Childhood Obesity and its Impact on the Health and Wellbeing of Children in the United Kingdom: Health and Social Care Dissertation, UOG, UK

OMED 1345: Theory, Evidence and Practice in Public Health and Wellbeing Dissertation

title: Childhood obesity and its impact on the health and wellbeing of children in the United Kingdom.

Abstract

The UK is facing a challenge with childhood obesity. According to National Child Management Programme (NCMP), a third of children age between 2 to 5 are obese (Childhood Obesity, 2020). Obese children are more likely to stay obese in adulthood. Obesity not only cost £5.1 billion but also affect the health and wellbeing of the public. Childhood obesity is a complex matter that is caused by many different factors such as income status, poor diet, physical activity level, lifestyle, and genetic condition.

This research focused on how childhood obesity affects the health and wellbeing of children who were classified as obese and what are the available interventions to tackle the childhood obesity issue in the UK. According to a medical report by Dr Nagi Giumma Barakat, obesity is the major cause of type 2 diabetes, asthma, heart disease, stroke, and various types of cancer. The obesity-related disease cost NHS more than £5.1 billion each year. Childhood obesity is also linked closely to a variety of psychological disorders such as anxiety, low self-esteem, and depression.

The study by Y Latzer found that obese children tend to have lower performance at school in terms of academic achievement due to psychological distress (Latzer, Y., Stein, D. A, 2013). There have been many interventions to encourage healthy eating and physical activities at school settings. however, school programmes alone had no significant effect on preventing childhood obesity.

There is stigma around childhood obesity to put all the responsibilities on parents or schools. It can be seen as individual problems. However, it is becoming serious social issue not only individuals but as a nation. The UK government came up with long term 10-year plan to reduce childhood obesity. These include a soft drinks industry levy across the nation, healthy eating and physical activity rating scheme for primary schools, and traffic light labelling in front of food packages to raise awareness in healthy eating and to help families to make healthier choices when buying food.

The Government is also launching a new champaign, NHS 12-week weight loss plan app. This campaign involves sufficient training healthcare professionals to give adequate advice and raise health awareness of children in the UK. Childhood obesity can be a life-long battle, so it is too soon to measure the effectiveness between new interventions and childhood obesity rates.

The government must address the core issue of deprivation other than School breakfast clubs targeting families in deprived areas. The core issue is not only about healthy foods and physical activities but also the environment that people live in. therefore, educational, economic, and social sectors must work together with political sectors to reduce the gap in socio-economic inequality to address childhood obesity.

1. Introduction and Background

It is reported that the UK is facing a challenge with childhood obesity. According to National Child Measurement Programme (NCMP), a third of children age between 2 to 15 are obese (Childhood Obesity, 2020). Obese children are more likely to stay obese in adulthood. Obesity not only costs NHS £5.1 billion but also affect the health and wellbeing of the public. Obesity is a great risk factor for developing heart disease, type 2 diabetes, and depression.

There are many existing policies to tackle childhood obesity such as the soft drink levy to reduce sugar intake in a soft drink restriction and a food advertising ban on mass media. However, there are many challenges that come with it.

Childhood obesity is a complex matter that is caused by many different factors such as income status, poor diet, physical activity level, lifestyle, and genetic condition (Obesity in children | Health Information | Bupa UK, 2020).

The Transtheoretical model by Prochaska in the 1970s describes that there are six stages of human behaviour changes to adopt a healthy lifestyle, which is Precontemplation, Contemplation, Preparation, Action, Maintenance, and Termination (The Transtheoretical Model (Stages of Change), 2020). This model points out that people do not change behaviour instantly, the behaviours require time to prepare and take action and maintain that behaviour.

Maslow’s hierarchy of needs explains that people tend to make healthy food choices as they are reaching out towards self-actualization (Cambridge Core, 2020). The basic needs of people should be met. People can move forward having a healthy lifestyle and maintain their well-being when the basic needs for survival are met. The Marmot Review revealed that people who live in the deprived areas have not only higher obesity rates but also higher mortality rate than people who live in the least deprived areas. Health inequality, led by obesity, results in greater social and economic loss to the nation such as years of active independent lives lost, economic loss due to poor productivity caused by illness, and up to £32 billion of welfare payment each year (The Marmot Review, 2010).

