'This is a war. If you are worried about the thing that hurts British people the most, it ain’t ISIS,’ TV chef Jamie Oliver said recently, describing how one in ten children is obese by the time they reach primary school, and one in five by the time they leave. There were high hopes that the obesity strategy, drafted under David Cameron’s premiership, would lead the fight against fat. Yet, according to Channel 4’s Dispatches, it was cut by two thirds before being published by new Prime Minister Theresa May. Hard-hitting pledges were watered down, and others, such as tackling promotional deals in supermarkets, removed altogether (see box).
Cue fury from health campaigners, scientists and MPs from across the political spectrum. Mr Oliver said Mrs May had ‘let every child in Britain down’. Professor Graham MacGregor, chairman of Action on Sugar, has called the plan ‘an insulting response’ that will ‘bankrupt the NHS unless something radical is done’.
Paul Gately, professor of exercise and obesity at Leeds Beckett University, said, ‘That strategy was a dereliction of duty. I have waited for the strategy for four years and I could not believe how poor it was.’ Conservative MP Maggie Throup, who chairs the All-Party Parliamentary Group on adult and child obesity, called it ‘a missed opportunity. I fail to see why the Department of Health has so ruthlessly chosen to overlook and exclude many of the recommendations made earlier this year by Public Health England and backed by the Health Select Committee. Perhaps the biggest surprise was the absence of any clear policy to regulate junk food. There have been many convincing arguments made in favour of a 9pm watershed on such advertising.’ Ms Throup also told Nursery Worldthere is ‘goodwill’ for restrictions on junk food offers from the big supermarkets.
EXERCISE
As things stand, the biggest shake-up comes through a soft drinks levy, the proceeds of which will go towards provision of physical activities and breakfast clubs for school-age children. However, those who reduce the sugar content of food to 5 grams per 100ml will avoid the sugar tax (Tesco has already taken out full-page ‘What Sugar Tax’? ads in newspapers), leaving open the question of how much will actually be raised.
Additionally, most local authorities do not currently invest in delivering weight management activities for children, according to a report by UK Active. FOI requests from the sports membership body to all local authorities in the country showed that they spent less than three per cent, on average, of their annual public health budgets on physical inactivity interventions in 2013-14.
Confusion exists about whose problem obesity is. Clinical Commissioning Groups, which are responsible for commissioning services in their areas, had made just three investments in weight management services for children, a report from Helping Overcome Obesity Problems found.
‘Over half of CCGs reported that they don’t believe they are responsible for obesity services, despite NHS England and Public Health England policy documents suggesting otherwise,’ it said.
But there are some signs of hope, with multi-agency ‘start well’ programmes in Birmingham and Manchester, based on or incorporating elements of obesity prevention.
Mr Gately says, ‘At the local level, there is a sense of “we have to get involved in this”. I believe the partnership approach is critical to moving forward.’
New guidelines
The sector is also awaiting an update to the EYFS. The obesity strategy states this will be updated to make ‘specific reference to the UK Chief Medical Officer’s guidelines for physical
activity in the early years (including active play)’. This should ‘make a significant difference’ to provision, according to Lala Manners, director of Active Matters.
She says, ‘The big problem has been that although in developmental terms children seem to be doing OK (nearly 90 per cent gained an “expected” in the latest Foundation Stage profile results), health-wise the situation is dire – only 10 per cent are actually experiencing the level of physical activity [they need] daily. The guidelines were therefore drawn up to address this issue. Only once the curriculum is amended can Ofsted amend their inspection framework.’
She added, ‘This is our one big chance to make a difference, for practitioners to play a much more proactive and responsible role in supporting children’s health. The early years workforce (all 180,000-plus) are in a prime position to step in.’
Implications for training
This year has also seen several new Level 3 courses in early years physical development come onto the market. In January, a Level 3 Certificate in Supporting Physical Development and Physical Activity in the Early Years was launched by Association for Physical Education and awarding body 1st4sport. The course trains practitioners working with children from birth to five.
