Inside the UK obesity clinic treating toddlers

Much of the clinic’s work involves educating parents on appropriate servings – there are no ”good” and “bad” foods but rather “everyday” foods and “sometimes” foods, and no restrictive calorie counting. Photo / 123RF

A new specialist centre in the UK is taking a cutting-edge approach to childhood obesity – and seeing astonishing results.

In a nondescript building tucked away on the high street of Taunton in Somerset, Michaela Critchley, 29, looks on proudly while her 2-year-old daughter Emilia plays with a box of toys. With curly hair and bright blue eyes, Emilia is – like toddlers should be – full of curiosity and fun. She is learning to speak, and is seemingly a picture of health.

But just a year and a half ago, it was a different story. In June 2023, shortly after turning one, Emilia was classed as being severely obese and gaining weight rapidly. Her family nickname was “Chub” and she weighed two stone – some 11lb (5kg) above average for her age and sex. Also, due to an excessive consumption of milk, which can hinder iron absorption, she was suffering from anaemia.

Most average-weight children her age gain around 3% of their body weight per month, but Emilia was gaining 7%, more than double that amount. After being referred to Splash – a unique clinic set up to tackle severe obesity in very young children – this has reduced to 2%.

“To be honest, I was always worried about Emilia’s weight but I didn’t know what to do about it,” her mother tells the Telegraph. “Out in public, I would feel that everyone was judging me for her size. But I have since learned so much about obesity and the psychology behind it. I’ve changed how I approach food, and I am much more confident about doing my best for Emilia.”

In the predominantly rural county of Somerset, finding severely obese children – which means their body mass index (BMI) is in the top 0.4% for their child’s age and sex – is not hard. Figures from 2022/2023 show 24% of reception-aged (4 to 5-year-old) children in the county are very overweight or obese (the national figure for England is similar), while come Year 6 – so 10 to 11-year-olds – this rises to 34%.

In England, the overall amount spent on obesity across all ages currently stands at £6.5 billion a year; the UK government is currently looking at providing “fat jabs” such as Ozempic on the NHS and banning junk food adverts before 9pm on television.

To help tackle this crisis – which was helped along by Covid – Splash was set up in April 2022 by the Somerset NHS Foundation Trust, with a special responsibility for the very youngest of children, in some cases within the first year of life and up until the age of 5.

So far, 67 families have been through its doors – many referred from GPs or health visitors. The youngest child to visit the clinic was just five months. Some 84%of the children aged 2-4 have seen a reduction in their BMI. The team has also managed to reverse fatty liver, a build-up of fat in the liver, in several patients – a real success, as it can cause long-term liver problems.

The weight loss has also helped several children who were suffering from sleep apnea – a disorder associated with obesity that causes your breathing to repeatedly stop or become shallow during sleep. And the clinic, which costs £131,500 ($293,435) a year to run, has intervened to help one child who they discovered had an increased risk of developing type-two diabetes.

Type-two diabetes is linked to lifestyle factors, and in New Zealand, the condition has increased children. Photo / 123RF

It is worth pointing out, though, that despite these successes, there are no quick fixes with obesity. Even after a year of help, the children generally did not see any radical weight loss, such as moving down the obesity categories or reaching an average weight for their height.

Instead, the work is about incremental improvements: slowing the rate of weight gain relative to height as the child grows. “Obesity is a complex issue,” says Isobel Feakins, Splash’s paediatric dietician. “We wouldn’t want the children to show big decreases in weight as this can impact on how they grow. We are aiming instead for them to adopt healthier behaviours long-term, such as increasing activity levels or trying new foods or reducing milk intake, which has a lot of calories in it. Without support, the children would continue to jump in weight.”

According to Splash, the problem of obesity is multifaceted. Nearly half (44%) of the families at the clinic suffer from deprivation. Research shows poorer communities may struggle to access healthier food or exercise.

For Feakins, the real villains are processed products, such as soft drinks, pizza and some breakfast cereals, and large portion sizes. “Some children have an awful lot of processed food – foods with hidden sugars which are very accessible, as well as takeaways and fast food,” she says. “But you also have some children who eat huge portion sizes. People think it’s eating too much McDonald’s but it’s not always that. It’s often children who are just having a large amount of food.”

Much of the clinic’s work involves educating parents on appropriate servings, signposting cheaper frozen fruit and vegetables, and helping to empower them to say no when their children ask repeatedly for snacks. There are also no ”good” and “bad” foods, but rather “everyday” foods and “sometimes” foods – and no restrictive calorie counting.

Tracey McCallum, the clinic’s healthy weight development lead, adds: “As a society, we’ve been doing restrictive diets forever and it’s been shown they just don’t work. At the clinic, we are focusing on better-quality foods. You can have your big dinner but it’s got to be healthier. It’s like going back in time to what our grandparents ate, such as loads of vegetables and lean meat. It is common sense but we’ve moved so far away from it. We’ve just followed the standard American diet.”

With the clinic's approach, "nothing is off-limits". Photo / 123RF

However, the clinic is clear habits can only be addressed if families engage, and this is where they feel they have the most impact. Dr Chris Knight, the clinic’s consultant paediatrician, says parents often know their child is overweight but disengage from the subject because of the stigma surrounding obesity. At Splash, weight issues are often not mentioned for several sessions, and Knight believes this partly explains why the rate of engagement after referral to the clinic is so high, at 89%.

“People often come with other problems first – money or access to services – before we get on to weight,” he says. “This is why we feel we have had such good engagement with the service.”

Families may talk with a psychologist for weeks before weight is even mentioned. Much of clinical psychologist Dr Megan Rowley’s work involves helping parents to make sense of their own relationship with their body weight and image and the role of food within the family. “I often support parents in managing heightened emotions and challenging behaviours in their children around food,” she says. “These often occur when children are highly demanding of food and parents are trying to put in consistent boundaries.”

“We focus on how parents can help their child to make sense of their emotions and feel comforted in ways that do not involve food. Some, but not all, parents have their own difficult relationship with food or with their own weight, so psychology can help parents to make sense of this.”

She explains while obesity is caused by a range of socio-economic and biological factors, there is also a “well-established” association between stress in early life, adverse childhood experiences and even inter-generational trauma.

“This is why we offer a trauma-informed approach. More of our families than not will have experienced or will still be experiencing trauma. Obesity is also linked to poorer mental health, difficulties in regulating emotions and low self-esteem – which in turn can lead to further weight gain. It’s important for us to offer support that considers these impacts on the child and family, as well as the medical aspects.”

For Emilia’s mother, it is this approach that has helped both her and her daughter. “I’ve always struggled with my own weight and body image and was at risk of passing that on to Emilia,” Critchley explains. “Splash helped me realise I was rewarding Emilia with food, encouraging her to eat a whole plateful so she could get to pudding. Now I give her all her food together and she is less interested in the pudding.”

“Nothing is off-limits. I still feed her McDonald’s sometimes but less often, and we are eating more home-cooked dinners and fruit. I am also determined to become healthier myself.”

But Critchley, like the staff and other patients, is aware Splash can only do so much and childhood obesity is not easily fixed.

“It’s starting with little steps,” explains Feakins. “But our focus is not weight loss but health gain – and a better relationship with food. But you can’t tell people what to eat and not eat. It has to come from them.”