Tag Archives: Children

Off the scales: time to act on childhood obesity

By 2050, it is said that obesity could cost the NHS almost £10 billion a year, with the full economic cost rising from around £27 billion today to £50 billion by then. Today, the Centre for Social Justice (CSJ) publishes its report, Off the scales: time to act on childhood obesity. It calls on the Government to put prevention, health, inequality and cross-departmental collaboration at the heart of its efforts to tackle childhood obesity, drawing particular attention to the need to address the question of why poorer children are at ever greater risk of being obese. It’s a question researchers at the ESRC International Centre for Lifecourse Studies at UCL, including our editor Yvonne Kelly, have been among the first to address.

There have been numerous major studies on childhood obesity over the past 10 years, many of which have shown the links with poverty. But our research looks specifically at why children from disadvantaged families are significantly more likely to be obese than their better off peers.

To examine this as robustly and rigorously as we could, we used data from the Millennium Cohort Study (MCS) which has tracked the lives of nearly 20,000 children from across the UK since the turn of the century. Using a range of measurements taken when the children were aged 5 and 11 together with detailed information about their backgrounds and family circumstances, we were able to demonstrate just how key poverty was in respect of their obesity.

At age 5, poor children were almost twice as likely to be obese compared with their better off peers. By the age of 11, the gap had nearly tripled.

Knowing as we do that obese children are less likely than their peers to grow into economically successful adults and that obesity is clearly linked with a range of chronic diseases, it’s reasonable to say that for these children, the future is far from bright. From a policy perspective it is also clear that unless the gap between rich and poor children can be closed the chances of reducing the overall obesity trend, as the Government states it is committed to doing, are pretty slim.

How is poverty linked to obesity?

The MCS collects a broad range of data, allowing us to dig beneath these headline numbers to tease out some of the specific ways in which relative poverty in childhood leads to an increased risk of obesity.

To examine this question of whether a parent’s own lifestyle might have a role, we looked at factors previously shown to be linked to the increased risk of obesity, such as whether the mother smoked during pregnancy, how long she breastfed for and whether the child was introduced to solid food before the age of four months.

We could also factor in the degree to which a mother was herself overweight or obese and assess children’s physical behaviour, such as how often they exercised, played and how many hours they spent watching TV or playing on a computer, and the time that they went to bed. We looked at whether the child skipped breakfast, how much fruit they ate and how often they had sweet drinks.

A lot of these factors were relevant. A mother’s behaviour when her child was very young was certainly important. Markers of an ‘unhealthy’ lifestyle here could mean as much as a 20 per cent additional risk of obesity for a child.

Obese and overweight children living in poor families were more likely to have mothers who did not breastfeed or breastfed for a shorter duration, who introduced solid foods early in infancy, who smoked during pregnancy, and who were overweight or obese. The poorest children were also more likely to spend more time watching TV and using a PC (and so have greater exposure to food and drink advertising), experience later and more irregular bedtimes, do less sports and be more physically inactive, engage less in active play with their parent, live in an area without a playground, and not have breakfast every day.

5-year-olds from poorer families were also much more likely to gain excess weight up to age 11 than richer children, leading us to conclude that the earlier certain risk factors can be challenged and the appropriate support provided for the least well off families, the greater the chance of positive impact on the risk of obesity and in a reduction in inequality.

Pathways to obesity

More recently we have identified four BMI trajectories for children. The good news is that 80 per cent of them are on a stable path where, on average, from when they’re born through to age 11, they are not overweight.

There is a small group of children who are obese at age 3 but then join the stable group by age 7. We call them the ‘decreasing’ group. There is a ‘moderate increasing group’ (13.1 per cent) where children are not overweight at age 3 but whose BMIs increase throughout childhood into the overweight (but not obese) range. Finally we have a ‘high increasing’ group of children (2.5 per cent) who are obese at age 3 and whose BMI continues to increase.

From an inequality perspective, what’s most striking here is that the wealthiest children are least likely to be in the ‘moderate increasing’ BMI group whilst the poorest children are more than twice as likely to be on the high increasing path.

Today’s CSJ report agrees with our analysis that early intervention is key and, in line with it, proposes three key early years intervention opportunities to ensure children get the healthiest start possible before they reach primary school age.

The report acknowledges that the Government is already trying to persuade families to eat more healthily and take more exercise. But it has joined a body of voices critical of the Childhood Obesity Plan, which, it believes, “fails to put reducing inequality as a goal … despite acknowledging that the childhood obesity burden falls hardest on the poorest children.”

Certainly our body of evidence indicates that policy makers need to acknowledge and address inequality as a root cause of obesity. Doing something about the structural factors in people’s lives is what is needed rather than ‘tinkering around the edges’ of the problem.

Today the CSJ asks why there are disproportionately high levels of obesity, particularly childhood obesity, in our most deprived communities. Our research has gone some way to answering that question, and makes it clear that there is no simple one-stop shop solution.

