Can the Tide of Childhood Obesity Be Stemmed?

ABSTRACT

Editor in chief emeritus professor Alan Glasper, from the University of Southampton, discusses global attempts to tackle the rising levels of obesity and type 2 diabetes among children and young people.

Introduction

On November 5, 2018 the English Department of Health and Social Care published a new policy entitled “Prevention is better than cure: Our vision to help you live well for longer” which aspires to put the prevention of ill health and especially childhood obesity at the core of the National Health Service (NHS) long-term plan (Department of Health & Social Care, 2018).

Like many other countries the United Kingdom is facing an obesity crisis. Because children and young people are tomorrow’s adults, the UK government aims to halve the incidence of childhood obesity by 2030. In a significant step, the UK government wants to eradicate the differences in obesity rates between children from the most and least deprived areas of society. The government is keen to stress the importance of healthy lifestyles and is seeking to support programs including its own NHS Diabetes Prevention Programme which helps identify adults at high risk of obesity. Importantly a recent audit conducted by the Organisation for Economic Cooperation and Development (OECD iLibrary, 2018) highlights that strides in improving life expectancy in the UK are being threatened by risk factors such as obesity.

The mission of the OECD, which has 36 member countries including the United States, the United Kingdom, and Australia, is to promote policies that will improve the economic and social well-being of people around the world. An important strand of the OECD is to consider the economic and well-being costs of the current obesity pandemic (OECD, 2018a).

Background

Dall, Mann, Zhang, Martin, and Chen (2008) have previously indicated that the total estimated cost of diabetes management in the United States in 2007 was #174 billion. With escalating costs of health care such as this it is not surprising that governments need to tackle childhood obesity through the application of stringent preventative measures. The current obesity crisis is reminiscent of a scene from the futuristic childhood cartoon movie “Wall-E” in which human beings had become so fat that they could barely move and they drank all of their meals through straws out of laziness. Today in our own present society children are becoming more and more obese year after year.

The latter part of the twentieth and the early years of the twenty-first century have been increasingly characterized by excessive sugar and fat consumption. What threatens the health of nations most is the rising burden of childhood obesity. This is because obese children are susceptible to developing type 2 diabetes and liver problems, among other diseases, during their childhood. Fat children are more likely to experience bullying at school and suffer low-esteem and a poorer quality of life. Most importantly they are likely to become fat adults who in turn have a higher risk of developing cancer, heart disease, and liver disease. The OECD 2017 obesity update found that 50% of adults and nearly 17% of children were classified as overweight or obese throughout the OECD counties in 2017 (OECD, 2018b).

The OECD 2017 data showed that the proportion of children who were overweight or obese at age 15 ranged from 10% in Denmark to 31% in the United States. What concerns OECD is that despite the implementation of policies in many countries to address childhood obesity over a number of years, the number of 15-year-olds who were reportedly overweight or obese has steadily increased since 2000 in the majority of countries.

National childhood obesity rates reveal that the UK is now ranked among the worst in Western Europe. As in other countries the incidence of childhood obesity in the UK is currently highest in families from deprived areas. Children growing up in such low-income households are more than twice as likely to be obese than those in higher income households. Although significant numbers of overweight and obese children are living in low-income households it is children from disadvantaged black and minority ethnic families who are more likely to become obese. UK government statistics show that in both the 4-to-5 and the 10-to-11 age groups, Black African children were the most likely to be overweight in 2015/2016. Furthermore in 2015/2016, Black African children aged 4–5 were more than twice as likely to be overweight compared with Indian children, of whom 14.5% were overweight (Gov.uk, 2018a).

Despite the UK government’s intention to drastically reduce the incidence of childhood obesity by 2030, data from OECD predicts further increase in obesity rates until at least 2030, especially in the United States, Mexico, and England, where 47%, 39%, and 35% of the population, respectively, are projected to be obese in 2030. Clearly this is not sustainable, and the costs of treating the morbidities associated with obesity are equally unmaintainable. Health economies around the world will be broken on the anvil that is obesity management!

