120.The National Child Measurement Programme measures the BMI of children at Reception—aged 4–5 years—and again at Year 6—aged 10–11 years. Witnesses highlighted the programme’s importance, one describing it as “critical” in outlining the “size of the problem we face”, and another calling it “absolutely essential”. We were also told of the ‘precarious nature’ of the programme:
The Chancellor has proposed that another £200 million is taken away from local authority public health budgets this year. That is clearly a false economy. It is going to cause all sorts of additional burdens for the national health service and, in addition, if school nurses are taken away from some local authorities that will just demolish the measurement programme at a stroke.
121.We were told that the programme could usefully be expanded, to measure children at the age of 2 or 3 years, given that one fifth of all children are already overweight or obese by the time of their first measurement. We were told it could also be expanded to look at secondary school age children, as increases in BMI continue over that period. However, the ADPH told us that given the current funding constraints faced by local authorities, they would be reluctant to make further investment, as this would withdraw resources from other interventions:
If I am looking at the limited resources of my team, which it often comes down to, I would rather they were out and doing that [interventions] rather than doing another year’s survey.
122.We also heard that while helpful from an epidemiological perspective, the NCMP is not linked to any treatments or support for children who are identified as overweight or obese:
That is the elephant in the room … the whole problem is that there are no treatments coupled or linked to the NCMP. Basically, we find out about children, but quite often the parents do not get the measurements or the interpretation of them back, and, if they do, in the vast majority of cases there is no treatment or treatment plan, or even advice to provide, that goes with that. It is a stand-alone system that is very helpful epidemiologically, but from a clinical perspective it is not very helpful at all. What you have just alluded to is exactly what we would like to have so that a GP or a parent who has a little Johnnie whose BMI is too high at three, four, five or 10 knows what to do and can refer them in to do something appropriate. Right now there is a disjunction, mostly because of cuts in funding as there are not many local services for obese and overweight children that link with the measurement programme.
123.Currently, children’s NHS numbers are not routinely linked to the NCMP, although there is nothing to stop individual schools or local authorities doing so. The Department for Education and Skills is currently assessing the costs and benefits of imposing a duty on schools in this area. Several witnesses told us that the effectiveness of current programmes to treat obese and overweight children is limited, and that most obese children go on to become overweight adults.
124.One longitudinal study of 1,844 parents of children in Reception (age 4–5) and Year 6 (age 10–11) who were measured as part of the 2010–2011 NCMP in five Primary Care Trusts found that three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Before they received NCMP feedback, only 14% of parents with overweight children and 35% of parents with obese children perceived their child to be overweight. Many parents did not consider their child’s overweight status to be a health risk. After accounting for deprivation and other sociodemographic characteristics, black and South Asian children in the study were three times more likely to have a lifestyle that leads to obesity than white children. The study concluded that:
125.Treatment of childhood obesity was beyond the scope of this inquiry and we do not seek to make recommendations. We note, however, the evidence that treating obesity once established is difficult and that obese children are highly likely to become obese adults. Given the personal costs especially to individual children as well as to wider society, we believe that the case for prevention and early intervention is compelling, as is the case for investing in further research into the most effective ways to prevent obesity and intervene early to help children who are sliding into difficulties with their weight. We also note the importance of identifying and helping underweight children, although that this was beyond the scope of our inquiry.
126.The National Child Measurement Programme is an essential tool in the fight to tackle childhood obesity, providing stark evidence of the scale of the problem. However, in our view, the opportunities for early intervention that this programme offers are being missed. A fifth of children are already overweight by the time they start primary school, suggesting that it would be helpful to begin measuring children’s BMI from an earlier age so that interventions can be targeted as early as possible. However given their current funding constraints local authorities may be unwilling to extend this valuable programme further. We heard suggestions that recent local authority funding cuts may put the delivery of even the current programme in jeopardy. As part of its strategy to tackle childhood obesity, the Government must protect funding for the National Child Measurement Programme, and should evaluate the benefit of extending measurements to younger children, given that over 20% of children are overweight or obese by the time they reach primary school.
127.The National Child Measurement Programme also provides stark evidence of the distribution of childhood obesity—put simply, the problem is twice as bad amongst the most deprived children. Revenue raised by a sugary drinks tax could and should be targeted to deliver the most help to communities where children are most severely affected by childhood obesity, and should be transparently allocated for the purpose of improving children’s health.
128.We recognise that further research is needed into interventions to help overweight and obese children, and recommend that projects funded through a sugary drinks tax should be carefully evaluated for their effectiveness.
136 Q276, Q242
137 Institute for Child Health EVALUATION OF THE NATIONAL CHILD MEASUREMENT PROGRAMME (NCMP) FEEDBACK, pp5-6
Prepared 27 November 2015