1. family and parenting
2. children

Couch kids:
the nation’s future...
Four years on from our first report into childhood
obesity and children still aren’t getting the diet or
exercise they need.
beating heart disease together
Foreword
Getting our kids off the couch - and why it matters
Currently, in the UK:
We all know that eating healthily and getting enough
physical activity are vital in helping to prevent obesity,
heart disease and other lifestyle-related ill health.
Almost two out of three adults and one in three
children are overweight or obese(1). If this
trend continues:
But this report shows us that despite concerted efforts
to get kids more active in recent years, worrying gaps
remain. A disturbingly high number of young people
in all four nations of the UK aren’t reaching the target
of 60 minutes of physical activity every day. Indeed, in
England, for example, 15% of boys and 19% of girls
aren’t even achieving 30 minutes a day.
Research has suggested that, without appropriate
intervention, overweight or obesity could affect as
many as nine out of ten adults and two out of three
children by 2050(1).
If we are serious about reversing the tide of
childhood obesity, we need to act now.
The British Heart Foundation (BHF) continues to call for
the toughest restrictions on the marketing of unhealthy
food to children and for an environment that empowers
parents, for example through better food labelling, to
make healthy food choices for their children. This must
be accompanied by action to ensure that opportunities
for kids to get more physically active are accessible,
appealing and part of everyday life.
While we shouldn’t underestimate the progress that
has been made in some parts of the UK, such as the
increase in PE hours taught in English schools, we
need to move decisively, and quickly, to ensure that
the current generation of our children and young
people have the best chance of long and healthy lives.
Peter Hollins
Chief Executive
British Heart Foundation
It’s an international problem. In 2003 the World Health
Organisation suggested that overweight and obesity
were starting to replace undernutrition and infectious
diseases as the most significant contributors to ill health(2).
And it’s especially important for our children.
Obese children are more likely to become obese
adults(3), making them more vulnerable to serious
conditions which increase the risk of heart disease,
strokes and some cancers. Conversely, active children
are more likely to be active adults(4).
There is clearly no single cause of the growing increase
in obesity - sedentary lifestyles, dietary changes, a
social environment conducive to obesity, and other
factors all play a part. However, evidence now exists
which shows that physical activity is one of the factors
that can play a major role in improving the future
health and wellbeing of our children.
This report presents the results of current research on
why physical activity is so important for our children,
how much physical activity they do, how much they
need and what provision is and should be made to
help them be more active. It assesses the levels of
obesity among our children and, crucially, puts forward
recommendations for action. In order to do this, we
have drawn on evidence from England, Scotland,
Wales and Northern Ireland, although in some areas,
more research is urgently needed to help us address
these vital issues.
The BHF will continue to campaign tirelessly on
this issue. Because we believe that the tide of
obesity can be turned, and that if all of us, from
government to individual parents, work together,
our children, and future generations, will live more
active, healthier, and happier lives.
2
Contents
Why is physical activity important for our children and young people?
4
How much activity should children and young people do?
6
• Children and young people aged five and over 6
• Children from birth to five years 7
How active are children and young people in the UK?
8
• Activity in schools 14
• Active transport 17
• Activity in leisure time outside school 19
How sedentary are our children and young people?
20
Factors associated with physical activity in children and young people
22
What motivates our children and young people to be active? And what
barriers stop them?
24
How good are our children’s and young people’s diets?
27
Obesity in children and young people
30
• Prevalence of overweight and obesity 30
• Differences in the prevalence of overweight and obesity according to gender,
ethnicity and socio-economic group 30
• Trends over time 30
• Potential health problems associated with obesity 32
• Possible causes of obesity 33
• Tackling the issue 33
• Young people’s concerns about their weight 33
Conclusion and recommendations
35
• The BHF and physical activity 38
Appendix 1. Key factors associated with physical activity for young people
40
3
Why is physical activity important for our children and
young people?
‘Evidence demonstrates that the physical fitness
and health… of children and young people are
substantially enhanced by frequent physical activity.’(5)
In 2004, a Department of Health report highlighted
the current and future health benefits of physical
activity for children and young people(6), which has
recently been supported by wide-ranging reviews of
the existing evidence(7)(5). While it is difficult to identify
clear outcomes of physical activity for children,
there is sufficient evidence to indicate that physical
activity is an important health behaviour that should
be encouraged(8)(9)(7).
Direct health benefits
Physical activity can help prevent overweight
and obesity and Type II diabetes, improve skeletal
health and can have psychological health benefits
for children(7). Some of the findings of a recent,
comprehensive review of the evidence(5) are:
Table 1: Health benefits of physical activity for children
and young people(5)
There is strong evidence for:
• better cardiovascular and metabolic health
• improved cardiorespiratory endurance and
muscular fitness
• stronger bones
• more favourable body fat composition.
There is some evidence for:
• reduced symptoms of anxiety and depression.
Potential improvement of health in adulthood
There is limited evidence that childhood physical
activity directly affects health in adulthood(7):
•
Obesity tracks from childhood to adulthood (ie,
obese children are more likely to be obese adults).
Physical activity helps maintain optimal body
weight in childhood, and consequently can help to
reduce the risk of obesity in adulthood(7).
• Stronger bones developed in childhood may reduce
the risk of later osteoporosis.
Increased likelihood of continuing to be active
as an adult
It is possible that an active lifestyle in childhood and
adolescence may track through into adulthood.
The potential tracking of physical activity from
childhood to adulthood is important as there is
comprehensive evidence that an active lifestyle in
adulthood has direct health benefits(6).
Although it’s difficult to determine the extent of
tracking from childhood to adulthood, it seems
physical activity does track. Research varies as
to whether the correlation is small(7) or small to
moderate(10), with stronger correlations between
adolescence and adulthood(10).
Tracking may be stronger among the more active(4)
and when the quality of the physical activity
experience in childhood is improved (11)(12)(13).
Other possible benefits
Physical activity and fitness in childhood may:
• improve cognitive function(7)
Cardiovascular disease (CVD) is the UK’s biggest killer,
and substantial evidence shows that CVD has its
origins in childhood(7). Although there is only a small
association between CVD risk factors and physical
activity in youth(6)(7), it seems that physically active
children and young people have more favourable
cardiovascular and metabolic risk profiles(5).
There is sufficient evidence to indicate that
physical activity is an important health
behaviour that should be encouraged.
4
• improve academic achievement(14)
• accelerate neurocognitive processing(15).
Some researchers suggest that physical activity may
be the best stimulus for the brain to be ready to learn
and grow(16)(17) and that solving problems through
play drives the development of neural pathways in
the brain(18).
Active children are also less likely to smoke, or to use
alcohol / get drunk or take illegal drugs(19)(20).
The UK ranked bottom out of 21 of the world’s richest
countries in UNICEF’s report on children’s wellbeing(21).
A wide range of factors were considered in relation to
children’s wellbeing including physical activity.
Physical activity is associated with psychological
health benefits including improved self-esteem(7) and
may therefore have an important role in improving
wellbeing. Children and young people see play as
important to them, and potential benefits associated
with play include:
• building resilience(22)
• contributing to development and learning(23)
• providing an opportunity to explore, experiment
and understand(23)
• rehearsing specific skills that may be needed in
adult later life(24).
Summary
With 33% of 15 year old girls and 19% of 15 year
old boys in Great Britain rating their health as fair or
poor(28), identifying ways to improve adolescents’
perceptions of their health is important and physical
activity may have an important role to play in this.
Overall there is a strong rationale for promoting
physical activity among children(7).
Identifying ways to improve adolescents’
perceptions of their health is important
and physical activity may have an
important role to play in this.
Benefits for individuals with a disability
There is strong evidence that physical activity can
improve the health of those with a physical or
cognitive disability(5), (please see p.12) although this
research was not specifically focused on children and
young people.
Benefits for preschoolers
There is growing evidence that increased physical
activity in preschool children is associated with
improved physical health status (including, for
example, adiposity, bone health and cardiovascular
risk factors)(25)(26)(27). However, more research is needed
in this area.
5
How much activity should children and young people do?
Evidence appears to suggest that a minimum
target of 60 minutes of physical activity a day is
appropriate for children and young people aged
5 to 18. There is a suggestion that more physical
activity may be better(29) and that the inclusion
of vigorous activity could have important
additional benefits(5).
It is clear that young people should participate in
certain types of physical activity to improve their
overall health. However, there’s not enough data
to produce definitive guidelines on the minimal or
optimal amounts of physical activity they need to
gain particular health benefits(5).
Children and young people should achieve
a total of at least 60 minutes of at least
moderate intensity physical activity
each day.
Children and young people aged five and over
UK guidelines
The current physical activity guidelines across the UK
are similar but not the same as indicated in Table 2:
Table 2: Current physical activity guidelines in the UK
Country
England(6)
Northern Ireland
Scotland(30)
Wales(31)
Guideline
A total of at least 60 minutes
of at least moderate intensity
physical activity each day
This should include activities to
improve bone health, muscle
strength and flexibility at least
twice a week
A total of at least 60 minutes
of at least moderate intensity
physical activity each day
At least 60 minutes of moderate
activity on most days of
the week
60 minutes of moderate
intensity physical activity on at
least five days of the week
The 60 minutes physical activity can be accumulated
throughout the day. This suits the sporadic nature of
6
childhood activity and may be as beneficial as longer
exercise sessions(32). However, some researchers have
suggested longer sessions may be necessary to help
prevent childhood obesity(33).
Table 3: Examples of activities to help children and
young people meet the physical activity guidelines
Moderate
Brisk walking, swimming,
intensity activities cycling, PE, dancing and
most sports
Activities to
Climbing, skipping, and jumping
enhance strength for younger children and body
conditioning and resistance
exercise for adolescents
Activities to
Gymnastics, dance, aerobics,
enhance bone
running, skipping and sports
health
such as basketball
Although most of the UK guidelines are well
established, awareness of them is poor, with only 10%
of both boys and girls in England able to correctly
recall the guideline(34). And, in Northern Ireland, only
8% of parents could recall the guideline(35).
EU guidelines
The European Union and its member states also
recommend a minimum of 60 minutes daily moderate
intensity physical activity for children and young
people(36). However there are concerns that this level
of activity may not be sufficient, particularly in terms
of preventing increasing levels of obesity(6)(37)(38).
In addition, physical activity at a vigorous, rather than
moderate, intensity, is recommended for maximum
cardiovascular protection(6)(5) and greater increases in
bone health(29).
Only 10% of both boys and girls in
England are able to correctly recall
the physical activity guideline.
Other countries’ guidelines
The US, Australia and Ireland, like the UK, all recommend:
•
at least 60 minutes of physical activity per day,
however, guidelines in these countries
include a combination of moderate and
vigorous activity(39)(40)(5)(41).
Further, the US recommend that young people
participate in vigorous intensity activity at least three
days per week in order to cause more improvement in
cardiorespiratory fitness(5).
Canada’s guidelines also include moderate to vigorous
intensity activity, and recommend that young people
should aim to increase their physical activity by 90
minutes a day (over five months), 30 minutes of
which should be vigorous(42)(43). A recent review of the
Canadian guidelines(29) has suggested retaining the
vigorous intensity but suggests a possible minimum
target of 60 minutes physical activity a day.
Like the UK, Canada, the US and Ireland all recommend
that young people include muscle and bone
strengthening activities as part of their 60 minutes
activity, with the US and Ireland suggesting this should
happen at least three days a week (as compared to the
two days currently recommended in England).
