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Childhood Obesity

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Summary of the problem of childhood obesity ... No definitive method to monitor obesity in childhood ... Patient pathways for childhood obesity are not clearly ... – PowerPoint PPT presentation

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Title: Childhood Obesity


1
Childhood Obesity
  • Is it a growing problem?
  • Dr Gerry McCartney
  • Public Health Specialist Registrar
  • NHS Greater Glasgow and Clyde

2
What is obesity?
  • Defined in adults using the body mass index
    (BMI) which is a function of weight and height
  • Obesity in adults is a BMI of greater than 30
    (normal range is 20-25)
  • Childrens BMIs vary through the normal processes
    of growth, therefore a BMI cut-off at 30 is less
    relevant

3
Source Scottish Health Survey as presented on
the Scottish Public Health Observatory website
4
How is obesity defined in childhood?
  • Current consensus is that obesity should be
    defined by comparing the distribution of BMI of
    todays children with historic BMI distributions
    (from 1990) as the best proxy measurement
  • Using this measure, children who would have been
    amongst the 5 highest BMIs in the 1990 BMI
    distribution are considered obese

5
Source ISD 2006 data extracted from child
health systems project which takes data from 10
health boards (includes Greater Glasgow for
preschool, but does not include Greater Glasgow
for schoolchildren)
6
Source ISD 2006 data extracted from child
health systems project which takes data from 10
health boards (includes Greater Glasgow for
preschool, but does not include Greater Glasgow
for schoolchildren)
7
Source ISD 2006 data extracted from child
health systems project which takes data from 10
health boards (includes Greater Glasgow for
preschool, but does not include Greater Glasgow
for schoolchildren)
8
Source ISD 2006 data extracted from child
health systems project which takes data from 10
health boards (includes Greater Glasgow for
preschool, but does not include Greater Glasgow
for schoolchildren)
9
Source CHSP PS, ISD 2006
10
Proportion of pre-school children who are
overweight by area
Source CHSP PS ISD 2006
11
Proportion of pre-school children who are obese
by area
Source CHSP PS ISD 2006
12
Summary of the problem of childhood obesity
  • Prevalence of obesity is rising, both in the very
    youngest age groups and in adulthood
  • 21 of Scottish preschool children are overweight
    or obese and 31 of 3rd year secondary children
  • Obesity is associated with numerous health
    problems including diabetes, depression and
    cardiovascular disease
  • Obesity is a universal problem with slightly
    higher rates in more deprivation populations
  • Measuring trends in obesity is problematic as
    data is not routinely collected and obesity can
    be defined in a variety of ways

13
Causes of Obesity
  • Obesogenic environment
  • Readily available, cheap and heavily marketed
    energy rich foods
  • Increase in labour saving devices (lifts, remote
    controls etc)
  • Increase in passive and motorised personal
    transport (cars as opposed to walking, cycling or
    walking to public transport hubs)
  • Possible decrease in participation in active
    leisure pursuits in favour of passive activities
    (computers, television, reading)

14
Prevention or Treatment?
  • There are few evidence-based interventions which
    have been shown to be effective in the treatment
    of obesity, particularly in children
  • Primary prevention of obesity is therefore the
    preferable option if an epidemic of obesity and
    its resultant diseases is to be avoided

15
Current situation
  • A large amount of activity is ongoing both within
    the NHS and our partner agencies which aim to
    reduce obesity, but this work has not reversed
    the increasing obesity trend, although it may be
    tempering the rise
  • It is currently unclear where there may be gaps
    or overlaps in activity across the obesogenic
    environment

16
Evidence for obesity monitoring NICE 2006
  • No definitive method to monitor obesity in
    childhood
  • Current consensus is that BMI (combination of
    weight and height measures) compared with
    historic BMI distributions (from 1990) is the
    best proxy measurement
  • There is no evidence to support routine screening
    for obesity in children (or adults)
  • With the introduction of Hall4, there is now no
    routine monitoring of childhood obesity for NHS
    Greater Glasgow and Clyde

17
Evidence of obesity prevention NICE 2006
  • There is evidence that upstream activities in
    the broad context of food policy, transport
    policy and urban planning is necessary to reverse
    the obesity epidemic (tackling the obesogenic
    environment)
  • There is a substantial body of evidence available
    to suggest that traditional health education
    techniques are ineffective in preventing obesity.
  • There is some evidence that pre-school
    interventions to improve diet or increase
    physical activity can be effective, but the
    evidence is weak and the effect small
  • The evidence to support whole school approaches
    and multi-component interventions is equivocal
    with some studies showing small positive effects
    and others showing no effect

18
  • There is some evidence that school meals policy
    could be a useful locus for intervention (eg
    Hulls free school meals and Glasgows big
    breakfast), but that there is a current
    decreasing trend in school meal uptake in favour
    of cheaper fast food options outwith the school
    gates
  • There is some limited evidence that interventions
    by health care professionals may have a role in
    the prevention of obesity, but this is largely
    based on studies in adults.
  • Interventions in the wider community have some
    evidence of positive effect, including measures
    to encourage active transport and public
    transport (eg. enhancing urban space for walking
    and cycling, reducing road space for cars,
    increasing subsidises for public transport and
    addressing safety concerns)
  • Health-orientated urban planning and architecture
    outwith the field of transport is also said to
    assist in reducing the obesogenic environment,
    such as housing built with high connectivity and
    building design that prioritises stairs and
    public transport use

19
Evidence for obesity treatment NICE 2006
  • The recommendations for children who present with
    obesity are based largely on expert opinion
    rather than robust evidence
  • The latest guidance suggests that obese children
    should be assessed for co-morbid features, and if
    these are found they should be referred to a
    specialist clinic for assessment and possible
    medical or surgical treatment
  • Patient pathways for childhood obesity are not
    clearly defined nor established in NHS Greater
    Glasgow and Clyde

20
Conclusions
  • We are facing a growing problem with obesity in
    Scotland.
  • Treatment of obesity is fraught with difficulty
  • Our priority should be to have comprehensive
    planning, policy and initiatives to reduce
    calorific intake and increase physical activity
  • NHS Greater Glasgow and Clyde are developing a
    framework with our partners through the CH(C)Ps
    to create changes in the obesogenic environment
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