Childhood Obesity

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Childhood Obesity

• PACE EventBradfordSeptember 2006Dr Soo Y
  YoongConsultant CommunityPaediatricianSt
  Lukes Hospital

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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

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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

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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

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Measurement

• Most widely used measurement is the BMI which is
  given by mass in kg/height in m2

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Definition

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

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Why monitor and not screen?

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

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Management

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

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Weight Management

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

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Intervention Energy Intake

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

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Intervention Physical Activity
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Home Activity
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Intervention Behaviour
Family based approach Family structure and social
support
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Meal times in most household
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Public Health Intervention

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

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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

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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

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Care Pathway For Children (Primary Care setting)
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Specialist Service
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FINALLY

• Keep a Positive Attitude !

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