Children’s health is weighing heavy

Overweight and obese children are at risk of a lifetime of ill health and an early death. Pharmacists need to be skilful in their approach if they are to help them, says Steve Titmarsh…

Childhood obesity in England soared during pandemic: according to some reports 1 in 4 children aged between 10 and 11 years are now obese,¹ although the proportion who are overweight (35 per cent) has not changed significantly for a decade.² And around a third of children aged 2 to 15 years are overweight or obese, with children becoming obese at a younger age and staying obese for longer.³

So bad is the situation that the WHO warns that childhood obesity could undermine many of the health gains made in recent decades.⁴ In England the NHS has launched a pilot of 15 new specialist clinics for severely obese children where they will be offered specialist treatment and tailored care packages developed with their family, which could include diet plans, mental health treatment and coaching.⁵

Being overweight or obese has serious health consequences. For example, obese adults are seven times more likely to develop type 2 diabetes and twice as likely to die early than their counterparts who are a healthy weight.³ Obesity is also linked to poor psychological and emotional health, and the experience of bullying is common for children who are overweight or obese.⁶

Poverty plays its part too: children from the most deprived areas are more likely to be obese than those who live in more affluent parts of the country.³ A range of complex factors lead to a person becoming obese, including behaviour, environment, genetics and culture.

Overweight or obesity during pregnancy is linked to babies being born above the normal weight range and the later development of childhood and adult obesity. Children who live with at least one adult who is obese at more likely to become obese themselves.⁶

Public health initiatives

The UK government has put in place a range of public health measures to tackle the growing problem. There are policies to persuade the food industry to reduce sugar levels in foods and drinks.³ Programmes in schools encourage physical activity along with healthy school meals. Moves to help people recognise healthy food options when food shopping are supported with apps like the NHS food scanner.⁷

The complex multifactorial nature of obesity demands a personalised approach to its prevention and management. At the very least a range of tools are needed to address the problem, involving strategies such as diet, physical activity and lifestyle.⁸

A Cochrane systematic review in 2019 of 153 trials found that interventions including diet and physical activity can reduce the risk of obesity in children aged 0–5 years. Physical activity alone was not effective. However, in children aged 6–12 years and adolescents 13–18 years old physical activity alone reduced the risk of obesity. Diet alone did not work.⁹

Unfortunately, the impact of the interventions was generally small, and perhaps not enough to have health benefits. The authors concluded that a system-wide approach is needed, including tackling the marketing of unhealthy food.

The Royal Society of Public Health says healthcare professionals need to make every encounter count. People may be willing to discuss issues beyond their immediate medical needs with a trusted healthcare professional (HCP). In particular, HCPs should be looking out for families living in difficult circumstances who are at higher risk of obesity and, where appropriate, signpost them to other agencies for help with poverty and adversity.¹⁰

Talking about weight in relation to children can be a challenge so guidance such as the National Child Measurement Programme, a conversation framework for talking to parents which is available from Public Health England, may be useful.¹¹

It’s diet and exercise

Diet and exercise are the fundamental means by which people can achieve and maintain a healthy weight. Information and motivation are key to helping them achieve that. Different strategies will work for different people, so it is important to understand what an individual's preferences are and to involve them in choosing for themselves the best approach to losing weight and maintaining a healthy weight.³

The Eatwell guide aims to help achieve a diet that consists of a balance of healthier and more sustainable food, showing people what they should eat overall from each food group.¹² Guidance from the chief medical officer in England advises that children up to the age of 5 years should aim for an average of at least 180 minutes of exercise each day.¹³ Children and young people aged 5 to 18 years should aim to be physically active for an average of at least an hour a day.¹⁴

A good night’s sleep is also an important component in maintaining healthy weight. Too little sleep is a risk factor for overweight and obesity among children. It is thought that too little sleep results in an energy imbalance caused by a change in hormone regulation, which in turn reduces the amount of physical activity a child undertakes so they are inactive for longer and eat more calories.¹⁵ Generally five-year-olds need about 11 hours sleep, while 9-year-olds need about 10 hours.¹⁶