Children from birth to five years
Intuitively, physical activity during earIy childhood
would seem natural and beneficial and evidence is
emerging of the potential benefits of physical activity in
this age group. A Canadian review(37) found that there is
currently little research to support a specific guideline
on the level of activity among preschool children
(2 - 5 years) that will significantly improve their health.
As little as an additional 60 minutes a week of
physical activity may improve bone properties, aerobic
fitness and motor skills in some children(37), but more
research is needed as the scientific evidence is too
weak to determine specific activity guidelines for this
age group.
While these guidelines seem reasonable, there is
no clear relationship between physical activity and
specific health outcomes in preschool children and
the amount and type of physical activity required to
optimise healthy growth and development during the
preschool years is not yet known(37).
However, some guidelines on how best to
encourage preschoolers to be active are important.
The Canadian review has suggested some more
general recommendations for preschoolers:
Table 4: Recommendations for physical activity in
preschool children(37)
•
Promoters of physical activity for preschool
children should consider their natural activity
patterns, which are typically spontaneous
and intermittent.
•
Physical activity for preschool children should focus
on gross motor play (eg, play activities involving
large muscle groups and whole body movements)
and locomotor activities (eg, walking, running,
galloping) that children find fun.
•
Physical activity experiences for preschool children
will be enhanced by adult facilitation (including
modelling) that provides mastery experiences (ie,
activities they can achieve successfully) and
positive feedback about those experiences.
• Whenever possible, preschool children should
be given access to play spaces and
equipment outdoors.
There are currently no recognised activity
recommendations for under-5s in the UK.
However, US guidelines suggest that preschoolers
aged 12-36 months should accumulate at least 30
minutes daily of structured physical activity and those
aged 3 - 5 years at least 60 minutes(44). In addition,
preschoolers should engage in at least 60 minutes
and up to several hours of daily, unstructured physical
activity and should not be sedentary for more than 60
minutes at a time except when sleeping.
As little as an additional 60 minutes a week
of physical activity may improve bone
properties, aerobic fitness and motor skills
in some children.
7
How active are children and young people in the UK?
National health surveys show that there are still
significant proportions of young people, especially
adolescent girls, who are not reaching the
recommended levels of physical activity. Studies using
objective measures indicate even higher numbers of
children and young people are not achieving the 60
minutes a day target.
Overall activity levels based on national
health surveys
2-15 year olds achieving 60 minutes a day, seven
days a week outside school hours (See Figure 1)
Boys
Girls
England (2007)
72%
63%(34)
Scotland (2003)
74%
63%(45)
Wales* (2007)
42%
30%(46)
* includes school time
However, 61% of boys and 49% of girls aged 4 -15 years
in Wales do reach the recommended target on at least
five days a week. Less data are available from Northern
Ireland as they do not currently have a comparable
health survey, but indications are that activity levels
here are low - one survey of 8 -12 year-olds found only
24% took part in 60 minutes a day(47) and another
revealed only 15% of young people taking part in
60 minutes a day of sport, exercise or active play that
made them ‘out breath or hot and sweaty’(48).
In comparing countries, it should be recognised that
differing research methodologies may have some
influence on the respective levels of activity recorded.
In England 15% of boys and 19% of girls
don’t even achieve 30 minutes of activity
each day.
Although activity levels appear relatively high in
England and Scotland, even in these countries a
disturbingly high number of young people aren’t
reaching the 60 minutes target. In England 15%
of boys and 19% of girls aren’t even achieving 30
minutes of activity each day (see Figure 2). In Wales, the
situation is equally worrying with 11% boys and 12%
girls not participating in 60 minutes of activity on any
day of the week(46). And in Northern Ireland, 22% of
11 to 16 year olds did not take part in even moderate
intensity activity on any day of the week(49).
8
The 2005/06 Health-Behaviour in School-aged
Children (HBSC) survey(28), conducted by the World
Health Organisation, which collects national data on
the physical activity levels of young people aged 11,
13 and 15 years, from 41 countries and regions,
is revealing.
The survey showed that, in England, Scotland and
Wales (Northern Ireland is not included in this survey),
the percentages of young people participating in 60
minutes of moderate-to-vigorous activity daily was
similar to the average for all the countries and regions
(see Figure 3). However, it is worrying that these figures
indicate high percentages of young people may
be missing out on the benefits of physical activity,
particularly as emerging evidence indicates that
vigorous activity may be important(5).
Average numbers of children achieving 60 minutes
of moderate to vigorous activity a day in England,
Scotland and Wales
Boys
Girls
11 yrs
34%
21%
15 yrs
20%
9%(28)
It is also troubling that 3 -5 year olds, who are generally
thought to be spontaneously active, may only
be taking part in limited amounts of moderate to
vigorous intensity activity(50)(51).
Objective measurements of physical activity
Objective measures consistently report lower
levels of activity than those reported by
children themselves.
The Health Surveys in England(34), Scotland(45) and
Wales(46) report relatively high levels of participation
in physical activity. However, because these surveys
rely on questionnaires to collect data, they are unlikely
to be as accurate as objective measurements, and
may substantially overestimate the number of young
people achieving the 60 minutes a day target(52)(53)(54).
While objective measures of physical activity
consistently record lower levels of physical activity,
these discrepancies vary. Studies using accelerometers
adopt different thresholds which affects the levels of
activity measured. For example, one study using three
METs* to represent ‘moderate’ intensity found that
60
70
50
60
40
50
30
40
Figure 1: Percentage of young people participating in
a minimum of 60 minutes physical activity of at least
moderate intensity on seven days a week
20
30
Figure
3: Percentage of young people aged 11 and
15
who
report participating in at least 60 minutes of
10
20
moderate-to-vigorous activity daily (2005/06)
0
10
80
0
70
40
60
20
25
20
70
15
20
10
60
10
15
0
50
5
10
40
Sources:
80
England: Health Survey for England 2007. See reference 34.
30
Scotland:
Scottish Health Survey 2003. See reference 45.
70
Wales: Welsh Health Survey 2007. See reference 46.
20 Health Survey for England and Scottish Health Survey do
Note:
60
not include physical activity within school.
10
50
Figure
2: Percentage of young people in England
0
achieving
high, medium and low levels of physical
40
activity (2007)
25
Figure
3b: 15 year olds
25
20
20
20
70
15
10
10
60
10
High
Medium
Low
5
5
40
40
0
30
35
0
80
20
30
HBSC average = the average for all 41 countries and regions in the
70
80
Health
Behaviour in School-aged Children Study.
10
25
High
Medium
Low
15
Source:
Health Survey for England 2007. See reference 34.
40 High = 60mins, 7 days a week;
Note:
Medium
= 30 -59 mins, 7 days a week;
10
35 = lower level or not at all.
Low
25
Low
0
15
20
Medium
0
5
30
80
0
25
High
25
30
30
80
5
30
Low
30
35
40
0
20
Medium
35
40
50
0
50
High
Figure 3a: 11 year olds
Source: Inequalities in Young People’s Health. Health Behaviour in
60
70
School-aged
children international report from the 2005/06 Survey.
See reference 28.
50
60
40
50
30
40
20
30
10
20
0
10
9
42% of boys and 11% of girls met the 60 minutes a day
guideline(55) while only 5.1% of boys and 0.4% of girls
were found to achieve 60 minutes a day in another
study that used four METs as the cut-off point(53).
*A Metabolic Equivalent Task (MET) is a measure used to compare the
energy expended doing an activity as compared to that expended at
rest (one MET).
Although objective measurements provide more
accurate data, tools such as accelerometers are costly
and complex and therefore would be difficult to use to
collect population-level data(34).
Trends in physical activity levels
There have been no major changes in young
peoples’ physical activity levels over the last
5 - 10 years.
Figure 4 shows that there have been no major
changes in the percentage of young people reaching
recommended activity levels in England between 2002
and 2007 or in Scotland between 1998 and 2003.
However, the Scottish data does show bigger
changes in some age groups, particularly for girls,
which is encouraging:
Girls achieving the 60 minutes a day target
in Scotland
5 - 7 yrs
8 - 10 yrs
13 - 15 yrs
1998
68%
64%
36%
2003
75%
75%
41%(45)
One positive trend in England seems to be a decline
in the proportion of people in the lowest physical
activity group, particularly among girls, which suggests
that some of the least active are starting to do more,
although they are still not reaching the recommended
60 minutes.
There have been no major changes in the
percentage of young people reaching
recommended activity levels in England
between 2002 and 2007.
10
Percentage of young people who did at least 30
minutes physical activity, seven days a week:
Boys
Girls
1997
64%
51%
2002
73%
65%
2007
85%
81%(56)(34)
Differences by gender
A consistent finding across all studies, both
those using surveys and those using objective
measurements, is that boys are more active than girls
across the 2-15 years age range.
The differences in activity levels between boys and
girls are apparent even at an early age(50) but the gap
between the sexes is greatest in adolescence(8)(57)(58).
The Health Survey for Scotland shows that boys
consistently record higher levels of physical
activity than girls. The gender gap was particularly
pronounced among older age groups: 68% of boys
aged 13-15 years participated in 60 minutes activity a
day compared to 41% of girls(45).
The differences in activity levels between
boys and girls are apparent even at an
early age.
Similarly, 15 year old boys in Wales were found to be
twice as likely as girls to take part in recommended
levels of activity(59), and in England 66% of 15 year old
boys participated in physical activity for 60 minutes a
day as compared to 47% of girls(34). The HBSC survey(28)
also shows consistently lower levels of physical activity
among 11-15 year old girls than among boys.
Studies using objective measurements have similarly
found boys to be more physically active than
girls(54)(53)(55), with differences observed both in the
percentage of boys and girls meeting the 60 minute a
day guideline and the time spent participating in
physical activity.
One study found that 42% of boys met the 60 minutes
a day guideline as compared to only 11% of girls.
Girls also spent 27% less time than boys participating
in physical activity (45 minutes a day versus 57
minutes a day(55)).
15
25
10
20
5
Young people’s perceptions of their own levels of
physical activity mirror these gender differences:
42% of boys and 29% of girls aged 11-15 years saw
themselves as ‘very physically active’ compared to
others and 10% of boys and 16% of girls said they were
‘not very’ or ‘not at all’ physically active(34).
Figure
4: Trends in percentage of young people
15
0
participating
in at least 60 minutes of moderate
physical activity daily
Differences by age
60
Physical activity levels of girls decrease with age, with a
particular drop-off after the age of about 10 years.
Scotland(45)
The Health Survey for
shows that boys
appear to maintain relatively high levels of physical
activity between 2 and 15 years but girls’ activity levels
decline, particularly after 10 years of age (see Figure 5).
This also held true for England:
Physical activity levels of girls decrease with
age, with a particular drop-off after the
age of about 10 years.
Girls meeting recommended levels of
physical activity (Scotland)
Age
Girls
8 - 10
75%
11 - 12
57%
13 - 15
41%*(45)
*By comparison, 68% of boys met the recommended levels.
Girls meeting recommended levels of
physical activity (England)
10
80
70
5
0
50
40
80
30
70
20
60
10
50
0
40
Sources:
30
England: Health Survey for England 2002 and 2007.
80 references 56 and 34.
See
20
Scotland:
Scottish Health Survey 2003. See reference 45.
