Childhood Obesity in London - PDF

Running head: DISSERTATION
Impact of government strategies in
tackling childhood obesity in London
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Abstract
Childhood obesity has emerged as one of the biggest health issues prevailing in the UK and
worldwidglobally, and in the UKe. The articles reviewed in this research study have shown that
there is a demand for enhancing increasing the awareness of the parents regarding on childhood
obesity, the risk factors and its health consequences is essential. It has been identified that in spite
of taking so manyimplementing several initiatives, the government lacks in taking alladoption of a
comprehensive around approach to tacklein managing childhood obesity. A positive relationship
between law government laws and food consumptionculture has been identified. Reviewing the
existing literature has helped the researcher in conducting aThe narrative literature review and pay
an in depth focus on analyseding the facts and evidences collected by the previous authors in similar
area or research topic(s). Apt An appropriate literature search strategy has helped in collecting some
of the most relevant articles from recent times, which in turn, helped in makingmade the study
credible and reliable.
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Table of Contents
Chapter 1: Introduction............................................................................................................3
Chapter 2: Research background, context and rationale..........................................................4
Research aim....................................................................................................................5
Research objective............................................................................................................5
Chapter 3: Literature Search Strategy-.....................................................................................6
Chapter 4-Main Findings from the Literature Reviewed.......................................................14
Chapter 5- Discussion & Conclusion.....................................................................................18
Discussion......................................................................................................................18
Conclusion......................................................................................................................20
References..............................................................................................................................22
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Chapter 1: Introduction
The concept ofterm childhood obesity can be defined as the situation or condition where
excess body fat becomes a major role in negatively affectingnegatively affects the development,
well-being and health of childrena child. The most appropriate technique which is basically used for
the purpose of determining, calculating and measuring the actual volume of fat present in the body
is called as Body Mass Index (BMI) (WHO, 2018). The BMI, or body mass index also known as
quetelet index has its mainplays a major role in developing a correlation between the mass weight
and height of an individual, to identify whether the person is obese or notpresence of obesity in a
person. Body mass index (BMI) has been considered as an important become a major tool,
commonly which is used by organisations and government authorities, for the purpose of
identifying the obesity levels majorly foramong children, belonging toranging between the age
group of 2 years and above. In recent times, it has been noticed that the concept of childhood
obesity has evolved itself to become of as one of the key national issues in countries such as, the
UK and the USA. PThe public health departments of various countries around the world are
working hard in order to reduce the problem of obesity among children, between the age group of 2-
10 years. There areChildhood obesity creates various effects that are usually borne by children due
to obesity such as on the physical, long-termmental and psychological outcomes of the children, in
the long run (Foundation, 2018). Physical effects of obesity among children could lead to heart
diseases, cancer and diabetes etc. Long-term effects of childhood obesity significantly impact their
adult life in the form of type 2 diabetes, osteoarthritis, cancer etc. FinallyIn addition, psychological
impacts of obesity can lead to the development of various situations such as, bullying,
discrimination and harassment in their entire life.
Similarly, theThe issue of childhood obesity has been categorised as one of the primary
healthcare issues of the country. As per the reports of the Telegraph, it has been noticed that one
among five primary school children has been sufferingsuffer from the issue of childhood obesity.
The statistical data of 2016/17, published by NHS clearly highlights that around 9.6% of children
have been measured overweight, by the time they have enrolledenroll themselves in the school.
Childhood obesity in the UK is increasing at an alarming speed, which is developingthereby
creating a panic situation in the country, by severely impacting affecting children belonging to
afrom deprived socio-economic background and disadvantageous family situation (Donnelly,
2017). The obesity rate ofrates of obesity in the UK clearly highlights that London is the
frontrunner in terms of maximum number of obese children, as compared to other cities in the
country. According to an article published in the UK, it has been observed that the rate of obesity in
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the city of London is higher as compared to other parts of the nation. The primary reason behind the
rise of obesity among children is mostly due to the presence ofprevalence of fast food businesses in
the country (CRERAR, 2015). The Labour mayoral candidate of UK, Mr Sadiq Khan has taken a
bold decision in order to minimise the frequency of obesity among children. Khan has introduced
health practices, which would restrict fast food outlets to set up their stores within 400 metres of the
school.
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Chapter 2: Research background, context and rationale
Over the years, Cchildhood obesity from the past has gained huge noticeimportance,
especially in the European and American countries, owing to largely to their diet and lifestyle
patterns. This has lead significantly led the development of various researchers which arestudies,
undertaken by authors all over the world, in order to identify and develop strategies to overcome the
issue of childhood obesity. SM (2015) has significantly focused on conducting an analysis of the
determinants that leads to the occurrence of obesity and children, globally (Mohamed, 2015). The
few of the Some of the major determinants of child obesity are genetics, birth weight, and age and
gender. The occurrence of obesity among children can arise from family genetics, if the when the
BMI of the mother and the father are overweightindicates them to be overweight. The aspect of fat
mass and obesity associated genes, present within the child can surely result in rising in weight
increase. The bBirth weight determinant is also a majoranother factor that leads to gain of weight, in
the future. The rapid increase in the weight of low weight infants should be considered as an
alarming factor for obesity in futureas there is a high chance of being obese in the future. The
impact of childhood obesity has also forced the World Health Organisation (WHO) to develop
appropriate norms and policies, which are required to be followed by countries, in order to control
childhood obesity. The statistical report of WHO clearly shows that the number associated with
childhood obesity has massively increased from 32 million globally in 1990, to 41 million children
in the year 2016 (WHO, 2018). World Health Organisation (WHO) reported that the majority of
cases of childhood obesity are generally from the African region. The increase of obese children in
the African region has risen from 4 million in 1990 to 9 million in 2016. The rate of childhood
obesity is recorded to be high in developing countries, as compared to developed nations. However,
there is no denying but that does not deny the fact that developed countries such as the UK, the
USA and Canada are taking immense several steps, by introducing new policies and regulations, to
prevent further rise of childhood obesity in their respective countries.
