2 Public health need and practice
In 2011 in England, around 3 out of 10 boys and girls aged 2 to 15 years were either overweight or obese. The proportion of those who are overweight has remained largely unchanged since the mid-1990s. However, childhood obesity has risen by around 1 percentage point every 2 years up to 2007 (NHS Information Centre 2013; Department of Health 2011).
In the 2011/2012 school year, around 23% of children in reception and 34% in year 6 were either overweight or obese. Around 9.5% and 19%, respectively, were obese. The prevalence of obesity was linked with socioeconomic deprivation and was more prevalent in urban areas. Obesity was also more prevalent among children from black, Asian, 'mixed' and 'other' minority ethnic groups than among their white counterparts (NHS Information Centre 2012).
Although the prevalence of obesity now appears to be levelling off, in 2011 around 17% of boys and just under 16% of girls aged 2 to 15 years were classed as obese (NHS Information Centre 2013).
Up to 79% of children who are obese in their early teens are likely to remain obese as adults (Chief Medical Officer 2008). Consequently, they will be at greater risk of conditions such as type 2 diabetes, coronary heart disease and some cancers in adulthood (Foresight 2007). Studies have also shown that a child with at least 1 obese parent is more likely to be obese themselves (Perez-Pastor et al. 2009).
Various diseases or conditions (comorbidities) may be associated with obesity in childhood. Of these, type 2 diabetes is a particular concern. It usually occurs in middle aged and older people and is associated with being overweight or obese. However, over the past decade, more younger people and children (some as young as 7) are being diagnosed with this condition (Diabetes UK 2011).
Being overweight as a child has also been associated with other cardiovascular risk factors in childhood or early adulthood (Craig et al. 2008; Logue and Sattar 2011). Other conditions associated with childhood obesity include: non-alcoholic fatty liver disease (Wei et al. 2011); gall stones (Koebnick et al. 2012); asthma and sleep-disordered breathing, including sleep apnoea (Figueroa-Munoz et al. 2001); and musculoskeletal conditions (Murray and Wilson 2008, Taylor et al 2006).
In addition, there is evidence that childhood obesity impacts on self-esteem and quality of life (Griffiths et al. 2010). In adolescence, it has been associated with depression (Sjoberg et al. 2005).
Overweight and obese children are likely to experience bullying and stigma (Griffiths et al. 2006) which can also impact on their self-esteem. Some of these issues may, in turn, lead to under-achievement at school (Bromfield 2009).
The 'Healthy child programme for 5–19 year olds' recommends that overweight or obese children should be referred to appropriate weight management services to help them achieve and maintain a healthier weight (Department of Health 2009).
Such programmes can also help improve self-esteem (Lowry et al. 2007). In addition, they have the potential to help improve how they see themselves which may, in turn, enhance their future wellbeing (even if weight loss is not apparent in the short term) (Griffiths et al. 2010).
In 2008, an estimated 314 to 375 weight management programmes for children were operating in England (Aicken et al. 2008). Lifestyle approaches focus on diet, physical activity, behaviour change or any combination of these factors. They may include programmes, courses or clubs (including online services) that are:
designed for overweight or obese children and young people or for their parents, carers or families
designed primarily for adults but which accept, or may be used by, children and young people
provided by the public, private or voluntary sector, in the community or in (or via) primary care organisations.
Some were small local schemes, others were available on a regional or national basis – such as those listed in the Department of Health's 'Child weight management programme and training providers framework' (Cross Government Obesity Unit 2009).
Unless obesity is addressed in childhood, most of the financial consequences are likely to be incurred when treating and managing the obesity-associated diseases or conditions (comorbidities) that arise in adulthood. (These include type 2 diabetes, coronary heart disease and some cancers.)