10.Arguably the most consistent message we heard throughout our inquiry was that implementation of an effective childhood obesity plan demands a holistic, joined-up, ‘whole systems’ approach with clear and effective leadership. This approach needs to encourage joint working between national and local Government, families and communities, third sector groups, schools, healthcare professionals, industry and academia, in order to deliver the results necessary to tackle childhood obesity in England. We need to change the narrative of childhood obesity to being ‘everyone’s business’, rather than just that of the health and social care sector. Leeds Beckett University explained in written evidence:
A whole systems approach corrals expertise and enthusiasm from across all sectors to develop a shared understanding of what causes obesity (locally or nationally), and then to identify points in the system where stakeholders can work collectively to change how the system functions. Such an approach takes time, continued engagement from all stakeholders, and for many, involves a new way of thinking and working.
11.The 2007 Foresight Report on Tackling Obesity argued that a wide range of factors affect the distribution and occurrence of obesity across England, and that tackling obesity requires a ‘joined-up’ approach, where each of the various determinants can be addressed in a multi-sectoral manner. So far, however, joined-up working to resolve childhood obesity has been limited.
12.In late 2017, the Centre for Social Justice published “Off The Scales: Tackling England’s childhood obesity crisis”, a comprehensive report on the state of the nation with regards to childhood obesity, and the actions necessary from Government and other stakeholders in order to address it. In the introduction to this report, the point was made that:
No single sector is fully responsible or will make much difference in isolation from other factors. Only when all key departments and sectors take ownership and recognise their responsibility will we have a society and culture conducive to good long-term health … moving from a fragmented to a collective, whole-systems approach … [is] essential for the Government to end childhood obesity.
13.This focus on the necessity of a ‘joined-up’ or ‘whole-systems’ approach was reiterated through our inquiry. The Health Action Campaign’s written evidence looked at international examples of successful childhood obesity schemes, and concluded that there are now at least three programmes known to reduce childhood obesity. We heard evidence during our visit to Amsterdam on EPODE in France, JOGG in Holland, and TCOCT (The Children’s Obesity Clinic Protocol) in Denmark. The Health Action Campaign argue that:
Each of these successful initiatives has adopted a sustained, systematic, joined up approach, rather than separate ad hoc initiatives, either in a community or a clinical setting. Each has reduced levels of childhood obesity, including in socially disadvantaged groups, thereby helping reduce health inequalities.
14.Evidence to our inquiry demonstrated that there are also a number of programmes being undertaken across England to tackle childhood obesity. We heard written and oral evidence about the successes of schemes including, but by no means limited to, NHS Champ in Manchester, HENRY and the Croydon Food Flagship programme in reducing childhood obesity at a local level. However, we echo the arguments made in the Centre for Social Justice’s report ‘Off The Scales’, that
[While] There are numerous whole-systems programmes and effective childhood obesity projects being delivered across England… unlike in Amsterdam where efforts are joined up and politically led, the current system in England remains fragmented.
15.We strongly believe that, in order for the important local examples of best practice relating to tackling childhood obesity across England to fulfil their potential, it is essential that they are ‘joined-up’ in a whole systems approach. We saw this demonstrated by the example of the Amsterdam Healthy Weight Programme (AAGG). We heard that AAGG committed to identifying and connecting different schemes that already existed in the city. Once that had taken place, the AAGG was able to recognise and ‘fill in the gaps’ where service provision was lacking.
During our visit to Amsterdam, the AAGG’s approach to tackling childhood obesity was described in terms of using sandbags as a flood defence.
Childhood obesity is a river, which has burst its banks. To protect society, we put in place sand bags, with each sand bag representing a specific policy to combat childhood obesity, such as a 9pm Watershed on junk food marketing, or increasing education in schools on healthy eating.
In isolation, each sandbag is unable to stop the flooding, much like, in isolation, no single specific policy can successfully tackle childhood obesity. It is only when we have a large collection of sandbags, which are effectively joined together, do we have a flood defence which works. Only when we have a variety of different evidence-based policies, and a joined-up system which connects them all, can we hope to tackle childhood obesity effectively.
17.Local leadership will be essential in identifying areas of greatest need and in drawing up action plans which can start by drawing on existing good practice and focus on joining up existing services by identifying community, school, local government and neighbourhood-led projects that already exist, and ‘filling in the gaps’ where service provision is lacking.
18.Alongside this, there needs to be a concerted effort at both national and local level to change the narrative around childhood obesity, to make it clear that reducing the personal cost and inequality is everyone’s business.
19.We heard that national and local Government collaboration and co-operation will be integral to the success of a whole system approach in England. In 2015, Public Health England (PHE) commissioned Leeds Beckett University to create a toolkit that enables local authorities to produce a whole systems approach for tackling obesity. Leeds Beckett University argued that the initial results of the pilot had been extremely promising. However, they reinforced the importance of national and local Government co-operation, stating:
Local authorities have levers available that can change how the local system functions—including how to create a healthier local environment. However, local authorities work within geographical and political boundaries. They cannot change all elements of their local systems, some require action and support from national government … national government must be seen by local authorities to be doing their part, obesity cannot be tackled by local authorities alone.
20.Evidence to our inquiry suggested that to allow local authorities to act effectively on childhood obesity, greater awareness was required of the priorities of different sectors to identify where ideas around obesity fit in with their existing work, to encourage cross-sectoral commitment. While local authorities can do this up to a point, the oversight and ‘big picture’ vision afforded to national Government is an essential supporting measure to inform local decisions.