The rationale for conducting the research on childhood obesity is largely due to thecan be
based on the fact that this issue is one of the hot topics in the a global health concern, world and
also one of the most serious issues prevailing in the healthcare department of theacross all
developed and developing countries. The conductance ofConducting an analysis on the issue of
childhood obesity would allow the readers to acquire an in-depth and accurate knowledge
understanding ofn the impact and causes that lead to the process of gaining excessive weight
gaining, among children ranging between the age group of 2-7 years (Kuhle et al., 2015). This study
would also look to discussillustrate the views of global authors and scholars who have been
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working for a very long time, in the past on the development of preventive measures to combat the
issue of childhood obesity. Furthermore, the completion of this dissertation, followed by
dissemination of its findings would also assist readers to identify various governmental strategies,
that are undertaken by the UK government as well asand their its impacts on the childhood obesity
in the country.
Research aim
The aim of this research is to investigate the impacts of government policies, formulated in
the UK, on rates of childhood obesity in the nation.
Research objective
The research objectives are given below:
 To determine the prevalence of childhood obesity among children, aged 2-10 years,
in the UK.
 To identify efforts taken by the government in formulating legislation and policies
for reducing childhood obesity rates
 To explore the impacts of the identified policies on the target population
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Chapter 3: Literature Search Strategy-
Search strategy could beis defined as a process of answering questions “where to go” and;
“how to go there”; etc. (Chakrabarti and Blessing, 2014). Search strategies refer to the organised
structure of major search terms that are used for exploring a database, with the aim of extracting
relevant articles.To review literature the foremost step is perhaps to select it throughSelecting
various, appropriate, means, that which not only help to make the entire study relevant but also
helps to add value to itforms the foremost step of conducting a literature review. Adopting and
implementing right strategy Ffor studies which are solelythat are based on secondary information
are extremely, adopting and implementing right strategy becomes highly significant. A good
literature search could lead to the following benefits:
 Synthesizing information from various sources,- mostly from previously conducted studies,-
which could enable in making thewould enable formulating the research background, and
topic justification, etc. stringer
 Providing valuable insight into the data, thereby helping to make the study better
 Finding potential gaps, (if any), existing in the literature
 Getting familiarized with the terms, and sentences that are, etc. necessary for finding
information, etc.
Some of the basic ways of searching relevant information for reviewing a literature include:
 Possible keywords
 Following citations
 Potential phrases
 Boolean operators
 Wildcard variations
 Subject headings, etc.
Since, the topic of the present study focused mainly on the governmental strategies to reduce
childhood intensity obesity in London (especially among the school going children), it was essential
to not just pay attention on the strategies being adopted by theways the UK government, for is
working towards addressing the issue, in addition to but also looking into the matter deeply by
focusing on the issue ofgaining a deeper understanding of childhood obesity, specifically among the
school going childrenin the target population, its underlying causes behind the issues, prevailin
governmentg policies and strategies, and their effectiveness. Hence, to proceed with the literature
review it was essential tothere was a need to take into consideration a wide range of key terms and
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Govt .poli
cies
Childhood
Obesity
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their combinations. As stated by Robson and McCartan, (2016) stated that, key words often play
significant role in retrieving relevant results articles from the databases. Therefore, using targeted
keywords was taken into consideration by the researcherwere used for the present study. Since
different concepts can be expressed differently, while using key terms, it was necessary for the
researcher to have to have a sound understanding awareness of the alternatives of the exact terms,
that were required to retrieve information. The for which using online as well asand offline
dictionary proved helpful for the same. Apart from thisIn addition, the topic of the the research
questions was broken fragmented into main several concepts, which in turn proved helpful for the
researcher to findfor finding synonyms and alternative phrasings for each of them. Hence, for the
present study, the key words phrases that were focused onused included “child health”,; “obesity”,;
“child obesity”,; “national measures for child obesity”,; and “child obesity prevalence”; etc.
Using truncation orTruncations wildcard variations were also used also proved to be helpful
for the present study. However, while using this strategy, the researcher took special care was taken
whilein paying attention towards certain facts like root words, which tended to havehad multiple
endings like “obese”,= “obesity”,; “obsessed”, “obeseness”,; and “obesely”; etc. using Wwildcard
variations helped in retrieving possible search results via using symbols like ‘!’, ‘?’, or ‘#’. This
mostly helped in retrievinggetting all possible results of even those words that were even spelled
differently., for e.g. theThe use of “government polic#s to fight childhood obesity in London”
helped to displaydisplayed results including “government policies (and also policy) to fight
childhood obesity in London”. On the other hand, while using truncation, specifically in PubMed,
the researcher had to use the method of “end- truncation” was used that focused onby using an
asterisk (*) with terms like such as, “child*”; “obesity*”, and; “health*”; etc. to get theThis
facilitated extracting most relevant information on the research topic (National Library of Medicine,
2016).
