In August 2016, the Government in England published Childhood Obesity: A Plan for Action. What does the plan cover and what can early years providers do to ensure that they provide a healthy diet for their children? Martin Hodgson investigates.
Childhood obesity is a growing public health challenge in the modern world. According to a report by the World Health Organization (WHO), the number of children under five who are overweight or obese worldwide has risen to 41 million, from 31 million in 1990. In the UK, it is estimated that one in five children is already overweight or obese by the time they reach school age.
Based on current trends, doctors warn that half of all children in the UK will be obese or overweight by 2020.
Child obesity is generally defined as being overweight to a degree that a child’s health is affected. Potential health issues include problems with joints and bones, high blood pressure, cardiovascular disease, and an increased risk of diabetes — normally diseases seen in adults.
As well as physical health problems, being overweight can also cause emotional problems. Overweight children are often bullied and being overweight can affect their confidence and self-esteem. It may even lead to social exclusion and depression.
In the longer term, overweight children are much more likely to become overweight adults, leading to a pattern of chronic illness and early mortality.
Causes of childhood obesity
Diet and nutrition are vitally important in the lives of young children. A varied, nutritious diet is essential for growth and to support concentration and learning. An adequate diet for the young ensures that they get the best start in life, ensuring that they develop healthy food choices and eating habits.
The immediate cause of obesity is usually a combination of an unhealthy diet — including too much fat or sugar in the diets of some children — and not enough exercise.
A diet high in sugar and fat early in life not only puts on weight but establishes eating patterns that influence health during childhood and into adulthood. Sugary food and drinks are a particular problem. A sugar-rich diet is a poor one, providing “empty calories” that fill children up but do not provide other essential nutrients. It not only causes obesity and raises the risk of diabetes but is also a major cause of tooth decay and serious dental issues.
Lack of exercise contributes to the problem. Today’s children are not as active as they were in the past and a lifestyle of too much television or computer and not enough play compounds the problems caused by sugar-rich diets.
Childhood obesity is especially prevalent in disadvantaged sectors of society. Public health agencies therefore recognise a root cause of some aspects of childhood obesity as a lack of available choices or a lack of awareness by parents and the effects of social and health inequalities linked to poverty. They point to the need to improve diet choices for all, closing up health inequalities between the rich and the poor and better promoting the importance of healthy nutrition across all social groups and populations.
In England alone, twice as many children in the most deprived areas are classed as obese.
Action by early years providers
Early years providers can do their bit to help prevent childhood obesity by promoting healthy eating and ensuring that the diet they provide is well balanced, nutritious and varied.
The promotion of healthy eating for young children is a key role of early years services. Not all children receive sufficient support from home. In this respect, early years services are well placed to support parents in establishing good eating habits in their children. In particular, nurseries and childminders can help parents become more confident about how to best feed and nourish their children.
In England, guidance is provided by the Advisory Panel on Food and Nutrition in Early Years, set-up in 2010 by the School Food Trust.
Nationally recognised guidelines include the following.
Nutritional Guidance for the Under Fives: Feeding Young Imaginations, published by the Pre-school Learning Alliance.
Voluntary Food and Drink Guidelines for Early Years Settings in England — A Practical Guide, published by the Children’s Food Trust to support their Eat Better, Start Better campaign.
Public Health England (PHE) commissioned the Children’s Food Trust to develop revised menus for early years settings by December 2016. These will be incorporated into voluntary guidelines for early years settings to help them meet current Government dietary recommendations. This will include practical ideas and suggestions as well as the sample menus.
Guidelines in Scotland include Nutritional Guidance for Early Years. In Wales nutritional guidance is provided in Food and Health Guidelines: For Early Years and Childcare Settings published by the Welsh Assembly.
The guidelines should be followed carefully by early years providers. High fat or sugary foods, including fizzy drinks, should be avoided while vegetables and fruit should be encouraged.
As well as promoting a healthy diet, early years providers should also follow the physical activity guidelines for under 5s (Factsheet 2) published by the four home countries’ Chief Medical Officers in 2011.
In early 2017, the Government will be launching a campaign to raise awareness of the importance of diet and exercise in early years and the updated guidance. It will also update the Early Years Foundation Stage (EYFS) framework to make specific reference to the UK Chief Medical Officer’s guidelines for physical activity in early years.
Caring for overweight children
Early years providers should work closely with parents and health agencies where a child has an identified health problem which includes obesity. This may include supporting a special diet. It may also include providing emotional support.
Parents often complain of a lack of help regarding their concerns about their children’s weight. Early years providers can support them by providing understanding and encouragement, as well as healthy food and a safe place for their children to exercise. Wherever necessary early years staff should be appropriately trained to provide this support.
Early years services are encouraged to ask parents what they can do to help and to enable a dialogue about healthy eating. In all cases, overweight children and their families should be treated with respect, sensitivity and care. Children should never be put on a weight loss diet without medical advice and supervision.
The obesity plan
The Childhood Obesity plan developed by the Government aims to significantly reduce England’s rate of childhood obesity within the next 10 years. It was developed following a report by the Royal College of Paediatrics and Child Health, Tackling England’s Childhood Obesity Crisis.
The plan includes the following.
A levy on the soft drinks industry — in England the revenue will be invested in health promotion programmes to encourage physical activity and balanced diets for children.
A “broad, structured sugar reduction programme” run by PHE to remove sugar from the products children eat most — the Government is targeting a reduction in sugar levels by at least 20% by 2020, including a 5% reduction in year one.
Supporting early years settings, including revised menus by the Children’s Food Trust for settings from December 2016, a campaign to raise awareness of the importance of diet and exercise in early years in early 2017, and updating the EYFS guidelines to make specific reference to the UK Chief Medical Officer’s guidelines for physical activity.
Updating the “nutrient profile” to help families to recognise healthier choices.
Working with local authorities and the Local Government Association to support the public sector in tackling childhood obesity.
Recommitting to the Healthy Start scheme which provides healthy food vouchers to families on low income.
Initiatives to encourage physical activity in young children — including PHE advice to schools for the academic year 2017/18 and a new “healthy schools” rating scheme.
The sugar reduction programme will initially focus on the nine categories that make the largest contributions to children’s sugar intakes: breakfast cereals, yogurts, biscuits, cakes, confectionery, morning goods (eg pastries), puddings, ice cream and sweet spreads.
Many manufacturers have already taken steps to reduce the overall levels of added sugar in their drinks and products for children. The Government believes that measures such as its levy will create stronger incentives for action.
However, the plan has been criticised by many involved in child health who feel that it does not go far enough and will not lead to the improvements required to address the alarming increases seen in childhood obesity in recent years.
In Scotland and Wales similar initiatives are under way. In Scotland there is a particularly serious problem with both adult and child obesity. The Scottish Health Survey suggests that in 2015, 15% children aged 2 to 15 were at risk of obesity, with a further 13% at risk of overweight. The Scottish Government has established a National Indicator as it works to increase the proportion of healthy weight children.
Childhood Obesity: A Plan for Action can be downloaded from the GOV.UK website and is available here.
Advice on diets and menu plans can be obtained from www.childrensfoodtrust.org.uk.
HENRY is a UK charity working to help families and early years practitioners to develop effective interventions to address child obesity in the very young. Their website at www.henry.org.uk contains a range of advice and resources.
For more information on nutritional guidelines for early years, see your Nutrition topic.