- Key issues and gaps
- Who is at risk and why
- The level of need in the population
- Current services in relation to need
- Service users and carers opinion
- Expert opinion and evidence base
- Projected service use in 3-5 years and 5-10 years
- Recommendations for consideration by commissioners
- Recommendations for further needs assessments
- Annual Public Health Report 2012
- Key contact
- Print-friendly version of this section (PDF, 349KB)
- Data for this section (Excel, 490KB)
The National Child Measurement Programme aims to identify the prevalence of childhood obesity locally to help plan and deliver local support services. Schoolchildren in reception (aged 4–5 years) and year 6 (aged 10–11 years) have their height and weight measured.
The 2012-13 NCMP demonstrated that over a fifth of all reception children measured across England were overweight or obese (22.5%), and a third of all Year 6 children (33.3%). The percentage of obese children in Year 6 (18.9%) was also over double that of Reception year children (9.3%). While the proportion of those who are overweight has remained largely unchanged since the mid 1990s, there has been a significant increase in childhood obesity levels over time, by around 1% every two years until 2007. The 2012-13 NCMP programme revealed the first drop in overweight and obesity prevalence in Year 6 children since 2006/7, however, further years’ data is needed to confirm a national decline. (see footnote 1). As more NCMP data becomes available and annual data aggregated to rolling averages, overall national and local trends over time will become more apparent.
Overweight and obesity profile of Haringey children
Evidence shows that at a basic level, obesity is caused by an intake of calories in excess of calories expended. However, obesity is a complex problem with a range of influences and determinants which makes it difficult for people to adapt their behaviour to make changes to their diet and lifestyle (see footnote 2).
Childhood obesity is associated with significant psychological and physiological health problems. As well as increasing mortality, obesity is a risk factor for a range of chronic diseases including Type 2 diabetes, coronary heart disease and some cancers. Most of these are diseases of adult life, but the major risk of obesity and overweight in children is the likelihood that this excess weight will continue through adulthood (overweight adolescents have a 70% chance of becoming overweight or obese adults), but some directly affect children themselves. Of particular concern is the emergence of type 2 diabetes, previously considered to be a disease of adulthood, in obese schoolchildren. Childhood obesity has also been linked to poor self-image, low self-confidence and depression, as well as social and psychological consequences – including stigmatisation, discrimination and prejudice. Postnote 2003 no.205 (PDF, 112KB)
Most of the financial costs of childhood obesity and overweight are likely to be stored up as future costs in treating and managing the arising co-morbidities in adulthood. However, there are examples of more contemporary costs – such as schools needing to purchase specialist classroom and gym equipment to accommodate the needs of obese and overweight children (see footnote 3).
In response to growing concerns about rates of obesity, the Department of Health published Healthy lives, healthy people: a call to action on obesity in England (external link) in October 2011 which outlines a national ambition to achieve: “a sustained downward trend in the level of excess weight in children by 2020.”
- The Foresight Report of 2007 (external link) remains a robust analysis of the causes of excess weight in England and potential solutions. It demonstrated how at the heart of the obesity issue is a fundamental energy imbalance– our calorie intake exceeds our calorie needs. It also showed how a complex interplay of factors drive this imbalance, from economic forces to biological ones. The report stated that no approach to obesity will be effective if it does not combine steps to address underlying environmental factors with individual action. Any approach will therefore need to address a wide range of issues in a coordinated way. The diagram below represents a simplified version of the factors affecting obesity:
Figure 1: Foresight Obesity Systems Atlas.
- ‘Healthy lives: a call to action on obesity in England’ states that a range of local interventions are needed to both prevent obesity and treat those who are already obese or overweight. The Healthy Child Programme from 5 to 19 years old (external link) recommends that overweight or obese children should be referred to appropriate weight management services to help them achieve and maintain a healthier weight.
- Reduced funding for Schools Sports Partnerships has had an impact on schools’ ability to provide physical activity interventions.
- The Dietetic Service in Haringey is currently only funded to treat adult patients.
- In adults, obesity is defined by a Body Mass Index (BMI) of 30 or more. The National Child Measurement Programme (NCMP) guidance for primary care requires that overweight or obesity be assessed by calculating BMI and plotting it onto a gender-specific BMI chart for children (UK 1990 chart for children aged over 4 years). Children over the 85th centile, and on or under the 95th centile, are categorised as 'overweight'. Children over the 95th centile are classified as 'obese'.
