Work with overweight young people. Professor Paul Gately Carnegie Weight Management Leeds Metropolitan University

Outline Levels of obesity and some challenges Physical literacy in the obese child? Carnegie Weight Management Results and Evaluation Capacity and capability

Levels of obesity and some challenges Physical literacy in the obese child? Carnegie Weight Management Results and Evaluation Capacity and Capability

EU Trends Males

Males © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25%

Males © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25%

Males © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25% Self Reported data

Males © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25% Self Reported data

Males © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25% Self Reported data

EU Trends Females

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25%

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25%

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25% Self Reported data

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25% Self Reported data

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25% Self Reported data

Overweight children 7-11 Trends in the last three decades Prevalence % IOTF 2004

GermanyNetherlands Prevalence % Overweight children 7-11 Trends in the last three decades IOTF 2004

Poland Prevalence % Overweight children 7-11 Trends in the last three decades Spain IOTF 2004 Yugoslavia Czech Republic

NCMP….  (participation = 48%)  (participation = 80%)  Deprivation  Ethnicity Overweight (%) Obese (%) Overweight + Obese (%) Boys Girls Combined

Rugby and Athletics Development Survey RADS  Partnership with city council and education authority.  4 cross sectional studies of year 7 children. (n=18,000) 85% of schools 96% of pupils within schools  1 longitudinal study at 2.5 years (n=2500)  Assessment tools Sports skills Anthropometry (BMI, Waist, % body fat) Demographics, educational attainment, ethnicity, deprivation, etc. Geographical investigations Psychology – Short Harter on (n=2000)

Between schools - Waist>85 th Gately (2006)

Can you see risk? This boy is 3 years, 3 weeks old. Is his BMI-for-age -below the 5 th percentile: underweight? - 5 th to <85 th percentile: normalweight? - >85 th to <95 th percentile: overweight? - >95 th percentile: obese? Photo from UC Berkeley Longitudinal Study, 1973

Measurements: Age=3 y 3 wks Height=100.8 cm (39.7 in) Weight=18.6 kg (41 lb) BMI=18.3 BMI-for-age= >95 th percentile =obese Plotted BMI-for-Age Boys: 2 to 20 years BMI

“How can someone let their child get to that size?”

Parental perceptions

Health Care Professional recognition Smith, Rudolf and Gately (in press)

Why is this a concern? Source: Pulmonary disease Fatty liver disease Fatty liver disease Coronary heart disease Diabetes Diabetes Dyslipidemia Dyslipidemia Hypertension Hypertension Gynecologic abnormalities Osteoarthritis Skin Gall bladder disease Cancer Gout Brain pressure Stroke Pancreas disease

A toxic or obesogenic environment Obesity as a normal response to an abnormal environment  side-effect of technological advances  reflects natural human preferences (eg easy, convenient, fast, low effort, value for money)  key factors energy-saving machines, passive recreation energy-dense foods & drinks, large portion sizes

Where should the focus be? 1 in 3 children are overweight or obese. 1 in 3 children who will become overweight or obese adults. 1 in 3 children who are and will remain normalweight /underweight?

Barriers in treatment of obesity  NO SINGLE SOLUTION  AWARENESS  IDENTIFICATION  RECRUITMENT  PARENTAL ACCEPTANCE  HCP RECOGNITION  EXPERTISE  SENSITIVITY – STIGMA  FUNDING  SUSTAINABILITY

Levels of obesity and some challenges Physical literacy in the obese child? Carnegie Weight Management Results and evaluation Capacity and capability

12-year old girls and boys

Social network mapping Strauss & Pollack, 2003

Fat-teasing in boys & girls (Murphy & Hill, 2003) ** *

The reality “My teacher told us that whoever finished last during the warm up (one lap of the field) would have to do a further 10 laps. I thought I was going to be okay until all the kids in my class sprinted off just before the line. I had to do my ten laps and missed playing football.”

Deforche et al. In press

Anthropometry and sports performance variables (RADS 05) Standing long jump (m) Chest push (m) 10 m sprint (sec) 20 m Sprint (sec) Speed bounce (n=) Total score Weight-0.28***-0.32***0.20***0.26***-0.25***-0.18*** BMI-0.37***0.19***0.26***0.33***-0.30***-0.28*** % Body fat -0.47*** ***0.42***-0.34***-0.35*** Waist-0.30***0.25***0.24***0.28***-0.33***-0.26***

Exercise tolerance  Differences between absolute and relative.  Light, moderate and vigorous are often used to describe relative exercise intensity. However two individuals can be exercising at the same absolute energy expenditure, say walking together at a speed of 3mph (4.8 km.h -1, 3 METS). Least fit obese person - vigorous exercise relative to their aerobic fitness (> 60% VO 2 max.) Fitter individual - light exercise intensity relative to their aerobic fitness (< 40% VO 2 max.).

