Theresa May has stipulated that every child is to be weighed by default in her Plan for Action to tackle childhood obesity. That is very welcome. But, since the Plan’s announcement in August, there has been total silence on what “ default “ actually means. Neither Nr 10 nor the Department of Health or any of the Medical Royal Colleges * who might have been expected to be consulted on the issue appear to have any idea of the detail. That is plainly wrong. The National Obesity Forum believes that, after 4 months, it is high time that the small print was published to prove how much serious thinking on the Plan has been done.
Just explaining what “ default “ actually means would be helpful. If it means that every child is weighed every time it shows up for a medical check, that would be rubbish: on average a child comes into contact with a health professional some 50 times by the time it leaves school. If however it was weighed at set times in order to identify a concerning weight trend, the programme would be brilliant. After all, animals are weighed annually in zoos to check on their health and our cars get an MOT yearly once over, so why not our children? Without such a programme another stated objective in the Plan - the identification of weight issues early on – will not be achievable.
Weighing children is nothing new. Indeed, programmes were initiated over a hundred years ago but they were axed before childhood obesity ever became a serious problem. Currently a child is weighed a few times in its first year of life but hardly at all thereafter. The Forum holds the view that this omission, over many years, to a huge number of children with critical weight gain not being identified and referred for treatment. A quarter of our 4-5 yr old population didn’t get overweight or obese overnight. Their plight is, in the words of the Secretary of State, is a “ great scandal “ – and he could have added that it is one that he should have substantially attenuated..
It is not as if he and former Health Secretaries were left in any doubt as to what to do. In his 2002 Annual Report the Chief Medical Officer for England, Sir Liam Donaldson, called on all primary care professionals – GPs, health visitors, school nurses and the rest - to identify the early stages of childhood obesity and offer early interventions. By 2004 the House of Commons’ Health Select Committee [HSC] recommended to the government that every child in primary school to be assessed for BMI annually. Again in 2010 Donaldson recommended that schoolchildren have annual fitness tests and most recently Dr Sarah Wollaston, the current HSC chair, repeated the call by the predecessors. Indeed to-day’s HSC recommends that the public health survey taken at 4-5yrs be brought forward to one at aged 2yrs. In the opinion of the National Obesity Forum, a default weighing programme should be implemented as soon as possible at all these ages. Had they been when recommended, there is no doubt that tens of thousands of excessively overweight children would have been spotted and could have been helped not to drift into obesity.
The Plan for Action already has already provided the opportunity. In a separate provision it has directed schools from the 2017/18 academic year to begin to deliver 30 minutes of physical activity and what better than to assess fitness levels at the same time, too? Although the proper interpretation of BMI data might rightfully be the preserve of health professionals, the actual job of assessment could be carried out by any responsible adult once they have been trained to do it. The equipment required is inexpensive and the methodology uninvasive. Carried out properly the operation could induce a significant improvement in the country’s obesity figures,
Finally, and from 2017 too, physically activity will be a key part of the new healthy schools rating scheme. They will have the opportunity to demonstrate what they are doing to help their pupils become or stay healthy and fit. They will be encouraged to work with the school nurses, health centres, healthy weight teams in local authorities across the country. Ofsted inspections will keep them up to the mark. It’s a win-win situation – and about time, too.
*Royal College of Paediatrics, Royal College of General Practitioners, Royal College of Physicians’
Rt Hon Jeremy Hunt MP
Secretary of State for Health
Department of Health
SW1A 2NS 11 January 2017
Dear Mr Hunt
We are writing this open letter to encourage you to elaborate on measures, set out in the Childhood Obesity Plan, for a default child weighing programme, or to launch a consultation with experts to determine how such an initiative could be best implemented.
Our belief is that such a programme could have a significant impact on levels of childhood obesity that remain dangerously high. It would allow early identification and intervention to prevent overweight and obesity in children that could affect their long-term health outcomes. And over time such a programme could ultimately help in counteracting obesity levels across the population as a whole, in turn reducing the cost of obesity to the NHS.
The inclusion of weighing children within the Childhood Obesity Plan was extremely welcome. While weighing children at every medical appointment would be excessive, an annual check would be in line with the recommendations of experts for annual child health checks, including those of former Chief Medical Officer Sir Liam Donaldson and Chair of the Health Select Committee Dr Sarah Wollaston.
With one in five children considered overweight or obese by the time they begin primary school, according to the National Child Measurement Programme, we would urge you to implement this part of the Childhood Obesity Plan with all haste. We believe this could be achieved at minimal cost but with great reward.
Professor David Haslam
Chairman, National Obesity Forum
Spokesman, National Obesity Forum