Protecting children and letting them grow into healthy adults its everyone’s business. Whilst the world around us in 2023, unfortunately battles problem after problem, with the help of the society, communities and the government, solutions are created to tackle problems such as obesity.
Why does socio-economic status play a role in childhood obesity?
Published in the UK, 2010, Sir Michael Marmot’s report (Fair Society, Healthy Lives) recognised the social determinants of health (the conditions in which we live, learn, work, and play) and health inequalities as a leading underlying cause of poor health.
It was observed that people living in areas of deprivation, suffered greater health inequalities and their wellbeing suffered compared to those with better income and decent places to live.
Summary of findings and recommendations
The detailed report contains many important findings, some of which are summarised below.
- People living in the poorest neighbourhoods in England will on average die seven years earlier than people living in the richest neighbourhoods
- People living in poorer areas not only die sooner, but spend more of their lives with disability – an average total difference of 17 years
- The Review highlights the social gradient of health inequalities – put simply, the lower one’s social and economic status, the poorer one’s health is likely to be
- Health inequalities arise from a complex interaction of many factors – housing, income, education, social isolation, disability – all of which are strongly affected by one’s economic and social status
- Health inequalities are largely preventable. Not only is there a strong social justice case for addressing health inequalities, but there is also a pressing economic case. It is estimated that the annual cost of health inequalities is between £36 billion to £40 billion through lost taxes, welfare payments and costs to the NHS
Action on health inequalities requires action across all the social determinants of health, including education, occupation, income, home and community.
What can we do? Use the social determinants of life as a preventative approach.
His review, 10 years later, looked at the latest result and unfortunately showed that the rates of individuals living in poor health increased and increased life expectancy had failed. Key point:
- The more deprived the area, the shorter the life expectancy. This social gradient has become steeper over the last decade, and it is women in the most deprived 10% of areas for whom life expectancy fell from 2010 – 12 and 2016 – 18.
In 2020, the Royal College of Physicians in the UK explored the link between inequalities and obesity, observed predominantly in people from deprived areas, with alarming rates of childhood obesity.
They stated that the key role driving obesity rates is poverty. Obesity is recognised as a complex chronic disease, which if left untreated can lead to health complications and potentially be lethal.
This is because the weight of an individual is higher than what is considered healthy for their height.
According to NICE guidance, the degree of overweight or obesity in children and young people is defined using the following classifications: overweight: BMI 91st centile + 1.34 standard deviations (SDs) clinical obesity: BMI 98th centile + 2.05 SDs, severe obesity: BMI 99.6th centile + 2.68 SDs.
Unfortunately, in January 2023, the government scrapped the white paper on health disparities, which was set to reduce the gap in health inequalities and address disparities, crucial to improve the long-term health of our nation.
Instead, there will be a new strategy, published in the summer, which will set out a strong and coherent policy agenda that sets out a shift to integrated, whole-person care. Interventions set out in the strategy will aim to alleviate pressure on the health system, as well as support the government’s objective to increase healthy life expectancy and reduce ill-health related labour market inactivity.
This new strategy will not focus on prevention, but mostly on treatment.
Where did we go wrong and when was childhood obesity first noticed as a problem?
Lifestyle interventions to prevent childhood obesity has history, beginning in the 1980’s, since the problem was notified in the 1970’s. Obesity, with its high rates globally, especially in young people and children, is now considered as an epidemic.
According to the World Health Organisation, there were 124 million children and adolescents affected by this new threat to their health by 2016. Childhood obesity is increasing in prevalence and children who are obese are at a much higher risk of developing diabetes and cardiovascular risk factors, even at young ages. In a recent policy paper from 2020, plans have been set out on how to tackle obesity in children. But despite this, in England, 1 in 3 children leaving primary school are overweight or living with obesity, with 1 in 5 living with obesity.
There is an awareness that causes of obesity are multiple, for example, our food, activities, and sleep; social determinants of health; genetics, illness and medications, such as steroids and antidepressant tablets.
Rates have increased in recent years, especially with the COVID pandemic, where we observed a shift toward consuming calorie-dense and nutrient-poor foods, children having long screen time, and limited physical activity due to the restrictions imposed to them.
