Group 3

Welcome to Queen Margaret University's Current and Emerging Roles in Physiotherapy Practice project. This space was created by and for the students at Queen Margaret University in Edinburgh, UK. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Alexander Dow, Andrea Civitarese, Lynne Turner, Alison O’Brien, Rachael Le Page, Courtney Ferguson

Top Contributors - Andrea Civitarese, Rachael Le Page, Lynne Turner, Courtney Ferguson and Alison O' Brien

 

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WELCOME

Who is this page for?

This online resource aims to provide guidance and information to you as a parent of an overweight or obese child aged between 5-12 years old. It will provide you with some useful tools and resources which we hope will help you to feel more confidence in managing your child’s weight and activity levels. By using this resource, we hope you will be able to achieve the learning outcomes shown below with the help of regular check points to reflect on each section. To assist you in achieving these learning outcomes we will provide you with a background on childhood obesity, the benefits of regular physical activity and the risks of inactivity. Alongside these, information on recommended guidelines and examples on how to meet these will be outlined. It also identifies and discusses possible barriers that you may encounter as well as facilitators to help you to overcome these barriers will be highlighted. At the end of this resource there will be information on a number of resources and local opportunities that are available that may help to manage your child’s weight in addition to information on when to seek medical advice.

Learning Outcomes

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Click on a bubble above to jump to that section!

Obesity Overview

What is Childhood Obesity?

For adults, body mass index (BMI) is the method that is most commonly used to diagnose obesity. This method uses an individual's height and weight to establish whether or not they fall within a healthy weight range. BMI ranges are listed below:

  • Healthy weight: BMI = 18.5-24.9
  • Overweight: BMI = 25-29.9
  • Obese: BMI = 30-39.9
  • Severely Obese: BMI = ≥40

Calculate your child's BMI using the NHS Healthy Weight Calculator.

In children, it is not just BMI alone that is used to diagnose obesity as children's bodies are constantly changing. To diagnose childhood obesity, paediatricians take into consideration multiple additional factors. Along with BMI, the paediatrician also take into consideration how your child is growing and developing, your family's history of obesity and related health problems (such as diabetes and heart disease), and your child's eating habits, activity levels, and general health.[1]

Why does this matter?

 [2]


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Check Point:

  • Have a think. Does your child fall into the overweight or obese category?
  • If yes, can you think of any habits that may be contributing to this?
  • Now read the next section


What Are The Benefits Of Physical Activity For My Child?

Physical activity and inactivity can have a big effect on your child's health and development in many ways. It is important to know and understand the benefits of regular activity and the risk of inactivity for your child between the ages of 5 - 12 years old.

Regular activity

Having your child participate in regular physical activity between the ages of 5 - 12 years old will benefit their body and mind health in a variety of ways including mentally, physically and academically [3][4][5][6][7]. These benefits are detailed below:

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Have a watch of this video which provides more details of the top 5 benefits of physical activity for your child with some research evidence.

 [8]

Inactivity

You may find that your child enjoys playing video games and watching tv and they spend a lot of time doing these. However this leads to a lot of sitting and therefore to an inactive lifestyle which can have a bad effect on your child’s future health[5][6]. These effects may not show until later life but it is important to be aware of the higher risk of developing the below major diseases due to childhood inactivity[6] and encourage regular physical activity to help reduce and prevent your child developing them in adulthood.

  • Obesity
  • Heart disease eg coronary heart disease
  • Stroke
  • Diabetes
  • Cancer
  • Mental health disease eg anxiety, depression and dementia
  • Earlier death
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Check point:
  • Take some time and have a think:
  • Are there any aspects of your child’s body and/or mind that you think would benefit from regular physical activity?
  • Are you aware of the guidelines?
  • Now read the next section

Physical Activity Guidelines for Children (Age 5-12)

How much physical activity do children (aged 5-12) need to be doing to stay healthy?

Children (aged 5-12) should partake in at least 60 minutes of physical activity a day - this should range from moderate activity to vigorous activity[9]. Amounts of physical activity greater than 60 minutes, provides additional heath benefits to your child[10].

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Moderate Activity

Moderate activity raises your heart rate and can make you sweat.

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Examples of activities which involve moderate exertion for children include:
  • Cycling on flat ground
  • Walking to school
  • Playing in the playground
  • Walking the dog
  • Riding a scooter
  • Rollerblading[9]

Vigorous Activity

Vigorous activity is known to improve general health, bone and muscle strength and self-esteem.

Vigorous activity can bring health benefits over and above that of moderate activity. Every one-minute of vigorous activity provides the same health benefits as two-minutes of moderate activity [9].

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Examples of activities which involve vigorous exercise for children include:
  • Swimming
  • Running
  • Gymnastics
  • Football
  • Karate
  • Rugby[9]

Three days a week children should include bone and muscle strengthening exercises.

