Effectiveness of the UK government programmes and policies to reducing childhood obesity in UK

The issue of childhood obesity is one of the most pressing paediatric nutrition problems that has affected many Western countries, the United Kingdom included. This paper will discuss the issue of childhood obesity in the UK and evaluate the different government interventions that have been put to reduce the prevalence of obesity in the UK.

 

The rationale of the study is the fact that obesity increases the risk of other chronic illnesses among children in the UK (Lobstein, Baur & Uauy, 2004). There are direct and indirect costs that are associated with increased prevalence of obesity in the UK (Wang & Lobstein, 2006). The question of obesity in children should be a great concern because of the manner in which obesity affects the physical development of the children. Apart from the health effects obesity affects academic performance of the children (Wang & Lobstein, 2006). In addition, once children become overweight, it becomes difficult and costly to treat the condition and they are likely to become obese even in adulthood. This increases the cost and the burden to the healthcare system. The study is therefore important in helping design prevention measures that can be used to reduce the prevalence of obesity in children and improve the health and wellbeing of the society.

Aims of the Study

The aim is to explore, examine and evaluate the effectiveness of government programmes in reducing childhood obesity in the UK.

Objectives

  • To evaluate the prevalence of childhood obesity in UK.
  • To determine the causes of childhood obesity in the UK.
  • To determine the effects of childhood obesity to individuals and families in the UK.
  • To explore how effective are the strategies in reducing childhood obesity in UK.

Literature Search Strategy

The aim of a systematic literature search for the current study will help the researcher get a comprehensive list of literature of primary studies dealing with childhood obesity. The search will start by inputting keywords into the following databases: AMED, Medline, Embrase and Google Scholar, DoH, PubMed, and CINAHL, ProQuest, BMC and EBSCO Host. The following searches terms will be used to assist the researcher generate a pool of relevant literature on childhood obesity within UK: “paediatric obesity” OR “paediatric” AND “obesity” OR “paediatric obesity “OR “childhood” AND “obesity” OR “childhood obesity “AND “UK” “Policy.” The reference list of each retrieved paper will also be scanned to identify the leading authors on childhood obesity, and where likely, all their works will be examined for further review and analysis.

Inclusion and exclusion criteria

  • The researcher will include literature that meets the following criteria;
  • Literature related to childhood obesity within UK. Since the study is focused on childhood obesity, any article dealing with one obesity relevant topic such as eating, overweight, obesity, sedentary lifestyle, and physical activity will be reviewed.
  • Literature related to childhood obesity outside the UK but within the western industrialised nations. Though these pieces of literature will not be considered much, they will be used because the western nations have almost similar lifestyles. However, such literature will not be considered when the issue of prevalence of childhood obesity and effectiveness of government programmes in reducing childhood obesity is considered.
  • Reviews published from 1996: This period was considered the most appropriate because it represents the point when the World Health organization declared obesity as serious health challenge.
  • Literature that is available in English language in the UK.
  • Studies relating to eating disorders will also be considered

Excluded Literature

  • Any literature that does not have obesity related topic. This will include literature dealing with under eating, intake of micro-nutrients such as calcium, literature addressing eating disorders.
  • Obesity literature relating to other age groups will be deemed irrelevant for the review. If a study covered the whole population, including children, it will also not be reviewed.
  • Reviews published before1996: Obesity was not labelled a serious health challenge before 1996, and therefore, such studies will offer little information for the current study
  • Not available in English language
  • Obesity studies from other countries not considered in the inclusion criteria above

Ethical consideration

One ethical concern in dealing with childhood obesity relates to policy interventions advocated by the government, which could be against individual liberties. The libertarian theory limits the role of the government, in order to ensure individuals can exercise their own freedom. However, the utilitarian theory and social contract approach propose that individual liberties should be secondary compared to overall welfare. The ethical solution to this dilemma is proposed by the harm principle propagated by John Mill. According to John Mill (1859), the state should intervene when the actions of an individual can be harmful to others. The harm principle recognizes the role of the government to intervene and protect the vulnerable populations from harming themselves or harming others. This harm principle can be extended to addressing the problem of obesity through the stewardship model. According to Nuffield Council on Bioethics (2007), the stewardship model argues that a government is a steward of the people and the communities at large and should ensure everything is done to protect the welfare of others. The stewardship model proposes what public health programs can do or should not do based on the harm principle. According to Nuffield Council on Bioethics (2007), public health initiative should attempt to reduce risks to children and others. In addition, good health should be promoted through legislation, providing people with information, provision of services to communities, and emphasizing health for children and vulnerable persons. On the other hand, public health should not intervene in ways that are indiscreet to the rights of children and others. The consent of those affected by any intervention to address childhood obesity should also be sought in order to ensure its success (Nuffield Council on Bioethics, 2007).

Anti-oppressive practices will also be considered when working on the research. The first anti-oppressive practice is that the study will not discriminate against the obese children based on their age, sex, religion or medical status. In this regard, there will be no stereotypical comments that will be made against the subjects of the study. The other anti-oppressive study is that the researcher will rely on qualified evidence to make conclusions on the findings from the study. The use of qualified evidence means that the research will be done in an objective manner. While working on the study, the researcher will be careful not to stigmatise the children affected by obesity. One challenge that will be faced is the fact that childhood obesity is more prevalent among the disadvantaged socio-economic group. This will make it difficult to target obesity within individuals.