70
10
Figure 5: Differences in percentages of young people
60
in0 Scotland achieving at least 60 minutes of moderate
intensity
physical activity daily according to gender
50
and age (2003)
40
80
30
70
20
60
10
50
Age
Girls
0
40
8
73%
30
15
47%(34)
There was also an increasing proportion of girls in
the ‘low’ physical activity category from the age of 12
onwards, with 17% of girls aged 10 and 11 and 34% of
those aged 15 years in this category(34).
20
10
0
Source: Scottish Health Survey 2003. See reference 45.
11
Differences by socio-economic status
There is no clear association between overall
physical activity and socio-economic status, but
there is evidence that socio-economic status may
affect the type of physical activity young people
participate in.
Although socio-economic status appears to have
little significant impact on physical activity levels,(58)
(60)(34), the 2003 Scottish Health Survey(45) did find a
slight tendency for girls’ activity to increase as income
decreased. For example, 68% of girls in the lowest
income quartile met the guidelines compared with
61% in the highest. However, the HBSC survey(28) found
that boys and girls from less affluent families tend to
report lower levels of activity.
However, if the primary significance of socio-economic
status (or social class) is that it determines life choices,
it may affect the type of physical activity young people
participate in(61). For example, the 2007 Health Survey
for England(34) found that participation in sport and
exercise tended to increase as comparable household
income increased, while the reverse was true for
walking, with higher levels of participation among
those in the lowest socio-economic group.
Socio-economic status can also influence the type
of physical activity young people do through its
impact on their participation in clubs. A survey in
2002(62) found that young people living in the 20% of
most deprived areas in England were less likely to be
members of a sports club than those living in other
areas (35% versus 47%), and were less likely to take
part in sport at youth clubs or other organisations
(48% versus 58%).
Participation among children and young people
with a disability
Children and young people with a disability take part
in physical activity and sport less frequently and their
experiences are less positive than their non-disabled
peers(63) and the proportion of those with a disability or
severe illness participating in sport and exercise tends
to be lower than for young people generally(64).
(Please also see p.5)
12
Participation among children and young people
from different ethnic groups
Ethnicity has an influence on participation in
physical activity.
With the exception of Pakistani boys and Irish boys
and girls, children in minority ethnic groups are less
likely than the general population to achieve their
60 minutes a day(65). Additionally, in most groups, girls
are less likely to have a high level of physical activity
than boys, though the proportions of boys and girls
achieving this level of physical activity are similar
among Black Caribbean, Chinese and Irish children.
Chinese boys (38%) were much less likely than boys
in other groups to have achieved the recommended
level of physical activity. Among girls, the proportions
who had reached this level ranged from 36% of
Pakistani girls to 60% of Irish girls.
A recent study also observed that Asian pupils and
black girls were considerably less active than white
pupils(66). Other studies also showed that both
adult and young South Asians consistently report
lower levels of physical activity compared to the
general population(67)(65).
Other participation patterns
A variety of other factors also influence activity levels.
Region
Activity levels are likely to vary from region to region
within each country. For example, in London only 63%
of boys and 50% of girls achieved the guideline,
while South West England recorded the highest
levels (81% of boys and 75% girls)(34).
Season
The time of year appears to have an effect, with
children being most active in the summer and least
active in the winter(68)(53)(69). Also, during school term
time, young people may be more active during
the week than at weekends(70)(53) but there may be
differences between boys and girls, with boys possibly
engaging in higher activity levels at weekends(71).
Some young people are less active during school
holidays(48) and, given free choice, as in holidays and at
weekends, children’s daily activity drops(72).
Parental activity
Parents’ physical activity levels also appear to influence
their childrens’. In households where both parents
reported high levels of physical activity, children in all
age and gender groups were also more likely to report
higher levels than households with only one active
parent(34). Parental physical activity levels may have
a particular impact on girls: teenage girls with low
activity levels have the highest proportions of parents
with low activity levels.
Much of the data are based on the percentages
of young people meeting the guideline of
60 minutes a day of moderate intensity activity.
There are indications that this level of activity may
not be sufficient to achieve all the potential health
benefits(5). However, if the UK guidelines are revised
in line with those adopted by some of the other
countries, data from the 2005/06 HBSC survey(28)
shows that even greater percentages of young
people may not reach recommended levels of
physical activity.
Summary
At best, there are still significant numbers of young
people not meeting the recommended levels of
physical activity, especially adolescent girls, with about
30% of boys and 40% of girls in England and Scotland
and significantly more than this in Wales and Northern
Ireland reportedly not reaching the 60 minutes a
day target(34)(45). However, studies using objective
measurements suggest that the situation could be
much worse, and further research is needed to fully
understand the current activity patterns of young
people in the UK.
The lack of awareness of the 60 minutes a day physical
activity guidelines among young people could be one
contributing factor to low activity levels among some
groups and this needs to be addressed.
There are significant numbers of young
people not meeting recommended levels of
physical activity…
The evidence particularly highlights a need to target
the low activity levels of adolescent girls who appear
to be missing out on the many benefits associated
with an active lifestyle. If girls are unsuccessful
in changing their activity patterns as they move
into adulthood, they could be more vulnerable to
those health problems associated with inactivity(34).
Interestingly, girls aged 11 -15 years (74%) were more
likely than boys (61%) to want to do more physical
activity regardless of age(34) so it appears there is the
potential to improve this situation.
…however, some studies suggest that the
situation could be much worse.
13
Activity in schools
Although the amount of curricular PE that schools
offer varies across the UK, in all cases extra-curricular
activities and breaktimes / lunchtimes provide
valuable opportunities for pupils to participate in
additional activity.
Schools have a vital role to play in helping our children
and young people get more active, by promoting
physical activity(73) and providing opportunities for, and
knowledge about, the activity our children need.
Within the UK, there are targets for all nations
regarding curriculum allocation for PE, which centre
around achieving a minimum of 2 hours per week.
However, the infra-structure and delivery mechanisms
for school sport and activity vary considerably across
the UK. In England, there is a long term Government
ambition as part of the School Sport and Young People
Strategy (PESSYP) which aims to offer all children at
least five hours of sport every week, comprising:
• at least two hours high quality PE in the curriculum
(for 5 -16 year olds)
•
the opportunity for at least a further three hours
sport outside the school day, delivered by a
range of school, community and club providers
(for 5 -19 yr olds).
The results are encouraging. In English schools taking
part in School Sports Partnerships, 90% of pupils took
part in at least two hours of high quality PE and out
of hours school sport in a typical week(74). This is a
significant increase on previous years, with the greatest
gains made in Years 1 (5 - 6 years) and 2 (6 - 7 years)
(see Figure 6). The percentage of pupils taking part
at this level increased from 56% in 2004/05 to 95%
in 2007/08.
Curriculum PE
For some young people, PE remains their only
structured or organised, regular physical activity.
It’s therefore crucial that all pupils receive at least two
hours of the highest quality physical education a week.
However, the National targets for PE and school sport
are, on their own, not sufficient to help children and
young people achieve the seven hours of physical
activity a week to receive all of the health benefits
from being active.
14
There has been a significant increase in the number
of young people participating in two hours or more
of curricular PE in England. In 2007/08 78% of pupils
participated in at least 120 minutes of curriculum
PE - compared to just 34% in 2003/04(74) (see Figures
7 and 8). This improvement is promising, and has had
a major impact on the success of the overall levels of
participation in PE and school sport, but it also means
that 22% of young people are still not receiving the
recommended two hours each week.
However, this represents the time teachers say pupils
spend in PE, rather than the actual amount of activity
they do. It’s likely that pupils are getting much less
than two hours of actual activity in their PE lessons.
One study showed that pupils were moderately
or vigorously active for approximately 18% of the
available lesson time - an average of only 6.6 minutes
per lesson(75).
22% of young people are still not receiving
the recommended two hours of PE
each week.
As with the percentage of pupils participating in at
least 2 hours of school sport, rates are fairly similar for
Years 1 - 9 but then drop by around 20 minutes at Years
10 (14 -15 years) and 11 (15 -16 years) to 99 minutes
and 96 minutes respectively. This drop in provision
is of concern, given the low levels of activity among
adolescent girls(74).
Provision in primary schools has significantly increased
between 2003 and 2008 with the greatest increases for
Years 1 & 2 - from 96 to 122 minutes per week(74).
Across all year groups, just 8% of pupils participated in
less than 90 minutes of curriculum PE in a typical week
while 12% had more than 150 minutes.
Schools in Scotland, Wales and Northern Ireland are
falling short of achieving the two hours curricular PE.
In Wales, primary schools offer, on average just 93
minutes per week across year groups and secondary
schools 99 minutes (ranging from 116 minutes in
Year 7 to just 77 minutes in Year 11)(76)(77). The HM
Inspectorate of Education for Scotland (HMIE) have
stated that, in 2008, of those primary schools inspected
in Scotland only a third were providing two hours of
PE at each stage and in secondary schools two thirds
of schools met the target at S1/S2, the majority at S3/4
and only one in seven at S5 and S6(78). In Northern
Ireland just 14% of primary schools pupils receive two
100
80
60
hours curriculum PE per week(79). In Northern Ireland
51% of pupils in secondary schools spent two or more
hours a week doing PE or games at school, 45% spent
up to two hours and 3% spent no time(49).
Figure 6: Changes in the percentage of young people in
different year groups participating in at least 2 hours of
high quality PE and out of school hours school sport in
a typical week
Figure 7: Total curriculum time that all pupils in each
year group spend taking part in PE in a typical week.
40
150
20
120
0
90
Figure 6a: Primary
100
100
60
80
80
100
30
60
60
80
0
40
40
60
Source:
School Sport Survey 2007 / 08. See reference 74.
20
20
40
0
20
1000
Figure 6b: Secondary
80
100
60
80
Figure 8: The amount of curricular PE per week in SSP
0
schools,
England 2007/08
80
70
60
50
40
40
60
20
40
30
20
10
0
20
0
800
70
Source:
School Sport Survey 2007/08. See reference 74.
80
60
70
50
60
40
50
30
Source:
School Sport Survey 2007/08. See reference 74.
60
50
40
15
30
Daily physical activity
Time constraints are the most often cited reason for
pressures on curriculum time for PE(80). However, there
is a move to improve out of school provision and
introduce daily physical activity sessions to broaden
and expand on what is offered in curriculum time.
The most effective school-based activites are those
which occur throughout the whole school day as part
of the curriculum(81). More schools have introduced 10
minute daily physical activity sessions, which have a
positive impact on; academic performance, students’
concentration and cognitive functioning(82), as well as
helping pupils focus on their classroom tasks(83).
Extracurricular activities
Extracurricular activities can be a fundamental
link between curricular PE and young people’s
participation in sport and physical activity in their
leisure time(84).
In England, there has been a substantial increase in
the range of activities available to pupils out of
school hours in schools involved in School Sport
Partnerships as a result of the national drive to raise
participation levels(85)(86). The latest School Sport
Survey(74) showed that 12% of pupils achieve their
two hours of PE and school sport through a ‘top
up’ of out-of-hours school sport, including lunch or
breaktime activities, rather than through curriculum
PE. In Northern Ireland, 50% of boys and 37% of girls
(aged 11-16) took part in sport or physical activity after
school on at least one day a week(49).
However, there is concern about the kinds of
extracurricular activities on offer and the strongly
competitive, performance and sporting orientation that
appears to characterise extracurricular provision(87).
In Northern Ireland, 50% of boys and
37% of girls (aged 11-16) took part in
physical activity after school at least one
day a week.