Many vigorous activities can help to build strong muscles and bones in children. This can include anything involving running and jumping, such as football or gymnastics[9].

Examples of suitable bone strengthening activities for children
  • Body weight lifting exercises
  • Jumping and climbing activites
  • Hopscotch
  • Rope Skipping

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Examples of suitable muscle-strengthening activities for children
  • Sit-ups and Press-ups
  • Gymnastics
  • Resistance band exercises
  • Rock Climbing[9]

Click here to download a helpful factsheet on physical activity guidelines for children [11].

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Check Point:

  • Take some time. Have a think.
  • Does your child carry out 60 minutes of physical activity a day?
  • Could your child start new activities which follow the recommended guidelines?
  • Now read the next section.

Barriers and Facilitators to Managing Childhood Obesity

One of the key roles of health visitors and health professionals is to effectively present parents with the most up to date evidence on childhood obesity and interventions. Factors such as race, ethnicity, lifestyle, genetics, culture, socio-economic status, and the environment tend to have great influence on dietary choices[12]. Dealing with obesity is a complicated process, which involves a broad sociological awareness and understanding. It also requires tactful and compassionate communication skills that can influence behaviour and bring about positive lifestyle changes by breaking down barriers and identifying facilitators.

Barriers: are things that get in the way

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Resources Barriers
  • Financial resources: This can be a massive barrier to physical fitness especially for large families.
  • Limited time: long working hours for parents can be a barrier to family exercise, especially if having to work during evenings or on weekends.
  • Access and availability of programs: access to exercise programs and activities can often be limited in areas or for certain age groups.
  • Knowledge gaps: incomplete knowledge surrounding healthy eating[13] [14], regular activity benefits and risk of inactivity.
Social Barriers
  • Cultural practices and expectations: cultural differences can contribute to difficulty in maintaining a healthy diet and activity levels.
  • Interpersonal dynamics: challenging family dynamics, such as shared custody, can make maintaining a healthy eating and exercise routine very challenging[15].
Emotional Barriers
  • Lack of confidence: uncertainty over the ability to control their child’s weight.
  • Defeat: feelings of defeat related to previous failed attempts at weight management.
  • Loneliness: young adolescents in particular often describe feelings of isolation and loneliness related to their overweight and obese status.
  • Denial: unwillingness of most parents in accepting their child has a weight issue is a big barrier despite their involvement in the medical system [13] [14]
  • Negative attitudes: these attitudes from parents, staff and peers can hinder your child’s interest in physical activity[16]
  • Embarrassment: vulnerability, disappointment and shame at appearing physically incapable are just some of the emotions your child may experience
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Check Point:
  • Have a think, what are the main barriers that come to mind for you
  • Write down the main barrier
  • Now read the next section


Facilitators: are what can make it easier

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Building Partnerships
  • The importance of building strong partnerships between patients, families, schools and health care providers is essential[17]
  • Specifically discussion and collaboration in goal setting with providers is a helpful element for weight management[18].
  • Engagement as an entire unit so parents and children can work better in partnership to achieve goals around healthy living.
  • GP or practice nurse can refer you to a local weight management programme for children, such as MEND and More Life.
Access to Resources
  • Primary care centres directly providing programs, including fitness classes, nutrition courses, and cooking classes.
  • Showing parents and children how to create a healthy snack that not only looks good but tastes good.
  • Access to support groups could be a helpful resource and nutrition education classes
  • Access to free local community programmes and after school clubs
  • Clearer signposting to available resources
Consistent Encouragement
  • The use of consistent encouragement by providers needs to be a key component of successful weight management.
  • Use of technology (eg, via text-messaging or email) for providing ongoing encouragement related to weight management between visits
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Check Point:

  • Look at the barrier you wrote down
  • Can you now think of a facilitator that could make it easier to overcome
  • Repeat this exercise for all of the barriers you thought of
  • Now read the next section

Stages of Change Model 

Before change can be implemented it is completely normal to go though stages to making these changes a reality, this is referred to as the Stages of Change.

The stages of change are:

  • Pre-contemplation (Not yet acknowledging that there is a problem behaviour that needs to be changed)
  • Contemplation (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change)
  • Preparation/Determination (Getting ready to change)
  • Action/Willpower (Changing behaviour)
  • Maintenance (Maintaining the behaviour change) and
  • Relapse (Returning to old behaviours and abandoning the new changes)

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Managing Childhood Obesity as a Parent

Before you read this section, it could be beneficial to think of how you are managing now[19].

Ask yourself some of these reflective questions to help you determine any area that you feel you need help or advice with:

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After you have thought about the reflective questions remember:

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Note: Parent, be aware that if you plan to change your child’s diet, remember to consult your GP or dietician first. 