Boolean operators such as, AND, OR, and NOT were also used by the researcher for
searching the literature via using AND, OR & NOT, as itand helped in trying combinations
ofcombining the different search terms like “children AND obesity” and; “government policies
AND childhood obesity”; etc. Using ‘AND’ enabled the researcher to narrow down the search and
get information on both childhood obesity as well as government policies,; children and obesity;
etc.
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Govt .policiesChildhood Obesity
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On the other hand, using ‘OR’ had widened up the searchbroadened the search hits by
including all the possible search results that involved childhood obesity,; and government policies
towards it; etc.
Furthermore, while using PubMed database, attention was given on using the Boolean
operators in capital letters. Another easier strategy that was followed by the researcher was to
review the reference lists and bibliography of the potential journals. This process made
speedspeeded up the process if searching literature searching and enabled in retrievingretrieved
similar and relevant studies. For searching the cited references, Google Scholar was used for
searching the references that were cited in the articles by the researcher along with searching
PubMed, since the database often contain “links to the full-text article on the publishers or ' Web
sites”.
Some of the databases which were used for searching the literature for the present study
included PubMed, BMJ, and; NCBI; etc. One of the significant reasons behind for using these
databases was that can be attributed to the fact that these were subject specific databases and helped
in retrieving peer reviewed journals, on the research topic.
One of the main criteria that were taken into consideration while retrieving articles from
these databases was the language. Articles which were only in English language were included in
the study. Apart from this, before considering an entire article to be relevant, its abstract was gone
through along with reviewing its completeness.
Table 1: BMJ searches to identify potential relevant data
Source: Self
Search Terms Relevant Articles
Retrieved
(In 1st page)
Child obesity in London 3
Obesity among school going kids in London 2
Government policies for child obesity in UK 2
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Child obesity in UK “AND” government policies 10
Table 2: BMJ searches to identify potential relevant data
Table 3: PubMed searches to identify potential relevant data
Source: Self
Search Terms Relevant Articles Retrieved
(In 1st page)
Child obesity AND UK 6
Child obesity in UK “AND” government
policies
20
Table 4: PubMed searches to identify potential relevant data
Source: Self
One of the main major significances of using PubMed was that it helped in retrieving
subject specific information, which in turn helped the researcher to speed up the entire process of
literature search. Furthermore, PubMedit is government sponsored database, maintained by the
National Centre for Biotechnology Information (NCBI) and has free access to relevant significant
full- text journals. PubMed (NCBI) also ensures to retrievehelped in retrieving peer reviewed those
journals which are peer reviewed and itsbased on their authenticity and is monitored and or
maintained by the Literature Selection Technical Review Committee (LSTRC) (National Library of
Medicine, 2017). BMJ Oon the other hand, BMJ helped the researchers to search for the
literaturearticles that were based on childhood obesity in London, and government strategies
strategies. BMJ also provided to address the issue along with having open access to the articles.
Moreover, by using this databaseuse of this database made, it became easier for the researcher to get
access to the latest “evidence based information”. Apart from thisIn addition, the strategy of using
key terms such as, ‘child obesity in UK’ and ‘child obesity in London’ proved useful in extracting
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articles from the Cochrane database. further proved to be fruitful for the researcher by using key
terms/ title like “Child Obesity in UK”; “Child Obesity in London”;
Table 5: Cochrane searches to identify potential relevant data
Source: Self
Search Terms Results Retrieved
Child Obesity in UK 1
Child Obesity in London 8
Obesity (MeSH Search) 25
Table 6: Cochrane searches to identify potential relevant data
To search of the literature on the present topic, focus has also been given on using MeSH
(Medical Subject Headings) terms were also used for the literature review. MeSH terms could beare
defined as “comprehensive and controlled vocabulary, used for the purpose of indexing journal
articles and books in theon life sciences” and . The terms assisted in the process of has helped in
narrowing down the search, by focusing mainly on “’obesity”’ and potential related information
around it, which also included information on paediatric obesity, childhood obesity, and teenage
obesity, etc.
Fig 1: MeSH trees of "Obesity"
Source: (Cochrane Library, 2018)
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Fig 1: MeSH trees of "Obesity"
Source: (Cochrane Library, 2018)
Another important search strategy that was utilised for searching literature involved
inclusion and exclusion criteria. The researcher independently assessed the abstracts of the
potentially eligible journal articles before selecting the final ones. Articles containing information
on obesity, specifically about childhood and teenage obesity among school going children, were
mostly eligible for inclusion.
Inclusion criteria was set for the literature search that assisted in the selection of prospective
articles that were relevant to the research topic. The inclusion criteria are given below:
 Articles published in English
 Abstract reviewing
 Full text articles
 Articles containing information on childhood obesity rates in the UK
 Articles containing information on governmental policies and frameworks that focus
on childhood obesity
 Articles that explained the impacts of the policies on the health abnormality of
interest
The researcher independently assessed the abstracts of the potentially eligible journal articles,
before selecting the final ones. Articles containing information on obesity, specifically about
childhood and teenage obesity among school going children, were mostly eligible for inclusion.
One of the main reasons behind getting relevant literature, is the additionto strict the inclusion
criteria which in turnthat improved the overall quality of the study, along with reducing the
possibility of any ethical issues.
Defining specific exclusion criteria helped in the process of excluding irrelevant articles
from the review. The exclusion criteria, employed for the search are given below:
 Articles that focused on obesity among adults
 Articles containing information on childhood obesity rates in Ireland or Scotland
 Articles that defined infant obesity in the UK.
