21/07/15 – Poor fitness and Early Childhood Obesity – suggestions to tackle these problems

Speaker: Professor Neena Modi, President of the Royal College of Paediatrics and Child Health; and Helen Clark reporting on the meeting with Lord Nash

21st July 2015 – meeting notes

All-Party Parliamentary Group on a Fit and Healthy Childhood

Chair :Jim Fitzpatrick MP

Jim Fitzpatrick MP opened the meeting and welcomed the attendees.

Helen Clark reported the outcome of the meeting between members of the Group and Lord Nash:

The meeting between members of the Group and Lord Nash was great and effective. Lord Nash recommended (and will facilitate) meetings with Ofsted, Lords Pearson and Farmer and the Minister Sam Gyimah MP, for the group. In addition, the office of the Secretary of State for Health has contacted Baroness Benjamin’s office with a view to arranging a meeting.

Professor Neena Modi

Reflecting the roles as the President of the Royal College of Paediatrics and Child health, the discussion will reflect my background as a clinician, scientist and the presidential role and cover the facts, the implications of poor fitness and early childhood obesity and consider suggestions to tackle these problems.

One in five children aged 5 are overweight or obese; this rises to 1 in 3 by the age of 10/11. Children born after the 1980’s are 3 times more at risk of being obese than previous generations. Deprivation and obesity are linked; the prevalence of type 2 diabetes is greater in areas of deprivation. This is a global issue.  Numerically there are move obese children in lower income countries.

Fitness and obesity have a strong converse relationship; being fit is not of itself going to overcome obesity. It would take more than walking from Glasgow to Edinburgh to walk off a mars bar. Levels of fitness and obesity are closely related, but they are not the same thing. The health risk are very well known, heart disease, diabetes, colonic cancer go up if you are obese.

Obesity and overweight in childhood can leave a mark for life. If a child is overweight in childhood and loses that weight it does not mean that they have totally eliminated the risks to their long term health chances. Childhood obesity poses lifelong health risks. There are gender differences in this area. A girl who slims down is much more likely to revert to her pre over weight risks for life-long health, whereas a boy who slims down is left with increased residual risk.It is all about obesity, cutting it down from the very start.

A foetus can become overweight or obese or ‘adipose’ where the proportion of their body weight made of lean tissue and fat is imbalanced. Research shows clearly that an overweight or obese mother has more chance of delivering a baby with adiposity. For each unit increase in BMI the baby’s adiposity will increase by 8cc. Although, of course, we cannot see what “overweight” is on a baby. Many of you will be familiar with the criticism of BMI, but it has been a useful but pragmatic measure.

There is a growing problem in society; there is a failure to recognise what is “overweight” or “obese” because of our distorted perceptions. Research shows that a third of parents to not recognise obesity or overweight in their children; they consider them to be of a normal weight. This is a problem that we also have to face, how do with deal with this shift in perception.  Similar research has been carried out with young adults. Those who were overweight had a greater chance of getting it wrong and thinking that they were normal weight.

The odds of having an overweight or obese baby increases three to four fold if the mother is overweight or obesity in during pregnancy.

In terms of the economic aspect, the effect of excess weigh on longevity is particularly marked in young adults. A young adult in their early 20’s is going to lose about 6 years of life. The cost of this to the NHS is £6 billion a year to treat obesity and a further £10 billion a year is spent to treat diabetes. The economic arguments are very stark. McKinsey have argued that the lost to GDP from overweight and obesity is about 3%. Compare this to the sums spent on obesity prevention; £650 million a year, there is a disparity the sums spent of prevention and the costs and the consequences.

When is the best time to intervene? Prevention has got to be the answer. In terms of weight loss, women have a 1 in 120 chance and men a 1 in 240 chance of reverting to their original weight. Even those who manage to lose the weight tend to put it back after 5 years. For children 1 in 5 manages to retain that weight, but it is difficult to maintain weight.

Pre-conception and pregnancy are the points at which to intervene. There is a need for more evaluation of preventative measures, there needs to be more primary research on areas such as the biological mechanisms of pre-pregnancy weight.

