The terms “overweight” and “obesity” are constantly in the news, with barely a day going by without a story about this epidemic hitting the headlines. As a nation, indeed as an international community, we are right to be worried. What is particularly concerning is that those affected are getting younger. The prevalence of infant, childhood and adolescent obesity is increasing worldwide, and in Britain today nearly one in four children under the age of five and a third of 10- to 11-year-olds are overweight or obese.
Obesity increases the risk of high blood pressure, diabetes and other conditions that usually present in middle-age, but are increasingly being seen in children and young adults. An obese child is much more likely to be an obese adult and an obese adult is likely to have obese children. This vicious transgenerational cycle has to be nipped in the bud. If not, for the first time in history, the life span of parents may well exceed that of their children.
The problem has not gone unrecognised by policymakers, so perhaps there is something more fundamental about the way the obesity epidemic is being approached. The adverse impact of an obesogenic environment coupled with increasingly sedentary lifestyles is well accepted, but I would argue that there has been insufficient recognition of the early origins of obesity. Paradoxically, both maternal under- and over-nutrition around the time of conception and during pregnancy increase the risk of childhood obesity, though in rich countries it is the latter that predominates. Children are increasingly exposed to highly processed, energy-dense foods that are high in sugar, salt and saturated and trans-fats. This is important to note, since taste preferences and appetite regulation are established during infancy, and patterns of activity and exercise are formed in childhood.
When it comes to obesity, too often the solutions proposed or implemented are quick fixes and insufficiently informed by evidence of what works. In the UK we have had the promotion of healthy eating and exercise in the form of initiatives such as Change4Life, and the responsibility deal intended to encourage the food industry to make voluntary commitments to make their products healthier. The intentions of these initiatives are good, but their success has been limited. In a study published earlier this year, researchers from the London School of Hygiene and Tropical Medicine concluded that “the current nature and formulation of the responsibility deal food pledges is that such pledge implementation is unlikely to have much effect on nutrition-related health in England”. In their detailed analysis they also noted that “the most effective strategies to improve diet such as food pricing strategies, restrictions on marketing and reducing sugar intake, are not reflected in the responsibility deal pledges”.
Last week, health secretary Jeremy Hunt called the UK’s childhood obesity rate “a scandal”, stating that reducing child obesity is a key priority for government and that an obesity strategy will soon be in place. In his Five Year Forward View, NHS chief executive Simon Stevens emphasised the need for prevention. He set out in stark terms the cost to the NHS (currently £5bn a year) of overweight and obesity. These promises offer real hope to make a difference.
But there must be a commitment to a long-term strategy involving individuals and organisations, parents and teachers, the medical profession, government and industry.
Investment in research is needed to identify what interventions are going to be effective, such as how best to help women start a pregnancy at a healthy weight and how to identify those infants at high risk. But that’s not to say that in the meantime we should sit back and do nothing. Medicine doesn’t stand still, and it is only through sustained research effort that we are able to deliver care that is continually improving; policy research is no different.
To date, knowledge acquired from a wealth of studies indicates that interventions in early life, and reductions in the obesogenic environment, are likely to have the greatest effects. This is why the Royal College of Paediatrics and Child Health is also calling for a public education campaign on healthy nutrition and healthy lifestyles, a commitment to create healthy food environments in schools, childcare settings and hospitals, and a tougher approach to industry with formal tests of the impact of taxes, marketing and advertising restrictions on reducing the consumption of sugar-sweetened non-alcoholic beverages and energy-dense, nutrient-poor foods. This plan would help us all: individuals, society and the NHS.
