Childhood obesity has risen ten-fold over the past 40 years. In the UK, roughly 30% of children are overweight or obese. Obesity rates are much higher among children living in deprived communities. In England, there is a clear trend: the wealthier a child’s family is, the more likely the child is to be a healthy weight. And those who are a healthy weight during childhood are much more likely to be a healthy weight in adolescence.
In 2006, then Labour leader and prime minister Tony Blair argued that many public health problems, including obesity, can be solved by getting people to change their lifestyles. But strong evidence from behavioural economics research and weight-loss trials shows that advocating personal responsibility is destined to fail in the long-term.
The fact remains that behavioural interventions alone – such as the NHS five a day and Change4Life campaigns – do little to address child obesity across society, because healthy food is not always easily accessible. In fact, these types of approaches widen socioeconomic health inequalities. Findings from my latest research drive this home: childhood obesity rates in Liverpool – one of England’s most deprived cities – increased by up to 3% between 2006 and 2012.
Lessons from Liverpool
For our study, we analysed data from the National Child Measurement Program (NCMP), which measures the height and weight of children within state schools across England. We examined the data of 25,905 children aged four to five years and 24,220 children aged ten to 11 years, recorded between 2006 and 2012, in order to track changes in childhood obesity and socioeconomic health inequalities over time.
Liverpool is the sixth largest city in England, and up until 2016 it was ranked as the nation’s most deprived, with over 90% of Liverpool’s 470,000 population living in areas of high deprivation. Across the six-year duration of the study, children who lived in deprived communities became overweight or obese at a greater rate than children living in less deprived communities.
As public health and other services across England continue to have their funding cut by central government, it’s more important than ever that the nation takes a new approach to tackling child obesity, and reduce inequalities linked with poor health.
A better way
For too long, behavioural interventions have been used to prompt people – especially parents – to take responsibility for individual instances of child obesity. For example, the national social marketing campaign Change4Life aims to prevent child obesity, by educating and informing families about the benefits of being physically active and eating healthily. And the NCMP informs parents if their child is overweight by means of a letter, reinforcing the idea that it’s the parent’s responsibility to address their child’s weight.
Meanwhile, little attention is paid to the policies or the social and environmental conditions which also shape healthy (or unhealthy) behaviours. Research points to inequality as a primary factor which prevents people from making healthy choices. For example, many deprived communities are “food deserts”, where affordable or high-quality fresh food is hard to come by.
Deprived communities also have few opportunities for physical activity, and typically live in areas where there are lots of fast food outlets. If we take Liverpool as an example, the city now houses over 600 fast food outlets – a figure which has risen by roughly 10% since 2014.
There is quite a lot of evidence showing that children are more likely to be overweight or obese if there are fast food outlets near their home or school. To reduce access and remove temptation, some councils in England have suggested banning fast food outlets within 400 metres of schools. But councils’ hands are tied, as they don’t have the powers to stop new takeaway outlets being built.
People are the product of their environment, and in modern society, the default choice for many people is the unhealthy choice – and for some, the only healthy eating choice has been shown to be more expensive. To address this major problem, government policies need to address public health priorities. The healthy choice needs to be just as easy as the unhealthy choice, and there needs to be a level playing field, in terms of the accessibility and pricing of decent food.
Placing the responsibility on children and families, without changing their economic and physical environment, will do little to tackle health inequality and reduce weight-related health problems in society. Instead, the government needs to step in and, through policy, create communities which promote and enhance healthy choices and lifestyles. Only this will ensure that the default choice for most people is the healthy choice.