In terms of tackling childhood obesity, Maslow’s social model has been studied in literature reviews to emphasise the importance of health and social inequality. People cannot think greater than the environment. Improving living environment conditions can help to reduce health inequality.

The topic of the Research is Childhood obesity and its impact on the health and wellbeing of children in the United Kingdom, and it is closely linked with health inequality in society. The aim of the research is to inform efforts to prevent childhood obesity and therefore reduce the burden of chronic disease in the UK. The research questions have been drawn to achieve the aim, which are, What are the cause and consequences of childhood obesity in the UK, What are the existing challenges to tackle childhood obesity,

What are effective interventions to tackle childhood obesity?  Childhood obesity cannot be approached only from a health perspective, as many environmental factors of individuals cause childhood obesity, it needs to be looked at from many different angles to consider the aspect of childhood obesity and develop effective interventions in order to improve the health and wellbeing of children.

2. Literature Review Methodology

The research inclusion criteria were to look for research done on childhood obesity age under 15 based on the UK from Google scholars and EBSCOhost Research Databases. The world is changing fast due to technology. As lifestyle and the cultural environment are rapidly changing, it is difficult to explain social phenome with any obesity-related documents published that are more than 12 years ago.

Therefore, the literature reviews were done on research published in the last 12 years to produce more relevant data in the modern-day world we live in. There were more than 7,000 search results, the search has been narrowed down in the medical database which included articles and journals from government websites such as NHS, NAO, RSPH, HM Government and articles from the newspaper, Guardian, and medical journal, the BMJ.

Medical articles provided clear understanding of current issue with childhood obesity in the UK. The research has been done based on online search data. The data was collected using purposive method for obtaining information on childhood obesity.  Snowballing method was used from relevant suggestion from researched articles.

There were so many wide ranges of articles and journals available around childhood obesity. It was very important to read as much available information to really understand a complex issue such as obesity. However, the research review focused on causes of childhood obesity and the risk factors of childhood obesity and how it affects the nation, as well as finding interventions to tackle childhood obesity. I have discarded any articles and journals about adult obesity and any information that is done based on other countries other than the UK.

The living environment is different in every country in terms of food, school system, culture, and lifestyle. The factors that trigger childhood obesity can be different depends on where we are and the interventions can be different in each country to tackle the issue.

For literature review, 9 most relevant articles and journals were selected and reviewed in this research. The actual search terms such as `child`, `childhood`, `children`, `obesity`, `overweight’, ‘interventions`, `effect`, `health’ and more were used. These search terms were drawn from research question that need to figure out the causes of childhood obesity and to find out available interventions to decrease and to prevent childhood obesity in the UK.

The research exclusion criteria were the statistical data done on the causes and effects of childhood obesity from any other country outside the UK, as it is targeting the population of the UK. The research also excluded any personal reviews, letters, and blogs.

The research focused on a social phenomenon in social and cultural behaviours associated with childhood obesity and how childhood obesity affects health and wellbeing of children in the UK as well as evaluate how effective the existing interventions are.  The research looked for a relevant social behavioural theory that explain the prevalence of childhood obesity to understand human behaviours behind obesity.

There were limitations to the methodology to understand the issue in greater depth because childhood obesity is broad and much more complex. It is not only about physical but all other psychological, environmental, social, and economic areas of literature to really understand the causes and effects of the phenomenon in childhood obesity.

Therefore, if I were searching mainly medical databases, then I could be leaving out relevant literature from other disciplines. The most difficult limitation to overcome might be finding appropriate interventions that are suitable for the future generation based on currently available literature, as the world is moving fast into digital and virtual reality.

