The surprising truth about fighting obesity

Forty years ago, around 1 in 100 children were obese. Globally, it’s now close to 6. And in the UK? 20.

I work at one of UK’s biggest charitable foundations. We work in inner-city London on complex urban health challenges. Our model is to test and explore ideas, and share what we find with others working in similar urban areas, in the UK and internationally.

We’re in the early years of a decade-long programme to address childhood obesity in our local neighbourhoods. We focus on childhood obesity because London has the highest rates of any major global city, because it disproportionately affects the most disadvantaged communities, and because its effects play out over a lifetime.

To inform our work, we’ve spent the past year investigating what sits behind childhood obesity rates in inner-city areas and, just as importantly, what works in addressing them. And the insights – drawn from behavioural science, lived experience, and leading practitioners – are fascinating. They tell us that we need to reframe and rethink the issue.

How the issue is framed

There’s a very clear story that sits in the public’s mind on childhood obesity: that it’s an issue about individuals, about insufficient willpower, and about people making bad choices. And if you frame the issue that way, the answer is simple: educate people as to what the right choice is, and leave the rest to them.

The problem is that this simple narrative overlooks much of the evidence from behavioural science that childhood obesity is a normal response to abnormal environments. How we consume food is often not a conscious decision. It’s rather an automatic response to cues in our environment – and inner-city environments increasingly bombard us with an overwhelming amount of opportunities to eat high energy food, and to be insufficiently active.

But perhaps what’s most fascinating is when you ask people with lived experience of these often poor, inner-city environments that cause obesity, what they think causes childhood obesity. Their answer? That it’s an issue about individuals, about insufficient willpower, and about people making bad choices.

That’s significant. It shows that this framing of childhood obesity as an issue about individuals, devoid of the environments in which they live, is the norm. So we need to change that story if we are to make meaningful progress.

The problem of inequality

Childhood obesity is a problem everywhere, but what is often counterintuitive is how closely it is linked to deprivation. In the UK, for example, kids from poorer areas are twice as likely to be obese as those from richer areas. This childhood obesity ‘deprivation gap’ has grown 50% in the past 10 years.

And it is especially pronounced in inner-city environments. Take for example Dulwich Green – an affluent neighbourhood in South London. It has an average household income of £60,000, 1 in 5 residents of minority ethnic background, and 1 in 10 kids are obese. Compare it to Camberwell Green, another neighbourhood just down the road. Here average household incomes are £30,000, 3 in 5 residents are of minority ethnic background, and 1 in 3 children are obese – the highest rate in Europe.

This matters because the evidence from behavioural science suggests poor decisions are exacerbated by scarcity, and families in disadvantaged areas have less cognitive defence against unhealthy environments. The huge pressures of just trying to get by means many simply don’t have the headspace to make healthy decisions. So if we’re to make meaningful progress, we need to break this link between deprivation and obesity, and focus efforts where they are most needed.

Cumulative, long-term and coordinated action

But we should be positive, because many cities around the world have made considerable progress in tackling childhood obesity.

The consistent lesson that stands out from them all is how many different actors need to be involved. The environments our children pass through – homes, schools and streets – are influenced by us all. Now that can seem overwhelming, or we can see it more positively: that we each get to play a part. And the evidence is that, while the issue is complex, the solutions don’t have to be.

Most important seems to be to get going, to focus on marginal and sustainable changes, and to be as comprehensive as possible in addressing the many different drivers of unhealthy weight.

For example, over the past five years, Amsterdam has built more cycling lanes, changed school caterers, banned junk food adverts aimed at kids, shifted product placement in stores, and appointed over 300 voluntary health ambassadors. The result? Close to a 10% reduction in obesity levels.

A turning point

This is an important moment in childhood obesity, with real momentum for doing what’s needed developing across the world. Our hope is that these three points – that we need to focus on environments; that we should focus extra efforts on tackling the deprivation gap; and that progress is possible, but only with cumulative and collective effort – can mark a significant turning point in not only what we need to do, but how we need to go about it.