Preventing childhood obesity – how early should early intervention be?

Written by: Dr Ruth Campbell, Consultant Dietitian in Public Health Nutrition, NHS Ayrshire & Arran @RuthCampbellPHN

The First Minister recently pledged that the Scottish Government will half childhood obesity by 2030.  That’s a challenging goal given that fewer children are a healthy weight today compared to a decade ago.  In the school year 2016/17, 12.4% of Primary 1 age children in Scotland were found to be at risk of overweight and 10.5% were at risk of obesity¹.  As with many other measures of health, childhood obesity is strongly linked to deprivation – children from the most deprived areas were almost twice as likely to be at risk of obesity compared to those in the least deprived areas.

Modern society is such that foods high in fat, sugar or salt are available in abundance round the clock.  The marketing and promotional strategies adopted by the food industry mean that cheap, energy dense, unhealthy food and drinks are over consumed, particularly by many children and young people.  Our built environment and aspects of our daily living mean that more children than ever before are sedentary for long periods of the day and are less physically active than recommended.  In addition to Government action to tackle our so called obesogenic environment, we must do more to support and enable families to make healthier choices at the earliest stage in their children’s lives.  So how early should early intervention be?  Evidence shows that a woman’s weight and her nutritional status before conception is a major determinant of her baby’s birthweight and subsequent lifelong health – even more so than her nutrition during pregnancy².  However, interventions to improve preconception nutrition in general are underdeveloped across the country.  In contrast, maternity care is provided universally to pregnant women and all women have several contacts with a midwife during pregnancy.  These contacts offer prime opportunity to provide advice and support on a range of topics such as eating well, including the importance of vitamin D supplementation; minimising weight gain for those above a healthy weight; smoking cessation; alcohol and physical activity.

There is compelling evidence on the health benefits of breastfeeding to mothers and babies both in the short and long term³.  Breast and formula fed babies have different growth trajectories due to differences in nutritional composition and energy levels between breast and formula milk.  Breastfed babies have slower weight gain during infancy and are less likely to be overweight later in childhood.  The food and drink patterns that young children develop after milk feeding and the portion sizes they consume also have a significant influence on their growth and future weight. As part of the universal health visiting pathway, all families are offered a minimum of 11 home visits spanning the antenatal to preschool period.  A holistic assessment of the child’s health and wellbeing is carried out at each contact and advice is provided to parents on infant feeding, weaning and eating well for the whole family.

Many dietitians are at the forefront of leading local strategies to prevent and treat childhood obesity across NHS Boards in Scotland. In Ayrshire intervening early to improve the nutritional health of pregnant women and children in their earliest years, as well as delivering child healthy weight programmes are key components of our Healthy Weight Strategy. It is my role to lead the implementation of our Healthy Weight action plan and ensure that there is a coordinated approach across Ayrshire.  Assistant practitioners from our Dietetic Health Promotion team are part of a wider multidisciplinary team alongside midwifery and physiotherapy staff who deliver Healthy Bump, Healthy Baby, a session offered to obese pregnant women.  In addition, our assistant practitioners deliver Messy Munchers a practical, interactive workshop on weaning for parents.  They also provide training on weaning and eating well in the early years to staff from a range of agencies who have a role in supporting families.

Another part of my role is to manage our child healthy weight team.  Our JumpStart evening programme is a 10 session family and community based intervention offered to families with a child above a healthy weight.  The programme is delivered by Health Coaches and is based on motivating and empowering families to make positive behaviour changes such as choosing healthier food and drinks, increasing physical activity levels and decreasing sedentary behaviour.  JumpStart Choices is an 8 session weekly programme delivered in primary schools and takes a whole class approach.  The content is based on the evening programme and parents are invited to attend one of the weeks during the programme.  Children are set family based activities to be completed at home each week to facilitate further parental engagement.

The activities I have described are important however will not be sufficient on their own to reduce childhood obesity levels. National and international organisations concerned with population health consistently recommend that a multifaceted approach over many decades is required; one where public, private and third sectors across society play their part. I am up for that, are you?

Further Information

For further information or to refer a child to JumpStart please contact Alan Brown on (01292) 885891 or alan.brown2@aapct.scot.nhs.uk

References

1. ISD Scotland, Primary 1 Body Mass Index statistics available from: http://www.isdscotland.org/Health-Topics/Child-Health/Child-Weight-and-Growth/
2. Stevenson J et al, 2018. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. The Lancet, 391, 1830-41.
3. Victora CG et al, 2016.  Breastfeeding in the 21^st century: epidemiology, mechanisms, and lifelong effect.  The Lancet, 387, 475-90.

 

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