1. Main messages
The main messages are:
- obesity prevalence fell between 2020 to 2021 and 2021 to 2022 in
girls and boys in both reception (aged 4 to 5 years old) and year 6
(aged 10 to 11 years old), but remained higher than pre-pandemic levels
(2019 to 2020)
- obesity prevalence in reception children returned much closer to
pre-pandemic levels than for children in year 6
- the change in obesity prevalence by ethnic group is complex, with no
clear patterns and no ethnic group shows consistent change across age
and sex groups
- obesity prevalence in boys and girls in many ethnic groups, in both
school years, remained higher than pre-pandemic levels, though Chinese
boys in year 6 had lower obesity prevalence in 2021 to 2022 than the
previous two years
- obesity prevalence in reception girls living in the three most
deprived deciles (deciles 1,2 and 3) and reception boys living in the
second most deprived decile (decile 2) remained higher than pre-pandemic
levels whereas prevalence in all other deciles dropped below
pre-pandemic levels
- obesity prevalence in reception girls and boys living in the East
Midlands and London, boys living in Yorkshire and The Humber, girls and
boys living in urban areas, and boys living in village areas remained
higher than pre-pandemic levels
- for girls and boys in year 6 living in every region, each
deprivation decile and all types of rural and urban areas, obesity
prevalence remained higher than pre-pandemic levels
2. Introduction
This report examines the changes in the prevalence of obesity and
severe obesity between academic years 2019 to 2020 and 2021 to 2022
using data from the National
Child Measurement Programme (NCMP). Data collected between September
2021 and July 2022 (2021 to 2022 NCMP) is compared to the two previous
years of NCMP data: data collected between September 2019 and March 2020
before the start of the coronavirus COVID-19 pandemic (2019 to 2020
NCMP), and data collected one year later between March 2021 and July
2021 (2020 to 2021 NCMP). More detail about the impact of the COVID-19
pandemic on NCMP data can be found in section “11.1 Impact of COVID-19
on data”.
2.1 Body mass index (BMI) classification definitions for population
monitoring
Assessing the BMI of children is more complicated than for adults as
children are still growing. Growth patterns differ between boys and
girls, so both the age and sex of a child needs to be considered when
estimating whether BMI is too high or too low.
For population monitoring purposes in England, the British 1990
growth reference (UK90) for BMI is recommended for use to determine
weight status according to a child’s age and sex. Each child’s BMI is
calculated and compared with the BMI distribution for children of their
age and sex from the UK90 growth reference. The population monitoring
cut points for overweight and obesity (85th and 95th centiles
respectively) are lower than the clinical cut points (91st and 98th
centiles respectively) used to assess individual children. This is
designed to also capture those children in the population who are at
high risk of moving into the clinical overweight or clinical obesity
categories. This helps ensure that adequate services are planned and
delivered for the whole population. Within this report BMI is classified
according to the following list using the UK90 growth reference:
- obesity: greater than or equal to 95th centile
- severe obesity: greater than or equal to 99.6th centile
2.2 About the NCMP
The NCMP is an annual programme that in a normal year measures the
height and weight of over 1 million children in reception (aged 4 to 5
years) and year 6 (aged 10 to 11 years) in mainstream state-funded
schools in England. Although the NCMP only covers two age groups, it
normally includes most children in those school year groups. In 2021 to
2022 around 1,170,000 children were measured; 92% of all children
eligible to be measured. The impact of COVID-19 pandemic meant that in
2020 to 2021, around 300,000 children (25% of previous full measurement
years) were measured and in 2019 to 2020 around 890,000 children were
measured (around 75% of previous years).
This report builds on last
year’s changes in the prevalence of child obesity report to identify
which population groups in England experienced returns to pre-pandemic
prevalence of obesity and investigates whether existing disparities in
child obesity have improved or worsened.
3. Trends over time
In this report we will focus on the recent changes in obesity and
severe obesity prevalence and how they vary between different population
groups.
