Dr. Grace O'Malley:

Absolutely. In the case of a child on the more severe end of the scale, there may be parental mental health issues which may or may not be dealt with. The parent may not be accessing services and the child will often have a mental health issue as a result. This may not be a priority for the child and adolescent mental health services because it may not reach a threshold at which it will be deemed a priority. Because of these issues, however, such children may not be going to school. Educational achievement is incredibly important for health outcomes in the long run.

We see that kind of mix from a mental health point of view. From a physical health point of view, our general understanding of this issue is "move more, eat less". However, these kids will experience pain, so they are not able to exercise. As they may not be confident moving or competent in their motor skill, they are not the kids who want to join sports. They will be sidelined at PE or, depending on the ethos of the school, they may not be encouraged to participate because they do not achieve well in movement and games.

As human beings, we all know that food has a multitude of uses for us. We use it to nourish ourselves to help ourselves grow but we also use it to soothe ourselves. If a child grows up in an environment where food is used as a reward or where it is used to sedate or placate, a cycle is set up very early. As a society, we still think very simplistically about obesity. The new Horizon 2020 research call includes funding in the area of endocrine disruptors. There are huge issues around pollution, which can disrupt how hormones work within the body. Water pollution, air pollution and plastics within our food system can affect us. The same is true of ultra-processed foods. It is like climate change. The child or adult is a physical manifestation of the environment in which he or she is living. This does not just include the family home. It pertains to people's own biology, the family home and the society they are living in.