Advances in ISSN: 2378-3168AOWMC

Obesity, Weight Management & Control
Review Article
Volume 5 Issue 2 - 2016
Childhood Obesity - Clinical Approach Aimed at Families
Anja Springthorpe*
BSc (Hons) Nutritional Therapy, USA
Received: September 23, 2016 | Published: November 10, 2016
*Corresponding author: Anja Springthorpe, BSc (Hons) Nutritional Therapy, Dipl BCNH, mBANT USA, Email:
Citation: Springthorpe A (2016) Childhood Obesity - Clinical Approach Aimed at Families. Adv Obes Weight Manag Control 5(2): 00128. DOI: 10.15406/aowmc.2016.05.00128

Introduction

Obesity rates in the United Kingdom are the highest in Europe and projections indicate this trend to continue for the unforeseen future. One out of four adults in the UK is obese and children have not escaped this worrisome trend as almost one in three children in England now are overweight or obese [1]. This epidemic of childhood obesity in the UK poses significant public health concerns now and in the future. The NHS spent £5.8 billion on diet-related ill health in 2005-2006 alone and with ever-rising obesity numbers this figure is likely to soar [2]. In addition to the public cost, childhood obesity also places a huge physical and psychological burden on the child due to significantly increased risk of suffering serious conditions such as type II diabetes, metabolic syndrome, cancers and cardiovascular disease (CVD) all of which contributes to reduced quality of life as well as shorter life span [2].

Diet and Lifestyle

There is consistent evidence that high intake of energy-dense food leads to a positive energy balance which manifests itself in increased weight gain and adiposity. The impact of dietary factors on obesity is complex and includes a multitude of macro- and micronutrients, but some particular foods appear to play a significant role in the development of childhood obesity. High intake of sugar sweetened drinks, added sugar, high glycaemic foods and processed and fast foods are positively associated with weight gain in children [2]. Interestingly though it was mainly the saturated fats that have received negative attention. During the 1960’ recommendations suggested that a low-fat diet reduces risk of CVD. This resulted in a 5% reduction in fat-derived calories which led to an increased consumption of carbohydrates. Because the public understanding of carbohydrate quality has been, and often still is, inadequate, a shift of dietary pattern towards high glycaemic foods and sugars occurred, which is believed to have contributed to the steady rise in obesity [3]. A recent meta-analysis of 68 trails and cohort studies confirms that sugars are a main contributing factor for childhood obesity and whilst we surly all agree that treat every now is nothing to worry about; most children are constantly exposed to these foods and have sugar consumptions well above the recommended 10% of total energy intake. Whether it is the availability of soft-drinks in schools, pint glasses of lemonade with free refill in many ‘family-friendly’ pubs, endless sweets and chocolate isles in supermarkets and relentless marketing from fast-food chains to attract families, it all adds to the excessive intake of energy-dense but nutrient-low food.

Exercise

Another significant factor in the development of obesity is lack of exercise. A steady decline children’s activity levels has been plotted over the last decades and research consistently shows that a sedentary lifestyle is positively associated with the rising trend in childhood obesity. A recent review of available research since 1964, examining data from 25million children, found that children today have 15% less cardiovascular fitness compared to their parents fitness levels during childhood which translates into a 5% decline in fitness for every decade [4]. Televisions, computers and games-consoles often receive the blame for the sedentary lifestyle in children. However, it this really what keeps kids indoors? A study which interviewed parents on perceived determinants of childhood obesity suggests that the increase of indoor hours has deeper roots. Parents today are less inclined to let children play outside over safety worries, lack of facilities for children to be active and expensive sport- and after school clubs are not affordable to all households [5].

Obesogenic Environments

So, whose job is it to protect children from excessive weight gain? Children have limited ability to make educated choices when it comes to nutritionally balanced meals, adequate energy intake in relation to activity levels and how their diet and lifestyle can affect physical and mental well-being. Children have to rely on parents to receive this guidance. However, the parents themselves may not possess the knowledge about how diet and lifestyle impacts weight and subsequently health. Parents provide the strongest influence of children health believes and behaviours, which may explain why children with overweight parents are more than twice as likely to be obese adults compared to children from non-obese parents [6]. This brings an ethical consideration with it. The adult may very well choose to be overweight, weighing up the advantages and disadvantages based on available information. The child however is less able to make these considerations, nor is the child likely to challenge the adult when it comes to diet and lifestyle.

Understand potential solutions to the problem, requires understanding the multitude of factors contributing to obesity. The term obesogenic was coined in 1999 and refers to environments which encourage excessive weight gain in predisposed individuals. The ever rising incidence of obesity in the UK confirms that we are surrounded by such an obesogenic environment. Food insecurity has largely been removed, increased costs of fruit and vegetables whilst decreased prices for sugar, refined grains & fat, increased demand of convenience foods, relentless marketing of snacking and fast foods, 24/7 availability of energy-dense foods and the list goes on [7].

So what can be done?

Tackling childhood obesity requires a multidimensional approach aimed at the whole family. This concept has successfully been utilized since 2004 by the Mind, Exercise, Nutrition, Do it (MEND) program, a community-based health intervention which engages families in the process of weight management by addressing three main components: nutrition, education and exercise. Whilst large studies about the effectiveness of MEND are still lacking, smaller trials conducted to date show promising results of sustainable weight-loss, increased exercise levels and raised self-esteem of the participating children [8]. Whilst not every family with overweight or obese children may have access to the MEND program, practitioners can base recommendations on the MEND approach.