Obesity is caused by a combination of environmental, biological, cultural and psychological factors, where one factor does not dominate and yet our obsessional search for the ‘one thing’ that can tackle obesity continues. If the Government is going to reduce obesity rates, it will indeed, need to introduce multiple bold measures in tandem across the entire ecosystem and recognise that success may only be measurable after a few years.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study is research by Alice Goisis, Amanda Sacker and Yvonne Kelly and is published in the European Journal of Public Health

BMI Development and Early Adolescent Psychosocial Well-Being: UK Millennium Cohort Study is research by Yvonne Kelly, Praveetha Patalay, Scott Montgomery and Amanda Sacker and is published in Pediatrics

Don’t let the kids get jet-lag: why regular bedtimes are key to a happy healthy childhood

The very best of sleep medicine and research is being presented at the World Sleep Congress in Prague this week. Among that research are findings from work by Child of our Time Editor, Professor Yvonne Kelly and colleagues at the ESRC International Centre for Lifecourse Studies. They have been trying to find out what it is about sleep that matters most when it comes to giving children the best possible start in life. Here Yvonne explains what they have found to date and why regular bedtimes are key to a healthy happy childhood.

What happens in the early years has profound implications for what happens later on in life. Thousands of research papers, many of them using the wonderful rich data in the British Birth Cohort studies, have documented the enduring impacts of the way we live our lives as children on how we fare later on. Children who get a poor start in life are much more likely to experience poor outcomes as adults, whether that’s to do with poor health or their ability to enjoy work and family life later on.

So what has all that got to do with getting enough sleep as a toddler you might ask? Well our research shows it is one of a number of important factors related to getting children off to the best possible start in life and here’s why.

Recommended sleep

The National Sleep Foundation recommends that toddlers should get around 11 to 14 hours sleep every day. For 3-5 year-olds, the recommendation is 10-13 hours and it suggests 9-11 hours for children once they’re at primary school. But is it all about the number of hours sleep children get, or is there more to it than that? Those are the questions we have been addressing in our research into children’s sleep and how it ties in with how they get on at home and at school across the first decade of their life.

Digging into one of those studies mentioned earlier, the Millennium Cohort Study, which has followed the lives of some 20,000 children since the turn of the century, we found that it’s not just the number of hours a child sleeps that matters, but also having consistent or regular bedtimes.

First we looked at the relationship between regular and irregular bedtimes and how the children got on in a range of cognitive tests. The results were striking. Children with irregular bedtimes had lower scores on maths, reading and spatial awareness tests.

Parents who took part in the MCS were asked whether their children went to bed at a regular time on weekdays. Those who answered “always” or “usually” were put in the regular bedtime group, while those who answered “sometimes” or “never” were put in the irregular bedtime group.

Interestingly, the time that children went to bed had little or no effect on their basic number skills, and ability to work with shapes. But having no set bedtime often led to lower scores, with effects particularly pronounced at age three and the greatest dip in test results seen in girls who had no set bedtime throughout their early life.

The key to understanding all this is circadian rhythms. If I travel from London to New York, when I get to there I’m likely to be slightly ragged because jet lag is not only going to harm my cognitive abilities, but also my appetite and emotions. That’s for me, an adult. If I bring one of my children with me and I want them to do well at a maths test having just jumped across time zones, they will struggle even more than I will. The body is an instrument, and a child’s is especially prone to getting out of tune.

The same thing happens when children go to bed at 8 p.m. one night, 10 p.m. the next and 7 p.m. another — we sometimes call this a “social jet lag effect.” Without ever getting on a plane, a child’s bodily systems get shuffled through time zones and their circadian rhythms and hormonal systems take a hit as a result.

Bedtimes and behaviour

Having established the importance of sleep to a child’s intellectual development, we turned our attention to the relationship between regular bedtimes and their behaviour.

At age 7, according to parents and teachers, children in the MCS who had irregular bedtimes were considerably more likely to have behaviour problems than their peers who had a regular bedtime. In addition, the longer a child had been able to go to bed at different times each night, the worse his or her behaviour problems were. In other words the problems accumulated through childhood.

One really important piece of good news was that we found that those negative effects appeared to be reversible, so children who changed from not having to having regular bedtimes showed improvements in their behaviour. There seems to be a clear message here that it’s never too late to help children back onto a positive path and a small change could make a big difference to how well they get on. Of course, the reverse was also true so the behaviour of children with a regular bedtime who switched to an irregular one, worsened.

Bedtimes and obesity

In a follow up study, which looked at the impact of routines including bedtimes on obesity, we reported that children with irregular bedtimes were more likely to be overweight and have lower self-esteem and satisfaction with their bodies.

In fact, of all the routines we studied, an inconsistent bedtime was most strongly associated with the risk of obesity, supporting other recent findings which showed that young children who skipped breakfast and went to bed at irregular times were more likely to be obese at age 11.

