This essay critically analyses the policy Healthy Lives, Healthy People: A call to Action on Obesity in England (Department of Health 2010), which focuses on promoting healthy eating to tackle obesity in England. The targeted population is childhood obesity (18 and below) valuates government policy on tackling obesity in children (below 18) which is a serious public health issue not only in England, but the UK and world at large (Who 2011). The essay analyses some of the strategies issued under the policy, to promote health nutrition in schools as part of the government strategy to reduce obesity. The essay defines child obesity and briefly outlines its prevalence in England in particular, and the UK in general, and the impact of obesity on physical, social and psychological health and wellbeing as well as on the fiscus. In the course of the discussion, the social determinants of health associated with childhood obesity will be analysed, before analysing the policy in particular, its aims, objectives, strategies and its limitations.
Child obesity is defined by having a Body Mass Index (BMI) of above ‘the 95th percentile for age and sex’. A report published by the National Child Measurement Programme (NCMP 2014/15) revealed that 20% of all children between the ages of four and five are overweight, and the prevalence is higher among boys (22.6%) when compared to girls (21.2%). In addition, the report revealed that a tenth of children between 4 and 5 years old, or reception, are obese, again, the percentage of obesity is higher in boys than girls. Furthermore, the same report highlighted that a third of children between the ages of 10 and 11 are overweight, again, boys are more overweight than girls. In addition, 20% of the 10 to 11 year olds who are overweight are considered morbidly obese (NCMP 2014/15). Obesity is a major public health issue, according to the Public Health England (2016). A global report published by the WHO (2011) indicated that in 2010 almost 43 million children globally were obese. The same report highlighted that obesity related morbidities killed more people than illnesses associated with underweight (WHO, 2011). Obesity is a risk factor for cardiovascular diseases (CD) coronary heart diseases (CHD), type 2 diabetes mellitus (T2DM), (Chan and Woo n.d), sleep apnoea, strokes, and certain types of cancers among other health related complications and costs the NHS and the government billions of money per year in treating obesity related illnesses (PHE 2016).
Many factors increase the risk of obesity, such as poverty, gender, ethnicity and social deprivation. For example, the report published by the NCMP, (2014/15) showed that 12% of the children who are overweight of obese live in socially deprived areas., compared to only 5.7% of those are overweight or obese who live least deprived areas, thus confirming a correlation between poverty and obesity. Lee et al. (2014) carried out a longitudinal study in the USA which linked obesity with poverty. The study, which comprised a sample of 1150 who were studied from the age of three through to the age of 15.5 years found that children who were exposed to poverty in early age of development (infancy), had higher incidents of obesity in adolescence (Lee et al. 2014). In agreement, a comparative study carried out by Drewnowsk et al. (2014) of Seattle and Paris showed that lower socio-economic status was linked with high incidence of obesity in the two cities. In addition to poverty and deprivation, other risk factors of obesity include ethnicity, for example, in the UK there is a wide body of evidence which shows that children from Black, Asian and Minority Ethnic groups (BAME) have high prevalence of obesity than children from Caucasian backgrounds (Caprio et al. 2008). A study carried out by Taveras et al. (2011) also indicated that there is a close link between ethnicity and obesity, with many children from BAME being obese than their white counterparts. Their study sample comprised 355 black children, 1343 white children and 128 Hispanic children who were studied from birth, and obesity was higher in Hispanics and black children. However, Caprio et al. (2008) argue that race and ethnicity are social constructs which depends on how different describe themselves, hence there is more to childhood obesity than race and ethnicity. One can argue that most ethnic minorities live in deprived areas and most are socially deprived, which will increase their risk of becoming obese. Children growing up in deprived areas may not afford to eat balanced nutrition which includes five fruits and vegetables per day .
