The first UK city to lower child obesity?

One of the great joys of the internet age (and yes, this says much about the geek in me) is that it is now possible to pick up a news story, read the scientific paper upon which it is based and check out the original data before getting out of bed. Which I did this morning on reading about Leeds, the “first UK city to lower its childhood obesity rate” according to the Guardian and many other news outlets. It is a great story. Something we would love to have been able to claim for Newcastle, but we can’t. Sadly, neither can Leeds.

The study, published in Paediatric Obesity, is based upon data readily available in Public Health England’s Fingertips website – in the section on NCMP and Child Obesity Profile, the figures are those for “Reception: Prevalence of obesity (including severe obesity), 5-years data combined”. The study was based upon 4 data points, equivalent to 4 consecutive 5-year rolling averages. For Leeds these showed a fall from 9.42% to 8.83% over the reported period from 2009/10-2013/14 to 2012/13-2016/17.

This prompted much admiration and praise on Twitter, including a Tweet by the Secretary of State, Matt Hancock, saying “Childhood obesity rates have fallen in Leeds after bringing in parenting classes, study shows – highlighting pivotal role parents play in tackling childhood obesity. Terrific step forward we must build on if we’re to protect health of future generations”.

I twitched a little at this narrative of parental choice and responsibility, particularly coming the day after publicity for a much larger study showing a powerful relationship between breastfeeding and obesity.

But what was missing from the news coverage and responses was the fact that there is now a fifth data point in the Fingertips data – for the period 2013/14-2017/18 – and this shows the prevalence of obesity in Leeds to have risen again to 8.98%. This is because the single-year data for the city in 2017/18 showed a rise to a prevalence figure of 9.5% in the reception age group.

OK, you might say, it is still a fall, and possibly a bit more than the national change over the same period. But let’s look at Newcastle’s figures for the same periods. These show that for the time covered by the published study, obesity in Newcastle, by the same measure, fell from 12.10% to 11.25%. And its figure for 2017/18 was 11.16%.

So, between 2009/10 and 2017/18, obesity by this yardstick fell in Leeds by 4.68%, whereas in Newcastle it fell by 7.81%.

Does this make Newcastle the first UK city to lower its obesity rate? Or does it mean that the Leeds data have been misleadingly over-interpreted?

This matters, because, however worthy the parental programme (HENRY) in Leeds may be, this study is not evidence that it works. But it has fuelled the individual, behavioural choice paradigm of childhood obesity, against which there is a mass of evidence, and that strikes me as irresponsible epidemiology.

 

2 thoughts on “The first UK city to lower child obesity?

  1. Dear Eugene

    Thank you.
    Your scepticism is fully justified.

    Particularly regarding the simplistic causal attribution to a single intervention delivered to a limited number of individuals.

    Furthermore, the authors say they have no interests to declare.
    Yet several apparently have financial or other involvement with Henry…..?

    I also strongly agree with your conclusions.
    We MUST rebut the victim-blaming, Individul Responsibility narrative,
    and instead talk up the upstream policy interventions and comprehensive prevention strategic approach. That has been so effective in tobacco and alcohol control,
    and was recently recommended by the Parliamentary Health Select Committee looking at Childhood Obesity.

    The Governements Chilhood Obesity Plans 1 & 2 represent a good start,
    but there is lots more to do…

    Best wishes

    Simon Capewell
    Liverpool University.
    (Also: Obesity Health Alliance, & Action on Sugar)

    Like

    • May we urge professionals to look at the full paper (Rudolf et al. Pediatr Obes. 2019 Apr 25:e12529. doi: 10.1111/ijpo.12529) and not just the media coverage.

      This was an observational study using all the published NCMP data that was available at the time of the analysis last year. It was prompted by people working in Leeds who had observed a decline in the prevalence of obesity among children starting school, but they sought external input from the University of Oxford to conduct an independent statistical comparison with other parts of the country. The key point in our analysis is that the decline in the prevalence of obesity in children aged 4/5y is primarily among children living in the most deprived areas, where the decrease is significantly greater than observed in the ‘comparator cities’ or England as a whole.

      The take-home message of the paper was straightforward: it would be instructive to explore if lessons can be learnt from Leeds to inform future action. The value of identifying localities showing encouraging trends in obesity is well-recognised elsewhere. In the American Child Obesity Declines Project four major municipalities (with similar reductions in obesity to Leeds) have been studied in depth to identify lessons that could assist others in their attempts to reduce obesity.

      The article itself made no claims that Leeds’ obesity strategy was responsible but it is a perfectly reasonable question for the media to ask “What has Leeds done?”. It is a matter of fact that the Leeds obesity strategy includes HENRY training for health and early years practitioners and delivery of the HENRY family programme in children’s centres. Whether this explains the decrease in the prevalence of obesity is unknown, but either way, it is abundantly clear that this is not enough. The prevalence of obesity is very high in Leeds and continues to increase in older children and adults. We have no hesitation in agreeing that other policy interventions are also required.

      We are also disappointed that the response to this glimmer of hope has been hijacked by some in the scientific community with accusations of a potential conflict of interest. The paper made clear the role and affiliations of each author. Importantly the analysis was conducted independently by the University of Oxford. It would have been wrong to exclude from authorship the people in Leeds City Council and the HENRY programme who initiated this analysis and helped to frame the research question.

      Like

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