Childhood Obesity in London Professor Paul Plant Deputy Director Health Improvement Public Health England - London 
 
Almost one in four children in Reception and more than one in three children in Year 6 are overweight or obese 
 
In Reception (4 to 5 years): London 23%, England 22.2% overweight or obese In Year 6 (10 to 11 years): London 37.4%, England 33.3% overweight or obese 

## London Has A High Rate Of Child Obesity Compared To Other Global Cities Prevalence Of Overweight And Obese Children, In Contrast To London, New York City Has Seen A Decline In Child Obesity Over Time

 In Tokyo, obesity is classed as BMI≥25 instead of 30, therefore separate overweight/obesity measures are difficult to obtain: % children with BMI ≥ 30 
was not available in Tokyo,  
SOURCE: Obesity in K–8 Students - New York City, 2006–07 to 2010–11 School Years. MMWR Morb Mortal Weekly Rep. 2011 Dec 

## Why Are Our Children Getting Fatter?

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Everyone has a theory!  The Foresight Report maps the whole picture 
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Determinants multi-factorial & operate in complex 'interactive' ways 
 
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Behaviours are learnt and habits formed early 
 
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We make choices but not in circumstances of our own making 
 
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Great increase in the prompts and opportunities to consume low price calories (eg fast food) 
 
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Demise of older eating habits (eg role of food in the family) and start of 
new ones  
 
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Physical activity patterns are changing 
 
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Obesity is an inequalities issue  
are Heath Why are our children getting fatter? 

England 

## What Does The Evidence Tell Us?

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There is no simple or single solution:  need whole system approach  
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Social marketing can work if based on consumer insight and power of different media 
 
 
148 m cubes of sugar taken out of diet (2015) 

104 m additional minutes of activity reported (49 minutes per family) (2014) 
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'Upstream' interventions have more impact but are more difficult to agree 
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Intervening early in life more acceptable and more cost effective 
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Personal support services may be too costly in future? 
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Change at scale is possible (eg New York ) 

## What Are Boroughs Doing?

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Some adopting a system leadership approach , multiple upstream 
interventions (eg Three boroughs, Tower Hamlets, six east London boroughs) 
 
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London Food Board and School Food Trust sponsoring whole system approaches (Food Flagship Boroughs: Lambeth & 
Croydon) 
 
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Many supporting school based action, with GLA Healthy Schools programme active in over 1000 schools 
 
 
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Opposite end of spectrum some stuck at the personal service intervention 'end' only providing face to face support (eg weight 
management) 
 

## School And Wider Food Environment

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40% of children eat school meals - in some areas, school meals make up 
just 15% of meals consumed by school age children 
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Fast food outlets need targeted action as they are an important and popular 
food source for children and young people (38% of Newham teenagers eat 
fast food once a week and 12% eat fast food every day) 
- Significant proportion of students' fat, salt and sugar intake comes from 
these foods, with a standard meal containing 58% RDA kcal, 51% RDA saturated fat and 52% RDA salt 
- Some shops use 'student offers' specifically to target school children - Interesting work by City University looking at fast food and what young 
people think in Haringey. 
 

## Case Studies In London Have Demonstrated The Popularity And Feasibility Of Healthy Alternatives Box Chicken Pilot, Newham

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We Are What We Do demonstrated the viability of a healthy, popular and financially sustainable alternative to existing fast food outlets through the Box Chicken pilot in Newham. 
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Mobile catering unit set up from 12-5pm Monday to Friday for a month. 
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Four recipes developed, all in line with PHE healthy eating guidelines. 
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Target audience: students at three local schools and members of the local community. Many students also took boxes home for their parents. 
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Hot, cheap and quick one pot meals served. 
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During the one month pilot with one van, Box Chicken made £970 profit, excluding the 
caterer salary. 50% more meal sales would be needed to break even. Box Chicken would be likely to reach profitability with a longer trading period and economies of scale. The council waived trading fees* for operation. 

## Better Health For London Health Democracy In Action

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Health improvement activities best directed and lead by leaders close to the 
communities they serve - you have legitimacy and understanding to take 
action on their behalf.   
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A role for national and regional organisations in support and to take action 
that can only be done at that level (eg reformulation of sugar in drinks). 
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Public Health England:  
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Provides evidence and health intelligence 
    (eg recent sugar in diet recommendations) 
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Leads national social marketing activities 
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Contributes to pan-London partnerships 

## Ambition

 
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Give every child the best start in life, taking a family based approach 
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Work with schools, making London schools the healthiest in the country 
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Reduce the proportion of sugar in children's diet by 50% 
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Develop healthy urban environments for children to grow and develop 
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Work together across London with new partners  to find innovative solutions 
 

## Better Health For London/  Lhb We Will Make Collective Progress If We:

Focus on children - give every child the best start in life and make London a 
great way to raise a family that is active and eats healthily.   
Supporting families - to meet this aspiration recognising the reality of 
bringing up children in different parts of the city. 
Uniting - agreeing a common set of ambitions for the city - to focus our 
collective efforts and scarce resources, recognising that each agency will make local decisions. 
Supportive messaging - supporting messages that are positive and 
consistent so wherever a family lives they are clear about what they can do for their children to ensure they have a healthy diet and are active. 
Doing things together - a small number of things where action at a pan-
London level makes the most sense 

## Supporting Local Action

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London Prevention Board - childhood obesity a priority 
 
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DPH for Lewisham leads for Directors of Public Health •
Active London obesity leads network 
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New London obesity group inaugural meeting 8th October 
 
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Work being commissioned where evidence weak (eg return on investment)  
 
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Sector led improvement on obesity, led by London Association of Directors of 
Public Health 
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Working with new partners eg London Sport, Jamie Oliver Foundation, 
planners, transport etc - building strategic alliances and relationships 
 
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PHE have developed tools, data, evaluation guides, economic assessment aids etc to help local authorities plan obesity strategies: 
https://www.noo.org.uk/ 

## What Next?

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By working together we will have greater impact 
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Let's be innovative together - if we always do what we've always 
done……….and learn collectively 
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We will be failing our children if we don't find innovative solutions 
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London can lead the way in turning the tide on obesity and giving every child the best start in life