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Epidemiology
We have entered the 21st century in the knowledge that more and more children in the UK are becoming overweight or obese. Data from a number of UK studies have indicated that there has been a marked increase, particularly since the 1980s. Data on 4–11-year-olds, from three independent cross-sectional surveys published in the British Medical Journal, showed that from 1984 to 1994 the percentage classified as overweight increased from 5.4% to 9% in English boys, and from 9.3% to 13.5% in English girls.1 Data from the Health Survey for England indicate that in 2001 approximately 8.5% of 6- year-olds and 15% of 15-year-olds were obese. Information collected by the European Association for the study of Obesity (EASO) Childhood Obesity Taskforce also showed that the UK has one of the highest prevalence rates of overweight children in Europe. |
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Unlike the universally accepted definition of adult obesity there is more variation in how ‘overweight’ and ‘obesity’ are defined in children. As childhood is a time of development, the body mass index (BMI) is not a static measurement. However, age- and genderspecific BMI centile charts, adjusted for growth, have been designed by the Child Growth Foundation. |
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As with adult obesity, any factors that cause energy intake to be greater than the energy expended can lead to obesity. The possible causes of childhood obesity include:
- Rare genetic factors
- Poor diet
- Physical inactivity
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For many obese children, obesity will continue into their adult lives. Habits established early in life are always more difficult to change, and for this reason it is important to take action to try to reverse the trend of weight gain. Apart from the difficulty in changing long established habits, health risks are likely to manifest themselves earlier if obesity continues into adult life. |
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The question of how to manage childhood obesity is one that perplexes health professionals, and many are cautious about whether to intervene. As with adult obesity, making a thorough assessment will help to establish the most suitable course of action for an individual child and their family. |
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There are few studies which report on the long-term effects of interventions to control weight in children. The Cochrane Review on interventions for preventing obesity in children concluded that there was a need for a much greater number of well-designed studies, which examine a range of interventions for childhood obesity.7 It has been identified that strategies which reduce sedentary behaviour and increase physical activity seem useful. In addition, behavioural interventions appear more successful when parents are included. |
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In 1998, a US expert committee was formed to develop recommendations for physicians, nurse practitioners and nutritionists to guide the evaluation and treatment of overweight children and adolescents.8 These recommendations include:
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If a primary care team has decided that a child has, in effect, ‘simple obesity’ and does not meet the criteria for referral to a specialist secondary team, then a suitable intervention plan needs to be devised.
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Parents, children and practitioners alike should understand that the treatment of obesity is a long-term process. However, setting short-term goals will help to provide focus and direction to the treatment. The major goal is to reduce the health risks associated with obesity, and ultimately to equip the child with the skills they need to manage their weight in adulthood. Any treatment plan should aim for permanent changes, and the steps taken should be small and gradual. A reward system (non-food based) may help to motivate children to achieve their goals and will act as a marker of accomplishment. |
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Parents need to consider:
- The types of foods that they have available at home
- Their attitude towards foods and snacks e.g. are certain foods used as rewards, do children have unregulated access to high fat/high sugar snacks?
- The structure of mealtimes at home e.g. does the family sit down to eat together?
- The lifestyle choices that they themselves make and the example they provide to their child
- How they can best encourage their child to make positive changes to their eating habits without allowing food to become a contentious issue
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Start by aiming to reduce the time spent in inactive pursuits, but make this a goal for the whole family and not just the child who is overweight
Encourage more physical activity through play with other children, walking, physically active games, swimming, dancing, cycling or through participation in school or community sport
Can any car journeys be replaced by walking?
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The long-term nature of obesity treatment should be emphasised and continually reinforced to children and their families. A system of support is vital if long-term weight maintenance is to be achieved.
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There has been a rapid increase in the number of overweight and obese children in the UK. The short and long-term consequences are likely to have enormous implications for the future health of these children.
‘Overweight’ and ‘obesity’ can be defined using appropriate BMI centile charts.
Once identified, the practitioner, child and family should decide on how to proceed.
The aims of the treatment should focus on resolving any co-morbidities, reversing the trend of weight gain and, when appropriate, weight loss.
Self-monitoring of both eating and physical activity habits is a key therapeutic tool.
More research is required to identify the best treatment strategies for infants, young children and adolescents, however, family-based interventions appear to offer the greatest chances of long-term success.
A system of support is vital if long-term maintenance is to be achieved.
The prevention of children becoming overweight and obese remains a priority.
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1. Chinn S, Rona RJ. Prevalence and trends in overweight and obesity in three cross-sectional studies of British children, 1974–94. BMJ 2001;322(7277):24– 26.
2. Scottish Intercollegiate Guidelines Network (SIGN). Management of obesity in children and young people. Edinburgh: SIGN, 2003.
3. McCarthy H, Jarrett K, Crawley H. The development of waist circumference percentiles in British children aged 5.0–16.9 y. Eur J Clin Nutr 2001;55(10):902– 907.
4. McCarthy HD, Ellis SM, Cole TJ. Central overweight and obesity in British youth aged 11–16 years: cross-sectional surveys of waist circumference. BMJ 2003;326(7390):624.
5. Parliamentary Office of Science and Technology (Postnote). Childhood obesity. London, 2003.
6. British Heart Foundation. Couch kids, the growing epidemic: looking at physical activity in children in the UK [booklet], May 2000.
7. Campbell K, Waters E, O'Meara S et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2001(1):CD001871.
8. Barlow SE, Dietz WH. Obesity Evaluation and Treatment: Expert Committee Recommendations. Pediatrics 1998;102(3):e29.
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22nd February 2008
Figures released yesterday by the National Child Measurement programme are deeply disturbing. The fact that 22.9% of children in year one in primary school are overweight or obese surely indicates that measuring the BMI of children should begin much earlier.
The NOF view is that measuring BMI should begin at the age of one year and be repeated at yearly intervals throughout childhood, using appropriate charts based on breastfed children. In this way deviations from the norm could be detected early and appropriate actions taken.
It has clearly been established that an early adiposity rebound is a significant risk factor for the subsequent development of childhood obesity.
We must not forget that left ventricular dysfunction has been detected in morbidly obese six year old children and that by early adolescents obese children display such features of the metabolic syndrome with hypertension, dyslipidaemia and endothelial dysfunction all of which point to the premature onset of cardio metabolic disease.
To only begin measuring the BMI of children at school entry is an insult to child health and wellbeing.
Dr Colin Waine
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(Preconception to 18 years)
Siobhan Ahearne-Smith 18th March 2008
Background
Primary prevention should be the unequivocal first strategy for halting childhood obesity. Statistics from the UK National Child Measurement Programme (2006-07) indicate the prevalence of overweight/obese children at age 4-5 to be 22.9%. Amongst 10-11 year old children 31.6% were found overweight/obese.1The true picture of overweight/obese children may however be higher as these figures were based only on 80% participation and research results indicate that a proportion of children who may be overweight/obese may not have been included in the measurement process.1 Further emphasizing that there is an absolute requirement for an approach to primary prevention of child obesity are the disturbing predictions of the Government’s scientific expert committee, the FORESIGHT team, which predicts that, by 2050, 55% of boys could be overweight or obese and 70% of girls overweight or obese.2 |
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MEND