Childhood obesity beyond the scales: rethinking prevention through environment and behaviour

According to the National Child Measurement Programme (NCMP), in 2024 to 2025, 23.5% of children in reception (aged four to five years) were overweight or living with obesity (boys 23.6%, girls 23.4%). These numbers have remained consistently high over the last decade.[3]

One of the most striking patterns is inequality: children living in the most deprived areas of England are twice as likely to be living with obesity compared with those in the least deprived areas. This highlights the strong influence of environment and socioeconomic conditions on health outcomes.

Children and young people are assessed using BMI centiles based on UK 1990 growth charts. A BMI on or above the 95th centile is classified as obesity.[3] Crucially, BMI does not diagnose health; it simply flags potential risk. Assessment should always include diet, activity, sleep, mental well-being and family circumstances.

Childhood obesity is not just about size or BMI charts but it influences many aspects of a child’s health and daily life, including:

Childhood obesity is rarely the product of one behaviour, such as 'too much screen time' or 'not enough vegetables'. Instead, it results from many interacting drivers across five major domains:

The most effective interventions target the environment, not just individual behaviour.
Here are some examples:

• Restricting marketing of unhealthy foods to children

• Improving local environments (eg, limiting fast-food outlets near schools)

• Community-based programmes with multi-agency collaboration

• Understanding the importance of key nutrients in children’s diets (eg, protein, fibre and healthy fat)

Schools continue to play a central role in prevention. The most successful initiatives usually involve the following:

• Curriculum-integrated nutrition education

• Consistent high-quality school meals

• Increased physical education time

• Active travel schemes

• Behaviour change strategies involving both children and adults

• Family or community participation for reinforcement at home

While BMI changes may be modest, improvements in diet quality, sedentary behaviour and activity are substantial and sustained.

NICE guidance emphasises holistic, family-based support rather than diets specifically targeted at children. Effective approaches include:

• Setting realistic, family-wide goals

• Cooking skills, meal planning and structured routines

• Improving sleep hygiene and reducing screen time

• Encouraging movement through play, not rigid exercise regimes

• Addressing psychosocial factors (eg, parental stress or mental health)

• Using neutral, non-judgmental language to reduce shame

Children should never be singled out; changes should benefit the whole family.

Professionals working with children, whether in healthcare, education or community settings, can make a significant difference by shifting the conversation away from weight and towards behaviours, the environment and well-being.

Instead of “obese child”, use "child living with obesity” or “child at higher weight”.

Prioritise behavioural and contextual factors over numerical values. Focus on the following factors:

• Energy levels

• Sleep

• Mood

• Eating patterns

• Stress

• Family logistics

• Access to food and safe play spaces

• What does a typical day’s food look like across home, school and after-school clubs?

• How are sleep routines structured?

• What opportunities does the child have for active play?

• Are there any barriers, such as cost, safety, housing or time?

• What is the child's emotional experience around food and body image?

These questions capture context and environment, not just food intake.

Professionals can advocate for:

• healthier meal provision and adequate time to eat;

• water availability throughout the day;

• restricting energy-dense snacks on site;

• regular movement breaks and inclusive PE;

• education for staff to reduce weight stigma in the classroom.

Families benefit most from small, achievable changes, such as:

• switching sugary drinks for water or milk;

• adding one piece of fruit or veg to familiar meals;

• encouraging 10–15 minutes of active play daily;

• creating consistent sleep routines;

• using structured, predictable mealtimes.

The goal is behavioural resilience, not perfection.