The Critical Importance of Early Years Nutrition in Prevention of Childhood Obesity

by Shona Goudie

One in Five Children Start School Overweight or with Obesity

Receiving good nutrition in the early years is vital to our children having the best start in life. This period is a critical window during which the foundations for a child’s development are established affecting their lifelong health and wellbeing.

With one in five children starting school with overweight and obesity1, evidently babies, toddlers and pre-schoolers in the UK are currently not eating sufficiently well to protect their health. This points to gaps and inadequacies in our food policy and food system in preventing childhood obesity. It also strongly illustrates that policies targeting school-aged children - whilst very important - are too late to be sufficient to tackle the ever-increasing problem of unhealthy weight in childhood.

Here we set out the scale of the problem by the time children are starting school, highlighting the need to move early years nutrition up the policy agenda so that children as young as five years old are not having to deal with the burden of diet-related ill health.

Approximately one fifth of children sitting in classrooms in their first year of education are an unhealthy weight.

This is seen across all four nations in the UK.

Poor nutrition and development impacts not only their health but their readiness to learn.

More alarmingly the situation is not improving.

We can see that levels of overweight and obesity in children in their first year of school have remained relatively constant for at least the past 10 to 15 years across all four UK nations.

Furthermore, the prevalence of overweight and obesity in early childhood is higher in the UK than in many other countries with similar economic status.

This problem is seen across a range of demographics in the UK, but some groups of the population are disproportionately affected.

Amongst younger children, there is a significant gradient in the prevalence of overweight and obesity across socioeconomic groups, and this continues as children get older.

Approximately twice as many children aged 4-5 in the most deprived fifth of households suffer from obesity compared with the least deprived fifth across England, Wales and Scotland.

In England, children in the most deprived fifth of households are shockingly four times as likely to have severe obesity than the least deprived fifth.

There is also marked variation across ethnic groups.

While obesity is a major concern due to its significant consequences in later life (including type 2 diabetes, heart disease, stroke, some cancers and many other conditions), it is not the only diet-related concern caused by poor diets in early childhood.

High consumption of sugar is well known to lead to dental decay. It is a highly prevalent and completely preventable problem in children.

The gravity of dental decay shouldn’t be underestimated – it is the leading cause of hospital admissions in 5-9 year olds.2

As with obesity, there are large discrepancies across deprivation groups with children in the most deprived group more than twice as likely to have tooth decay compared with those in the least deprived groups.

Whether children reach their full growth potential is a good indicator of nutritional status.

As with obesity, the UK is performing poorly compared to similar countries (coming in at the bottom of inter-country rankings) suggesting our children are not receiving the nutrition they need to optimally develop and grow.

A key driver of poor diets in this age group is that many children in the UK are being born into poverty putting them at higher risk of food insecurity.

The prevalence of children aged under 5 living in poverty in the UK has increased more rapidly over the past decade than for other children.3

Household food insecurity during infancy and early childhood is linked to increased risk of obesity.4

Even before the child is born, food insecurity in the pregnant mother is associated with increased risk of low birth weight and birth defects, as well as gestational diabetes and maternal depression (both of which can impact on the health of the child).5

Poor diets in the early years of life can have long-term consequences.

Children’s brains and bodies need to develop correctly to allow them to grow up to be adults at low risk of disease.

Lack of sufficient nutrition (either quantity or quality) during critical periods in early life may cause irreversible changes to development, and therefore increase risk of chronic disease in later life – a phenomenon known as nutritional programming.6

Children’s earliest experiences of food can shape lifelong habits and establish their long-term relationship with food7. Children and adolescents with obesity are five times more likely to have obesity as adults than adults who were not obese in childhood8.

If trends continue, for children born in 2021, 22% will have overweight or obesity by the time they start school. By age 65, only 18% will be a healthy weight.

It is predicted that obesity among the current cohort of children will generate up to £74 billion in NHS costs over the course of their lifetime and £405 billion for wider society through lost productivity and sickness.9

Therefore, investing in early years food and nutrition interventions could have huge savings in the long term.

The Food Foundation’s In-Depth Study on Early Years

The data tell a bleak story of the scale of the problem of children’s diets before they even start school, raising considerable questions about feeding practices and the nutritional quality of food that our youngest children are eating. It is clear there is a need for higher prioritisation of early years nutrition in preventing childhood obesity and better policy enabling healthy diets during this period.

The attention of many policymakers and public health professionals when it comes to child obesity and food insecurity is mostly focussed on school-aged children. The Government’s Childhood Obesity Plans make a nod to the early years, but our youngest children are far from central to the plan. While ensuring older children have access to healthy food is of critical importance, earlier intervention is a necessity. Until this area is given the appropriate level of policy focus, leadership and investment, we will continue to see children in the UK failing to be given the best start in life with lifelong implications for them individually and for wider society. 

To provide a foundation of evidence from which to propose better policies, The Food Foundation (funded by the Nuffield Foundation, Impact on Urban Health and the AIM Foundation) will be conducting an in-depth study on food and nutrition in the early years. Transitioning through the stages of development from pre-conception to starting school, we will use national datasets, secondary sources, focus groups and interviews to compile a picture of what current diets and feeding practices look like in the early years. We will investigate the drivers of feeding practices and food choices including affordability, influence by industry and the food environment, levels of support, and awareness of best practice nutrition advice and feeding practices. We will explore the barriers and challenges facing pregnant women in securing a healthy diet for themselves and facing parents in providing a healthy diet for their children from birth to starting school. Finally, we will look at where policy is falling short and what additional policy measures are needed, leading to a manifesto of evidence-based policy recommendations to transform the nutritional status of our youngest children and prevent childhood obesity. 

Please see here for the full concept note. 

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