Even children who ‘usually’ had a regular bedtime were 20 per cent more likely to be obese than those who ‘always’ went to bed at around the same time.

So we have a body of robust evidence now that shows very clearly that regular bedtimes really matter when it comes to a child’s health and development over that important first decade of their life.

Providing that evidence in the form of advice to parents and all those caring for young children alongside recommended hours of sleep could make a real difference, helping protect our children from ‘social jet-lag’ and getting them off to a flying start instead.

Equally protected children: one step closer

In 2015 UCL researchers Anja Heilmann, Yvonne Kelly and Richard Watt produced a report, which showed that there was ample evidence that physical punishment can damage children and escalate into physical abuse. Together with the children’s charities that commissioned the report, they called for urgent action to provide children with the same legal protection against violence that British adults enjoy. The report was at the heart of Scottish MSP John Finnie’s proposed Children (Equal Protection from Assault) Bill which the Scottish Government have just announced that they will support in their programme for the coming year. The Bill would make Scotland the first UK country to outlaw all physical punishment by removing the defence of “justifiable assault” of children, and giving them the same protection as adults. Lead researcher, Anja Heilmann, reflects on the news and what she hopes it might mean for the human rights of children in Scotland and elsewhere.

On 11 May 2017, John Finnie MSP proposed a Bill to the Scottish Parliament to “give children equal protection from assault by prohibiting the physical punishment of children by parents and others caring for or in charge of children”.

After a three month consultation, which received more than 650 responses, the majority positive (75 per cent), that Bill became part of the Scottish Government’s plans for the next year, as Nicola Sturgeon announced she would not oppose it.

If passed, the Bill will prohibit the physical punishment of children by ending the existing common-law position that physical punishment by parents can be defended as reasonable chastisement and therefore be lawful. The Bill will not create a new criminal offence, as the common law offence of assault will apply (with a modification removing the reasonable chastisement defence).

It’s a far cry from similar efforts made in Scotland in 2002 to prohibit the physical punishment of children under the age of three. Back then, not only did a majority of MSPs reject the idea, but it was branded as “ridiculous” and an unwelcome intrusion into family life by many parents and the media.

15 years on it seems attitudes may have changed significantly. In the foreword to the Bill, John Finnie himself said:

“We would no longer consider it acceptable…. to allow our children to roam freely in the back of the car when going on a journey. Neither would we dream of taking them to a cinema if they had to watch a film through a fug of cigarette smoke … Attitudes towards these and many other fundamental societal issues have dramatically changed.”

Those attitudes changed as the result of a clear presentation of the evidence – the hard facts about the damage that those behaviours could cause.

We believe that, in this case, our evidence has made it clear for all to see that hitting children can not only damage them, but it carries the risk of escalation into physical abuse. It is a clear violation of international human rights law and children should and must be afforded the same rights as adults in this respect.

Overwhelming evidence

The evidence for the detrimental effects of physical punishment is vast and consistent. In short, our summary of the available evidence showed that physical punishment was related to increased aggression, delinquency and other anti-social behaviour over time. It also showed the more physical punishment suffered by a child, the worse the subsequent problem behaviour.

There was also a clear link between physical punishment and more serious child maltreatment and negative effects continued into adulthood, including problems of drug and alcohol dependency.

Half-hearted responses to recent human rights rulings condemning the physical punishment of children need to become wholehearted changes to the law, not tinkering that does just enough to meet the minimum requirements of those judgments rather than properly respect the rights of children.

The UN Committee on the Rights of the Child is unequivocal – all forms of corporal punishment of children are unacceptable. Let’s hope the Scottish Parliament can find the courage to make that statement a reality and show the rest of the UK the way.

As Martin Crewe of Barnardo’s Scotland stated:

“This is a huge step forward and sends a very clear message about the kind of Scotland we want to see for our children.”

Personally, I am hoping it’s a kind of Scotland and indeed UK, we WILL see in the not too distant future and I appeal to all MSPs to listen to the evidence and support the Bill.

Equally Protected? A review of the evidence on the physical punishment of children by Dr Anja Heilmann, Professor Yvonne Kelly and Professor Richard G Watt was commissioned by NSPCC Scotland, CHILDREN 1st, Barnardo’s Scotland and the Children and Young People’s Commissioner Scotland.

Do mental health problems have their roots in the primary school years?

Recent reports have shown worrying rises in young people suffering from mental health problems. A study for the Department of Education showed more than a third of teenage girls reporting depression, anxiety and low self-esteem. To try to understand this growing problem, Dr Afshin Zilanawala and fellow researchers from the ESRC International Centre for Lifecourse Studies at UCL have investigated how certain aspects of learning in the primary school years and success affect the behaviour and wellbeing of early adolescents.

Young people who drink, smoke and have behavioural problems are known to be at risk of suffering poor health as adults.

