by Dr Samantha Ross, General Practitioner, GPwSI in Pre-School Growth and Nutrition
Childhood obesity prevalence rates remain high in the UK. There is concern that this major public health issue needs a multilateral and holistic approach to tackle and reduce the risk of development of co-morbid conditions which are increasingly seen in later childhood as well as in adolescence and adulthood.
The RCPCH report ‘Tackling England’s Obesity Crisis‘ (October 2015) outlines the clinical issues.
General principles for reducing the risk of early childhood weight include:
- Generally responsive breastfeeding is protective against the development of obesity.
- Overfeeding is a contributory factor and responsive bottle feeding aims to reduce this risk, but parents may need support to identify feeding cues.
- Early weaning1, and excessive portion sizes2 can lead to overriding of appetite control which can then contribute to development of overweight. Parents may need to be signposted to Health Visitors for support and reliable resources (such as those produced by First Steps Nutrition Trust).
Not all overweight and obese infants will become obese adults and it is important to highlight that the WHO growth charts are based on optimum nutrition, ie. a healthy breastfed population.
Healthcare professionals should use the WHO growth charts to assess weight and BMI. These supersede older charts (such as UK90). If weights are compared to the previously employed UK90 charts around 3% of one year old children would be at or above the 98th centile for weight on the UK90 charts but 6% of these infants will be at or above the 98th centile on the current WHO weight charts.
Be aware of the increased risk for:
- Large babies (>4kg at birth)1
- Infants showing rapid crossing of centiles in the first few months1
- Other findings such as dysmorphism, developmental delay and length disparity (short height relative to weight*).
Clinicians should consider the possibility of an underlying disorder in such cases.
*Most children will have a weight centile no more than one to two centile spaces above or below their height. More than this should prompt further review for potential underlying causes (see the Patient.co.uk page Obesity in Children).
When speaking with parents, it is important to have documented the weight and BMI in those over 2 years of age. The BMI look up tool on the A4 WHO 2-4 year old growth chart is a simple ready reckoner which identifies the overweight and obese child. Showing the parent the growth chart and asking them what they think can help to introduce this topic, and can also facilitate discussion to find out how ready families are to change behaviours. The use of other tools, such as an accurate food diary, may help identify habits amenable to change. Parents may respond to discussion on protecting their child’s future health and reducing risk. Health visitors are pivotal in the early management and prevention of overweight and obesity.
In consultations regarding childhood obesity, use of the term ‘obese’ may be unhelpful and it is considered more constructive in discussions with parents to use objective observations- for example a child’s weight being ‘outside the desirable range’, or ‘out of proportion with length or height’. If necessary ‘very overweight’ is a preferable term.
It is important to assess every baby and child holistically within the context of their family and environment and be aware of safeguarding (child protection) and vulnerability concerns. Sharing information with child protection teams and social services where you have concerns in a timely manner is important. All GPs have a responsibility to ensure they remain up to date and maintain competencies in safeguarding and child protection. Local training should be available, and GPs should refer to local guidance when considering any child where there may be concerns.
Interventions and Nutrition Resources
HENRY (Health, Exercise, Nutrition for the Really Young) Evidence Based childhood obesity early intervention programme, providing training and resources for health care practitioners and childcare settings, structured family interventions and peer support schemes
The NHS Website: What can I do if my Child is Very Overweight? Advice for parents on healthy eating, portion size, activity, parental role modelling and support options.
First Steps Nutrition Trust: Infants and New Mums Resources including information on breastfeeding and eating well in the first year
First Steps Nutrition Trust: Eating Well in the Early Years Includes a range of resources including cost-effective nutritious meal and packed-lunch recipes and portion size guides.
Healthier Scotland: Eat Better Feel Better Recipes and tips for healthy eating
The Eatwell Guide UK Government/Public Health England dietary recommendations for children over the age of 1 and adults (2016). Includes the updated ‘Eatwell Guide’ infographic.
Physical Activity Guidelines
Start4Life & Healthy Start Information
Start4Life NHS Campaign aligned with NICE guidelines, WHO guidance and UNICEF’s Baby Friendly Initiative. Provides information for parents to assist a healthy start for all babies, including the potential to subscribe to weekly emails and videos to support a lifestyle from pregnancy through to parenthood.
Healthy Start UK-wide government scheme to improve the health of low-income pregnant women and families on benefits and tax credits. Provides vouchers which can be used to obtain fresh fruit and vegetables, milk and Healthy Start Vitamins.
Healthy Start for Health Professionals Explains the Healthy Start scheme for healthcare professionals.
Public Health Information
NHS Digital: National Child Measurement Programme Explains the role of the mandatory programme designed to inform local planning and delivery of services for children, gather data on childhood overweight/obesity and provide information to assist in engaging children and families with healthy lifestyles and weight issues.
Public Health England: Childhood Obesity Applying All Our Health Report summarising the public health issues around childhood obesity, potential interventions and guidelines.
Public Health Wales: Take our 10 steps to a healthy weight to help beat childhood obesity Includes 10 Steps to a Healthy Weight infographic and video.
Obesity Action Scotland Providing independent advocacy and clinical leadership on preventing and reducing overweight and obesity in Scotland.
Public Health England: Child Health Profiles (‘Fingertips’) Child health statistics including breastfeeding initiation and prevalence and prevalence of childhood obesity by region or CCG can be examined for England. Use the drop-down boxes to change the viewing parameters.
National Child and Maternal Health Intelligence Network (CHIMAT): Child Health Profiles Includes links to ‘Fingertips’ and child health profiles by Local Authority.
- Weng S, Redsell S, Swift J, Yang M, Glazebrook C. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Archives of Disease in Childhood. 2012;97:1019-1026.
- WHO: Limiting Portion Sizes to Reduce the Risk of Childhood Overweight and Obesity 2014