 Non-English articles
 Incomplete manuscripts
 Only abstracts
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Since, it was essential to focus mainly on articles based on child obesity and those
containing information regarding the government policies to address the issue, articles which only
gave data adult obesity were excluded. Moreover, the researcher also excluded those articled which
took into consideration regions other than London and England. More precisely, the following were
excluded from the literature search:
 Obesity among adults
 Child obesity in Scotland or Ireland
 Obesity among infants; etc.
Specific attention to the inclusion critieria helped in retrieving the article, Instance of this
could be taken in case of searching “Effect of school-based physical activity interventions on body
mass index in children: a meta-analysis”, an article authored by (Harris et al., 2009), where
inclusion criteria was given specific attention. Before considering this article for the literature
search, the researcher had gone through if it had all the key terms that could help in answering the
research question. Apart from this, an independent review of the abstract was conducted to have an
understanding regarding the subject matter of the article. Furthermore, the strategy of using
appropriate search terms and phrases like “body mass index (BMI) in children”; “local
governments’ strategies to fight childhood obesity”; “obesity intervention”; etc. was utilised used in
databases like PubMed, MEDLINE, and the Cochrane Library. The researcher also “hand-
searched”manually searched pertinent articles from the reference lists. Since, Owing to the fact that
the main topic of the research study was “to analyse the impact of government strategies in tackling
childhood obesity amongst primary and secondary school aged children in London”, this article was
chosenselected, as it not only stated about the interventions but also critically assessed its
effectiveness of the interventions.
Retrieving the articleUse of appropriate search terms helped in extracting the article, “The
role of law in the control of obesity in England: looking at the contribution of law to a healthy food
culture” by (Martin, 2008) ,was possible by using relevant key terms infrom the PubMed (NCBI)
database. The researcher used phrases/ key terms like “obesity in England”; “role of law in the
control of obesity in the UK”; “child obesity in London”; etc. Apart from this Boolean operators
like “child obesity AND London”; “role of law AND childhood obesity”; etc. was were also
adopted to retrieve the most relevant articles for the present research study. TheFollowing the
inclusion criteria that was considered while selecting this article was the use of the above mentioned
key terms along with the fact that it gave aresulted in retrieval of this article that provided a detailed
look into thedescription of the role of the local government, in controlling obesity in England
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(including the city of London). Apart from thisIn addition, this article also opened aprovided an
opportunity scope to give a critical look into the role played byto gain a sound understanding of the
impacts of “the physical and cultural context of food consumption in England, and the evolution of
government policy on obesity”. It further elucidated the effectiveness of the government laws and
legislation in and how much law could play role in changing the food habit of people.
On the other hand, “Changes in objectively measured BMI in children aged 4–11 years: data
from the National Child Measurement Program” by (Pearce, SarahWebb-Phillips and Bray, 2015),
was selected from Oxford Academic database, by using key terms like “BMI in children”,; “obesity
in primary school in the UK”,; “child health in the UK”, and; “national child measurement
program”; etc. The search yielded 10 potential articles on page 1 and the researcher, aftera thorough
abstract reviewing all their abstracts, selected the above mentioned oneresulted in the selection of
the aforementioned article. Boolean operators like “Childhood AND obesity”,; “”childcare AND
the UK”,; “child obesity AND government policies”; etc. were also used, while focusing on by the
researcher along with focusing on the inclusion criteria as mentioned above.
In the similar way, the article named “Effectiveness of a childhood obesity prevention
program delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial
(WAVES study)” by (Adab et al., 2018) was also selected by a similar procedure. The majorTo be
more precise, it could be stated that while selecting the article one thing that was taken into
consideration was its focus on awas the specific government strategy to addressthat addressed the
issues of childhood obesity, targeting 6 and 7 year olds, which in turn helped the author to
analysesin an analysis of the effectiveness of the identified interventions’s efficiency in dealing
with the issue. Apart from thisMoreover, the article also paid attention on UK primary school,
which also helped the researcher to fulfil the research objectives, which mainly focused on
identifying the prevalence of obesity amongst primary and secondary school aged children in
London. To retrieve this article, Ttruncations were was also utilised used with terms like “childhood
obesity*”,; “prevention programs in the UK*”, and; “childhood obesity*”; etc. However, before
selecting the article, the researcher went through the the entire abstracts were reviewed for ensuring
to ensure its relevancevalidity and relevance to the research objective.
As already stated, for the researcher, in order toWith the aim of acquiringe appropriate
journal articles on the topic of on the impact of governmental strategies to tacklefor tackling
childhood obesity, it was very important to ensure that not only journal article should bethere was a
need to ensure authenticity of the articles and presence of all authentic in nature but also to ensure
that all the search terms such as, government strategies, childhood obesity and the UK are properly
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mentioned. The researcher had conducted an extensive search on the internet by using the phrases
and search term such as childhood obesity and the UK in order to acquire appropriate journal
articles on the preventive measures of UK towards the process of tackling obesity among children.
The selection of the journal article of "Time for the UK to commit to tackling childhood obesity" by
(Hanson, Modi and Mullins, 2017) was largely due to that fact that all thehad all the search terms
that matched with the article. The authenticity of the journal is established by the fact that as it isit
was published under in the BMJ journalinvoked the researcher to select the article. BMJ publishing
is an online database that aims at providing its users with authentic and peer-reviewed journal
articles on medical research (Hanson, Mullins and Modi, 2017). Furthermore, before confirming
this article, athe researcher was also found to be involved in the process of cross-checking was also
performed all the contents by searching all the practices undertaken by the UK government, in order
to tackle the issue of childhood obesity in the country.
