In most developed (and many developing) countries, childhood obesity has become much more common over the last few decades, and is now regarded as one of the most serious global public health challenges of the 21st century.
In England, one in five four to five-year-olds are overweight or obese, rising to one in three 10 to 11-year-olds (1). This sharp increase in obesity rates over the primary school years, alongside the long-term contact that schools have with the majority of children and their parents, are two factors that have led to primary schools being seen as a key setting for obesity prevention.
Schools can provide an environment for children to eat healthily and engage in regular physical activity, and the curriculum presents opportunities for learning about healthy lifestyles. But should schools have a responsibility for obesity prevention?
As part of a research project, we interviewed 22 headteachers from socio-economically and ethnically diverse primary schools across the West Midlands to ascertain their views on the role of schools in preventing obesity (2). By understanding headteacher opinions, we hope to contribute towards shaping future approaches to children’s health in schools.
All headteachers identified that schools have an important role to play in promoting health and wellbeing, and this was seen within the context of the moral responsibility of schools towards children’s holistic development.
Headteachers discussed ways in which their schools contributed towards preventing obesity, for example through providing healthy school meals and extra-curricular activities, or the implementation of health policies aimed at promoting consistency throughout the school.
This consistency of approach between the school environment, policies and curriculum was perceived as vital in a systematic review of the views of stakeholders on the role of primary schools in preventing obesity (3).
For example, to avoid contradictory messages to children and families, school food provision (including foods provided as rewards or sold at fundraisers) should be in harmony with the healthy eating messages promoted by the school within and outside of the curriculum. There is a need for consistency between the school environment, school policies and the messages promoted within the curriculum. Ideally, these messages should also be consistent with what parents promote outside of school.
In the interviews, headteachers could see clear benefits in promoting healthier lifestyles, and the link between health and academic success was a key driver for schools. As one headteacher explained: “I think healthier children are more switched on to their learning and they seem more enthusiastic and more willing to work hard and be independent and engage with the learning.”
Despite this, there were noticeable differences between schools in some aspects of health promotion. For example, extra-curricular provision for physical activity, and the perception of its value, varied widely.
Some schools offered a huge variety of opportunities for children to engage in out-of-school-hours physical activity, whereas in other schools this was much more limited. Some headteachers discussed how a lack of equipment or space was a barrier to expanding provision.
Funding was also seen as a major influence: some schools serving deprived communities were able to provide activities for all children using Pupil Premium funding, whereas others charged parents to cover costs.
There were interesting differences in the use of school staff in the running of extra-curricular clubs, highlighted in these contrasting quotes from two headteachers: “They just can’t (run extra-curricular clubs) because they’re too busy, they have to plan lessons. I mean, most teachers ... do a 10-hour day anyway and then you just want to go home and flop, haven’t got any energy to do anything else” and “All my teaching staff are expected to do an after-school or lunchtime activity, so that’s part of their contracted hours.”
Many headteachers discussed how they would like to dedicate more curriculum time to promoting healthier lifestyles, as they believed this would benefit children both in terms of health and education.
Yet, academic demands and the “prescriptive curriculum” were found to be the principal barriers for schools in doing more. One headteacher was convinced that by committing more curriculum time to physical activity and healthy eating, test results would improve. However, she was too scared to take the gamble because of pressure from the government agenda: “If this was my school and I was able to run it in any way I wanted to, a bigger part of their education would be healthy eating and active lifestyles. I can only do it minimally because of the government agenda, which has to be the ultimate priority otherwise I get into trouble.”
This view resonates with a recent interview study with primary school teachers, where taking time away from core curricular subjects (e.g. to participate in physical activity) was also perceived as too risky (4).
Nevertheless, reviews of the association between school-based physical activity and academic performance (5, 6) have shown that increased physical activity is either positively related to academic performance or that there is no relationship, and therefore additional physical activity can be incorporated into the curriculum without hindering academic achievement.
However, until school leaders feel supported in dedicating more time to healthier lifestyles, this situation is unlikely to improve.
In our interview study, despite unanimous support for the school role in promoting health, headteachers were keen to point out that this was only a secondary role, with parents having the main responsibility.
Issues arose when it was considered that parents were not fulfilling their responsibilities adequately, for example in not providing children with breakfast or PE kit, or where parents appeared to be lacking in the knowledge and skills required to lead healthier lifestyles.
Headteachers recognised that some families face barriers to adopting healthy lifestyles and require assistance. Such barriers, including lack of time due to working hours and the costs of healthy food and activities, were also recognised by parents in a recent study (7), and were particularly the case in schools serving deprived communities. In these situations, many headteachers perceived the school role as a “backstop”, taking on responsibilities which in other schools would be seen as more in the parental domain.
One headteacher said: “We have a big gap in parenting knowledge and so we almost step into the shoes and have to do an awful lot that would ordinarily be done by parents elsewhere.”
A number of schools involved parents in health promotion activities, for example inviting parents in to work alongside their children, or parent education sessions. These attempts to engage parents were, however, often thought to be too late: “Often by the time they’ve come to us and they’re four and five-years-old, those habits have been set and it’s about unbreaking the habits. We do need to start much, much earlier.”
Although many headteachers agreed that schools were ideally placed to help families, some felt that they lacked the necessary capacity and expertise to tackle the complex issues surrounding obesity.
In some cases, difficulties in accessing support from over-stretched school nurses, a perceived lack of assistance for schools and parents following the National Child Measurement Programme, and the withdrawal of previously valued support (such as local Healthy Schools Teams and Children’s Centres) compounded frustrations.
Overall, our research suggests that headteachers are happy for schools to play a part in preventing obesity, and schools would reap the benefits in terms of academic success, if they were able to do more. Schools need to act upon what is within their control: staff should consistently encourage and promote healthy behaviours, and provide healthy role-models for children.
All schools could have active healthy eating and physical activity policies ensuring a coherent whole-school approach. However, support is required, through resources and government policy, to enable schools to expand on their current contribution. Targeting of resources to schools serving deprived communities may help to reduce health inequalities.
- Dr Joanne Clarke is a research fellow at the University of Birmingham, and has a PhD in “the role of the primary school in preventing childhood obesity”. She can be contacted by email at j.l.clarke@bham.ac.uk
References
- National Child Measurement Programme: England, 2013/14 school year (Health and Social Care Information Centre, 2014).
- Obesity prevention in English primary schools: headteacher perspectives (Clarke et al, Health Promotion International 2015).
- The views of stakeholders on the role of the primary school in preventing childhood obesity: a qualitative systematic review (Clarke et al, Obesity Reviews 2013).
- Teacher experiences of delivering an obesity prevention programme (The WAVES study intervention) in a primary school setting (Griffin et al, Health Education Journal 2014).
- The association between school-based physical activity, including physical education, and academic performance: a systematic review of the literature (Rasberry et al, Preventive Medicine 2011).
- Physical education, school physical activity, school sports and academic performance (Trudeau & Shephard, IJBNPA 2008).
- Parent and child perceptions of school-based obesity prevention in England: a qualitative study (Clarke et al, BMC Public Health 2015).