Childhood Obesity: Stemming the Tide of a Threat to Global Child Health

Introduction

One morning some weeks ago, as I walked to my local train station for the journey to my office at the University of Southampton, I was astounded to see a young person devouring a whole family size bag of potato chips, presumably for breakfast!

In December 2015 the chief medical officer of England, Professor Dame Sally C. Davies published her annual report entitled The Health of the 51%: Women. Her report is oriented towards the gender of 51% of the UK population, i.e., women, and highlights the growing health burden of obesity (Davies, 2015). It is perhaps important to note that the health warnings of the English chief medical officer which are aimed at women also apply to the female health service workforce which is not immune to the health risks that apply to their own gender. Some might wonder why the English chief medical officer has concentrated her report on the 51% of the population who are female. Given the pivotal role that women in society play in child rearing, where the health of their children and their own health may be inextricably linked, this is not erroneous. Data discussed in this report from 2013 show that there are an estimated 3.2 million people with diabetes in the UK, predicted to reach 4 million by 2025.Much of this increase is predicated on rising levels of societal obesity. In England the proportion of men and women classified as obese has increased in recent years and the chief medical officer is committed to tackling obesity in the whole population and sees this as an accepted public health priority. It is not only adults who are becoming more obese. The World Health Organization (WHO) regards obesity in childhood one of the most significant threats to health in the twenty-first century. This is because childhood obesity is linked to the later development of a range of health problems such as type 2 diabetes and a risk of morbid obesity in later adulthood (WHO, n.d.)

In the United States, the Centers for Disease Control and Prevention (2015) have shown that more than one third of children and adolescents were overweight or obese in 2012.

Public Health England, which is part of the UK Department of Health, was established to protect and improve the nation’s health and wellbeing and to reduce inequalities. As childhood obesity is now regarded as a disease of the poor and disadvantaged it is not surprising that the National Obesity Observatory has become part of this public body. Data from Public Health England (n.d.) for 2014–2015 show that 19.1% of children aged 10–11 were obese and a further 14.2% were overweight. Of children in aged 4–5, 9.1% were obese and another 12.8% were overweight. Similar to the United States this means a third of 10–11 year olds and over a fifth of 4–5 year olds in England were overweight or obese.

Background

The origins of childhood obesity may lie in the pre-conception health of women. This is because obesity may be endangering pregnant women’s health and that of their babies. Maternal obesity is now viewed as a tangible threat and an important challenge for maternity services (Singleton & Furber, 2014) and this is one of the priorities identified by the English chief medical officer, who wants to destroy the myth that pregnancy is a time to eat for two!

Schmied et al. (2007) have compared the obesity epidemic in midwifery to a runaway train, with concerns that the issue of obesity in pregnant women is moving faster than the ability of health care systems to respond to its effects.

England, like many western nations, is facing an increase in the burden of non-communicable diseases (NCDs) caused by obesity but especially type 2 diabetes. This is because maternal obesity is one of several influences that appear to underlie the fetal or pre-conceptional origins of later risk of NCDs. A staggering 50% of all women aged 25 to 34 in the UK are overweight or obese, as are 36% of 16–24-year-olds. with many of them seeking to conceive. The English chief medical officer believes that this presents a window of opportunity for nurses and midwives to initiate dialogue with women about their weight but concedes that that these opportunities to tackle obesity are often missed. To illuminate this, Miller et al. (2008) in a survey of 760 registered nurses, found that almost 54% of these nurses were overweight or obese and admitted having the motivation to make lifestyle changes. Although 93% of these nurses surveyed acknowledged that obesity was a health care challenge requiring intervention, 76% do not pursue the topic with overweight and obese patients

Although the English chief medical officer has made many recommendations to tackle obesity, especially in pregnancy, she specifically recommends changes to the school curriculum for personal, social, and health education (PSHE) which should include much more effective information on interventions for pupils to maintain healthy weight.

Her report highlights the importance of breast feeding and reveals that only 1% of women in England are exclusively breast feeding their babies at 6 months. This is regrettable as breast feeding in infants is associated with lower rates of gastro enteritis, sudden infant death syndrome, and respiratory illnesses, as well as improved cognitive development and fewer behavior problems (Davies, 2015). Furthermore, research indicates that that breastfeeding will significantly reduce and mitigate against children becoming overweight and reduce their chances of becoming obese adults (Armstrong & Reilly, 2002).

Taking action to promote breast feeding

Clearly if breastfeeding is associated with a reduction in the risk of developing childhood obesity then nurses and midwives need to work more closely together to promote its benefits. People such as myself who work as specialist advisors for the English health care regulator, the Care Quality Commission (CQC), are mandated during hospital inspections of children’s services, to investigate if the hospital has been accredited by UNICEF as “baby friendly.” UNICEF is the acronym for the United Nations International Children’s Emergency Fund which was founded in 1947 after World War II and aspires to improve children’s health. One of its key functions is to promote breast feeding in infancy and a systematic review by Sankar et al. (2015) of the empirical literature showed that UNICEF Baby Friendly Hospital support within a health service was the most effective intervention to improve rates of breast feeding. Hospitals accredited as being baby friendly are assessed for compliance to a stringent set of standards that are designed to ensure that parents are given the maximum support from staff to breast feed their babies. However an analysis of the data from the UK UNICEF charity shows that only 53% of maternity services in the UK have been accredited as being baby friendly (UNICEF, n.d.).

Conclusion

Although the report of the English chief medical officer covers many aspects of women’s health it is the rising levels of obesity, especially in children, that gives her cause for most concern. If the old adage that “the child is the father of man,” attributed to the poet William Wordsworth, is true, then the origins of obesity in adulthood is inextricably linked to obesity in childhood. There will be readers who are familiar with the Disney movie WALL-E where mankind in the future, after abandoning an earth blighted by pollution to live in space, becomes morbidly obese. This destiny of obesity can only be stopped by a huge public health initiative that embraces all sectors of society including health professionals, politicians, and manufactures. As always it will be nurses, and especially children’s nurses, who will have to play a major part in ensuring that health promotion and education to thwart obesity do not become mere rhetoric. Targeting young children, but especially girls, might hold the key to the successful abolition of the disease that is obesity. Even though the English chief medical officer is cautious of ostracizing and victim blaming obese women, she is aiming to empower women to help them eat more healthily for the sake of themselves and the health of any future children they may have.

Key points

• The English chief medical officer is clear that pregnancy is not a time to eat more but a time for women to stay fit.

• Obesity in childhood is one of the most significant threats to health in the twenty-first century.

• Curtailing rising levels of childhood obesity has to be a national priority and should be included in national risk planning.

• Promoting breast feeding should be a priority for all nurses and more hospitals should seek UNICEF baby friendly status.

Declaration of interest

The author reports no conflict of interest. The author alone is responsible for the content and writing of this paper.