In brief Gen Z and health
- There is a slow upward trend in childhood obesity across Europe and the US, but prevalence varies from country to country and rates in many European countries have stabilised.
- However, the odds seem currently stacked against Generation Z maintaining a healthy weight into adulthood (along with Millennials, they are 2-3 times more likely to become obese or overweight compared to older generations in England).
- The strongest indicator of obesity in children is socioeconomic, not generational. There is a wide range of BMIs within Generation Z – with those in lower-income households much more likely to be overweight or obese. Approximately 27% of childhood obesity has been estimated to be directly linked to lower household income.
- There appears to be a ‘cohort effect’ towards lower physical activity in some countries – in part due to more online time. There has been a halving of the proportion meeting the recommended activity levels, with over half of 13-15 year olds in England classed as ‘low activity’ – nine percentage points more than eight years ago.
- But more positively, average free sugar (sugar added to food by manufacturers or consumers) intake among children has significantly reduced since 2008, mostly due to a decline in sugary drink consumption.
THE IMPLICATIONS AND THE FUTURE
Childhood obesity is everyone’s problem
Pressure to act effectively on childhood obesity is here to stay. Legislation has been introduced in countries including the UK, Canada, Portugal and France to increase the price of unhealthy or sugary food and drink; and manufacturers and supermarkets have come under increased pressure to change their product ingredients, layout, branding and advertising campaigns.
However, so far, these initiatives have often been patchy and focused on select issues. A dawning realisation that interventions are most effective when public health bodies, business, government and non-profit leaders work together is already encouraging some multi-sector responsibility and collaboration on obesity issues (although more is needed).
There are many examples of local government seeking partnerships with private developers and community groups to tackle childhood obesity in their local area. Health goals are being integrated into the strategies of other departments, such as town planning, where local governments are collaborating to expand the opportunities for physical activity, such as building more recreational facilities, parks and playgrounds.
Community and local programmes – such as Guy’s and St Thomas’ Charity’s (a public healthcare provider in London) campaign ‘Bite Size’ – are looking to collaboratively tackle the health socioeconomic disparities that shape Generation Z’s obesity levels. Bite Size focuses on reducing the higher levels of childhood obesity in more deprived areas of Greater London, working with other charities, as well as public and private sector organisations, to look at the home and school environments.32
With the increase in childhood obesity rates slowing, high public acceptance of intervention to improve children’s diets and a more system-focused approach that recognises the inter-relation of different influences on our diet, we could be approaching an inflection point in the seemingly inevitable increase in obesity in much of the western world.
A future less sweet
Central to this more hopeful view of the future is that the global push to reduce sugar consumption is gaining momentum. Attitudes of legislators and consumers indicate that producers and retailers who resist the need to change will likely find little support from either group.33 As Ipsos MORI’s recent report on trends in sugar has shown, people are ashamed of high sugar consumption – and people do not protect what they’re ashamed of.
It seems this attitudinal shift on sugar has led to real behaviour change among parents and children – with Generation Z less likely to consume free sugars and sugary drinks. There is, therefore, a huge space for developing chocolate bars and treats for children that have less sugar.
In 2018, Nestlé released Milkybar Wowsomes – the first example of a chocolate bar containing less sugar without using artificial sweeteners. Wowsomes contain 30% less sugar than a typical chocolate bar by using physically altered sugar. With an immediate share boost for Nestlé, this was an example of companies keeping on top of public demand and policy intervention. The potential market for less sugary snacks is huge – and likely only to expand to meet the attitudinal and behavioural shifts among children and young people.
Of course, public opinion and the regulatory environment can be fickle, and one of the top future-focused questions for manufacturers is whether this is a passing fad or the start of a long-term trend: reformulation is difficult and expensive, and dietary health guidelines and pariahs are notoriously changeable. Sugar wasn’t really mentioned in US dietary guidelines as recently as 2005, when the focus was very much on fat. But at this point, momentum seems to be growing rather than shrinking.
