In most developed (and many developing) countries, childhood obesity has become much more common over the last few decades, and it is now regarded as one of the most serious global public health challenges of the 21st century. In England, one in five 4-5-year-olds are now overweight or obese, rising to one in three 10-11-year-olds. This sharp increase in obesity rates over the primary school years, alongside the long-term contact that schools have with the majority of children and their parents, are two factors that have led to primary schools being seen as a potential key setting for obesity prevention. Schools can provide an environment for children to eat healthily and engage in regular physical activity, and the curriculum presents opportunities for learning about healthy lifestyles. But should schools have a responsibility for obesity prevention?
We interviewed 22 headteachers from socio-economically and ethnically diverse primary schools across the West Midlands, UK, to ascertain their views on the role of schools in preventing obesity. By understanding headteacher opinions, we hoped to contribute towards shaping future approaches to children’s health in schools.
All headteachers identified that schools have an important role to play in the health and wellbeing of their pupils and that part of this was the promotion of healthy eating and physical activity. They discussed ways in which their schools contributed towards preventing childhood obesity, for example through the provision of healthy school meals and extra-curricular activities, or the implementation of health policies aimed at promoting consistent messages throughout the school. Headteachers saw benefits in promoting healthier lifestyles, and the link between children’s health and academic success was a key driver for schools.
“I think healthier children are more switched on to their learning and they seem more enthusiastic and more willing to work hard and be independent and engage with the learning.”
Many headteachers discussed how they would like to dedicate more time to promoting healthier lifestyles, as they believed that this would benefit children both in terms of their health and their education. However, academic pressure and the ‘prescriptive curriculum’ were found to be the principal barriers for schools in doing more (alongside a lack of space and facilities). One headteacher was convinced that by committing more curriculum time to physical activity and healthy eating, test results would improve. However, she was too scared to take the risk because of pressure from the government agenda.
“If this was my school and I was able to run it in any way I wanted to… a bigger part of their education would be healthy eating and active lifestyles. I can only do it minimally because of the government agenda… which has to be the ultimate priority otherwise I get into trouble.”
Despite unanimous support for the school role in promoting healthier lifestyles, headteachers were keen to point out that this was only a supporting role, with parents having the main responsibility.
“We will play a role, we will support… we will educate, but I firmly believe that it’s got to be parents who take the ultimate responsibility.”
Issues arose when it was considered that parents were not fulfilling their responsibilities adequately, for example in not providing children with breakfast or PE kits, or where parents appeared to be lacking in the knowledge and skills required to lead healthier lifestyles. Headteachers recognised that some families face barriers to adopting healthy lifestyles and require support, particularly the case in schools serving deprived communities. In these situations, many headteachers perceived the school role as a ‘backstop’, taking on responsibilities which in other schools would be seen as more in the parental domain.
“We have a big gap in parenting knowledge and so we almost step into the shoes and have to do an awful lot of that that would ordinarily be done by parents elsewhere.”
A number of schools involved parents in health promotion activities, although this was often thought to be too late.
“Often by the time they’ve come to us and they’re four and five years old, those habits have been set and it’s about unbreaking the habits, you know, we do need to start much, much earlier.”
Although many headteachers agreed that schools were ideally placed to support families, some felt that they lacked the necessary capacity and expertise to tackle the complex issues surrounding childhood obesity.
Our study suggests that headteachers are happy for their schools to play a part in contributing towards obesity prevention, and that schools would reap the benefits in terms of academic success, if they were able to do more. However, support is required, through resources and government policy, to enable them to expand on their current contribution. Targeting of such resources to those schools serving deprived communities may help to reduce health inequalities.
Featured image credit: During playtime by JackHoang. CC0 public domain via Wikimedia Commons.