By Lisa McNally and Jim McManus
When reporting on children’s health issues, the media loves a good ‘ticking time bomb’ story. Their frequent headlines citing a “children’s mental health” time bomb or a “child obesity” time bomb are increasingly turning children’s health issues into a scene from Goldfinger.
But as we run from one time bomb to the other, desperately trying to defuse them, how aware are we that they are actually wired up together? Can we see that our efforts to stop the clock on one are potentially speeding up the countdown on the other?
Consider our efforts to reduce child obesity. Despite widespread criticism, we still persevere with our tactic of weighing children and then sending a letter home saying how overweight they are. We have not been discouraged by evidence of the adverse emotional impact of these letters on children (Nnyanzi, 2015) or more generally by the well documented psychological distress caused by ‘weight-labelling’. Neither are we put off by the well documented link between the experience of weight discrimination among young people and incidents of self-harm or even suicide.
Can we see that our efforts to stop the clock on one [child health issue] are potentially speeding up the countdown on the other?
Of course, there are many that see this as just ‘tough love’. If we are to defuse the child obesity ‘time bomb’ then our kids and their parents need to hear the truth, right? After all, you can’t make a low-fat omelette without breaking some eggs?
Unfortunately, the evidence suggests that the stigmatising potential of our child obesity work may actually make obesity worse. For example, research studies have found that being labeled as “too fat” in childhood not only leads to poorer mental wellbeing, but is also associated with a higher risk of being obese nearly a decade later. Importantly, this relationship was found to be independent of initial BMI and so can’t be simply put down to children’s objective weight at baseline.
Long term studies have also shown that poor mental wellbeing in adolescence, as well as adverse experiences like bullying, can lead to obesity in adulthood (even when childhood weight is taken into account) (Franko et al., 2005; Baldwin et al., 2016). Studies have also indicated that emotional factors such as low self esteem are far more important predictors of bulimia and compulsive eating than children’s body weight (Nicholls et al., 2016).
The stigmatising potential of child obesity work may actually make obesity worse
So, it seems that while we bash away at the ticking time bomb of child obesity with our ‘individual-blaming’ hammer, we are actually making it more likely to go off in our faces, while simultaneously putting children’s mental wellbeing at risk. Could it be time to change our strategy?
The first step is to take off our ‘behavioural blinkers’ and look beyond the individual. We need to focus more on the circumstances that children find themselves in each day. Every time they walk down the street, watch TV or use social media they are sold cheap, easily accessible junk food while simultaneously being told they aren’t good enough unless they buy a certain product or look like a certain person.
The evidence is clear that these ‘environmental’ factors are where we can have the greatest impact. For example, the accumulated data on the positive impact of sugar taxation is now compelling, with studies showing benefits are maintained years after changes are made. Research also highlights the importance of restricting junk food advertising to children, a strategy that is understandably popular among parents.
While we bash away at the ticking time bomb of child obesity with our ‘individual-blaming’ hammer, we are actually making it more likely to go off in our faces, while simultaneously putting children’s mental wellbeing at risk.
Evidence also suggests an important role for local community networks. NICE Guidance recommends that “Public health teams should use community engagement and capacity-building methods to identify networks of local people, champions and advocates who have the potential to co-produce action on obesity as part of an integrated health and wellbeing strategy.” Local authorities should take a key role in the coordination of these networks, along with school nurses, health visitors, schools, the voluntary sector and local businesses.
In summary, we’re not going to successfully defuse the ‘ticking time bomb’ of child obesity with some weighing scales and a stack of mail merged letters. This will only make that other time bomb, child mental health, an even bigger problem than it already is. Rather, place-based approaches that focus on self-esteem, peer support and positive community activity are required, while we direct the ‘tough love’ to those large companies making a fast buck out of young people’s ill health.