Managing Childhood Obesity

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Managing Childhood Obesity

• A Secondary Care Approach
• Dr Julia Potter

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Consequences of Obesity
Medical Psychological

• Increased growth
• Increased HR CO
• Early menarche
• Hyperlipidemia
• Hyperinsulinaemia
• Hypertension
• Slipped femoral epiphysis
• Sleep apnoea
• Asthma

• Low self esteem
• Depression
• Negative stereotype
• Disturbed body image
• Bulimia

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Fast food
Ethnicity
Community characteristics
Socio-economic status
School
Parent characteristics
Sibling interactions
TV viewing
Child characteristics
Sedentary behaviour
Weight status
Dietary intake
Physical activity
Activity patterns
Food preferences, knowledge availability
Weight status
Leisure time facilities
Safety
Davison KK, Birch LL, 2001
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PROJECT AIMS

• Reduce the incidence of obesity in West Sussex
• Collect data on the impact of exercise
  intervention alongside dietary intervention on
  overweight children.
• Improve the health and general well-being of
  individuals who become involved in the project.
• Gain a better understanding of the problem of
  childhood obesity

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New LEAF

• Lifestyle Eating Activity and Fitness
• Clinic based a St Richards Hospital, Chichester
• Since September 2001

Paediatrician
Physical Education Teacher
Dietician
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The Assessment

• Measurement of body composition by impedence
• Pattern of obesity
• Central obesity confers risk confers greatest
  risk of adverse CVS symptoms
• Blood pressure
• Menstrual history
• Acanthosis nigricans
• Indicative of insulin resistance
• Signs of endocrinopathy
• Signs of genetic obesity syndromes
• Concomitant drug use
• Steroids
• Anti-psychotic medications

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DIET

• But I didnt eat anything.

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DIETARY INTERVENTION

• Assessment of current diet
• Structured eating plan
• What healthy foods do they like? Increase the
  number of those they eat
• Goal setting
• Discussion of a healthy diet with the young
  people and their parents
• Alternative activities to eating i.e. in cases of
  emotional stress
• Making it a family project
• Overall aim to maintain weight
• Understand what a healthy diet is.

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Structured Eating Plan

• Balance of Good Health Portion Sizes
• Smaller portions of food from following groups
  prescribed to provide 75 expected energy
  requirement
• Bread, other cereals, potatoes
• Fruit and Vegetables
• Meat
• Dairy
• Fat and sugar
• Treats
• Vitamin and mineral supplement

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PHYSICAL ACTIVITY

• I cleaned my bedroom every day so my mom gave me
  a big bag of sweets..

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Physical activity Obesity

• Protects from development of obesity
• Increased energy expenditure
• Increased resting metabolic rate
• Increased fat utilisation
• Paucity of data in children on substrate
  utilisation and energy balance particularly in
  growing children
• Improved health in every dimension

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Physical activity

• Play, chores, organized sports and exercise
• Considered a behaviour
• Physical fitness - an attribute
• -measurable
• Physical activity - difficult to measure
• in children

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Activity Intervention

• Assessment of current activity
• Unstructured activity plan
• goal setting
• family project
• Activity clubs
• 2 hrs twice each week

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RESULTS?

• 50 children have lost weight
• 33 have lost fat
• both have been sustained
• boys seem to respond best to the eating plan
• girls seem to respond best to the dietary
  intervention

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What did we learn?

• Identification and acceptance of the problem
• Emotional barriers to health change
• The importance of monitoring body fat not just
  BMI
• Involvement of the whole family
• Identification of different parental types
• Reject the health messages, resistance
• Not engaged
• Knowledge of overindulgence.
• Parents see themselves as responsible for food
  but not activity
• The importance of hope support and effective
  communication
• It works in other settings

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Weight decreases along with fat mass while lean
mass increases
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Weight stable lean tissue increases while fat
mass decreases
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Weight increases along with lean tissue mass
while fat mass is stable
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FMI/FFMI
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FMI/FFMI
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New LEAF Pilot in Secondary school
56 invitations sent out to obese children 13
agreed to come and just 11 came regularly 5 boys
and 6 girls aged 11-13 years. In just 9 weeks
the results were
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In the light of this and MEND..

• New treatment structure
• Individual appointment with dietician
• Twice weekly exercise session at University of
  Chichester with exercise instructor, for 12
  weeks.
• Family to attend at least 2 sessions.
• Attendance at Family Life Coach Day
• Dietician and paediatric review at 1 month
• Dietician and paediatric review at 3 month
• Option to start anti-obesity medication.
• Metformin Sibutramine combination trial
• At 3 months repeat assessment tests.
• Discharged from New LEAF Programme to self
  management.
• Cost of programme approximately 435 per child.
• If on medication continue dietetic and medical
  reviewed by paediatric consultant and dietician
• Consideration of bariatric surgery