NAO calls for cross-government initiative on childhood obesity

A new report from the National Audit Office has concluded “it is not clear” that the Department of Health and Social Care’s (DHSC) current programme for reducing childhood obesity “will be able to make the step change needed in the timescale available”.

Despite action by successive governments, in 2018/19, almost 10% of four to five year olds and 20.2% of 10 to 11 year olds in England were obese.

There is also still a significant wealth divide across the country; children in the younger age bracket in deprived areas are twice as likely to be obese than those in more affluent regions (13% versus 6.4%, respectively), while for those aged 10 to 11 the gap is even wider, at 26.9% versus 13%, respectively.

Obesity rates for children in different ethnic groups also vary “considerably', the NAO noted. For example, just over 9% of white children aged four to give years were classified as obese in 2018/19, compared with more than 15% of black children. These figures were 18% and nearly 29%, respectively, by age 10 to 11.

Aside from the detrimental impact on health, the government estimates that the cost of obesity to the NHS is £6.1 billion and £27 billion to wider society.

According to the NAO, governments have tried to tackle childhood obesity but with limited success.

In 2016 the government launched a new childhood obesity plan (the Plan) with a challenging aim to halve childhood obesity and reduce the gap in obesity between children from the most and least deprived areas by 2030.

The Plan has many similar themes and interventions to previous strategies but includes more legislative regulatory action such as taxation.

However, the NAO found that DHSC has not fully evaluated the success of past strategies, “meaning it will struggle to prioritise actions or apply lessons to its new approach with confidence of success”.

DHSC runs the Childhood Obesity Programme which oversees the Plan's delivery, but its cross-government nature “means many of its projects are outside of DHSC’s control”.

Also, the NAO found “limited awareness and co-ordination across departments of wider factors and activities that may impact on childhood obesity rates, such as sponsorship of sporting events by the food industry, which makes it difficult to ensure they are compatible with the overall aim of reducing childhood obesity”.

The NAO also highlighted that, in 2007, DHSC committed to take forward a research agenda on obesity but did not follow through with this until 2017, when it sponsored the creation of the National Institute of Health Research’s obesity policy research unit.

The NAO’s report concluded that the focus of interventions, including calorie reduction in food, is largely right, but the evidence that the schemes in the Programme will reduce childhood obesity rates “is more limited”.

“Tackling childhood obesity is a major challenge, and one that governments have struggled with since the 2000s. It is clear that children living in deprived areas or from ethnic minorities are far more likely to be obese and the problem is worsening,” said Gareth Davies, head of the NAO.

“Progress with the Childhood Obesity Programme has been slow and many commitments are not yet in place. The new strategy announced in July has signalled a greater intention to tackle obesity but the government will need to follow through with more urgency, commitment and cohesion if it is to address this severe risk to people’s health.”

To accelerate progress in reducing childhood obesity, the NAO is recommending that, by Autumn 2021, DHSC, with support from the Cabinet Office, should introduce stronger procedures that allow the Department to hold other departments responsible for delivering their elements of the Programme.

Also, in the proposed spending review, the government should target support and funding to local authorities and groups who have the greater obesity problems, with greater support available to local authorities to help implementation of efforts to slash childhood obesity.

“It is disappointing to hear that the government’s latest attempt to tackle child obesity does not seem to be learning from the failures of past efforts,” said Dr Layla McCay, director at the NHS Confederation.

“This is such an important moment for effective action, but it risks becoming lost amidst reorganisation and delays.

“At a time when obesity is in the spotlight for putting people with COVID-19 at greater risk of needing hospital admission or intensive care, it has never been clearer that an effective approach is needed to reduce obesity, which exacerbates health inequalities – and is estimated to cost the NHS £6.1 billion.

“We back the NAO’s recommendations that tackling child obesity needs to be a cross-government initiative and also that the government should target funding to deprived areas where there is a particular risk of childhood obesity, empowering local leaders to take the right actions for their population.”