The researcher had selected another journal articleAnother article named "General practice
views of managing childhood obesity in primary care: a qualitative analysis" by (O'Donnell,
Foskett-Tharby & Gill, (2017) was selected for the purpose. The only purpose behind the selection
of this journal article is that it enabled the researcher to gaingaining knowledge on the appropriate
government practices that are being implied in the UK to tackle reduce childhood obesity. The
researcher in order to acquire this journal has used the sSpecific search terms related to of
government practice and childhood obesity over the internetwere used for extracting this article.
Moreover, the researcher was also involved in the process of carefully reading the entire summary
of the article, which clearly signifies the entire motive of the research. The summary itself assisted
the researcher to gain adequate knowledge of the objectives, design, setting, participants, outcomes
and results, which in -turn saved a large amount ofsaved time (O’Donnell, Foskett-Tharby and Gill,
2017). In order to ensure the authenticity of the contents of the article, the researcher was found to
be using the database of The Royal Society of Medicine, which is one of the best online journal
websites that helped in collecting from where authentic and ethical medical research papers are
collected. The background of the authors has also beenwere also cross-checked by the researcher
before implying itbefore using the findings in the dissertation. Another most important factor
behind the selection of this article is the use of thematic analysis, which allowed the researcher to
generate different themes on the concept of tackling childhood obesity in the UK.
The journal article of "Preventing childhood obesity: Early-life messages from
epidemiology" by (Robinson, 2017) has also beenwas also selected by the researcher in order to
identify ways and practices, followed by public health in the UK to combat the issue of childhood
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obesity. This journal article was found on the internet by using the search term and phrases such as,
‘childhood obesity’, ‘healthcare practices’ and the ‘UK’. This journal article is unique in nature as it
aimeds at highlighting the medical practices developed by the governmental authorities of UK to
mitigate the issue of childhood obesity in the country. The selection of article would also prove
toproved be beneficial for the readers as it would concentrateas it illustrated on discussing about the
various epidemiology of that prevail in the obesity such as maternal obesity, gestational weight gain
and duration of breastfeeding etc. This journal article on childhood obesity was retrieved by the
researcher by implying theusing the Boolean technique of searching the Nutrition Bulletin journal
database, rather than specifically concentrating on BMI database (Robinson, 2017). The uniqueness
of this journal article can be simply understood by studying the entire abstract. The contents of the
abstract are completely based not only on highlighting healthcare practices undertaken by UK
healthcare sector but also focused on discussing various medical terms and processes that could
help in limiting the issue of childhood obesity, in the future. The outcome of this article was the
most important factor that leads to the selection of this article as it focused on highlightingas it
highlighted precautionary measures that should be undertaken by mother before conception, in
order to improve the health of their child.
The selection of the journal article of "The evolution of policy and actions to tackle obesity
in England" by (Jebb, Aveyard & Hawkes, 2013) is completelywas based on its content and
structure. This journal article has beenwas gathered from the internet search by using the following
keywords such as ‘obesity’, ‘England’, ‘strategy’, ‘public health’ and ‘policy’ and from the
database of Obesity Reviews. The uniqueness of this journal article is that the entire content is
completely based on the effectiveness of the entire policies that have been developed by the UK
government’ in the past to tackle the issue of childhood obesity. This article highlights on
comparing the two governmental strategies developed in 2008 and 2011, respectively in order to
reduce the gap in managing to tackle childhood obesity (Jebb, Aveyard and Hawkes, 2013). The
authenticity of the journal article can be judged by the background and educational qualification of
the authors, who are eminent members of MRC Human Nutrition Research. Furthermore, this
article also discusses about the impact of governmental policies to tackle the issue of childhood
obesity in the country.
Chapter 4-Main Findings from the Literature Reviewed
Theme 1- Law plays a vital role in controlling childhood obesity by influencing physical
environment
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As identified from the article “The role of law in the control of obesity in England: looking
at the contribution of law to a healthy food culture” by Martin (2008), helped in identification of the
fact that law play an important role in controlling childhood obesity, by bringing changes in the
environment in which children consume food. This can be done by regulating media practices. For
instance, it is often seen that the Food and beverage manufacturing and selling companies have a
common tendency to advertise their products like soft drinks and snacks majorly in television
programmes for children, as they are the biggest target customers. Most of the soft drinks and
snacks are rich in calorie that, in turn, increases their chances of developing obesity at an early age.
At the same time, enforcement of appropriate law has the potential to regulate the commercial food
practices. This generally involves minimising sugar content in food and beverages. This can be
explained by the fact thatFor example, the UK government of the UK has made it a legal obligation
for the organisations operating in the UK food and beverage industry to reduce sugar level in their
products by minimum 20%, by the end of 2020, along with minimising proportion sizes (Tedstone,
2016). The above stated article has also highlighted the importance of informed consent by making
provision for information. In other words, it is essential for the organisations to inform the
nutritional content of their food products to all consumers to allow the latter to so that people can
understand the food components that are being consumed on a regular basis. It would also help in
determining the the level of such food they should consume and determine the quantity of such
foodthese foods for their children. It has been identified from the same article that The article also
suggested that bringing positive changes in the attitudes of the public and their eating behaviours is
essential, in order to control obesity, where law plays an important role. This is because it hasSuch
changes have the potential to develop expectation among people to follow health standards and
maintain healthy dietary habits. Such habits and behaviours are an integral part of the environment
where children are consuming and thus, have the ability to restrict children from consuming
unhealthy foods. Many research studies have claimed that self-control is the best way to control and
prevent obesity. However, a point to be noted in this context is that, there is no denying the fact that
self-control itself is a challenging task. It is even more difficult for children as they are not even
aware of what they are consuming in terms of itsthe nutritional content of the food being consumed
and the way theirits immediate effect on their eating behaviour would affect their health. Each and
every country has its own food and health culture. Thus, governmental strategies that work in other
countries might not be that effective in the UK. This indicates the need for customising such
strategies, while taking some ideas from the international strategies in this context.
