Dr Lisa McNally – Consultant in Public Health at Bracknell Forest Council
Once a year, English children can be seen queuing up at school to be weighed and measured. Letters are then sent to parents informing them if their child is overweight, with the dangers of obesity highlighted and changes in behaviour advised.
This is all part of the National Child Measurement Programme (NCMP), which is directed by Public Health England and implemented by local authorities as part of their mandated responsibilities.
The costs of the NCMP to local authorities are significant (Shield 2013). Despite this, it has arguably failed to achieve any positive effects. The latest report from the NCMP showed that the prevalence of childhood obesity has increased in the last year and is higher among Year 6 children than when the programme began a decade ago (NCMP, 2016).
Research into why the NCMP has been ineffective in reducing obesity has focused on the letters sent home to parents. These studies reveal that the NCMP letters do not tend to inspire behaviour change (eg: Falconer et al., 2014) and that they even have the potential to provoke adverse emotional reactions in children (Nnyanzi, 2015).
Are these emotional reactions a clue to where we are going wrong? A large body of research shows that poor emotional well-being in children can be a significant cause (as well as a consequence) of obesity (see Mannann et al 2016 for a review). Long term, prospective studies have also shown that poor mental well-being in adolescence, as well as adverse experiences like bullying, can lead to obesity in adulthood (even when childhood weight is taken into account) (Franko et al 2005; (Baldwin et al., 2016). Studies have also indicated that emotional factors such as low self esteem are far more important predictors of bulimia and compulsive eating than children’s body weight (Nicholls et al., 2016).
So is it time for a shift in focus? Maybe we need to move away from weighing and measuring children and more towards understanding and supporting them. Specifically, rather than demanding that local authorities spend significant resources on the NCMP, maybe it’s time for more initiatives aimed at enhancing emotional well-being and mental health?
This is something that local authorities are well placed to do, as discussed previously on this website (McNally 2016) and there is certainly evidence that it could be effective. For example, Stavrou et al, 2016 demonstrated that a childhood weight management programme that included stress management and psychological support, produced significantly more weight loss than a standard programme based on diet and exercise alone. It also demonstrated a significant reduction in depression and anxiety. These effects are a far cry from those currently produced by the NCMP.
Therefore, let’s stop using up valuable local government resources on large-scale programmes of weighing and measuring. Rather, let’s leave the surveillance to central government (as we do with other issues like smoking) and focus local resources on improving emotional well-being among our children. Aside from being more likely to have a positive effect on obesity, this approach will also result in a wide range of other positive outcomes, including less demand on stretched NHS mental health services. It’s also a more compassionate way to influence health at a time when young people (and parents) are already under significant pressure to meet the standards set by wider society.
Blog written by Dr Lisa McNally – Consultant in Public Health at Bracknell Forest Council
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