Children are becoming fat because 'health visitors are worried about offending parents' Nottingham University study has concluded that this lack of action could create a long-term "cycle of disadvantage" for obese children Health visitors consider weight to be a "sensitive issue" with parents Many health visitors are "uncertain" about importance of smoking during pregnancy and high birth weight, both known risk factors for child obesity There is an "urgent need" for better training so health visitors stop heavy children becoming obese By Robin Yapp Children are becoming obese because health visitors are worried about offending their parents, experts have warned Children are becoming obese because health visitors are worried about offending their parents, experts have warned. Researchers said health visitors were too worried about alienating parents and believed some were happier to have "chubby" babies. But their lack of action could create a damaging long-term "cycle of disadvantage" for fat children who struggle to do enough exercise. "Health visitors currently lack the skills, knowledge and confidence to proactively manage obesity risk in infants," the authors wrote. They warned of an "urgent need" for better training so healthcare professionals do more to stop heavy children becoming obese. One in ten four and five-year-olds in the UK and nearly one in five 10 and 11-year-olds were classed as obese by the NHS Information Centre in 2010. Lead author Professor Sarah Redsell, of the School of Nursing, Midwifery and Physiotherapy at the University of Nottingham, said the main risk factors can be identified "during infancy or even earlier." Between a quarter and a third of babies are thought to gain weight too quickly in the first six months of life - a risk factor for obesity. But health visitors considered this a "sensitive issue" which made them "unsure how to intervene without alienating parents." "Health visitors felt they had a role in advising parents about diet but did not formally identify and/or intervene with larger infants," the team wrote in the journal Maternal & Child Nutrition. They believed some parents preferred larger infants and were unaware that their feeding practices might be contributing to obesity risk. Children are more likely to be overweight if their mothers were overweight and smoked during pregnancy. Breastfeeding and late introduction of solid foods reduces the risk but Professor Redsell's team found inconsistency in the Department of Health's recommendation not to wean a baby until it is six-months-old. Some [health visitors] endorsed this advice while others felt it was a step too far for most parents. "These participants advised parents to provide "tasters" and small amounts of solid food from around four-months onwards," they wrote. Health visitors' lack of action could create a damaging long-term 'cycle of disadvantage' for fat children who struggle to do enough exercise Many health visitors were "uncertain" about the importance of smoking during pregnancy and high birth weight, both known risk factors for child obesity. The experts concluded: "There is an urgent need for tools and training to enable all health care professionals to recognise and manage infants at risk of developing obesity without creating a sense of blame." Fat children may suffer from delayed motor development, which could lead to lower physical activity and create a long-term "cycle of disadvantage," they warned. The study involved phone interviews of up to one hour with 20 health visitors, seven nursery nurses and three registered nurses in Nottinghamshire and Lincolnshire. Rural, urban, affluent and deprived areas were all covered. The researchers contrasted the UK with the U.S., where obesity risk factors are considered as part of every child visit by a healthcare professional. UK health visitors have a statutory duty to offer a public health service to families with children under five-years-old, including advice about health and nutrition. Breastfeeding and late introduction of solid foods reduces the risk of obesity but the team found inconsistency in the Department of Health's recommendation not to wean a baby until it is six-months-old However, there is no national guidance on identifying infants at risk of obesity, despite the issue having been highlighted by the House of Commons Health Committee in 2004 and the National Institute for Health and Clinical Excellence in 2006. Dave Munday, professional officer at Unite and a registered health visitor, said the government's Health Visitor Implementation Plan 2011-2015 will help ease the burden on staff, with recruitment of an extra 4,200 health visitors. "The hope is that with the extra resources, families will get extra support and health visitors won't just be concentrating on crisis situations," he said. Health visitors need to have a good relationship with families but also need to be able to have those really difficult conversations. If the only message a family gets is that a health visitor thinks their child is fat, that's not going to work. It takes skill and time to plant seeds so that a family will make decisions that are healthier for their child.