The ethical challenges were my perspectives and perceptions associated with obesity in general. This could lead to bias toward certain literature. I tried to consider various views from various studies available and develop the ability to think critically and to remain objective and make a point of literature review based on evidence.

To minimise unintended pragmatism in the process of writing a literature review, I needed to always acknowledge studies of other people. I tried to make sure to follow appropriate referencing guidelines from Greenwich University.

3. Research Findings

The topic of this research is Childhood obesity and its impact on the health and wellbeing of children in the United Kingdom.

The most important and relevant findings were summarised into two major categories. The first group was on how childhood obesity affects health and wellbeing of children who were classified as obese and how it puts a strain on NHS and public health. The second group was the available interventions to tackle the childhood obesity issue in the UK.

Body mass index (BMI) is used to measure obesity by dividing an individual’s weight by the square of heights. Weight status of children depend on age and sex due to the fact that children are still growing. Therefore, children who are above 95^th percentile in BMI chart are considered as obese (Defining Childhood Obesity | Overweight & Obesity | CDC, 2021).

It is reported that nearly a third of children under 15 in the UK are overweight or obese (HM Government, 2016). National Child Measurement Programme (NCMP) 2019/20 statistic data showed that 35.2% children in Year 6 is overweight or obese which is an increase from the previous year, 20.1% and the number of obese children from deprived areas were over double compared to children from the least deprived areas (PHE data and analysis tools, 2021).

The literature review consists of quantitative data from government documents that provided figures and statistics on childhood obesity epidemic in the UK and qualitative methods studies done on its impact on health and wellbeing of children and what interventions available to tackle this issue. That quantitative statistical data showed the current prevalence of childhood obesity in the UK. Obesity statistics done by Carl Baker pointed out that according to a 2017 OECD report, the obesity rate of the UK ranked 10^th among these countries (Baker, 2021).

The above evidence indicates that childhood obesity in the UK is clearly at crisis point. Information on Childhood obesity and its impact on the health and wellbeing of children were collected from Centres for Disease Control and Prevention (CDC), the BMJ, medical journal, NHS, HM Government report, and Royal Society for Public Health (RSPH). The reviews were divided into 2 categories, which are the risk factors and intervention. There were 2 themes that were identified under risk factors and 2 themes under interventions.

3.1 Risk Factors of Childhood Obesity

3.1.1 Theme 1. Physical Non-Communicable Disease

It is reported by Dr Nagi Giumma Barakat that obese children are at great risk of developing serious physical illness, such as osteoarthritis, asthma, heart disease, stroke, and even various types of cancer. This is due to too much pressure on bones and joints, high blood pressure and cholesterol, type 2 diabetes, and more (Bupa UK, 2021). According to medical report, obesity affects how the body deals with glucose, and it becomes major cause of type 2 diabetes.

Blocked arteries can cause heart attack or stroke in their adulthood (Mayo Clinic, 2020). In addition, childhood obesity comes with great social and economic cost. NHS in England spent £5.1 Billion on obesity related disease in 2014/15 alone (HM Government, 2016) and the figure continued to rise to £6.1 Billion.

According to the report from Department of Health & Social Care, it costs society up to £27 Billion as result of economic loss, for example, from sickness and absence from work (Nao, 2020). NHS digital in 2016/17 published the fact that 617,000 NHS hospital admission related to obesity as either a primary or secondary cause, which is an increase of 18% from the previous year (NHS Digital, 2018).

3.1.2 Theme 2. Mental and Psychological Disorders

Childhood obesity not only causes various preventable chronic disease, but it is also linked very closely to a variety of psychological disorders such as anxiety, low self-esteem, stigma, and depression (RSPH, 2015).

Lucy J. Griffiths et al conducted an examination to study association between psychological problems and obesity through UK’s Millennium Cohort Study involving 11,202 children. This research found out obese 5-year-old children particularly in boys have conduct problems, inattention problems, peer relationship problems, and many other behavioural problems. Childhood obesity is linked very closely with emotional, mental, and behavioural problems (Lucy J. Griffiths et al.,2010).

