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This essay focuses on childhood obesity and the social
determinants of health. It highlights


the extent of the issue of childhood obesity as a public
health problem using available

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statistics and outlines the potential consequences for both
children and adults. Public health


initiatives nationally and locally in Manchester that are in
place to address this condition will


also be discussed. Public health is “the science and art of
preventing disease, prolonging life


and promoting health through the organised efforts of
society” (Acheson 1988).



Obesity is a medical condition that can affect children of
all ages lasting into adulthood if it is


not addressed (DoH 2008). 
This recognisable condition is rapidly increasing in today’s


society with long lasting adverse consequences for patients.
Children do gain weight as they


grow and develop but it can become a problem when a child
gains extra pounds not needed


for normal growth as this can lead to obesity and a negative
effect on their health (DoH


2008). Body mass
index (BMI) is a measure used to determine a child’s weight status and an


indication of obesity (WHO 2017b). It is age and sex
specific and often referred to as BMI-


for-age. If children have a BMI between the 85th
and 94th percentile they are classed as being


overweight whereas obesity is defined as a BMI at or above
the 95th percentile (WHO





A child may become obese due to a number of determinants
that makes them susceptible to


the condition.  Social
determinants of health are defined as “the conditions in which people


are born, grow, live, work and age. These circumstances are
shaped by the distribution of


money, power and resources at global, national and local
levels. The social determinants of


health are mostly responsible for health inequities- the
unfair and avoidable differences in


health status seen within and between countries” (WHO 2017a).
Biological, behavioural,


social, environmental and economic are all contributing
determinants (Sanyal et al, 2012). So,


obesity is not just about consuming large amounts of high
calorie foods whilst avoiding


exercise and being inactive. Genetics, technology, exposure
to advertising and parent’s


attitudes all play a contribution to the condition. Socio-economic
factors are contributing


issues as children from poorer backgrounds are more likely
to suffer from obesity as the


increase in healthy food prices may mean parents spend less
on quality food or buy varieties


that are cheaper and lack nutritional value (Marmot review,
2010). The Marmot review


(2010) highlights the inequalities of childhood obesity, it
found that most deprived children


were twice as likely to be obese than least deprived. The
review produced recommendations


to include giving every child the best start in life and to
ensure healthy standards of living for


all (Marmot review, 2010).



Today’s lifestyles have resulted for many families in a move
away from home cooked meals


and more towards the frequent use of convenience foods and
takeaways. (Sallis et al 2006)


With parents working it can cause time constraints,
resulting in them not always having


enough time to devote to planning healthy meals. At least
once every week 27.1% of adults


and one fifth of children eat out (PHE, 2017). Parents do influence
their child’s food choices


and behaviours concerning eating habits, they are role
models (Huffman et al, 2010). It is


now thought that a child with one obese parent is three
times more likely to be obese than a


child with no obese parents (McCormick et al, 2007). The
Foresight report (2007) states that


our environment with the availability of food with high
calorie content makes it harder for


families to maintain a healthy lifestyle and that parents may
have a limited knowledge on


nutrition and struggle to assess their child’s weight status
and lack of physical activity.


Therefore, parents need support on how to help their child
pursue a healthy lifestyle.



Being inactive will cause weight gain, children need to be
active to sustain a healthy weight


and support healthy bone and muscle growth (Hills et al,
2011). In current society, many


children have changed from outdoor play to spending a lot of
their time indoors watching


television, surfing the internet or playing computer games
therefore adding to a lack of


physical activity (Hills et al, 2011). It is stated that
only 22% of children aged between 5 and


15 are active for 60 minutes a day (GOV.UK, 2017).



There is a need to prevent and manage obesity as other
conditions are caused by it. Childhood


obesity has been related to several serious disorders such
as diabetes, asthma, high blood


pressure, heart disease and cancer (PHE, 2014). It can also
affect the child psychologically,


being overweight can lead to a low self- respect and esteem
for themselves and poor social


skills caused by bullying about their size (PHE, 2017). Therefore,
mental health issues can


arise. However, there could be future health risks if they
become adults with obesity as the


conditions are likely to be more severe.



It has been suggested that the younger the child is the more
receptive they are to succeed at


beating obesity. As the older they become they are less
likely to exercise due to a lack of


confidence brought on by their condition (MEND Foundation, 2010).
Another belief is that


preschool aged children need to have developed certain
behaviours of a healthy lifestyle to


prevent obesity happening (Skouteris et al 2011). Schools
are an important place for


promoting health and influencing behaviours towards health
from an early age as they play a


vital role in educating and supporting children to make
healthy choices (Naidoo, et al 2016).


However, there is increasing pressure on schools to achieve
academically and reduced


emphasis on physical activity which contributes to weight
gain. A balance is needed through


curricular activities to include physical exercise and
education on the importance of healthy


eating and nutritional values (DoH 2008). 



It is estimated that the health problems associated with
obesity costs the NHS more than £5


billion every year and projected to reach £9.7 billion by
2050 as by this time 25% of children


will be obese and 40% overweight (Foresight 2007). It is
also considered that obesity is


responsible for more than 30,000 deaths each year and
deprives individuals of 9 years of life


when it is a preventable disease, so Public Health England
has made tackling this condition a


key priority (PHE, 2017).



