The latest figures tell us that more than a quarter of children aged 4 or 5 in Wales are measured as being overweight or obese, with one in ten being obese. These figures should concern us, but they should also not be seen in isolation from their context. The reasons behind these figures are complex. They include the impact of living in poverty; the sedentary behaviours that reflect the impact of technological advances on modern life; the influence and lifestyle of friends and family; and the promotion and consumption of unhealthy foods to children and young people.
But in discussions of obesity and weight, there is a danger in placing too much emphasis on individuals’ own actions and choices. Particularly when it comes to children, the challenges and choices are not with each individual, but are restricted by the society around them.
Consequently, I welcome the work Welsh Government is currently doing to consult on proposals to make food environments healthier. This approach recognises the wider societal impacts on children’s health, and I hope that we in Wales can maximise the opportunity to create healthy food environments, informed by children and young people themselves. A consultation on these proposals is open for responses until 23rd September.
Children have a human right to a healthy and nutritious diet
Under article 24 of the UN Convention on the Rights of the Child (UNCRC), every child has the right to the highest possible standard of health, and as part of this, governments should provide ‘adequate nutritious foods’. Article 24 also states that governments should ensure ‘all segments of society, in particular parents and children, are informed and have access to education and are supported in the use of basic knowledge of child health and nutrition…’.
The UN Committee on the Rights of the Child produces ‘General Comments’, designed to provide advice and instruction to States on upholding the UNCRC. General Comment No. 15 (2013) on article 24 states that:
“Adequate nutrition and growth monitoring in early childhood are particularly important…
…School feeding is desirable to ensure all pupils have access to a full meal every day, which can also enhance children’s attention for learning and increase school enrolment…
…Children’s exposure to “fast foods” that are high in fat, sugar or salt, energy-dense and micronutrient-poor, and drinks containing high levels of caffeine or other potentially harmful substances should be limited. The marketing of these substances – especially when such marketing is focused on children – should be regulated and their availability in schools and other places controlled…
I am pleased that several of these recommended actions are recognised by the Welsh Government’s strategy to tackle obesity – Healthy Weight: Healthy Wales.
Childhood obesity in Wales
Children in Wales are more likely to be measured as overweight or obese than children in Scotland or England, and this continues to be the case in the latest published figures. The deprivation gap in the figures is stark, with children living in the ‘most deprived fifth’ postcode areas statistically significantly more likely to be overweight or obese compared to the least deprived. There are also gaps between local authority areas. For example, 7.9% of children in Monmouthshire were measured as obese, while the figure was 14.3% of children in Blaenau Gwent.
These statistics paint a picture of inequality which is highly concerning, but weight measurements of children, do not, by themselves, tell us much in terms of how to tackle childhood obesity. I believe the following are some areas that must be tackled in order to try to reduce these figures. We need to view childhood obesity as an indicator of wider health determinants, including deprivation, and ensure measures tackle these holistically. This includes considering the crucial role of food and nutrition, and physical activity in determining weight and wellbeing.
Healthy food environments – school meals
One vital part of combatting poor nutrition in children is to improve the quality of the food children eat at school. I am very supportive of Welsh Government’s now complete roll out of free school meals for all primary school children in Wales (as part of the Cooperation Agreement with Plaid Cymru); a move which provides a real opportunity to provide healthy meals for thousands of children in Wales. I have previously called for the extension of free school meals to secondary school children too, but in the meantime I would like to see the adjustment of the currently extremely low earnings threshold beyond which young people do not currently qualify, because of the importance of nutrition and sustenance for children’s development at all ages.
We know that many children also experience hunger during the school holidays, and I have previously expressed my dismay at the Welsh Government’s decision to withdraw free school meal provision during the school holidays; a decision which Welsh Government has admitted did not adequately take into account children’s rights under the UNCRC following a judicial review.
In April 2024, my office conducted a survey asking children’s views on school dinners. 490 individual children took part aged between 7 and 18. A further 1250 children took part in groups, with teachers and youth workers submitting a summary of their views. Here are some of the key results:
- Only 19% of children said they were full after their meal. Almost half (44%) said they can’t have more food (seconds) if they ask for it.