Latzer, Y., Stein, D. A conducted a review on psychological problems in childhood obesity and found that obese children are at a much greater risk of psychological distress and lower performance at school in terms of academic achievement (Latzer, Y., Stein, D. A, 2013).

Shelly Russel-Mayhew et al. carried out a systematic literature review of 131 articles to find evidence about relation between psychological and emotional health and childhood obesity. The review found that various psychological factors are caused by childhood obesity such as depression, anxiety, distorted boy image, eating disorders and more.

The review found that obese children are twice more likely to be victimised by peer groups and negative body image can even lead to suicide attempts (Shelly Russel-Mayhew et al., 1012). There is clinical evidence of a strong association between obesity and quality of life, which implies obese children scored low physical functions and low emotional stability.

3.2 Childhood Obesity Interventions

3.2.1 Early Interventions

Julie Lanigan et al. conducted research on childhood obesity and found that it normally begins even before preschool years. Therefore, early interventions should be in place to tackle childhood obesity, as it causes life-long health issues and obesity is very difficult to reverse. This research suggested that breastfeeding lower the risk of obesity. School children should have limited screen time and should be involved in physical activities at least 1 hour a day, 3 hours a day for preschool children (Julie Lanigan, et al., 2019).

A cluster randomised controlled trial, primary research, was conducted involving 200 randomly selected primary schools from the West Midlands for 30 months to test the effectiveness of school and family-based healthy lifestyle programme (WAVES study). Interventions encouraging healthy eating and physical activities with additional family workshops on healthy cooking skills.

The result showed that healthy eating programmes and school activity involvement had no significant effect on preventing childhood obesity in terms of BMI measure. The interventions would not work with school programmes alone without support from multiple sectors and living environments (BMJ, 2018).

HM Government report on childhood obesity: A Plan for Action pointed out that the initial cause of obesity in children is an energy imbalance. Children should burn more energy than energy intake through food. Therefore, physical activity is very important for quality sleep and to help maintain a healthy weight. It strongly emphasised the correlation between physical activity and improved academic performance (HM Government, 1016).

3.2.2 Interventions Enforced by the UK Government Policy

The UK government came up with long term 10-year plan to reduce childhood obesity. Health and Social Care Secretary, Jeremy Hunt has accounted that the government aim to reduce the number of childhood obesity down to half by 2030 (GOV.UK, 2018). The first plan is to introduce a soft drinks industry levy across the UK to reduce sugar intake by children.

The revenue from the levy will be reinvested in Primary PE and various physical activities such as healthy breakfast clubs for children at school. The second plan is to provide a healthier environment to children and families by enforcing the Government Buying Standards for Food and Catering Services (GBSF) standards in every public sector setting.

This is to raise awareness and promote healthier food and drink choices. The third plan is to introduce a healthy rating scheme for primary schools. As schools are deeply involved in healthy eating and physical activity of children, this scheme is evaluated by Ofsted inspections. The last plan is to regulate traffic light labelling in front of food packages for helping families to make healthier choices when buying food.

Health Education England (HEE) and PHE launched `MAKE EVERY CONTACT COUNT’ programme. This programme provides opportunity to train for health visitors and school nurses to identify obesity problems in children (HM Government, 1016).

There was a restriction on advertising and sponsorship from junk food around children’s TV programmes since 2006 by broadcast regulator Ofcom. However, children nowadays have access to various social media from a very young age. Without tighter regulations in place by the Committee of Advertising Practice (CAP), the limited restrictions on certain media would not have a significant impact on reducing the childhood obesity epidemic (RSPH, 2015).

The UK government is launching a new campaign, PHE’s new Better Health campaign, to promote evidence-based tools and weight loss apps with the free NHS 12-week weight loss plan app. This is to encourage people with obesity to make changes in their behaviour toward health and ultimately to prevent serious preventable chronic disease and reduce hospital admissions caused by obesity.

The government will provide adequate training to staff across all Primary Care Networks to have enough knowledge and information to coach and provide evidence-based advice to people who are obese. GPs in communities will play a core role in consulting and referring individuals to weight management service within the local health care systems.