Figures 1a and b show obesity prevalence and severe obesity
prevalence for children in reception (aged 4 to 5 years) and year 6
(aged 10 to 11 years) since the programme began in 2006 to 2007:
- obesity prevalence in 2021 to 2022 was significantly lower compared
to high percentages in 2020 to 2021 and children in reception had larger
decreases in obesity prevalence than children in year 6, but prevalence
still remains above pre-pandemic levels in 2019 to 2020 particularly for
year 6 (figure 1a)
- a similar pattern was seen for severe obesity where prevalence in
2021 to 2022 was significantly lower compared to 2020 to 2021 and
children in reception had larger decreases in obesity prevalence than
children in year 6 (figure 1b)
Severe obesity prevalence trend
4. Interpreting change charts presented throughout this report
This report uses interactive charts to display the prevalence figures
for 3 years of data. An example to help interpretation is shown in
Figure 2; the dark blue bar on the chart is the prevalence of obesity or
severe obesity for 2021 to 2022 (the latest year of data), the green
horizontal line is the prevalence data for 2020 to 2021, and the orange
circle shows the prevalence data for 2019 to 2020 (pre-pandemic). The
higher the top of the blue bar, green line or orange circle the higher
the prevalence value.
Use the computer mouse to hover over the bars and data points in the
charts in this report to show an information box that will provide
prevalence values, confidence intervals, and whether the differences
between the data years are statistically significantly different (see
section 11.4 of this report for how significant differences are
calculated). To download an image of the chart, click on the small icon
of a camera to the top right of the chart (this is visible only when
hovering over the data chart).
5. Changes in the prevalence of obesity and severe
obesity by age and sex
Figures 3a and 3b show the change in obesity and severe obesity
prevalence by age group and sex. Important findings to note are:
- prevalence of obesity among girls and boys in reception in 2021 to
2022 returned to levels close to, though still higher than, pre-pandemic
rates from 2019 to 2020 (figure 3a)
- prevalence of obesity in girls and boys in year 6 in 2021 to 2022
remains much higher than pre-pandemic rates from 2019 to 2020 (figure
3b)
- There was a similar pattern for severe obesity (figure 3a and
3b)
Severe obesity prevalence
6. Changes in the prevalence of obesity and severe obesity by age,
sex, and ethnic group
There are known disparities in weight status by ethnicity, with
children from black and some Asian ethnic groups having higher
prevalence of obesity than children of white British ethnicity. Some of
the differences in prevalence between ethnic groups could be due to
confounding factors such as area level deprivation. The commentary is
restricted to children where ethnicity was known which represents 86% of
children in reception and 89% of children in year 6.
6.1 Obesity prevalence
For obesity prevalence (Figure 4a, 4b, 4c, 4d):
- in reception, girls and boys in nearly all ethnic groups had lower
obesity prevalence in 2021 to 2022 compared to 2020 to 2021 (figure 4a
and 4b)
- in reception in 2021 to 2022, obesity prevalence remained higher
than pre-pandemic levels (2019 to 2020) for black African girls, girls
from any other Asian background, and any other ethnic group, and
Pakistani boys, white and Asian boys, and boys from other black
backgrounds (figure 4a and 4b)
- in year 6, Indian girls, Pakistani girls, white and black Caribbean
girls, white British girls, white Irish girls, Chinese girls, girls from
any other Asian background and girls from any other black background had
lower obesity prevalence in 2021 to 2022 compared to 2020 to 2021
(figure 4c)
- in year 6, Indian boys, Pakistani boys, Chinese boys, boys from any
