Why are our children overweight by the time they start school?

When we think about childhood obesity, the focus tends to be on school-aged children eating badly and not exercising.

But in Cumbria the problem is starting at a much younger age.

Each year, unlike other parts of England, more children in the county are overweight or obese by the time they reach reception age.

Claire King, a consultant in public health at Cumbria County Council, is among those working to prevent that.

She believes in many cases, the route to obesity begins when children are babies - and even before they are born.

Breastfeeding can help, as can promoting a healthy diet from the moment you start to wean your baby onto solid foods. Keeping young children active every day is also key.

But Miss King said that although it sounds simple, there are many factors coming into play to impact these choices.

Later this week, the county's public health team are hosting a Healthy Weight Summit to look at the county's obesity crisis in more depth and come up with a plan to tackle it.

Miss King explained why it is now such a priority.

"In Cumbria the situation is different to what’s happening nationally. We can see this trend developing, but in a bad way.

“if you look at that data for the children that have been most recently measured, if they carry on as they are, based on what we know, we could be looking at a cohort of children with 40 per cent carrying excess weight by the time they are in year six. That’s massive. It’s nearly one in two children," she said.

Asked why children under the age of five are likely to have excess weight, Miss King said it is complex.

Factors include genetics, accessibility to healthy or unhealthy food, opportunities to be active, poverty and individual lifestyle choices. In under fives these choices are influenced by parents, but also grandparents, other relatives and childcare settings.

“One of the big problems is sugary drinks and sweets. Young children are regularly having fizzy drinks, sweets and crisps," she said.

“I know how difficult it is. Nobody wants to be the parent saying they can’t have this or that. What we are seeing though is that instead of a treat, it is now becoming the norm.

“We are also seeing anecdotal feedback that a lot of younger children are having takeaways regularly as part of a family meal. People have got busy lives so at the end of the day it’s easy to go for a takeaway. But these are usually big portions, high in fat and also salt."

Children are also exercising less than they used to.

“I think we have this culture of more children having screen time. They use iPads, tablets regularly and that can encourage them to become more sedentary. Also children play out less than they used to. They tend to be indoors a lot more," she said.

“There are two sides to this. They are taking more calories in, but less calories are being used."

In terms of how these trends can be changed, she said they have to work with parents to promote healthier choices from birth.

That includes doing more to support mums to breastfeed.

“Breastfeeding is really good, not only for the weight of the mum but also the child. The evidence tells us that children who are bottle-fed are more likely to be overweight. They tend to end up having more milk. Breastfeeding is therefore absolutely the best start," she said.

There is also more education needed about what foods are best for children, so they are weaned onto a healthy diet and then stick with that as they grow older and start school.

"Really, the message is eat well and move more. With under fives we also add another message - lots of active play. Young children should be active for three hours a day," she said.

“There are lots things you can do, even indoors. I like to set up obstacle courses in the house with my little one and we take it in turns trying to get round. It’s really fun and very energetic. You can always do something, wherever you are."

But Miss King said they do not want to the blame on parents. Instead they want to work with families to understand the barriers to healthy lifestyles and see what can be done to break them down.

“Yes it is the responsibility of the individual, but there are a lot of other factors. Access to healthy food and play opportunities are all key. That’s why we are having the summit, to see what we can do to improve that access," she explained.

“There is a bigger picture and we need to take this into account in all sorts of areas. For example, healthy planning policies.

"If we’ve got four or five takeaways in one high street, it will have an impact. But then you have to balance economic developments.

"Would you rather see those shops empty? It’s very complex, but needs attention.

“Genetics does play a part too, but we have to look at what is in our power to change.

"We want to support individuals to make healthy choices, but also look at the wider issues."

She said it is clear that childhood obesity is more common in deprived areas, so there is a definite link to deprivation.

“Public Health England have carried out further analysis, looking at postcodes of all the children and mapping them by levels of deprivation. It is quite clear that there is a link between obesity and deprivation," she said.

Miss King said it is obvious that parents on a tight budget will opt for the cheapest foods available, which are often processed and high in fats and sugars.

For example, when buying snacks for their young children, they can get packets of biscuits and multi-packs of crisps often for pence, whereas fruits like berries can be much more expensive.

She said in many cases they may not have transport to get to the budget supermarkets so some foods are just not available.