16
This is particularly true in Scotland, where there has
been a decrease in the number of pupils taking part
in extracurricular activity, with evidence suggesting
that school provision appeals to those who are already
keen to participate, resulting in a small number of
pupils taking part in large amounts of activity(88).
Only up to half of young people may be taking part in
extracurricular activities:
Participation in out of school activities
Wales
Scotland
58%
60%
Primary
Secondary
42%(89)
29%(90)
In addition, data from Scotland indicate that the
percentages taking part in after school clubs are
increasing among pupils in primary schools but
decreasing for secondary school pupils and boys in
secondary schools (36%) are more likely than girls
(22%) to go to a club.
Club-based activity plays an important part. In
England, schools had links to an average of 7.6
different clubs during 2007/08, up from just 5
in 2003/04:
Pupils participating in school-linked club-based
activity (England)
Yrs 2 - 11 (av.)
32%
Primary
40%
Secondary
25%
Yr 11
19%(74)
Participation in club-based activities in Wales is higher,
but this data does not specifically focus on clubs linked
to schools:
Pupils participating in club-based activity (Wales)
Primary
78%
Secondary
73%
of which:
Boys
59%
Girls
47%(89)
And, in Northern Ireland, 59% of pupils were members
of a club or team (not connected with their school)
that involved them in sport or physical activity(49).
Breaktimes
Children in the UK can have up to 600 break periods
at school per year(91), providing valuable opportunities
to take part in daily physical activity. Primary school
boys and girls aged 5-10 years may spend about
30% of breaktimes engaged in moderate to vigorous
physical activity (MVPA) with boys tending to be more
active than girls(92). In a survey of 11 to 16 year olds in
Northern Ireland, 58% of boys said they were active
during lunchtimes as compared to 15% of girls, while
during breaktimes 38% of boys were active compared
to only 7% of girls(49).
Environmental changes, eg, providing playground
markings(93), obstacle courses(94), and equipment(95)
have been found to increase breaktime MVPA levels.
Although children take part in self-directed active
play, schools also often provide activity sessions /
clubs at breaktime. For example, in Scotland 25% of
extracurricular activities in secondary schools take place
at lunchtime and 27% of primary school pupils and
29% of secondary attend lunch/breaktime clubs(90).
Active transport
Active transport (such as walking and cycling),
particularly to and from school, has decreased in the
last three decades but there are initial signs that this
downward trend may be starting to change.
Since 1975, the change in school journeys from
walking and cycling to car has been marked
(see Figure 9, p.18). However, evidence suggests that in
the last few years this trend may be slowing:
Journeys to school
On foot
By car
1975/76 (5-15 yrs)
61%
11%(96)
2005/06 (5-16 yrs)
46%
30%(97)
Fewer parents now allow their children to walk to
school unaccompanied(99).
Journeys to school alone (5-10 yr olds)
1985/86
2005
21%
6%(99)(100)
Even greater changes are evident if comparisons are
made with earlier years. About 40% of people born in
1932/41 travelled to school alone at the age of 10-11
years compared to 9% of children of a similar age born
in 1990/91(101).
Active transport particularly to and
from school, has decreased in the last
three decades.
The decline in active transport to and from school
may be starting to change(97). There have been slight
increases in the proportion of young people walking
to and from school:
Journeys to school
5 - 10 yr olds
11 - 16 yr olds
2003
51%
40%
2006
52%
41%(97)
17
60
50
50
40
40
30
30
20
Although these figures are still less than those
recorded in 1995/97, and a long way short of numbers
walking to school in the 1970s, they are a promising
move in the right direction.
Between 2003 and 2006 levels of cycling remained
static at 1% in the younger age group, but have
risen in 11-16 year olds from 2% to 3%. There was a
corresponding decrease, of three percentage points in
13-16 year olds being taken to school by car but there
was no change for children aged 5 -10 years.
Encouraging schools to introduce travel plans may be
contributing to these possible positive changes.
These plans reduce car journeys to and from school
in 60 to 90% of schools and at the end of March 2007
more than 14,000 schools in England (56%) had an
approved travel plan in place(102).
Walking to school may make a significant contribution
to young people’s activity levels and, particularly for boys,
active transport may contribute to a more physically
active profile across the day(70)(103)(104)(105)(106)(107).
Findings have included the following:
• The journey to and from school can contribute
8-14 minutes per day of moderate to vigorous
intensity activity(103).
• Children aged 12-13 may use more calories in a
week walking to and from school than they do in
two hours of PE(70).
• Children and adolescents who walk or cycle to
school are more likely to meet activity guidelines
than those who travel by car or bus(106).
• Children who walk to school are significantly more
likely to play sport(104).
Increasingly, research is showing the value of active
travel and its potential contribution to activity levels(7).
Patterns of travel to school can have a significant
impact on overall activity levels among young people
and are likely to contribute to the differences in
participation in physical activity internationally(108).
With recent data suggesting that some progress may
have been made in reversing the decline in active
travel, continuing efforts in this area are important.
18
Figure
9: Changes in mode of transport to and from
20
10
school, 1995/97, 2003 and 2006
10
0
Figure
9a: 5-10 year-olds.
0
60
60
50
50
40
40
30
30
20
20
10
10
0
0
Figure
9b: 11 – 16 year olds
50
50
40
40
30
30
20
20
10
10
0
0
Source: National Travel Survey 2006. See reference 97.
Activity in leisure time outside school
Active play continues to be the most common type of
activity children participate in outside of school.
When asked what they like doing, 83% of children
aged 4-16 years mentioned ‘playing sport’ and 58%
‘playing outside near home’(109). Further, 73% indicated
they would like to play more sport and 62% that they
would like to play outside more. But how do young
people actually spend their leisure time beyond school?
Active play
Not surprisingly, there are seasonal differences in
active play with one study showing that 89% of 3-5
year olds played outside in July as compared to only
21% in January(113). (See also p.12)
Participation in sports and exercise
Participation levels in sports and exercise are lower
than for active play:
Sports and exercise participation in 2-15 year olds
England
Outdoor and unstructured play may be one of
the best forms of physical activity for children(110).
Play is also creative and helps socialisation. The Chief
Medical Officer for England’s report recommended
that children should have 3 - 4 afternoon or evening
play opportunities in a week, and that this would
make an important contribution to their activity
levels(6). Unstructured play can account for as much as
210 minutes of activity a week, often making a more
significant contribution to overall activity levels than
PE lessons(111).
Active play continues to be the most common type of
physical activity children take part in outside school:
Active play days per week in England (2 - 15 years)
At least 1 day
5 or more days
Boys
93%(34)
70%(112)
Girls
88%(34)
59%(112)
Active play hours per week in Scotland (2 - 15 years)
7 hrs or more
Av. hrs per week
Boys
52%
8.5%
Girls
44%
7.5%(45)
The amount of time spent on active play decreases
with age for both boys and girls. This is particularly
pronounced in girls - by the time they reach 15, only
16% of girls in Scotland spend seven hours or more in
active play(45) and 29% of those in England(112) engage
in this type of activity at least five days a week.
At least 1 day
5 or more days
None
Boys
69%(34)
22%(112)
33%(112)
Girls
64%(34)
14%(112)
40%(112)
Scotland
7 hrs or more
None
Boys
24%
27%
Girls
14%
32%(45)
In both England(34) and Scotland(45), boys’ participation
in sports and exercise increases significantly at 5-6
years of age and then remains relatively stable, while
for girls participation drops off significantly after the
age of 10-11.
Boys said they would like to do more ball sports (39%),
bike riding and swimming (both 35%), girls preferred
swimming (47%) and ball sports (38%)(34). There is a
general decrease in interest in most activities with age,
with the exception of jogging and walking which vary
little with age.
Walking
In England, 91% of both boys and girls had walked
continuously for 5 minutes at least once a week out
of school hours(34), with 65% of boys and 63% of girls
having done so on at least five days a week(112). Similar
levels were recorded in Scotland(45): 70% of Scottish
girls and boys participated in walking on five or more
days a week, spending an average of 4.2 and 4.1 hours
respectively on this type of activity each week.
19
How sedentary are our children and young people?
Young people are increasingly spending a significant
amount of time being sedentary, which could have
important implications for their health, irrespective
of the amount of physical activity they do.
Some researchers suggest that high levels of sedentary
behaviour can have a negative impact on the health
and wellbeing of children and young people
whether or not they meet the physical activity
guidelines(114)(115)(116). Also:
• there may be a relationship between sedentary
behaviour and overweight(117)(118)
• the effects of sedentary behaviour may build up
over the course of childhood(119)
• sedentary behaviour may contribute to
weight status independently of the level of
physical activity(118)(120).
We need to fully understand the potential
independent effects of sedentary behaviour on
health, and more research is needed in this area.
However, it is clear that young people should avoid
being too sedentary and, where possible, find
physically active alternatives.
This has prompted physical activity guidelines in a
number of countries that include a recommendation
to reduce sedentary behaviour(39)(40)(42)(43). The National
Association for Sport and Physical Education (NASPE)
in the US discourages periods of inactivity over two
hours among children, especially during
the daytime(121).
It is clear that young people should avoid
being too sedentary and, where possible,
find physically active alternatives.
Sedentary behaviour doesn’t just refer to screen-based
activities such as watching TV, playing computer
games, or social networking, which tend to be the
focus of attention. Listening to music, spending time
with friends, homework and reading are all examples
of sedentary activities which, although they are
valuable, also take up a substantial percentage of
young people’s free time(122).
Young people appear to spend a lot of time being
sedentary. This pattern may start at a very young age
with median time* spent in sedentary behaviour
recorded as 79% of monitored hours at three years of
age, and 76% at five years in one study(51).
*This refers to taking a middle figure in a study range rather than
an overall average.
20
For 14 year old girls, one study revealed that the
five most consuming sedentary activities occupied,
on average, around 4.38 hours per weekday and
6.66 hours per weekend day as compared to active
transport and sports and exercise which only occupied
44.2 minutes and 53 minutes on weekdays and
weekend days respectively(123). A study of 5 -11
year-olds who were overweight found they were
sedentary for 80.7% of their monitored time(124).
Socio-economic factors may be relevant. There is some
evidence that sedentary behaviour is greater in those
from lower socio-economic groups(66).
Screen-based sedentary behaviour
Watching TV occupies a significant amount of young
peoples’ time but as children watch TV and engage
in physical activity at different times of the day,
the relationship between TV viewing and physical
activity is small and it seems there is time for both.
The fact that TV viewing, computer and video games,
and social networking take up large amounts of young
people’s time is hardly surprising: 80% of 5 -16 year olds
have their own TV, 70% have their own DVD player,and
nearly all have a computer at home, with more than
half having their own computer(125).
TV / video viewing takes up at least one and a half
hours per day(126) and children and young people
spend an average of five hours and 20 minutes a day
in front of a TV or computer screen(127).
The overall volume of media viewing (watching
TV, playing video games and using computers) is
estimated at 35-40 hours a week in 11-17 year olds(128).
Watching television every day seems to be the norm
even at 22 months of age. In Scotland, 64% of children
of this age watch TV every day and 24% of children
aged 1 - 3 years watch one to two hours a day on
weekdays(113). The same survey found that 84% of 3 - 5
year olds in Scotland watched TV every day and 30%
watched over two hours every day.
TV accounts for 40-50% of the time young
people spend inactively on weekdays and
35-50% at weekends.
Children watch significant amounts of TV on both
weekdays and weekends(123) (see Figure 10).
