Dame Sally calls time on childhood obesity, writes Tam Fry FRSA, Chairman of the National Obesity Forum
In ten years from now, the UK Government will have halved childhood obesity. That is, at least, its aim. But based on past experience and without a change of attitude in the future, there seems little chance of it succeeding. Exactly ten years ago, the Conservative coalition under David Cameron aimed to bring childhood obesity down to 2000 levels by 2020 but not only has the target comprehensively failed but obesity figures have reached a new high. To be honest, governments of all hues have missed every target they have set since the 1990s simply because none of them has taken obesity seriously enough to control it.
Time To Solve Childhood Obesity
That is what England’s outgoing Chief Medical Officer, Dame Sally Davies, thinks, too. In her October 2019 special report on childhood obesity, her final advice to government on health issues, she doubted that the 2030 target could be reached without some really serious measures being introduced. So, in Time To Solve Childhood Obesity, she lists the bold measures she thinks need to be taken – the same draconian and game-changing measures that Theresa May and Jeremy Hunt promised but never delivered before they lost their jobs. The pity is that Davies will no longer be in the post to oversee her solutions take shape. There is not the space in this column to go through all 49 of them, but one should be looked at in detail. There’s some history to go through and it’s shaming.
Child health checks
In advocating the routine measurement of children’s weight and height, Dame Sally has attempted to right the wrongs wrought on a generation of children. The wrongs began in 2002 when Whitehall failed to implement a similar proposal made by her predecessor, Sir Liam Donaldson. At a stroke, the government condemned millions of schoolchildren to grow into obesity without the professional checks on their health to which they should be entitled. It is sadly ironic that animals are measured yearly during health checks in zoos and annual MOTs ensure that our cars are in good working order, but with children – the nation’s future – no such checks have been deemed relevant until now.
Identifying obesity at an early stage
In his 2002 Report, Sir Liam called on all community health professionals, – GPs, school nurses, practice nurses – to identify the early stages of obesity in children and to offer interventions at any early stage. To emphasise the point, he dubbed obesity a “ticking time bomb” which could spell catastrophe for the NHS if not quickly curbed. Not two years had passed before the House of Commons Health Select Committee [HSC] also made a similar recommendation. Following a year’s Inquiry into childhood obesity, the HSC demanded that the BMI of every child in the country be assessed annually throughout their school years. It again made the undeniable case that action was urgently required.
BMI monitoring
The aim of both recommendations couldn’t have been clearer. If schoolchildren’s BMI was accurately monitored yearly, it would be quite possible to identify any individual displaying concerning weight gain within a reasonable time frame. The child could then be flagged up for intervention, either by referral to a specialist weight management course before its weight gain got worse or to community dietitians to monitor more closely the child’s return to a healthy weight. Though a single BMI is not the gold standard when diagnosing obesity, over a period of time it will find the child on the wrong trajectory. Since parents hold their children’s Personal Child Health Record containing growth charts up to age 18 – to which paediatric BMI charts can also be added – all the tools to do the job are in place.
To be fair, following the HSC’s Inquiry, the Department of Health did call for a high-level discussion to examine how the NHS should respond. It decided however to do no more than launch a public health initiative, entitled MEASURING CHILDHOOD OBESITY. Instead of following the politicians’ advice, the DH decided that it would pay for only two measurements, or “snapshots”, six years apart. But though they would produce population obesity statistics in primary school Reception Year and Year Six, they were remote from what the HSC intended. Tragically, the initiative was also so badly introduced that it bombed from the outset. Relying on parents “opting-in” to the scheme, the DH was shaken to find that only 48% of children ever got measured. It hadn’t anticipated that angry parents in their droves would decide not to have their children put on scales by the “fat police” [school nurses] since they were sure that their children were neither obese nor needed to be measured.
This piece of incompetence led to the scheme being immediately scrapped with a new programme, written by a senior public health doctor, replacing it. It was rebranded the National Child Measurement Programme [NCMP] that we know and love today. Based on “opting out”, when diehard parents had actively to prevent their children from being assessed, the programme became meaningful more or less overnight and today has achieved close to a 95% success rate. The UK has some truly brilliant statistics to inform public health policy but it is still not a proper clinical tool.
It will be if Dame Sally gets her wish. The government has no option but to listen to her recommendation if it is to prevent yet more of our young people growing into not only obese children but obese adults, probably with co-morbidities and certainly bringing the health service further to its knees. Of course, this monitoring won’t halve childhood obesity by itself and the government must take on board the bulk of the good lady’s proposals if it is to achieve the 2030 goal.
Tam Fry, 82, joined the Board of the National Obesity Forum in 2005 and subsequently became its spokesperson until 2016. Previously, he was Chairman of the Child Growth Foundation. His trade is television and directed the majority of major BBC current affairs programmes for 25yrs between 1963 – 1988.