If a pregnant mother is overweight, the child is born with adiposity and brought up in an obesogenic environment the child is on a pathway to tragedy.Consider a female baby; in a toxic inter-uterine environment, which then bombards the eggs of that baby creating generational obesity.

Epigenetics – understanding the biological processes in humans is needed; we are at a point where we can study small babies safely.

What we don’t understand at the moment:

  • Trans-generational links
  • How childhood obesity tracks in the lifeline
  • Is early intervention needed at 1, 2 or 3, does that mean that a child’s healthy lifespan returns to normal after intervention at these points. Currently we do not know how early we need to intervene.
  • How do train infant tastes, can they be entrained very early on?
  • What are other biomarkers of risk?
  • What factors promote physical activity?
  • What is the impact of regulation and statutory measures?

In conclusion, we need a multi-faceted, targeted approach, which cuts across all of society, including the public and private sectors to work together. The most striking intervention can come from public heath perspective, those such as the clean air act, and on clean water and smoking.

Questions and discussion

What is your view on the national measurement programme?

The emerging evidence suggests that inequality based differences in overweight and obesity at age of 11 is widening.

What do you think about the guidelines from the institute of medicine on weight gain in pregnancy?

Measurement is a good thing; if we don’t measure we just don’t know. But we need to start it earlier on, pool and analyse the data and then act on it.

I couldn’t agree more with the point about inequalities, there is an association between deprivation and obesity, and we cannot lose sight of that.

The Institute’s guidelines are a few years old; the criticism has been that the evidence base was the best of its time, but not great. European information on gestational weight suggests that weight gain may not be the issue, but there is an evidence gap here, whereas evidence on pre-pregnancy weight does exits and that is an important period.

Policy on children’s play has ignored the fact that for generations children played outside their homes every day. One change that can be made at virtually no cost is to make use of the existing Street playgrounds legislation. This would create an environmental and public health change.

Is there any data on the risks of obesity with unplanned pregnancies?

I don’t know of any relevant data on unplanned parenthood, it is obviously difficult to come by. It is better that all young women and men have aspirations to be healthy. 30% of women going into pregnancy now are overweight or obese.

Why is it important to do physical exercise alongside being fit?

Should we use Sure Start a lot more, getting them to expand rather than close?

Can breastfeeding be a way for infants to expand their taste buds, by “tasting” foods from breast feeding?

There has been research to examine the impact of telling diners how much exercise they would have to carry out in order to eat a Big Mac, if you are made aware of the data it influences your choices.

It is possible to be overweight but healthy, yes, there is a correlation but it is not always the case that you are unhealthy if you are overweight. BMI is problematic; it depends on how fit people are. It is important not to conflate body size and fitness.

Breast feeding is the best start in life; the jury is out on whether or not this reduces obesity for babies.

A recent survey on healthy conversations with pregnant women showed that there is a resistance by professional to talk about weight. We need to educate healthcare professionals on how to have these conversations.

Looking at the metrics of the report from the Academy of Medical Colleges, what happened to the measures since the report’s publication in 2013?

Royal College of Paediatrics and Child Health has a seat at the Academy table and we want to make sure that we can work with the government in its anti-obesity strategy. As for the metrics, the proof of the pudding will be when we see a reversal of current trends.

Healthcare professionals have had to learn how to have conversations on what would previously have been considered to be taboo subjects.  They can be trained to have conversations about weight now.

British women’s milk tends to be short of Vitamin D, we need to remind them to take Vitamin D when breast feeding.

Is there any research that links mental health with obesity, be that maternal or child mental health?

Play has always been without parents being there. Road safety organisations are the enemy of children’s health.

Are politicians getting it? Are they moving into the right area or are they lagging behind the evidence?

Vitamin D is healthy as is playing outside, a natural source of Vitamin D. Be active, not just to lose weight but to be physically and mentally healthy. Play is important because it is about many things; like building imagination. Politicians have got it; there is so much discussion and commitment with eventhe Prime Minister taking an interest.

Please view the issue as a scientist would:

  • Admit not knowing it all
  • Explore and get rid of stuff that does not work
  • Use good application to get it right
  • There is a need to invest.
  • Consider the importance of data, analysis research and evidence.

I  would say “let’s see if this works”.

The meeting closed.