Executive summary
Childhood obesity has risen to alarming levels in most countries around the world, including the UK and Italy. Across Europe, the prevalence of overweight or obesity is around 30% in both boys and girls. Within countries, there is substantial variation between different settings, for example, between the most deprived and least deprived areas, with socioeconomic factors playing a key role in shaping disparities in childhood obesity rates.
Severe obesity leads to a range of health problems in childhood. However, the public health consequences of childhood obesity go beyond this, as obesity typically persists into adulthood and increases the risks of a wide range of later-life cardiometabolic and other health problems that limit both healthspan and lifespan. It can also be associated with lower educational attainment and employment opportunities which, along with adverse health consequences, lead to reduced human potential and economic costs. Moreover, there is now evidence for passage of obesity risk across generations by several mechanisms. This emphasises the importance of viewing child obesity through a life-course lens.2
In October 2024, the UK Academy of Medical Sciences and the Accademia Nazionale dei Lincei (Italian National Academy of Sciences) held a joint policy workshop on childhood obesity and its implications for health later in childhood and during adulthood. Participants (see Annexe 1) took stock of the current epidemiological picture in the two countries and discussed evidence relating to policy and other interventions designed to promote healthier lifestyles and reduce childhood obesity. Discussions at the meeting highlighted key themes relating to policymaking that should be prioritised:
Intervene early: Developmental trajectories are set early in life, including during the prenatal period, and appear difficult to alter after the age of about 5 years. The first 1000 days of life are critical to development and health across the life-course. Pregnant women are therefore a key group, and participants argued that entering pregnancy with a healthy weight is vital to ensure a healthy pregnancy. Breastfeeding should be encouraged for a host of reasons, including its association with a reduced risk of childhood obesity. Rapid ‘catch-up’ growth in low-birth-weight babies should not be encouraged, as it may increase the risk of later-life obesity and poor cardiometabolic health. The overall goal should be to establish and maintain a healthy body-weight trajectory that avoids excess gain early in life.
Take a systems approach: Multiple factors affect weight gain during infancy and childhood. Much evidence suggests that targeting single factors, such as diet or physical activity, in single settings, without consideration of wider contexts, is rarely an effective way to tackle obesity. Rather than look for ‘silver bullets’, participants suggested that policymakers should target wider societal drivers, to create an enabling and supportive environment for healthy lifestyles. The evidence suggests that complex interventions targeting multiple factors affecting energy balance are more likely to be effective. As these are delivered within complex systems, they may have unintended consequences, emphasising the need to assess multiple outcomes.
Implement cross-sectoral solutions: Policies in multiple sectors affect the environment that shapes diet and physical activity, including food policy, education, urban planning and transport. Participants stressed the need to avoid conflicting policies – such as public health policies that encourage people to be more active, and urban planning policy that makes this more difficult. Conversely, some policies are likely to be mutually reinforcing and deliver co-benefits – such as both health and climate benefits. Participants also highlighted the need to explore potential impacts on health inequalities. A robust approach to regulation, such as legislation to regulate the food industry rather than voluntary agreements, were felt to be necessary to create environments that help people to adopt healthier lifestyles.
Refine messaging: Communication about obesity is often challenging, with overweight or obesity sometimes being portrayed as a character flaw, leading to stigmatisation. Lack of care with messaging can be counterproductive, leading to mental health impacts that may increase the risk of unhealthier diet and lifestyles. Participants supported more positive messaging emphasising the benefits of maintaining a healthy weight, rather than focusing on obesity per se. Healthcare workers have a critical role to play in public and patient communication but need guidance on how to communicate most effectively. There is also a need to understand better how other mediators and communication channels favoured by young people influence attitudes and behaviours, and how they can contribute to more effective and less stigmatising messaging.
Strengthen research and researcher–policymaker engagement: Continuing research is needed to close key knowledge gaps on the interplay between physiological, psychological and social factors affecting weight, particularly to bridge the gap between statistical associations and causative pathways. Participants suggested there was a need to move beyond body mass index (BMI) as a core metric, focusing more on biomarkers of harmful adiposity. Closer ties with policymakers are needed, with development of clear messages that acknowledge but do not overplay uncertainty, and economic analyses that include the consequences of failure to act. By focusing on the adverse economic and societal impacts of rising population obesity, efforts could be made to establish a cross-party political consensus around the need to intervene, to ensure long-term prioritisation and a stable, forward-looking policy landscape.
Childhood obesity has become an urgent public health challenge that is both affecting lives today and storing up problems for the future. As well as shortening individual lives, it will increase demands on the health system. It has proved to be stubbornly hard to address through simple behavioural interventions, emphasising the importance of policy initiatives that create the environment in which healthier lifestyle choices are the default option or easier to adopt. Success is likely to be the cumulative result of multiple actions taken across a wide range of domains, within and outside health, which consistently promote and facilitate the adoption of healthy lifestyles among children and their caregivers.