- Almost a quarter (24%) of children said they can’t always have vegetables if they want them, and 22% said they can’t always have fruit if they want it.
When asked for their ideas on making school dinners better, by far the most common answer amongst children related to wanting more food. I have shared the findings from my office’s survey, and discussed them with the Cabinet Secretaries for Health and Education. It is important that we understand why it is children are reporting not feeling full. It is likely, in my view, to be a combination of issues around portion sizes, nutritional value, the cost of school food / free school meal allowance.
This issue is not unique to Wales and, as such, some areas for improvement can be drawn from elsewhere, including this work by Food Active. Food Active undertook a series of face-to face focus groups with approximately 40 secondary school learners across the North West of England. Among the findings of their report published in May 2024 were that:
- Break time provision is a very popular food service, however healthier options are currently limited.
- Cost of food and drink is an important factor for young people; some referenced price increases alongside a reduction in portion sizes.
- Young people consistently raised issues about the chaotic and stressful nature of the dining space, and lengthy queues.
- Lunchtimes are too short, and many young people report issues such as running out of food and making compromises on other activities such as clubs and sport in order to eat.
- Young people frequently noted the poor quality and limited variety of foods being served across the school day and want to see this improved.
- Young people were typically unfamiliar with schools offering healthy eating initiatives or aware of any policies relating to provision of healthier options.
- Young people had lots of ideas on how to encourage healthier eating in school, including making healthier foods more appealing, changes to pricing, providing more information on healthy eating, introducing gardening clubs and restricting the promotion of less healthy options when paying.
- Places to buy food on a pupil’s journey to school are generally dominated by less healthy options, and these are popular, attractive and convenient for young people when compared to the offer within schools.
While the work to update regulations on food in schools is vitally important, Welsh Government must further consider those environmental factors. Given that work remains at the earliest stages, there is every opportunity to ensure that these views from children and young people are taken into account as part of the revised regulations and guidance.
I am pleased that Welsh Government, as part of their Healthy Weight: Healthy Wales delivery plan 2022-24, committed to ‘reviewing the regulations on school food nutrition in line with the latest nutritional standards and guidelines, and update current standards’. The nutritional value of school food must be a priority when reviewing the regulations, and must aim to meet the highest possible standards in line with article 24 of the UNCRC. it is vital that children and young people are consulted during the testing of the proposed new standards. We will be raising the need for children and young people to take an active part in these revisions with Welsh Government.
Public Health Wales has recently published a report on the potential of school food to improve children’s health, which found that the diets of many children and young people in Wales fall short of national dietary recommendations, and opportunities to improve population health through school food are not being maximised. The report points out that ‘…although the Healthy Eating in Schools (Nutritional Standards and Requirements) Regulations, 2013 are within law, the compliance with the nutritional standards in schools across Wales and the contribution they have made to the dietary intake of school-aged children in Wales is unknown’. The report calls for a monitoring and compliance framework in order to establish whether schools are meeting the expected standards. I fully endorse this call as it is hugely important that there is true accountability attached to the new revised Regulations.
Healthy food environments at home and in the community
The cost of living and the cost of food is impacting on families across Wales, and we know that many families are experiencing food insecurity in the home, leading to children being restricted in their healthy food choices. Our nationwide survey of over 10,000 children, young people, parents, carers and professionals found that:
- 45% of children aged 7-11, and 26% of young people 12-18 said they worry about having enough to eat.
- 36% of parents said that they worry about their children having enough food.
- Almost two-thirds (61%) of children aged 7-11 worried about their families not having enough money for the things they need, as did a majority (52%) of children aged 12-18.
The Food Foundation produce a monthly food insecurity tracker, which shows that millions of children across the UK experience food insecurity. We know that making health food choices can be very difficult for families living on a low income because healthy food can be far more expensive. The most recent report from June highlights that “23% of families with three children experienced food insecurity as a result of the two-child benefit limit, rising to 26% of families with four or more children”.