How the dissertation is organised

This dissertation is organised in chapters. Chapter One is the introduction that introduces the topic and the rationale of the study. Chapter Two is the literature review that reviews literature from scholarly sources on the topic of childhood obesity. This chapter discusses the different strategies like taxing junk food, promoting breastfeeding, promoting physical activity in homes and schools, improving national labelling of food, regulating sodium consumption, banning sale of junk food in schools and regulating advertisement of unhealthy foods. Chapter three will identify a case study of service delivery organisation or agency, the Public Health Agency. The programme identified is the education on physical activity that has been implemented by this agency. Chapter four is recommendations and conclusion that provides recommendations of how to better handle the issue of childhood obesity. Some of the recommendations include improving knowledge of service providers, promoting positive lifestyles like regular exercises and eating of healthy foods and removing the barriers to screening of obesity in children.

Chapter Two

Literature review

Definitions

Obesity is said to be present in the body when there is excess fat in the body of an individual. However, the definition of overweight and obesity in children is not as standard as the definition in adulthood. This is because of the natural psychological variations that come about due to age differences between children and adults (Livingstone, 2001). The psychological variations in children make it difficult to differentiate between normal and excessive adiposity. The measurement of body mass index (BMI)-for-age expressed as a z-score can be used to determine the prevalence of obesity within the UK population (Must et al. 2006). This is because of the direct correlation of the BMI-for-age and the adjusted BMI for age measurement with adiposity in children (Must et al. 2006). The advantage of using BMI-for-age in children is that BMI is the standard measure of obesity in adults. This means that the measure can be easily scaled for future use during adulthood (Must et al. 2006).

Causes of childhood obesity

There are different factors that have increased the prevalence of obesity in the UK and made it a public health problem. The factors can either be environmental, behavioural and genetic (Lobstein et al. 2004).

Environmental factors

Just like other industrialised nations of the world, the increased use of private transport in the UK has increased sedentary lifestyle among the population. The government departments have had different land usage plans. For example, there are designated commercial areas which are separated from residential areas. This separation of land use plan has made vehicular transport more practical in the UK. It is important to note that families and children who live in neighbourhoods that have safe bicycle paths, sidewalks, streetlights and recreational facilities are likely to engage in more physical activities when compared to families that live in neighbourhoods that do not have these facilities. The active lifestyle among these families reduces their relative exposure to factors causing obesity (Haslam et al. 2005).

 

The other environmental factor that is linked to obesity is the socio-economic status of the family. Children and households living in low-income regions are disadvantaged because they cannot easily access supermarkets and fruit stores from where they can purchase fresh fruits and vegetables (Haslam et al. 2005). Such families rely mainly on fast food restaurants and convenience stores. In addition, the low-income areas are always not safe thereby making it difficult for residents of these neighbourhoods to engage in leisure physical activities. The effect of this is that such people are increasingly exposed to obesity (Koukourikos et al. 2013).

Behavioural factors

The behavioural factors include increased energy intake, reduced physical activity and sedentary lifestyle. Certain eating habits and the consumption of energy rich foods increase the amount of energy that is taken by the body. Some of these habits include consumption of junk food, snacks, sugar-sweetened foods, drinks and consumption of large portions of food. The consumption of these foods is a problem that has existed in the UK for quite some time now (Koukourikos et al. 2013). The eating habits of children are affected by the environment in which they are brought up in. In many cases, families in the UK grapple with the problem of lack of free time and excessive working hours. This has limited the food choices of children who are forced to take energy and fat rich foods that are very low in nutritional value.

 

When the increased energy intake is not followed by physical activity, then the fats generated from digestion of energy rich foods will be deposited in the body. Lack of exercise therefore increases the risk of developing obesity in both boys and girls although there are studies that have shown that boys exercise more than girls (Fedewa et al. 2011). In addition, the advancement of technology has brought about sedentary lifestyle among many UK families. For example, in many cases children engage in TV watching or playing computer games. These are activities that are not physical in nature and are closely associated with consumption of snacks and other junk food (Koukourikos et al. 2013). The sedentary lifestyle has been worsened by TV commercials that promote negative health behaviour among the children. For example, there are many TV commercials that promote the consumption of junk food.

 

Genetic factors

There are many studies that have tried to determine the genetic factors of obesity. However, in most of the studies, it has been reported that there is not direct relationship between genetics and obesity (Farooqi, 2007). However, as has been stated above, the environment that the parents expose their children may make them to develop habits that may lead to obesity. The research by (Farooqi, 2007) found out that being brought up with an obese parent would increase the chances of the child being obese. This is because of the foods consumed in the house and the activities that the parent would engage the child in would expose him or her to obesity (Farooqi, 2007).

 

There are children whose genetic composition has predisposed them to obesity (Seal, 2011). However, the rapid increase in the prevalence of obesity may not be explained to genetic factors. Because there are many factors that contribute to obesity, it is very difficult to determine the individual factors that predispose a child to obesity. The meaning of this is that there is no single factor that dominates the factors that contribute to obesity (Tawia, 2013).