Although only a minority watch more than four hours
a day, TV accounts for 40 - 50% of the time young
people spend inactively on weekdays and 35 - 50% at
weekends(123)(129)(130). Recent data from adolescent girls
show that 38% watch more than two hours TV a day
on weekdays and 58% at weekends(129).
Figure 10: Percentage of young people aged 11 and 15
who report watching television for two or more hours
on weekdays 2005/06
Using computers and playing computer games are
other key sedentary activities. The proportion of young
people using a computer for emails, internet and /or
homework for two or more hours on weekdays
is higher than the average for other countries in
the 2005/06 HBSC survey (see Figure 11, p.23(28)).
There are no big differences between boys and girls,
but computer use increases with age.
Figure 10a: 11 year-olds
The percentages of young people playing computer
games or on games consoles for two or more hours on
weekdays are similar in other countries (see Figure 12,
p.23), but there is some variability between England,
Scotland and Wales. (No data are currently available
for Northern Ireland). Boys are far more likely to play
computer games in both age groups. Significant
differences between boys and girls in levels of
playing computer games have also been noted in
other studies(129)(123).
40
60
80% of 5-16 year olds have their own TV.
Figure
10b 15 year-olds
70
0
Watching TV and other electronic media are often
blamed for increasing inactivity and obesity among
young people. However, the relationship between
watching TV and physical activity is small(131) and it
seems there is time for both(131)(132). On weekdays,
out-of-school TV viewing peaks later in the day, during
middle to late evening, and physical activity earlier, so
the two behaviours do not necessarily compete(132).
The relationship between sedentary behaviour and
levels of overweight and obesity may be more about
the associated eating habits of young people rather
than its impact on physical activity. TV viewing has
been associated with higher consumption of energydense foods(133), sweets and soft drinks and lower
consumption of fruit and vegetables(134).
It is important to look at the whole range of sedentary
behaviours. Currently, little is known about the factors
underlying habitual inactivity in young people(8) and
there is a need to consider specific behaviours such
as watching TV in the wider context of changes in
lifestyle and the structure of society(128).
80
70
60
80
50
70
30
50
20
40
10
30
0
20
80
10
60
80
50
70
40
60
30
50
20
40
10
30
0
20
10
40
0
35
HBSC
average = the average for all 41 countries and regions in the
30
40
Health Behaviour in school-aged Children Study.
Source:
Inequalities in Young People’s Health. Health Behaviour in
25
35
School-aged children international report from the 2005/06 Survey.
See reference 28.
20
30
15
25
10
20
5
15
0
10
21
There may be a need for different behavioural targets
in interventions to reduce sedentary behaviour(126)
and it may be useful to attempt to reduce sedentary
behaviour when it is most likely to compete with
physical activity. The hours immediately after school
are critical to adolescents’ participation in physical
activity(107). Promoting active transport and restricting
the use of technology may help increase physical
activity at this time. Research indicates this doesn’t
appear to displace time spent doing homework(107).
Sedentary behaviour should be studied separately
from physical activity(128)(8)(135). And developing a better
understanding of sedentary behaviour in relation to
physical activity and overweight may be critical for
preventing and reducing overweight in youth(136).
Factors associated with physical activity in children and
young people
A range of related factors (known as correlates) of
physical activity have been identified which, other
than age and gender, are likely to have only small or
small-to-moderate effects in isolation and may work
best in interaction with other influences(7).
Appendix 1 (please see p.40) identifies factors that
have consistently been associated with physical
activity in children and young people. It provides
a summary of the findings identified in a review
of these factors which was carried out by the NICE
Public Health Collaborating – Physical Activity(137).
Conclusions were based on findings from five
systematic reviews(57)(138)(139)(140)(58).
Correlates of physical activity were grouped under
five main headings: demographic and biological,
psychological, behavioural, social/cultural and
environmental. Appendix 1 summarises key correlates
identified under each of these headings(137).
The review(137) also considered the evidence relating
to socio-economics and Body Mass Index (BMI) as
correlates of physical activity but findings
were inconsistent. The relationship between
socio-economic status and physical activity is
unclear with respect to children and adolescents
(measurement variability is a potential issue here)
and higher BMI seems only to correlate with lower
activity levels in recent data on adolescent girls.
22
Correlates of preschool children and physical activity
have also been considered(141) and three variables, in
particular, appear to have an effect:
• Boys are more active than girls.
• The children of parents who participate in physical
activity with them are more active.
• Children who spend more time in outdoor play
spaces are more active.
70
80
60
70
50
60
40
50
30
Figure 11: Percentage of young people aged 11 and 15
40
20 report using a computer for emails, internet and /
who
or
30 homework for two or more hours on weekdays
10
(2005/06)
20
0
50
60
40
50
30
40
20
Figure12:
Percentage of young people aged 11 and
30
15 who report playing computer games or games
console
for two or more hours on weekdays
10
20
(2005/06)
0
Figure 11a: 11 year-olds
10
Figure
12a: 11 year-olds
40
0
60
0
10
35
40
30
35
25
30
20
25
15
20
10
15
5
10
0
5
60
0
Figure
11b: 15 year-olds
50
60
40
50
30
40
20
30
10
20
0
10
50
0
Figure 12b: 15 year-olds
50
60
40
50
40
50
30
40
30
40
20
20
30
30
10
10
20
20
0
10
60
0
0
10
0
50
60 average = the average for all 41 countries and regions in the
HBSC
Health
Behaviour in school-aged Children Study.
40
Source:
Inequalities in Young People’s Health. Health Behaviour in
50
School-aged children international report from the 2005/06 Survey.
See
30 reference 28.
HBSC average = the average for all 41 countries and regions in the
Health Behaviour in school-aged Children Study.
Source: Inequalities in Young People’s Health. Health Behaviour in
School-aged children international report from the 2005/06 Survey.
See reference 28.
40
20
30
10
20
0
10
23
What motivates our young people to be active?
And what barriers stop them?
A recent review suggests that for children of all ages,
enjoyment, friendship groups, social interaction,
parental, familial and peer supports influence young
people’s participation in physical activity(142).
The following are all influential:
One survey found that 61% of boys and 74% of girls
would like to do more physical activity, which is very
encouraging(34). It’s particularly promising that 76%
of 15 year old girls indicated they would like to be
more active, which is important given the low levels
of activity in this group. So what’s stopping them from
putting this desire into action?
• the opportunity to do things with other family
members(143).
What motivates young people to be active?*
Aspects of physical activity that children value
Local opportunities are important in encouraging
young people to be more active. In particular, there is
a need for:
These include:
• better provision of youth clubs
• having a choice of sporting and exercise
opportunities
• cleaning up of parks and open spaces
• activity as a means of having fun and spending
time with friends
• more extra-curricular opportunities in schools, and
• a sense of belonging (for those in a team)
• enjoying competition and
• feelings of achievement.
Children also mention keeping ‘fit and healthy’, being in
good shape and controlling weight, particularly girls(143).
Enjoyment and a chance to show off their skills(144) and
opportunities for independent outdoor play(142) have
also been highlighted as important, and older children
identify physical activity as a way of relaxing, forgetting
their troubles(143) and relieving stress(144).
*The sub-headings under which facilitators and barriers have been grouped
are those used in a systematic review of this area, which included factors
identified by children themselves and by their parents(143).
Family life and parental support
Parents have an important role to play in:
• creating opportunities for physical activity and
giving financial support(144)
• encouraging their children, providing transport
and paying for activities(145)
Parental physical activity(112)(139), parental education(139)
and family income(139) are also important factors.
24
• a supportive, encouraging, inspiring family
• parents who provide practical support, and
Most children develop their attitudes and behaviours
through socialisation, and the family (together with
peers and teachers) have a key influence(146).
Greater access to opportunities for
physical activity
• better cycle paths
• making school facilities more accessible outside
school lesson times(143).
Owning a car (and therefore being able to access
opportunities further away from home) and having a
garden will also encourage more physical activity(143) as
will greater access to more activity opportunities.
In England 61% of boys and 74% of girls
would like to do more physical activity.
More variation in the types of activity on offer can
increase interest among children(147)(144). In particular
developing the social side of physical activity through
more opportunities for activities that are fun, with
space and time for both single-sex and mixed
activities(144). Light and moderate intensity activities
and those categorised as individual can also achieve
higher levels of sustained participation than vigorous
intensity or team activities(148).
What barriers stop young people being active?
And:
Brunton et al (2004) identified key but interrelated
barriers to children’s participation in physical activity
which fall into the following four main areas(143).
• parental constraints related to fear of strangers(23)
Preferences and priorities
• poor quality of places to play(142).
Lack of spare time and preference for doing other
things are barriers to physical activity. (This doesn’t
necessarily mean that children don’t like sport and
physical activity - they often just find other things
more interesting)(143)(23)(144).
Due to concerns over safety, parents (and children)
impose restrictions on their activity and children
are unable to go very far away from home and /or
unable to use local play areas, even if they’re close to
home. Children’s opportunity to range independently
has dropped considerably(149)(150)(151)(152)(153). A recent
survey found that 42% of children aged 7-12 years
are not allowed to play in their local park without an
adult present(154) and over recent decades parents
have increasingly tried to avoid risks to their children
from outside the home by restricting their children’s
independent mobility(155). Indeed, cultural shifts
are such that letting children roam or play outside
unaccompanied is now sometimes judged as an
indication of irresponsible parenthood(156).
Family life and parental support
Although family life and parental support can help
increase levels of activity in young people, they can
also act as barriers. For example, if parents don’t
participate in sport and exercise or are not enthusiastic
about them, it could have a negative impact on
their children(143).
The transfer of attitudes, beliefs and behaviours from
parents and peers play a key role in explaining social
inequalities in health, and the underlying factors and
behaviours associated with poorer health, including a
lack of physical activity(34).
Restrictions on opportunities for physical activity
• safety and cultural factors(144)
• risk of personal accidents(142) and
Intolerant adults complaining about noise
and nuisance can also be a barrier, forcing
children indoors(157).
Lack of enjoyment
• cost
Enjoyment is crucial to young people to taking part in
physical activity, and a lack of enjoyment is clearly
a barrier.
• distance, particularly for those in rural areas
Factors include:
For structured sport, this includes:
• lack of a means of safe travel, and
• lack of facilities(143).
Also, children from lower incomes families are more
likely to identify cost and lack of local access to
facilities as barriers(143). (See also p.12)
Young people also mention a lack of choice of physical
activity as a barrier, together with not being asked
about what types of activity they would like to do and
a lack of practical and material resources needed to
keep them involved(144).
For unstructured physical activity, barriers include:
• busy traffic
• believing their physique or coordination skills are
not well suited to a particular sport
• shame and embarrassment
• frustration with complex or unclear rules
• boredom
• playing sport in bad weather(143). (See p.12)
For many, the fact that friends are not taking part stops
them being active.
Other negative factors include:
• self-consciousness about bodies(144)
• threat of crime
• dislike of highly structured activities or those
organised by adults(144)
• threat of intimidation by older children, and
• inadequate or unwelcoming facilities(63)
• neglect of local play areas(143).
• an overtly competitive and stressful atmosphere(158)(159).
25
Further, being hit or kicked, falling over, getting cold
and wet, getting hot and sweaty(62) and sport and
exercise being ‘too difficult/tiring’(160) also put young
people off sport.
When 11-16 year olds were asked about what could be
done to help them get involved in physical activity(144),
the majority of their suggestions related to increasing
practical and material resources such as:
An additional barrier may be that those who most
need to be more active don’t realise it - a high
proportion of both boys and girls whose activity
levels were low saw themselves as being fairly active
compared to others (68% and 67% respectively).