- Regular physical activity can reduce the risk of many chronic conditions including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions. The Department of Health report Start active, stay active: a report on physical activity from the four home countries' Chief Medical Officers (external link) emphasises the benefits of physical activity across the life course and highlights the risks of sedentary behaviour for all age groups. Evidence cited in the report shows an association between sedentary behaviour and overweight and obesity, with some research also suggesting that sedentary behaviour is independently associated with all-cause mortality, type 2 diabetes, some types of cancer and metabolic dysfunction. For children, the report recommends the following:
Early years (under 5s)
- Physical activity should be encouraged from birth, particularly through floor based play and water based activities in safe environments.
- Children of pre-school age who are capable of walking unaided should be physically active daily for at least 180 minutes (3 hours) spread throughout the day.
- All under 5s should minimise the amount of time spent being sedentary for extended periods (except for time spent sleeping).
Children and young people (5-18 years)
- All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours a day.
- Vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week.
- All children and young people should minimise the amount of time spent being sedentary (sitting) for extended periods.
- Childhood obesity is closely linked to parental and family influence. If a child has at least one obese parent, they are around three times more likely to be obese than a child with no obese parents (see footnote 4). Parents have a significant influence on the eating habits of their children but for a variety of reasons may not always encourage the healthiest choices for their children. The reasons for this are multifaceted but may include:
- Lack of information
- Conflicting marketing messages about what constitutes healthy food
- “Junk food” may be cheaper and more available locally than fresh healthy food
- The economic situation and increase in food prices may mean people spend less on food or buy foods that are cheaper, energy dense and nutrient poor.
Ethnicity and deprivation
Although children may be inheriting unhealthy lifestyle habits from their parents, some children are genetically more susceptible than others. The London Health Observatory in their review of deprivation and ethnicity (see footnote 5) based on the 2008/09 NCMP data found that:
- Children in Black ethnic groups have a significantly higher risk of obesity than those in Mixed, Asian, Other and White ethnic groups.
- Children living in deprived areas have a higher risk of obesity than those living in less deprived areas. However, the increased risk associated with deprivation is greatest for White children, whereas it seems to have much less of an effect for Black children. For Asian, Other, and Mixed ethnic children deprivation increases the risk of obesity, but not as much as for White children.
Analysis by the National Obesity Observatory (external link) suggests that ethnicity may not be as strongly linked to obesity as deprivation because weight differences between ethnic groups may be linked to differences in body composition and other physical categories e.g. height (see footnote 6).
The London Health Observatory found that deprivation and ethnicity seem to have a stronger effect on obesity risk in Year 6 than in Reception. Attempts at tackling childhood obesity may therefore be more effective at an earlier rather than later stage, before factors related to deprivation and ethnic group become increasingly pronounced.
A short piece of research was undertaken in Haringey in 2007 which looked at the factors influencing childhood obesity which included access to fast food outlets. Figure 2 describes levels of obesity in relation to the distribution of fast food outlets. Obesity is higher in the east of the borough where there is also a higher concentration of fast food outlets. The Public Health Directorate recently worked with City University London to undertake a study focussing on selected secondary schools and fast food outlets. We wanted to hear the voices of local children and young people, and the key findings were that children’s intake of fast food and sugary soft drinks goes up when it is easily available and cheap This report is due to be published in September 2014.
For more information, please this 2014 Haringey presentation on Childhood Obesity (PDF:1.67MB)
Figure 2: Percentage of obese and overweight children in year 6 in 2011 with fast food outlets.
In the school year 2012/13, the NCMP showed that in Haringey, 10.2% of reception, and 23.4% of year 6 children were classed as obese.
22.7% of children in reception and 39.4% in year 6 were either overweight or obese.(see footnote 7) These numbers align with the national obesity trend, with prevalence considerably higher in year 6 children than amongst reception classes. Overweight and obesity rates in both reception year and year 6 have fluctuated considerably in Haringey from 2006 to 2013.
Figure 3: Trends in obesity and overweight prevalence in reception.
Source: Public Health England
There is no statistical difference in prevalence between Haringey and London.
Figure 4: Trends in obesity and overweight prevalence in year 6.
Source: Public Health England
There is no statistical difference in prevalence between Haringey and London.
There are geographical variations within Haringey. Obesity rates are higher in the east of the borough which reflects the demographic profile of Haringey i.e. more deprived in the east and more ethnic diversity.