other Asian background, black African boys, boys from any other Asian
background, any other black background, mixed white and black Caribbean
background and any other ethnic groups, white British boys and boys from
any other white background have lower obesity prevalence in 2021 to 2022
compared to 2020 to 2021 (figure 4d)
- in year 6 in 2021 to 2022, obesity prevalence remained higher than
pre-pandemic levels for Indian girls, Pakistani girls, black African
girls, white British girls, and girls from any other black background,
any other mixed background, any other white background, and any other
ethnic group (figure 4c)
- in year 6, Chinese boys had lower obesity prevalence in 2021 to 2022
compared to 2019 to 2020, most of the other ethnic groups had higher
obesity prevalence than before the pandemic (figure 4d)
6.2 Severe obesity prevalence
For severe obesity prevalence (Figure 4e, 4f, 4g, 4h):
- in reception, girls and boys in nearly all ethnic groups had lower
severe obesity prevalence in 2021 to 2022 compared to 2020 to 2021
(figure 4e and 4f)
- in reception in 2021 to 2022, severe obesity prevalence remained
higher than pre-pandemic levels (2019 to 2020) for black African girls,
white British girls, Bangladeshi boys, Indian boys, Pakistani boys,
white British boys and boys from any other ethnic group (figure 4e and
4f)
- in year 6, only Indian girls, Pakistani girls, girls from any other
Asian background and white and black Caribbean girls had lower severe
obesity prevalence in 2021 to 2022 compared to 2020 to 2021 (figure
4g)
- in year 6, black African boys, boys from any other black background
and any other ethnic group and white British boys had lower severe
obesity prevalence in 2021 to 2022 compared to 2020 to 2021 (figure
4h)
- in year 6, Bangladeshi girls, Pakistani girls, black African girls,
black Caribbean girls, white British girls and girls from any other
Asian background, any other ethnic group, and any other white
background, had a higher prevalence of severe obesity in 2021 to 2022
compared to pre-pandemic rates from 2019 to 2020 (figure 4g)
- in year 6, severe obesity prevalence in 2021 to 2022 remained higher
than pre-pandemic rates of 2019 to 2020 in Pakistani boys, black African
boys, black Caribbean boys, white British boys, boys from any other
Asian background, white and Asian boys, white and black Caribbean boys,
boys from any other black background, any other white background and any
other ethnic group (figure 4h)
7. Changes in the prevalence of obesity and severe obesity by age,
sex, and deprivation
There is a strong correlation between weight status and deprivation,
with children living in the more deprived areas experiencing a higher
prevalence of obesity. Data is presented using the 2019 Index
of Multiple Deprivation (IMD), a measure of relative deprivation for
small areas. The small areas are divided according to their deprivation
rank into 10 equal groups (deciles), ranging from the most deprived
(decile 1) to the least deprived (decile 10).
7.1 Obesity prevalence
For obesity prevalence (Figure 5a, 5b,5c,5d):
- in reception, girls and boys across all deciles had significantly
lower obesity prevalence in 2021 to 2022 compared to 2020 to 2021
(figure 5a and 5b)
- in reception, obesity prevalence remained higher than pre-pandemic
rates of 2019 to 2020 for girls living in the three most deprived
deciles (deciles 1, 2 and 3), and boys living in the second most
deprived decile (decile 2 (figure 5a and 5b)
- in year 6, girls living in deciles 1 to 7 and boys living in deciles
1 to 9 had lower obesity prevalence in 2021 to 2022 compared to 2020 to
2021 (figure 5c and 5d)
- in year 6, obesity prevalence remained higher than pre-pandemic
rates of 2019 to 2020 for girls and boys living in every decile (figure
5c and 5d)
7.2 Severe obesity prevalence
For severe obesity prevalence (Figure 5e, 5f, 5g, 5h):