Understanding what causes this risky behaviour, and the anxiety and low self-esteem associated with it, can help professionals to target those most likely to drop out of school, become pregnant as a teenager, become obese or to suffer other long-term health issues.

By planning support and prevention programmes during childhood, they can improve the likelihood of a successful and healthy adulthood for our most vulnerable young people, and reduce the pressure on health and social services.

Mental health

A recent YouGov survey of Britain’s university students revealed that more than a quarter of them report depression and poor mental health.

But could the roots of these problems be found by looking more closely at how children develop and learn throughout the primary school years?

Information on more than 11,000 children collected by the UK Millennium Cohort Study (MCS) was used in our research, which explores the links between children’s verbal abilities and their behaviour and well-being as they make the move to secondary school.

Using information collected at ages three, five, seven and 11, we were able to see how well they could read, the range of their vocabulary and their verbal reasoning skills.

Then, at age 11, the children were asked about their school work and life, their family and friends and their appearance. There were questions about how happy they were, whether they felt good about themselves. They were also asked if they had tried cigarettes or alcohol, and if they had stolen anything or damaged property.

Verbal performance

In terms of how well they were getting on, the children were divided into three groups (low, average and high verbal achievers).

This in itself produced a startling and worrying view of the diverging paths these different children follow over time, particularly between the ages of seven and 11. One in five of the children (the high achievers) did better and better at the verbal tests, stretching away from their peers as they prepared to head to secondary school. The majority (around three quarters) of children were on the middle path, making steady progress but then plateauing off. But, most striking of all was what happened to the low achieving group (around one in 17 of the children), whose verbal abilities declined steeply.

Verbal ability

Millennium Cohort Study

Having established these pathways, we went on to look at which children at age 11 were involved in risky behaviours and then to dig deeper to see how these behaviours related to their progress to date. We also looked at what other factors, especially those related to their family circumstances, might be at play.

Boys were more likely than girls to be smoking and drinking or getting involved in anti-social behaviour. Girls were more likely to suffer from low self-esteem. First-born children were happier and had higher self-esteem, and were less likely to smoke, drink and have problem behaviours than second or later birth-order children. Children with younger mums were also more likely to engage in risky behaviour.

Those from disadvantaged backgrounds and those with more unsupervised time were more likely to suffer from poor mental health. We also found those whose mothers suffered from depression were more at risk of mental health problems.

Looking at the raw data, the low achieving children were three times more likely to smoke than their high achieving peers and twice as likely as the average group. Low achieving and average achieving children were also more likely to drink.

One in three of the low achieving children compared with one in five of the high achievers had been involved in anti-social behaviour and were more than four times more likely to have behaviour problems as reported by their parent. They also had much lower levels of self esteem.

Family factors

When we took a range of family factors into account including the child’s age and gender, mother’s age and mental health and socioeconomic circumstances, many or all of the differences between the groups disappeared or became smaller, confirming the overriding importance of the family and social environment.

However, we can say, for the first time, and with considerable confidence, that how well children are reading, talking and reasoning, can and does influence their health and well-being as they become adolescents. Indeed, we found clear evidence that children who were performing below average in this area across childhood were more at risk of poor mental health and risky behaviour than their consistently above-average performing peers.

If we want those children to stand a better chance of a healthy and happy life, we need to focus a great deal of attention on what is happening at home and at school in those early years, particularly, our research would seem to show, between the ages of 7 and 11.

Our results are consistent with other research, which demonstrates the huge challenge for young people with poor verbal skills, who arrive at the doorstep of adolescence with mental health, self-esteem and behavioural issues, which are likely to continue into adult life.

Recent reports that child poverty figures in the UK are continuing to rise, despite successive Governments’ promises to reduce them, does not bode well in this context. Indeed, it would seem to indicate that it will be some time before the yawning gaps in inequality that we see at primary school and their knock-on effects on children’s wellbeing in adolescence can be closed.

Longitudinal Latent Cognitive Profiles and Psychosocial Well-being in Early Adolescence is research by Afshin Zilanawala, Amanda Sacker and Yvonne Kelly and is published in the Journal of Adolescent Health

Photo credit: Creative curriculum  US.Army

 

Screen use at seven: overweight at 11. Why it’s time to say no to a TV in the bedroom for children

Since the launch of the Childhood Obesity Strategy in 2016, there has been much attention focused on the so-called ‘Sugar Tax’. The March 2017 Budget saw confirmation that sugary soft drinks would be taxed in an attempt to combat rising levels of obesity. This is an important move that has been met with widespread approval from public health professionals. Still, obesity is hugely complex and there are many other things at play in addition to the sugary drinks and snacks that children may consume. Researchers at UCL have been looking in detail at different factors associated with obesity and, in a recent paper, find that children who have a television in their bedroom have higher BMI and more body fat than those who do not. Lead researcher, Anja Heilmann, explains the research and why saying no to a TV in the bedroom could be another important strategy in combatting childhood obesity.

