Primary school-aged children are to be weighed as the new school year starts this September, amid fears that the coronavirus pandemic has exacerbated the UK’s child obesity problem.  

Designed to alert parents if their child is at risk of developing a weight problem, the National Child Measurement Programme (NCMP) also collects data on a large scale. The latest dataset contains the largest number of measurements collected to date, with 1,169,941 valid measurements from state-maintained schools in England. The programme has been on pause since March 2020 when the nation went into lockdown.  

How does the National Child Measurement Programme Work?

Although NCMP is not compulsory, parents have to choose to opt out. According to Jayne Ashby, team leader of Doncaster school nursing team, “most reception children are not fazed and are quite happy to be weighed” while “year six children ask more questions”.  

Most schools have one screening assistant who explains the process to the children before they are taken into small groups to be measured.   

It’s common knowledge that childhood obesity is on the rise, and data from the NCMP show this. Trends in excessive weight-gain and obesity in year six boys and girls continue to show year on year increases, with one in five children in reception classed as overweight or obese, rising to one in three in year six.

What happens to the data?

After children are weighed, parents receive a letter with their child’s individual results. This information is not shared with school staff or other pupils, but is used to inform local planning and services for children.  

The main body of the letter parents receive is designed by the NHS; it is then up to local councils to decide what support is offered to families in the area.  

Ashby explains that in Doncaster, the school nursing team manages follow-up phone calls for parents, but any extra follow-up work is usually passed to support workers and occupational therapists.  

In 2018, Reenie Greenwood, from Norwich, received a letter inviting her then 10-year-old son to a “healthy lifestyle programme” following the NCMP. She was particularly shocked that the envelope was directly addressed to her son. “I didn’t consider my son to be an unhealthy weight,” she said. “He was an active child and he ate a well-balanced, mostly home-cooked diet. He was carrying a little puppy fat, but I believed that to be normal for a boy his age — although I couldn’t find a definite answer as to what his correct weight should be.”  

Greenwood said that the letter — dubbed a ‘fat letter’ by some critics of the NCMP — can make parents feel inept. “Most of us know the dangers of high-sugar, high-fat foods and try to eat sensibly,” she said. “Posting a letter inviting children to attend a programme is just sticking a plaster on a problem and hoping it will go away. What if, as a parent, I wasn’t bothered about my son’s weight and I took no notice of the information he came home with? Who would be picking up at the end of the programme and ensuring that it continues at home?” 

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Is BMI an accurate measurement for children?

Whether a child is considered to be a healthy weight depends upon their body mass index (BMI). In adults, BMI is calculated by dividing an individual’s weight (kg) by the square of their height (m2 ).  

However, a child’s BMI is more complicated because weight and height change as children mature, and growth patterns differ between boys and girls. The calculation is done the same way (kg÷ m2) but the result is then compared with other children of the same age and sex to work out the child’s ‘centile’ — or position relative to others on a scale of one to 100.  

The NHS says BMI is an accurate way to measure obesity in children. 

However, researchers from the University of Alabama, USA, found that adolescents are incorrectly diagnosed as overweight 19.4% of the time, particularly those with a leaner and more muscular frame or children who are rapidly growing.  

They suggested that triponderal mass index (TMI), where weight is divided by height cubed, is a more accurate way of estimating body fat. 

If you take people straight to the means, you immediately assume that the knowledge of their problem and the desire to do something about it is already there — which in most cases it is not

Making changes

One organisation that wants a rethink to how parents are supported is Living Loud. Data gathered by the charity showed that in one county, 90% of families that received a letter saying their child was overweight failed to respond. Only half of those who did respond entered a programme; and with many dropping out, only 1.5-2% of children were effectively supported.  

Living Loud’s founder, Daniel Parker, attributes this result to an overwhelming failure to communicate and engage with families. “We need to look at the basic building blocks of behaviour change. Does this child have a problem? Are they motivated to do something about it? And do they have the means to do something about it?  

“If you take people straight to the means, you immediately assume that the knowledge of their problem and the desire to do something about it is already there — which in most cases it is not.”  

Emma Citron, a consultant clinical psychologist, thinks that weighing children is extremely damaging, particularly for year six pupils. “This is such a sensitive age in terms of the emerging sense of self, body and sexuality,” she says.  

“It’s also a crucial age for triggering eating disorders. Young people often tell me that they were put on a diet at the age of 10 or 11 by their mum or frogmarched on early morning runs because they were fat. I could spend months working with a year six child because of the impact it’s having on them psychologically.”  

So how to approach the issue in a safe manner? Like Daniel Parker, Citron believes the solutions are accessibility and motivation. “I think it can be approached from a fit and wellbeing angle, without mentioning weight,” she says.  

“For example, more money could go into PE and sport, more after-school funded sports opportunities and free holiday schemes. Within those activities you have that positive spirit; leaders who can be wielding in messages about vegetables, fruit and junk food in a very genteel way.”  

Changing the food environment

Obesity and eating behaviour have often been framed as issues of individual knowledge, motivation and choice, provoking calls for information campaigns and increased parent education to address the issue. However, a report from the Guy’s and St Thomas’ Charity suggests that childhood obesity is simply “a normal response to an abnormal environment”.

The charity says that instead of focusing on personal responsibility and education, we need to make changes to the unhealthy environments in which we live.  

Kieron Boyle, chief executive, said: “The places our children grow up — our homes, schools and streets — are influenced by many different people. We will create environments that make the healthy thing to do, the easy thing to do.”  

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