Younger girls had the least accurate perception of their
own levels of activity(34).
• creating more cycle lanes
Specific motivators and barriers are particularly
relevant for different target groups and types of
activity. It’s not possible to consider these here
but a series of reviews by the NICE Public Health
Collaborating Centre - Physical Activity identify
facilitators and barriers for girls, active travel, active play
and children under eight years(142)(23).
Parental support can help increase young
people’s activity levels…
Summary
The factors above have important implications for
anyone responsible for encouraging and supporting
more young people to be active. Action to help
increase physical activity could include empowerment
of children, emphasis on fun and enjoyment, and
enhancing positive attitudes of parents to all forms of
activity regardless of gender and age(142). There isn’t
space to consider effective interventions in detail in
this report, but please refer to NICE Reviews 4-8(161)(162)
(163)(164)(23) for information on interventions for different
target groups / types of activity.
26
• making activities more affordable
• increasing access to clubs for dancing and
•
providing single sex physical activities in youth
clubs alongside or followed by mixed sex
(non-physical) activities (combining sports and
leisure facilities).
They also suggested emphasising the fun and social
aspects of physical activity.
Motivators may differ according to whether young
people are active:
• social benefits
• competitiveness
• a sense of achievement, and
• feelings of confidence.
or inactive:
• enjoyment
• wellbeing
• avoiding boredom and
• help with losing weight (for females)(165).
…but if parents don’t participate or
aren’t enthusiastic, it could have a
negative impact.
Similarly, barriers may vary according to age and in
relation to significant turning points in children’s lives.
For example, physical activity tends to drop off with
the transition from primary to secondary school.
This is associated with individual factors such as
internal developmental changes as well as structural
factors such as a different physical activity culture and
ethos(166). Support from family and significant others
at key transitional phases is essential to keep children
active(167). (See also p.24 and p.25)
How good are our children’s and young people’s diets?
Young people’s diets are too high in saturated
fat, salt and sugar and most still don’t eat enough
fruit and vegetables. More work is needed to help
children and young people to put knowledge
into action when it comes to healthy eating.
However, education alone is unlikely to be
sufficient to achieve this.
Healthy eating during childhood and adolescence
is vital as a means to ensure healthy growth and
development and to set up a pattern of positive
eating habits to carry through into adult life. Eating
healthily, combined with being more physically active
can help to prevent key risk factors for heart disease
in adulthood, including raised cholesterol levels and
blood pressure. Eating at least five portions of fruit and
vegetables a day is also important for a balanced and
healthy diet.
What are our children and young people eating?
The National Diet and Nutrition Survey (NDNS) of young
people aged 4-18 years(168) provides comprehensive
information on the dietary habits and nutritional status
of the population in Great Britain. Using this survey as a
basis, we can identify areas of concern in relation to the
eating habits of this age group.
Diets high in saturated fat are linked to
raised cholesterol levels and excess salt is
linked to raised blood pressure.
Overall, diets were found to exceed the Committee
On Medical Aspects of Food Policy (COMA)(169)
recommendations for saturated fat, non-milk extrinsic
sugars (NMES) and salt, all of which have implications
for future health problems. Diets high in saturated fat
are linked to raised cholesterol levels and excess salt is
linked to raised blood pressure, both of which are risk
factors for heart disease.
Some regional and national differences were also
observed, with intakes of vitamins and minerals being
lower in Scotland and Northern England than in
other areas.
Fruit and vegetable consumption
Populations with higher consumption levels of fruit
and vegetables have been shown to have lower levels
of a range of chronic diseases including heart disease,
diabetes and certain cancers. As a result the UK has
developed a recommendation for people to consume
at least five portions of fruit and vegetables per day.
In the UK, figures show that on average, adults are
not meeting this recommendation, and that average
consumption of fruit and vegetables is even lower for
children(34) (45). In order to increase children’s intake,
there has been considerable emphasis on education as
well as the practical provision of fruit and vegetables
in schools through changes to school meals and
dedicated fruit and vegetable schemes.
To some extent, these messages appear to be
getting through to children. Figures show that a
high proportion (63% of boys and 73% of girls in
England) knew that they need to eat five portions
of fruit or vegetables a day(34). Intake also appears to
be increasing:
However, while this is encouraging, average
consumption figures remain below the minimum
of five portions a day (see Figure 13, p.29). Figures for
both England and Scotland show that the majority
of children are still eating less than the minimum
recommendation:
Percentage of 5-15 year olds eating five portions
of fruit and vegetables a day
England
Boys
Girls
2001
11%
11%
2007
21%
21%(34)
Boys
Girls
12%
12%(45)
Scotland
2003
Intake however, appears to decline with age. Teenagers
are eating less fruit and vegetables than younger
children and, and further analysis of data reveals
additional differences between groups. Consumption
of fruit and vegetables increases as household income
increases(34)(45) with children in the highest income
group in Scotland, for example, being twice as likely to
eat their five portions a day as compared to those in
other income groups.
27
This finding was confirmed by the recent Low
Income National Diet and Nutrition Survey (170), which
highlighted that intake of fruit and vegetables was
even lower among low income families than the
general population. Girls were consuming, on average,
two portions of fruit and vegetables a day and boys
only 1.6 portions.
Consumption of high fat, salt and sugar
(HFSS) foods
Foods that are high in fat, salt and/or sugar are
contributing to the increased levels of saturated fat,
salt and sugar seen in the NDNS(168). Savoury snacks,
chips, biscuits and chocolate confectionary were
among the foods most commonly consumed during
the survey and eaten by 80% of the group during the
survey period. Three quarters of those participating in
the survey also drank carbonated soft drinks. Although
45% drank low calorie versions, the full sugar versions
were the primary source of NMES intake, followed by
chocolate confectionary. In 2000/01, almost half of 13
year olds boys and girls in Scotland, a third of those
in England, and a quarter in Wales, reported eating
sweets or chocolate bars every day(108) (see Figure 14).
A third of 13 year olds in England reported
eating sweets or chocolate bars every day.
The Health Survey for Scotland shows that in 2003
young people were still eating large quantities of such
foods. Among children aged 2 - 15:
• 60% consumed sweets and chocolates at least
once a day
• 50% ate crisps daily and
• around half usually ate biscuits at least
once a day(45).
28
In Wales:
• 29% of children aged 4-15 years ate sweets every
day and
• 22% ate crisps daily(46).
A proportion of children develop a pattern of
consuming less healthy foods and drinks at a very early
age. A recent study in Scotland identified that 90% of
children aged 22 months ate sweets or chocolate once
a week or more often, including 43% who ate sweets
or chocolate once a day or more(113). Almost half of
children this age had crisps or savoury snacks once
a day or more and over one in ten had a soft drink at
least once a day.
90% of Scottish children aged 22 months
ate sweets or chocolate once a week
or more.
Fatty and sugary foods and drinks are heavily marketed
and promoted(102), and the food industry spends an
estimated 75% of its £450 million advertising budget
targeting children(171), with a large proportion of this
being spent on HFSS products. Given the amount
of children consuming these products seen in the
NDNS, the potential impact of such advertising cannot
be exaggerated.
Please also see the BHF’s campaign report on children’s
food marketing How parents are being misled(172).
The food industry spends an estimated
75% of its £450 million advertising budget
targeting children.
25
20
20
15
15
10
Figure 13: Percentage of young people in England
consuming five or more portions of fruit and
vegetables per day (2001/06)
Figure 14: Percentage of young people aged 11 and
10 in England, Scotland and Wales who report eating
15
5
sweets or chocolate bars every day (2001/02)
25
0
Figure
14a: 11 year-olds
20
15
10
5
0
50
Source: Health Survey for England 2006. See reference 112.
40
5
50
0
50
40
40
30
30
20
20
10
10
0
0
50
Figure
14b: 15 year-olds
30
50
40
20
40
30
10
30
20
0
20
10
50
10
0
40
30
0
Source: Health Behaviour in School-aged Children Study.
See reference 108.
20
10
0
29
Obesity in children and young people
Obesity during childhood, especially in adolescence,
is linked to obesity in adulthood. This in turn is an
independent risk factor for heart disease and will
also impact on other risk factors. Levels of obesity
in adults and children have increased rapidly over
the last 30 years. The causes of this rise in obesity
are likely to be multifactoral but at the core is an
energy imbalance resulting from excess energy
consumption and insufficient energy expenditure.
Ethnicity
In England, Chinese boys were less likely than boys
in the general population to be overweight or obese.
Black Caribbean and Black African boys and girls and
Pakistani boys were more likely than boys and girls
in the general population to be obese, but a lower
percentage of Pakistani girls were obese than in the
general population(65). (Please also see p.12)
Percentage of obese boys and girls aged
2-15 years
Prevalence of overweight and obesity
National health surveys suggest that approximately
a third of young people aged 2-15 years in England,
Scotland and Wales are overweight or obese, with
Welsh figures (at 36%) slightly higher than those in the
other two countries(34)(173)(46) (see Figures 15 and 16).
Obesity figures from Northern Ireland suggest similar
levels to the other countries(174):
Obesity in England, Scotland, Wales and
Northern Ireland
Boys
Girls
Black African
31%
27%
Black Caribbean
28%
27%
Pakistani
25%
15%
Chinese
14%
12%
General population
19%
18%(65)
Socio-economic status
Boys
Girls
England
17%
16%(34)
Scotland
17%
13%(173)
Wales
20%
19%(46)
Northern Ireland
20%
15%(174)
There is no clear association between overweight and
obesity and socio-economic classification among boys
but there are some differences among girls(45)(34). The
highest prevalence is seen in the lowest income groups.
Overweight/obesity: Lowest vs highest income
group, girls 2-15 years
England
Differences in the prevalence of overweight
and obesity according to gender, ethnicity and
socio-economic group.
In the UK there appear to be no consistent differences
between the levels of obesity among boys and girls.
There is some evidence of an association between
socio-economic status and obesity in girls, but not in
boys, and obesity varies according to ethnicity.
30
Overweight
Obese
Highest
24%
9%
Lowest
35%
22%(34)
No significant differences were found among boys
of any age.
Gender
Trends over time
The most recent data indicate that in England and
Wales, levels of overweight and obesity are similar in
boys and girls(34)(46), but in Scotland, overall, a greater
proportion of boys (36%) than girls (27%) were either
overweight or obese(173).
There have been significant increases in the
prevalence of obesity over the last 30 years. While it
is impossible to predict the trajectory of childhood
obesity with absolute certainty, predictions suggest
that this issue will continue to remain important for
personal and public health in the future.
Significant increases in the prevalence of overweight
and obesity in England(56)(175)(176) and Scotland(175) have
been observed over the last 30 years.
Obesity in England and Scotland (2 -15 year olds)
(See Figure 17, p. 32)
If trends continue upwards, however, the Foresight
report (2008)(177) has suggested that by 2025 obesity
among 11-15 year olds could have increased by 6
percentage points for boys and 11 percentage points
for girls from 2004 levels(177).
Figure 15: Prevalence of obesity and overweight among
2-15 year olds in England (2007)
England
Boys
Girls
1995
11%
12%
2007
17%
16%(34)
35
30
25
Scotland
Boys
Girls
1998
14%
14%
2003
18%
14%(173)
20
35
15
30
10
25
5
20
Although there was an overall upward trend in the
prevalence of obesity between 1995 and 2007 in
England, there are indications that the trend may
be flattening out(34). Despite a significant increase
between 2000 and 2007 in the percentage of boys
aged 2 -15 years classed as overweight or obese
(four percentage points) and among girls aged
2 -10 years (five percentage points), there has been
statistically no significant change in the prevalence
of obesity year-on-year between 2005 and 2007.
