Tackling childhood obesity - a better start Eustace de Sousa National Lead Children Young People and Families A Better Start Learning and Development event, March 2016

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3 Prevalence of excess weight among children National Child Measurement Programme 2014/15 One in five children in Reception is overweight or obese (boys 22.6%, girls 21.2%) One in three children in Year 6 is overweight or obese (boys 34.9%, girls 31.5%) Child obesity: BMI ≥ 95 th centile of the UK90 growth reference Child overweight (including obesity)/ excess weight: BMI ≥ 85 th centile of the UK90 growth reference

4Tackling childhood obesity Around one in ten children in Reception is obese (boys 9.5%, girls 8.7%) Around one in five children in Year 6 is obese (boys 20.7%, girls 17.4%) Prevalence of obesity among children National Child Measurement Programme 2014/15

Trend in the prevalence of obesity and excess weight Children aged 2-15 years; Health Survey for England Tackling childhood obesity Child excess weight BMI ≥ 85 th centile, child obesity BMI ≥ 95 th centile of the UK90 growth reference. 95% confidence intervals are displayed on the chart

Prevalence of obesity by age and sex National Child Measurement Programme 2006/07 to 2014/15 6Tackling childhood obesity

Prevalence of excess weight by age and sex National Child Measurement Programme 2006/07 to 2014/15 7Tackling childhood obesity

Obesity prevalence by deprivation decile National Child Measurement Programme 2014/15 8Tackling childhood obesity Child obesity: BMI ≥ 95 th centile of the UK90 growth reference

9Tackling childhood obesity Obesity prevalence by ethnic group National Child Measurement Programme 2014/15 Children in Reception (aged 4-5 years)Children in Year 6 (aged years) Child obesity: BMI ≥ 95 th centile of the UK90 growth reference

10Tackling childhood obesity Obesity prevalence by region National Child Measurement Programme 2014/15 Children in Year 6 (aged years)

2014/15 NCMP results summary  There has been a relatively small overall change in overweight and obesity prevalence over the last 5 years; levels remain unacceptably high.  As in previous years, prevalence of obesity increases between Reception and Year 6, and is more than double in Year 6 compared with Reception.  Prevalence of obesity in the most deprived 10% of areas in England is double that of the 10% least deprived areas – the gap is widening.  Substantial variation in obesity prevalence between ethnic groups - higher among children of Black and Asian ethnicities, compared to White children.  Prevalence of obesity is higher in boys than in girls for both Reception and Year 6. 11Tackling childhood obesity

Physical activity in the under 5s Amongst 2-4 years only 9% boys and 10% girls meet the government recommendation for physical activity (HSCIC, 2013). CMO guidelines for children under 5: from birth: particularly through floor-based play and water-based activities in safe environments. pre-school who are capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day. All under fives should minimise the amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping). 12Tackling childhood obesity

13 Oral health – not just teeth Oral health is improving however in England almost a third (27.9%) of 5 year olds have tooth decay with 3 or 4 teeth affected (PHE 2012) Hospital admissions for yr olds were 9,585 Hospital admissions for 5 – 9 yr olds were 26,356 Stark inequalities exist with some of the most vulnerable, disadvantaged and socially excluded facing significant oral health problems - 44% of variation explained by deprivation Impact of poor oral health: Pain School absence/school readiness Treatment  fear and anxiety  time off school and work. Cost across all ages – £3.4 billion NHS Tackling childhood obesity

Taking Action

Early intervention - why is this important? Pregnancy and early childhood present an opportunity to intervene and reduce a child’s risk of obesity. During this critical time parents of babies and young children have frequent contact with health and early year’s professionals and are often receptive to help, support and behaviour change. Tackling sensitive issues with families such as weight loss or food choices can be difficult. It is well documented that parents are often unaware that their child is overweight or that their child's weight poses a risk to their health. Professionals need to be equipped with the skills, knowledge and confidence to enable behaviour change in relation to eating, activity and weight. 15Tackling childhood obesity

Life course approach Pre- conceptual & maternal Early years School aged children Working age adults Older adults 16Tackling childhood obesity

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18Tackling childhood obesity *LGA. A new home for public health services for children aged 0-5: A resource for local authorities 061e51f079b0 The transformed health visiting service: model* 4 Levels of the Health Visiting Service 5 Universal Health Visitor reviews 6 High Impact areas HVs deliver 5 universal contacts including a holistic antenatal contact at 28+ weeks of pregnancy. High impact areas include ‘Healthy weight and nutrition’ and ‘Breastfeeding’ health-services-for-children health-services-for-children

Early years workforce: the opportunities Opportunity to: Offer interventions and support at critical points in a child's development and provide: assessment lifestyle advice referrals Encourage parents and carers to model a healthy lifestyle Encourage parents and carers to take a whole family approach Recognising babies and toddlers who are at particular risk of obesity Provide training on how to help parents make lifestyle changes Encourage practitioners to model healthy lifestyles themselves 19Tackling childhood obesity

