Issue: 2015, Vol 1, No 1, Pages 1–40

Suffer the fat little children

Tam Fry

Tam Fry
Spokesperson for the National Obesity Forum

An extension of the National Child Measurement Programme (NCMP), one of the key initiatives in the current battle to bring childhood obesity in the UK under control, has been deemed by a recent House of Commons Health Select Committee report as being an issue not worthy of consideration by May’s incoming administration (House of Commons, 2015). Seemingly against the advice of its Chair, and former GP, Sarah Wollaston, who very publicly called for such a move last year (Chorley, 2014), the opportunity to make a real advance in the battle has been lost.

Such is democracy at Westminster that politicians cannot see the wood for the trees. They first overturned a similar opportunity when, over 10 years ago, Whitehall ignored the plea by the then Chief Medical Officer for England, Sir Liam Donaldson, to identify the early signs of childhood obesity in primary care and offer interventions at an early stage. Writing in his 2002 Annual Report, Sir Liam dubbed childhood obesity a "health time bomb" which, unless diffused, would have disastrous consequences (Donaldson, 2003). How right he was. The consequence of the Blair administration’s obstruction meant that, by last December, 22.5% of our 4-year-olds and 33.5% of our 10-year-olds were recorded by the NCMP as being either over weight or obese (Health and Social Care Information Centre, 2014). Disaster indeed.

This political blindness persisted even into 2004, when a previous Health Select Committee supported Sir Liam's plea by recommending that all primary school children be measured annually and have their BMI recorded (House of Commons, 2004). Under duress, the most that Downing St would sanction was that BMI be recorded at primary school entrance and exit, but only as a public health data collection exercise and not remotely as care for individual children. The best that can be said for such a minimalist measure is that it has statistically proved that twice as many pupils become obese during their first 6 years of the Healthy Schools system as in the second and that, far from intervening on their behalf, the NHS seems quite content to let them pile on the pounds uncharted. The latest figures show that some 37% of 11–15-year-olds are in an unhealthy BMI range (Public Health England, 2014).

The fact that this year's Select Committee sat on its hands beggars belief. It is not as if the case for a justifiable measurement programme has not been made. Professor John Wass, a Vice-President of the Royal College of Physicians (RCP) and co-author of its report Action on Obesity (RCP, 2013), highlighted the "gaps" in the NCMP in his oral evidence at a Committee hearing. Wass had researched his proposal thoroughly, but the Committee chose not to take his words on board. In fact, it did worse. In its report, it stated that the NCMP provided the opportunity for babies and children to have their BMI assessed at different points in their childhood, whereas nothing could be further from the truth. Toddlers might get their first BMI assessment at some point around their second birthday if they are lucky, but the majority won't get any where near a height check for another two years. It was a woeful and a sloppy mistake to make.

If anything good comes from the Committee's mindless decision, it will be because Dr Wollaston has stated her intention to champion childhood obesity and reverse the decision if she gets the chance after re-election on 7th May. In an inter view for her local radio station, in which it became obvious that her Committee colleagues had forced her to sign off on a political rather than medical decision, she talked about the NCMP at length. Quite apart from her wish to see the programme extended to every year at primary school, she hinted that routine annual preschool measurements might also be in her sights as well. In this, she is quite correct and echoes Sir Liam Donaldson's point. Identifying the first signs of unhealthy weight gain at an age when there is a greater likelihood that inter ventions will be successful has got to be the game plan for the next administration if ever obesity is to be tackled. Leaving the child to become worryingly over weight and only then trying to do something about it is a banal policy.

On the day that Wollaston succeeds in calling a post-election inquiry, her Select Committee should also heed the conclusion of an article to be published in the Spring issue of the Journal of Longitudinal and Life Course Studies (Costa et al, 2015). It reports the additive inf luence of maternal and paternal BMI on weight status trajectories from childhood into mid-adulthood and makes the point that the higher the parents' BMI, the greater the risk of their children being obese by age 42 years. In brief, the Committee should be looking at measures which might help to reduce parental obesity by the time they plan to have children. In particular, it should reconsider monitoring the weight gain of mothers-to-be as they progress through pregnancy. In the very descriptive words of a one-time Public Health Minister, Anna Soubry, it is "bonkers" that the BMI of all pregnant women is not routinely assessed so that they can be helped to keep within reasonable guidelines (Martin, 2013). At the moment, only "obese" women with a BMI of ≥30 kg/m2 are flagged to get regular attention, leaving the majority of women who are still officially "overweight" to plough through the next 9 months "eating for two". Even in these women, there is an increased risk of producing macrosomic babies (Larsen et al, 1990).

Which brings us back to school measurement. It should be obligatory that local education authorities check the weight gain of all secondary school children, not just for their own health but also for that of the generations of children for whom they may be responsible for bringing into the world. The secondary school years offer the best opportunity to educate the parents of the future en masse, and the opportunity should be grabbed. The message should be that, before considering raising a family, both parents should get in shape. Several years ago, the obstetric and gynaecological section of the Royal Society of Medicine heard a lecture on the subject entitled "Get in shape for serious sex". Believe me, the speaker meant it.

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