 

Effects of childhood obesity

Childhood obesity has effects on the health and wellbeing of the children. Being obese can have both physical and mental health effects on the children. The immediate health effects include: obesity increases the risk of cardiovascular diseases and high blood pressure (Tawia, 2013). Obesity also increases the risk of diabetes in children. This is a condition where the blood sugar level is more than the recommended sugar level (Mayer-Davis et al. 2009). The other effect of obesity is pain in the knees and hip joints. The pains may limit the ability of the obese children from participating in physical activities that can help them in managing their weight (Stovitz et al. 2008). Asthma is another problem that may affect the obese children (Vahlkvist et al. 2009). In addition, obesity affects the social life of the children as they may have a low self-esteem (Franklin et al. 2006).

There are different studies that have shown the relationship between obesity and psychological disorders in children (Ells et al. 2006). However, it is important for care practitioners to note that obesity is not a psychological problem in children (Pizzi & Vroman, 2013). Obesity affects the mental health of children because it affects the way the children feel and how they feel about themselves. This is due to the stigma that is associated with the condition.

The long-term effects of obesity include the likelihood of developing obesity in adulthood (Singh et al. 2008). Childhood obesity is also associated with increased risk of stroke, type 1 and type 2 diabetes, hypertension and coronary heart disease (Verbeeten et al. 2011). The adverse effects of obesity may include death of the obese children as obesity increases the mortality of children in adulthood (Reilly & Kelly, 2011). Childhood obesity may also predispose the children to cancer in their later stages of life (Reilly & Kelly, 2011).

Preventing and managing obesity

According to the World Health Organisation (WHO), infants should be exclusively breastfed for the first six months. After this, breastfeeding should be supplemented with food with at least two years (World Health Organisation, 2015). This is because breast milk is considered the ideal food for infants as it has the nutrients to meet the nutritional needs of the infants (Yan et al. 2014). Apart from having the right quantity of nutrients, breast milk contains antibodies that can help in reducing infections including pneumonia, gastrointestinal infections and neonatal infections (Stolzer, 2011). Research has also shown that children who were effectively breastfed have reduced chances of obesity, type 2diabetes and hypertension (Yan et al. 2014).

From the literature review, it has been seen that the family and the lifestyle model developed in the family plays a role in development of childhood obesity (Koukourikos et al. 2013). In most cases, children imitate what they learn from their parents and therefore interventions to reduce the prevalence of obesity should target lifestyle change among the parents. Nutritional information should be provided to the parents and parents should be informed of the rights and responsibilities that they have in promoting the health and welfare of their children. The family should therefore adopt healthy lifestyle including having regular exercise like walking, swimming and having healthy eating habits. This will reduce the exposure that children have to obesity (Ben-Sefer et al. 2009). Apart from parents, teachers and the entire school system should also play a role in promoting healthy eating habits among the children. Specifically, schools should encourage the children to eat more fruits and vegetables, water and fresh juices (Han et al. 2010). Han et al. (2010) recommend that the school curriculum should also promote regular exercise for the children to participate in physical activities and burn out excess fat within their bodies.

Within the community, the environment should be made safe so that children are encouraged to engage in physical activity (Koukourikos et al. 2013). The authorities should have programmes that ensure proper access and use of basic exercise facilities by the children. This will help in increasing the amount of physical exercise that the children engage in thereby reducing the prevalence of obesity in the society.

The UK government has also instituted programmes and policies that are geared towards reducing the prevalence of childhood obesity in the UK. Some of the programmes and policies are discussed below. The effectiveness of these programmes is also discussed below.

Effectiveness of the government programmes to reducing childhood obesity

In a bid to reduce the economic burden of obesity within the UK society, the government has instituted different policy and legislative frameworks. These are discussed below.

Taxing junk food

This is a measure that has been proposed and implemented to help reduce the consumption of junk food in UK. The rationale behind this is that if the tax on junk food is increased, then the price of junk food will increase and thereby reduce consumption (Bambra et al. 2012). The proponents of junk food tax argue that the revenue generated from this tax can be used to subsidise the price of healthy foods (Bambra et al. 2012). However, these programmes have not been effective as many adults and children still engage in consumption of junk food in the UK. The reason for this is the relative inelastic nature of fast food consumption which means that an increase in cost of food does not necessarily result in a substantial reduction in the amount of junk food consumed by the population. This is based on the aggressive marketing that the food companies have put in order to sustain consumption of their products so that they can maintain profitability. The other factor that has limited the success of this intervention is the availability of other options. According to Bambra et al. (2012), when the price of junk food is increased, many people have resorted to other untaxed foods some of which have high energy content. The result of this is that the population has continued to consume foods that are rich in energy, fats and sugar. Increasing the prices of food through taxation could have a negative effect on low-income households some of whom depend on the junk food for their nutritional intake. This has the effect of compounding the problem and bringing about other issues like malnutrition thereby increasing the burden to the health system.

Promoting breastfeeding

As has been mentioned, children should be exclusively breastfed up to the age of six months after which the breast milk can be supplemented with other food rations. This is because breast milk is considered the ideal food for infants as it has the nutrients to meet the nutritional needs of the infants (Yan et al. 2014). The UK government has promoted this as one of the sure ways of reducing the prevalence of childhood obesity in the UK. In addition, the government has provided advice on complementary feeding. Complementary feeding can be defined as the transition from exclusive breastfeeding and the gradual introduction of the child to the family diet (Pearce et al. 2013). In summary, the recommendations include the introduction of fruits and vegetables, cereals mixed with milk as first foods after 6 months. This should then be followed with chicken, fish, meat, pasta, rice, pulses and lentils and dairy foods that should be used after the child has gotten used with the first foods. The recommendations propose that the child should be almost fully integrated to the family diet by eating three chopped or minced foods daily together with breast milk. By the age of 12 months, the infant should be consuming a modified version of the family diet (Pearce & Langley-Evans, 2013).