Figure 5: Percentage of reception age children who are obese - 2012
Figure 6: Percentage of year 6 children who are obese - 2012
Prevalence of Obesity relative to deprivation
Nationally, there is a link between levels of deprivation and obesity. Data from the 2013-13 NCMP clearly show this link locally (see chart below where 1 is the most deprived and 10 the most affluent areas of Haringey). Each child’s record was assigned a deprivation score based on the child’s address. For both Reception and Year 6 children there is a positive correlation between the two variables.
Figure 7: Prevalence of obesity relative to deprivation.
The table below (figure 8) shows the local analysis of prevalence of obesity and overweight in children in the largest ethnic groups in Haringey: Any Other White, White British and Black African. Obesity rates in reception and Year 6 are statistically higher in each of these ethnic groups than White British Children. Black African ethnicity is also statistically higher than Any other White ethnic group and Black Caribbean ethnicity in Reception (confidence intervals of 95%). In year 6, nearly half of all Black African and Black Caribbean children are overweight or obese.
Figure 8: Prevalence of overweight and obesity by main Haringey ethnic groups.
- Haringey has recently achieved stage 1 Baby Friendly Accreditation which aims to improve the support provided for women to initiate and maintain breastfeeding - see maternity section.
- Breast milk has been shown to decrease the risk of obesity in later life, which is why the Public Health directorate has recently commissioned a breast feeding support group to help mothers to support each other to breast feed.
- Healthy Start provides vouchers for fresh fruit and vegetables for eligible families and is promoted in Haringey by midwives, health visitors and Children’s Centres.
- Early identification and prevention of obesity is a key priority of the Healthy Child Programme (external link). The Healthy Child programme is currently targeted at vulnerable families in Haringey. Families are given information and advice around breastfeeding, healthy weaning, healthy eating and active play.
- The HENRY (Health Exercise Nutrition for the Really Young) programme has recently started in Haringey. Trained facilitators run an 8 week programme for parents and carers of very young children aiming to introduce healthy lifestyles at a young age. Courses are run from children's centres and professionals can refer families onto the courses. Further information is available from Sheena Carr (email@example.com)
- Healthy Schools Programme – schools are encouraged to achieve and maintain their Healthy Schools Bronze, Silver and Gold awards by completing a review detailing how they are promoting healthy eating and physical activity and to work towards becoming Enhanced Healthy Schools. To achieve their Silver and Gold awards, schools devise an action plan by choosing a health priority and including childhood obesity and doing a targeted piece of work focusing on their most vulnerable pupils. The Healthy Schools Haringey programme is aligned with the Healthy Schools London network (external link)
- The Public Health directorate strongly promotes the national Change 4 Life campaign (external link) in schools and the local community. Our schools and partnership work ties in with the national Change 4 Life campaign to promote healthy living to families and to alert partners to new national campaigns.
- Despite reduced funding, the Schools Sports Partnership is still working with schools to promote sport and organise competitions between schools.
Families with concerns about their child’s weight can access primary care services via their GP. The Public Health directorate has recently developed a child obesity pathway which will help to signpost and support families and children and young people who have concerns regarding their weight. Raising issues about a child’s weight with their parent or carer can be difficult, so we provide weight management training for a wide range of professionals to work sensitively and effectively with families. Further information is available from Healthy Schools Haringey lead, Debbie Arrigon: (firstname.lastname@example.org)
The Schools Health Education Unit (SHEU) (external link) carried out a survey in 2009/10 in Haringey. A total of over 1800 pupils took part in 17 primary schools and 8 secondary schools in Haringey. The pupils at the Pupil Referral Unit also undertook the exercise. The survey was coordinated by the former Healthy Schools Team in Haringey as a way of collecting robust information about young people’s lifestyles.
- Pupils were asked to identify, from a list, the foods which they ate ‘on most days’. 61% of pupils said they have fresh fruit and 43% said vegetables. 19% said crisps and 22% said sweets ‘on most days’.
- 28% of pupils said that they ‘rarely’ or ‘never’ ate fish or fish fingers. 14% said they ‘rarely’ or ‘never’ had salads.
- 33% of pupils had eaten 5 or more portions of fruit and vegetables on the day before the survey, 7% had eaten none.
The SHEU survey will be repeated in a sample of Haringey schools in 2013.
There is a vast amount of evidence relating to obesity. The key documents are listed below.
- Department of Health: Healthy lives, healthy people: a call to action on obesity in England (external link)
- The Foresight Report of (2007) (external link)
- Greater London Authority: Childhood Obesity in London. April 2011 (PDF, 2.36MB - external link)
- Parliamentary Office of Science and Technology: Postnote 2003 no.205 (PDF, 112KB)
- Weight management before, during and after pregnancy. NICE public health guidance 27 (2010).