Data from the next few years will confirm whether
this apparent halt in the year-on-year rise in obesity
is sustained or whether, longer term, the trend will
continue upwards(34). In Scotland, for example, the
upward trend among boys, but not girls, seems to
have continued unabated:
Overweight or obesity among 2-15 year olds in
Scotland (1998/08)
Boys
Girls
1998
28%
28%
2003
32%
29%
2008
37%
27%(173)
0
15
10 Figures are based on UK BMI reference data.
Note:
50
Source: Health Survey for England 2007. See reference 34.
5
40
Figure
16: Prevalence of obesity and overweight among
0
2-15 year olds in Scotland (2008)
30
50
20
40
10
30
0
20
35
10
30
0
25
Note: Figures are based on UK BMI reference data.
20
Source:
Scottish Health Survey 2008. See reference 173.
35
15
30
10
25
5
20
0
15
10
35
31
30
20
10
Figure
17: Trends in overweight and obesity prevalence
0
among children aged 2-15 in England (1995/07)
35
30
Potential health problems associated
with obesity
25
Obesity in childhood often persists into adulthood,
when it can have a significant impact on health.
20
15
10
5
0
Notes: Figures are based on UK BMI reference data.
Data for 2004 and 2007 have been weighted for non-response.
35
Source:
Health Survey for England 2007. See reference 34.
30
Table 7 shows further predicted changes in the future.
Foresight
also estimate that, by 2050, 70% of girls
25
could be overweight or obese, with only 30% in the
healthy
BMI range. A different picture emerges for
20
boys, with 55% predicted to be overweight or obese
15 2050 and around 45% in the healthy range.
by
10
Table 7: Percentage predicted to be obese
(international
definition), by sex and age
5
0
Boys
50
Girls
40
Age
2004
2025
2050
6 - 10
10%
21%
>35%
11 - 15
5%
11%
23%
6 - 10
10%
14%
20%
11 - 15
11%
22%
35%
*Very
wide confidence interval.
30
Source: McPherson et al, 2007. See reference 178.
20 recent National Heart Forum report(179) however,
A
analysed HSE data published since the Foresight report
using
a similar methodology. This suggests that while
10
rates of childhood obesity are likely to remain high, the
rate with which this is set to increase may be slowing.
0
While
this is encouraging, more data is required to
understand if this is to be an ongoing trend.
By 2050, 70% of girls could be overweight
or obese.
32
Regardless of the rate of increase, however, both
reports suggest that childhood obesity levels will
remain unacceptably high and it is vital that action to
address this issue continues.
While obesity is established as a risk factor for CHD
and linked to other risk factors including diabetes and
raised blood pressure in adults, the impact for children
is not as clear. Reports have suggested that a younger
onset of conditions such as raised cholesterol and
blood pressure and diabetes have been seen, but large
trials have shown no impact on long term health if
overweight children become healthy weight adults.
In practise, however, obese children are likely to remain
overweight as they move into adulthood. Data show
that 26 - 41% of children who are obese at
pre-school age and 42-63% of obese school-age
children become obese adults(6). One US study found
that 79% of obese 10 -14 year olds remained obese
into adulthood(3). This means that these children will
start adulthood with an increased risk of coronary heart
disease, along with other health problems.
The younger they are when they become obese, the
longer they are likely to be living with this risk factor,
meaning that they are at greater risk of developing
health problems at a younger age(180). It is estimated
that severely obese individuals (those with a BMI
over 45) are likely to die on average 11 years earlier
than those with a healthy weight(181), comparable
to, and in some cases worse than, the reduction in
life expectancy from smoking(102). Obese adults who
were overweight as adolescents have higher levels of
weight-related ill health and a higher risk of early death
than adults who only become obese in adulthood(6).
26 - 41% of obese preschool children and
42 - 63% of obese school-age children
become obese adults.
However, in addition to the future risk of health
problems, young people who are obese are likely
to have lower levels of fitness, suffer from social
discrimination and have low self-esteem and lower
quality of life(6).
Possible causes of obesity
At its root, obesity is a consequence of an energy
imbalance – either too much consumed or insufficient
expenditure. But the factors which have led to a
situation where it is becoming the norm to be
overweight or obese are numerous, and are the result
of the attitudes and behaviours of individuals and
society at large and the changing environment we are
all exposed to.
Although diet and physical activity are at the
root of this issue, the recent Foresight Report(177)
acknowledges the radical changes in society over
the past five decades that have resulted in today’s
increased levels of obesity. These changes, coupled
with an underlying propensity in many people to
both put on weight and retain it, have resulted in the
prevalence in obesity today.
The primary focus of this report is on the potential
impact of physical activity and sedentary behaviours
on levels of obesity. The majority of recent evidence
appears to support a role for physical activity in
preventing overweight and obesity in young people.
However, more research is vital to accurately record
our children’s routine levels of physical activity and
total energy expenditure.
Sedentary behaviour is a specific risk factor for obesity,
especially watching TV(182). Reducing sedentary
behaviour has resulted in some success in weight
control(183) and may also be a marker for certain eating
behaviours or food choices. The content of viewing
may also have an impact on children’s food choices
in relation to the advertising of HFSS foods during
programmes children watch regularly. However,
watching TV per se may not be significant as it does
not necessarily replace physical activity(131)(58) (see p.21)
and the amount watched by young people has not
increased(184)(185) alongside increases in obesity.
Tackling the issue
Parents may be unaware of their tendency to
underestimate how much they and their children eat
and overestimate the amount of physical activity they
do(186). In addition, research has shown that parents
often don’t recognise when their children have a
weight problem(187). Coupled with this is the failure
to make the connection between their children
being obese and how this may contribute to
long-term health problems, including heart disease
and Type 2 diabetes.
Increasing physical activity and decreasing sedentary
behaviour may be effective in reducing overweight
and obesity in children and adolescents alongside
appropriate nutritional intake(188). However, due to the
variability in the causes of obesity, we need a range
of different solutions to reduce its prevalence (177).
Physical activity is therefore a key part of this, with some
researchers suggesting that, unless physical activity
increases to boost energy demands, dietary habits will
need to be changed to meet the nutritional needs of a
largely sedentary population(189).
Targets have been set for obesity in Scotland to reduce
the rate of increase in the proportion of children
whose BMI is outside a healthy range by 2018.
In England, the aim is to both reverse the trend in
rising obesity and overweight among children and
reduce it back to 2000 levels by 2020. This would mean
reducing obesity in children aged 2-10 to 12% and
overweight to 13%(112).
If solutions to address the high levels of obesity are to
be effective, Foresight recommends that we need to:
• involve partners outside traditional health sectors
• adopt multidisciplinary approaches to stimulate
effective behaviour change
• establish new social norms
• create a supportive environment and, critically in
the case of children,
• engage parents(177).
Due to the numerous factors contributing to
obesity, solving the problem is a complex challenge.
Campaigning by organisations like the BHF and
positive action by government are vital to stemming
the tide. There is also a key role for the food industry
– manufacturers, retailers and caterers – in addressing
pricing, reformulation, nutritional labelling and
acceptable marketing of foods. However, it is also crucial
that parents are made aware of the importance of their
role in safeguarding the health of their children.
Young people’s concerns about their weight
There are indications that many young people,
especially girls, are unhappy with their weight and use
weight control practices.
33
25
30
20
25
15
20
10
15
5
46% of 15 year old girls believe they
are too fat.
Figure 18: Percentage of young people aged 11 and 15
10
who think they are too fat (2005/06)
Although addressing the problem of growing
childhood obesity is crucial, it’s important not to cause
children and adolescents unnecessary anxiety about
their weight. The stigmatisation of overweight and
obesity appears to be increasing(190) and body image
has an important role in self-evaluation, mental health
and psychological wellbeing(191) (192) (193).
Figure 18a: 11 year-olds
Many young people, particularly girls, are unhappy
about their weight (see Figure 18) and attempt to
control their weight which, in turn, can have negative
physical and psychological effects. Girls are more likely
than boys to judge themselves as too fat and this
negative body image becomes more prevalent with
age among girls.
Percentage of UK children who believe they are
too fat
Age
Boys
Girls
11
24%
29%
15
25%
46%(28)
Furthermore, many young people are engaged in
dieting and weight control behaviour. More girls than
boys attempt to lose weight and this increases with age:
0
5
0
35
30
35
25
30
20
25
15
20
10
15
5
10
0
5
50
0
Figure 18b: 15 year olds
40
50
30
40
20
30
Percentage of UK children who attempt to
lose weight
Age
Boys
Girls
11
14%
17%
15
9%
27%(28)
10
20
0
10
0
This is a cause for concern, since extensive
and/or long-term dieting to lose weight could have
potentially serious consequences for young people’s
development and health(28).
The World Health Organisation points out that a
balance is needed to ensure that young people both
maintain a healthy body weight and are protected
from the pressures of negative body image and weight
control practices(28).
34
Source: Inequalities in Young People’s Health. Health Behaviour in
School-aged children international report from the 2005/06 Survey.
See reference 28.
Conclusion and recommendations
Childhood obesity has never been higher up the
list of public concerns, and levels are predicted to
remain high if we do not address this issue now.
Despite this, there have been no major changes in
children and young people’s physical activity levels
over the last decade. This report has demonstrated
that there is still a significant proportion of children
and young people who are not reaching the
recommended daily levels of physical activity. Some of
the shortfall is concentrated in particular groups, such
as adolescent girls, young people from ethnic minority
backgrounds and young people with a disability, and
dedicated solutions are needed.
The emphasis on increasing physical activity in schools
has had a positive effect, particularly in England.
However, this success is not replicated across the rest
of the UK. There is still a lot more that can be done
to integrate physical activity into and around the
school day. This includes maximising the range of
opportunities available to pupils during lunch and
breaktimes and making journeys to and from school
more active.
Outside of school, children and young people are
spending a significant amount of time in sedentary
behaviour which could have a detrimental impact on
their health, irrespective of the amount of physical
activity they do. Children and young people need a
range of easily accessible physical activities in their
local community, especially the chance to take part in
unstructured play.
It’s clear that action is urgently needed to ensure that
children are able to make healthy choices – including
opportunities to achieve the recommended 60
minutes of physical activity each day. This action
must encompass:
• raising awareness of the importance of
physical activity
• provision of a range of opportunities to be active
• consideration of the barriers to getting active, and
• concerted efforts to reduce health inequalities.
Since the last edition of Couch Kidsin 2004, we
have seen childhood obesity move up the political
agenda in all four UK nations. This has been matched
by greater investment and support for a range of
measures to get children and young people to be
more active.
In England, physical activity has been given greater
prominence through the Fair Playand Be Active Be
Healthy strategies and a continuing focus on tackling
childhood obesity. And, in 2009, the Department
of Health launched Change4Life, a comprehensive
social marketing programme to raise awareness of
diet and exercise among parents and children, and
to provide the support to help them make changes.
At the time of publication, it is too early to evaluate
the effectiveness of this initiative. The Westminster
Government remains committed to increasing the
number of play spaces for children and young people,
including through Sure Startcentres, and has set
targets for the number of active school travel plans.