As our TV screens have got flatter, our children have got fatter. There is no getting away from it! Screen-based activities play a central role in our children’s lives. At a very young age, they have unparalleled access to television screens, computers, game consoles and a host of mobile devices. Among 5 to 11 year-olds, TV is still the most consumed medium, with gaming coming second.

At the same time, childhood obesity is not just a national, but a global health worry. In 2014/15 a third of 11 year-old children in England were overweight and a fifth were obese.

Research has repeatedly reported a link between TV viewing and obesity, but although some has hinted at the idea that a television in a child’s bedroom might exacerbate the problem, the evidence here has been rather contradictory. Other plausible pathways could include eating unhealthy snacks whilst watching TV, exposure to food advertising and insufficient and poor quality sleep.

Using information from the Millennium Cohort Study (MCS), which has followed the lives of more than 18,000 children born around the turn of the century, we had the opportunity to see whether having a TV in their bedroom when they were age 7 was, in any way, linked with a child being overweight when they were 11 years old. In other words, we wanted to get to grips with whether there were implications over a child’s lifetime of their screen use and if so, what those implications were.

Useful information

Using trained interviewers, the MCS collects a wide range of useful information including the independently measured height, weight and body fat of a child. These provided us with a set of obesity-related measurements: weight, Body Mass Index (BMI) and Fat Mass Index (FMI), a powerful set of measures for overweight and obesity.

When the children were age seven, parents were asked if their son or daughter had a TV in their bedroom, how many hours they spent watching TV or DVDs and how much time they spent playing on a computer.

 At age 7, more than half of the 12,556 boys and girls we looked at in our research had a TV in their room and it was these children who were more likely to be overweight when they turned 11 when we compared them with those without a TV. They were also more likely to have higher BMI and FMI. In total, a quarter of the boys and nearly a third of the girls were overweight at age 11 and the links between having a TV in the bedroom and overweight were stronger for the girls.

Another strength of the research is that we controlled for the child’s BMI at age 3 and maternal BMI, that way adjusting for genetic factors, as well as food environment in the family. We also adjusted for family income and mother’s education – both of which are important as overweight/obesity is socially patterned, as is TV use.

Interestingly, there was no link between overweight and the time a child, whether they were a boy or a girl, spent playing on a computer.

Clear link

So, given the size of our sample and the robustness of the methods employed here, we can say with considerable confidence that there is a clear link between having a TV in the bedroom as a young child and being overweight a few years down the line. For girls, this represents a 30 per cent increase in the risk of being overweight at 11 compared with their peers who do not have one. For boys the risk increases by around 20 per cent.

Another interesting point to note is that the size of this risk or effect is about the same as that of other things shown to be linked with obesity, such as not being breastfed and being physically inactive.

Nevertheless, policy makers looking to create and implement strategies to reduce obesity should certainly consider building access to television screens in children’s bedrooms into their thinking. Specific initiatives focused on young girls could also be important.

Meanwhile, for parents who may consider it a good idea for a young child to have their own TV in their bedroom or feel under pressure to provide one, the message is quite clear: resist the idea and you may be doing even more to set your child on a healthier path into their teenage years and beyond.

Longitudinal associations between television in the bedroom and body fatness in a UK cohort study is research by Anja Heilmann, Patrick Rouxel, Emla Fitzsimons, Yvonne Kelly, and Richard Watt and is published in the International Journal of Obesity.

A risky problem: what can keep young people away from alcohol and cigarettes?

Smoking and drinking among very young people has been declining in recent years, but it’s not all good news. There is still a lot of public health concern around the numbers of older children who are consuming alcohol and cigarettes, as these are the young people most likely to come to harm as a result of drinking too much. Their risky behaviours are also likely to persist and intensify into adulthood. So what factors might prevent a young person from smoking and drinking in the first place? New research published in BMC Public Health shows that levels of happiness among children and awareness of the risks may be key to success. Lead author on the research, Noriko Cable, explains more. 

According to Public Health England (PHE), alcohol is now the leading risk factor for ill-health, early mortality and disability among those aged 15 to 49 in England. It wants to “prevent and reduce” the harms caused by alcohol. It also has ambitions to create “a tobacco-free generation” by 2025.

The most recent figures from the Survey of Smoking, Drinking and Drug Use Among Young People in England show that around 90,000 children aged between 11 and 15 are regular smokers and 240,000 have drunk alcohol in the past week. These figures are the lowest they have been since the survey began in 1982.

However, recent research published in BMC Public Health by colleagues at UCL, shows that around one in seven 11 year-olds is drinking alcohol and that having peers who consume alcohol makes them four times more likely to drink that their peers who don’t. We also know that smokers start young, two thirds of them before the age of 18.

So we wanted to examine more closely the sorts of things that might drive young people away from cigarettes and alcohol. In this way we hope to arm policy makers, health practitioners and those working directly with or caring for children and young people with information that can help with the development of clear policies and interventions.