From the summary, it can be seen that the interventions provide very good guidance on healthy food choices for children. However, the interventions provide very little guidance on child-feeding behaviours (Clark et al. 2007). The other limitation is that the interventions do not consider the socioeconomic status of all households. There are some families that are not able to adequately afford the food in the correct ratios. There are other families where the mothers are too busy that they cannot supplement the complementary diet with breast milk. The busy mothers also do not adequately monitor their children’s feeding programme. The result of this is that children are given foods that are rich in energy thereby exposing them to obesity. This shows that the programme is not very effective as it does not adequately address the issues of parenthood and the socioeconomic environments that households are living and operating in (Pearce & Langley-Evans, 2013).

The interventions on breastfeeding do not also adequately address the UK cultural issues on the shape and configuration of breasts. There are women who have believed that if they breastfeed for long, then they will lose their shape and will no longer be attractive (Smyth, 2008). The result of this is that relatively fewer UK women have engaged in exclusive breastfeeding programmes (Boyer, 2012). The implication of this is that the children are not given good nutrition that can help reduce their exposure to obesity.

Promoting physical activity in homes and schools

Physical activity should be encouraged as part of the culture and lifestyle of the UK people. The UK government has instituted policies to make physical activity easier and safer for the children whether they are at home or in schools. All children aged between 5-19 years are expected to get between moderate to intense physical activity depending on the weight-age relationship. The objective of this is to help the children burn the excess fat that may be within their body systems (Davidson, 2007).

However, this programme has not been very effective because it relies so much on self reporting where the children and the adults are expected to provide self-reports of their physical activities. The self reports are riddled with exaggerations on the intensity of physical activity that the children have engaged in. The result is that most of the children do not achieve their recommended intensities of physical activity. According to Elliott (2011), as the children advance in age, their levels of physical activity reduce because of the sedentary lifestyles that they adopt. Children past the age of 10 years are likely to engage more in playing computer games or watching television (Elliott, 2011). The implication of this is that the government’s promotion of physical activity has not been effective in reducing the levels of obesity in UK (Davidson, 2007).

Within the school environment, the curriculum and timetable have been designed to allow for physical education (PE) in schools. This is where the children step out of their classrooms and engage in different sports and physical activities. PE was also designed to help reduce the boredom of learning throughout the day. The PE programme has helped increase the levels of physical activity in schools. However, PE alone cannot reduce obesity in the UK. This is because schools do not have the systems to ensure that children engage in physical activity that is safe during the PE lessons (Davidson, 2007).

The government has also promoted the active school concept where schools are required to have a commitment to physical activity through different strategies. This means that the culture of schools should change and adopt activities that can promote the health and wellbeing of the children (Fox et al. 2004). The current system has not been very effective because it has focused on the traditional model of physical education without considering changing the culture of the schools to ensure that they achieve the set objectives (Davidson, 2007). The concept of the active school has been integrated with the concept of health promotion in schools. This is where the government expects the schools to work towards reducing the prevalence of obesity in UK. However, the programmes of health promotion and active school have not been effective because most schools do not have the burden and responsibility of reducing the prevalence of obesity (Davidson, 2007).

Within the schools, teachers have been encouraged to be role models to children. Teachers are expected to help influence positive lifestyle choices among the children. This will help in having the children adopt positive lifestyle choices that can help improve their health and wellbeing. Some of the lifestyle choices that teachers can impart on the children include positive eating and regular exercising among others (Davidson, 2007). However, this programme has not been very effective because of the relationship that exists between the children and their teachers. This has made it difficult for the children to consider the teachers as their role models.

Improving nutritional labelling of food

Another legislative intervention that has been undertaken by the government is the nutritional labelling of food products. This includes items that are in restaurant menus. The objective of the labels is to provide written and any graphical warning to the purchasers and consumers of the food on the nutritional value of the foods. One of these systems is the food “traffic light system’ that was implemented in 2005. This is a voluntary system that uses red, green and amber colours to indicate the nutritional content of the foods. The colours are based on the recommended daily intake of fats, sugars, saturated fats and sodium for children and adults. The labels are in most processed foods in the UK and are geared towards reducing confusion and help consumers make good choices on the healthy foods that they want to purchase. The result of this is that UK manufacturers have had to reformulate the nutritional content of their foods so that it is consistent with the customer demands (Petrovici et al. 2012).

The UK citizens have been adequately educated and trained on the UK food “traffic light system” and this has improved its efficiency (Alexander et al. 2009). UK consumers have been educated on food labels and how to interpret the labels. However, more needs to be done on the issue of serving sizes. This is because the current legislation has given manufacturers the leeway to determine the serving sizes. The problem with non-standard serving sizes is that it is difficult to compare nutritional value of similar products from different brands and the different serving sizes are not representative of the real world portions.