- in reception, girls and boys across all deciles except girls living
in the second least deprived decile (decile 9) had lower severe obesity
prevalence in 2021 to 2022 compared to 2020 to 2021 with prevalence
returning close to the pre-pandemic rates of 2019 to 2020 but still with
some statistically significant difference for some subgroups (figure 5e
and 5f)
- in reception, severe obesity prevalence remained higher than
pre-pandemic rates of 2019 to 2020 for girls living in deciles 1, 2, 3,
6 and 8 and boys living deciles 1, 2, 3, 7, 9 and 10 (figure 5e and
5f)
- in year 6, girls living in deciles 1, 3 and 5 and boys living in
deciles 1, 2, 3, 7, and 8 had lower severe obesity prevalence in 2021 to
2022 compared to 2020 to 2021 and boys living in decile 10 had higher
severe obesity prevalence in 2021 to 2022 compared to 2020 to 2021
(figure 5g and 5h)
- in year 6, severe obesity prevalence remained higher than
pre-pandemic rates of 2019 to 2020 for girls and boys living in each
decile (figure 5g and 5h)
8. Changes in the prevalence of obesity and severe obesity by age,
sex, and region of child residence
8.1 Obesity prevalence
For obesity prevalence (Figure 6a, 6b, 6c and 6d):
- in reception, girls and boys in all regions had lower obesity
prevalence in 2021 to 2022 compared to 2020 to 2021 with prevalence
returning close to pre-pandemic rates from 2019 to 2020 but still with
some statistically significant difference for some subgroups (figure 6a
and 6b)
- in reception, girls and boys living in the East Midlands and London
and boys living in Yorkshire and The Humber had higher obesity
prevalence compared to pre-pandemic prevalence of 2019 to 2020 (figure
6a and 6b)
- in year 6, girls in the North East, East of England and London and
boys in every region had lower obesity prevalence in 2021 to 2022
compared to 2020 to 2021 (figure 6c and 6d)
- in year 6, obesity prevalence remained higher than pre-pandemic
rates of 2019 to 2020 for girls and boys living in every region (figure
6c and 6d)
8.2 Severe obesity prevalence
For severe obesity prevalence (Figure 6e, 6f, 6g and 6h):
- in reception, girls and boys in all regions had lower severe obesity
prevalence in 2021 to 2022 compared to 2020 to 2021 with prevalence
returning close to pre-pandemic rates from 2019 to 2020 but still with
some statistically significant difference for some subgroups (figure 6e
and 6f)
- in reception, girls living in Yorkshire and The Humber, West
Midlands, East of England and London and boys in every region except the
East Midlands had higher severe obesity prevalence compared to
pre-pandemic prevalence of 2019 to 2020 (figure 6e and 6f)
- in year 6, severe obesity prevalence remained higher than
pre-pandemic rates of 2019 to 2020 for girls and boys living in every
region (figure 6g and 6h)
- in year 6, boys in Yorkshire and The Humber and London and girls in
the West Midlands, East of England and London had lower prevalence of
severe obesity in 2021 to 2022 compared to 2020 to 2021, for girls and
boys in all other regions, except for girls in the North West,
prevalence of severe obesity remained similar in 2021 to 2022 to the
high rates seen in 2020 to 2021 (figure 6g and 6h)
- in year 6, girls living in the North West had higher severe obesity
prevalence in 2021 to 2022 compared to 2020 to 2021, though severe
obesity prevalence remained similar between 2019 to 2020 and 2020 to
2021 for girls in this region (figure 6g)
9. Changes in the prevalence of obesity and severe obesity by age,
sex, and rural urban classification
An area where a child lives is classified as either urban or rural
based on the type of settlement in which residents in that area
typically live. Areas are categorised using the 2011
rural / urban classification. In this report urban/rural
classifications are grouped by settlement type: Urban, Town and Fringe,
Village and Hamlet and Isolated Dwelling.