The proper guidelines of the Quality Outcome framework for doctors will be available by National Institute for Health and Care Excellence (NICE) (GOV.UK, 2020). The strength is that the central government is acknowledging the urgency of childhood obesity and making necessary policies to tackle the issue in the UK.

Despite various intervention programmes implemented by the government since 2016, the childhood obesity rates have not gone down. In fact, the rates are on the rise. The current global pandemic Coronavirus lockdown certainly gets in the way of tackling childhood obesity. Obesity can be a life-long battle, so it is too soon to measure the effectiveness between new interventions and childhood obesity rates.

However, the weakness is that despite a clear link between childhood obesity and deprivation, the childhood obesity intervention programmes from the central government are not addressing the core issue of deprivation other than School breakfast clubs targeting families in deprived areas.

4. Discussion

Maslow’s hierarchy of needs is a pyramid-shaped model of human psychology that consist of 5 hierarchy levels, which were developed by Abraham Maslow in 1943 (BBC Bitesize, 2021). According to Malow’s hierarchy of needs, there are 5 levels of how individuals strive to achieve their highest potential to create happier and healthier lives for themselves and others. The 5 levels of needs are physical need, safety, belonging, esteem, and self-actualisation. The basic needs for survival must be fulfilled before individuals move forward to the next level.

To develop a healthier lifestyle, socio-economic status plays an important role when it comes to making healthy food choices and doing exercise for health and wellbeing of individuals. As the finding showed that childhood obesity rates are much higher among children living in deprived community, it is because healthy food, balanced diet and health consciousness require sufficient budget and knowledge about nutrition.

People from deprived areas tend to have low level of education, limited budget, and limited access to a healthy food market. For people in deprived areas, the priority is affordable food and housing to sustain their survival. When these basic needs are met, people are able to relate to healthcare for their safety. The next level is love and belonging, which is the ability to connect to family, friends, and community. When all these levels are satisfied, people seek out better self-esteem to evolve a better version of themselves.

The final level is for self-actualisation, to care for other humans. People with low income and education are normally stuck in the first and second level of Maslow’s hierarchy model of human needs (Van Lenthe et al., 2015). Deprived people are in constant survival mode and food means nothing more than a source of energy for surviving and they do not normally have the luxury of access to a gym or other forms of sport to keep themselves physically and mentally fit. It is not easy thing to do for low-income families to breastfeed their child or to spend certain amount of time outdoor due to long working hours.

As described in the findings, it is medically and scientifically proven that childhood obesity causes various physical health problems and mental ill health for children who are overweight. Some might argue that the parents are ultimately responsible for the wellbeing of their children.

However, if both parents must work to make ends meet to put the food on the table, the parents are not to be solely accused. The world people are living in now is totally different from 20-30 years ago. Environment can influence healthy eating on children. Children nowadays are surrounded by fast food stores on every corner in the community, which makes it easy for children to make unhealthy food choices and develop bad eating behaviour, which will become social norm.

As educational organisations have limited funding to create healthier environment, childhood obesity is a difficult issue to tackle by schools alone without support from other stakeholders such as parents, community support groups, and local authority as well as the government.

The government produced ranges of policies and legislations to tackle the many issues regarding childhood obesity. Childhood Obesity: A Plan for Action is not targeting all children in the UK and certainly not including children from deprived areas.

At the present situation with COVID 19 global pandemic, many people are out of employment and social distancing forces people to stay indoors longer that discourage social interaction with others and being active physically. The government not recognising the urgency of socio-economic inequality. It should not be just about taxing products with high sugar content or funding school activities.

The actions must be taken by national and local government to improve the quality of life and develop deprived areas and giving people education opportunities and employment.

Childhood obesity is not only about healthy foods and physical activities but also the environment that they live in. Therefore, educational, economic, and social sectors must work together with political sectors to reduce the gap in socio-economic inequality to address childhood obesity.

