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Must Know: Healthy weight

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Is your council using the National Child Measurement Programme to promote healthy weight?
The purpose of this ‘Must Know’ is to understand the National Child Measurement Programme (NCMP) and how it is used locally to support local planning.

Introduction

Every year more than one million children are weighed and measured at school as part of the National Child Measurement Programme (NCMP). The exercise – one of the biggest programmes of its kind in the world – provides England with a record of how many children are underweight, a healthy weight, overweight and living with obesity.

The most recent NCMP data from 2020/21 found that over one in five reception year children (27.7 per cent) and over one in three Year 6 pupils (40.9 per cent) are overweight or living with obesity. But it is more than just a simple data collection exercise. It also provides a valuable opportunity to engage children, schools, parents and other partners in tackling health inequalities.

The purpose of this ‘Must Know’ is to understand the NCMP and how it is used locally to support local planning.

What is the National Child Measurement Programme?

The NCMP was established in 2006 and involves measuring the height and weight of children in Reception (aged 4-5 years) and Year 6 (children aged 10-11 years) at state-funded schools, including academies, in England. Every year, more than one million children are measured, and annual participation rates are consistently high (around 95 per cent), with over 99 per cent of eligible schools (approximately 17,000 schools) taking part.

The programme has two key purposes:

1. To provide robust public health surveillance data on child weight status, to understand obesity prevalence and trends at local and national levels, to inform obesity planning and commissioning and underpin the Public Health Outcomes Framework indicator on excess weight in 4-5- and 10-11-year-olds

2. To provide parents with feedback on their child’s weight status: to help them understand their child’s growth and health status, support and encourage behaviour change and provide a mechanism for direct engagement with families with children who are overweight, underweight and living with obesity.

Is delivery of the NCMP a statutory public health duty for councils?

Yes. Councils took on a duty for local delivery of the NCMP from 1 April 2013, part way through an annual collection. As a mandated public health programme, provision to resource the delivery of the NCMP is made through the ring-fenced public health grant for councils. Nationally, the programme and data analysis are overseen by the Office for Health Improvement and Disparities.

What does delivering the NCMP involve?

  • The programme is overseen by a health care professional, such as a registered school nurse or dietitian.
  • The height and weight of eligible children in Reception and Year 6 attending schools in the locality are measured annually.
  • Data collected through the NCMP are returned to NHS Digital, where it is analysed. 
  • A report summarising local and national data is then published. Local areas use this high-quality data to inform the development and delivery of services to improve the health of children by promoting a healthy weight.
  • Nationally it is used to track trends in child obesity levels over time, to inform policy and is key to monitoring progress of the government’s childhood obesity plan.
  • Operational guidance produced by the Office for Health Improvement and Disparities is used by local commissioners, providers and schools to provide detailed information about running the NCMP.
  • Every state-maintained primary and middle school, including academy and free schools, should be included in the NCMP and are included in the calculated participation rates.

Who delivers the NCMP?

In most areas of the country, delivery of the programme is commissioned as part of the school nursing service or to other provider organisations. Making sure school nursing teams and other providers have a good understanding of the programme and their responsibilities will help with effective delivery.

School nursing teams and provider organisations play an important role in leading, coordinating and advocating for the programme. They may also help to influence the development of appropriate services that respond to identified need and support the implementation of effective follow-up and referral pathways.

A registered medical practitioner, registered nurse, or registered dietitian must oversee the programme, the measuring may be undertaken by a healthcare assistant, children’s nursery nurse or similar member of staff with appropriate competencies and support.

How do you maintain the mental well-being of pupils in the NCMP?

The wellbeing of children and families is very important part of the NCMP. Measurements are conducted in a sensitive way, in private and away from other children. The weight and height information is shared with the parent or carer in a feedback letter, where letters are provided. No individual information is shared with the children themselves, the teachers or the school.

It is a parent’s choice if they share the information with their child. If a parent is concerned about their child’s growth, weight, body image or eating patterns, NCMP feedback letters provide national and local information to support parents and advise on when to seek further support from a school nurse or GP.