UnfortunatelyHowever, governments in the UK are not always allowed to make their laws
independently as it is a legal obligation for the EU member states to implement the European
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Directives, as indicate in the article mentioned above. HoweverIn addition, Brexit would eliminate
such obligation that would be advantageous for the UK as the government can customise its laws
for preventing and controlling childhood obesity.
Theme 2- Integrated Effort of General Practitioners and Schools is effective for Controlling
Childhood Obesity
There has always been a debate on a single topic i.e. whether childhood obesity can be best
managed in primary care or by at schools. This is cdan be attributed to the fact that the because
children spend wholesome quality time in their respective schools. and thus,Thus, it is expected that
the school staff and teachers would be more aware of their eating habits and behaviours. Such
awareness would be helpful in influencing their eating behaviour and habit by educating them about
the significance of healthy eating from a very early age, through fun games and activities. Being
aware of the importance of healthy eating would automatically encourage children to consume
healthy food and eliminate as much sugar content as possible from the food they consume. This, in
turn, would bring down their risk to obesity. However, it is often seen that the school teachers lack
sensitivity of the issue (childhood obesity), as indicated in the article "General practice views of
managing childhood obesity in primary care: a qualitative analysis" by O'Donnell, Foskett-Tharby
& Gill (2017). At the same time, they need to have advance training on managing such issues,
which is lacking in the UK. On the other hand, most of the primary care practitioners have
underwent some kind of training on such issues, and thusThus, it can be expected that they would
have a better understanding of managing childhood obesity efficiently. However, it has been
revealed by some qualitative researches used in the above stated earlier that, there are several social
and family causes of childhood obesity, that is difficult to understand.understanding which is
difficult for them. This, in turn, restricts them from addressing the issue of childhood obesity. Also,
they do not have the time and resources to work with the families of obese children effectively.
This is not the case for the school teachers. This isSchool teachers because they have better scope
for ofinteracting with the parents as well as observing the behaviours and attitudes of the children,
in order to gain a certain level of understanding of their social and family environment.
AlsoFurthermore, it has been claimed by the practitioners that they often do not get the
neededadequate training, as a result of which, they lack confidence in tackling childhood obesity.
Some of them even believe that childhood obesity is not a medical problem and does not fall in their
domain. This shows that the practitioner do not even have the basic knowledge of childhood
obesity. The evidences presented in the above stated article indicate that there is a need for the
primary care practitioners, as well as the school teachers in managing childhood obesity. On one
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hand, the practitioners have the experience and on the other handand, the school teachers have
higher scope for interaction with children and their parents. However, the most important thing to
be remembered is providing effective training to both practitioners and teachers is crucial, to
enhance and develop their ability to tackleto manage childhood obesity. Thus, it can be stated that
integration of the efforts of school teachers and primary care practitioners is an effective way to
tackle childhood obesity.
Theme 3- BMI is a Strong Indicator of Childhood Obesity
It has been identified from theThe article “Changes in objectively measured BMI in children
aged 4–11 years: data from the National Child Measurement Program” by Pearce, Sarah Webb-
Phillips and Bray (2015) stated that, growth in the early life of the individuals increases the later
risk of obesity in childhood that is influenced by an interplay between several risk factors and there
are several risk factors for developing obesity that initiate during childhood. At article has
furtherThe article also claimed that the ability to children at a higher risk of developing obesity is
essential for mitigating future obesity. Evidences used in this article show that being overweight at
the time of birth has a positive link with gaining weight in future, and thereby, developing obesity
once an individual reaches childhood. Studies have also indicated that weight gain in pre-school
increases the chances of developing childhood obesity. The research carried out by the authors of
the above mentioned article has revealed that, children whose BMI was between 85 and 94
percentile at rReception, were 13 times more likely to become overweight and subsequently
increasing their risk to childhood obesity. It has been identified that BMI greater than 95th percentile
is the most effective measure for obesity at yYear 6. This indicates that BMI is often used by the
experts to identify the children who are at a higher risk to develop obesity. This is because abnormal
BMI indicates the chances gaining excess body weight that ultimately results in childhood obesity.
Cross sectional analysis undertaken in the same article has confirmed the existed of a positive
relationship between deprivation and obesity at rReception, as well as Year 6. It has been observed
by the researchers that the most deprived quintile at both rReception and yYear 6 has had highest
number of obese children. It has been identified from the article searchingThe article “Effect of
school-based physical activity interventions on body mass index in children: a meta-analysis” by
Harris et al. (2009) that,mentioned that school managements are increasingly focusing on
performing physical activities in order to maintaining standard BMI amongof children. This is
because thecan be associated with the alarming increase in the prevalence of childhood obesity in
the UK is increasing at an alarming rate. As Owing to the fact that most of the children spend
quality time in their schools, engaging them in school based physical activities would bewould
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prove helpful in keeping their BMI at the acceptable level, and thereby, minimizing their chances of
gaining excessive weight or developing obesity at an early age. AlthoughHowever, the results of the
research carried by the authors of the stated article have revealed that school based physical
activities merely have a positive impact on BMI, they have, but such activities have other positive
effects on the quality of life of the children. It has been further revealed that the existing population
based policies that make it mandatory increase physical activities mandatory in schools are not less
likely to make anybring about significance improvements in the prevalence of childhood obesity.
