Report title: Underweight, healthy weight, overweight, and obesity among the child population in Waltham Forest

Priority report relates to: The Best Start in Life

Report to: Health and Wellbeing board 16 March 2017

Report author: Soumya-Kanti Chatterjee

Report author’s organisation: LBWF

Contact email of author: soumya.chatterjee@walthamforest.gov.uk

1 Purpose of the paper

Please include a clear summary of what you are asking the Board to do with this report, include, whether the paper is for decision, plan, implement or review.

This paper provides an overview of the patterns and trends for underweight, healthy weight, overweight, and obesity amongst children in Waltham Forest as measured through the National Child Measurement Programme (NCMP).

Is this for paper for: decision, plan, implement, review or information?

Review and Information

What are you asking this board to do? What is the outcome you require today?

Consider if actions within the Healthy Weight Strategy are sufficient to address the issue of healthy weight in children in light of this deep dive.

2 Summary

2.1 Key findings

a. Nearly 24% of children aged 4-5 years resident in Waltham Forest were of excess weight (overweight including obese). This is nearly 2% higher than both London and England averages.

b. Nearly 40% of children aged 10-11 years resident in Waltham Forest were of excess weight (overweight including obese). This nearly 2% higher than the London average and 6% higher than the England average.

c. Black children in reception (age 4-5 years) had higher excess weight when compared to Asian and White reception children.

d. A noticeable increase is seen in the proportion of overweight or obese children in year 6 for 2015/16.

e. There has been no significant progress in reducing the levels of excess weight at either Reception or Year 6 over the last 10 years.

2.2 Recommendations (if applicable)

For recommendations in relation to healthy weight, please see accompanying paper – Overview of The Healthy Weight Strategy 2015-2020

3 Background

3.1 What is the National Child Measurement Programme?

The National Child Measurement Programme (NCMP) began in 2006/07 and involves measuring the weight and height of Reception (aged 4-5 years) and Year 6 (aged 10-11 years) children at state-maintained schools, including academies, in England. All 53 primary schools within Waltham Forest took part in the NCMP, with 95.5% of the eligible 6551 pupils being measured.

3.2 What were the results for Waltham Forest for 2015-16?

23.7% of reception children were overweight including obese in Waltham Forest (1.8% higher than the London average, 1.6% higher than the England average), increasing to 40% for year 6 children (1.9% higher than the London average, 5.8% higher than the England average).

Fig 1: Comparing overweight including obese children in reception (4-5 years) and Year 6 (age 10-11 years) in Waltham Forest with both London and England.

3.3 Were there any differences amongst specific groups?

Yes, there were. Initial analysis of the pupil level data showed some differences between specific groups of children. Further investigation is needed to provide an explanation as to the factors involved in contributing to these differences.

Year 6 boys (41%) had higher levels of excess weight (i.e. overweight including obese) than year 6 girls (39%) (gender variation), with more Year 6 pupils being overweight and obese when compared to reception pupils (proportional change). Black (31%) reception year pupils had higher levels of excess weight than their White (23%) and Asian (20%) counterparts (ethnic variation).

3.4 How has overweight and obesity changed over time in Waltham Forest?

Although there had been little change in the levels of overweight and obesity amongst reception and year 6 pupils between 2006/07 and 2014/15 (fig 2, 3), a noticeable increase is seen in the proportion of overweight or obese children in year 6 for 2015/16 (fig 3).

Fig 2: Trends in overweight and obese amongst reception children for Waltham Forest

Fig 3: Trends in overweight and obese amongst year 6 children for Waltham Forest

3.5 What does the initial analysis of NCMP in Waltham Forest tell us?

There has been no significant progress in reducing the levels of excess weight at either Reception or Year 6. The level of excess weight is higher amongst year 6 pupils when compared with reception pupils; hence there is clearly more scope for intervention at both infant and primary school. The problem of overweight and obesity is an issue across all wards in the borough and as such requires a borough wide response.