Does the NCMP apply to home-educated children, and children being educated in settings other than state-maintained schools?

Children educated in these settings are not included in the participation rates calculated for councils, it is down to local determination to decide whether measurements are undertaken for children attending other education settings, such as independent schools, pupil referral units, special schools, alternative provision or children who are being educated at home.

Measurement in special and privately funded schools is encouraged where possible. Data from these schools will be included in the national database and returned to councils as part of their enhanced dataset.

However, since established relations with these schools vary between areas they will not be included when calculating participation rates, nor will they be included in the national report. This is because the low participation rates from privately funded and special schools mean that the data is unlikely to be representative. For all schools that do participate, communicating results to parents and carers is encouraged.

Who will feed back the results to parents?

The approach for sharing results with parents is determined on a locally led basis – whether on a routine or request only basis. To-date, the vast majority of public health teams have shared results with parents routinely, and the others have done so on a request-only basis. National evaluation and research have consistently shown that parents want to receive their child’s result, and that sharing a child’s weight status with their parent is an effective mechanism for raising awareness of how their child is growing and the potential health risks for children of a higher weight. It also gives parents the opportunity to seek advice and support if they want it.

What can councillors do to help?

Evidence shows that parents and even healthcare professionals are poor at judging usually whether a child is a healthy weight. Councillors can help by raising awareness of the importance of promoting healthy growth and reducing the prevalence of obesity and underweight amongst children, and by raising the importance of assessing with an objective measurement, as the NCMP does, rather than assuming it is possible to judge by eye.

Councillors can also help children and parents who are concerned about their results, whether a child is a higher weight or underweight, by being aware of the leisure, healthy lifestyle and weight management initiatives that are available locally and signposting to and encouraging participation in those activities.

Councillors can play a vital role in championing a whole systems approach to address obesity and promote a healthy weight in their local area:

“A local whole systems approach responds to complexity through an ongoing, dynamic and flexible way of working. It enables local stakeholders, including communities, to come together, share an understanding of the reality of the challenge, consider how the local system is operating and where there are the greatest opportunities for change. Stakeholders agree actions and decide as a network how to work together in an integrated way to bring about sustainable, long-term systems change”.

Active member involvement sends a clear signal that promoting child health and reducing child obesity is a priority for the local area and gives officers permission to work differently. This includes providing officers with ongoing, visible and active support to local whole systems approaches, including opening and attending workshops and meetings.

The commitment and support of councillors also helps to ensure that sufficient time and resource will be available to maintain momentum. The engagement of community organisations and the public in this approach is vital to ensure that it reflects their views.

Councillors’ extensive reach into their local communities enables them to raise awareness of the benefits of helping their area give every child the opportunity to grow up healthily, as well as gaining wider support for this agenda.

How reliable is the data?

With over 99 per cent (17,000) schools and around 95 per cent of eligible children participating in the NCMP across England, the data produced are recognised as being extremely robust and reliable at national and local level.

What is NCMP data used for?

NCMP data provides robust local intelligence on child obesity prevalence and trends, to inform the Joint Strategic Needs Assessment and underpin obesity services planning and commissioning decisions. The data will underpin the Public Health Outcomes Framework indicator on excess weight in 4-5 and 10-11 year. Additionally, in most areas, data is shared directly with the parents of the children who participated. This acts as a means of direct engagement with these families.

Why is child health and reducing obesity an important issue?

Recent findings from the NHS Digital National Child Measurement Programme, England 2020/21 School Year Report found that:

  • Prevalence rates remain stubbornly high (among the highest in Europe), with prevalence increasing in all councils between the first and the last years of primary school.
  • Just over one quarter (27.7 per cent) of children in reception (aged 4–5 years) are overweight or living with obesity, rising to 40.9 per cent of children in year 6 (10–11-year-olds).
  • Across both year groups, boys have a higher obesity prevalence than girls. In Reception, 14.8 per cent of boys were living with obesity compared to 14.1 per cent of girls. In Year 6, 29.2 per cent of boys were living with obesity compared to 21.7 per cent of girls.
  • Children living in the most deprived areas were more than twice as likely to be living with obesity, than those living in the least deprived areas.