This is a useful image to help guide you on how much food your child should be eating from each food group[20] [21]:

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Checkpoint:
  • Do you feel more empowered and reassured after asking yourself the reflective questions?
  • Do you feel there are changes you could make?
  • Make a list of some changes you could make to manage childhood obesity.
  • Now read the next section

Local Opportunities for Physical Activity in Edinburgh

Here is a list of some local activities and sports and online apps that are available which may give you some ideas of how to manage your child's weight and help your child to become more physically active. Click on the wording in blue to go to the website and find out some more information.

Gyms, activities and sports teams

It is good to know that some gyms in Edinburgh provide loads of facilities and classes for your children.

These are just a selected few;
  1. Virgin Active Gym have plenty of fun varied classes for you and your kids such as swimming, balloon volleyball, musical games and crafts
  2. Energy Gym this gym has some great fitness options for your children. They have a great understanding of the challenges to get kids to exercise. They have gymnastics classes, a cross-fit youth club and dance classes.
  3. Edinburgh Leisure – they have loads of activities that can cater to everyone’s interests some which include-swimming, tennis, football, racquet sports, soft play, and climbing and rock sports.
Edinburgh City Council

Edinburgh City Council provide a lot of information on a wide-range physical activities and sports some which include;

  • Football
  • Cricket
  • Golf
  • Badminton
  • Cycling
  • Rugby
They also have sports clubs such as:
  1. Sports Club Edinburgh - which lets you find your nearest sports club to your location and what facilities they have to offer.
  2. Dance classes- the link to the website below lets you search for local dance classes in your area.
  3. Activities for under 5s - provide fun play activities ideas from ages 0-10.
  4. Play Parks- If you simply want to know where some of the nearest play parks are to you in the city or simply want to find a park near your children’s school.

This link provided takes you to the Edinburgh City Council website with additional information and all the details on the different sports and activities that are available in your area.

Apps

Here is a list of free apps online that will encourage your child to perform physical activity and also provide ideas of activities. This is not an exhaustive list and there is a wide variety and many more apps available.

  1. HOOP: Find and book fun things to do in your local area for children aged 0-11 years old. (iOS & Android)
  2. Kiddy Keep Fit by Scotty & Lulu: Uses music and games to get children moving and exercising. (iOS)
  3. 7-minute workout for kids: High intensity workouts with rests to develop strength, stability and balance. (iOS)
  4. Habitz: Set up by Health Professionals to help parents to inspire their children to develop healthy habits and lifestyles. (iOS)
  5. Sworkit Kids – Fitness Meets Fun (7-14 year olds): Wide variety and duration of fun exercises to develop and enhance strength, agility and flexibility. (iOS & Android)
  6. Appu’s Yoga for Kids: Easy yoga poses for children to enhance and refresh your child's body and mind. (iOS & Android)
  7. Wuf Shanti Yoga Fun Machine: Yoga app using games and music to promote health and happiness for your child through yoga, meditation and mindfulness. (iOS)

Physical activities that involve minimal cost

Walking, Hiking, Playing catch, Frisbee, Football, Biking, Running, Skipping, Hopscotch, Tug-of-war and Rounders are just some activities that are fun and cost effective.

When to ask for help... And who to ask

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Check point:

Now you have read all of the above information we hope it has answered any questions you may have and provided you with useful information, some ideas to help with your child’s weight or obesity and you have achieved the learning outcomes of this online resource.


Now take some time to make a plan of what you would like to do and the goals that you would like to achieve with your child and family in the next:

  • 1 week
  • 1 month
  • 6 months
  • 1 year

Conclusion

To bring everything together, childhood obesity between the ages of 5-12 years old is rising and is a current global concern and challenge. Unfortunately, in this present age the growing popularity in the daily use of technology in children, among the many other barriers mentioned above, is enhancing an inactive lifestyle. As a parent it is important for you to understand childhood obesity and your essential role in encouraging your child to become more active and make changes to help manage your child’s weight and maintain a healthy lifestyle.

Within this online resource we have provided you with information and knowledge on what childhood obesity is and highlighted the health benefits of your child taking part in regular physical activity as well as the long-term health risks of childhood obesity and inactivity. We have informed you of the guidelines for your child and the different types of activity along with some examples of how these can be achieved. We have also provided guidance on ways that can help you to become more confident in approaching and managing your child’s weight. Potential barriers that you may encounter have been discussed as well as facilitators to help you to overcome these. A select number of many resources and opportunities that are available have been provided along with links to the websites or apps.

We hope that the information and resources, along with the checkpoints, have helped you to think and reflect on different aspect of childhood obesity and you have developed a personal plan for you and your child to manage their weight. In addition, we hope to have given you the confidence and motivation to start to make a change, however big or small.  

Please see the "Useful Links" section below for further resources, and feel free to use this page as a reference whenever you need it.

Useful Links

References

see adding references tutorial.