Protective role

We focused on three factors thought to play a protective role in preventing young people from starting to smoke and drink. These were: their awareness of the harms, their well-being or happiness and how supportive their networks of friends and family were.

Information came from Understanding Society, a large UK survey, which, in addition to collecting a wide range of social and economic information from everyone in the household aged 16 and over, has a special self-completion questionnaire for 10-15 year olds. Our sample contained 1,729 boys and girls.

We examined answers at two time points (approximately a year apart) to questions about their smoking and drinking. With these two sets of information, we were able to see whether they had started but then stopped smoking or drinking, whether they were persistent users of cigarettes and alcohol, whether they had started between the first and second surveys (initiation) or whether they had not smoked or drunk alcohol at either point.

The children were also asked about how happy they were with different aspects of their lives, including how they were getting on at school, how they felt about their appearance, family and friends and life in general.

On a scale of 1-4, the children were asked to rate how risky they thought different levels of smoking and drinking were. They were also asked how many supportive friends they had; friends they could confide in.

Harm awareness and happiness

Nearly 70 per cent of the study participants described themselves as persistent non-users of alcohol and cigarettes, and around 13 per cent categorized themselves as persistent users. Persistent non-users scored highest on harm awareness and happiness tests compared to the other groups.

About 8 per cent of the study group labelled themselves as ex-users and about 13 per cent had started using alcohol or cigarettes between the first and second time they completed the survey. Young people aged 10 to 12 were more likely to be in the persistent non-use group, whereas participants aged 13 and above were more likely to be in the persistent user and initiation groups.

We were surprised that while, for most young people, knowledge of the potential and actual harms of alcohol and smoking was linked with them never drinking or smoking, for some it seemed to be associated with them starting to drink or smoke. It is possible that positive expectations from drinking alcohol or smoking cigarettes may, in some way, have overridden their awareness of what harm they could do.

The happier the young person was, and more aware of the harms of alcohol and cigarettes, the more likely they were never to drink or smoke. Having supportive friends to confide in did not play a role in preventing adolescents from using alcohol or cigarettes.

Promoting happiness and harms

So it seems that promoting young people’s happiness and well-being and making them aware of the harms of smoking and drinking may be key to keeping them away from alcohol and cigarettes. In terms of possible timings for information and interventions, another takeaway from the study might be that working with children between the ages of 10 and 12, before they start trying cigarettes and alcohol, could be important.

Because the information used in this study is self-reported, we need to interpret the findings with caution, but they do suggest that making adolescents aware of alcohol and smoking related harm can be helpful in preventing them from engaging in risky health behaviors.

Colleagues at the Centre are now getting to grips with the new age 14 data from the Millennium Cohort Study and, in collaboration with Mentor, a charity working on the ground in schools to tackle alcohol and drug abuse, are hoping to develop our growing body of evidence in this area that will help formulate policies and activities to make some of Public Health England’s ambitions around smoking and alcohol a reality.

Further information

What could keep young people away from alcohol and cigarettes? Findings from the UK Household Longitudinal Study is research by Noriko Cable, Maria Francisca Roman Mella and Yvonne Kelly and is published in BMC Public Health.

 

Tackling the childhood obesity epidemic: Can regular bedtimes help?

Nearly one in five 10 and 11-year-olds in England is obese, according to NHS figures. With childhood obesity posing not just a nationwide, but a worldwide health threat, public health researchers around the globe are striving to establish which aspects of a young child’s life might set them on a path to being obese later on. Associate Professor Sarah Anderson from The Ohio State University College of Public Health and colleagues from University College London outline the first research to try to disentangle the role of children’s routines and behaviour at age 3 on obesity at age 11 and show that bedtime routines and learning to manage emotions really do matter.

The UK’s Chief Medical Officer Professor Dame Sally Davies has warned that the health of millions of children is in jeopardy and is concerned that being overweight is becoming the norm. She fears half the population could be obese by 2050 at a cost of billions of pounds to the health service and wider economy.

The latest statistics highlight a stark contrast between the wealthiest and poorest families, with childhood obesity rates in the most deprived areas more than double those in the most affluent areas.

Despite the publication in August 2016 of the Government’s long-awaited childhood obesity strategy, charities and health organisations remain highly critical, describing it as a watered-down effort that puts business interests ahead of those of public health. Even the recent introduction of the so-called ‘sugar-tax’ on soft drinks has been met with scepticism in some quarters.

To help inform public health strategies going forward, our researchers looked at the bedtime, mealtime and tv/video routines of very young children and their emotional and behavioural development to see if, at this early stage, it is possible to identify those most at risk of becoming obese.

The study includes information on nearly 11,000 children collected through the UK Millennium Cohort Study (MCS). When the children were three, their parents reported whether children always, usually, sometimes, or never or almost never had a regular bedtime and mealtime, and the amount of television and video they watched each day.

