Last reviewed 24 September 2021
Childhood obesity has become a key health concern over recent years, particularly in relation to primary school aged children. Kate Goulson considers this sensitive subject and how it impacts upon children, parents and schools.
A growing problem
Obesity and weight management are serious issues for all age groups. Recent data shows that 63% of adults in the UK are above a healthy weight and over 30% are in the obese category. Children's weight has also reached new highs, with a third becoming overweight by the end of primary school and more than 20% living with obesity. Many professionals find these numbers alarming, especially as they have been rising slightly year on year.
The implications of childhood obesity can be considerable. According to Public Health England, children living with obesity have a higher likelihood of illness and health problems than their peers, including conditions such as type 2 diabetes, musculoskeletal pain and asthma. This can lead to increased absence from school and become a barrier to accessing education.
What are the suggested causes?
The factors that lead to childhood obesity are complex. A healthy diet and an active lifestyle can reduce the chances of a child becoming obese, but finding the right pathway for individual children to access the healthiest options is often problematic. Primary-age children usually have little control over what they eat or how much exercise they take, and there are always multiple influences on a child’s weight and health, ranging from behavioural and situational to genetic.
Social deprivation plays a significant role. Five-year-olds from the lowest income families are over twice as likely to be living with obesity as those from the highest income families. By the time they are 11, this has increased to almost three times as likely.
How is childhood obesity measured?
The main tool for assessing obesity and healthy weight is BMI (Body Mass Index). For adults, this is calculated by dividing weight in kilograms by height in meters squared. For children, who develop and grow at very variable rates, the results are adjusted using a set of sex and age-related data collected during the 1990s.
BMI itself is somewhat controversial. Critics argue that it doesn’t take into account the subtleties of individual situations, particularly for children, and is not a reliable indicator of overall health. While BMI can be useful in assessing the weight of the population as a whole, many agree that for individuals it is best used as a starting point for a more nuanced conversation.
Collecting the data in primary schools
Since 2006, state maintained primary schools have been collecting data as part of the National Child Measurement Programme (NCMP), which is currently coordinated by local authorities. Children’s height and weight are measured twice, once in Reception and again in Year 6, usually by the school nursing team. Although this is a mandated national initiative, individual participation is voluntary. The results are usually shared with the child’s parents, though never with any other parties, and are randomised to avoid identification when incorporated into the national database.
The NCMP Operational Guidance offers useful advice on how schools can implement the programme. Covid-19 has complicated the process a little, and the guidance has been updated to include measures for staying Covid-secure.
Encouraging better health
Schools can help address issues around childhood obesity through a combination of direct PSHE teaching, staff modelling of healthy behaviour, and by creating an environment that proactively supports healthy choices. A recent Ofsted review concluded that although schools should actively promote healthy lifestyles, it would be a mistake to believe that they alone could directly change a child’s weight as there are too many other influences.
Nevertheless, there are several national initiatives aimed at improving general childhood health which schools can champion. These include discouraging the consumption of high-sugar energy drinks, limiting exposure to “junk food”, and helping all children access an hour of physical activity per day. It’s recommended that at least 30 minutes of that physical activity should take place in school through PE lessons, whole class movement breaks, and unstructured break time play.
Local authorities often have funding and resources available to further help schools encourage healthy choices, and can advise schools on the best steps to take for the needs of their particular cohort.
Recent examples of local authority leadership in this area include:
overseeing Whole School Health days that provide a choice of units for teachers to carry out on topics such as snacking and sleep
referring children most at risk of poor health to nutritionists and/or psychotherapists through the school nurse programme
allocating funding for low-impact physical activity alternatives such as yoga classes and outdoor gyms.
It is vital that schools carefully consider how, and if, to talk to their students about weight. Imprudent language around weight and dieting has the potential to heighten negative self-concepts in certain children. This can lead to decreased physical activity if those children feel embarrassed about participating. Negative self-image can contribute to disordered over-eating, which has the capacity to exacerbate obesity, and is also a risk factor in disordered under-eating.
Overweight children are statistically more likely to suffer social exclusion and bullying. Schools can recognise and address this by offering emotional support and educating the perpetrators to help them change their behaviour.
Actions that individual schools can take
There are a number of steps that individual schools can take.
Run breakfast clubs to give children access to balanced nutrition at the start of each school day.
Offer a range of healthy school meals.
Encourage active travel to school where possible, including walking, scooting and cycling.
Host inclusive workshops for parents around healthy lifestyles, such as cookery or exercise classes.
Role-model positive eating and exercise habits among staff.
Make exercise fun and engaging for all, not just those who enjoy traditional sports, through initiatives such as the Active Mile.
Use body positive language to encourage an ethos of “making our bodies work best”.
Avoid using language which is judgemental or shaming in relation to weight.
Teach Relationships and Sex Education (RSE) to promote whole-child health “including content on the importance of daily exercise, good nutrition and the risks associated with an inactive lifestyle, including obesity”. (NCMP Operational Guidance)
Being overweight or obese can negatively affect a child’s physical, mental and emotional health.
Children’s weight and height are measured in school at age five and again at age 11.
Schools can support primary-aged children to make healthy choices and access balanced nutrition.
For the majority, emphasis on a healthy lifestyle, rather than weight loss, is good practice.
Local authority funding and resources can support schools to create a healthy ethos and environment.