The Way Forward: Proposals, Guidelines, Recommendations

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The Way Forward Proposals, Guidelines,
Recommendations

• Professor Paul Gately
• Carnegie Weight Management

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Prevention

• Lack of evidence.
• Evidence is disappointing
• Reilly 2002 (Lancet) - only 2 studies of suitable
  methodological quality.
• Gortmaker (1999) n641 School based and n654
  controls. Change in Obesity prevalence girls I
  -3.3, C 2.2. Boys I -1.5, C -2.3.
• Luepker (1996) n 5106 in 28 schools over 3
  years. Significant (Plt0.05) changes occurred Fat
  intake ?38.7-31.9, ?PA, (58.6 mins vs 46.5
  mins, intervention schools vs controls). BP,
  body size and cholesterol did not change
  significantly.
• Resource intensive.

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Treatment

• Lack of evidence
• Reilly 2002 (Lancet) - only 3 studies of suitable
  methodological quality.
• Mellin USA (1987). n37 14X90min education
  sessions. Body mass change 3 month -3.11kg, 6
  months -1.40kg, 15 months -3.88kg.
• Epstein USA (1995). n48 ? Sed. Beh., ? PA,
  combination. OW change at 1 year I1 -18.7,
  I2 -10.3, I3 -8.7.
• Epstein USA (2000). n76 IG-? PA, C-? Sed. Beh.
  OW change 25.6, high dose -26.4. C low
  dose 22.4, high dose -27.4.

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American College of Sports Medicine and Chief
Medical Officer

• For the maintenance of health adults should
  accumulate at least 30 minutes of moderate
  physical activity on at least 5 days per week.
• Children should undertake approx. 1 hour of
  physical activity per day.

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International Obesity Task Force.

• For the prevention of unhealthy weight gain
  adults must accumulate 60 mins of moderate
  physical activity, for those who have lost weight
  or overweight they require 90mins per day and
  although data is limited children should
  undertake approximately 1 hour per day.

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Public Service Agreement

• To halt, by 2010, the year on year increase in
  obesity among children under 11 in the context of
  a broader strategy to tackle obesity in the
  population as a whole

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Challenges of Target

• No routine testing in place
• Began in 2006, full roll out 2007
• 2006 40 compliance in some PCTs
• Why year 6?
• Assessment and Monitoring?
• What to measure?
• When to measure?
• How to use the data?
• No programmes in place to tackle the problem.
• Stigma
• Children
• Staff

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National Audit Office review of delivery.

• Although cross governmental programmes aim to
  deliver wider benefits, many also have the
  potential to contribute to achieving the obesity
  target. For example, the school sport strategy,
  improving school meals, five a day and childrens
  play.

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Evidence of impact on weight.

• No debate such initiatives are good!!
• However, the degree to which they influence
  weight is in question.
• Field (2003) No impact on weight of fruit or
  veg consumption.
• Lack of impact in very well designed obesity
  prevention programmes Planet Health.
• No evaluation of school food programme, or PESSCL
  strategy in terms of influencing weight.

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Where should the focus be?
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0f Population
The Sports Relay Race Youth Sport Trust, Sport
England and UK Sport
?
UK SPORT
YOUTH SPORT TRUST
SPORT ENGLAND
TALENT CONFIRM 2 YRS
WC DEVELOPMENT 2 YRS
WC PODIUM 4YRS
1 hr
3 hrs
2 hrs
5 hrs
4 hrs
WORLD CLASS PATHWAY
NON WC ELITE

• SUSTAINING PARTICIPATION
• - PLAYER PATHWAYS
• - COMPETITIVE CLUB SPORT
• COACHING/OFFICIATING

COMPETITIVE SCHOOL SPORT SCHOOL/CLUB LINKS
20-30
WC PERFORMANCE
WC STANDARDS
Up To 60
WC IMPACT

• INCREASING PARTICIPATION
• - FITNESS
• COMMUNITY SPORT
• VOLUNTERING

OUT OF SCHOOL HOURS OPPS
SCHOOL/ COMMUNITY LINKS
20-30
ACTIVE LIFESTYLES
Age 5
Age 16
NON WORLD CLASS ELITE PATHWAY
Key OPPS Opportunities WC World Class
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Are the assumptions correct?
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Females
Gately (2006) www.carnegieweightmanagement.com
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Between schools BMIgt85th
Gately (2006) www.carnegieweightmanagement.com
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Between schools - Waistgt85th
Gately (2006) www.carnegieweightmanagement.com
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Can you see risk?

• This boy is 3 years, 3 weeks old.
• Is his BMI-for-age
• - below the 5th percentile?
• - 5th to lt85th percentile normalweight?
• - gt85th to lt95th percentile overweight?
• - gt95th percentile
• obese?

