In November 2021, NHS Digital released new data from England’s National Childhood Measurement Programme (NCMP). This surveillance programme collects data on the weight and height of children in their first and last years of primary school and is used to understand trends in children’s weight.
What the data show
Crucially, this data set provides the first solid evidence of the impact of the Covid-19 pandemic on excess weight prevalence in children in England. The data paints a grim view of children’s health:
- In Reception children, 27.7% are above a healthy weight, with 14.4% living with obesity (up from 23% and 9.9% respectively in 2019/20)
- In Year 6 children, 40.9% are above a healthy weight, with 25.5 living with obesity (up from 35.2% and 21% respectively in 2019/20)
This large jump in overweight and obesity is unprecedented. Levels of excess weight in children, although high, has been relatively stable in recent years, with the largest increase seen previously just under one percentage point.
What’s particularly concerning is the widening gap in inequality. Children living in the most deprived areas were more than twice as likely to have a weight classed as obese, than those living in the least deprived areas
- 20.3% of Reception children living in the most deprived areas have obesity compared to 7.8% of those living in the least deprived areas
- 33.8% of Year 6 children living in the most deprived areas have obesity compared to 14.3% of those living in the least deprived areas
What’s behind the rise?
Lockdown measures indisputably played a key role. It is known that weight gain is linked with time spent out of school during holiday closures and is greater among those of lower socioeconomic status. Reduced incomes and rising food insecurity from the economic fall-out of COVID and the impact of losing access to breakfast clubs and free school meals for some pupils may have also led to changes to family diets which are often associated with poor nutrition because access to healthier food is limited.
Reduced physical activity?
It may be tempting to ascribe this rise to children’s reduced physical activity during lockdowns. And while less exercise and movement won’t have helped matters, it’s not the whole story. Dr Joseph Henson from the University of Leicester explains, “Being physically active, brings many significant physical and mental health benefits, and plays a key role in weight maintenance. Indeed, physical activity is the most modifiable factor of energy expenditure that can affect the energy balance equation. However, it is unlikely that reductions in physical activity alone will have led to the large increase in excess weight prevalence in children these data show.”
Although physical activity is secondary to diet in terms of drivers of weight gain, the challenge of promoting adequate physical activity in children remains a major public health concern. It is clear that lockdowns and the subsequent closure of parks, sports clubs and extra-curricular activities have resulted in crucial changes in children’s daily routines and their opportunities for being active. Dr Joseph Henson says: “Lockdown measures had a negative impact on the total number of active children and young people, which were already at very low levels pre pandemic with less than 50% of children achieving physical activity guidelines. Even when restrictions allowed only 60 minutes of exercise in a local area, nearly 30% of children reported not leaving the house on a typical day. It appears that the COVID-19 pandemic has exacerbated all the risk factors for weight gain typically seen on weekend days and during the summer months, thus presenting enormous consequences for children’s overall physical health and potentially increasing future demand on NHS resources.”
The ongoing COVID-19 pandemic has highlighted the importance of our environments and our access to opportunities to be physically active as part of daily life and it is important to capitalise on this with cross-cutting population health approaches to children’s health more broadly.
The role of food
Several surveys have shown adults and young people reporting snacking more in lockdown, and this is likely to extend to children too. Snack food like crisps and biscuits tends to be high in calories and low in nutrients. This reported increase is reflected in sales data showing a rise in sales. For example, an extra £160.8m was spent on biscuits in 2020, a rise of 5.5% – equivalent to an extra 144 million packets, with similar rises seen in other ‘treat’ foods, such as cakes. Food delivery companies also saw record growth. This is likely to have played a role, as portion size in the out-of-home sector is often larger than portions sold in retailers and, in addition, the food largely available tends to be higher in calories, fat and salt, and is generally less healthy than food prepared at home.
One key thing these types of foods have in common is that manufacturers have spent years heavily bombarding us with marketing messages equating their products to key emotions – comfort, treats and rewards. It’s no wonder under lockdown, struggling to entertain or educate children, food took on a whole new importance.
The food industry certainly capitalized on this opportunity of lockdown. A report from the NCD Alliance listed hundreds of ways the food and drink industry has used the pandemic to promote its products and take advantage of the situation—particularly alcohol, sugary drinks, and ultra-processed food. It is now more important than ever that the Government pushes on with stronger regulations to reduce the marketing of food and drinks that do not benefit children’s health.
What does this mean for the future?
Given the record size of the rise of excess weight prevalence, is it possible that this year’s data could be a blip? Less data was collected this year than in previous years, but significant work was undertaken by NHS Digital to ensure it was a representative sample and adjusted for biases.
The other question is whether the data reflects an unprecedented situation and as children have (for the most part) returned to school and other activities can we expect this cohort of children to return to a lower weight? Professor Mary Fewtrell from University College London thinks we won’t know until we see future years data but pointed to existing research on children’s weight trajectories. “There is certainly evidence that excess weight and obesity may track to later ages, from longitudinal studies in populations studied over different periods, although that doesn’t mean that at an individual level a child with overweight or obesity will always stay that way.”
What is clear is that prevalence of excess weight in children was unacceptably high even before the pandemic – so much so that the Government set a target to halve childhood obesity before 2030. It is now unclear whether that target is achievable as COVID-19 has made a bad situation so much worse.
Now, more than ever before, we need the Government to do more to prioritise children’s health with evidence-based measures that address the obesogenic environment and will reach children of all ages and backgrounds, giving every child the chance to grow up healthy.
In September 2021 the Obesity Health Alliance published ‘Turning the Tide: a 10-year Healthy Weight Strategy’ which sets out 30 evidence-informed recommendations for governments to address obesity and improve health.