Meanwhile, a full award covering two- to five-year-olds has been launched by awarding body Active IQ and the YSD i-Academy, a training course provider based at Loughborough University. Much of the course, also called Supporting Physical Development and Physical Activity in the Early Years, is delivered online, with a face-to-face training day. Ms Manners, who designed and delivers a two-day CACHE-endorsed early years physical development course at Level 3, says availability of training around the country is ‘patchy’.
NUTRITION AND DIET
The only other early years-specific measure in the obesity strategy was a campaign to raise awareness of a planned Public Health England initiative to revise menus for early years settings. But outside of this, there are moves for a sector-wide response on early years nutrition. The Early Years Nutrition (EYN) Partnership was launched in September at Westminster – an initiative between the Pre-School Learning Alliance, the British Nutrition Foundation and Danone Nutricia Early Life Nutrition. Danone is providing £1m in funding over three years, and the aim is to create a social enterprise that becomes self-funding.
The idea is that early years settings pay an annual subscription (price as yet unconfirmed) to access a registered nutritionist or dietician providing ‘hands-on’ support. The fee also covers the cost of two Level 3 CACHE awards in nutrition and hydration in the early years.
Bespoke classes for parents, children or staff are available at extra cost, and there are subsidies (again, precise amounts have not been decided yet) available.
Panel members have been keen to stress that the EYN Partnership is independent of Danone, which owns milk formula and baby food brands including Cow & Gate. They add that there are no references to the company or its products in any of the materials, and its nutritionists/dieticians have not been trained by, and would not be endorsing, Danone or its products.
The EYN partnership board, which is chaired by the Pre-School Learning Alliance’s Neil Leitch, will be ‘advised’ by Danone Nutricia Early Life Nutrition during a set-up phase. It adds that an external expert panel is there to help ensure that the programme is ‘evidence-based, impartial and current’, featuring members such as Christine Pascal, director of the Centre for Research in Early Childhood, and Pinki Sahota, professor of nutrition and childhood obesity at Leeds Beckett University.
For the long term, the Government’s obesity strategy may not always be a lame duck. Mr Oliver has said he is going to be ‘really, really annoying’ for the rest of this Parliament. And Ms Throup has called on the Prime Minister to ‘open up a conversation’ in order to re-examine the plan. She adds that her work on the strategy is far from over. ‘We’ve had phase one, we are not happy with it; now we are going to go to phase two.
‘I think the Government could have gone further without being criticised as being a nanny state. It’s too important an issue to be wishy washy about.’
DISPATCHES’ FINDINGS: WHAT CHANGED?
An aim to halve England’s rate of child obesity within the next decade was replaced with ‘significantly reduce’ childhood obesity in England within this timeframe.
Supermarkets were to be challenged to ‘[remove] unhealthy food and drink… in prominent locations such as check-outs and end of aisles’. This was cut.
Offers on unhealthy foods: the draft plan initially stated, ‘40 per cent of the food and drink we buy to eat at home is bought on price promotion…double that of other European countries… We challenge individual retailers to take action by… ending the promotion of unhealthy foods.’
Advertising of junk food: the draft strategy aimed to, ‘put in place… measures to further reduce families’ exposure to adverts for unhealthy food… This will mean that fewer of the shows watched by many of our children - including, for example, some popular Saturday-night entertainment – will contain adverts for unhealthy food.’ This entire section has been removed.
Exercise: the plan states, ‘Every primary school child should get at least 60 minutes of moderate to vigorous physical activity a day.’ But the following qualifying paragraph was removed: ‘We must recognise that increasing the amount of exercise children undertake will not in itself solve childhood obesity. The number of calories we can burn through physical activity is dwarfed by the amount we can easily consume through food.’
The Department of Health calls the plan ‘ground-breaking’. A spokesman says, ‘No other developed country has done anything as ambitious. The Government has intentionally taken a careful and measured approach, which will reduce obesity. We are taking bold action though the Soft Drinks Industry Levy to cut the amount of sugar consumed by young people. Alongside this, our restrictions on advertising and promotion are among the toughest in the world. We have not ruled out further action if the right results are not seen.’