The other problem to labelling that has been experienced in other countries is the financial and operational obstacles that have resulted in many restaurants showing reluctance to implement the legislation on labelling (Alexander et al. 2009). Once a restaurant commits to such a scheme, there are many difficulties to implementation of the scheme including the limited space on the menus and the loss of flexibility that the scheme can bring about to the operations of the restaurant. In some cases, restaurants do not provide the accurate information and may be exposed to libel risks (Alexander et al. 2009).

The other factor that has affected the effectiveness of this intervention is the controversy that has faced the labelling system where some restaurants have complained that the FSA forces the restaurants to adopt the traffic light system (Khun, 2007). The problem with this is that the hospitality industry is a very diverse and complex industry and the traffic light system as it is cannot be used to adequately to adequately solve the obesity problem (Alexander et al. 2009).

Regulating sodium consumption

In most cases, children and adult intake of sodium in the UK is always higher than the recommended amounts. High intake of sodium exposes an individual to other conditions including hypertension and heart complications (Hanevold, 2013). In addition, sodium is an ingredient that is available in junk food and its intake enhances the consumption of junk and processed foods thereby increasing the prevalence of obesity. The government has therefore proposed to reduce the amount of sodium in processed and junk food so that their palatability and consumption reduces so that the prevalence of obesity epidemic is reduced. Reduction in sodium intake may offer little impact to the individuals but may have major impacts on the society and the government as the health burden of obesity will be reduced. This can be used to evaluate the effectiveness of this programme as it has been touted to offer little benefits to individuals, benefits that can be very difficult to measure (Wang & Bowman, 2013).

Banning the sale of junk food in schools

As has been mentioned, junk food and soft drinks can have negative effects on the nutrition of children. To help reduce this effect, the government has banned the sale of junk food and soft drinks in vending machines in schools. These have been replaced with healthy foods and the government has encouraged teachers and parents to advice their children to focus more on consumption of fruits and vegetables (Devi et al. 2010). However, these programmes have not been effective because some of the junk foods have been replaced with nut equivalents and some juices (Fletcher et al. 2014). This is because the energy value of these foods is almost identical to the energy levels of junk foods. However, the nutritional content of nuts and other foods that have replaced the junk food is higher than that of the junk food. Through this, the policymakers intend to encourage healthy eating lifestyles among the children.

Regulating advertisement of unhealthy foods

The UK government has instituted regulations that have limited advertisement of fast food to children. This has been widely criticised by corporations who believe that adverts provide meaningful information which can help the children in decision making (Effertz et al. 2014). However, the authorities have considered the adverts as sources of misleading information that may distract the children from the possible negative consequences of fast foods, snacks and sweets. The government has had an objective of reducing the exposure that children have to adverts of some products. This has been done by requiring that some products have warning in them. However, the problem with this is that the warnings and the pictorial warnings may contain conflicting information that may end up confusing the children (Jenkin et al. 2010). The government has also developed policies that have promoted healthy foods as a means of reducing obesity and other conditions in the society. This has been done through marketing of healthy foods. The regulations on advertisements have been effective and have been taken up even by other countries like the United States (Darwin, 2009).

Barriers to success of these interventions

There are many factors that may act as barriers to change for the children and their families. According to Shield & Tremblay (2008), one of the factors is information and communication technology that the children have to use for their entertainment and school purposes. The use of computers and other technology tools have greatly reduced the levels of physical activity that children engage in (Shields & Tremblay, 2008). Children use technology on the internet and on social networking sites.

The other barrier to implementation of change is the stress that people are increasingly exposed to. This is due to the fact that the society has become increasingly competitive. Block et al. (2009) found out that to cope with the different stressors in life, many people have resorted to food to give them comfort. In addition, there are some stressors which result from poverty and the socioeconomic status of the parents and the children. These people may adopt different lifestyles that may be difficult to change through policy unless the policy focuses on reduction of poverty for the families (Drewnowski, 2009). The activities of food companies to promote their products so that they increase their profitability are another factor that acts as a barrier to successful implementation of the programmes. The corporations engage in deceptive advertising while promoting their products (Ludwig & Nestle, 2008).

Chapter Three

Agency Programme

The agency selected is the Public Health Agency. The organisation was selected due to the role that it has played in improving the health and wellbeing of many people in the UK especially in Northern Ireland. This organisation acknowledges that there has been a considerable increase in the prevalence of childhood obesity in the UK and this has effects on the public health system (Public Health Agency, 2015). This organisation received funding from the government.

After its inception in 2009-2010, the Public Health Agency has strived to ensure development of evidence based approaches for the management of childhood obesity. Some of the actions that have been implemented under this include the information on physical activity that is aimed at encouraging the children to engage more in physical activities. This organisation has done in collaboration with other agencies like Chartered Institute of Environmental Health and the Food Standards Agency. The Public Health Agency continues to work with primary and secondary care providers, leisure activities providers to help reduce the prevalence of childhood obesity in the UK (Public Health Agency, 2015).

The initiatives by the PHA (Public Health Agency) have been successful. For example, by partnering with the FSA, the organisation managed to deliver a course on Nutrition and Public Health while collaborating with the Royal Society of Public Health. One of the limitations of the initiatives is that they are still not innovative in developing strategies that can help reduce the prevalence of childhood obesity in the UK (Public Health Agency, 2015).

