The proportion of healthy-weight young people in England trying to shed the pounds has nearly tripled from around 1 in 20 to nearly 1 in 7, reveals an analysis of 20 years of annual health survey data, published online in Archives of Disease in Childhood.
But reported slimming attempts among children across the weight spectrum have shot up, particularly among those who are overweight and obese, not only outpacing the rise in excess weight gain during this period, but also the provision of services to meet demand, the analysis shows.
The prevalence of overweight and obesity among English children has risen steadily in recent decades: one in three children in the UK is now overweight or obese as defined by the BMI-Z score, used for children who are still growing.
Childhood obesity first became a UK government priority in 2004, but there’s relatively little information on how many children attend NHS weight management programmes and/or attempt to lose weight.
In a bid to plug this knowledge gap, the researchers analysed data from 34,235 children aged 8 to 17 who took part in the annual nationally representative Health Survey for England from 1997 to 2016: 8 waves of the survey included questions on weight loss.
The survey reported on the social and demographic features potentially associated with weight loss attempts, including age, gender, ethnicity and household income. Height and weight were measured by trained nurses during a home visit.
Analysis of the responses showed a significant increase over time in the overall proportion of children reporting attempts to lose weight – from around 1 in 5 (21.5%) in 1997-98 to more than 1 in 4 (26.5%) in 2015-16 – one in five 8-12 year olds and one in three 13-17 year olds.
The absolute prevalence of weight loss attempts increased across all categories of weight between 1997-8 and 2015-16, outpacing the proportion of children gaining excess weight.
The proportion attempting to lose weight rose from 9% to more than 39% among those who were overweight and from just under 33% to nearly 63% among those who were obese. And it nearly tripled among children of a healthy weight, rising from more than 5% (1 in 20) to nearly 14% (1 in 7) over the same time period.
The steepest increase in the prevalence of weight loss attempts was in 2011-12, and was apparent across all categories of weight. For example, from 2009-10 to 2011-12, prevalence rose from 13% to nearly 49% among overweight children, and from 38% to 81% among obese children.
Among older children (13-17 year olds), the frequency of weight loss attempts increased from just over 4% to 57.5% among those who were overweight, and from nearly 31.5% to nearly 82% among those who were obese, between 2009-10 and 2011-12.
The 2011-12 survey year was also the first to find evidence of a notable proportion of healthy weight children reporting weight loss attempts, up from 0% the previous year to just over 15%. Similar trends were also apparent in younger children (8-12 year olds).
Coincidentally, this date marked the start of individual feedback on weight to parents or carers as part of the National Child Measurement Programme, note the researchers.
The absolute prevalence of reported weight loss attempts was generally higher in girls than in boys, but the increase over time was significant only for boys. Similarly, the absolute prevalence of weight loss attempts was higher among older children than younger children and increased significantly over time among older children. Weight loss attempts were higher among children of ethnic minority backgrounds than among white children in both age groups, and higher among children from lower income households.
Current overweight/obesity, ethnicity, and household income were all independently associated with attempts to lose weight in younger children, while gender was also a factor for older children.
“The rise in efforts to lose weight among children who were overweight or obese may imply some success in communicating the importance of weight control to this group,” write the researchers.
But they add: “It is of concern that the increase has not been matched by an increase in the provision of weight management services in England, creating a risk of unsupervised and potentially inappropriate weight control behaviours.
Meanwhile, the rise in weight loss attempts among children with a healthy weight raises concerns and suggests greater attention is needed to target weight control messages appropriately.”
They conclude: “More research is needed to understand the drivers of weight loss attempts among young people with a healthy weight and to reduce their occurrence. Policies to tackle obesity in young people need to be sensitive to reduce the risk of encouraging inappropriate weight control practices.”
Paper: Trends in weight loss attempts among children in England. Archives of Disease in Childhood; https://adc.bmj.com/lookup/doi/10.1136/archdischild-2021-323493