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Tackling childhood obesity

Paul Wilson, BA (Hons).

Research Fellow/Dissemination Officer, NHS Centre for Reviews and Dissemination, University of York, York

...

There is world-wide concern about the increasing rise of obesity in childhood. In the UK the prevalence of obesity among children has increased substantially over the past 20 years (Chinn and Rona, 2001). There is debate around the reasons for the increasing prevalence of childhood overweight and obesity, and possible explanations include an increase in sedentary lifestyles and changes in dietary patterns and eating habits.

Childhood obesity has been linked with a number of health problems (including hypertension and an increased risk of cardiovascular problems), and can have a significant impact on psychological well-being.

Halting the rising prevalence of overweight and obesity in children is a public health priority. Primary and community health professionals, including GPs, practice nurses, dietitians, health visitors and school nurses can play an important role in the recognition and management of childhood obesity. Guidelines on the weight management of children and adolescents in primary care have been published by the Royal College of Paediatrics and Child Health, in conjunction with the National Obesity Forum (Gibson, 2002). Additionally, the Scottish Intercollegiate Guidelines Network is also producing guidance on the management of obesity in children and young people in primary care (SIGN, 2002).

This article outlines the main findings of a recent issue of Effective Health Care (NHS Centre for Reviews and Dissemination, 2002). Based on updated Cochrane reviews (Campbell et al, 2002; Summerbell et al, 2002), the bulletin summarised the effectiveness of interventions in the prevention and treatment of childhood obesity.

School-based programmes
There is now a number of government initiatives specifically highlighting the key role that schools can play in improving the health of children. There is some evidence that multi-faceted, school-based programmes that promote physical activity, the modification of dietary intake and the targeting of sedentary behaviours may help reduce obesity in school children, particularly girls.

Family-based interventions
Limited evidence suggests that education programmes that focus on promoting healthy eating and physical activity and involve sustained contact with children and parents may effect changes in the dietary habits of those targeted, but effects on weight loss are less clear.

There is some evidence that family-based programmes that promote physical activity, provide dietary education and target reductions in sedentary behaviour may help children lose weight.

There is some evidence that behaviour-modification programmes in which parents take primary responsibility and act as agents of change, may help children of primary school age lose weight.

A variety of behaviour-modification programmes involving children and parents have been subject to evaluation in randomised controlled trials. Some appear promising, but given the small size of some studies and the disparate nature of the interventions evaluated, there is at present insufficient evidence to recommend any specific programme.

Research evidence
There is a lack of good quality evidence on the effectiveness of interventions on which to base national strategies or to inform clinical practice. Many of the included randomised controlled trials have methodological problems such as small sample sizes and high rates of attrition (drop out), leading to low statistical power and potential bias. Many of the interventions have been evaluated in only one or two studies and crucially involve settings that may be difficult to translate to the UK. Only one study was conducted in a UK setting.

Future research must be of good methodological quality, involve large numbers of participants in appropriate settings and needs to be of longer duration and intensity.

- Effective Health Care is an independent report based on systematic reviews of the research evidence, produced by the NHS Centre for Reviews and Dissemination, University of York. The bulletin aims to provide NHS decision-makers with information on the effectiveness of interventions and the delivery and organisation of care. For more information, tel: 01904-433648 or email: crdpub@york.ac.uk

Campbell, K., Waters, E., O'Meara, S. et al. (2002)Interventions for preventing obesity in children (Cochrane review). The Cochrane Library Issue 4. Oxford: Update Software.

Chinn, S., Rona, R.J.Prevalence and trends in overweight and obesity in three cross-sectional studies of British children. British Medical Journal 322: 24-26.

Gibson, P., Edmunds, L., Haslam, D. et al. (2002)An Approach to Weight Management in Children and Adolescents (2-18 years) in Primary Care. London: Royal College of Paediatrics and Child Health, National Obesity Forum.

NHS Centre for Reviews and Dissemination. (2002)The prevention and treatment of childhood obesity. Effective Health Care 7: 6, 1-12.

Scottish Intercollegiate Guidelines Network. (2002)Obesity in Children and Young People. A national clinical guideline. Edinburgh: SIGN.

Summerbell, C.D., Waters, E, Edmunds, L. et al. (2002)Interventions for treating obesity in children (Cochrane review). The Cochrane Library Issue 4. Oxford: Update Software.

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