5Early years and schools
Early years
60.The first 1000 days (from conception to a child’s second birthday) are widely considered to be the most formative in a child’s development, with health behaviours already heavily influenced. For example, the most excess weight gain before a child hits puberty occurs before children reach five years of age. Health Exercise, Nutrition for the Really Young (HENRY) argued in written evidence:
One of the key barriers to better prevention of child obesity is the current lack of focus and investment in obesity prevention in the early years. Attention is concentrated on obesity prevention and management with primary school aged children … The early years (including pregnancy) provide a unique window of opportunity to prevent obesity before it can develop. It’s much easier to establish healthy eating and activity habits early than it is to try break poor habits once they become routine. Additionally, the early years is a time when parents have more contact with health professionals and services and are more receptive to help and support.68
61.In England each year 10% of children who start school aged 4–5 years are already obese, with a further 13% overweight.69 Recent analysis by PHE found that of only 1 in 20 children who start school obese will have returned to a normal weight by the time they begin secondary school, and early childhood obesity disproportionately affects children from the most deprived backgrounds.70 Despite this, the Government’s first childhood obesity plan was troublingly lacking on early years provision, with the only action being to commission the Children’s Food Trust to develop revised menus for early years settings which would be incorporated into voluntary guidelines for early years settings.71
62.The argument has also been made to us that, while much early years’ service provision would, in an ideal world, be granted more central Government funding, there are best practice examples of cost neutral programmes which have revolutionised service provision currently underway in England. For example, NHS Champ in Manchester is a multi-partnership, collaborative approach committed to producing a digital growth chart for every child as a fundamental indicator of health and wellbeing as well as a predictor of future health and wellbeing. The scheme was able to provide additional measurement data for early years children whilst remaining cost neutral by harnessing technology in the way that children were weighed and measured. As they stated in oral evidence,
This means that school nurses, who already go into all 137 primary schools in Manchester, across the city, can weigh a whole school in the same time that they weighed and measured two classes before. That is why it is cost neutral: it is no more time and no more effort.72
63.We recommend that the Government should put in place further measures around early years and the first 1000 days of life to combat childhood obesity. Such programmes should include:
- Promotion and support for breastfeeding for all infants in all areas (including improved provision for mothers to breastfeed in the community), and further support and advice on appropriate and responsive bottle feeding for those cases where breast feeding is not appropriate.
- A ban on advertising and promotion of follow on formula milk as this has long represented a ‘back door’ route to advertising of formula feeding. There needs to be better enforcement of the existing rules around the promotion of infant formula milk.
- Improved early years education to inform and promote appropriate introduction of solids to infants’ diets.
- The strategy needs to set ambitious targets for initiation and maintenance of breastfeeding.
- Training and equipping the early years workforce, in both the voluntary and statutory sector, to effectively support parents and families to promote healthy eating and activity in their children. Evidence-based training should be made available and the long-term effectiveness of current national online training should be independently evaluated.
- A programme to ensure the widespread take-up of best practice, cost-neutral early years schemes such as the NHS Champ project in Manchester, and continued support to those already in operation.
- Government funding for local authorities to make available effective interventions to support families with pre-school children most at risk of obesity.
Measurement
64.Further to early years service provision, Prof Russell Viner told us:
One key thing that we would argue for is expansion of measurement … At the moment children are measured at birth by their GP at the six-week rate, but it is often not written down. They are often measured quite a lot through their early life and the data are not gathered in one place; it is not put together. They are measured exceptionally well by the national child measurement programme at four and at school leaving at 11, but between birth and four the data are in no particular place, sometimes in the parent’s red book, and after 11 there is no measurement.
The data systems should work together; it should be held by parents and by GPs. There should be systems that allow GPs to record and act upon that data purely through signposting. At the moment, our primary care systems are not designed to allow GPs simply to make every contact count. We do not want a child to turn up at primary school at age four already overweight and obese. We want GPs, nurses or others to advise parents on when a child is going off trajectory, heading towards being overweight, and to guide them back.73
65.We recommend that the next childhood obesity plan include specific measures to ensure that data on child measurement are able to flow effectively between different parts of the health and social care system to the child’s general practitioner, who should take on primary responsibility for co-ordinating appropriate weight management advice and services, and to the child’s parent. We recommend that consideration is given to including a further measurement point within the Child Measurement Programme, in addition to better collation of opportunistically gathered measurements. Early identification and targeted support is necessary to reduce health inequalities.
Schools
66.In the Government’s original childhood obesity plan, a large section of the recommendations focused on school-based measures, including updating the School Food Standards, introducing a Healthy Schools rating programme and running a campaign to encourage academies to sign up to the School Food Standards.74 We heard no convincing evidence that any of these school-related measures had been implemented in an effective or holistic manner, and we retain significant concerns about the current approach of the Department for Education in making any significant contribution to the Government’s childhood obesity plan.75
67.The focus on schools as an important element of an effective childhood obesity plan is demonstrated by the Amsterdam Healthy Weight Project. As the Centre for Social Justice’s ‘Off The Scales’ report states,
A critical element of the programme is the work in schools. The programme is based on the belief that children have the right to a healthy school environment in which they don’t eat unhealthy products and have sufficient, effective exercise. The programme states that all schools in Amsterdam promote health. All pre-schools and schools can get help achieving this through the Amsterdam school programme ‘Jump-in’. Jump-in supports all the primary schools in Amsterdam, but especially those where the percentage of children with an unhealthy BMI is higher than the average percentage for the Netherlands.76
68.We were also interested in the focus on sleep in the Jump-in model, which sets “getting enough sleep” as one of the core eight targets for a school to be considered a ‘Healthy School’. We understand that the Government is working with the Obesity Policy Research Unit on this policy area in relation to the UK, and eagerly anticipate the publication of the findings from this work.77
69.We urge the Government, and specifically the Department for Education, to review its performance in executing the measures contained in the Government’s first childhood obesity plan relating to schools. We urge a full and timely implementation of all of the measures contained in their first Childhood Obesity Action Plan, including updating the School Food Plan to account for the updated dietary recommendations for free sugars and fibre. School Food Standards should be mandatory for all schools including all academies, as should the Healthy Rating Scheme.
70.We endorse the approach taken by the Amsterdam Jump In programme and in particular the culture change it drives around a healthy food and drink environment as well as the importance of wellbeing and physical activity. We look forward to the Government’s publication of its appraisal of the role of sleep quality in tackling obesity and improving wellbeing. The Government should act on its findings and recommendations.
71.The greatest attention should be focused on schools with the greatest prevalence of obesity in order to reduce the unacceptable and widening health inequality of childhood obesity. Messages however should be positive and focus on health and wellbeing rather than stigmatise obesity. We also recommend that the Government commission research to find the messages that will be most effective within communities at greatest risk, for example on the need to reduce sugar to protect children’s teeth.
68 HENRY (COY0037) p.2
69 Ibid p.2
70 HENRY (COY0037) p.2
72 Q9
73 Q142, Q143
76 Off the scales - The Centre for Social Justice, December 2017, p.43
77 Q378
Published: 30 May 2018