Child obesity: who is measuring who? And what?

Abstract

The government's 'Call to Action on Obesity' in England has set the ambition of a sustained downward trend in levels of excess weight in children by 2020. Bearing in mind the steep trajectory of increasing child obesity since the late 1980s, this is no mean feat, although recent statistics have hinted at a possible levelling in the trend.1 It is not entirely clear how this ambition might be achieved, as influencing a child's excess weight is complex and obesity - a chronic relapsing condition - is typically resistant to treatment.Obesity Leadership and the Localism AgendaThe localism agenda, in conjunction with the new organisational architecture of the National Health Service (NHS) in England, has meant that obesity leadership is uncertain and often dictated by the personal choices of local commissioners and public health leads. A recent British Medical Journal (BMJ) leader succinctly highlighted the grey areas where responsibility for commissioning services is unclear.2 Even where a local Joint Strategic Needs Assessment highlights a clear child obesity priority, this may not translate to service provision on the ground because of local decisions to focus on prevention approaches rather than treatment services.Reasons may include past experiences of poor uptake of pilot schemes and difficulties in demonstrating effective outcomes from interventions. The evidence base more easily demonstrates benefits from prevention approaches across communities than from treatment programmes, and it is therefore understandable that, when stretched, funds may be diverted to prevention - particularly when it could be argued that obese children as well as normal weight children might benefit from avoiding a further body mass index (BMI) increase from an effective prevention approach.Political leadership is essential to drive balanced development of both obesity prevention and treatment approaches, in order to help localities avoid postcode lottery provision that fails to address either political ambitions or the needs of the individual. For example, while risking 'Nanny State-ism', defining a minimum standard of obesity service provision, supporting nutritional standards in all schools and challenging the food industry's strong control over foodrelated behavioural trends would help to level the toxic playing field that families are currently exposed to.An example is the concept of 'kids' menus, where children are assumed (and hence learn) to eat only a narrow selection of processed fried foods, thereby missing out on repeated exposures to a broader range of foods, which is the usual mechanism whereby we develop a taste for a healthy diet.The limitations of the Responsibility Deal and the localism agenda mean that responsibility for body shape cannot yet be leftsolely to individuals. Political leadership and practical support are needed to help address complex societal, environmental and marketing pressures in order for individual responsibility over each individual's life course to become a feasible reality.The National Child Measurement ProgrammeWhile public health teams may state that their support of the National Child Measurement Programme (NCMP) represents action on child obesity, NCMP is a growth monitoring programme that provides largely epidemiological population level data and does not dictate a management component. There is no uniform approach to dealing with highlighted cases and no nationally agreed primary or secondary care funding stream to support child obesity management.3 While grasping the scale of the obesity problem was a sensible starting point, it is now time to build on the early steps of the NCMP by developing and funding structured, evidence-based support for highlighted families, in addition to continuing a strong focus on obesity prevention. Furthermore, it is unclear as to who is tasked with measuring and following up children outside of the NCMP, with health visitors, general practitioners and school nurses all looking towards each other with uncertainty as to who is best placed to do what. …