Thus, much research needs to be conducted to explore the a question mark still exists on the
effective ways of maintaining to maintain standard BMI of children in order to prevent them from
childhood obesity.
Theme 4- Government’s Approach to Tackle Childhood Obesity has One-Sided Focus
Due to the increasingAn increase in the number of obese children in the UK, has made the
government has takenadopt several initiatives for bringing the situation under control and
preventing further cases of childhood obesity. The government not only focuses on identifying
children at higher risk to obesity, but also on the short term and long term impact of obesity on the
health of the children. It has been identified from the article “Time for the UK to commit to tackling
childhood obesity" by Hanson, Modi and Mullins (2017) that, the government has failed to
recognise the role of adjustable biological, behavioural, environmental and commercial factors on
prevalence of that overweight and obesity in children as well as young individuals are driven by
several adjustable biological, behavioural, environmental and commercial factors. Some of these
factors are even present before thepresent from the time of conception and birth of a child. At the
same time, the The government has also failed to recognise that the damage made by exerted by
these factors extends across generations also. The authors of the above stated article believed that
such failures of the government points towards the loss of opportunity lost for effective prevention
of childhood obesity. There areIndividuals belonging to several some communities, where majority
of the population do notfail to get proper nutrition that gets passed on to successive . As it is a
general trend in such communities, such trend is carried forward to next generations. As a
resultThis increases the likelihood of the, newborns of people belonging to those communities
would be at a higher risk of developingto develop childhood obesity. However, this factor can be
changedis preventable and avoidable. For example, it has been found in the above mentioned article
that, pPeople in communities who have beensubjected to malnutrition are now experiencing rise in
nutrition, by bringing about changes in their diets, sedentary lifestyles. In this context, the poorPoor
maternal health of the mothers hascreates an adverse effect impact on the health of the children. At
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the same time, it is seen that maternal In addition, maternal obesity and gestational diabetes are
prevalent in people belonging to lower socioeconomic and educational groups, which in turn that
increases the chance of childhood obesity in next generations. Despite the fact the government has
mentioned the link between socioeconomic adversity and childhood obesity in its plans, there has
been merely anynegligible effective steps have been taken by the government for controlling such
growing inequalityinequalities. There is a need for the Efforts must be taken by the government to
focus on promoting health inequalities, in different communities living in the UK, considering the
growing migrant population in the country. This would be helpful in ensuring that children are
notreduce vulnerability of the children vulnerable tto developing obesity due to their belongingness
to some specific communities. At the same timeFurthermore, it is also essential to undertake
campaigns to educate parents about the ways to eliminate or minimise the chances of their children
to developchildhood obesity. This would help in increasing an awareness of the parents regarding
that includes their own eating habits and behaviours also. Educating them about theProviding
information on the nutritional content of the food items would be further helpful in this context
would also prove useful.
Chapter 5- Discussion & Conclusion
Discussion
Thus, it can be deduced from the aforementioned findings that It has been identified that the
the laws, policies and legislation of a country plays an important role in managing childhood
obesity. This is because it hasThey have the potential to influence the physical environment that has
a direct impact on obesity on children. There are three key amajor areas that require maximum
attention of the law i.e.namely, marketing techniques of the food and beverage companies, sugar
content in the food and beverages and mandatory skill development training for the primary care
practitioners, and school teachers, to tackle childhood obesity. Focusing on these areas would help
in controlling and preventing childhood obesity. The biggest benefit of the article “The role of law
in the control of obesity in England: looking at the contribution of law to a healthy food culture” by
Martin (2008) is its focus on the relationship between law and childhood obesity, which is a rare
area of researchhas rarely been investigated. At the same time, the article has explicitly explained
various laws in the UK that have been enforced with the objective of controllingaim to control
childhood obesity, and thereby, strengthening the knowledge of the reader(s). However, merely
anythere is lack of significant evidences have been provided on the strengths and weaknesses of
various laws prevailing in the UK for managing childhood obesity.
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Treating childhood obesity by the primary care practitioners and school teachers both play
an important role., due to their expertise in respective fields The reason is that both of them have
their own expertise in this field. For example, theThe school teachers have a better knowhow
knowledge of the family and social culture of the children. On the other hand, and the practitioners
have sound medical knowledge that underlies the condition. Bringing their expertise together is the
most effective way to deal with childhood obesity. However, unfortunately teachers as well asand
practitioners are not provide lack adequate training that restricts them from undertaking their roles
and responsibilities that pertain to successfully in controlling obesity in children. The article
"General practice views of managing childhood obesity in primary care: a qualitative analysis" by
O'Donnell, Foskett-Tharby & Gill (2017) has shed light on this context. It has undertaken awas
focused on a primary study on of wide sample population, which is its biggest strength. Moreover,
the article has successfully and demonstrated the waythe effects of inadequate lack of training of the
practitioners is actually affecting their on their self- confidence. The findings suggested that and
thereby,lack of training restricting restricted them from offering quality services to the obese
children. However, the focus was majorly on the practitioners that can be considered its weakness.