According to Menza and Probart (2013), school age children are active and grow quickly hence they require high energy nutrients more than adults and older people. As a result, they require foods and drinks that meet the nutritional requirements of their needs. The British Nutrition Foundation (2017) recommends that school age children should have a diet rich in starchy and high carbohydrate foods such as potatoes, rice, pasta, oats, grains, breakfast cereals and bread, which are the main source of energy they require. In addition, they require proteins to repair tissues and for growth, and foods such as lean meat, eggs, dairy products, soya and bean products as well as fish, are rich sources of protein for them (Bergen and Robertson 2013). The BNF, (2016) therefore recommends that school age children should consume at least two portions of fish every week, of which one portion should be oily fish to provide them with omega 3 fatty acids, such as salmon and mackerel. In addition, children require both saturated fats (from animal products) and unsaturated fats (from vegetables, seeds and nuts) however, the fat must be the right amount otherwise excess saturated fats can result in overweight and obesity (Bergen and Robertson, 2013; Menza and Probart 2013). In addition, they also require a balanced amount of vitamins (A, C and D); minerals such as iron and calcium, the latter for bone healthy (Menza and Probart 2013). Obesity occurs when there is an imbalance between caloric intake and what the body uses as energy (Menza and Probart 2013). Most school age children, especially those growing in underprivileged communities, have a propensity of eating unhealthy foods such as saturated fats (Schanzenbach 2005) hence the high risk of obesity. Furthermore, children on free school meals have also been linked with high incidents of obesity largely due to poverty (Story, Nanney and Schwartz, 2009). Schools can contribute a lot towards maintaining good nutrition for children (Christine et al. 2015), which is why most government policies such as the Health Lives Healthy People: A Call to Action on Obesity (DO H 2013) target schools in tackling obesity.
The policy Healthy Lives, Healthy People: A call to action on obesity in England (DOH 2011) is a follow up with other polices to fight against obesity which were introduced by successive UK governments, such as The Health of the Nation: a strategy for health in England (DOH 1992), which aimed to reduce the prevalence of adult obesity by 7% by 2005. This policy, however, focused on exercising and healthy eating but did not address the main challenges that make people susceptible to obesity, such as tackling poverty and involving all stakeholders (Jebb et al. 2013). As a result, in 2002, the prevalence of obesity in England was still alarmingly very high, and the Chief Medical Officer (CMO) described obesity in England as a ‘time bomb’ waiting to tick off (DOH 2002). In response, the government held a public inquiry into tacking obesity, and resolved to include key stakeholders such as the food industry, scientists and professionals (McPherson, Marsh and Brown 2007), and the inquiry concluded that due to obesity, younger generations risked having their life expectancies reduced if action to address the root cause of obesity was not taken or addressed (Kopelman et al., 2007). As one of the public inquiry recommendations, focus was to be on children, who risked having reduced life expectancy due to obesity. As a result, The National Public Service Agreement (PSA 2004) stated that its main focus was, by 2010, to reduce obesity in all children under 11 years (DOH 2007). Some of the strategies for this policy included focusing on increasing physical exercising and an action plan on diet (Butland et al., 2007). Nonetheless, obesity among children and adults remained a national problem, rather reducing, however, it increased or remained stable. This led to the introduction of policies such as Healthy Weight: Healthy Lives (DOH 2008), this time the policy recognised the importance of focusing on community based initiatives and social marketing (Bhattacharya 2013). From a health promotion perspectives, one can argue that the earlier policies to tackle obesity were top-down approaches in which the government prescribed what needed to be down (Naidoo and Wills 2009), but failing to address issues such as poverty which is a major risk factor for obesity, hence community based initiatives would address some of the challenges experienced by the government in tackling obesity.
Some of the community based initiatives included involving Primary Care Trusts ,(Wall et al. 2011). There was notable improvement in tackling obesity in some Trusts, for example, the Calderdale Primary Care Trust reported that at least 700 obese adults in their Trust lost significant weight after the Trust invested £130,000 to fight obesity (The Director of Public Health’s Annual Health Report for Calderdale 2010), however, it is not very clear how these people were able to reduce their weight, whether it was through healthy eating if physical activity or both. As a result, the Trust said it had saved £53,000 (in treating obesity related illnesses) in 2010 as a result of its strategy to reduce obesity. Thus the government’s focus was now on involving all key stakeholders including communities and NHS Trusts. The government set aside a ring-fenced budget of £373 million to fight against obesity (Jebb et al. 2013). The government, through Healthy Weight: Healthy Lives (DOH 2008), focused on improving the environment to reduce child obesity, for example, through increased physical activities, adopting healthy diets, and supporting mothers to breastfeed their infants as there was evidence which indicated that formula milk increased the risk of obesity (O’Sullivan, Farver and Smilowitz 2015). Healthy weaning of infants was also emphasised (DH 2008). Furthermore, the policy put some restrictions on the advertising of unhealthy foods to children such as foods high in saturated fats (potato crisps for example), and foods high in salts, and sugars, which all increased the risk of obesity. From this perspective, one can see that the government, through Healthy Weight: Healthy Lives (DOH 2008) shifted focus on nutritional standards, and also set some nutritional standards for all schools in England, which they had to abide by to reduce child obesity (Jebb et al. 2013). In addition to focusing on schools, the NHS also introduced some interventions such as Change4life, which encouraged carers and parents to pack healthy foods in their children’s lunch boxes, while another NHS led initiative Start4life, encouraged breastfeeding as stated earlier. In addition, the policy stated that the food industry should introduce calorie-labelling on their menus and foods so that citizens are empowered to know the amount of calories in the foods they consume , again, focusing on social marketing (Jebb et a. 2013). The policy also introduced restrictions on advertisements of unhealthy foods during prime times on television to dissuade young people from buying unhealthy foods (OFCOM 2007).
