Analysis

Time for the UK to commit to tackling child obesity

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j762 (Published 22 February 2017) Cite this as: BMJ 2017;356:j762

Re: Time for the UK to commit to tackling child obesity

Hanson and colleagues are quite right to call for further action to tackle the obesity epidemic.(1) It should be noted that the original brief government plan was billed as “a start” and not “the final word” (2) and we believe it is now time to build on this and develop a comprehensive long term strategy.(3) Such a strategy should contain at least three “Es”: environmental change; education and enforcement. This multicomponent methodology has been utilised successfully for other child public health topics, for example, accident prevention.(4)

We agree that focusing purely on individual responsibility is unhelpful. Such approaches have in the past led to “victim blaming” where individuals can feel disempowered in obesogenic environments.(5) At the moment many children, particularly those from lower socioeconomic groups, are growing up in environments that encourage excessive weight gain and obesity. We need to create supportive environments where the healthier choices are the easier ones.

The second “E”, education is important for the children themselves and key professionals who can support them. Schools are one place where there is tremendous potential to maintain and promote the health of children. Personal, social and health education (PSHE) can be used to promote and maintain the health of children but unfortunately PHSE provision has been declining for a number of years. A crucial first step here is making PSHE statutory in all schools. Teachers, school nurses and catering staff all have parts to play in creating health promoting schools, however if they are to be effective they will need training and support.

Multi professional training has in the past been available to update staff, increase commitment and to promote future collaborations. There is the opportunity to enlist a wide range of people including: catering managers; dietitians; doctors; environmental health officers; and health and safety officers. Food policy action groups could also be established in each authority to plan and coordinate multiagency action and ensure that there is concerted effort.

In the past such training and multi-agency groups have been facilitated by public health staff.(6,7) However, many local authority public health departments will need increased resources to undertake this important work: a “radical upgrade” is needed.(8,9) Well-resourced departments would be able to lead, support, and drive forward improvements in child health.

The third “E” is enforcement and concerns the use of legislation, regulations or standards to promote healthier behaviour, products or environments. Although it may to some sound controversial, public health law does have a successful well-established history. Introducing compulsory standardised simple labelling on food and drinks and tackling advertising in the mass media are just two ways that this approach can be used to tackle this epidemic.(10)

We believe that the government is ethically bound to protect children and one important aspect of this is reducing the risk of obesity.(11) A failure to act will have considerable health, social and economic consequences in the future. It is essential that the government acts now and provides the increased commitment and leadership needed to tackle this childhood epidemic.
References
1) Hanson M, Mullins E, Modi N. Time for the UK to commit to tackling child obesity. BMJ 2017;356:j762

2) Department of Health. Guidance: childhood obesity: a plan for action. 2016. www.gov.uk/government/publications/childhood-obesity-a-plan-for-action.

3) Watson M and Lloyd. Taxing sugar should be just one element of a multifaceted campaign BMJ 2015;351:h4388.

4) Watson M C and Errington G. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health.2016; 26(5), 194-199.

5) Thompson S. The Essential Guide to Public Health and Health Promotion. Abingdon: Routledge, 2014.

6) Health Education Authority. Take Heart. Good Practice in Coronary Heart Disease Prevention. London: Health Education Authority, 1990.

7) Project Health. Bulletin 6. Special Edition. Peterborough’s Food Policy. Peterborough: Health Education Service, 1990.

8) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. 2014. www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf.

9) Watson M C and Lloyd J. Need for increased investment in public health BMJ 2016;352:i761.

10) BMA. Food for thought: promoting healthy diets among children and young people. London: BMA, 2015.

11) WHO. Report of the Commission on Ending Childhood Obesity: implementation plan. Report by the Secretariat for the 140th Session of the WHO Executive Board. Geneva: WHO, 2017.

Competing interests: No competing interests

28 February 2017
Michael Craig Watson
Associate Professor of Public Health.
Sue Thompson, Secretary Institute of Health Promotion and Education, Welwyn AL6 0UD, UK
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA
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