They were also asked a series of questions about the child’s behaviour during the previous six months. Questions were about how children cope with emotions and their persistence and independence in play, including how easily the child became frustrated and whether they sought help from adults when faced with a difficult task. This was to get an idea of how well the child was able to ‘self-regulate’ their behaviour in these areas.

Regular routines

Children with regular bed and mealtimes and who watched less television were better able to control their emotions than their peers with less regular and consistent routines.

At 11-years-old, 6.2 per cent (682) of the children in the MCS were obese, with obesity more common in lower income and less educated families.

Of the routines we studied, inconsistent bedtime was most strongly associated with the risk of obesity, supporting recent findings by our UCL colleagues which showed that young children who skipped breakfast and went to bed at irregular times were more likely to be obese at age 11, stressing the importance of adequate sleep for preventing childhood obesity.

Even children who ‘usually’ had a regular bedtime were 20 per cent more likely to be obese than those who ‘always’ went to bed at around the same time.

Regular bedtimes and obesity

Surprisingly, toddlers with irregular meal times had a lower risk of obesity at age 11. Once other routines were factored in, television viewing was not related to obesity, although it is important to note that computer use was not taken into account, and the media environment for young children today is different than it was when children in MCS were young.

There was also a clear link between lower levels of emotional self-control in early childhood and obesity later on. Children with poor emotion regulation at age 3 were over 50 per cent more likely to be obese when studied at age 11.

Children’s level of persistence and independence was not linked to later obesity, however, and it is possible that this could be explained by the relative immaturity of the parts of the brain responsible for a child’s cognitive compared with their emotional development at this young age.

Strongest risk

Our study is the first to look at the relationship between a child’s routines, their ability to regulate their emotions and behaviour and how these factors work together to predict obesity.

The two strongest risk factors for obesity were irregular bedtime and a poor ability to control emotions and these were completely independent of each other. In other words, the link between bedtimes and obesity could not be explained away by a child’s inability to regulate their emotions.

There is a need to look more closely at the timing and regularity of children’s mealtimes and how they impact obesity later on, as we think there may be a lot more factors at play than we have considered here. We also need to better understand how the development of emotional and cognitive self-regulation interacts with metabolic, behavioural and social pathways to obesity.

However, our study supports previous research showing that children’s emotional regulation develops within a family context which includes routines.

One message from our study is crystal clear. To be effective, obesity strategies must target early childhood, and must find a way to support parents, especially those from the most deprived areas, to introduce and maintain consistent bedtimes and other home routines, as well as help children regulate emotions and respond to stress.

Another key message is that one size does not fit all. There is a lot going on in children’s lives that is important for their health and development. Saying that, it would seem that getting our children to bed at the same time every night could be a simple, cost-effective tool in the tool-kit to get them off to a good start and maybe in the larger battle against obesity.

Self-regulation and household routines at age three and obesity at age 11: Longitudinal analysis of the Millennium Cohort Study is research by Sarah Anderson from The Ohio State University College of Public Health; Amanda Sacker and Yvonne Kelly from University College London and Robert Whitaker of Temple University, Philadelphia.

Giving children the best possible start – what matters most?

Child of our Time Editor Yvonne Kelly spoke to a 500-strong audience of politicians and professionals in Gothenburg recently on what matters when it comes to giving children the best possible start in life.

Yvonne was the keynote speaker at the conference hoping to identify the best strategies for making Gothenburg a more equal and socially sustainable city.

Yvonne, Professor of Lifecourse Epidemiology at the ESRC International Centre for Lifecourse Studies at UCL  explained which factors are most closely linked with a child’s health and well-being and presented her research findings on children’s verbal skills, behaviour, bedtimes, reading and obesity.

Better start for children

Giving children the best possible start in life is the topic of a keynote talk today by our editor Yvonne Kelly.

Yvonne will be presenting a range of new evidence from the ESRC International Centre for Lifecourse Studies  to politicians, business leaders, and other professionals and key decision makers at an event discussing how Gothenburg can be made an equal and socially sustainable city.

Yvonne will talk about the factors which are most closely linked with a child’s health and well-being and present findings on children’s verbal skills, behaviour, bedtimes, reading and obesity. She will make the case that signs of social inequalities are evident early in a child’s life and that it is important to intervene early to tackle those inequalities.

Sugar-coating the childhood obesity problem

Child obesity figures appear to be on the rise again, causing much concern after earlier signs they had levelled off.  The proportion of  10- and 11-year-olds who were obese in 2015-16 was 19.8 percent, up 0.7 percent on the year before. There was a rise of 0.2 percent among four- and five-year-olds. The announcement comes as researchers at the ESRC International Centre for Lifecourse Studies at UCL have been looking in detail at how and when children become overweight. The team has also been asking whether children who are overweight are more likely to go on to smoke and drink alcohol and if their mental health suffers as they become adolescents. Yvonne Kelly explains the research findings, and considers their implications for the Government’s recent strategy for tackling the childhood obesity epidemic.

