How do we tackle the incidence of childhood obesity in Wales?

Rocio Cifuentes, Children’s Commissioner for Wales

Around a quarter of children aged 4 or 5 in Wales are measured as being overweight or obese. These figures should concern us, but they should also not be seen in isolation from their context.

The reasons include the impact of living in poverty; the sedentary behaviours that reflect the impact of technological advances on modern life; the influence and lifestyle of friends and family; and the promotion and consumption of unhealthy foods to children and young people.

But in discussions of obesity and weight, there is a danger in placing too much emphasis on individuals’ own actions and choices. Particularly when it comes to children, the challenges and choices are not with each individual, but are restricted by the society around them.

Childhood obesity in Wales

The deprivation gap in the latest figures is stark, with children living in the ‘most deprived fifth’ postcode areas statistically significantly more likely to be overweight or obese compared to the least deprived. These statistics paint a highly concerning picture of inequality, but weight measurements of children, do not, by themselves, tell us much in terms of how to tackle childhood obesity.

I believe the following are some areas that must be tackled to reduce these figures. Childhood obesity is an indicator of wider health determinants, including deprivation, and measures need to tackle these holistically. This includes considering the crucial role of food and nutrition, and physical activity in determining weight and wellbeing.

Healthy food environments – school meals

One vital part of combatting poor nutrition in children is to improve the quality of the food children eat at school. Public Health Wales has recently published a report on the potential of school food to improve children’s health, which found that the diets of many children and young people in Wales fall short of national dietary recommendations.

They also said that opportunities to improve population health through school food are not being maximised.

This echoes the findings of my own survey on school food, where children talked about small portions and some not always being able to have fruit or vegetables every time they want them.

Welsh Government has committed to reviewing the current regulations for schools on school meals and young people should be actively involved in this process. It’s vital that school meals support our national effort for healthy development in children particularly now that we have universal free school meals for primary school children

Making food environments healthier

I am also highly concerned about the promotion of unhealthy food and drinks to children, including energy drinks.

In September, I asked children and young people what they thought of the proposals from Welsh Government to restrict the promotion of unhealthy foods. Around 60% of children and young people felt that where sugary, salty or fatty food is displayed always or sometimes makes a difference to whether they buy it or not.

Many children and young people mentioned placement by the tills or at the front of shops, and that unhealthy foods ‘caught their eye’.

Neary three-quarters said that deals like buy one get on free made them want to buy unhealthy foods. They mentioned feeling like they had missed out on free food if they didn’t buy them, or being influenced by pictures of the food.

Promotion of unhealthy foods clearly does make a big difference, and young people’s views need to be considered as these proposals are taken forward.

Physical activity

I also wonder whether, perhaps due to the fact that it is easier to collate data on weight, we over-emphasise weight and neglect the fundamental role of activity and exercise in child health.

The most recent Active Healthy Kids Wales report card (2021) paints a concerning picture of poor overall physical activity, with a score in relation to sedentary behaviour ranking Wales as joint lowest (with just three other countries) of the 57 countries that participate.

In 2022, Sport Wales undertook a survey of over 116,000 from 1,000 schools. The survey found that there had been a 9% point decrease in children taking part in regular organised sport outside of the curriculum since 2018; an 8% point increase in those reporting no regular participation in sport outside of the curriculum.

It is clear that we must do more to support children to avoid sedentary behaviour and to encourage involvement in physical activity, alongside promoting a healthy diet. Last year, my office called for Welsh Government to ensure the roll out of the Daily Active Programme to schools in Wales. I have also called for local authorities to apply children’s rights impact assessments to their decision-making processes, so that facilities where children can take part in physical activity can be protected.

A focus on the wider determinants of obesity

While a focus on improving the outcomes of children and young people when it comes to their health is extremely important, I urge Welsh Government and others to ensure they emphasise the importance of those wider societal determinants, above any arguments around personal responsibilities, and ensure that children’s health is conceptualized in its broadest sense, to include nutrition and physical activity.

We need to support children and families to make healthy choices and give them the right opportunities to do so.