The policy which makes the basis for this discussion, the White Paper Healthy Lives Healthy People (DH 2011), therefore built up on policies that had been enacted before, but which had very minimal success in tackling obesity, especially child obesity. The policy focused on both nutrition and physical activity, however, making sure that communities and all stakeholders are included. Some local authorities, such as Worcester, embarked on projects that encourage people to walk to work, for example, a pedestrian and cycling bridge was built as part of the Worcester Connect2 project (DH 2011). This helped to reduce congestion in the main city area, and in the same process, increased cycling by 31% and walking by 19% (DH 2011). In Birmingham, as part of the Healthy Lives Healthy People (DH 2011), GPs in the city was encouraged to write letters to people with a Body Mass Index of 30 as part of Lighten Up obesity campaign. The scheme targeted approximately 6000 obese people in the city and encouraged them to lose weight.
Like previous policies on obesity and healthy living, this policy also focused on healthy eating and calorie reduction. One of its purposes was to reduce the population’s calorie consumption by 5 billion calories (kcal) a day as a way of maintain a balance between calorie consumption and energy released out. This also included educating citizens on potion control (DH 2011), and calorie labelling, and working with schools to promote healthy eating in schools menus. However, the government will also need to tackle poverty and improve socio-economic environments for this policy, and any other future policies on obesity, to be effective. At international level, the UK signed up to the WHO European Food and Nutrition Action Plan 2015–2020, and the he Rome Declaration on Nutrition (2014) which are both international strategies to reduce obesity in general. In the European Union, of which UK is still a member state, the EU introduced the policy “EU Action Plan on Childhood Obesity 2014-2020, which is committed to health prevalence of childhood obesity. The policy recognise the importance of involving all key stakeholders in the fight against childhood obesity. Among other objectives of the policy, it recognises the importance of improving the consumption of fruit and vegetables in the EU falls below the recommended 400g per day (WHO 2012).The policy also intends to improve access to healthy foods for young people and their parents ,as well as making healthy foods affordable. However, without tackling poverty, the EU policy on tackling childhood obesity may be problematic. Furthermore, in the UK there have been initiatives to introduce tax on sugary drinks as a way of tackling obesity in children (SOURCE).
It can be argued that obesity and nutrition policies alone are not going to achieve the government’s target of reducing obesity (including child obesity). There are many barriers that can make this very difficult to achieve. First and foremost, a policy is merely a guideline and it is not legally enforceable, such as the Smoking Ban (2003) which is a legislation banning smoking in all public places. Obesity and overweight strategies involve behaviour change and lifestyle modification, for example, even if the OFCOM bans advertising of unhealthy foods during prime television time, this does not mean that people, especially children, will stop buying foods with saturated fats such as potato crisps and chocolates. This requires behaviour change at individual level (Naidoo and Wills 2009). In addition, technological advances mean that people in general and children in particular are becoming more and more less active: people uses cars to move from place to pace, children spend more time playing computer and video games or on their electronic gadgets (Shields and Tremblay, 2008; McDonalds et al., 2009), hence reducing calorie consumption alone without matching calorie input with energy expenditure will not achieve the desired effects of the policy Healthy Lives Health People (DH 2011). Hence the revolution in technological advancement make it difficult for governments to introduce effective strategies in tackling obesity.
In conclusion, although it was difficult to find a public policy that only focuses on nutrition and nutritional standards for citizens, this essay identified the policy Healthy Lives Healthy People: A call To Action on Obesity in England (DH 2011), as one policy that in its quest to tackle obesity, sets out some nutrition strategies for schools and whole populations in England. The policy sets out some nutrition standards for schools, and recommends food industries to label calories. The writer identified the risk factors of obesity, the social determinants of health linked with obesity, and critically analysed the policy aimed at improving nutrition and physical activity (as the two go hand in hand for an effective strategy), and also identified some of the challenges of this policy in reducing obesity. Nutritional interventions remain key to tackling obesity, however, socio-economic challenges should also be addressed as government level to reduce health inequalities of those at risk of becoming obese