Food and Behaviour Research

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19 August 2016 - The Conversation - Childhood obesity plan forgets about babies and toddlers

Amy Brown, Associate Professor of Child Public Health, Swansea University

The British government’s long-awaited childhood obesity plan has finally been published. Touted as a proposal to “significantly reduce childhood obesity by supporting healthier choices”, it includes measures such as a soft drinks tax, a new healthy rating scale for schools, and daily hour-long activity in the curriculum to curb obesity over the next ten years.

The plan was immediately met with criticism and horror from several corners. The Guardian deemed it a “massive damp squib”, the BBC criticised it as being “weak and watered down”, while sugar tax warrior Jamie Oliver said the plans were “underwhelming and disappointing”.

Overall the strategy did not go far enough with measures: it only placed a sugar tax on soft drinks, for example, rather than all sugar-laden foods. The government also failed to restrict junk food advertising – apparently because Prime Minister Teresa May believes the economy is more important than our health right now. In addition, there is an over-reliance on voluntary action rather than legislation.

While these omissions are serious, what is particularly concerning is that the government appear to have completely ignored an entire critical period when children’s weight gain patterns, eating habits and even taste preferences are developed: pregnancy and the first years of life.

Early eating

The government plan focuses predominantly on school-aged children, but a quarter of children aged two to five-years-old are overweight or obese before they even start education. Their weight is not simply due to genetics either: the number of overweight children has doubled in the last 20 years at a rate far exceeding genetic mutation.

Copious research has shown that the early years of life are a critical period for the development of healthy eating habits and weight. Maternal obesity and excessive weight gain during pregnancy have been linked to increasing the risk of childhood obesity by two to three times.

In fact, food preferences begin in the womb: babies are exposed to their mother’s food as the aminotic fluid gets flavoured with the taste of it. Preferences for vegetables can be developed in the womb, but a pregnancy diet high in junk food may prime the brain to want more of these foods.

Breastfeeding is also critical to healthy weight development, and the longer and more exclusive the better. Meta analyses suggest that for each month a baby is breastfed the risk of obesity falls by 4%. The reasons for this are multifaceted: formula-fed babies consume a greater volume of milk; formula milk is too high in protein; and bottle-fed babies have less control over the amount they consume, as parents worry about them finishing all the milk in their bottle.

Introduction to solid foods is also important. Doing it too early can increase the risk of obesity, as babies may consume more calories and protein overall. What foods babies eat also matters. Many parents rely on ready made baby foods but these are often predominantly based on sweet tastes, emphasising sugar intake, and are often lower in nutrients) than many home-cooked meals.

Whatever milk or food a baby receives, the feeding environment is also critical to developing positive relationships with food. So critical in fact that the World Health Organisation flags responsive feeding – where babies are allowed to set the pace of their meal and enjoy and explore food under their own control – as central to developing good eating habits for life. Indeed, babies who are fed responsively during weaning have better appetite control and eat a wider range of foods as toddlers.

So why are these early influences so starkly missing from the government’s plan? It’s not as if the UK already has excellent early feeding outcomes. Half of women are overweight during pregnancy, we have the lowest breastfeeding rates in the world and three-quarters of babies are introduced to solids before they are five months old. Clearly, education, support and investment are desperately needed in these areas

Was it an omission? A political play? Or another example of preference to the economy over health? The government’s already established Change4life campaign aimed at promoting healthy behaviours is heavily funded by formula and baby food companies, despite the known link between formula, early solids and obesity.

If the government had simply looked westwards from Westminster, it would have seen that the Welsh government has already developed a programme that is far more on target than this narrow national plan. Six of the “ten steps to a healthy weight” cover preconception, pregnancy and the baby and toddler years, aimed at helping children grow up healthily from day one.

Sadly, the UK-wide plan starts far too late in life, and fails to invest in early prevention. Sticking a plaster over the problem won’t suffice, we need a plan, and investment behind it, which addresses childhood obesity before it becomes an even more life-threatening problem.