Last updated: 10/09/2024
Obesity monitoring for children
Continued universal BMI monitoring for children in reception and year 6
- Very low impact on obesity
A percentage estimate of how much the policy would reduce national obesity rates
- Relative reduction in obesity prevalence: 0%
- High evidence quality
A rating of the strength of evidence, accounting for both reliability and validity of the evidence
- Reliability and validity rating: 4/5
- Low cost to governments
Cost to UK and devolved governments over 5 years
- Costs to governments over 5 years: £118m
- Benefit to governments per year: £0
What is the policy?
This policy relates to continuing the UK Government’s existing National Child Measurement Programme (NCMP), known as the School Height and Weight Checks. This is a mandatory yearly programme that measures the height and weight of school children in England in reception and year 6. The programme is overseen by NHS England and Department for Health and Social Care (DHSC), and delivered by local authorities in collaboration with state-maintained schools.
Recent context
The NCMP began in 2006 and has occurred yearly since then (with lower participation throughout Covid-19). Over 99% (~17,000) of eligible state-funded schools participate, leading to over one million children (in reception and year 6 classes) measured through the programme. The purpose of the NCMP is to serve the UK Government’s obesity strategy to inform local service planning and delivery, and to analyse trends in growth patterns and obesity. It also facilitates engagement with families regarding weight concerns by sending feedback letters to parents about their child’s weight category and directing them to support services for maintaining a healthy weight.
The Child Measurement Programme (CMP) was introduced in Wales in 2011. The CMP measures the height and weight of children in their reception class, using the same growth reference as England (UK90), enabling comparisons across the two countries. Due to staffing and residual Covid-19 pandemic impacts on data collection, the latest release does not have national reach, but it is expected that 2022/2023 data will cover all of Wales. A feasibility study has been completed on the possibility of measuring at year 4, but no decision has been made on this.
In Scotland, Public Health Scotland collects height and weight measurements during health reviews in Primary 1 (for children aged around five years). They also compare children’s BMIs to the range seen among a similar reference group in order to identify children as either a healthy or unhealthy weight. This data is published annually by Public Health Scotland.
Case studies
Using the NCMP to support local authority level public health initiatives to reduce obesity
Although the NCMP is a national programme, it also serves as a crucial source of local data on childhood obesity and overweight and is used by local authorities to inform their health policies and initiatives. The following case study was highlighted by the Local Government Association (LGA) as an example of the NCMP impacting at the local level.
The NCMP data revealed that 18% of children in the Solihull local authority area were already living with excess weight by the time they started reception. This finding highlighted the need for earlier intervention by local health officials and the council.
In response, the council commissioned the University of Warwick to conduct research aimed at improving the identification of children at risk of becoming overweight or obese in their early years. The research revealed that healthcare professionals working with young children and their families felt ill-equipped to address the issue of overweight and did not feel empowered to discuss it. This indicated a significant skills gap among the professionals. To address this, Solihull Council developed a training programme for local health staff, equipping them with the necessary skills to discuss weight concerns with families.
Considerations for implementation
This recommendation is to continue funding of an existing policy, therefore no new considerations for implementation are needed at this stage.
Estimating the population impact
We estimated that this policy would reduce average daily calorie intake by approximately 0 kcal per person
There is currently no evidence to suggest national child measurement programmes work for obesity reduction or prevention. An evaluation of NCMP by Falconer et al. (2014) showed that providing feedback letters to parents/guardians following child measurement did not result in changes in dietary behaviours.
Estimating the per-person impact
We estimated that this policy would reduce average daily calorie intake by approximately 0 kcal per person
Data for modelling impact was taken from Falconer et al. (2014).
Given evidence that dietary behaviour does not change following receipt of a feedback letter we assumed the net calorie deficit for both adults and children to be zero.
Estimating the population reach
In our analytical model, we applied the effect sizes to children living with overweight or obesity (BMI percentile of greater than or equal to 85) whose parents/guardians would be in receipt of feedback letters in England, That is, five year olds (reception) and 10–11 year olds (year 6).
Changes in the prevalence of people living with obesity
Analytical modelling found that this policy would have no effect for children over a five-year period.
Table 1 summarises the percentage reduction of children moving from BMI percentile ≥ 85 into a healthier BMI percentile/ category following continuation of national child measurement programmes (at five-year follow up).
| Adults (England and Wales) | Children (England and Wales) | Adults (Scotland) | Children (Scotland) |
| 0% | 0% | 0% | 0% |
Cost and benefits
Cost over 5 years
We estimated that this policy would cost the governments approximately £118 million over five years
We commissioned HealthLumen to estimate the cost of the policy to both industry and governments over a five-year period.
Table 2 below shows a breakdown of costs. The direct costs to the national governments are estimated at approximately £1.2 million. The direct costs to the local authority/NHS are estimated at approximately £117 million. The costs to the food industry are not applicable here.
| Group affected | Cost | Horizon | Detail |
| Costs | |||
| Government | £1.2m | Annual (5 years) | Central government administration |
| Government (Local authority/NHS) | £0.1bn | Annual (5 years) | Delivery of measurements |
Total annual benefit
We estimated that this policy would have an annual benefit of approximately £0
Based on our analysis, and using analysis conducted by the Tony Blair Institute and Frontier Economics we estimate this policy would not lead to monetary benefit for the governments.
Collecting data to monitor trends in childhood obesity is vital. However given the high costs and low impact on obesity outcomes, governments should consider monitoring a representative sample of the child population and use the savings to fund evidence based solutions for obesity.
Impact on disease incidence
Based on our analysis and analysis conducted by HealthLumen, there is no evidence that this policy would impact disease incidence avoided after five years.
Behind the averages: impact on inequalities
Despite no evidence of impact, data yielded from the NCMP has provided vital evidence of the prevalence of obesity being much greater in children from the most deprived backgrounds. It is therefore important to continue surveillance to track whether policies to improve national obesity rates are having the equitable effects for children across the UK.
It is important that national child measurement programmes do not widen health inequalities by stigmatising children from marginalised groups. Additionally, when communicating NCMP results to parents, communications should be appropriate to their circumstances, ensuring fair access to evidence-based interventions.
There is a risk that continuation of this policy could exacerbate weight stigma.
Rating the strength of evidence
We asked experts working in the fields of obesity, food, and health research to rate the strength of the evidence base for each policy, taking into account both reliability (size and consistency) and validity (quality and content) of the evidence. Policies were rated on a Likert scale of 1–5 (none, limited, medium, strong, and very strong evidence base). The Blueprint Expert Advisory Group rated this policy as having a Strong evidence base.
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