SHEFFIELD — Doctors treating the most severely obese children in England say missing school may be a major, overlooked part of the childhood obesity crisis. The view comes from specialist NHS weight-loss clinics that have seen more than 6,000 young people, most of whom are not attending school regularly or at all.
Those clinicians say the problem is not just about food, but about routine, exercise and the structure school life provides. The picture has sharpened since the Covid-19 lockdowns, when obesity rates rose sharply and many children spent long periods at home. One teenager treated in Sheffield said her weight worsened during that time, when she lost the daily rhythm of school and began snacking more often.
Why doctors think school attendance matters for weight
Specialists say school can shape children’s health in several ways at once. Meals are more tightly controlled in school than at home, where food choices are more variable and healthy-lunch rules do not apply. A study from the University of Leeds found that only 1.1% of packed lunches met the nutritional standards expected of a school meal.
Physical activity is another factor. Research cited by doctors found children are generally more active on school days than at weekends, with the simple act of walking to school counted as beneficial. Prof Ken Ong, lead clinician at Cambridge University Hospital’s CEW clinic, said children’s poorer diets, lower activity levels and isolation during the pandemic may all have fed into the current obesity levels.
Although the science is not settled, doctors believe school absence may be one cause among several, alongside ultra-processed food and other pressures on family life.
Lockdowns, persistent absence and the rise in childhood obesity
Childhood obesity had already been rising in the UK for years, but the pandemic made the trend worse. Government figures show the proportion of overweight and obese 10 and 11-year-olds rose from 35% to 41% during the lockdown period, with poorer children hit hardest. Rates have since eased, but they have not returned to pre-pandemic levels.
Absence from school has also become more common. In 2019, about 10% of pupils at English state schools were classed as persistently absent, meaning they missed at least 10% of classes. That figure is now 18%. International research has suggested a link between obesity and absence, including a 2017 meta-analysis across seven countries that found obese children were 54% more likely to miss school than children at a healthy weight.
Doctors say the relationship may run both ways: school absence may contribute to weight gain, but obesity can also make it harder for children to attend.
How clinics are trying to help children build healthier routines
England’s Complications from Excess Weight, or CEW, clinics are now trying practical changes that go beyond medication. Some teams have sent health workers into schools to build personalised plans, while therapists have suggested letting some children follow individual diet arrangements that may not match standard school rules.
Tessa Saunders, a family therapist at Cambridge’s CEW clinic, said obese children may benefit from more time in the canteen so they eat more slowly, plus an extra afternoon snack to reduce overeating when they get home. She also said staff could monitor water intake, since thirst is sometimes mistaken for hunger.
Dr Catherine Falconer of the UK Health Security Agency said school absence should be seen as a public health issue, not just an education issue. She also argued that more school nurses could help identify vulnerable children earlier.
Severe obesity, weight-loss drugs and the limits of treatment alone
The clinics are treating some children with GLP-1 weight-loss drugs such as Mounjaro and Ozempic, although these medicines are only licensed for those aged 12 and over and are not routinely recommended for under-18s by NICE guidance. Some parents want the drugs as a quicker option, but doctors say medication alone cannot fix the wider problems.
Prof Simon Kenny, NHS England’s national clinical director for children and young people, said some severely obese children are so withdrawn that they disappear not just from school but from wider social life too. Prof Julian Hamilton-Shield said the young people he treats are among the unhappiest children he has seen.
One Sheffield teenager, Ibbie, lost 10 stone after treatment and says the support transformed her health and confidence. Doctors say her case shows why routine, support and school attendance may matter as much as medical treatment in tackling severe childhood obesity.
The CEW clinic network now covers 39 specialist NHS hubs in England, but it reaches only about 5% of children eligible for help, while obesity-related ill health costs the NHS an estimated £12bn a year.
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