5. Conclusion

It is reported that nearly a third of children under 15 in the UK are overweight or obese and the UK government is facing a toughest challenge tackling the issue and it creates great social and economic losses for the nation and also create an enormous burden to NHS. Childhood obesity is a great risk factor of non-communicable diseases such as asthma, heart disease, stroke, type 2 diabetes and more.

Childhood obesity is also closely linked to various psychological disorders such as anxiety, low self-esteem, and depression. These psychological disorders lead to inattention problems, peer relationship problems and many other behavioral problems including low performance at school. In order to address the issue, at individual level, it is important to breastfeed infant at birth, children must spend enough time on outdoor activities and must participate school activity programmes.

At national level, the UK government introduced 10-year plan to reduce childhood obesity such as a soft drinks industry levy, consulting nutritional standards in the GBSF to implement healthy diet in public sectors including NHS and schools, a regulation to display traffic light labeling in front of food packages and restriction on junk food advertisements around children’s TV programmes.

The UK government is acknowledging the urgency of childhood obesity and making necessary policies to tackle the issue. Obesity can be a lifelong battle, so it is too soon to measure the effectiveness between new interventions and childhood obesity rates. However, the government is not addressing the core issue of deprivation that causes health and economic inequality to improve and to provide better living environment for the future generations.

It is a fact that a larger number of obese children are from deprived areas. Healthy good, balanced diet and health consciousness requires sufficient budget and knowledge about nutrition. People from deprived areas tend to have low level of education, limited budget, and limited access to a healthy food market. As Maslow’s hierarchy of needs describe human psychology in seeking and maintain healthy consciousness, it is important that the government must take actions to reduce socio-economic inequality.

Approaches treating childhood obesity is not as effective than treating the fundamental causes. The matter cannot be solved by focusing solely on physical activities or junk foods but looking at the matter from broad perspective including social, cultural, education, economic, and political views. Childhood obesity is a complex matter that requires joint efforts from every stakeholder including the parents, schools, children themselves, community, and the government.

I would make suggestions for further research on how stress hormones drive comfort eating and binge eating that lead to unhealthy diet. The world is evolving rapidly. Technology is developing much faster than our lifestyle can catch up, which produce stress hormones in the brain. It is like people are constantly living under stress within fast paced environment with emergency button, stress hormone, on.

It became normal adapting technology as part of our lives and children now have access to so many different social media that create so much stress in their minds without knowing. Minds affect the body. Healthy and distressed mind can contribute to grow healthy consciousness, which helps to develop healthy behavior toward food.

When both parents are working long hours for low pay to take care of the children can contribute to development of mental stress.  During the absence of parents, children tend to be locked up indoors and consume mal-nutritive food. This causes daily stresses and the stresses lead to unhealthy eating behaviors. The government and the communities must work on community developments to reduce inequality for everyone to live happier and healthier life.

6. Personal reflection

I have chosen a broad topic for my dissertation. The title is on Childhood obesity and its    impact on the health and wellbeing of children in the United Kingdom. In the beginning, I had no idea where to start.  I knew I had to look for many relevant information to deepen my knowledge and understanding. Obesity is very closely linked to everyday of people’s lives.

There were so much information relevant to obesity. I have learnt to search for relevant data by using key words. I have read all the relevant data provided by government statistics and medical journals that supports my research questions. I have learnt how to use relevant data using snowball effect as a part of purposive sampling method. I have learnt basic of researching process on what to include and exclude during research information. I have read enough information relevant to the research question.

I had to find the key factors that answer my research questions from all the materials that I have read. I found that the government and the communities try to tackle childhood obesity. However, it is difficult to measure the effectiveness of the policies and regulations yet. My topic is too broad to cover the fundamental solutions that I have looked for.

The next time, I would think a little deeper to narrow down the research that could be food, physical activities, mental wellness, or lifestyle in relation to childhood obesity. Rather than looking for answers to tackle all the issues around childhood obesity, just focus on one of the factors could be more effective to reduce childhood obesity with better contribution by my dissertation.

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