21.The next round of the Government’s childhood obesity plan must include a dedicated discussion of the role and responsibility that local government has in reducing childhood obesity, and the specific ways in which the Government intends to support local government to achieve that aim. We heard that many local authorities feel that their influence can only go so far. National Government must give them the levers they need to be able to tackle the obesogenic environment and to provide an effective range of support services. We therefore urge national Government to listen to local authorities and give them greater powers to reduce health inequality at local level.
22.The Obesity Policy Research Unit’s report ‘What can be learned from the Amsterdam Healthy Weight programme to inform the policy response to obesity in England?’ highlights strong political leadership as critical to the success of the Amsterdam AAGG. This is reiterated by the Centre for Social Justice’s ‘Off The Scales’ report, which states,
The resounding emphasis from experts connected to or involved in AAGG is that the political leadership–most notably the leadership, vision and commitment to overseeing the project by Alderman van der Burg–has been integral to its success in being city-wide and effectively holding every sector to account. [Van der Burg] “understood the gravity of the problem and propelled childhood obesity to the top of the city’s agenda”. In doing so, other key politicians formally committed to introducing the programme in 2013 and, in publicly signing up to the long-term vision and ambitions, are now fully accountable to ensuring its success.
We met Mr Van Der Burg ourselves during our visit to Amsterdam, and were impressed by his drive and commitment to the policy area of childhood obesity, and the long-term vision he adopted when attempting to devise solutions to the problem.
23.The Centre for Social Justice report goes on to recommend,
The first step the Government, and specifically the Prime Minister, must take to end childhood obesity is to commit to doing so, secure the cross-party, cross-departmental and cross-sector commitment to support this and set out a bold, long-term, target-led, non-partisan strategy. The Government should focus on area-based targeting: start in areas with the highest proportion of childhood obesity and then roll out interventions proportionate to an area’s childhood obesity rates.
24.In England, political leadership on Childhood obesity prevention has been lacking, despite the Government’s 2016 Plan. In written evidence, Sustain, a charity focusing on better food and farming, stated:
… leadership on sugar reduction efforts shown by Public Health England and the NHS has not been matched by other Government departments, or from Number 10 itself. The Childhood Obesity Plan has remained primarily within the remit of the Department for Health, rather than high level cross-government leadership from the Prime Minister personally and by the Cabinet Office … Whilst there is a committee of civil servants from across relevant departments which meets quarterly to look at the progress on implementing the Childhood Obesity Plan, this is very different from the high level ministerial—and indeed prime ministerial—leadership and coordination of policy that was originally envisaged. Meanwhile there is little evidence that departments such as DCMS, DEFRA or DexEU/Trade are integrating public health or the Obesity Plan appropriately with their own strategies and plans.
25.The revised government Childhood Obesity Plan should be championed by the Prime Minister. A cross-department Cabinet-level committee should be set up which reviews and evaluates the implementation and effectiveness of the plan, with mandatory reporting across all departments on the implementation of the childhood obesity plan every six months. Tackling childhood obesity effectively will take time, and political leadership will be needed to bring decision-makers together with a shared mandate to create and sustain healthy food and activity environments for children.
28.The Obesity Policy Research Unit’s report also highlights that clear expectations were critical to the success of the Amsterdam AAGG. They state,
There is a recognition that eradicating child obesity is a long term project. However, to ensure there is continued buy-in, and to mitigate against the disruption caused by electoral cycles, the AAGG has established shorter term goals along the way (see programme description). The potential effect is if it can be demonstrated that the milestone goals are being achieved this may encourage continued buy-in from different sectors and across election cycles. This will then facilitate the achievement of the AAGG’s long-term goal.
29.In 2016, it was suggested by Channel 4’s Dispatches programme that the Government’s Childhood Obesity: A Plan for Action had been significantly diluted from its original draft. The programme claimed that the draft contained a pledge to halve childhood obesity by 2026 to 800,000 cases. However, when the full strategy was released, that had been changed to a pledge to “significantly reduce” the number of chronically overweight children. Evidence to this inquiry suggested that this change had been detrimental to the success of the Government’s plan, and that the next round of the Government’s plan must redress this failure. In oral evidence, Kieron Boyle of Guy’s and St Thomas’ Charity stated:
… we need a road map. Everybody recognises that this is a complex issue. To have a genuine 10-year plan, we need to say what we hope to see after years 1, 3 and 5. Year 1 need not be that ambitious if we know that it is pointing toward where we need to be by year 10.
30.We fully endorse the conclusion of our predecessor Committee in its 2017 report–Childhood Obesity: Follow Up - that “Vague statements about looking ‘to further levers’ if the current plan does not work are not adequate to the seriousness and urgency of this major public health challenge.” We repeat its call for the Government to set clear goals for reducing overall levels of childhood obesity, as well as goals for reducing the unacceptable and widening levels of inequality.
15 , December 2017, p.18
16 Ibid p. 14
18 , 17th October 2007
19 , December 2017 p. 37
21 Ibid p.12
25 , December 2017, p.37
26 Ibid p.41
29 Q13 Dr Nobles
30 , December 2017, p.39
31 , December 2017, p.56
33 Obesity Policy Research Unit (OPRU): Rapid response briefing paper - What can be learned from the Amsterdam Healthy Weight programme to inform the policy response to obesity in England?, 18 December 2017 p.10
34 The Secret Plan to Save Fat Britain: Channel 4 Dispatches, 31 Oct 2016
35 p. 4
36 Q17, Kieron Boyle
Published: 30 May 2018