Nurse lecturer Florence Mitchell on why we urgently need evidence-based interventions to tackle obesity in children
If we already think we have problems meeting care expectations, we must tackle obesity in children before it becomes too serious for us to manage. To put this problem into context, recent research published in The Lancet reports that by the year 2030, 26 million people living in the UK could be suffering from obesity.
Fat children have been depicted in literature throughout the ages, from the fat boy in The Pickwick Papers and Billy Bunter to characters in the Nancy Drew and Sweet Valley High books. They used to stand out because they were different, but this is no longer the case.
Research evidence estimates there are 22 million overweight children worldwide; 33% of these are aged 2-10. This poses serious consequences for these children and society, with major risks for long-term conditions, such as type 2 diabetes, cardiovascular disease, hypertension, stroke and certain cancers.
The epidemic has reached a level where people find it difficult to identify when a child is overweight, even incorrectly believing their children have a healthy weight. Parents often rationalise excess weight as “puppy fat” rather than facing facts and are appalled when the body mass index of their child is recorded.
“Parents often rationalise excess weight as ‘puppy fat’ rather than facing facts”
In the UK, there has been much policy interest in obesity. The National Institute for Health and Clinical Excellence published guidelines in 2006; and the Cross-Government Obesity Unit was established in 2008, with the aim of reversing the trend so that levels in 2020 would have returned to those of 2000. But to date, we have yet to make a significant impact on the problem.
Despite statistics being collated and research undertaken, little clear evidence has emerged on how to prevent obesity becoming unmanageable in just a few years. The range of interventions is wide but many are based on low-grade scientific evidence.
Numerous factors are thought to contribute to the imbalance between energy input and expenditure: children snack more and consume more prepared foods than previous generations; they are less active; and their diets consist of many more carbohydrates and fats. Parental obesity increases the risk of childhood obesity and a strong, consistent relationship has been observed between low socioeconomic status in early life and fatness in adulthood. Advertising, convenience foods and inadequate cooking skills contribute to our environment being obesogenic - physical, socioeconomic and cultural factors combine to promote calorie intake and discourage activity.
Sleep deprivation has also been suggested as a contributory factor. Lack of exercise may lead to poor sleep, resulting in low leptin and high ghrelin levels, encouraging children to eat more.
A cognitive approach should accompany all other approaches to help children and parents understand the problem, and school, family and societal interventions should be considered. Many are modelled on a 10-12 week programme, although management of obesity is a lifelong process. Research shows that obese children will become obese adults without appropriate interventions.
There is insufficient evidence on obesity management to recommend screening but studies suggest monitoring growth charts may be beneficial and the National Child Measurement Programme provides surveillance statistics. We must ensure the design, delivery and evaluation of services for obese children are outcomes focused, evidence informed and practice based.
Florence Mitchell is a lecturer in nursing and childhood obesity coordinator, School of Nursing & Midwifery, Queens University Belfast