  1. Mayo Clinic. Childhood Obesity Diagnosis. https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833 (accessed 31 March 2018).
  2. Childhood Obesity in the UK Available from: https://www.youtube.com/watch?v=5Km1fFLX6T8 [last accessed 15/03/18]
  3. Gov.UK. Publication: Start active, stay active: infographics on physical activity. Available from:https://www.gov.uk/government/publications/start-active-stay-active-infographics-on-physical-activity (accessed 02 April 2018)
  4. SSEHS Active. Interpreting the UK physical activity guidelines for children. Available from:http://www.ssehsactive.org.uk/young-people-resources-and-publications-item/39/443/index.html (accessed 02 April 2018)
  5. 5.0 5.1 Great Ormond Street. Exercise for children and young people. Available from: https://www.gosh.nhs.uk/medical-information/general-health-advice/leading-active-lifestyle/exercise-children-and-young-people (accessed 02 April 2018)
  6. 6.0 6.1 6.2 Kohl III, H. W., and CooK, H. D. Educating the Student Body: Taking Physical Activity and Physical Education to School. Washington: The National Academies Press. Available from: https://www.ncbi.nlm.nih.gov/books/NBK201497/(accessed 02 April 2018)
  7. SSEHS Active. Children and young people evidence briefing. Available from:http://www.ssehsactive.org.uk/resources-and-publications-item/40/475/index.html (accessed 02 April 2018)
  8. 5 Reasons Why Physical Activity is Important for Children Available from: https://www.youtube.com/watch?v=nD-0Wc6eSUE [last accessed 28/03/18]
  9. 9.0 9.1 9.2 9.3 9.4 9.5 NHS., 2015. Physical Activity Guidelines for Children and Young People [online]. [viewed 9th April 2018]. Available from: https://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-young-people.aspx
  10. World Health Organization., 2016. Physical Activity and Young People [online]. [viewed 9th April 2018]. Avaiable from: http://www.who.int/dietphysicalactivity/factsheet_young_people/en/
  11. GOV.UK. 2011. UK Physical Activity Guidelines [online]. [viewed 9th April 2018]. Available from: https://www.gov.uk/government/publications/uk-physical-activity-guidelines
  12. El-Sayed, A.M.; Scarborough, P.; and Galea, S. (2011) Ethnic Inequalities in Obesity Among Children and Adults in the UK: A Systematic Review of the Literature. Obesity Review. 12 (5).
  13. 13.0 13.1 Keenan, J.; and Stapleton, H. (2010) Bonny Babies? Motherhood and Nurturing in Age of Obesity. Health, Risk&Society, 12 (4).
  14. 14.0 14.1 Redsell, S.A.; Atkinson, P.; Nathan, D.; Siriwardena, A.N.; Swift, J.A.; and Glazebrook, C. (2010) Parents’ Beliefs about Appropriate Infant Size, Growth, and Feeding Behaviour: Implications for the Prevention of Childhood Obesity. BMC Public Health, 10 (711).
  15. Barriers and Facilitators of Pediatric Weight Management Among Diverse Families Lauren Brown, BA1,2, Sarah-Bianca Dolisca, BS3 , and Jennifer K. Cheng, MD, MPH3,4 Clinical Pediatrics 2015, Vol. 54(7) 643–651 © The Author(s) 2014 Reprints and permissions:
  16. Larsen, L.M.; Ledderer, L.; Jarbøl, D.E. (2015) Management of Overweight during Childhood: A Focus Group Study on Health Professionals’ Experiences in General Practice International Journal of Family Medicine. Volume 2015, Article ID 248985
  17. Shields N, Synnot A. Perceived barriers and facilitators to participation in physical activity for children with disability: a qualitative study. BMC pediatrics. 2012 Jan 19;16(1):1.
  18. Redsell, S.A.; Atkinson, P.; Nathan, D.; Siriwardena, A.N.; Swift, J.A.; and Glazebrook, C. (2013) UK Health Visitors’ Role in Identifying and Intervening with Infants at Risk of Developing Obesity. Maternal and Child Nutrition, 9 (3).
  19. TURNER, K.M., SALISBURY, C. AND SHIELD, J.P., 2011. Parents’ views and experiences of childhood obesity management in primary care: a qualitative study. Family Practice29(4), pp.476-481.
  20. ACADEMY OF NUTRITION AND DIETETICS., 2017. How to Talk to Kids about Weight and Obesity [online]. [viewed 30 March 2018]. Available from:  https://www.eatright.org/health/weight-loss/overweight-and-obesity/how-to-talk-to-kids-about-weight-and-obesity. 
  21. CENTER FOR DISEASE CONTROL AND PREVENTION., 2017. Tips for Parents-Ideas to Help Children and Maintain a Healthy Weight [online]. [viewed 29 March 2018]. Available from: https://www.cdc.gov/healthyweight/children/index.html.