One of the lifestyle modifiable risk factors been nutrition is also the link between obesity and mental health or neurological dysfunction. More closely, psychological disorders are associated with consumption of the Western dietary pattern, high intakes of snacks, high fats, chocolate, carbonated drinks, sweets and desserts. Potential relation is inflammation, oxidative stress, the gut microbiome and dysbiosis, epigenetic modifications and neuroplasticity, caused by the quality of the diet. Therefore, to protect against these disorders, it is recommended to increase the intakes of fruits, citrus fruits, vegetables, but also to reduce obesity rates in children.
What can we do?
Tackling obesity – NICE guidelines recommendations are a preventative approach first, where health care professionals have to take into consideration the individual needs, preferences and values of their patients or the people using their service.
At present, here in the UK we live in obesogenic environments, which creates an even bigger gap between the shift in obesity prevention. Children living in the most deprived areas have the highest access to fast food outlets, which offer cheap and calorie dense products to be consumed.
Recent reports by Royal College of Paediatrics and Child Health (RCPCH), published on the 31 March 2023, is showing that these are the children experiencing worsening health. The fast-food outlets are an issue, that needs to be carefully considered by local authorities and where possible, their density reduced and healthier options have to be made available.
Local authorities can refuse planning permission for a new food outlet if they can demonstrate that it will have an adverse impact on the health and wellbeing of the local population.
Ways to encourage healthier options. Source: gov.uk, 2017.
The plan of action from the UK government, published in 2017, set out to help business for this to happens, but clearly more needs to be done. For example, they have to full uptake of the Government Buying Standards for Food and Catering Services (GBSF) which are followed by all central government departments.
The impact on later life, mental health, social life and employment rates.
Children have the right to grow in healthy environments whilst multiple stakeholders have the role in contributing to their lifestyle formation, which influence their health in the long term.
The closest to a child is their parents and family and a recent study indicated that combined efforts are needed to manage the success of any programs related to their nutrition and physical activities.
Additionally, the body of research shows that childhood obesity leads to obesity in adults, which has also been linked to mental health illnesses, with some severe cases.
Reducing inequalities in mental Illness focuses on some of the actions that local areas can take to reduce health inequalities experienced by people living with mental health problems, with the aim of achieving improved health outcomes and life expectancy.
Throughout the years, unemployment has been observed, not only in those who are obese, but for the purposes of this article, we will shine a light on those who have been classed as obese. Findings from the UKHLS, annual longitudinal survey of over UK 40,000 households demonstrated a positive association between unemployment in obese participants, mainly related to obesity-associated health problems.
Recent synthesis of the literature looked at the gap in mechanisms and pathways that underscore the complex relationship between food insecurity, unemployment, low income, diet, and weight outcomes. Their findings were multiple and all of them need to be taken into consideration.
Some examples are, longer length of the given intervention, more contact time with participants during the intervention, culturally or gender tailored intervention, regular monitoring and support, positive attitude of coaches, simplicity of tasks/messages, high satisfaction and acceptance of intervention, variation in activities, interactive and engaging activities, small changes approach and high compliance.
Each child is a person with complex, super- dynamic system, with their role in society and future economy. Whilst they are still growing, their healthy development is crucial to the future well-being of any society. Poverty, inadequate health care, and nutrition are some of the factors which could affect the future of children and therefore the future of the societies in which they live.
The role of charities
NICE guidelines states that local authorities should facilitate links between health professionals and other organisations, such as voluntary and children’s charities, to ensure that local public policies improve access to healthy foods and opportunities for physical activity.
See full text here: 1 Guidance | Obesity prevention | Guidance | NICE.
Empowerment is needed, to break the cycle of inequalities, support the parents and make a difference, to reduce poverty rates. This can be done through the collaboration with local communities to help the improvement of children’s health, by taking preventative approach.
The role of some charities in the UK is to work together to promote good health and tackle inequalities across the UK, and it is backed up by the new Office for Health Promotion. They were to also join the national efforts to level up the health of the nation and close the gap on disparities.
I will end on here with some quotes from Sir Michael Marmot’s speech in Zurich from a few years ago.
“If we want to make a difference, we can either do something, do more or do it better! There is something here for all of us to close the gap!”
“The search for effective prevention and treatment strategies must now become a major priority if we are to protect current and future generations from developing childhood obesity and its associated major long-term complications.”