Childhood Obesity

1
Childhood Obesity

• PACE Event
• Bradford
• September 2006
• Dr Dee KyleDirector of Public Health

2
Background

• Facts
• Increasing prevalence of childhood obesity
• obese children likely to become obese adults

• Implications
• Important public health problem contributing to
  significant disease and mortality

3
Implications

• Adverse metabolic consequences
• Hyperinsulinaemia
• Hyperlipidaemia
• Type 2 diabetes

• Arthritis other mechanical disorders
• Certain types of cancer (colorectal, breast,
  uterine)
• Sleep apnoea
• Assoc. with asthma
• Gall stones
• Female infertility

4
Aetiology

• Obesity results from an interaction of genes and
  health behaviours around food intake and levels
  of physical activity
• There is a very small number of obese children
  with specific syndromes and single gene causes of
  obesity

5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
Definition

• The British BMI reference cut offs derived from
  the 1990 nine centile charts
• BMI 91st centile overweight
• BMI 98th centile obese

9
Why monitor and not screen?

• Expert Consensus Meeting
• No evidence of any effective intervention
• BMI as a monitoring tool
• BMI at 5y and 11y

10
Management

• Degree of overweight
• Age
• Co-morbidities
• Commitment to change lifestyle

11
Weight Management

• A sustainable healthy lifestyle is the primary
  goal
• Dietary
• Physical activity
• Behavioural

12
Intervention Energy Intake

• Increase in consumption of more high fat foods
• Poor diet containing too much saturated fat and
  too little fruit and vegetables

13
Intervention Physical Activity
14
Intervention Behaviour
Family based approach Family structure and social
support
15
Public Health Intervention

• Community level Healthy schools (DfE)
• Political/societal level Public health campaigns

16
Summary

• Interventions could be considered at these
  levels
• The treatment of individuals who identify
  themselves as obese and request help
• Seeking individuals who are at risk, offering
  interventions
• Offering interventions to whole communities eg
  schools which attempt to change the health
  behaviours of individuals within those
  communities

17
For Discussion

• Local Care Pathways
• Primary Care Setting
• Specialist service for severe obesity
• Available national guidance
• NICE/RCPCH
• Scottish Intercollegiate Guidelines Network
  (SIGN)
• National Obesity Forum

18
Relative Risk of Obese compared to non-Obese
PeopleInternational Studies in National Audit
Office Report on Obesity HAD 2002
19
Health benefits of losing weight Is it worth it?

• 10 loss of weight in a100kg obese person with
  other diseases such as coronary heart disease or
  diabetes
• Fall in more than 20 overall mortality
• Fall of 10mmHg in diastolic systolic blood
  pressure
• Fall of 10 of total cholesterol
• Fall of 30 triglycerides
• Fall of 50 in fasting glucose levels
• As body weight increases, so does the risk of
  dying as a result

20
Child Obesity Data for Year 6 Pupils2005 - 2006
As a percentage of all children on school
roll As a percentage of all children measured
21
Levels of even light physical activity are low in
the City. As light physical activity is more
likely to be done regularly, initiatives to
encourage the population to be more active should
focus on activities at this intensity level, eg
walking.
Source Health in the City, Lifestyle Survey
2005, Bradford City PCT Public Health April 2006
22
In total, only 11 of all residents are achieving
the recommended 2.5 hours per week. There are
no significant differences in the proportion
achieving the target by gender or ethnicity, but
there are differences by age.
Source Health in the City, Lifestyle Survey
2005, Bradford City PCT Public Health April 2006
23
Proportions of residents achieving physical
activity target ()
Source Health in the City, Lifestyle Survey
2005, Bradford City PCT Public Health April 2006
24
Participation Rates Local Authorities
(Bradford) Interim Survey results taken from Oct
2005 April 2006
Note Interim data was collected from the period
October 2005 to April 2006, therefore
participation rates are expected to be lower due
to seasonality. The minimum survey sample size
per LA is 385, the maximum survey sample size is
619
Source Sport England / IPSOS MORI Active People
Survey
25
School hours per week on physical activities
Source Children Exercise 2005 Survey Findings,
Bradford Met District Council
26
Hours per week exercising outside school
Source Children Exercise 2005 Survey Findings,
Bradford Met District Council
27

• Examining the distribution of fruit and vegetable
  portions consumed highlights
• 4 of residents who eat no portions of fruit
  and vegetables a day
• Almost a quarter (22) who eat 2 portions or
  less than this
• Amongst the younger group (18-24s), 7 eat no
  portions, 30 eat 2 or fewer portions

Source Health in the City, Lifestyle Survey
2005, Bradford City PCT Public Health April 2006
28
5-a-day Consumption by Ward
Source Health in the City, Lifestyle Survey
2005, Bradford City PCT Public Health April 2006
29
Over a quarter of all residents (28) have a
fizzy or flavoured drink such as Coke, Pepsi,
lemonade, Oasis etc, which is NOT a low calorie
or diet drink, on most days of the week or more
often. The other Pakistani and Bangladeshi
groups have high reported levels of consumption
of fizzy drinks. Amongst the 18-24 year old
group, 62 have a fizzy or flavoured drink on
most days of the week or more frequently.
Source Health in the City, Lifestyle Survey
2005, Bradford City PCT Public Health April 2006
30
Percentage drinking fizzy or flavoured drinks
(not low-calorie or diet) most days of the week
or more often
Source Health in the City, Lifestyle Survey
2005, Bradford City PCT Public Health April 2006
31
Percentage of people who have hot take-aways to
eat at home, most days or more often
Source Health in the City, Lifestyle Survey
2005, Bradford City PCT Public Health April 2006