 

 

Chapter Four

Recommendations and conclusion

In conclusion, obesity has been a pandemic problem that has negatively affected the UK society. The objectives of this study have been: to evaluate the prevalence of childhood obesity in the UK, to determine the causes of childhood obesity and the effects of childhood obesity to individuals and families in the UK, to explore the effectiveness of government strategies in reducing childhood obesity in the UK. These objectives have been discussed one by one. From the discussion, it can be seen that there is a high prevalence of obesity in the UK. This high prevalence is affecting the children, their families and is having a health burden on the public health system (Lake, 2009). To reduce this burden, the government has instituted policies and regulations to help reduce the consumption of junk food and encourage healthy lifestyles among children and families in the UK (Gewargis & Grimble, 2010). However, the recommendations have not achieved their objectives due to the manner in which they are implemented.

As a recommendation, the UK government should focus on promoting positive lifestyle within the UK society. Positive lifestyle entails regular exercising and eating healthy foods. The government should create a conducive environment where people can exercise regularly. For example, parks should be more accessible to the children and there should be incentives for those parents who engage in more physical activity with their children. In addition, healthy food options should be promoted as a means of reducing obesity and other chronic conditions. This will eliminate the need of having to increase the tax on food. Promotion of positive lifestyle will also help children while at school as they will have teachers to learn from. The positive lifestyles promoted will go a long way in ensuring that the prevalence of obesity in the UK is reduced (Hagobian & Phelan, 2013).

It is important to note that policies that have a direct effect on behaviour should have a direct effect on the environment or setting in which the children and their parents live (Sacks et al. 2009). The settings include schools, homes and the general environment that children interact with. The government should improve on health promotion by encouraging parents not to have television sets in children’s bedrooms (van Zutphen et al. 2007). The families should also be encouraged to have regular meal times and to have healthy diets (Oates & Newman, 2010). This will help in encouraging discipline among the children as they will learn not to engage in binge eating and to eat only the diet that they eat at home.

The barriers to screening and early detection of obesity should be eliminated. At the physical level, some of the barriers include stigmatisation and attitude towards obesity patients, lack of time to adequately address obesity issues, lack of motivation from the physicians, low training on obesity low self-efficacy in handling obese patients (Villagra, 2009). At the patient level, some of the barriers include stigmatisation, difficulties in accessing weight management services and lack of time to seek for medical help (Yang et al. 2007). These barriers should be eliminated so that obesity is detected early in advance. In addition, when the barriers are eliminated, then patients will not find difficulty in seeking treatment in case of obesity. By seeking treatment, the children and their families will work together with nurses and other healthcare professionals to design interventions that can help manage obesity. This can help in reducing the prevalence of obesity in the UK (Chan & Woo, 2010).

The primary healthcare providers can also play a role in reducing the prevalence of obesity. As a policy, the number of primary care professionals should be increased in hospitals and other care facilities. Specifically, the number of nutritionists and dieticians should be increased in hospitals and community care settings. These professionals can help in providing individuals and populations with the needed knowledge on how to reduce the prevalence of obesity (Lazarou & Kouta, 2010).

In summary, policy alone cannot help in reducing the prevalence of obesity in the UK. The policies can just facilitate the process of reduction of the prevalence. It is important that all members of the UK society make a commitment to change their lifestyles and adopt healthy lifestyles that can help reduce obesity (Chan & Woo, 2010). There are different questions that individuals and families can ask themselves including the factors that can help them and their children to increase the level of their physical activity, the ways in which they can improve on their diet and whether they want to lead healthy lifestyles. These questions can help the families develop good models and lifestyles of reducing obesity.

Reflection

While working on this project, I have learnt the importance of early planning and organisation. The project required careful search and analysis of the research question. It looked simple but required an evaluation of the sources so that the best information and literature could be used. This is an aspect that I believe will help in my professional development.

I also learnt to great deal the issue of childhood obesity in the UK and how the intervention programmes have not been successful in reducing the prevalence of childhood obesity in the UK. From the literature review, I have discovered that childhood obesity is an epidemic that has created a burden on the public health system. The main causes of childhood obesity are lifestyle factors that children adopt from their families. It is therefore important that government institutes workable programmes and policies that can help in reducing the prevalence of obesity in the UK.

 

 

References

Alexander, M., O’Gorman, K. & Wood, K. (2009). Nutritional labelling in restaurants: Whose

responsibility is it anyway? International Journal of Contemporary Hospitality Management, 22(4), pp. 572-579.

Bambra, C.L., Hillier, F.C., Moore, H.J. & Summerbell, C.D. (2012). Tackling inequalities in

obesity: a protocol for a systematic review of effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children. Systematic Reviews, 1, pp. 16-22.

Ben-Sefer, E.,  Ben-Natan, M. & Ehrenfeld, M. (2009). Childhood obesity: Current literature,

policy and implications for practice. International Nursing Review, 56(2), pp. 166–173.

Block, J.P., He, Y., Zaslavsky, A.M., Ding, L. & Ayanian, J.Z. (2009). Psychosocial stress and

change in weight among US adults. American Journal of Epidemiology, 170, pp. 181–192.

Boyer, K. (2012). Affect, corporeality and the limits of belonging: Breastfeeding in public in the

contemporary UK. Health & Place, 18, pp. 552-560.