The health tech boom
Another positive implication of the cultural concern about obesity is the stimulation of a wider and more innovative set of means to help Generation Z keep a healthy weight into adulthood. As much of Generation Z’s personal environment is, and will continue be digital, an important method to tackle obesity will be through technology, which is exactly what is happening now. Wearable devices such as the Apple Watch are becoming more common, and there is incredible potential to utilise the data captured by these gadgets for incentivising healthier behaviour. Health tech which encourages physical exercise is already becoming smarter, smaller and more integrated. The sports equipment company Oakley’s Radar Pace glasses offer automated coaching and information and miles and pace through built-in headphones.34
However, to be successful, the potential of these technologies needs to reach not just those already involved in sport, or the middle classes who can afford them. Tech is also becoming more integrated – combining data on physical exercise, calorie intake and personal biology information to help people manage their diet and overall wellbeing. While advanced tech is currently focused, for the most part, on helping patients tackling illness and disease, there is a huge market for using the same algorithms to encourage people to better self-manage their weight and overall health. One such example is the app LivingWith, which helps cancer patients manage appointments, record their feelings and connect with others – it also syncs with other fitness wearables to help patients self-manage their broader health. Broadening the application of these approaches, building them into day-to-day life, including through their clothing (see opposite) could well be a reality for Gen Z.
no gadget too small
Since the Nobel Prize-winning discovery of graphene – tiny, molecule thin thermal sensors – the team at Bonbouton has developed an impressive array of smart clothing. The sensors, seamlessly integrated into clothing, can measure a number of vitals including body temperature, heart rate, breathing, sleep and muscle motion.
The clothing can be used not only to monitor exercise, but can be used to predict injury, detect infection and has already been lauded for its use in tracking and helping manage diabetes.
The company has even more ambitious plans for the future – hoping to integrate into mobile platforms so that patients and physicians can interact with each other, patient data can be monitored, personalised treatment plans can be developed and treatment progress tracked.
THE CURRENT EVIDENCE
Childhood obesity is a chronic condition in the western world, not an acute one
Childhood obesity has not massively increased in many countries across the western world over the past 15 years or so. Although prevalence varies from country to country (and with the caveat that there are different ways to measure obesity), only in some Eastern European countries has there been a consistent significant increase in obesity in 11-15 year olds since 2002 – and this is partly due to the relatively low prevalence of obesity during that period (for example, obesity among Russian secondary school children has increased from 1% to 4%).35
But for the rest of Europe, childhood obesity has generally stabilised over the last few years – with some countries, such as Portugal, even seeing a downward trend among school children.36
Looking at England in detail as one example, obesity among secondary school-age children (11-15), has fluctuated year-on-year, but since 2003 it has pretty much stayed the same. A quarter of 11-15 year olds (23%) are obese and more than a third (36%) are overweight or obese. An approximate like-for-like comparison with Millennials in 2003 shows that almost exactly the same proportion of 11-15 year old Millennials were obese (21%) and overweight or obese (37%) at that time.
The fact that a third of adolescents are obese or overweight has serious implications for individuals, and society as a whole – but it does mean that, as a cohort, English Generation Z are no more or less likely to be overweight than Millennials were at the same age. At least, on this measure and in England, childhood obesity has stopped escalating.
In the US, we see a slightly more worrying trend. Generation Z high schoolers in 2015 are more likely to be overweight or obese than their Millennial counterparts were in 1999 (30% compared to 25%).37 But even here, increases have been shallow over the last 16 years and mostly involve increased numbers of high-schoolers being overweight rather than obese.
Generational odds stacked against them?
However, this cohort-based slowdown in absolute obesity levels does not necessarily mean that adult obesity won’t become worse. A study examining cohort body mass index (BMI) across all five living cohorts in the UK (Generation Z, Millennials, Generation X, Baby Boomers and Pre-War) predicted that Generation Z have already developed a higher probability than older generations to become overweight or obese when they’re adults.38
Although not without caveats, this study found a concerning split between children born in England after the 1980s (Millennials and Generation Z) and those born before. By age ten, the estimated probabilities of being overweight or obese after the 1980s were 2-3 times greater than those born before the 1980s. If this is correct, Generation Z may already have the odds stacked against them to stay a healthy weight in their adult lives, and will need all the help they can get. The authors attribute this to Generation Z’s increased exposure to conditions which will cause obesity as they age. These ‘obesogenic’ factors can be found in all aspects of Gen Z’s life, and include social/cultural norms (many more adults who children interact with are obese or overweight); parental factors (around knowledge, cooking skills, time available); environmental factors (accessibility or convenience of places to exercise or what food is available at school, at home; food adverts they see) – all of which, although we’re seeing improvements, are more geared towards promoting obesity than their parents ever had growing up.
