Researchers reveal that whilst most of England faces worsening childhood obesity rates, a handful of London and South-East communities show slower growth, or even decline, highlighting the influence of deprivation, ethnicity, and local health policies in obesity trends.
Study: Trends in childhood obesity for upper tier local authorities in England between 2007/08 and 2023/24: a latent trajectory analysis. Image credit: Eviart/Shutterstock.com
A study published in the Journal of Public Health shows that while most areas of England follow national patterns of childhood obesity, a small cluster of local authorities, primarily located in London and the South East, show less adverse trajectories. In these areas, obesity levels among children remain high in absolute terms, but the trends are somewhat more favorable than in the rest of the country.
Background
Childhood obesity has become a significant public health concern because of its long-term health consequences. In England, the prevalence of obesity remained high but stable (9.6%) between 2008 and 2024 for children aged 4–5; however, for children aged 10–11, the prevalence increased from 18.3% in 2008 to 22.1% in 2024.
Socioeconomic inequalities play a major role in shaping childhood obesity rates. In 2024, children living in the most deprived areas were far more likely to be obese than those in the least deprived areas. Among 4–5-year-olds, the prevalence gap was 6.9 percentage points, while among 10-11-year-olds, the gap widened dramatically to 16.1 percentage points. These figures highlight how disadvantage accumulates with age and are evidence of the strong link between deprivation and poorer health outcomes in children.
Regarding regional variation, recent estimations demonstrate that the South East and South West England have the lowest prevalence, whereas the North East and West Midlands have the highest prevalence. These differences are partly associated with deprivation and ethnicity.
Three national plans to control childhood obesity were initiated in England between 2016 and 2020. The primary objectives of these plans include investing in weight management strategies, imposing restrictions around food marketing, and introducing new tools for local authorities to deliver systems change. In addition to these strategies, understanding the causes of variation in childhood obesity prevalence is vital to improving health outcomes.
Since 2006, children living in England have been evaluated for height and weight measurements in the first and last years of attending state-funded primary schools (Reception, aged 4–5 years, and Year 6, aged 10–11 years, respectively). This data is used to calculate z-BMI (UK90 reference, ≥95th percentile) of children to determine the prevalence of obesity for each local authority.
In the current study, researchers at the University College London (UCL) analyzed data from 150 local authorities in the National Child Measurement Programme to explore the differences in obesity prevalence between areas over time. They used latent growth mixture models to identify distinct groups based on the longitudinal obesity prevalence data collected for Reception and Year 6 children (2007/08 – 2023/24, excluding 2019/20 and 2020/21 due to COVID-19 disruptions). They also used unadjusted logistic regression to test whether deprivation (multiple deprivation and income deprivation) and ethnicity predicted group assignments. Multiple deprivation refers to multidimensional deprivation, including poverty, poor health, low education, and unsafe living conditions.
Key findings
The study reported that the obesity prevalence in Reception across 150 local authorities was 9.9% in 2008, which remained stable until 2024. However, the prevalence in Year 6 increased from 18.9% in 2008 to 22.6% in 2024.
Regarding deprivation and ethnic differences, the study reported relative improvement in deprivation rank (multiple deprivation and income deprivation) between 2010 and 2019, and a reduction in White ethnicity between 2010 and 2024.
The growth mixture models assigned 88% of local authorities to the ‘Moderate & Stable’ class (Class I) for Reception. This class had a moderate initial prevalence of obesity that remained stable over time. The remaining 12% were assigned to a divergent ‘High & Declining’ class (Class II), with a higher initial prevalence that declined over time.
For Year 6, the models assigned 90% of local authorities to a prevailing ‘Moderate & Rapidly Increasing’ class (Class I), with a moderate initial prevalence that rapidly increased over time. The remaining 10% were assigned to a divergent ‘High & Gradually Increasing’ class (Class II), with a higher initial prevalence that gradually increased over time.
Regarding geographical locations, 17 of 18 Class II authorities for Reception and 14 of 15 for Year 6 were in London and the South East. Across both groups, 11 local authorities overlapped, all of them in London. Two additional Class II authorities were in the North-East. Assignment to Class II was associated with higher deprivation, larger ethnic minority populations, relative improvements in deprivation rank, and shifts in school ethnic composition.
Study significance
The study identifies two distinct groups with different trends in obesity prevalence among children aged 4 to 5 and 10 to 11. Most local authorities in England exhibit a moderate and stable prevalence of obesity among children aged 4 to 5 and a moderate and rapidly increasing prevalence among children aged 10 to 11.
A small number of local authorities, predominantly located in London and South-East England, have observed fewer adverse obesity trajectories compared to national trends. Despite a high absolute obesity prevalence, these authorities follow a declining trend among children aged 4 to 5 and a gradually increasing trend among children aged 10 to 11.
These local authorities are characterized by high deprivation and larger ethnic minority populations. Over time, relative improvements in deprivation rank were observed in these areas, accompanied by demographic shifts in the child population.
Overall, the study highlights the associations of childhood obesity prevalence with changes in deprivation and ethnicity. The observed differences between distinct local authorities may reflect changes in ethnic makeup or the socio-economic status of families with children.
The observed trends in childhood obesity in London and South-East England may be associated with specific policies, activities, or investments delivered across these regions. Implementing measures like breakfast clubs, universal free school meals, restrictions on advertising less-healthy food, and higher levels of investment in public services in London may have contributed to the observed changes in obesity prevalence. However, the study does not establish causation.
Notably, the study reveals that approximately 90% of local authorities share a similar trend, despite marked variation in deprivation and ethnicity. Although relatively favorable trends have been observed in some regions, the overall trend of childhood obesity is concerning, particularly among children aged 10 to 11 years.
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