Childhood obesity is being taken seriously by the government
and Public Health England


with £5 million of funding for a new obesity research policy
in place to understand the causes


of this condition (GOV.UK, 2016). One statistic is that one
in ten children are overweight or


obese when they begin school, increasing to one in five by
the time they leave primary school


(PHE, 2014) Therefore over the next decade the government
aims to significantly reduce


childhood obesity. The Childhood obesity plan (2016) states
how the government will be


working with the local communities, schools, the food
industry and the NHS. In April 2018


the government is enforcing a levy on sugary drinks in an
attempt to try and cut obesity in


children as teenagers are big consumers of sugar-sweetened
drinks that contain too many


calories and lead to a high risk of type 2 diabetes (GOV.UK,
2016). The income from the


levy is going to be invested in programmes to encourage
physical activity and healthy eating


for children of school age (GOV.UK, 2016). A programme to
reduce sugar in products that


children consume regularly such as breakfast cereals,
biscuits, cakes and yoghurts has been


proposed (GOV.UK, 2016). The food and drinks industry have
been given a target to reduce


sugar in products by a minimum of 20% by 2020 (GOV.UK, 2016).



As stated low income families have high rates of obesity
therefore the Healthy start scheme


has been re-activated. In 2016 1.7 million vouchers for
healthy foods were distributed every


four weeks benefiting 480,000 children of poorer families
(GOV.UK, 2016).



Being active is a must for healthy children and UK chief
medical officer’s state that all young


people should participate in at least sixty minutes of
physical activity every day as one in five


children are already obese before they start school (GOV.UK,
2016). Physical activity in


schools is a key part of the new healthy schools rating
scheme so support will be given to


schools by nurses and healthy weight teams so the children
can gain a healthy lifestyle


(GOV.UK, 2016). School meals have been impacted with The
School Food Plan of 2015


bringing in improvements (GOV.UK, 2016).



Manchester has a higher rate than the national average for
childhood obesity with 23.6% of


year 6 children classed as obese as well as high levels of
deprivation and adult obesity.


Manchester is taking action, the vision is that in the next ten
years the people of Manchester


will be healthier, maintain a healthy weight and live longer
fulfilled lives (Manchester City


Council, 2010). The “Manchester Healthy Weight Strategy” is
tackling obesity, focusing on


special groups that are at most risk including young and
single parents and the most deprived


socio-economic groups (Manchester City Council, 2010).
Health, Exercise and Nutrition for


the Really Young is a training programme to support parents
to give their families a healthy


lifestyle and since 2013 children are weighed from six
months of age at quarterly intervals so


if any are overweight they can be referred to the Children
and Family Weight Management


Service to encourage an active lifestyle and achieve a
healthy weight (Manchester City


council, 2013). Public Health Manchester has developed a
School Health Specification


developing the role of the school nurse and Healthy Schools
staff to help identify, treat and


prevent obesity in children (Manchester City Council, 2013).
Manchester City Football club


(2017) is using football to increase physical activity and a
healthy diet for over 20000


children. CITC coaches provide health education on nutrition
and the “city cook


Programmes” which have proved successful as 100% of those
participating have reported a


healthier lifestyle.



In nursing practice, it is of upmost importance that early
detection, the correct treatment and


ultimately prevention of obesity is tackled through being
committed to health promotion and


education (Naidoo et al, 2016). Nurses have to be seen as
the frontline promoters of health


and work with schools and communities giving their support.
(Sheehan et al, 2006). They


need to be aware and understand the social determinants and
the effect they have on children.


Nurses are role models, listeners and educators not only for
the children but also families and


communities. By being sensitive, caring and non-judgemental
about the issue of being


overweight the nurse can gain the trust of their young
patient which puts them in a powerful


position to influence and help them positively (NMC, 2015).
It is important that the child


understands the health implications of obesity, so that the
nurses can motivate and persuade


them to make changes in their lifestyle and behaviours
(Naidoo et al, 2016). Ultimately


giving them skills and confidence to take control of their
own health (Naidoo et al, 2016).


However respect for their autonomy is paramount whether the
nurse approves or not (NMC,


2015). The nurse has a duty of care to provide the information
and implications so they can


make their own decisions (NMC, 2015).



The Making Every Contact Count initiative for a practising
nurse is a vital opportunistic


health approach for helping combat this condition (PHE, 2012).
Through interactions


opportunities arise to talk and advise the young patients
and their parents about their health


and wellbeing and how to make positive improvements to live
healthier lifestyles (PHE,


2012). Nurses have the support of the HEE and PHE with training
resources on obesity


and nutrition so they can be confident with talking about
health and weight issues. By


building strong relationships and promoting health through
educating and counselling it can


help reduce health inequalities in our society (NMC, 2015).



Childhood obesity needs to continue to be addressed in the
UK, it is a public health problem,


however it is encouraging that a number of programmes have
been implemented. This


condition is a risk factor for many chronic conditions with the
consequences being serious


and far reaching with both physical and psychological issues
needing treatment. However, if


the causes are understood as most are preventable then the
problems can be addressed and


lives will be saved. Overweight children are highly likely
to become overweight adults unless


they start living a healthier life to include eating
sensibly and taking exercise regularly, they


need to be supported and respected to lose weight and
maintain a healthy lifestyle. Childhood


and adolescence are when great change happens and often
lifetime habits and attitudes gained


so this is when healthy behaviours need to be developed. The
future aim is for children to


achieve a healthy weight so they become healthier, fitter
and increase their self-confidence


consequently leading to a reduction in the number of obese
adults. Preventing childhood


obesity requires intervention and education with nursing
practice having an increased


awareness, providing treatment plans and be an advocate for
healthy living. Children are one


of the most vulnerable groups in our society and they need
the chance to lead a healthy life.

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