Chan, R.S. & Woo, J. (2010). Prevention of overweight and obesity: how effective is the current

public health approach. International Journal of Research in Public Health, 7(3), pp. 765-783.

Clark, H.R., Goyder, E., Bissell, P., Blank, L. & Peters, J. (2007). How do parents’ child-feeding

behaviours influence child weight? Implications for childhood obesity policy. Journal of Public Health, 29(2), pp. 132-141.

Darwin, D. (2009). Advertising obesity: can the US follow the lead of the UK in limiting

television marketing of unhealthy foods to children? Vanderbilt Journal of transnational law, 42(1), pp. 317-350.

Davidson, F. (2007). Childhood obesity prevention and physical activity in schools. Health

Education, 107(4), pp. 377-395.

Devi, A., Surender, R. & Rayner, M. (2010). Improving the food environment in UK schools:

policy opportunities and challenges. Journal of Public Health Policy, 31(2), pp. 212-226.

Drewnowski, A. (2009). Obesity, diets, and social inequalities. Nutritional Review, 67, pp. S36–

39.

Effertz, T., Franke, M. & Teichert, T. (2014). Adolescents’ assessments of advertisements for

unhealthy food: an example of warning label for soft drinks. Journal of Consumer Policy, 37, pp. 279-299.

Elliott, C. (2011). “It’s junk food and chicken nuggets”: children’s perspective on ‘kids’ food

and the question of food classification. Journal of Consumer Behaviour, 10, pp. 133-140.

Ells, L. J., Lang, R., Shield, J. P. H., Wilkinson, J. R., Lidstone, J. S. M., Coulton, S., et al.

(2006). Obesity and disability- a short review. Obesity Review, 7, 341–345.

Farooqi, I.S. (2007). Genetic factors in human obesity. Obesity Reviews, 8(S1), pp. 37-40.

Fedewa, A.L. & Ahn, S. (2011). The effects of physical achievement and cognitive outcomes: a

meta-analysis. Research Quarterly for Exercise in Sport, 82(3), pp. 521-535.

Fletcher, A., Jamal, F., Fitzgerald-Yau, N. & Bonell, C. (2014). ‘We’ve got some underground

business selling junk food’: qualitative evidence of the unintended effects of English school food policies. Sociology, 48(3), pp. 500-517.

Fox, K.R., Cooper, A. & McKenna, J. (2004). The school and promotion of children’s health-

enhancing physical activity: perspectives from the United Kingdom. Journal of Teaching Physical Education, 23, pp. 338-358.

Franklin, J., Denyer, G., Steinbeck, K.S., Caterson, I.D. & Hill, A.J. (2006). Obesity and risk of

low self-esteem: a statewide survey of Australian children. Pediatrics 118, pp. 2481–2487.

Gerwargis, A. & Grimble, G.K. (2010). Attitude of British general practitioner towards

childhood obesity in the UK. Proceedings of the Nutrition Society, 69, p. E551.

Hagobian, T.A. & Phelan, S. (2013). Lifestyle interventions to reduce obesity and diabetes.

American Journal of Lifestyle Medicine, 7(2), pp. 84-98.

Han, J.C., Lawlor, D.A. & Kimm, S.Y.S. (2010). Childhood obesity. The Lancet, 375, pp. 1737-

1748.

Hanevold, C.D. (2013). Sodium intake and blood pressure in children. Current Hypertension

Reports, 15, pp. 417-425.

Haslam, D.W. & James, P. (2005). Obesity. The Lancet, 366(9492), pp. 1197-1209.

Jenkin, G., Wilson, N. & Hermanson, N. (2010). Identifying ‘unhealthy’ food advertising on

television: a case study applying the UK Nutrient Profile Model. Public Health Nutrition, 12(5), pp. 614-623.

Khun, K. (2007), “FSA denies talks with restaurants over traffic light labelling system”, Caterer

and Hotelkeeper, available at: www.caterersearch.com/Articles/2007/11/19/317358/fsadenies-talks-with-restaurants-over-traffic-light-labelling-system.html (accessed 16 April 2015).

Koukourikos, K., Lavdaniti, M. & Avramika, M. (2013). An overview on childhood obesity.

Programme Health Science, 3(1), pp. 128-133.

Lake, J. (2009). The development of surveillance and screening for childhood obesity in the UK.

Critical Public Health, 19(1), pp. 3-10.

Lazarou, C. & Kouta, C. (2010). The role of nurses in the prevention and management of

obesity. British Journal of Nursing, 19(10), pp. 641-647.

Livingstone, M.B.E. (2001). Childhood obesity in Europe: a growing concern. Public Health

Nutrition, 4(1A), pp. 109-116.

Lobstein, T.,  Baur, L. & Uauy, R. (2004). IASO International Obesity TaskForce. Obesity in

children and young people: a crisis in public health. Obesity Review, 5(S1), pp. 104.

Ludwig, D.S. & Nestle, M. (2008). Can the food industry play a constructive role in the obesity

epidemic? JAMA, 300, pp. 1808–1811.

Mayer-Davis, E.J., Bell, R.A., Dabelea, D., D’Agostino, R., Imperatore, G., Lawrence, J.M., Liu,

L., Marcovina, S. & the SEARCH for Diabetes in Youth Study Group (2009). The many faces of diabetes in American youth: type 1 and type 2 diabetes in five race and ethnic populations: the SEARCH for Diabetes in Youth Study. Diabetes Care, 32(S2), pp. S99–S101.

