You might assume that childhood obesity is primarily a health issue. Research and policy papers on childhood obesity generally start by framing the importance of preventing children becoming obese in order to reduce their risk of suffering chronic disease.
But when it comes to making the policy case for preventing obesity to a government minister, it is not the health gains so much as the economic and social costs of obesity that get their attention.
What are the costs of childhood obesity? It is not just costs incurred for healthcare and treatment, but costs in terms of lost opportunities, lost education, lost skills and abilities: in short lost human capital.
Human capital is the knowledge, skills, educational achievement and cognitive ability, and the social and personal characteristics that individuals possess in order to contribute to economic and social prosperity. Obesity reduces a person’s ability to contribute fully; health issues may prevent people working, and people with obesity, especially women, experience discrimination reducing their employment prospects.
Previous studies have shown that obesity in childhood is negatively associated with wellbeing including lower levels of self-esteem, increased likelihood of being bullied, poorer school achievements, reduced social engagement and worse employment prospects.
Using three longitudinal surveys of UK children born in the 1950s, 1970s and 1990s, a project funded by the Health Foundation is examining the short- and long-term consequences of childhood obesity and asks whether obesity is a cause of lower educational attainment, employment status, income level and social participation. The project is being undertaken by a consortium headed by Imperial College London, and including the World Obesity Federation.
The first statistical analyses have looked at the relationship between childhood obesity and educational attainment. Key findings are:
- This study confirms the relationships between higher body mass index (BMI) and lower educational achievement and employment prospects.
- There is evidence that higher BMI was associated with depression, and with pressure to lose weight, especially among girls.
- Among boys, higher BMI was associated with bullying as well as pressure to lose weight.
- The most recent cohort was more susceptible to negative consequences of childhood obesity than previous cohorts.
The latest Cochrane review of child obesity interventions, largely school-based, found that no intervention was reliably effective in older children. Those combining physical activity and dietary changes had a small effect on children aged 5-12 years, and a slightly larger effect on children aged 0-5 years. However, in both cases the reduction in BMI compared to controls was less than 1%. Importantly, there was no indication that even this very modest effect was sustained after the intervention ended.
Let us accept, for the moment, that targeting obesity prevention in schools is likely to fail. For children involved with those interventions, hoping they might lose weight, this failure may lead a sense they were personally responsible. It may lower the child’s self-esteem, decrease a sense of individual agency and empowerment, reduce interest in academic achievement, diminish their participation in society and lower their expectations of future employment.
Perhaps more importantly, this can occur even when there is no specific intervention programme: the prevailing culture in the media, in the projection of ideal body sizes, the dieting industry, the fashion industry and the general narrative which holds individuals responsible for their weight gain – all these will have a similar negative impact on a child experiencing overweight. And among their peers (and perhaps the school staff) the prevailing culture encourages negative thinking and language about obesity, encouraging weight discrimination.
This implies that schools may not be the best place for obesity prevention programmes. Instead, perhaps they should be the place where children experiencing overweight will be considered as suffering a condition for which they have no responsibility, and which needs respect and understanding. Schools will need to develop carefully designed programmes to ensure these children are not slipping behind in educational achievements. The language of respect being taught in schools to counter bullying and racism should be extended to include respect for children of all weights and sizes.
This is not to negate the value of schools teaching the importance of health and of healthy growth, but it is to understand that no-one should be lost in the effort to ensure all children achieve their potential.