The findings of the study undertaken by Jebb, Aveyard and Hawkes (2013), directly draws
attention towards exploring the evolution of the policies and actions undertaken by the UK
government, in tackling the issue of childhood policy. Therefore, the study could be taken to beis
directly linked with the research topic. The findings of the study helped in revealing the
factrevealed that the UK government has paid close attention towards dealing obesity and related
issues among adults a long time back. However, the growing public heathrates of childhood obesity
nonetheless had also pushed it toled to the formulation of formulate new healthcare policies as
welland as campaigns that encouraged the parents as well as the kids to adopt healthy lifestyle and
eating habits. This article, therefore, pays attention towardsfocused on analysing the situation of the
prevalence of obesity in young children, and in younger adults, than compared to their older
counterpartspeers. In addition to this, the article also revealeds the impacts of government
campaigns like such as, Call to Action on Obesity, Healthy Weight, Healthy Lives, etc, which
focused on promoting healthy eating and healthy ways of living. Moreover, it also highlighted two
governmental strategies developed in 2008 and 2011, respectively in order to reduce the gap to
tackle childhood obesity. This in a way,This helped to createcreated awareness regarding the
methods utilised by the UK government in addressing the issues along with evaluating their
effectiveness. However, the limitation of the research included the lack of “systematic attempt to
link the evaluation of the various policy interventions to understand the mechanisms underpinning
changes in obesity prevalence”. In other words, the research does not shed enough light on deeply
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analysing the basic question of “has the strategy worked”, which tend to make all the efforts
incomplete.
Much similar to theShowing consistency with the above mentioned article, the one study
conducted by Hanson, Modi and Mullins (2017)- “Time for the UK to commit to tackling childhood
obesity”, also tried to bringillustrated the out the involvement of the UK government in tackling the
issue of childhood obesity. The research successfully brings out theidentified the existing gaps
existing in the government policies by stating that at present the policies have “failed to recognise
that overweight and obesity in children and young people are driven by multiple modifiable
biological, behavioural, environmental, and commercial factors, some of which operate before
conception and birth”. This could be stated as was one of the strengths of the study, as it made the
readers aware o the essentiality toit increased an awareness on exploring the look into the matter of
childhood obesity during the pre-natal as well as neo-natal stages. Apart from thisIn additoon, it
also successfully highlighted the measures that could be undertaken as a part offor dealing the issue
of with childhood obesity, by taking into consideration of the factors such as, by considering factors
like parental smoking, reducing high pre-pregnancy body mass index, and avoiding excessive
gestational weight gain, etc.
On the other hand, the study-article “Effectiveness of a childhood obesity prevention
program delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial
(WAVES study)”- conducted by Adab et al. (2018), has brought forth the intervention strategies to
reduce the issue ofmanage and prevent childhood obecity, by specifically focusing on the age group
between of 6-7 years and 7. One of the strengths of this artical article had been the exploring thecan
be associated with the fact that the article explored implementation of a school based intervention
program in school (or school based intervention). Moreover, the WAVE was conducted within a
socioeconomically and ethnically diverse population, with sufficient sample size, which helped it to
assess thein assessement of primary outcomes. Alsoos, thethis intervention method was guided by
the Medical Research Council Fframework for complex interventions, which helped in
increasingincreased the its feasibility. However, the limitations limitations of the research included
limited lack of parental consent, which might have resulted in biasness in the findingsintroduced the
chances of biasness. Also, it had norableIn addition, notable baseline imbalance was observed
between arms in the group 2 cohort that might have attenuated the main results.
Conclusion
Thus, it can be concluded that childhood obesity is the most prevalent health issue, not only
in the UK, but also in manyacross the globe other countries. Tackling Appropriate management of
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this issue requires joint efforts of the practitioners, parents, school teachers and the government.
Parents need toshould follow a demonstrate healthy eating behaviour that would be replicated
byimitated by their children. The government needs to undertake wholesome investments in bring
health equality in the countryin reducing all forms of health inequality in the country. School
teachers are required to encourage children to increase their participation in physical activities.
Efforts must be taken by and the practitioners need to ensure early diagnosis of childhood obesity
and identification of children who are vulnerable to gaining excess weight gaining, and subsequent
and developingdevelopment of obesity. Controlling Management of childhood obesity is not an
easy task; rather it requires spending wholesome time and money. Moreover, the studies also
revealed that conducting only school based intervention might not always have effective
resultsprove effective in changing the lifestyle and behaviour of both the children and their family
members. It is true thatAlthough children spend a considerable time at their schools, and they getare
highly influenced by their peer behaviour and the lessons they are taught in their classes,. However,
it is also essential for them to get similar lessons and behaviour, should also be taught at their
homes too. Therefore, there is a need for the local agencies, NGOs and the national government to
take measures for creating a positive impact on it could be deduced that to have true impact on
modifyingthe behaviour, lifestyle and healthy eatingeating habits of the school going children. a
combined step is needed to be taken both by the national government, the local agencies as well as
the NGOs who are working in the field of childhood obesity. Apart from thisIn addition, it is also
necessary imperative for the government to focus on other prenatal factors such as, improving
nutritional literacy among the parents, proper screening of the health of women during their
pregnancy, checking the health condition of the expecting mothers , in addition to payingnot just
pay attention on to the lifestyle of the child. but also other factors even before the child birth like
improving nutritional literacy among the parents, proper screening of the health of women during
their pregnancy, checking the health condition of the expecting mothers, etc. Apart from
thisMoreover, it also essential for the government to keep a track on analysing the effectiveness of
its appliedthe implemented strategies and policies, which can be achieved by surveying the target
group(s), to reviewand reviewing their success of the interventions, in a time bound manner.
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