  1. Emphasis should not be to put obese children on a diet to lose weight, but to achieve a long-term mind-set which has weight-loss as subsequence. Frequent weighing in fact is discouraged to instill a sense of getting healthy, rather than getting thin [6].
  2. Formulate achievable weekly targets based on the family’s current knowledge about diet and lifestyle, accessibility to resources and financial situation.
  3. Educating by giving healthy eating advice of what a balanced diet consists of. Children have been found to achieve long-term lifestyle-changes if they have access to education and knowledge. A study published in Psychological Science found that 5-year olds that are being read age-appropriate books about digestion, foods and nutrients followed by conversation about nutrition ate twice as many vegetables as they normally did [9].
  4. Educate parents and children about “healthy weight”. Research suggests that the high prevalence of overweight or obese individuals (25% of the UK population), has shifted perception, resulting that overweight now often is perceived as normal weight.
  5. Recommend replacement of sugars and refined carbohydrate’s with complex carbohydrates with a particular emphasis on the avoidance of sugar sweetened drinks and high calorific snacks. Although research on the exact impact of sugar reduction in children is scarce, an average loss of 0.8kg has been reported in response to a sugar intake of no more than 10% of daily energy intake.
  6. Give allowances for occasional treats and encourage that parents and children agree on a strategy such as: “If we are going out later for a pizza, let’s have a salad at lunchtime.” Children which are included into the decision making process are more likely to adhere to weight-loss strategies [6].
  7. Practical advice such as guided super-market tours explaining how to read and interpret food and drink labels; informal sessions preparing fruit and vegetables with the whole family and encouraging everyone to participate and to try “new foods”, handing out recipes and educating about appropriate portion sizes has shown to instill confidence in the parents of how to implement changes.
  8. Encourage the right eating behaviour. A meta-analysis analyzing 23 studies of the determinates of excessive calorie intake, found that eating in front of the TV distracts ability to gauge appropriate food intake, resulting in consistently higher calorie intake compared to eating meals on the table [10]. Data from 182 836 children suggest that families which have at least 3 or more shared meals per week seated on a table have a 12% lower incidence of overweight children and 24% increase in intake of healthy food compared to families which do not share meals together [11].
  9. Lack of adequate amounts of sleep (less than ten hours/day) in children also increases the risk of excessive weight. It appears that chronic tiredness modulates the endocrine system resulting in higher calorie consumption during the day [8]. Recommendations on sleep and sleep hygiene should be part of the approach.
  10. Recommend exercise. Latest findings based on links between CVD risk and childhood exercise levels suggest that boys require 80 and girls require 60 min of physical exercise per day in order to maintain a healthy weight and healthy cardiovascular system.

These recommendations can greatly contribute to an environment within the home setting which encourages a healthy lifestyle with subsequent weight-loss. However, it takes more than just the family setting to adapt and make changes in order to reduce the childhood obesity epidemic. Reducing the obesogenic environment our children are exposed to requires public health initiatives and even legislative measures. Providing safe and supervised opportunity to exercise for every child, provision of healthy foods in childcare/school settings and more focus on educating children in regards to diet and lifestyle should be top priorities in the attempt to reduce childhood obesity.

References

  1. OECD (2012) Obesity and the economics of prevention: Fit not Fat-England.
  2. Scarborough P, Bhatnagar P, Wickramasinghe KK, Allender S, Foster C, et al. (2011) The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs. Journal of Public Health 33(4): 527-535.
  3. Slyper AH (2013) New directions in the prevention of pediatric atherogenesis and obesity. Journal of the American College of Nutrition 32(5): 355-358.
  4. Tomkinson G (2013) Children's cardiovascular fitness declining worldwide SS13 Abstract 13498, American Heart Association Scientific Sessions Dallas Convention Center.
  5. Carver A, Timperio A, Hesketh K, Crawford D (2010) Are children and adolescents less active if parents restrict their physical activity and active transport due to perceived risk? Soc Sci Med 70(11): 1799-1805.
  6. Biro FM, Wien M (2010) Childhood obesity and adult morbidities. American Journal of Clinical Nutrition 91(5): 1499S-1505S.
  7. Ulijaszek SJ (2007) Obesity: a disorder of convenience. Obes Rev8(Suppl 1) 183-187.
  8. Sacher PM, Kolotourou M, Chadwick PM, Cole TJ, Lawson MS, et al. (2010) Randomized Controlled Trial of the MEND Program: A Family-based Community Intervention for Childhood Obesity. Obesity 18 (Suppl 1): S62-S68.
  9. Jiménez-Pavón D, Konstabel K, Patrick Bergman, Wolfgang Ahrens, Hermann Pohlabeln, et al. (2013) Physical activity and clustered cardiovascular disease risk factors in young children: a cross-sectional study (The IDEFICS study). BMC Medicine11(172): 1741-7015.
  10. Chapman CD, Benedict C, Brooks SJ, Schiöth HB (2012) Lifestyle determinants of the drive to eat: a meta-analysis. American Journal of Clinical Nutrition 96(3): 492-497.
  11. Hammons AJ, Fiese BH (2011) Is Frequency of Shared Family Meals Related to the Nutritional Health of Children and Adolescents? Paediatrics 127(6): e1565-e1574.
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