The largest increases in weight loss attempts were seen in boys, older children, Asian children, and children from lower income households, according to the study published today in the Archives of Disease in Childhood.
The researchers examined data from over 34,000 children aged 8-17 who participated in the Health Survey for England (HSE) from 1997-2016. Using this data, the researchers tracked how common weight loss attempts were across several sociodemographic characteristics, including age, gender, weight status, ethnicity, and household income.
Childhood obesity was first identified as a government priority in England in 2004, and in 2006 the National Institute for Health and Care Excellence (NICE) published their first guidelines on the prevention and treatment of excess weight in children leading to a rise in the commissioning of child weight management interventions or programmes.
Melissa Little, registered Dietitian and Doctoral student at the Nuffield Department of Primary Care Health Sciences, University of Oxford, said: 'There’s been a steady rise in the number of children with overweight or obesity in England over the past decades amongst children and young people. However, we don’t know much about the numbers or characteristics of those children who may be attempting to lose weight. So, for this study, we wanted to see if there were any trends or changes in the prevalence of weight loss attempts amongst 8- to 17-year-old children.'
The study adhered to the World Health Organization classifications of weight as defined by the BMI-Z score, used for children who are still growing, which considers height, weight, gender, and age.
Dr Aryati Ahmad, Co-lead author and researcher from the Nuffield Department of Primary Care Health Sciences, University of Oxford, now based at Universiti Sultan Zainal Abidin, Malaysia, said: 'Overall, we saw that the number of children reporting weight loss attempts is growing at a faster rate than the rise in excess weight.
'Alarmingly, the data also showed that an increasing proportion of children with a ‘healthy’ weight also reported trying to lose weight. This raises concerns and suggests greater attention is needed to target weight control messages appropriately.'
Co-lead author Dr Carmen Piernas of the University of Oxford’s Nuffield Department of Primary Care Health Sciences said: 'We found that children were more likely to attempt to lose weight if they were overweight or obese, female, from an ethnic minority group or living in a low-income household. However, weight loss attempts increased across all BMI categories, and especially among boys, older children, children of Asian ethnicity, and those from lower income families.'
While weight loss attempts in children with overweight or obesity have increased, this has not been matched by an increase in the provision of weight management services in England, creating a risk of unsupervised and potentially inappropriate weight control behaviours. This, they say, suggests that weight management services for young people with obesity need to expand to meet the rise in weight loss attempts – including research into more effective interventions.
The researchers suggest one possible explanation for the observed increase in weight loss attempts was the introduction of providing individual level feedback on weight by the National Child Measurement Programme between 2010 and 2011.
The authors also note that further research is necessary to understand the drivers of weight loss attempts among young people with a healthy weight and to reduce their occurrence. Policies and programmes to tackle overweight and obesity in young people will need to be sensitive to the risk of encouraging inappropriate weight control practices.
The authors note that while body weight and height were measured by trained interviewers for the HSE data, there were still a number of limiting factors to interpretations of the results, including the fact that questions about weight loss attempts were not asked every year, limiting the ability to look for recent changes, and that while weight loss attempt for 13-17 year olds were self-reported, parents were responsible for answering interview questions on behalf of the younger children.
The full paper 'Trends in weight loss attempts among children in England' can be read in Archives of Disease in Childhood one of more than 70 specialist journals published by BMJ.