Childhood Obesity

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, Kim Jackson, Lucinda hampton, Courtney Ferguson, Alison O' Brien, Alexander Dow and Rachael Lowe

 

Who is this page for?

The goal of creating this page was to provide guidance and information to parents of overweight and obese children. We hope to give you some tools and resources in order to help you feel confident in managing your child's weight and activity levels.

By using this page, we hope you will be able to...

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, BMI alone is not used to diagnose obesity, as children's bodies are constantly changing. To diagnose childhood obesity, paediatricians need to take many factors into consideration. Your child's doctor will first calculate which percentile of weight your child falls into. For example, if your child is in the 80th percentile for weight (based on BMI), this means that 80% of children of the same sex and age have a lower BMI. Along with this calculation, the paediatrician will 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. A diagnosis of childhood obesity will rely on all of these factors taken together, rather than BMI calculation alone.

Why does this matter?

EMBED youtube video "childhood obesity in the UK"

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.

Regular activity

Having your child participate in regular physical activity between the ages of 5 and 12 years old can help the health of their body and mind in a variety of ways.

Body

• Burns off fat and maintains a healthy body weight
• Reduces their risk of developing chronic and major illnesses (see inactivity below)
• Builds and strengthens their muscles and bones
• Improves their fitness and establishes a healthy lifestyle which transfers into adulthood
• Improves their balance, coordination and posture
• Builds core skills eg walking, running and throwing

Mind

• Builds their confidence, self-esteem and mood
• Reduces stress, anxiety and depression
• Improves their sleep
• Builds friendships and social skills
• Improves concentration, learning and academic performance

EMBED Youtube video: https://www.youtube.com/watch?v=nD-0Wc6eSUE

Inactivity

You may find that your child enjoys playing video games and watching tv and spends a lot of their time doing so. However this leads to an inactive lifestyle which can have a bad effect on your child’s future health. Even though these effects do not show until later in life it is important to be aware of the risks and keep your child active as there is a higher risk the following major illnesses and disease which have been found to develop from an inactive childhood (HW Kohl III, 2013):

• Obesity
• Heart disease eg coronary heart disease
• Stroke
• Diabetes
• Cancer
• Mental health disease eg anxiety, depression and dementia
• Earlier death

Physical Activity Guidelines for Children (Age 5-12)

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 (El-Sayed et al, 2011). 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

Resources Barriers

• Financial resources. financial barriers can be a massive barrier to physical fitness. In particular the costs of community exercise programs can be a barrier to enrolling their children in structured activities. this problem is then magnified for larger families.
• Limited time. work hours for parents can be a barrier to family exercise, especially if having to work during evenings or on weekends, thus limiting their opportunities to exercise with their children
• Access to programs. access to exercise programs can often be limited, particularly for young children such as those in pre-school and primary school
• Knowledge gaps. incomplete knowledge surrounding healthy eating as another important barrier to successful weight management. According to Keenan and Stapleton (2010) and Redsell et al (2010), many parents regard large children as cute and healthy

Social Barriers

• Cultural practices and expectations. cultural differences can contribute to difficulty in maintaining a healthy diet. Some cultural diets can lead to increased consumption of unhealthy foods.
• Interpersonal dynamics. challenging family dynamics can add an additional aspect of social context that can pose a barrier to weight management. Some parents may have shared custody of their children so trying to maintain a healthy eating and exercise routine can be very challenging.

Emotional Barriers

• Lack of confidence. uncertainty over their ability to control their child’s weight, with resultant feelings of worry and stress for parents
• Defeat. feelings of defeat related to previous failed attempts at weight management
• Loneliness. adolescents in particular often described feelings of isolation and loneliness related to their overweight status
• Denial. despite their involvement with the medical system, some families did not acknowledge any problems regarding their child’s overweight status, and others expressed satisfaction with their child’s current lifestyle and overall health. According to Keenan and Stapleton (2010) and Redsell et al (2010), most parents are unwilling to accept that their child has a weight issue, despite the health professionals’ diagnosis, as they conform to the belief that a big child equals a happy child.
• Negative attitudes. from parents, staff and peers can hinder your child’s interest in physical activity [REF] It may come in the form of teasing from other children and/or teachers who lack training in adapting activities to suit your child needs. This also results in excluding them from taking part in school clubs and activities [REF]
• Embarrassment. vulnerability, disappointment and shame at appearing physically incapable are just some of the uncomfortable emotions your child may experience

Facilitators: are what can make it easier

Building Partnerships

• the importance of building strong partnerships between patients, families, schools and health care providers is essential
• specifically discussed goal setting in collaboration with providers as a helpful element for weight management.
• engaged as an entire unit, so that parents and children could better partner to achieve goals around healthy living.
• GP or practice nurse may be able to refer you to a local weight management programme for children, such as those run by MEND and More Life. These programmes are often free to attend through your local health authority, and typically involve a series of weekly group workshop sessions with other parents and their children

Access to Resources

• primary care centre 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 potentially helpful resource and nutrition education classes
• access to free local community programmes and after school clubs for those who require assistance on health grounds
• 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

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 often 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 older behaviours and abandoning the new changes)

The Role of the Physiotherapist in Managing Childhood Obesity

Physiotherapists have many unique skills that are well-suited to addressing childhood obesity. Physiotherapists undergo training in anatomy, movement science, and behaviour-change techniques that allow them to prescribe physical activity and lifestyle changes in an effective and safe manner. Though physiotherapy may be traditionally thought of as a clinical or hospital role, physiotherapists work in a variety of settings including schools, care centres, and in the community. The continuing trend of inactivity and risk of obesity in children means that the role of physiotherapists will need to further expand in order to address these problems.

Some of the ways in which physiotherapists could help in the management of childhood obesity include:

• Assisting in the development of physical education programmes in schools
• Address childhood obesity when coming into contact with overweight or obese children in a clinical setting
• Encourage physical activity and outline physical activity guidelines for all children
• Discuss lifestyle changes with parents of overweight or obese children including changes in nutrition and exercise
• Treat muscle and joint problems that may be interfering with physical activity
• Provide feedback and motivation for children and their families

References

see adding references tutorial.