Measures to address childhood obesity

The predominant model of the human body in modern western medicine has been that of the machine (Marcum, 2005). Mechanistic medicine or the biomechanical model of medicine has for centuries sought to reduce patients to separate, individual body parts just as a motor mechanic would if seeking to repair a car engine. Contemporary public health professionals in contemporary medicine believe it is much more effective to prevent the engine (the human body) from breaking down in the first place and that prevention is crucial to improving the health of the whole population. Despite this, in the UK £97 billion of public money is spent annually on treating disease and only £8 billion on preventing disease (Gov.uk, 2018b).

Within the world of public health, mechanistic medicine and preventative medicine have been analogized through the concept of “upstream” and “downstream” factors which impact on health. It is upstream factors pertaining to obesity in childhood which need to be tackled. Gehlert et al. (2008) believe that the understanding of upstream determinants of health is best achieved through partnerships with community stakeholders. What governments are seeking to do is to promote healthy lifestyles and focus on what is causing children in families to become obese in the first place rather than treating their obesity after they have become overweight. It is the attention on upstream determinants of health which may mitigate or prevent the emergence of costly childhood obesity.

It is known that mortality rates increase dramatically once people become overweight and obese and the lifespan of someone who develops obesity can be up to 8–10 years shorter than that of someone with a normal weight. Hence the risk of premature death for an individual increases by approximately 30% for every 15 additional kilograms of weight gain (OECD, 2010).

Governments within the OECD countries have endeavored to tackle obesity in childhood by making new healthy options available or by making existing ones more accessible and affordable. Some societies have tried to eradicate some of the supermarket strategies that shoppers find difficult to resist, such as promoting unhealthy food at the checkout counters where so called “pester power” prevails. This happens when children see chocolate bars or other confectionary in open view while waiting at the checkout and pester their stressed parents into buying for them. In the UK the government wants to change fundamentally the “buy one get one free” deals offered by many supermarkets to make them a healthier choice. Because of this the government intends to promote legislation to ban retail price promotions such as “buy one get one free” and multi-buy offers or unlimited refills of unhealthy foods and drinks. Most importantly the UK government aspires to protect children and young people from the almost subliminal advertising which encourages children to develop an appetite for unhealthy food. Plans by the UK to introduce a 9 pm watershed on TV advertising of high fat, sugar, and salt products are being considered. Similar measures are being considered to protect children from online advertisements of unhealthy food.

Additionally many societies are using persuasion, education, and information to make healthy options more attractive to families. New developments in communication policies include easy-to-understand schemes of food labeling, mass media campaigns to increase public awareness, the use of social networks and new technologies for health promotion campaigns, and reinforced regulation of the marketing of potentially unhealthy products, especially when directed to children. Many of these governments are endeavoring to endorse the principles of healthy eating and, especially, more exercise among the childhood population. A large majority of governments have adopted initiatives aimed at school-age children, including changes in the school environment, notably regarding food and drink, as well as improvements in facilities for physical activity. Thus when childhood obesity prevention interventions are combined as a corporate strategy, overall health gains among the childhood population can be arguably enhanced.

Conclusion

Preventing childhood obesity cannot be resolved by the governmental health and social care systems alone and all health professionals involved with the care of children and young people need to play their part. Children’s nurses working across interagency boundaries must also recognize the responsibilities of families in reducing the chances of childhood obesity in the first place. By working in partnership with families nurses can play an active part in tackling the global pandemic of childhood obesity.

Key points

• Children and young people are tomorrow’s adults, and the UK government has an ambition to halve the incidence of childhood obesity by 2030.

• A recent audit conducted by the Organisation for Economic Cooperation and Development (OECD iLibrary, 2018) highlights that strides in improving life expectancy in the UK and elsewhere are being threatened by risk factors such as obesity.

• OECD 2017 data (OECD, 2018b) show that the proportion of children who were overweight or obese at age 15 ranged from 10% in Denmark to 31% in the United States.

• In the UK £97 billion of public money is spent annually in the UK on treating disease and only £8 billion on preventing disease.

• By working in partnership with families, nurses can play an active part in tackling the global pandemic of childhood obesity.