National Assembly for Wales


Children and Young People Committee


CO 27


Inquiry into Childhood Obesity


Evidence from : Betsi Cadwaladr University Health Board (BCUHB)


A Collated response from:Nutrition and Dietetics Department, Betsi Cadwaladr University Health Board (BCUHB)

The Dietetics Department within BCUHB welcome the opportunity to respond to the National Assembly for Wales’ Children and Young People Committee Inquiry into Childhood Obesity.

(1)  The extent of childhood obesity in Wales and any effects from factors such as geographical location or social background


Currently, data gathering in this area is, we understand in development e.g. the Child Measurement Programme. Whilst we have access to the Welsh Health Survey data which gives an indication of prevalence, opportunities to segment the data and widen to enable a greater understanding of differences in location and social background are needed and would be welcomed.



(2)  The measurement, evaluation and effectiveness of the Welsh Government’s programmes and schemes aimed at reducing the level of obesity in children in Wales specifically:


Health related programmes including: Change4Life, MEND


Within Change for Life, the brand Start4Life (S4L) includes a range of materials to support early years nutrition. We would welcome the opportunity to extend the suite of materials to include promotion of nutrition and physical activity messages for pregnancy (including preconception). Interventions and investment to prevent and manage child obesity should commence at the beginning of the ‘life course’. Support for programmes targeting women pre, during and after pregnancy are urgently needed. Currently 27% of all women entering pregnancy across North Wales are obese (BMI ≥30). There is credible and mounting evidence linking maternal obesity with congenital malformations, infant mortality, reduced likelihood of breastfeeding and an increased risk of obesity in childhood and adolescence (CMACE, 2010; Tennant et al, 2011; Rasmussen et al 2011). We would like to see greater priority placed in the allocation/ redirection of funds to this address this.


A ‘settings’ based approach is needed to enable the creation of supportive environments for health and well being, specifically within early childcare, schools and other settings where children and young people frequent. The National Healthy and Sustainable Pre School Scheme (HSPSS) and Welsh Government Food and Health Guidelines for Early Years and Childcare settings promote a whole setting approach to nutrition in pre school/early child care settings. Within BCUHB we support and work in partnership with local authority colleagues to encourage settings to participate in the HSPSS, and provide expertise on food and nutrition to enable settings to achieve this criteria. In addition we have developed and offer ‘Tiny Tums’, which is a best practice scheme enabling settings such as nurseries and playgroups to submit their food and drink menus for assessment and to ensure full compliance with the Welsh Government Food & health Guidelines. This scheme is highly regarded and provides reassurance to parents and the settings/ organisations who participate that the best possible nutritional care is being provided. Alongside efforts to promote active play, the scheme provides supportive active at level 1 of the All Wales Obesity Pathway. 


Currently MEND provides the only intervention available to meet Level 2 of the All Obesity Pathway e.g. targeted at children who are already overweight or obese and their families. Greater flexibility on what could be run, as opposed to delivering MEND or do nothing (based on current funding allocations) would allow other areas to perhaps identify something locally that suits their client group and the staffing available to deliver. MEND as a programme does have the evidence base that supportive its effectiveness in terms of delivering favourable outcomes however, it is a programme that is very time intensive for all involved and a lot is invested in recruitment, often with poor uptake, which means a group cannot run and staff time spent on recruitment is not funded.


Programmes related to nutrition in schools including Appetite for Life (AFL)


School based nutrition programmes offer real potential for improving the food and nutrition choices of children and young people, laying the foundations for health and wellbeing both in the short and long term. It’s imperative that funding now allocated to local authorities is protected to enable the Healthy Eating in Schools Measure (A4L) to be properly resourced with the support, training and pupil involvement to enable successful implementation.


Leisure facilities that are sited next to/ within close proximity of school premises that provide a range of food and beverages (including vending) has in some local authorities within North Wales caused complications in terms of supporting schools to work towards achieving the AFL food and drink based guidelines. Opportunities to review leisure centre food and drink provision and perhaps explore capacity to roll out schemes such as the ‘Healthy Options Award’ operated by Environmental Health would be welcomed and would help promote a more consistent message to children, young people and families.


Cross cutting programmes for example leisure and sport related programmes (Creating an Active Wales; planning policy)


Wrexham Local Authority in conjunction with partners successfully prohibited future planning applications for hot food takeaways within a 400m radius of schools or colleges in the county. This approach should set precedence for other local authorities and their planning departments in Wales.

Encouragement should also be given to applying methods such as Health Impact Assessment to ensure the wider health and wellbeing impact of new developments are considered and whether these might contribute to an ‘obesogenic’ environment.


(3)  The barriers to reducing the level of childhood obesity in Wales


Work ongoing at a ‘settings’ level is crucial so that we can avoid sending children and young people mixed messages about food and health. Where conflicting messages are apparent, this presents a potential barrier in terms of affecting lifestyle behaviours now and in the future.


At a national level we believe UK legislation on food and health issues is vital and requires support from Welsh government to lobby its benefits for the people of Wales. Equally we need the cooperation of the food and drink industry in order to promote responsible advertising and marketing of foods.


(4)  Whether any improvements are needed to current Welsh Government programmes and schemes and any additional actions that could be explored


Diet is a key modifiable risk factor in the prevention and risk reduction of obesity, diabetes, cardiovascular diseases (CVD), and some cancers, all of which disproportionately affect those in lower socioeconomic groups. Action should focus on prevention in the early years and addressing nutrition related inequalities in health. Investment in preventive services needs to address the current gaps in public health dietetic provision to continue to build capacity in communities to support and enable people to improve their health.




Centre for Maternity and Child Enquiries (December, 2010). Maternal obesity in the UK: findings from a national project. London: CMACE. Available from:  Accessed 24 August 2011


Government Office for Science (2007). Foresight. Tackling Obesities: Future Choices- Summary of key messages. Available from:


Rasmussen, K.M., Dieterich, C.M., Zelek, S.L. Altabet, J.B., Kjolhede, C.L. (2011). Interventions to increase the duration of breastfeeding in obese mothers: the Bassett Improving Breastfeeding Study. Breastfeeding Medicine 6 (2), 69-75.


Tennant, P.W.G, Rankin, J. and Bell, R. (2011). Maternal body mass index and the risk of foetal and infant death: a cohort study from the North of England. Human Reproduction, 26 (6), 1501-11


Welsh Government (2010) All Wales Obesity Pathway