I have consistently joined my UK Counterparts in calling for this cruel two-child benefit cap policy to be scrapped. I make this plea to the UK Government once again.
I am also highly concerned about the promotion of unhealthy food and drinks to children, including energy drinks. I am pleased, therefore, that Welsh Government is taking forward regulations to restrict the promotion of unhealthy foods – tackling things like offering deals on particular food and drink; the placement of unhealthy food and drink in certain places known to encourage purchasing, in shops and online. The changes will also restrict free refill promotions on unhealthy drinks.
Welsh Government have also put out a call for evidence on proposals to restrict the sale of energy drinks to under 16s.
This action from Welsh Government is welcome, and I urge the government to act quickly to implement these changes.
Physical activity
I also wonder whether, perhaps due to the fact that it is easier to collate data on weight, we over-emphasise weight and neglect the fundamental role of activity and exercise in child health.
The most recent Active Healthy Kids Wales report card (2021) paints a concerning picture of poor overall physical activity, with a score in relation to sedentary behaviour ranking Wales as joint lowest (with just three other countries) of the 57 countries that participate.
In 2022, Sport Wales undertook a survey of over 116,000 from 1,000 schools. The survey found that there had been a 9% point decrease in children taking part in regular organised sport outside of the curriculum since 2018; an 8% point increase in those reporting no regular participation in sport outside of the curriculum. Those taking part in sport in a community club setting at least once a week decreased by 9% points. Just 40% of pupils said they enjoyed extracurricular sport ‘a lot’, 57% enjoyed PE ‘a lot’ and 47% enjoyed community club sport ‘a lot’.
The survey found that there is a 15% point difference in participation in organised sport outside of the curriculum between the least and most deprived areas. This gap has widened since 2018. Only 60% of schools said they had the equipment to include disabled pupils, pupils with an impairment or Additional Learning Need.
It is clear that we must do more to support children to avoid sedentary behaviour and to encourage involvement in physical activity, alongside promoting a healthy diet. The Welsh Government has committed to develop and implement a ‘Daily Active Offer’ for schools, to create opportunities for children and young people to be active during the school day. It was a specific recommendation of my 2022-23 Annual Report for the Offer to commence without delay. While we understand that early adopters of the offer have begun to roll this out this year, at the time of writing it is unclear what progress has been made.
In May 2024, we undertook a survey of around 1,300 children and young people, asking them about their opportunities to enjoy play or break time during school. This of course related to children’s ability to exercise, socialise and access food.
46% of respondents answered ‘yes’ to the question ‘do you ever miss your play / break time?’. While lots of the reasons given for missing break time were around detention, many responded that they were kept in to complete work if they had not completed it in class time, others commented that ‘we don’t always go out for 5 minutes play’, or ‘because it’s raining’. When asked what would make play or break time better, many children raised that they would like more equipment to be able to do exercise and activities. Many said they feel that their break times are too short. There were also comments in relation to having time to get food:
…the time too short being held back at break times…
…no space to play when it rains, have to sit down and there’s not much space not aloud [sic] to play football or aloud [sic] to play on the grass…
…with breaktime there’s not enough time to go to the toilet and get food they took away the good food and there’s no good food anymore…
A focus on the wider determinants of obesity
I am encouraged that many of those concerned with the health of children and young people are making determined efforts to focus on those wider determinants of obesity. This includes Public Health Wales, who list influencing the wider determinants of health, and promoting preventative and early intervention approaches as part of their 6 key strategic priorities in their 2023-26 strategic plan.
While a focus on improving the outcomes of children and young people when it comes to their health is extremely important, I urge Welsh Government and others to ensure they emphasise the importance of those wider societal determinants, above any arguments around personal responsibilities, and ensure that children’s health is conceptualized in its broadest sense, to include nutrition and physical activity. A supportive and asset-based approach is needed not a punitive and deficit-based one which risks ignoring the social constraints which shape children and families’ lives and choices.
Rocio Cifuentes
Children’s Commissoner for Wales