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Managing obesity in children and adults

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Ann Shuttleworth, BA.

Freelance Health Journalist

Since 1980, the prevalence of obesity has almost trebled in the UK and continues to rise. In 2001, nearly two-thirds of men and over half of women were either overweight or obese (Joint Health Surveys Unit, 2002).

Since 1980, the prevalence of obesity has almost trebled in the UK and continues to rise. In 2001, nearly two-thirds of men and over half of women were either overweight or obese (Joint Health Surveys Unit, 2002).

Obesity among children is also rising. In 2001, 8.5% of six-year-olds and 15% of 15-year-olds were obese, and in the period 1996-2001 the proportion of overweight children increased by 7% and of obese children by 3.5% (Joint Health Surveys Unit, 2002).

The increase in incidence of obesity and overweight is a source of concern to many health professionals and to the Government, as it increases the risk of developing a number of conditions including diabetes mellitus Type 2, arthritis, gallstones, coronary heart disease, high blood pressure and some cancers.

Obesity among children is a particular concern, as this may lead to increased incidence of obesity-related conditions among younger adults.

Studies have confirmed that physical inactivity, unhealthy eating habits and coming from a low socio-economic background are associated with overweight in children (Muller et al, 1999), and that parental weight, activity and cardiovascular risk factors can affect children's weight (Golan et al, 1999).

The Health Development Agency recently published a review of how food promotion such as television advertising affects children's food knowledge, preferences and behaviour. It concluded that:

- A great deal of food advertising is directed at children

- The advertised diet is less healthy than the recommended one

- Food promotion is affecting children's preferences, purchase behaviour and consumption.

A recent report by the Health Development Agency presented evidence from a number of meta-analyses and systematic reviews of interventions shown to be effective in the management of obesity and overweight in children, adolescents and adults. The report found clear evidence to support a range of interventions.

Children and adolescents
School-based multifaceted interventions including nutrition education, promotion of physical activity, behavioural therapy, teacher training and modification of school tuck shops and meals were found to be the most effective preventive strategy. They were particularly suitable for girls.

A range of treatments were found to be effective:

- Family-based interventions involving at least one parent, with health promotion and physical activity

- Multifaceted family-based behaviour-modification programmes in which parents take primary responsibility for changing their children's behaviour

- Laboratory-based exercise programmes.

Treatment and management interventions for overweight in children are different to those used for adults, as they must take account of the fact that children are growing. Rapid weight loss and strict dieting are not appropriate unless under specialist care, and management usually involves minimal weight loss, no weight gain as height increases, or weight gain slower than height gain.

Adults
While no conclusive evidence was found to support interventions aimed at preventing obesity and overweight in adults, a range of treatments were effective:

- Low-calorie diets (1000-1500kcal per day)

- Clinically prescribed very low calorie diets (400-500 kcal per day)

- Low-fat diets with or without energy restriction

- Increased physical activity alone or with dietary intervention

- Behavioural therapy with other weight loss practices

- Workplace health promotion

- Brief educational interventions for GPs

- Shared care between GPs and hospitals

- Inpatient obesity services

- Training for health professionals and leaders of self-help weight loss clinics.

All interventions require patients to be willing to make lifestyle changes, which include addressing eating habits, physical activity, family and psychosocial issues.

The HDA report calls for further research to be undertaken on the prevention of obesity and overweight and on the maintenance of weight loss. However, it states that there is abundant evidence of which treatment interventions have been found to work.

Golan, M., Weitzman, A., Fainaru, M. (1999) Impact of treatment for childhood obesity on parental risk factors for cardiovascular disease. Preventive Medicine 29: 519-526.

Joint Health Surveys Unit. (2002)Health Survey for England. London: The Stationery Office.

Muller, M.J., Koertzinger, I., Mast, M. et al. (1999)Physical activity and diet in 5- to 7-year-old children. Public Health Nutrition 2: 443-444.

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