With the launch of National Childhood Obesity Week, the coalition is challenged by the National Obesity Forum and Mend, a social enterprise helping obese children, to set out a clear strategy for coping with obesity.
What shall we tell the children? It’s a common enough question in these straitened times. As financial gloom touches everyone’s lives and livelihoods, it is well to recognise that social and economic deprivation and the physiological stress factors associated with chronic poverty provide the fertile conditions in which ill health, including obesity, can flourish. But these aren’t the only factors that relate to the pressing need to take effective action on what must be one of the government’s primary health concerns.
With the launch of National Childhood Obesity Week, the coalition is challenged by the National Obesity Forum and Mend, a social enterprise helping obese children, to set out a clear strategy for coping with the problem. Backed by many like-minded NGOs, they want Andrew Lansley to make commitments to do far better than his predecessors in galvanising “big society” into action.
The trouble is that the goalposts were conveniently shifted when it became clear that the last government could not do anything without the compliance of the food and beverage sector that in many ways already defines the limits of public health policy in this area. With no possibility of achieving even the meagre target of reducing overweight and obesity to the levels reached at the start of the millennium, the last government allowed their 2010 deadline to slide to 2020 with the connivance of some expert advisers participating in a self-defeating exercise in a numbers game that evades the real issues.
Many public health staff with responsibility for obesity initiatives fear that the wind is already being taken out of their sails as posts are left vacant, staff have to double up, resources for commissioning are limited, and there remains a real dearth of quality training for the many and varied professions required to engage with the obesity issue, especially when it comes to dealing responsibly with children.
The undeclared reality is that despite all the travelling circus of conferences, the plethora of reports and the best efforts of serious scientific endeavour embodied in the Foresight report, no one has achieved a really coherent cross-government, society-wide effort to tackle obesity in a way that would have any real impact on the figures. So if we content ourselves only with the fanfare of the Change4Life motif, but don’t get everyone on the march, we must get accustomed to the idea that childhood obesity is here to stay.
As the new Office of National Statistics Social Trends 2010 report reiterated last week, the proportion of the adult population in England classed as obese BMI rose from 15.7% in 1994 to 24.5% in 2008. In Scotland, the figure was 26.8% in 2008 contrasting with 21% in Wales. For children aged under 16, overweight and obesity rose from 25% in 1995 to 30% in 2008, reaching 33% in Wales and 32% in Scotland.
So in the second decade of the 21st century, there is a new reality to consider. When 20% of all adolescents are clinically obese at the threshold of their adult lives, we must get accustomed to the idea of adult obesity not flat-lining nor miraculously disappearing in the yearned-for Change4Life transformation, where individuals must change but the world surrounding them causing everyone to become fatter does not change. Instead obesity will rise from that new base line of 20% prevalence among the youngest adults spreading to far higher levels among the middle-aged. Suddenly, the Foresight report’s prognostications of future obesity rates reaching 50-60% and swallowing up a third of the NHS budget do not look like distant prospects.
We certainly need to plan for the kind of adaptive strategies that are already market-driven in the US. Far more than $3bn a year is spent by US hospitals on extra-large wheelchairs, reinforced beds, trolleys, even longer hypodermic syringes and supersized cuffs for checking blood pressure. And that only benefits the minority who can afford to access healthcare. Many of the obese in the US – where 50% of black women have a BMI above 30 – suffer the consequences and ultimately fatal complications of type 2 diabetes and cardiovascular disease. Will we tolerate a similar scale of institutional neglect in the UK?
There is a genuine will in some quarters to protect children from the predations of commercial interests that are woven into so many of the social, cultural and educational facets of our lives; even sporting attractions seem designed to lure children into brand fidelity through stealth marketing. The World Health Assembly – a UN gathering of government health ministers – voted in May for firm measures to deal with marketing to children. At the same time, intense and expensive food sector lobbying estimated to have cost the industry up to £1bn, effectively stopped in its tracks EU plans to bring in traffic light labelling to make the nature and quality of food products transparent to the consumer.
Meanwhile, advertisers have switched their focus to where parents are often not looking. Can anyone stop the stalkers on the internet – including some major brands – grooming children to become gadget hungry, label conscious mini-consumers, particularly of the junk food we are meant to be eschewing, if the government really does want everyone to make a genuine change for life?
With no expectation of a sudden return to “normal” levels of overweight and obesity – a statistical conceit which assumed that 15% of children were overweight and 5% were obese in 1990 – the challenge to the coalition is to show its colours: will it back a robust and effective attack on the causes of the elevated levels of childhood overweight and obesity presently standing at about 30% overall, or merely resume handing around the calorie-laden fudge that guarantees future governments will be contending with a massive obesity epidemic and the disastrous social, economic and health consequences for the rest of the century.