9.1 Obesity prevalence
For obesity prevalence (Figure 7a, 7b, 7c, 7d):
- in reception, girls and boys across all rural and urban areas had
lower obesity prevalence in 2021 to 2022 compared to 2020 to 2021 with
prevalence returning close to pre-pandemic rates from 2019 to 2020 but
still with some statistically significant difference for some subgroups
(figure 7a and 7b)
- in reception, girls and boys living in urban areas and boys living
village areas had higher obesity prevalence compared to pre-pandemic
prevalence in 2019 to 2020 (figure 7a and 7b)
- in reception, girls living in hamlet and isolated dwelling had lower
obesity prevalence compared to pre-pandemic prevalence in 2019 to 2020
(figure 7a)
- in year 6, girls and boys living in urban areas, had lower obesity
prevalence in 2021 to 2022 compared to 2020 to 2021, and boys in Town
and Fringe areas had lower obesity prevalence (figure 7c and 7d)
- in year 6, obesity prevalence remained higher than pre-pandemic
rates of 2019 to 2020 for girls and boys living in each rural and urban
classification (figure 7c and 7d)
9.2 Severe obesity prevalence
For severe obesity prevalence (Figure 7e, 7f, 7g, 7h):
- in reception, girls and boys across all rural and urban areas had
lower severe obesity prevalence in 2021 to 2022 compared to 2020 to 2021
with prevalence returning close to pre-pandemic rates from 2019 to 2020
but still with some statistically significant difference for some areas
(figure 7e and 7f)
- in reception, girls and boys living in urban areas and boys living
in village areas had higher severe obesity prevalence compared to
pre-pandemic prevalence in 2019 to 2020 (figure 7e and 7f)
- in year 6, girls and boys living in urban areas, had lower severe
obesity prevalence in 2021 to 2022 compared to 2020 to 2021 (figure 7g
and 7h)
- in year 6, severe obesity prevalence remained higher than
pre-pandemic rates of 2019 to 2020 for girls and boys living in all
areas (figure 7g and 7h)
10. Conclusion
The unprecedented increases in the prevalence of obesity and severe
obesity in 2020 to 2021 following the COVID-19 pandemic which led to
school closures and other public health measures have for the most part
reversed, but for many population groups obesity prevalence in 2021 to
2022 remains higher than pre-pandemic prevalence, particularly for
children in year 6. Prior to 2020 to 2021 prevalence of obesity and
severe obesity had seen only small annual changes since the start of the
NCMP in 2006 which had not exceeded 1.1 percentage points. Whilst boys
and girls in reception had the largest relative increase in prevalence
in 2020 to 2021, in 2021 to 2022 they have seen a large relative
decrease.
However, it is important to remember that each of the three years of
data looked at here are separate cohorts of children and it is not
known, for example, whether the cohort measured in reception and year 6
in 2020 to 2021 experienced a decrease in prevalence in 2021 to 2022 as
they will have moved into years 2 and 7 so were not measured as part of
the NCMP.
In both reception and year 6, boys had a higher prevalence of obesity
and severe obesity than girls in all three NCMP years, with the
difference between boys and girls in year 6 remaining greater in 2021 to
2022 than experienced pre-pandemic.
The change in obesity prevalence by ethnic group is complex, with no
clear patterns and no ethnic group shows consistent change across age
and sex groups. However, among many groups, for boys and girls in both
school years prevalence remained higher than pre-pandemic levels, though
Chinese boys in year 6 had lower obesity prevalence in 2021 to 2022 than
the previous two years.
Prior to the pandemic, the largest increases in the prevalence of
obesity and severe obesity in boys and girls occurred in the most
deprived areas of England among children in year 6. Disparities reported
on in previous NCMP publications continue to persist with children
living in the most deprived areas continuing to experience prevalence
that is at least double that of children living in the least deprived
areas.
Generally, urban areas in England with the highest prevalence
historically saw the largest increases in obesity and severe obesity
prevalence prior to the pandemic, though for children in year 6, obesity
and severe obesity prevalence remains higher than pre-pandemic rates
regardless of where they live.
Throughout the
report where an increase or decrease in prevalence is mentioned
(described as higher or lower), it is statistically significant. The
spreadsheet published alongside this report also has a column to
indicate which changes are statistically significant compared to 2021 to
2022 data.