the way. As well as living with COVID-19, today’s children face an obesity epidemic that could be seen as the most devastating disease of our time.
Almost a quarter (25%) of children in reception year and over a third (35%) in year 6 have overweight or obesity (1). What is even more worrying is that children living with obesity are likely to carry this through childhood and into adult life. Most extra weight in childhood is gained early, even before starting primary school (2). Having obesity as an adult could lead to serious non-communicable diseases (NCDs) (3). Heart disease and Type 2 diabetes are more common in people living with obesity who may also have a higher risk of some forms of cancers.
In recent months, we have seen our highly valued and much-loved NHS in danger of being completely overwhelmed by COVID-19. People living with obesity, and related conditions such as diabetes, are among those at highest risk of severe complications. This has highlighted the urgent need to protect children, our future adults, from the consequences, not only of NCDs but also from the severe complications they can cause.
Focusing on early years
Of course, our country is facing an unprecedented health and economic crisis and it is more important than ever before to target resources where they are likely to have the most effect. Without any doubt, interventions to prevent obesity should begin as early as possible(4). Once a child is on the path to gaining excess weight, urgent action is needed to slow weight gain and prevent obesity. To do this the National Institute for Clinical Excellence (NICE) recommends lifestyle interventions (tier 2 services) that target the whole family to improve lifestyle behaviours and reduce the risk of having obesity (5).
In England, the government’s current national strategy aims to halve childhood obesity by 2030. This ambitious plan is welcomed, and highly applauded (6). However, achieving this is a major challenge to policy makers, government agencies and the healthcare professionals.
Healthcare professionals are at the frontline, working with children and families to prevent excess weight gain in childhood or, where this is not possible, to provide the best possible services to reverse it and put the child back on a healthy growth trajectory.
With limited resources available, joined up thinking and collaboration between key stakeholders is imperative in our efforts to support people living with obesity. The BDA PSG is working hard to bridge gaps in childhood obesity prevention (tier 2) and treatment (tier 2 and 3) services. There are currently limited services available and few initiatives with evidence to show they are effective in weight management (7).
As part of this effort, the BDA PSG has produced a range of resources for first line management of obesity. A toolkit is also under production that aims to guide management of childhood obesity in acute and community settings across the UK. This will include guidance on growth monitoring from infancy to adolescence, anthropometric and medical assessments and dietary intervention (using evidence-based portion sizes).
Furthermore, we are committed to working with healthcare and government agencies and the food industry to ensure they play their part in tackling childhood obesity.
Wider support needed
We are determined to protect our children from the health impacts of overweight and obesity by getting them on the right track from the outset. There is so much work to do and, with the best will in the world, our group of volunteers cannot achieve this alone, even with the support of our professional association. We need the action from government, the NHS and PHE to ensure dietitians can help the parents and families who so urgently need our support.
We need to align in our efforts on childhood obesity to give our children the future they deserve. A future filled with hope and happiness for happy, healthy, well-fed families!
(1) National Child Measurement Programme 2018 - https://www.gov.uk/government/statistics/ncmp-and-child-obesity-profile-academic-year-2017-to-2018-update
(2) World Health Organisation – https://www.who.int/dietphysicalactivity/childhood_consequences/en/
(3) Cunningham SA, Kramer MR & Narayan KMV (2014) Incidence of Childhood Obesity in the United States. N Engl J Med 370, 403-11. (4) Brown SR
(4) Brown T et al, Interventions for Preventing Obesity in Children. https://doi.org/10.1002/14651858.CD001871.pub4
(5) National Institute for Health and Care Excellence. NICE public health guidance 47: Managing overweight and obesity among children and young people:lifestyle weight management services. 2015. Published online: 1 July 2015. https://www.nice.org.uk/guidance/qs94
(7) Lanigan J, Tee, L and Brandreth, R. Childhood obesity, Medicine, https://doi.org/10.1016/j.mpmed.2018.12.007
Co-Chair, Paediatric Specialist Group