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Government has “moral duty” to act on child obesity, says outgoing chief medical officer

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5945 (Published 10 October 2019) Cite this as: BMJ 2019;367:l5945

Linked Opinion

What will it take to halve childhood obesity by 2030?

The obesity epidemic: bold and decisive action needed.

The Institute of Health Promotion and Education welcomes the independent Report by the Chief Medical Officer on childhood obesity.(1,2) It provides an opportunity at this critical time to raise awareness of one of the most serious public health challenges of the 21st century. It also builds on the wealth of authoritative reports in the past that have called for urgent action.(3-11)

The Department of Health and Social Care is currently consulting on a new national health strategy and the Health and Social Care Committee is seeking views on the next steps that the Government should take to tackle childhood obesity.(12,13) With the evidence available, there is now a real opportunity for the Government to act and significantly reduce levels of childhood obesity and improve our children’s health as well as reduce potential future pressures on our overloaded NHS.

We have for some time argued the case that there is no single silver bullet that will tackle this issue. We believe that in general, health promoters should not be involved in just tinkering around with one tool for bringing about changes in behaviour; the obesity epidemic needs a well-structured multifaceted campaign. On their own, better labelling, altering portion size, increasing taxation on certain foods, and banning junk food in hospitals will not be successful.(14-18) What is needed is a positive comprehensive healthy eating strategy supporting children and their families and at the same time, tackling obesogenic environments.

In schools, education within the classroom provides an important opportunity to improve young people’s knowledge and skills in relation to heathy eating.(19) However, it has long been known that whole school approaches are likely to be more effective than isolated education.(19, 20) Providing healthy food and drink options and enlisting the support of school nurses and catering staff in a coordinated way are also needed. For this to happen, teachers and other staff need to be both competent and confident and will need training and support. Public health specialists could provide this as well as supplying much needed momentum.

Similarly, in the NHS doctors and nurses could be far more involved in health promotion.(8,9) Here again a whole systems approach is necessary where for example there are heathy food options available for patients and staff. Public health specialists have the skills and knowledge to support such approaches.

We strongly believe that at a local level, public health specialists are key to tackling the obesity epidemic by stimulating, coordinating and supporting action in different settings. However, they will only be successful if they are given sufficient resources for the scale of the tasks and if at the same time there is firm national commitment.(21-23)

There is now an urgent health, economic and social case to increase investments to confront the obesity epidemic and promote healthy lifestyles.(24-26) We urge the Government to scale up activities and to produce a robust coordinated healthy eating strategy.

References
1) Iacobucci G. Government has “moral duty” to act on child obesity, says outgoing chief medical officer. BMJ 2019;367:l594510.1136/bmj.l5945.
https://www.bmj.com/content/367/bmj.l5945

2) Davies S. Time to Solve Childhood Obesity. London: Department of Health Social Care 2019.
https://www.gov.uk/government/publications/time-to-solve-childhood-obesi...

3) Garrow J. Obesity — Public health enemy No 2? Health Education Journal 1986; 45(1): 57-58.
https://journals.sagepub.com/doi/abs/10.1177/001789698604500122

4) Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obesity Reviews, 2004, 5(Suppl 1):4–104.

5) Foresight. Tackling Obesities: Future Choices – Project Report. Government Office for Science: London 2007.

6) World Health Organization. Population-based approaches to Childhood Obesity Prevention. Geneva: World Health Organization, 2012.

7) World Health Organization. Prioritizing areas for action in the field of population-based prevention of childhood obesity. A set of tools for Member states to determine and identify priority areas for action. Geneva: World Health Organization 2012.

8) Academy of Medical Royal Colleges. Measuring Up: The Medical Profession’s Prescription for the Nations Obesity Crisis. London: Academy of Medical Royal Colleges 2013.
https://www.aomrc.org.uk/reports-guidance/measuring-up-0213/

9) BMA Food for thought: promoting healthy diets among children and young people. London: BMA 2015.
https://www.bma.org.uk/collective-voice/policy-and-research/public-and-p...

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

11) House of Commons Health Committee. Childhood obesity: follow-up. 27 Mar 2017. www.parliament.uk/business/committees/committees-a-z/commons-select/heal....

12) Watson M C and Lloyd J. The need for a health strategy that unites the country. British Medical Journal Rapid Response 27th July 2019.
https://www.bmj.com/content/366/bmj.l4829/rr

13) Health and Social Care Committee. Childhood obesity follow-up 2019 inquiry. [accessed 11/10/2019]
https://www.parliament.uk/business/committees/committees-a-z/commons-sel...

14) Watson M 2013 Consistent food labelling system is rolled out across UK. BMJ Rapid Response 23rd June 2013.
http://www.bmj.com/content/346/bmj.f4010/rr/651049

15) Watson M and Lloyd J, 2013 It’s time to ban junk food on hospital premises. BMJ Rapid Response 1st July 2013. http://www.bmj.com/content/346/bmj.f3932/rr/652126

16) Watson M and Lloyd J. Taxing sugar should be just one element of a multifaceted campaign BMJ 2015;351:h4388
https://www.bmj.com/content/351/bmj.h4388

17) Watson MC and Thompson S. Re: Time for the UK to commit to tackling child obesity. British Medical Journal Rapid Response, 28th February 2017.
https://www.bmj.com/content/356/bmj.j762/rr-3

18) Watson M C, Theaker T. Re: Fight childhood obesity with multiple methods, not just more taxes, MPs hear. BMJ Rapid Response. 7th May 2018. https://www.bmj.com/content/361/bmj.k1963/rr

19) Lloyd J, Watson M. IHPE Position Statement: PSHE. Lichfield: IHPE, 2019.
https://ihpe.org.uk/wp-content/uploads/2019/10/IHPE-Position-Statement-P...

20) Campbell C (Editor) New Directions in Health Education. London: The Falmer Press, 1985.

21) Watson M C and Lloyd J. Need for increased investment in public health BMJ 2016;352:i761.
https://www.bmj.com/content/352/bmj.i761

22) BMA. Funding for ill-health prevention and public health in the UK. May 2017. http://bit.ly/2quLN3K

23) Watson M C and Thompson S. Government must get serious about prevention. BMJ 2018;360:k1279.
https://www.bmj.com/content/360/bmj.k1279

24) World Health Organization. Taking Action on Childhood Obesity. Geneva: World Health Organization, 2018.
https://www.who.int/end-childhood-obesity/publications/taking-action-chi...

25) OECD The Heavy Burden of Obesity: The Economics of Prevention. OECD Publishing: Paris, 2019.
http://www.oecd.org/health/tackling-obesity-would-boost-economic-and-soc...

26) Mytton O, Fenton-Glynn C, Pawson E, Viner R and Davies S. Protecting children's rights: why governments must be bold to tackle childhood obesity. The Lancet, 2019.DOI:doi.org/10.1016/S0140-6736(19)32274-3
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32274-3/fulltext#articleInformation

Competing interests: No competing interests

12 October 2019
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK. http://ihpe.org.uk/