Impact of cuts to local government spending on Sure Start children’s centres on childhood obesity in England: a longitudinal ecological study

BACKGROUND: Childhood obesity is rising in disadvantaged areas in England. Sure Start children’s centres provide community-based services for children <5 years and their parents, including many services that can support healthy weight, directly or indirectly. Since 2010, austerity-driven cuts to local authority (LA) budgets have led to substantially reduced public expenditure on Sure Start services. We assessed whether childhood obesity prevalence has increased more since 2010 in those areas in England that experienced greater cuts to spending on Sure Start. METHODS: This longitudinal ecological study covers the period 2010/2011–2017/2018. Our exposure was LA expenditure on Sure Start, using Department for Education data. Our main outcome was LA obesity prevalence at age 4–5 years, using National Child Measurement Programme data. We used fixed-effects panel regression to quantify the association between change in spending and change in the prevalence of childhood obesity. RESULTS: Spending on Sure Start children’s centres decreased on average 53% over the study period, with deeper cuts in more deprived LAs. Each 10% spending cut was associated with a 0.34% relative increase in obesity prevalence the following year (95% CI 0.15% to 0.53%). We estimated there were an additional 4575 children with obesity (95% CI 1751 to 7399) and 9174 overweight or obese (95% CI 2689 to 15 660) compared with expected numbers had funding levels been maintained. CONCLUSIONS: Cuts to spending on Sure Start children’s centres were associated with increased childhood obesity. With deprived areas experiencing bigger spending cuts, reinvesting in these services may, alongside wider benefits for child development, contribute to reducing inequalities in childhood obesity.