Background to the Research

• Fit Futures is a cross-departmental taskforce established by the Ministerial Group on Public Health in response to concerns about the rising levels of overweight and obese children and young people. A small steering group, responsible for managing the work of the taskforce, commissioned research and analysis, and directed an engagement process to ensure that the wide range of organisations and groups with an interest in obesity in children and young people were involved in the work of the taskforce. This report presents the findings of this process.
  

Research Approach

• The engagement process sought the opinions and suggestions of more than 300 children and young people and over 200 parents, so that these views could inform and direct discussions with all other groups. The process concluded with an intersectoral stakeholder event in March 2005, which was attended by over 100 people from a variety of professions, sectors and organisations.
  

Main Findings

• The results of investigations conducted as part of Fit Futures support the description of obesity as a 'health time bomb':
  • Obesity reduces life expectancy by approximately nine years;
  • Obesity significantly increases the risk of NI's biggest killers - Coronary Heart Disease and Cancer;
  • Obesity dramatically increases the chances of being diabetic;
  • Obesity and diabetes, traditionally considered as diseases of middle age, are now being identified in children and young people;
  • Obesity can impact on the emotional and psychological well-being of young people and on their sense of self-esteem;
  • Obese children are more likely to become obese adults and children of obese parents are significantly more likely to become obese, thus creating the potential for an upward spiral in levels of obesity.
• Obesity is in many ways only the visible part of a public health iceberg, caused by changes in eating habits and activity levels. Fit Futures found a very significant disparity between the actual eating habits and activity levels of many children and young people and what activity levels and nutrition should be to promote and support good health.
• Rising obesity levels are also identified as a potential financial time bomb, due to high costs of treating obesity and its consequences.
• As has been found in many developed and developing countries, levels of obesity of children living in NI were found to be increasing year on year, with around one in five boys and one in four girls being overweight or obese in primary one. These levels were also found to have increased by over a quarter in ten years.
• Obesity can be a bigger problem for some sections of society, and whilst there is only limited evidence to suggest that children from less well off families are more likely to be obese, it is clear that children and young people from families in lower socio-economic groups eat a poorer diet and are less likely to participate in sport or exercise.
• The taskforce was provided with many examples of good practice in relation to improving nutrition and increasing activity levels, although obesity prevention was generally not the principal objective. Stakeholders also identified a number of strategic policies either already contributing to obesity prevention or having the potential to do so. There was a clear consensus that a more systematic approach to obesity prevention would be required.
• The Fit Futures steering Group established a vision, to direct this new approach to obesity prevention: "In the Fit Future, children and young people, of all ages and from all sections of our society, will be motivated and supported to access a range of readily available, quality, enjoyable opportunities to be active and eat healthily."
• Having considered both what should be done, and how it should be done to have most effect, the taskforce recommends that policies and strategies to tackle obesity should take adequate account of the importance of the role of parents and families in establishing and supporting good nutrition and active living, particularly during the first few years of a child's life. A key message is that parents have primary responsibility for ensuring the health and well-being of their children, but action also needs to be taken to support parents in doing this.
• The taskforce identified the development of the basic knowledge and skills necessary to encourage and support children and young people to be active and to eat healthily, among those supporting and working on a daily basis with children and young people, as an important way of enabling children to make healthy choices. Policies and programmes also need to recognise the complexity of obesity and that a long-term commitment will be needed if trends are to be halted and reversed.
• While obesity is not restricted to one sector of society, certain groups are more at risk, such as children and young people from low income families or with a disability. It is also necessary to note that the most effective solutions are likely to focus on promoting and developing the self-esteem of young people. The taskforce recognises that policies and strategies to tackle obesity must take account of the available evidence in relation to what works and what doesn't.
• Fit Futures identified six priorities for action, the first being the development of joined-up healthy public policy.
• The second priority was the provision of real choice, in terms of improving the obesogenic environment in which we live, and addressing those aspects of the media, physical, consumer and financial environment that promote obesity and prevent children and young people from exercising real choice.
• Thirdly, supporting healthy early years was highlighted, such as the extension of the healthy schools programme to early year's settings.
• The fourth priority was the creation of healthy schools, the focus of which was the negation of the benefits of health education by the conflicting messages being sent out by unhealthy school meals, tuck shops and vending machines. Further highlighted in this priority were the importance of whole school approaches, a food in schools programme, and the development of an active schools programme.
• The fifth priority was encouraging the development of healthy communities, with community-based approaches being noted as possibly effective in engaging people from lower socio-economic groups. The healthy schools programme should seek to support the development of schools as hubs within their community, which would also support the health and well-being of their local community.
• The final priority was building the evidence base of understanding of overweight and obesity in children and young people, with systematic surveillance of obesity levels, childhood nutrition and activity levels.

Conclusions

• Given that the taskforce was able to identify examples from across NI, England, Scotland, Wales, the Republic of Ireland and even Scandinavia, in which its' recommended policies and practices were already being implemented, all the recommendations can and should be implemented as a matter of priority.
• Initial investment should focus on targeting need, building capacity and developing joined-up delivery structures. Government departments should work together to provide the required resources to support the delivery of Fit Future's recommendations.
• The Ministerial Group on Public Health should publish a response to the recommendations within 3 months; monitor the implementation of agreed recommendations; and publish a progress report on an annual basis.