Last reviewed 11 May 2016

The World Health Organization (WHO) regards childhood obesity as one of the most serious global public health challenges of the 21st century, and its latest research found 41 million under-fives overweight or obese. With over a fifth of children starting school in England either overweight or obese, it is essential that effective interventions are used in the early years to tackle this crisis. Early years providers can play a key role in supporting families and enabling the children in their care to move towards a healthier weight. Elizabeth Walker looks at the issues involved.

Why the early years are so important

Children are growing up in an increasingly obesogenic environment, particularly in disadvantaged areas. Overweight children are much more likely to have overweight parents and to become obese adults themselves.

Childhood obesity has long-term implications for poor health and social wellbeing in adulthood, as well as premature death. It is therefore vital that the right support is available in the early years, if not before, as preventing childhood obesity starts during pregnancy. Birth weights are steadily increasing and there are greater numbers of babies already deemed overweight at birth. Experts believe this could be due to rising obesity in mothers and poor diets during pregnancy.

  1. Overweight babies and toddlers are more than five times as likely to be overweight at the age of 12 as those who were a healthy weight in infancy.

  2. Child obesity tracks into adulthood — at least 70% of obese children will go on to become obese adults.

  3. Obese children are at greater risk of serious long-term health problems, including cardiovascular problems and Type 2 diabetes. Early signs of fatty liver disease and arteriosclerosis, previously unheard of in children, are now being seen in childhood.

  4. The emotional consequences of obesity in childhood can be severe and long-lasting, including bullying, low self-esteem and social exclusion.

  5. Eating and activity habits and food preferences are developed early in life.

Causes of childhood obesity

Like adult obesity, childhood obesity has many influencing factors, but essentially is caused by taking in more energy than is used up over a long period of time. Key factors that can influence a child's weight include:

  • an excess intake of low nutrient, high energy food and drink

  • increasingly sedentary behaviour

  • insufficient sleep

  • insufficient fruit, vegetable and fibre consumption

  • early introduction of solid food

  • maternal diet and smoking during pregnancy

  • insufficient exercise and activity levels.

Unlike adults, young children have little control over their food intake and their diet and exercise patterns are largely controlled by their parents or caregivers.

Child healthy weight

The weight of babies and very young children can vary and fluctuate widely. Midwives and health visitors monitor child weight and growth and development during this time.

They advise parents on issues around feeding, nutrition, and weaning and provide extra support and onwards referral should specialist help be required. Adult healthy weight is calculated using Body Mass Index (BMI = weight in kilograms divided by the square of the height in metres: kg/m2) where obesity is defined as having a BMI of 30 or over.

Children’s BMI charts are completely different to the BMI charts used for adults — they still look at height and weight, but they are different for boys and girls and take into account their age. BMI centile charts for children can be found in a child's “red book”. Children are currently weighed at the integrated review and in reception class on entry to primary school as part of the National Child Measurement programme.

Identifying children at risk

There are a range of factors that influence whether a child is at risk of obesity and practitioners should consider:

  • higher birth weight

  • parental obesity

  • whether the child lives in a deprived area

  • whether the child is looked after

  • parental health and wellbeing.

Early years providers can work in partnership with families to help support children who are overweight or obese or at risk of becoming so. Practitioners can encourage parents to:

  • model a healthy lifestyle

  • take a whole-family approach

  • encourage responsive feeding

  • reduce availability and accessibility of energy-dense food in the home

  • reduce consumption of sweet drinks and increase consumption of water

  • increase acceptance of healthy foods — including fruit and vegetables

  • ensure portion sizes are appropriate for age

  • establish positive family mealtimes

  • encourage 60 minutes of physical activity per day

  • reduce sedentary activities, including screen time

  • ensure children get a good night’s sleep.

Practitioner training and confidence

Early years providers should encourage staff to model healthy lifestyles themselves. It is also essential that staff are provided with relevant training as raising the issue of weight with families requires a sensitive approach. Research suggests that practitioners feel that they lack the skills and confidence to work effectively with parents around child obesity. Discussing issues around weight, both personally and that of their children, can be highly emotive for parents. Providers should contact local authorities for recommended training programmes and advice for practitioners on how to raise the issue of weight with families.

In all cases, the parents or guardians need to be included and supported to make the family lifestyle changes needed to achieve a healthy weight. Some parents or guardians can feel that their parenting skills are being questioned or perhaps feel anxious that raising the issue will affect their child’s self-esteem. It is therefore important to seek permission from the parent or guardian before giving advice or information.

Practitioners should consider their language and tone when addressing the issue — a good approach is to ask open questions to encourage open answers and reduce potential defensiveness. Some practitioners prefer to avoid the terms “obese” and “overweight” and instead use “above healthy weight” or “unhealthy weight” as more sensitive alternatives. It is also important that all staff know how to signpost parents to further information or support if they are unable to provide it themselves.

Key policy

The Government's long-awaited childhood obesity strategy is due to be published later this year and will set out key policy messages and recommendations. A new sugar tax on the soft drinks industry in the UK has already been announced and will be introduced in 2018. The Government has said that the money raised from the sugar tax will be spent on increasing the funding for sport in primary schools.

It is hoped that the Government's forthcoming strategy will include strong measures to help tackle the childhood obesity epidemic and to support the healthcare sector, which currently spends £5 billion a year on obesity-related conditions and social care.

Further information

  • Child Obesity: Their Lives in our Hands, Children's Food Trust, 2015

  • The National Obesity Framework, APPG on a Fit and Healthy Childhood, 2016

  • Tackling England’s Childhood Obesity Crisis, Royal College of Paediatrics and Child Health, 2015

  • Tackling Obesity Through the Healthy Child Programme: A Framework for Action, Public Health England, 2009