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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.
Read more: Defining obesity in children
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
Read more: Causes and Risk Factors
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.
Read more: Long-term Effects
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.
Read more: Assessment
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.
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:
Read more: General Approach to Therapy
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.
Read more: Developing an intervention plan
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.
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
Read more: Parental Responsibility
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?
Read more: Physical Activity
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.
Read more: Maintaining Behavioural Changes
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.
www.childgrowthfoundation.org
www.heightmatters.org.uk
www.healthforallchildren.co.uk
MEND provides programmes, services and resources to help children and families learn how to improve their health, fitness and the way they feel about their bodies. All of these elements help families manage their weight better and lead healthier lives, contributing to national and international efforts to prevent and treat overweight and obesity in children.
We currently offer three different programmes which families can join: MEND 7-13 for overweight children aged 7-13, MEND 5-7 for overweight children aged 5-7 and MEND 2-4, an early years healthy lifestyle programme for 2-4 year olds and their families, whatever the child's weight. All of our programmes involve parents or carers.
MEND is a social enterprise with a mission to enable a significant, measurable and sustained reduction in overweight and obesity. MEND works in partnership with Great Ormond Street Hospital for Children NHS Trust and UCL Institute of Child Health. The MEND 7-13 programme has been extensively researched and an RCT has shown significant improvements in waist circumference, BMI, cardiovascular fitness and self-esteem (Sacher et al, 2007).
Places on all of MEND’s courses are offered to families completely free of charge on a first come first served basis.
Why refer to MEND 7-13?
- FREE* evidence-based weight management programme for overweight / obese children aged 7 to 13 (≥91st BMI centile)
- Developed in partnership with Great Ormond Street Hospital and UCL Institute of Child Health
- Meets all NICE guidance recommendations for treatment of child obesity
- Average BMI reduction at 6 months = 1.9kg/m2
- Average waist circumference reduction at 6 months = 4.3 cm
- Results maintained at 12 months
- 20 fun after-school sessions over 10 weeks, plus continuing post-programme support
- Engages hard to reach communities
- 20 peer reviewed publications demonstrating improved health and psycho-social outcomes
- National Obesity Forum (NOF) approved
- MEND is a national partner of the DH Change 4 Life movement
*MEND’s programmes are funded nationally by Primary Care Trusts, Local Authorities, Leisure Providers, The Big Lottery Fund, Sainsbury’s, Sport England and the Youth Sport Trust.
If you require any more information on your local MEND Programmes or to refer any children, please contact MEND on Freephone 0800 230 0263 or visit the website on www.mendcentral.org or email us at info@mendcentral.org
“MEND provides evidence that weight management can be successfully undertaken across a population in a community setting. I am excited that with the advent of practice based commissioning, GP practices will now be able to commission evidence-based solutions such as MEND directly” Dr. David Haslam
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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