Where pharmacies fit in

Community pharmacies have been found to be effective in delivering public health initiatives. Their role in providing weight management services was endorsed recently by the NHS with a move to allow community pharmacy teams to refer adults living with obesity and other conditions to a 12-week online NHS weight management programme.^17,18

Adults living with obesity plus hypertension or diabetes can access the service, which is provided via an app on a smartphone or online. People from black, Asian and minority ethnic backgrounds with a body mass index (BMI) of 27.5 are also eligible for the service.¹⁶

Providing weight management education and support to adult clients may well have an impact on childhood obesity. It is known that children’s eating habits are influenced by their parents. For example, having access to healthy foods is key to developing preferences and overcoming dislike of foods.

Structured mealtimes are important and families who eat together tend to eat more healthy foods.¹⁹ Encouraging and supporting adults to have a healthy approach to the foods they choose to eat, as well as adopting a healthy lifestyle, could benefit their children and may help them avoid the lifelong impact of being overweight or obese.

References

1. www.theguardian.com/society/2021/nov/16/childhood-obesity-in-england-soared-during-pandemic; accessed 4 April 2022.
2. https://stateofchildhealth.rcpch.ac.uk/evidence/prevention-of-ill-health/healthy-weight; accessed 4 April 2022.
3. www.gov.uk/government/publications/childhood-obesity-a-plan-for-action/childhood-obesity-a-plan-for-action; accessed 4 April 2022.
4. Breda J, Sant’Angelo VF, Duleva V, et al. Mobilizing governments and society to combat obesity: Reflections on how data from the WHO European Childhood Obesity Surveillance Initiative are helping to drive policy progress. Obesity Reviews 2021;22 Suppl 6:e13217.
5. www.england.nhs.uk/2021/11/specialist-clinics; accessed 4 April 2022.
6. www.gov.uk/government/publications/childhood-obesity-applying-all-our-health/childhood-obesity-applying-all-our-health; accessed 4 April 2022.
7. www.nhs.uk/healthier-families/food-facts/nhs-food-scanner-app/?WT.mc_ID=Search_FS_Jan_2022&gclid=CjwKCAjwloCSBhAeEiwA3hVo_Y4KKoFRytlWxjfNXVOGn4I4uGmF3wKLx56G1yg5WDs8TSI5a9nflhoC0PwQAvD_BwE&gclsrc=aw.ds; accessed 4 April 2022.
8. Motevalli M, Drenowatz C, Tanous DR, et al. Management of Childhood Obesity – Time to Shift from Generalized to Personalized Intervention Strategies. Nutrients 2021;13(4):1200.
9. evidence.nihr.ac.uk/alert/diet-and-physical-activity-interventions-targeting-children-and-youth-have-different-yet-small-effects-on-preventing-obesity;accessed 4 April 2022.
10. https://stateofchildhealth.rcpch.ac.uk/evidence/prevention-of-ill-health/healthy-weight; accessed 4 April 2022.
11. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/788813/NCMP_Conversation_framework_for_talking_to_parents.pdf; accessed 4 April 2022.
12. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/528193/Eatwell_guide_colour.pdf; accessed 4 April 2022.
13. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1054686/physical-activity-for-early-years-birth-to-5.pdf; accessed 4 April 2022.
14. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1054282/physical-activity-for-children-and-young-people-5-to-18-years.pdf; accessed 4 April 2022.
15. Morrissey B, Taveras E, Allender S, et al. Sleep and obesity among children: A systematic review of multiple sleep dimensions. Pediatric Obesity 2020;15(4):e12619.
16. www.nhs.uk/live-well/sleep-and-tiredness/healthy-sleep-tips-for-children; accessed 4 April 2022.
17. England.nhs.uk/2022/01/new-weight-loss-support-on-the-high-street; accessed 7 April 2022.
18. England.nhs.uk/digital-weight-management; accessed 7 April 2022.
19. ncbi.nlm.nih.gov/pmc/articles/PMC4408699; accessed 4 April 2022.
20. www.nhs.uk/live-well/healthy-weight/childrens-weight/very-overweight-children-advice-for-parents