Socioeconomic inequalities trump cohort factors
Whether this pre-disposition towards obesity leads to greater prevalence among adult Generation Z remains to be seen. However, one of the strongest and most consistent correlations with childhood obesity in Europe is not cohort-based – it’s based on income and social class. Within Generation Z, there is a wide variation in BMI between children living in the richest and poorest households. On a European level, countries with higher levels of socioeconomic inequalities generally have higher levels of childhood obesity.39
In Slovakia, for example, adolescents from lower socioeconomic groups were less likely to be physically active.40 In England, a third (32%) of children (aged 2-15) in the lowest household income percentile were overweight or obese, compared with just 18% of children living in the highest income percentile.41
And this gap appears to be widening over time. The Health Behaviour in School-aged Children (HBSC) survey, controlling for other factors, calculated that 18% of childhood obesity in 2002 across 34 countries was attributable to socioeconomic differences. This essentially means that in a world where children were socioeconomically equal, 18% fewer children would be obese. In 2014, this estimate had risen to 27%, indicating that socioeconomic differences are becoming a more significant influence on childhood obesity.42
It is important to note that this doesn’t mean lower income causes higher levels of childhood obesity. In fact, studies attempting to link a causal relationship have concluded there isn’t one (at least in the UK).43 The nature of this correlation is not clear. Some have argued a reverse causality – where obesity is a cause of lower household income (among adults) due to obese people suffering labour market discrimination and public stigma,44 but it seems likely to be an interaction.
Sedentary lifestyles of Gen Z
However, there is generational cause for concern if we look at some of the associated causes of obesity. Physical activity is a complex behaviour and can be measured in different ways (where frequency, duration and intensity all play a part), but generally the guidelines for children and young people are to get 60 minutes of at least moderate-intensity activity a day.
Self-reported levels among adolescents in Europe is a mixed bag – with some countries such as Norway, Poland and Ukraine seeing a rise in the number of young people hitting the recommended activity levels. Yet in countries such as Belgium, Denmark and Greece there has been a significant decrease in activity levels between 2002 (Millennials) and 2014 (Generation Z).45
One of the countries with the biggest shift in self-reported activity levels is England – where Generation Z aged 13-15 are nearly half as likely to meet recommended levels of activity for children as Millennials were in 2008.46
Perhaps even more concerning, more than half of 13-15 year olds are classed as ‘low activity’ (52%) – the lowest category – which means they’ve been getting less than half an hour’s exercise a day. This is a clear shift, and if a generation of children have not been habitually exercising for the correct amount of time per day, then the likelihood of adult obesity among Generation Z is arguably higher.
Again, reflecting the connection between socioeconomic characteristics and weight, young people from households with higher income met the recommended guidelines more often. For example, in Italy, girls from the most affluent families were twice as likely as girls from the least affluent families to get at least 60 minutes of exercise per day (boys were 1.8 times as likely).47
A life less sweet
More cheeringly, in England at least, Generation Z seem to be consuming less free sugars than Millennials were.
Taking the latest results from the National Diet and Nutrition Survey (NDNS), the mean intake of free sugars among English children aged 11-18 years in 2015-2016 is significantly lower compared with 2008-2010. This drop is thought to be at least in part down to children consuming fewer sugar-sweetened beverages. Children aged 4-10 in 2008-10 consumed around 130g of sugary drinks a day, compared with the 83g consumed by the same age group today.
This seems to be a European-wide shift in behaviour among children and young people. The HBSC survey recorded an 11% drop in daily consumption of soft-drinks in adolescents between 2002 and 2015 (from 29% to 18%) across 32 European countries.48
FINAL THOUGHTS …
Overall then, it seems most likely that Generation Z will continue on the trajectory to high levels of obesity – although not as part of an acute obesity crisis unique to this particular generation.
While the drivers of the obesity crisis remain very powerful, Gen Z will have access to a wider and more innovative set of ways that will make keeping a healthy weight into adulthood easier – particularly from the combination of greater systemic intervention from legislation, the use of emerging technology and a better appreciation of how to use behavioural science to nudge them towards healthier outcomes.
For example, we know Generation Z spend much more time interacting online with friends and communities of interest. The wider repertoire in which younger generations connect with people online is already creating new online resources and approaches for engaging people in managing their own health.
We may be seeing an inflection point in the health of young people in western countries. It may be too late to entirely turn around the future for many in this cohort, but a lot is still up for grabs, and the youngest in Gen Z (and generations to follow) may mark the end of a sense that a fatter future is inevitable. Ensuring this brighter, lighter future is spread more evenly across socioeconomic groups will be the crucial challenge.