Bite Size: Breaking down the challenge of inner-city childhood obesity

New report calls for more action on childhood obesity ‘deprivation gap’

  • Evidence shows childhood obesity is driven by the environments children grow up in
  • ‘Obesogenic’ environments in deprived inner cities are contributing to high levels of childhood obesity
  • Report highlights the ‘deprivation gap’ which has increased by more than 50% in a decade. Children in the poorest areas of England are twice as likely to be obese than wealthier neighbours.

A new report from Guy’s and St Thomas’ Charity argues that framing obesity as an issue of individual willpower overlooks the overwhelming evidence from behavioural science on how environments – both social and physical – influence people’s decision making.

Bite Size: Breaking down the challenge of inner-city childhood obesity was developed in partnership with The Behavioural Insights Team. It takes a detailed look at the evidence on how the ‘obesogenic’ inner-city environment is increasingly bombarding people with an overwhelming amount of opportunities to eat high energy food, therefore promoting unhealthy choices.

Experts including Shirley Cramer from the Royal Society for Public Health and Jamie Oliver, have contributed to the report, which highlights that:

  • Childhood obesity is a problem of inequality – There is a clear and persistent relationship between childhood obesity and deprivation. Rates of childhood obesity are higher in urban areas and children living in the poorest areas are twice as likely to be obese than their wealthier neighbours[1]. The ‘deprivation gap’ – the difference in obesity rates between the least and most deprived areas in the UK – ­­has increased by over 50% in the past decade.  To reduce overall rates, it is vital to break the link between childhood obesity and deprivation.


  • Poor decisions are exacerbated by scarcity – Families in disadvantaged areas have less cognitive defence against unhealthy environments. Their decision-making is affected by having less available time and money and a need to focus on immediate issues. The report calls for a more realistic and sympathetic view of people’s eating behaviour and to focus on creating environments that help make the healthy choice the norm.


  • Solutions don’t have to be complicated, but they do take time Bite Size calls for more initiatives that create coordinated small steps, articulating the cumulative value of looking for marginal gains such as reducing unhealthy snacking or increasing incidental physical activity.


  • We have a collective responsibility to take action – The environments children live in are influenced by businesses, government and communities. The report highlights the role for everyone to play in helping children stay a healthy weight and calls for political leadership to bring decision-makers together under one mandate: to create and sustain healthy food and activity environments for children.

Despite increasing rates of childhood obesity across the developed world, the Charity claims progress is possible if efforts are focused on breaking the link between deprivation and obesity, particularly in inner-cities.

Kieron Boyle, Chief Executive of Guy’s and St Thomas’ Charity, said:

“In the UK, one in 10 children start school obese. That’s enough to fill London’s Olympic Stadium four times over, and entirely unacceptable.

“To tackle childhood obesity, we need to be clear that its effects are disproportionately centred on poorer families; that it is as much a problem of environments as it is of willpower; and that although the issue is complex, the solutions do not have to be.

“Our report demonstrates that everyone needs to play a role. The places our children grow up – our homes, schools and streets – are influenced by many different people. We will succeed by bringing them together and creating environments that make the healthy thing to do, the easy thing to do.”

 Meryem, 35-year-old single mum of three who lives in Kennington, said: “The food options in my area aren’t very healthy at all – fried chicken, Chinese takeaways, or pizza. There are a few new restaurants opening up but they just aren’t affordable with my budget, and you think to yourself – it’s a lot more expensive than the takeaways.

“Because I have kids I want to get healthy food for them. My son would probably want to eat chicken and chips everyday if I let him, but I try to buy and cook healthier food at home for the kids so it’s ready when they come back from school.”

 Jamie Oliver, chef and campaigner, said: “Childhood obesity is the health epidemic of our time. The Guys’ and St Thomas’ Charity report shows that obesity is not caused by parents and kids lacking in willpower – it’s actually our high streets, schools and shared public environments that are having a truly negative impact on kids’ health.

“Now we have this evidence to hand, I’m looking forward to seeing how robustly and logically the government choose to act in the formation of the much-awaited and absolutely imperative Childhood Obesity Strategy Chapter 2. Time is not on our side and this young generation need to be healthy and happy in order to build the foundation of a strong and stable nation.”

Dr Alison Tedstone, Chief Nutritionist at Public Health England, said: “There’s no denying our environment encourages children to eat too much food high in calories, fat, salt and sugar. We’re working across sectors to reduce this, from our engagement with the food industry to reduce sugar and calories in food, to advising the government on town planning guidance.

“This report shows that tackling obesity is everyone’s business – including local authorities, communities and the people who make and sell our food.”

The report reflects experiences from projects on the ground as well as families living in disadvantaged areas. It features contributions from Greater London Authority, Public Health England, Jamie Oliver Foundation, Alexandra Rose Charity, the Amsterdam Programme, and other experts in nutrition and public health.

The international evidence base on childhood obesity demonstrates the importance of coordinated responses to the many drivers of unhealthy weight. Guy’s and St Thomas’ Charity is taking a place-based approach, working with local neighbourhoods to better understand the drivers and context in which effective action needs to take place.  Working in partnership with Guy’s and St Thomas’ NHS Foundation Trust and others, the Charity aims to reduce the obesity deprivation gap focussing on environments where children and families spend their time: home, school and street.


 Facts and figures

  • Children living in poorest areas are twice as likely to be obese than wealthier neighbours.[i]
  • There is a strong relationship between deprivation and obesity. In England, close to 3 in 10 Year 6 children living in the most deprived areas are obese, compared to around 1 in 10 in the least deprived.[ii]
  • And the deprivation gap has increased by over 50% in the past 10 years. The difference between rates amongst the most deprived and least deprived 10 to 11 year olds has increased from 5% to 13.4% between 2006/7 and 2016/17.[iii]
  • Rates of childhood obesity are higher in urban areas. 20% of 10 to 11 year olds in urban areas are obese, compared to 15% of their rural peers.[iv]
  • London has the highest rate of childhood obesity of any peer global city – higher than New York, Sydney, Paris or Hong Kong.[v]
  • There are exceptionally high pockets of obesity within the boroughs of Lambeth and Southwark in South London. Rates are particularly severe in Southwark. The worst area is Camberwell Green, which has the highest prevalence in London and second highest in [vi]

Notes to editors
Guy’s and St Thomas’ Charity is an independent, place-based foundation. We work with Guy’s and St Thomas’ NHS Foundation Trust and others to improve the health of people in the London boroughs of Lambeth and Southwark.

Our programmatic approach focuses on a few complex health issues at a time. Currently we’re aiming to reduce childhood obesity and improve health and care for people with multiple long-term conditions. Led by evidence and focussed outcomes, we bring great minds together, supporting new approaches to health and sharing insights with anyone facing similar challenges.

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[1] HM Government Childhood Obesity: A Plan for Action, August 2016

[i] HM Government Childhood Obesity: A Plan for Action, August 2016

[ii] For more information: Table 6b (deprivation based on postcode of the school), National Child Measurement Programme, England, 2016/17 school year.

[iii] For more information: Table 6b (deprivation based on postcode of the school), National Child Measurement Programme, England, 2016/17 school year.

[iv] For more information: Table 5a, National Child Measurement Programme: England, 2016/17 school year.

[v] London Health Commission, Global City Comparisons, Overview, September 2016

[vi] National Child Measurement Programme – England, 2015-16.