Dietz (2001)
Photo from UC Berkeley Longitudinal Study, 1973
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Plotted BMI-for-Age
Measurements Age3 y 3 wks Height100.8 cm
(39.7in) Weight18.6 kg (41 lb) BMI18.3
BMI-for-agegt95th percentile obese
Dietz (2001)
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Parental perceptions
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12-year old girls and boys
Source Hill et al.
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Fat-teasing in boys girls (Murphy Hill,
2003)





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Social network mapping
Strauss Pollack, 2003
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Your thoughts?

• His eating is better now he has his own
  microwave meals for dinner.

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My best friend told everyone I went on camp so I
went mad at her in case they thought like oh my
god youre fat and everything. In case they made
fun of me for going to a fat camp
I just want to be in a healthy, forgivable and
easy routine that is just sort of is normal to
me..just being in a routine and not knowing
anything else.. I dont like having to try and do
something that I shouldnt have to try and do
Its frustrating when (parents), if I was having
3 slices of toast and cereal and 2 glasses of
fruit juice, are like, What are you doing? Dont
talk rubbish you (didnt) have that sort stuff at
camp- you wouldnt have lost weight
Ill just get stuck into it all. Ill be like
(Dave) is now. I mean he does everythinghe has
raw eggs! He drinks raw eggs to build his muscles
up-I couldnt do that!
UNHEALTHY
NORMAL
SUPERHEALTHY
I know it could be 6 months down the line and
Ive put on 4 stone.. which is what happened last
year theres not a day that I dont think about
my weight
Even though I knew I had to eat I was finding it
hard to find something that I knew that was
acceptable to eat.. I ended up eating lunch at
4pm
Doing Thin Behaviour Dieter Exerciser Good
foods Outsiderness
Being Overweight Appearance Over
eater Sedentary Bad foods Outsiderness
Looking behaving like peers
Even if you lose a pound a week thats like 3
stone in a year. Youve still got 3 years (until)
youre down to your ideal weight
I hope to get to the stage where Im a good sort
of role model. Where I can do like a magazine
thing where Ive lost 8 stone- look at me now!
People stay normal weight dont really focus
on it. They have their food and they live their
life
I hope to get down and go into normal shops and
get all the kinda (clothes) that I want to get.
Like (now), when I walk into shops, Im like I
cant get anything in here!
Id probably turn around and go hold on a minute,
I can do something with my life here and then get
stuck into exercising and dieting, get the weight
out of the way and then go for a job and get a
job, get married and have kids like every other
person
I knew I was being good so why should people
mind that I was eating but NOW its like people
see me eating bad food and they know Im being
BADI feel bad when Im being bad
My (teacher) used to give me a set dinner meal
every week. She used to hand it to the dinner
staff and the dinner staff would give me a meal
and I wouldnt be able to choose anything else
Illustrative accounts of the discontinuities
between current behaviour and appearance Hester
and Gately (2007)
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Information skill use post intervention.

• Problem Solving (e.g. trying new activities when
  bored of old routine)
• Planning (e.g. TV free days, healthy packed
  lunches)
• Time management (e.g. use of scheduling
  behaviour)
• Monitoring of activity levels and eating
  behaviour
• Goal setting (e.g. short term goal to join after
  school sports to achieve long term aim to lose
  weight)
• Stimuli control and cues (e.g. reducing snack
  food available at home, limiting eating to one
  room)
• Modifying eating behaviour (e.g. 3-meals a day)

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Whats needed?

• Government leadership
• Schools have potential but research on
  feasibility is required.
• Treatment and prevention both required.
• Research and development support
• Training and CPD
• All staff
• Interventions for overweight and whole school.
• Assessment, anti discrimination, behaviour
  modification.
• Partnership
• What works? - dont reinvent the wheel
• More needs to be done to work in partnership.
• Effective use of time and resources.
• Within or extra curricula?

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Carnegie Weight Management
To maximise our impact on the health and well
being of not only the families we work with but
our wider society.
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Carnegie Weight Management
Training Health Fitness monitoring
Research informing practice TV Consultancy
Residential Programmes
Community Programmes
10 ? relative BMI 1-3 yr Follow up
1? relative BMI 6 m -1 yr Follow up
Treatment 1 ? relative BMI 6 m Prevention No
evidence
No evidence
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Theoretical framework

• Self Determination Theory (Deci,1985)
• Motivation
• Competence
• Autonomy
• Relatedness Safe and all in the same boat
• ?Positive and ?negative environments (Solution
  focused).

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Short term results
Gately et al. Pediatrics 2005
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Self Perception Profile for Children (SPPC)



Source Walker et al. (2002) (Plt0.01)
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Skill based exercise




Plt0.001 pre to post
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Long term results
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Sustainability - Vocational Certificate and
training
Community Group
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- Leeds Met
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THANKS FOR LISTENING
Carnegie Weight Management The Grange Headingley
Campus, Leeds Metropolitan University. www.carneg
ieweightmanagement.com