- Prevention of cardiovascular disease. NICE public health guidance 25 (2010).
- Promoting physical activity for children and young people. NICE public health guidance 17 (2009).
- Maternal and child nutrition. NICE public health guidance 11 (2008).
- Physical activity and the environment. NICE public health guidance 8 (2008).
- Behaviour change. NICE public health guidance 6 (2007).
- Obesity. NICE clinical guidelines PH47 (2013): Managing overweight and obesity among children and young people: lifestyle weight management services (external link)
- National Institute for Health and Clinical Excellence: Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children 2006 (external link)
- The Marmot Review (2010) Fair society, healthy lives: strategic review of health inequalities in England post 2010 (external link)
- Healthy child programme: Pregnancy and the first 5 years of life (external link)
- Healthy child programme: The two year review (external link)
- Healthy child programme: From 5–19 years old (external link)
- Healthy lives, healthy people: a call to action on obesity in England (external link)
- Healthy weight, healthy lives (external link)
Healthy Weight Healthy Lives A toolkit for developing local strategies (external link) stated that the proportion of children who are obese in the under 20 age group will rise to approximately 15% in 2025 (with slightly lower prevalence in boys than in girls).
- By 2050, it is estimated that 25% of under 20 year olds will be obese.
- By 2050, it is predicted that 70% of girls could be overweight or obese, with only 30% in the healthy BMI range. For boys, it is estimated that 55% could be overweight or obese and around 45% could be in the healthy range.
- Among children aged 6-10 years, boys will be more obese than girls, with an estimate of 35% of boys being obese by 2050, compared with 20% of girls.
- Among children aged 11-15 years, more girls than boys will be obese by 2050 – 23% of boys and 35% of girls
Predicted figures should be viewed with caution as confidence intervals associated with these figures grow larger as one project into the future.
- Utilise the broad range of partners at the Health and Wellbeing Board to oversee the strategic high impact changes that commissioners and leaders can embed into service specifications, tenders and service level agreements to tackle the broad range of factors affecting childhood obesity.
- Work with the Clinical Commissioning Groups to ensure that both primary care and secondary care have a role in identification, brief advice, onward referral and commissioning clinical action.
- Continue to undertake the NCMP to build local intelligence in order to inform service planning through robust analysis of childhood obesity “hotspots”.
- Share the evidence base with schools, Children’s Centres and other providers of services to children to enable them to make the best decisions to improve the health of the children in their care.
- Ensure early identification and prevention of obesity through the commissioning of the Healthy Child Programme to encourage health professionals to provide nutrition and physical activity information/advice to pregnant women and parents of young children.
- Promote the HENRY Programme to professionals and encourage referrals.
- Continue to work with schools, supporting them to maintain their Healthy Schools Status and work to achieve an Enhanced Healthy Schools Status, which has reducing childhood obesity as a key priority.
- Utilise the evidence base to implement school based interventions using local capacity e.g. the Tottenham Hotspur Foundation, Schools Sports Partnership and Healthy Schools team within Public Health.
- Use opportunities in the local media to raise awareness of childhood obesity and healthy lifestyle information with the general population.
- Work with colleagues in the Council to restrict the number of new fast food outlets, particularly near schools.
- Work with fast food outlets to support them in reducing the salt, fat and sugar content in their menus.
Ongoing analysis of National Child Measurement Programme (NCMP) data in Haringey.
Sheena Carr, Senior Public Health Commissioning Strategist, Children & Young People
- NCMP England, (2012/13) Report (PDF, 1.35MB)
- Childhood Obesity in London (PDF, 2.36MB - external link)
- NICE Guidance PH47 - (October 2013) Managing overweight and obesity among children and young people: lifestyle weight management services (external link)
- McCormick, B. Stone, I. and Corporate Analytical Team. 2007. “Economic costs of obesity and the case for government intervention”. Obesity reviews 8 (Suppl.1), 161-164
- Causes of childhood obesity in London - London Health Observatory (2009) NCMP Analysis
- Ridler C, Townsend N, Dinsdale H, Mulhall C, and Rutter H. “Detailed Analysis of the 2007/08 National Dataset. National Obesity Observatory, April 2009.
- National Child Measurement Programme: England, 2010/11 school year - The NHS Information Centre (external link)
- Tackling Obesities: Future Choices - Project Report, Foresight 2007, PDF 11MB (external link)
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