Halving rates of childhood obesity by 2030 was the bold ambition set by the Scottish Government back in 2018. However, the onset of the COVID-19 pandemic and its restrictions have created large barriers for achieving this goal and alongside a lack of progress on improving food environments we look to be heading in completely the wrong direction.
The latest Primary 1 BMI data (published on 14th December 2021) highlights significant and worrying trends in the weight of Scottish children. In the 2020/21 school year, 29.5% of children in Primary 1 were at risk of developing overweight or obesity, an increase of 6.8% from the previous year. Importantly, the biggest increase across weight categories was seen in those at risk of obesity which rose to 15.5% (up from 10% in 2019/20). While levels of overweight and obesity have remained fairly constant in Primary 1 children since records began in 2001, this is the first year there has been a significant uptick in unhealthy weights. We know that obesity in children is associated with health risks for them both now and in their future and these results should be a matter of serious concern to us all.
Social Inequality
The data shows that 36% of children from the most deprived areas in Scotland are at risk of overweight and obesity, compared to 21% of children from the least deprived areas. This is the biggest gap between these groups seen in the last 20 years. Furthermore, when looking at obesity alone, children from the most deprived backgrounds are almost three times as likely to be at risk of obesity than their peers from the least deprived areas (21% vs 8%).
How complete is this year’s data?
Data collection across many health fields has been impacted by the COVID-19 pandemic and this was reflected in the reduced coverage of this year’s Primary 1 BMI data. Restrictions meant that only 37% of children in Scotland were measured, compared to usually over double that number in previous years. However, additional analysis in the report showed that this year’s data was similar enough to that of previous (in terms of characteristics of the children measured) for it to be used in comparisons.
A second caveat of this year’s data is the slight under-representation of children from the least deprived areas in Scotland, meaning results could be slightly skewed towards measurements of more deprived pupils.
Primary 1 BMI data is currently the only official source of weight data for children in Scotland collected annually following recent adjustments to the Scottish Health Survey (SHeS) as a result of the pandemic. This means our understanding of childhood weight is more limited as we can only see a snapshot of data which is taken from different children each year.
This lack of data is concerning at a time when we know that the pandemic is having impacts on children’s health and wellbeing. It is also important that data is available to assess progress towards the Scottish Government’s ambition to halve childhood obesity by 2030.
Impact of the pandemic
Children included in the data collection are largely in the age range of 4.5 - 5.5 years old. Since measures to tackle the pandemic were first put in place in March 2020, this means that many pupils in this year’s cohort will have lived nearly a quarter of their lives under various restrictions. Our polling report from last year showed that the effects of pandemic restrictions have led many adults to eat less healthily, and there is no doubt that a similar effect has occurred in children.
Prevention work for children
Obesity prevention work for young school children in Scotland is currently very limited. The Scottish Government commissioned a report published in December 2021 which outlined existing work to encourage healthy weight in children from preconception through to Primary 1. Efforts to prevent obesity in children starting school are largely focused on verbal presentations by school nurses or local health promotion professionals to encourage healthy eating and exercise. Such initiatives vary from area to area and there is little consistency in how schools approach the issue. Furthermore, these efforts are now rarer than before as this kind of work no longer falls into the official remit of school nurses.
Whilst the Government is committed to a Whole System Approach and many of the early adopters are focusing on childhood obesity, the impact and outcomes of this work have been severely affected by the pandemic.
A note on maternal obesity
Earlier this month Public Health Scotland also published the Births in Scottish Hospitals report for 2021. It showed maternal obesity rates in Scotland to be the highest on record at 54% and disparities were again found across different levels of deprivation. There is significant evidence showing that maternal obesity is linked to child obesity1 and while we cannot draw any direct links between these two data sets, it is fair to say that rising levels of maternal obesity will likely have a negative effect on the weight of children in Primary 1 in years to come.
Where are we now?
Pandemic restrictions have only exacerbated the effects of what was already a failing food system for children and parents. Providing information to children and parents will not halt a rise in childhood obesity. The impact of the pandemic is wide-reaching but we must not allow the long-term health of our children to be overlooked. The evidence tells us it is much more effective to prevent childhood overweight and obesity, and so measures to allow us to address this need implemented with urgency.
Parents should be able to access nutritious food for their children without the influence of relentless marketing and promotion of less healthy products, while also not being priced-out of healthier alternatives. Wide-reaching, structural changes are needed if the Scottish Government is to be successful in reaching its target of halving childhood obesity by 2030.
Read the full Primary 1 BMI report for 2020/21 here
Read our response here
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