The school environment to prevent overweight and obesity

Laura Martin, Public Health Intelligence Advisor, NHS Health Scotland

Note from the editor

There is a strong evidence base that being overweight or obese increases the risk of developing 11 types of cancer – bowel, breast (in post-menopausal women), gallbladder, kidney, liver, oesophagus, ovary, pancreas, prostate (advanced), stomach and womb. It is estimated that 17% of all cancers could be prevented if everyone stayed a normal weight. As almost two thirds of children at the highest BMIs become obese adults it is particularly important to consider what can be done to reduce childhood obesity rates.

The prevalence of childhood obesity in Scotland has remained stubbornly high. In 2015, 28% of 2-15 year olds were at risk of being overweight or obese^[1]. Overweight and obesity in childhood is associated with poorer health outcomes in later life, such as, type 2 diabetes, cardiovascular diseases, depression and thirteen cancers^[2-4].

The scale of the problem in Scotland requires action to change systems and environments in which people live to enable weight loss to be both made and maintained^[5-6], alongside action to support individual knowledge and skills.

A rapid evidence review undertaken by NHS Health Scotland Evidence for environmental interventions to prevent childhood overweight and obesity within schools^[7], found the following actions may be effective in reducing the rise of overweight and obesity within school populations:

• Comprehensive nutritional policies within schools, which include all aspects of food provision e.g. canteens, vending machines and tuck-shops, were associated with greatest impact on overweight and obesity levels.
• Reducing availability of unhealthy foods, lowering fat content and reducing portion sizes of food provided can all decrease overall calorie consumption during school lunch times.
• Reducing availability of unhealthy foods, lowering fat content and reducing portion sizes of food provided can all decrease overall calorie consumption during school lunch times.
• Making water more accessible was associated with a reduction in prevalence of overweight within the school population.
• Reducing financial and social barriers to eating in school and making school dining areas more aesthetically pleasing may encourage pupils to eat in school, therefore increasing the impact of school nutritional policies.

1. Brown L, Campbell-Jack D, Gray L et al. The Scottish Health Survey: Main Report 2015. Vol 1 Edinburgh: The Scottish Government, 2016.1. Brown L, Campbell-Jack D, Gray L et al. The Scottish Health Survey: Main Report 2015. Vol 1 Edinburgh: The Scottish Government, 2016.
2. Sonntag A, Lehnert K, Reidel-Heller K. Estimating the lifetime cost of childhood obesity in Germany: Results of the Markov Model Pediatric Obesity 2015
3. Public Health England. Making the case for tackling obesity – why invest? Presentation and fact sheet available at https://www.noo.org.uk/NOO_pub/
4. Cancer Research UK http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/bodyweight-and-cancer
5. Roberto CA, Swinburn B, Hawkes C et al. Patchy progress on obesity prevention: Emerging examples, entrenched barriers, and new thinking. The Lancet. 2015; 385(9985), 2400-9.
6. Swinburn, Egger and Raza.  Dissecting obesogenic environments, the development and application of a framework for identifying and prioritising environmental interventions for obesity.  Prev Med 29 1999 563-70
7. http://www.healthscotland.scot/publications/interventions-to-prevent-childhood-overweight-and-obesity-within-schools