The Government’s much-awaited and much-debated childhood obesity strategy was published in August. In the end, it was less comprehensive than had been anticipated, less draconian too. It focuses on two things – reducing sugar consumption and increasing physical activity. But will it be effective in reversing this worrying obesity trend among our children?

It’s fair to say we don’t fully understand what things influence whether, when and why a child might become overweight. Research to date has shown three distinct weight pathways for children: a healthy BMI throughout childhood; becoming overweight during childhood and being overweight/obese throughout childhood.

Previous research has also shown that the child’s mother’s weight, smoking in pregnancy, mental health and other social and economic factors have some link to childhood obesity. But the evidence is far from complete and, where a child’s own mental health is concerned, it’s not at all clear which way the association works.

To try to get a clearer picture of all these things, our research looked at the BMI paths of the participants in the Millennium Cohort Study, which has tracked the lives of nearly 20,000 children born between 2000-2002. We used data collected at birth, 9 months, age 3, 5, 7 and 11.

Once we had established who was on which BMI path, we were able to look at what factors were at play in their lives and to see whether a tendency to overweight and obesity was an indication that a child would go on to face mental health difficulties in early adolescence or start smoking and drinking.

Four pathways to obesity

The BMI data for the 17,000 children we were able to look at for our study showed four distinct groups of children. More than 80 per cent of them stayed on an average non-overweight path throughout their childhood – we call it the ‘stable’ path. There was a small group (0.6 percent) of children who were obese at age 3 but were then in the stable group by age 7. We call them the the ‘decreasing’ group. There was a ‘moderate increasing group’ (13.1 percent) where children were not overweight at age 3 but whose BMIs increased throughout childhood into the overweight (but not obese) range. Finally we had a ‘high increasing’ group of children (2.5 percent) who were obese at age 3 and whose BMIs continued to increase.

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Girls were 30 percent more likely to be in the ‘moderate increasing’ group than boys and were half as likely to be on the ‘decreasing’ path. Indian, Pakistani and Black African children were up to two times more likely to be on the ‘moderate increasing’ path whilst Pakistani, Black Caribbean and Black African children were up to three times more likely to belong to the ‘high increasing’ group.

The wealthiest children were least likely to be in the ‘moderate increasing’ BMI group and children of mums who smoked during pregnancy were up to two times as likely to belong to increasing BMI groups. Children with overweight mums were most likely to be on the moderate and high increasing paths.

Children on the moderate and high increasing paths were less likely to have regular family routines – they were more likely to skip breakfast or have non-regular bedtime schedules. Interestingly, however, no strong links emerged with some of the things more readily linked with childhood obesity such as sugary drinks and snacks, watching TV and lack of physical activity such as sports, the main focus of the newly published childhood obesity strategy.

Overweight factors

So it seems quite a large range of factors influence the likelihood of a child becoming overweight or obese over the first decade of their life. On top of this, being overweight or obese would also seem to point to a less happy and fulfilling early adolescence and a tendency to explore risky behaviours like smoking and drinking.

Although our research did not show a clear link with sugary drinks and snacks, there are nevertheless some compelling arguments for reducing the sugar intake of our children. These are not only related to problems of obesity, but to wider issues including the major issue of tooth decay and associated emergency hospital admissions. There is also increasing evidence of the ‘addictive’ nature of sugar with research suggesting that it stimulates a sort of ‘reward path’ in certain centres of the brain meaning that the more we have the more we want. It has been shown that people who reduce their sugar intake tend to crave it less.

Where sugar taxes have been introduced in other countries (Mexico, France, Denmark, South Africa amongst others), the intervention has been shown to help reduce the consumption of sugary drinks. As yet, there is no evidence that it helps reduce BMI and tackle obesity, but it’s argued it will take time for us to see an effect on whole populations.

Disadvantaged families

It is hard to predict how much impact the voluntary rather than mandatory reduction in sugar content of drinks and snacks agreed in the strategy will have. As for the sugar tax that will be introduced in two years’ time, there remain concerns that disadvantaged families more likely to purchase and consume sugary goods than their better off counterparts will be hardest hit. Policy makers will need to think hard about how any negative consequences of this might be counteracted.

Our research shows clearly that when it comes to the likelihood of a child becoming overweight or obese in the first decade of their life, there are many more influences than just sugar. Those influences are at play in families even before our children are born.

Helping pregnant women to stop smoking and maintain a healthy weight, making sure all young children have healthy eating and sleeping routines would seem to be key, together with targeted support for the ethnic and social groups identified as being most at risk.

Further information and resources

BMI development and early adolescent psychosocial well-being: UK Millennium Cohort Study is research by Yvonne Kelly, Praveetha Patalay, Scott Montgomery, and Amanda Sacker. The work, published in Pediatrics, is funded by the Economic and Social Research Council.

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Photo credit: Kim Stromstad