Chart: Obesity prevalence percentage by deprivation and Year Group. Source: NHS Digital 2021

Block chart shows for Year Groups reception and year6: Least deprived in reception as 7.8% and most deprived as 20.3% In year 6 Least deprived 14.3% and most deprived 33.8%

What is the impact of childhood obesity?

Child obesity is a critical public health concern issue and one of the greatest long-term health challenges faced both nationally and internationally.

The World Health Organisation estimated that in 2019, 38.2 million children under the age of five years were overweight or living with obesity globally.

Obesity was previously considered an issue for high income nations alone. However, in recent years, rates of childhood obesity have started to increase in low- and medium- income nations, particularly in areas of urban density. 

Globally, the prevalence of overweight and obesity amongst children and young people aged 5-19 years-old has increased from 4 per cent in 1975 to over 18 per cent in 2016.

In England, the prevalence of obesity vastly differs from most to least deprived areas; as the above chart illustrates, a child living in the most deprived areas is almost twice as likely to be living with obesity than a child living in the least deprived areas.

Children living with obesity are more likely to become adults living with obesity. Living with obesity in childhood puts children at greater risk of developing several health conditions in later life, including type 2 diabetes, heart disease and premature mortality in adulthood.

As well as affecting a child’s physical health, obesity can have impacts on a child’s mental health and wellbeing. Children living with overweight, or obesity are more likely to face discrimination, stigma or bullying and as a result, they may have low self-esteem.

Why should councils support it?

Councils consistently rate childhood obesity as one of their most important health issues. The delivery of the surveillance aspects of the NCMP is a statutory duty of councils. Local government is uniquely well placed to bring together the broad coalition of partners required to improve children’s health.  

The data collected can be used nationally to support public health initiatives, and locally to inform the planning and delivery of services for children (such as promoting healthy growth, weight management interventions or subsidised physical activity).

Data collected through the NCMP is used to monitor the Office for Health Improvement and Disparities Public Health Outcomes Framework indicator on excess weight in children. The data collected allows for an analysis of trends in growth patterns and obesity in children. It can also be a useful tool for local services and relevant professionals to engage with children and families about healthy lifestyles and promoting a healthy weight.

Tackling child and adult obesity is a renewed and strengthened priority for the government, as evidenced by the government’s 2020 obesity strategy: ‘Tackling obesity: empowering adults and children to live healthier lives’.

In Part 2 of the government’s ‘Childhood Obesity Plan: A Plan for Action (published in 2018) the strategy outlines the actions the government will take towards its goal of halving childhood obesity and reducing the gap in obesity between children from the most and least deprived areas by 2030.

Questions to consider

1. What healthy growth, healthy lifestyle or weight management services are available to children, young people and families in my local authority?

2. Have the findings from NCMP data been reported to the Health and Wellbeing Board to inform strategic decisions?

3. Is there a multi-agency partnership programme of work in place to promote children’s healthy growth which encompasses both the prevalence of under and overweight?  

4. Are the results from NCMP data informing the Joint Strategic Needs Assessment and underpinning planning and commissioning decisions for children who are overweight, living with obesity and underweight?

5. Is my local authority working in partnership with schools and nurseries to address issues relating to the prevalence of underweight and overweight by promoting healthy growth through healthy eating plans and active lifestyles?

Useful resources

NCMP data

View the NCMP data sets and explore national and local data:

Councils and service providers

The NCMP Operational Guidance advises local commissioners and providers of the NCMP on how the programme should be implemented:

Information about the National Child Measurement Programme (NCMP) IT system, including how to access it and guidance documentation:

Education services and headteachers

This guidance provides information for school leaders, staff and governing bodies on key tasks that schools can help with to ensure the programme runs smoothly:

Parents, carers and families

Information for parents, carers and families about the NCMP, including the NCMP process and results and signposting to resources:

Better Health - Healthier Families: Children’s Weight: The National Child Measurement Programme