“Often their main source of food is a local convenience store, which don’t always have a great variety of fruit and vegetables and if they do, they tend to be quite expensive," said Miss King.

She said it is these wider issues that they will be looking at, working with local children's centres and others to support families.

Miss King said ahead of the summit, they held a workshop looking specifically at healthy weight and physical activity in early years.

The event, which took place at the West Cumberland Hospital in Whitehaven last month, brought together public health, children’s centres, health visitors, Active Cumbria and midwives.

Together they identified gaps in the current services and opportunities for improvement, then drew up an action plan.

This includes giving consistent messages to families at all stages, helping parents and parents-to-be with their own weight where appropriate, and looking more closely at postnatal trends.

They will also flag up gaps in leisure services with local councils, educate parents on healthy food swaps, and look at other ways to get messages out to families, including social media.

Miss King is also urging parents to look at www.nhs.uk/change4life for advice, ideas and money off vouchers.

Breastfeeding rates across Cumbria vary significantly, prompting concerns that not all new mums are getting the support they need.

Following a significant drop at the end of last year, overall rates in the county have risen again - but there are still wide variations depending which district of the county you live in.

Latest statistics show the lowest rates are currently in Barrow, where 57 per cent of children are recorded as being breastfed.

The highest is Copeland, where it is 87.9 per cent.

Improving breastfeeding uptake is one of the key public health goals in the Cumbria-wide Health and Wellbeing Strategy.

Concerns have been flagged up with health trust bosses at recent meetings of the county's health and wellbeing board.

Across the county there are a number of breastfeeding groups, infant feeding advisors and peer supporters, some linked to the NHS and others run by volunteers.

Hazel Graham is currently breastfeeding her youngest daughter Evie and is part of the Brampton Breastfeeding Support Group.

She said it appears there are inconsistencies in the levels of support women receive in different areas, and believes it is largely due to government cuts to health visiting budgets.

The mum-of-two said: "Not everyone can breastfeed, and not everyone wants to breastfeed, and that’s fine.

"But there should be sufficient support in place for women who want to try.

"The UK has one of the lowest breastfeeding rates in the world and we are missing out on the major health benefits for breastfed babies and breastfeeding mums.

"With both of my kids, the first two to three weeks of breastfeeding have been the hardest. It hurts. You are shattered. You feel unconfident.

"Your supply takes a while to stabilise. But if you can grit your teeth and get through the early days, then it just gets easier and easier.

"It now feels like the most peaceful and natural thing to do. I’ve never once had any hassle in public, in fact the only comments I have ever had have been supportive," she added.

Mrs Graham said it is not only easier, because she doesn't need to sterilise any equipment or pack bottles when they go out, she has also saved hundreds of pounds by not having to pay for formula milk.

But she said that without having support in those early weeks, many women who want to breastfeed are giving up.

"The trouble is, with health visitor services slashed, the support available to get people through the first few weeks has been hit really hard," she added.

"In addition we have profit-making companies with huge marketing budgets pushing the sale of formula."

The Brampton group meets every Tuesday from 10am until 11.30am at Brampton Community Centre.

Similar groups are up and running across the county.

Mum-of-two Melissa Greaves overcame her own struggles to breastfeed her second child.

She is now employed by Action for Children as a breastfeeding champion at Greengate Children's Centre in Barrow.

Part of her role is to help improve uptake rates in the area.
She said: "I work directly with mothers and mothers-to-be, giving them advice and support on breastfeeding, and the emotional support that goes with it.

"My main message is just to try the first feed. If you try that first one and don't like it you've still done a lot of good. That first feed is the most important as it lines the baby's gut, and also for bonding. I just say set yourself small goals - that first day, the first week."

In a bid to provide early support, an antenatal breastfeeding workshop is taking place on Friday this week at Greengate between 1pm and 3pm.

The pilot session will help give mums-to-be breastfeeding support before they give birth, so they are more likely to give it a try.

There is also a weekly support group at the Barrow centre on Wednesday mornings and at the Dalton children's centre on the first and third Thursday of each month.

South Cumbria Breastfeeding Support also hosts regular support sessions in Ulverston, Kendal and Winderemere. For details and times visit cumbriabreastfeeding.org.uk.

In north and west Cumbria, the NHS runs several support groups. For details call Fiona Sim on 07717 577107 or Helen Ferris on 07879 632018.