Childhood Obesity

'Timebomb' alert over child obesity Advertising influences children's eating habits, the FSA has found Child obesity due to poor nutrition and lack of exercise is a "ticking timebomb" for life expectancy levels, the UK's food watchdog has warned. The Food Standards Agency (FSA) chairman, Sir John Krebs, said the trend meant young people today would live less long than their parents - the first reduction in more than a century. Taken from BBC News website

Definition Adults – obesity = BMI (weight kg/hgt m2) > 30 Children – BMI varies from birth to adulthood and between boys and girls. Interpret BMI by comparing with population data. Obese children = BMI > 98th centile of UK 1990 ref chart for age and sex. Overwgt children = BMI > 91st centile.

Prevalence Worldwide concern about increase and by 1991 1 in 5 children in USA were overweight U.K. – 6 recent surveys all show higher than expected childhood obesity c/f 1990 data. 11% 6 yr olds and 17% 15 yr old > 95th centile relative to 1990 data Increases above expected 5 % suggest a trend to an increase in obesity prevalence.

Impact Cardiovascular Risk Factors Cohort/case control studies show good evidence of association childhood obesity and CVS RF. Obesity epidemic in US has led to increase I prevalence of adolescent type II diabetes. Main CVS consequences of childhood obesity occurring in childhood are subclinical atherosclerosis and coronary artery disease. (American post mortem studies) Little direct evidence for intervention but inferred that would be beneficial.

Impact 2 CVS Risk factors shown to be associated with childhood obesity are: Increased BP Adverse lipid profiles Adverse changes in left ventricular mass - Hyperinsulinaemia - Clustering of risk factors i.e. a tendency to have more than one which also results in an increased risk. CVS RF in children also related to central adiposty and a family history of coronary artery disease.

Impact 3 Psychological impact Other medical More likely to show evidence of psychological distress c/f non obese. Associated with – poor self esteem, being perceived as unattractive, depression, disordered eating, bulimia. Other medical ?chronic inflammatory condition – increased CRP in obese children Increased risk of asthma Abnormal foot structure and function Increased risk of type I diabetes.

Impact on the adult Evidence suggests RF present in child are carried into adulthood – BP, lipids, insulin and glucose synthesis. Cohort in Dutch men showed an increased 32yr mortality if BMI> 26 at 18yrs. Uk/USA studies show adverse association between childhood obesity, education attainment and income in women. Appears to be a tendency for child obesity to persist into adulthood but no evidence to show a direct link tendency more if parents obese, and increases with age of child and severity of obesity.

Diagnosis Body mass index=wt (kg)/height (m2) Obese = BMI ≥ 98th centile Overweight = BMI ≥ 91st centile See tables From SIGN guidelines

Treatment Consider when – obese and motivated Aim is weight maintenance Components – healthy eating, physical activity >30 min/day, reduce inactivity , <2hours/day

Refer In those with serious obesity related morbidity Those with underlying medical cause (think in short/obese) BMI ≥ 99.6th centile

Primary Prevention Media influences modest – OFCOM survey – more honesty in advertising needed Ofsted – national minimum standards in schools Schools are very variable - lots of local initiatives Only so much can be done - eg PE only realisitically once a week

You should be aiming for                                                                           A lot of young people are active for a total of 30 minutes a day. This may sound okay but actually it's not enough to keep your heart and body in good health. You should be aiming for                                                                                                                                                         Activities like brisk walking, cycling and dancing are all excellent examples of moderate activity.                                                                                                                                                                      Play the 'Spot the Mod' game                                               The good news is that your one hour of physical activity does not have to be carried out all in one go, but can be built up over the day. See how easy it is to build up an hour with bouts of physical activity and what a typical day may look like for you. Play the 'Making an hour' game.