Childhood and Adolescent Obesity

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Childhood and Adolescent Obesity

• Laura Stewart BSc BA RD
• Independent Consultant Dietitian
• the childrens weight clinic

www.childrensweightclinic.com
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What is obesity?
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How big is the problem ?
There are approximately one million obese
children and adolescents in the UK
BMA 2005
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What about Scotland ?
Pre-school 20.7 P1
21.8 P7 34.1 S3
31.3 ISD Scotland
2006
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Does it matter ?

• Dyslipideamia raised triglycerides, LDL,
  lowered HDL
• Insulin resistance
• Raised blood glucose
• Hypertension
• Metabolic syndrome
• Obesity tracking into adulthood

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And that means ?

• Heart disease
• Type II diabetes
• Polycystic ovary disease
• Liver disease
• Respiratory problems asthma, sleep apnoea
• Orthopaedic problems
• Psychosocial / self-esteem

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Energy Balance

• Physical activity
• - 1 hour /day
• Sedentary time
• - lt 2 hours /day

• Food and drink
• - ? foods particularly high in fat and sugar
• - discourage multiple snacks
• - portion sizes

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More physical activity
Less sedentary time
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SPARKLE what children do all day
Reilly et al Lancet 2004
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I can resist anything but temptationOscar
Wilde (playwright, poet wit)
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Best bets - prevention

• School based intervention integrated into
  interdisciplinary curriculum
• Uses trained enthusiastic teachers
• Targeted increasing fruit and vegetables
• Decreasing television viewing
• Increasing moderate to vigorous physical activity
• Planet Health
  Gortmaker 1999

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Best bets - treatment

• treatment should be directed at motivated
  families only
• treatment is directed at the entire family
• weight maintenance is a desirable treatment
  outcome
• treatment should be more intensive than the norm
  (more frequent and longer appointments)
• treatment should target diet plus changes in
  physical activity and/or reduction in sedentary
  behaviour

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Useful Resources

• SIGN 69 guideline 2003 (www.sign.ac.uk)
• RCPCH Gibson et al 2002 (www.rcpch.ac.uk)
• US expert committee report Barlow Dietz 1998
  (www.pediatrics.org/cgicontent/full/102/3/e29)

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Useful Resources

• Interventions for treating obesity in childhood.
  (Cochrane review). Summerbell et al 2003
• HEBS website (www.hebs.scot.nhs.uk/learningcentre/
  weightmanagement/childhood)
• Reilly et al 2002 Arch Dis Child 86392-395

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Useful Resources

• NICE Guidelines on Adult and Childhood Obesity
  and Overweight 43. 2006
• Cochrane Review, Prevention of Childhood Obesity.
  2005
• Gortmaker,S. Planet Health, Archives of Pediatric
  and Adolescent medicine 1999151409-418.