Children and obesity

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Children and obesity

• Katrina Wyatt, Jenny Lloyd and Stuart Logan

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Children and obesity

• Background
• Our general approach to the issue
• Early results from one of our projects
• Conclusions

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Katie (age 12)

• Presentation
• Severe uni-lateral headaches
• Increasing frequency and severity over 2 years
• Some nausea, no vomiting
• Mild photophobia
• Substantial time off school
• Commonly begin on Monday evening

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Katie

• On examination
• BP 106/67
• Fundi NAD
• Neurologically normal
• BMI gt 99.8th centile

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Consequences of childhood obesity

• Hypertension
• Dyslipidaemia
• Diabetes
• Poor self esteem
• Depression
• Joint problems
• Adult obesity

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Prevalence of obesity in 5-10 year olds by period
(England)

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Max (age 4 years 8months)

• Presentation
• Parental concerns -
• Always ill
• Multiple URTI
• Poor appetite
• Not thriving

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Max

• On examination
• Ht 25th centile
• Wt 15th centile
• No abnormalities
• Twin brother
• Ht 50th centile
• Wt gtgt 99th centile

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Katie

• Mother BMI gt30
• Brother skinny
• Father Was thin but now has a paunch
• Multiple diets by mother and daughter, father
  thinks healthy lifestyle advice is all nonsense

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Childhood obesity

• Societal norms of body size have changed
  dramatically
• Definitions of obesity are arbitrary
• It is almost impossible for one member of a
  family to change their lifestyle

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Tracking of childhood obesity

• Serdula et al (1993)
• 26 41 of obese pre-school children become
  obese adults
• 42 63 of obese schoolchildren become obese
  adults

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Tracking of childhood obesity
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Prevalence of obesity in 5-10 year olds by period
(England)

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Relationship between actual and recommended
portion size
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Childrens Lifestyles

• 93 had TVs in their bedroom and 65 had no
  restrictions on viewing time
• Average TV viewing 3.9 hours/day
• There is no objective time trend data on overall
  activity although TV viewing has increased and
  walking/cycling has decreased
• The causal direction between activity and obesity
  is unclear

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Childhood obesity by income group
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The issue

• Obesity in children has risen by almost 50 in
  England since 1997
• It has been estimated that by 2050 almost 2/3 of
  children will be overweight or obese if the rise
  continues
• 97 of obese children have obese or overweight
  parents

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Obesity its simple!

• Obesity is the result of an energy imbalance
• Energy intake gt energy expenditure

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Obesity perhaps not quite so simple!
Foresight obesity causal map
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Evidence for prevention/ reduction

• Obesity is not a knowledge issue
• There is very little good evidence of effective
  interventions
• Small trials
• effect on anthropometric measures not seen at
  follow-up
• American trial Planet Health the most promising
• Promotion PA
• Modification of diet
• Reduction sedentary behaviours
• Reduction in BMI stat. significant in girls
  (linked to decrease in TV viewing)

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TR14ers
Camborne
How healthy are we?
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TR14ers
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Engagement engagement engagement

• Understanding what the issues are
• Going to where the people are
• Finding what might work for them in their
  circumstances
• Understanding the barriers and levers
• Letting it grow organically

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The challenge

• Tackling obesity can not mean more of the same
• Of necessity it will require new partnerships and
  creative funding arrangements
• Bringing about behaviour change means we are all
  going to have to work differently
• Obesity is an engagement issue rather than a
  medical issue

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The 80/20Healthy Lifestyles Project(HeLP)
Development of a complex intervention
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Incorrect Energy Balance!
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Goal Setting

• I will replace my chocolate bar on the way to
  school on Mon-Friday with a cereal bar, apple,
  banana or make sure I have a bigger breakfast
  (2-3 Weetabix).
• I will replace my after tea TV on Mon-Thurs with
  doing my homework, dancing, going on the
  trampoline.
• I will replace my teatime fizzy drink on
  Mon-Thurs with a no sugar squash and fizzy water.

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Results

• The intervention was feasible and acceptable to
  schools, teachers, children and their families.
• Analysis of accelerometry data showed that
  sedentary behaviour decreased as did self report
  TV viewing.
• Children also reported decreased in consumption
  of energy dense snacks.

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Obesity is simple?

• Obesity is the result of energy imbalance
• But depends on
• Genes
• Family habits and beliefs
• Peer group norms
• Environmental factors
• Societal norms

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Interventions to address childrens lifestyles

• Get the children excited
• Get them to think about solutions
• Health not fat
• Get the parents involved

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Interventions for obesity (and everything else!)

• Need to
• Address (and engage!)
• Child
• Family
• School environment
• Social context
• Be sustainable
• Be fun