Mill J. S. (1859).On liberty. Oxford (GB): Oxford University Press. pp. 21–22.

Must, A., Hollander, S.A. & Economos, C. (2006). Childhood obesity: a growing public health

concern. Expert Review of Endocrinology & Metabolism, 1(2), pp. 233-254.

Nuffield Council on Bioethics (2007).Public health: ethical issues. London(GB): Nuffield

Council; [online]; available from; http://www.nuffieldbioethics.org/public-health [Accessed 16 April 2015]

Oates, C.J. & Newman, N. (2010). Food on young children’s television in the UK. Young

Consumers, 11(3), pp. 160-169.

Pearce, J. & Langley-Evans, S.C. (2013). The types of food introduced during complementary

feeding and the risk of childhood obesity: a systematic review. International Journal of Obesity, 37, 477-485.

Pearce, J., Taylor, M.A. & Langley-Evans, S.C. (2013). Timing of the introduction of

complementary feeding and risk of childhood obesity: a systematic review. International Journal of Obesity, 37, pp. 1295-1306.

Petrovici, D., Fearne, A., Nagya, R.M. & Drolias, D. (2012). Nutritional knowledge, nutritional

labels, and health claims of food. A study of supermarket shoppers in the South East of London. British Food Journal, 114(6), pp. 768-783.

Pizzi, M.A. & Vroman, K. (2013).Childhood obesity: Effects on children’s participation, mental

health, and psychological development. Occupational Therapy in Health, 27(2), pp. 99-112.

Public Health Agency. (2015). Tackling childhood obesity. Retrieved April 30, 2015, from

Public Health Agency: http://www.publichealth.hscni.net/directorate-public-health/health-and-social-wellbeing-improvement/tackling-childhood-obesity

Reilly, J.J. & Kelly, J. (2011). Long-term impact of overweight and obesity in childhood and

adolescence on morbidity and premature mortality in adulthood: systematic review. International Journal of Obesity, 35, pp. 891–898.

Sacks, G., Swinburn, B. & Lawrence, M. (2009). Obesity Policy Action framework and analysis

grids for a comprehensive policy approach to reducing obesity. Obesity Review, 10, pp. 76–86.

Seal, N. (2011). Introduction to genetics and childhood obesity: relevance to nursing practice.

Biological Research for Nursing, 13, pp. 61–69.

Shields, M. & Tremblay, M.S. (2008).  Sedentary behaviour and obesity. Health Reports. 19, pp.

19–30.

Singh, A.S., Mulder, C., Twisk, J.W., Van Mechelen, W. & Chinapaw, M.J.M. (2008). Tracking

of childhood overweight into adulthood: a systematic review of the literature. Obesity Reviews, 9, pp. 474–488.

Smyth, L., 2008. Gendered spaces and intimate citizenship: the case of breastfeeding. European

Journal of Women’s Studies, 15 (2), pp. 83–99.

Stolzer, J.M. (2011). Breastfeeding and obesity: a meta-analysis. Open Journal of Preventive

Medicine, 1, pp. 88–93.

Stovitz, S.D., Pardee, P.E., Vazquez, G., Duval, S. & Schwimmer, J.B. (2008). Musculoskeletal

pain in obese children and adolescents. Acta Paediatrica, pp. 489–493.

Tawia, S. (2013). Childhood obesity and being breastfed. Breastfeeding Review, 21(2), pp. 42-

48.

Vahlkvist, S. & Pedersen, S. (2009). Fitness, daily activity and body composition in children

with newly diagnosed, untreated asthma. Allergy 64, pp. 1649–1655.

van Zutphen, M., Bell, A.C., Kremer, P.J. & Swinburn, B.A. (2007). Association between the

family environment and television viewing in Australian children. Journal of Pediatrics and Child Health, 43, pp. 458–463.

Verbeeten, K.C., Elks, C.E. Daneman, D. &  Ong, K.K. (2011). Association between childhood

obesity and subsequent Type 1 diabetes: a systematic review and meta-analysis. Diabetic Medicine, 28, pp. 10–18.

Villagra, V.G. (2009). An obesity/cardiometabolic risk reduction disease management program:

a population-based approach. American Journal of Medicine, 122, pp. S33–36.

Wang, G. & Bowman, B.A. (2013). Recent economic evaluations of interventions to prevent

cardiovascular disease by reducing sodium intake. Current Atherosclerosis Reports, 15, pp. 349-357.

Wang, Y. & Lobstein, T. (2006). Worldwide trends in childhood overweight and obesity.

International Journal of Pediatric Obesity, 1, pp. 11-25.

World Health Organization. (2015). [http://www.who.int/topics/breastfeeding/en/]

Yan, J., Liu, L., Zhu, Y., Huang, G. & Wang, P.P. (2014). The association between breastfeeding

and childhood obesity: a meta analysis. BMC Public Health, 14, pp. 1267-1277.

Yang, X., Telama, R., Leskinen, E., Mansikkaniemi, K., Viikari, J. & Raitakari, O.T. (2007).

Testing a model of physical activity and obesity tracking from youth to adulthood: the cardiovascular risk in young Finns study. International Journal of Obesity, 31, pp. 521–527.