In Scotland, the Active Schoolsprogramme has helped
to encourage healthy lifestyles at school and into
adulthood. While there has been good progress on
integrating physical education into the school day
and local sports strategies, provision is not universal or
necessarily prioritised. The Scottish Parliament’s Health
Committee has recently expressed concerns about
physical activity levels(78).
In Wales, there has been good progress in introducing
primary school children to a range of activities through
the Dragon Sportinitiative and support for secondary
school sport. Welsh planning statements seek to
ensure that the built environment promotes physical
activity. In May 2009, the Welsh Assembly launched an
action plan, Creating an Active Wales(31), to build on the
investment in improving people's health so far. It aims
to develop a physical environment that makes it easier
for people to choose to be more physically active, to
support children and young people to live active lives
and become more active adults, to encourage more
adults to be more active more often throughout life
and to increase participation.
In Northern Ireland, investment in physical activity is
allocated through the Extended Schools programme
and the Sports Council for Northern Ireland. The
Department of Education has invested over £3.7m
in a physical literacy sports programme for primary
school children. This programme involves coaches
from the Gaelic Athletic Association and the Irish
Football Association working with some 600 primary
schools (Foundation Stage and Key Stage 1 pupils)
to develop the physical literacy skills among young
people. Additionally, the DHSSPS’s Get a life, get active
initiative brings together key messages and resources
on physical activity and the Fit Futures taskforce has
identified physical activity as a key element of its work.
35
Recommendations
Schools
It is challenging to recommend blanket action as both
the diverse needs of children and young people, and
the range of barriers that may prevent them getting
more active, need to be addressed. Nevertheless, the
BHF has identified a number of measures that would
help ensure physical activity is more accessible.
Schools across the UK should maximise the
opportunities for children to take part in physical
activity during and around the school day.
This should encompass motivating and prompting
children to be physically active at breaktimes, and
to encourage opportunities outside school hours
through the concept of Extended Schools. Including
minimum hours for PE in the English curriculum has
helped to drive improvements and this should now
be taken up in other parts of the UK. We support
the recent recommendation from the Scottish
Parliament’s Health Committee that the two hours
PE per week target should be included in all Single
Outcome Agreements.
At national levels
Tackling childhood obesity has been identified as a
cross-government priority. However, further action is
needed to make this a genuine priority beyond health
ministries. In particular, public health must feature
more strongly in the motivation for transport, local
authority planning and education policies.
We support the recent recommendations(194) from
the House of Commons Health Select Committee for
national governments to publish a Planning Policy
Statement on Health and to ensure that health
trusts are made statutory consultees for local
planning procedures.
This must include recognition of the importance of
active travel to public health, including safe walking
and cycling access for children to interesting places to
play and to schools.
As previously highlighted by the BHF, the quality of food
available in leisure facilities has been overlooked(195).
More cross-government action is needed to link
physical activity and healthy eating, for example by
requiring healthy food options to be available in
venues participating in Change4Life initiatives.
National Government guidelines
UK governments should develop consistent guidelines,
supported by a communications programme to
ensure public awareness, on recommended levels of
physical activity for all age groups. Recommendations
for under-5s should be a priority and dedicated
resources will be needed to ensure that these are
communicated to early years professionals.
The low levels of awareness about the importance
of 60 minutes of physical activity a day for children
are a concern. Sustained communication at
population and individual level is needed to
improve understanding. Existing vehicles such as the
Change4Life campaign in England and the Get a life,
get active initiative in Northern Ireland should be used
to drive up levels of awareness.
36
School provision should explicitly recognise the
diversity of provision and approaches needed to
ensure that physical activity reaches as many children
and young people as possible. In particular, schools
must demonstrate how they are meeting the needs
of adolescent girls and the least active groups.
There has been good progress on developing school
travel plans in England. Governments in Scotland,
Wales and Northern Ireland should now seek to
replicate this success and set ambitious targets for
schools to develop these plans.
Securing the Olympic legacy
The run-up to the London 2012 Olympic and
Paralympic Games and the Glasgow 2014
Commonwealth Games gives us an unprecedented
opportunity to raise awareness of the importance
of physical activity across the UK. A legacy that
engenders physical activity for all must be the
key test for the success of the Olympics and the
Commonwealth Games, including an increase in the
number of people taking part in physical activity.
This is an opportunity to galvanise young people that
must not be missed.
Collection of data
We have found that Couch Kids has been valued
by policymakers and practitioners as it provides a
snapshot of physical activity levels among children
and young people across the UK. However, the
collection of information on physical activity levels
and associated barriers is inconsistent across the
four nations. This makes direct comparisons and
the tracking of trends over time, including health
inequalities between countries, difficult. This should
be addressed through consistent collection of data
by local authorities, regional bodies and national
governments. This should cover the full range of
physical activity including active travel and
everyday activities.
activity should be allocated through Local Strategic
Partnerships, Single Outcome Agreements and other
local priority-setting mechanisms.
Professional support
If we are to achieve a step change in physical activity
levels across the UK, professionals leading and
delivering opportunities to get active need to be
confident and well resourced. Governments across the
UK should ensure that dedicated resources are made
available to support professional development,
particularly focusing on those individuals for whom
delivering physical activity is only a part of their role.
NICE guidelines
The National Institute for Health and Clinical Excellence
(NICE) has published comprehensive guidance in
this area, which includes recommendations for
local authorities to develop physical activity plans in
consultation with young people and for evaluation
of physical activity interventions. The Scottish
Government has also published a perspective echoing
these recommendations. The challenge remains
ensuring that this guidance is implemented in full.
UK governments should undertake a costing
exercise to establish the resources needed to
implement NICE guidance on physical activity.
Research
The BHF National Centre for Physical Activity and
Health is committed to strengthening the evidence
base for effective physical activity interventions.
This role must also be championed by the National
Institute for Health and Clinical Excellence, NHS
Scotland and others.
While increasing emphasis and resources have been
placed on physical activity, this must be coupled with
initiatives to tackle sedentary behaviour. This needs
to be examined through dedicated research.
We have strategies to increase physical activity levels
either in place or in development in all four nations
of the UK, but indications are that these remain at the
policy level – the real test is getting these strategies
implemented at regional and local level. Infrastructure
support must be put in place for county sports
partnerships and appropriate resources for physical
37
The BHF and physical activity
The BHF is committed to improving the heart health of
the population and our engagement in public health
is wide-ranging. Playing our part in supporting higher
levels of physical activity across the UK is a key element
of this work.
For the last five years we have run our wide-ranging
Food4Thoughtcampaign which aims to help tackle
childhood obesity by making it easier for children
and parents to make healthier choices about food
and activity. Food4Thoughtis a multi-dimensional
social marketing programme which targets 11-13 year
olds, teachers, policymakers and parents. Messages
are promoted via student and teaching packs, online
resources, PR and advertising. In 2009, children will be
able to learn about the benefits of physical activity via
the ‘Yoobot ’, which allows them to create a mini version
of themselves and test out what happens to health
over decades in the future when the Yoobot makes
healthy or unhealthy diet and activity choices. A poster
campaign spreading the 60 minutes a day message
throughout the UK is also available to primary and
secondary schools.
Since April 2000, we have funded the BHF National
Centre for Physical Activity and Health based in
the School of Sport, Exercise and Health Sciences
at Loughborough University. The centre provides
information, translates evidence into practice and
raises the profile of physical activity in the health
agenda, particularly in relation to the prevention of
heart disease.
We’ve also developed fundraising initiatives for
children to get involved in physical activity with
Jump Rope for Heart, a sponsored skipping challenge
which raises money for both the BHF and local schools
or children’s groups. The programme has been a great
success since it was launched in 1987, and in
2008/09 alone around 100,000 children got more
active by getting involved. A key part of the
programme’s success has been the way that it allows
children to get active either on their own or in groups.
In 2007 we introduced Artie’s Olympics, a programme
of competitive and non-competitive activities for
under 8s and in 2009 we launched Ultimate Dodgeball,
a team event for 7-16 year olds which helps children to
organise a tournament and raise funds for the BHF and
their school.
38
We produce many resources for use in and out of
school for children and young people, teachers,
playworkers and parents. In schools we have a range
of resources from posters to teaching packs, one of
which helps primary schools prepare a whole school
development plan on physical activity. Out of school,
we train tutors throughout the UK to offer Active Club
Workshops, where they teach play leaders and child
minders, who are often inexperienced at supervising
physical activity, to use the BHF’s comprehensive free
Active Clubpack.
Resources for children to increase their activity over
several weeks, and for parents to be active role models,
are all aimed at making increased activity achievable
from whatever starting point.
Working in partnership with others to help tackle
inequalities in cardiovascular disease is one of the
BHF’s strategic objectives. In 2009, we launched
the Hearty Livesprogramme, which invests £9m in
local areas with a disproportionately high incidence
of cardiovascular disease. We are working with
local health trusts and local authorities to develop
innovative projects to support their communities.
For example, we will be working in partnership with
NHS Hastings and Rother and Hastings Borough
Council to increase the amount of time children and
their families spend being active.
We believe that our initiatives help to ensure that
children and young people can be more active,
reducing their risk of future health problems.
But we must work together. If we are to be successful
in reversing the trend in childhood obesity, concerted
action from governments across the UK is vital.
39
Appendix 1.
Key factors associated with physical activity for young people
Summary of key correlates of physical activity for young people (137)
Correlate
Direction of
association
Estimated strength
of association
Comments
Demographic and biological correlates(57)(139)(140)(58)
Male gender
+
Moderate to large
-
At least
small -to - moderate in
adolescence
Age
Gender differences are highly reproducible,
but they could vary depending on type of
physical activity studied.
Highly reproducible but little effect in
pre-adolescence.
Psychological correlates(57)(58)
Positive motivation
+
Effects are less likely in younger children.
Perceived competence seems to be an
important correlate of physical activity for
Small in adolescent girls
adolescents.
Enjoyment of activity seems more important
for girls than boys.
+
Small - to - moderate in
adolescent girls
-
Small - to - moderate
Perceived barriers may reflect real barriers or
be justifications of personal preferences
+
Moderate
Consistent with evidence for moderate
tracking during childhood and adolescence.
+
At least moderate
Smoking
-
Moderate
Sedentary behaviour
at weekends and
after school
-
Small
(eg, enjoyment,
perceived
competence,
self-efficacy)
Body image
Barriers
Behavioural correlates(57)(139)(140)(58)
Previous physical
activity
Sport participation
Some evidence for larger effect in
adolescent girls.
Overall sedentary time was unrelated to
physical activity.
Social/cultural correlates(57)(139)(140)(58)
Parental and social
support
40
+
Large
Parental support comes in many different
forms including social, material or emotional.
It is unclear what the most positive type of
parental support is.*
Correlate
Direction of
association
Estimated strength
of association
Comments
Environmental correlates(57)(138)(139)(58)
Access to facilities
Distance from home
to school
Time spent outside
Local crime
+
Small to moderate
-
Moderate
+
Moderate to large
-
Small
Variables clustered around concepts of
access, opportunities and availability to be
active are associated with higher levels of
physical activity.
This will interact with local conditions.
This is likely to interact with factors such as
local amenities, safety, road traffic density etc.
Source: See reference 137.
Note: All evidence is derived from systematic reviews of observational studies.
*A distinction needs to be made between parental support and parental behaviour. There is ‘much uncertainty’ about the relationship
between parental and child activity levels(140).
41
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Phone: 020 7554 0000
Fax: 020 7554 0100
Website: bhf.org.uk