Cooke and Gately 2004

Gately et al 2003 *** *

Inter-Individual Variability Aggregate Participant 1 Participant 2 Participant 3 Prolonged LIST to fatigue Backhouse et. al. unpublished data 2004

Gately et al. 2003

Levels of obesity and some challenges Physical literacy in the obese child? Carnegie Weight Management Results and Evaluation Capacity and capability

Communication Capacity & Capability

CWM Research Objectives 1Understanding the key ingredients of successful weight management in children. 2Investigation of appropriate research methodologies for treatment of childhood obesity. 3Basic science & validity of assessment methodologies. 4Transfer to other contexts.

Weight loss journey Carnegie International Camp Carnegie Day Camp Carnegie Clubs Severe obesity

Weight loss journey Carnegie Day Camp Carnegie Clubs Obese

Weight loss journey Carnegie Clubs Overweight

Carnegie Curriculum Behaviour Change Theory & Tools Theories Self Determination Competence Fun and friends Autonomy Relatedness Solution focused Tools CBT Curriculum sessions Res. Camp - 48 Day camp – 30 Club - 24

Levels of obesity and some challenges Physical literacy in the obese child? Carnegie Weight Management Results and evaluation Capacity and capability

Self Perception Profile for Children (SPPC) ** Source: Walker et al. (2002) ** (P<0.01)

Salience of worries, Walker et al 2002 *P<0.05, ** P<0.01, ***P<0.001 *

Hill et al 2004

12 month outcomes for Athletic competence clubs programme

Skill based exercise *** *** P<0.001 pre to post ***

‘Being’ Overweight Appearance Over eater Sedentary ‘Bad’ foods ‘Outsiderness’ ‘Doing’ ‘Thin’ Behaviour Dieter Exerciser ‘Good’ foods ‘Outsiderness’ “People stay normal weight & don’t really focus on it. They have their food and they live their life” UNHEALTHY NORMAL‘SUPER’HEALTHY Looking & behaving like peers Illustrative accounts of the discontinuities between current behaviour and appearance Hester and Gately (2007) “Even though I knew I had to eat I was finding it hard to find something that I knew that was acceptable to eat.. I ended up eating lunch at 4pm” “My best friend told everyone I went on camp so I went mad at her… in case they thought like oh my god you’re fat and everything. In case they made fun of me for going to a fat camp” “I knew I was being good so why should people mind that I was eating but NOW it’s like people see me eating bad food and they know I’m being BAD…I feel bad when I’m being bad” “I just want to be in a healthy, forgivable and easy routine that is just sort of is normal to me..just being in a routine and not knowing anything else.. I don’t like having to try and do something that I shouldn’t have to try and do” “Even if you lose a pound a week that’s like 3 stone in a year. You’ve still got 3 years (until) you’re down to your ideal weight” I’ll just get stuck into it all. I’ll be like (Dave) is now. I mean he does everything…he has raw eggs! He drinks raw eggs to build his muscles up- ……I couldn’t do that!” “My (teacher) used to give me a set dinner meal every week. She used to hand it to the dinner staff and the dinner staff would give me a meal and I wouldn’t be able to choose anything else” I’d probably turn around and go hold on a minute, I can do something with my life here and then get stuck into exercising and dieting, get the weight out of the way and then go for a job and get a job, get married and have kids like every other person” “I hope to get to the stage where I’m a good sort of role model. Where I can do like a magazine thing where I’ve lost 8 stone- look at me now!” “It’s frustrating when (parents), if I was having 3 slices of toast and cereal and 2 glasses of fruit juice, are like, What are you doing? Don’t talk rubbish you (didn’t) have that sort stuff at camp- you wouldn’t have lost weight” “I know it could be 6 months down the line and I’ve put on 4 stone.. which is what happened last year… there’s not a day that I don’t think about my weight” “I hope to get down and go into normal shops and get all the kinda (clothes) that I want to get. Like (now), when I walk into shops, I’m like I can’t get anything in here!”

Long term results of residential programme

Results of process research  Comments on exercise: “ I prefer to do sports than watch TV, just don’t get the chance, I’m too fat.” “I don’t like walking or running its boring, just never do it.” “I like doing sports, having fun with friends.”  Comments on lifestyle: “His eating is better now because he has his own microwave meals.” “We never see him now he is always out with his friends.”  Comments on support: “Dr. told me I was going to die, I don’t go to him anymore”. “Parents are always nagging me, not helping me”.

Community club outcomes Change ChildrenParents Body mass (kg) BMI (kg.m -2 ) BMI SDS NA Waist (cm) % Body fat Fitness (l.min -1 )

Levels of obesity and some challenges Physical literacy in the obese child? Carnegie Weight Management Results and evaluation Capacity and capability

Building Capacity and Capability  Obesity Care Pathway Implementation Since 2002 partnership with children and PCT’s  Training Vocational Certificate in Weight Management. One day awareness training programme.  CWM Partnership Scaleable and support for direct delivery  Communication How to identify, recruit and refer?  Evaluation Does it work? What can we do to find out? Ethics?

Carnegie Weight Management The Grange Headingley Campus Leeds Metropolitan University Leeds LS6 3QS Tel