Special note

NCMP data is for the year 2015-16, normally reported at the end of the calendar year with a 1 year lag. The effect of interventions to address healthy weight are likely to take several years to demonstrate as a population based outcome (as opposed to an individual outcome in terms of their body weight), which should be considered when making any observations around the available data. For instance, actions taken as a result of the 2015 Healthy Weight Strategy will not begin to be observable in the data until 2016/17 data (available late 2017), and wouldn’t be fully incorporated into data until 2021/22 (available late 2022).

4 Child weight in Waltham Forest

4.1 Comparisons and trends: Waltham Forest and London Boroughs (NCMP profile)

Some interesting trends emerge when comparing Waltham Forest (WF) with both London and England, demonstrating the increasing complexity of managing children’s weight (table 1). Historically, the proportion of underweight children in WF has been worse than both London and England (fig 4), although this is the first time that the trend has reversed for children of ages 4-5 years. In 2015-16 WF has a lower proportion of underweight children at reception (1.04%) when compared to London (1.54%), although it is statistically similar to England (0.97%). This cannot be said for children in year 6 (10-11 years), where the proportion of underweight children continues to remain significantly higher than both London and England.

Fig 4: Prevalence of underweight (age 4-5 years): 2015-16. Trends for WF compared with the London average including comparisons with other London boroughs.

The funnel plots (standard methodology for making comparison between areas) show where local authorities are statistically significantly different from the London average (figs 5, 6). They measure the expected variation about the London average for a range of population sizes of the local authorities to be compared. This allows us to distinguish between random variation because of differences in population sizes of local authorities and variation unlikely to be random (which would require further investigation). WF falls outside the 3SD (99.8% CI) for obesity prevalence (year 6), indicating that this difference is not only due to random variation (fig 6).

When compared with the rest of London, WF is ranked 12th (1=highest prevalence) for the prevalence of obesity (reception), and 7th for the prevalence of obesity (year 6). The London region map shows how each borough compares to the London average (figs 7, 8).

Fig 5: Prevalence of obesity (age 4-5 years): 2015-16 Fig 6: Prevalence of obesity (age 10-11 years): 2015-16

Fig 7: Prevalence of obesity (age 4-5 years): Fig 8: Prevalence of obesity (age 10-11 years): 2015-16 2015-16

Table 1: Comparison of the NCMP across Waltham Forest, London and England (2015-16)

NCMP Waltham Forest Profile 2015-16 Waltham Forest

London EnglandChildren in reception (age 4-5 years) Prevalence of healthy weight 75.2% 76.5% 76.9% Prevalence of overweight including obese 23.7% 22.0% 22.1% Prevalence of obesity 10.9% 10.3% 9.3%Children in year 6 (age 10-11 years) Prevalence of healthy weight 58.3% 60.3% 64.5% Prevalence of overweight including obese 40.2% 38.1% 34.2% Prevalence of obesity 26.1% 23.2% 19.8%

Red = statistically significantly worse than both London and EnglandAmber = statistically similar to London but significantly worse than England

Waltham Forest

4.2 Comparisons and trends: Within borough (ward level)

Child weight data mapped at the ward level show chronological variations requiring further investigation. Data has been aggregated for 3 years at ward level (to reduce natural variation) and the differences compared from 2008 to 2015. Interestingly, very high proportional increases in obesity at reception (Chingford +26%, Cann Hall +28%) over this period interestingly does not reflect in the proportional obesity change at year 6 for the same wards (Chingford -3%, Cann Hall -12%) – which in fact demonstrate a decrease. Nonetheless, there seems to be some association between deprivation and child obesity (fig 9) when they are mapped concurrently.

Fig 9: Ward level obesity maps – changes in proportional prevalence in obesity at reception and Y6 (2008-15)

Similar maps have been constructed for excess weight by gender for both reception and year 6 showing the distinctive variations in the levels of obesity between the wards in the borough (fig 10, 11).

Fig 10: Levels of excess weight amongst girls and boys in reception, by ward of residence, 2015/16 (yellow dots indicate the location of participating schools)

Fig 11: Levels of excess weight amongst Year 6 girls and boys, by ward of residence, 2015/16 (yellow dots indicate the location of participating schools)