Early years workforce: the opportunities Provide advice and support for parents on: Breastfeeding Responsive feeding and age-appropriate portion sizes Using the complementary feeding period to familiarise babies with a wide range of healthy foods Whole family approach to a healthy and balanced diet and eating habits Active play and limited screen time Sleep Coordination of the care and advice provided by the wide range of professionals children and families see is important. 20Tackling childhood obesity

PHE Priorities for Children, Young People and Families Ensuring every child has the best start in life An increase in the proportion of children ‘ready to learn at two and ready for school at five’. Government ambition to reduce the rate of stillbirths, neonatal and maternal deaths in England by 50% by Tackling child obesity An increase in the proportion of children leaving primary school with a healthy weight Reducing numbers of children with poor oral health Strengthen and enhance the National Child Measurement Programme, improving data to schools and LAs, and information and advice to parents of around 1.1 million children per year. Reducing health inequalities A reduction in health inequalities in relation to obesity including ethnicity, gender, disability and deprivation. 21Tackling childhood obesity

What is PHE doing? Published SACN report setting out key actions at a national level Child Obesity Framework to support local government in the emerging governmental childhood obesity priority. Prioritisation Tool that offers a process and support to local authorities for prioritising action on child obesity. Best Start in Life Framework supporting local authorities to deliver on this ambition. NCMP Local Authority Profile an online data tool examining data at a local level. Maternity and child data set developed to help achieve better outcomes of care for mothers, babies and children. Breastfeeding campaign (breastfeeding celebration week) supports the role of breastfeeding in bonding and attachment between mother and baby. Expanded Start4Life Information Service for Parents up to 4. Workforce development All O R Health programme 22Tackling childhood obesity

Sugar Reduction: The evidence for action PHE has carried out an extensive programme of work over the past 12 months in order to provide a package of evidence to inform the government’s thinking on sugar in the diet. The findings are set out in Sugar Reduction: The evidence for action, published on 22 nd October 2015.Sugar Reduction: The evidence for action The evidence review draws conclusions about what drives our consumption and advises on actions that could be implemented to change our sugar intakes in these areas: Influencers: marketing and advertising, price promotions and fiscal measures Food supply: sugar content of food and drinks Knowledge, education, training & local action It is clear that no single action will be effective on its own. PHE has identified a broad range of measures which, if implemented in parallel are likely to be effective. 23Tackling childhood obesity 23 Tackling childhood obesity

All O R Health programme All O R Health programme aims to support and shape “health promoting practice” that encompasses both personalised care and population health across all ages, care places and with individuals, families and communities. All O R Health toolkit will support practitioners’ access to best evidence for practice and to support nurse managers and commissioners to develop services which use the knowledge and skills health care professionals use to deliver the best health outcomes for the populations they serve. It includes a series of chapters on specific health issues that outline the key facts, guidance, links to the outcomes framework, areas of greatest impact, and links to good practice. These include: Obesity Beginning of Life Healthy 2 year olds. 24Tackling childhood obesity

NCMP – Next steps Improve the breadth and depth of NCMP data which is provided to local areas Build on NCMP and C4L as key opportunities to engage families Focus on effective communication to pro-actively engage parents Support implementation and create opportunities to share best practice 25Tackling childhood obesity

Resources

27Tackling childhood obesity Screenshot of webpage

28Tackling childhood obesity Updated C4L Sugar swaps leaflet to include: Explanation of the new guidelines Clear message about sugary drinks Introducing the new sugar app Lots of sugar swaps suggestions for cutting back on sugar throughout the day Recommended maximum sugar intakes for different ages Illustration of how much sugar is in everyday drinks, snacks and puddings Change4Life resources

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Key publications and resources Healthy Lives, Healthy People: A Call to Action on Obesity in England obesity-in-england obesity-in-england Health Visiting Programme The five universal reviews key-visits/ key-visits/ The six high impact areas health-services-for-childrenwww.gov.uk/government/publications/commissioning-of-public- health-services-for-children Healthy Start voucher scheme Information Service for Parents Change4Life PHE Obesity website 30Tackling childhood obesity

Key publications and resources Everybody active, every day: an evidence-based approach to physical activity framework-to-embed-physical-activity-into-daily-life framework-to-embed-physical-activity-into-daily-life Guidance on commissioning weight management services management-services management-services Guidance on healthier and more sustainable catering on_principles.pdf on_principles.pdf National child measurement programme operational guidance operational-guidance operational-guidance Obesity and the environment: increasing physical activity and active travel increasing-physical-activity-and-active-travel increasing-physical-activity-and-active-travel PHE Obesity website 31Tackling childhood obesity

For more information Eustace de Sousa Web: 32Tackling childhood obesity NCMP Twitter: Web: