It’s impossible to shy away from the fact that childhood obesity is one of the most challenging public health issues of our time. Recent survey figures show that more than one-in-five children are overweight or obese when they start school aged four to five years, rising to one-in-three by the time they leave primary school aged 10 to 11 years.1
Weight gain as early as infancy tends to track into obesity in later life. Also, lifestyle choices such as food preferences and physical activity tend to be established in the early years, a time when young children are likely to be more receptive, so it is clear that helping families affected by obesity may be needed long before children reach school.
Obesity is a complex condition and multiple factors are involved including sedentary behaviour, unhealthy dietary patterns, maternal obesity, low birth weight and associated catch up growth, and genetic influences. Health professionals who work with children and their families are in an ideal position to provide timely support to parents as early as in pregnancy.
Communication and potential barriers
Raising sensitive weight and lifestyle issues with parents can be challenging. Uncertainty about effective obesity care, concerns about alienating patients and feeling unable to raise the topic within time constraints, lack of training, resources or confidence may all be adding to the reluctance of health professionals to broach the topic of weight. Addressing these concerns through training or by providing evidence of effective interventions that are feasible to deliver within consultations may lead to greater practitioner engagement and willingness to raise the topic.2 Discussions with parents should always be conducted in a context of empowering them to improve the diets and physical activity habits of their children.
Intervention and management
Research has suggested that it is easier to prevent or reverse obesity early in life, when parents are most receptive to help and support, and when children are establishing dietary and activity habits.3 Therefore, it is important to be equipped with the skills, knowledge and confidence to help parents adopt a healthy family lifestyle as early as possible, and to respond effectively to signs of rapid weight gain and obesity in infants and young children.
Effective approaches to management of children that exceed a healthy weight has been demonstrated in community based programmes such as MEND or More Life, which are family focused and usually entail a regime combining diet, physical activity and behaviour-change. The objective is that the child grows to be an acceptable weight for their height, as well as gains confidence and self-esteem, and that healthy diet and lifestyle habits are adopted long-term for the whole family.
Obesity is a major problem that will not go away overnight. Recognition of, and support for, the critical role health professionals can play must form part of the solution.
1. National Child Measurement Programme, 2014/2015. hscic.gov.uk/catalogue/PUB19109 (accessed 3 June 2016).
2. Blackburn M, Stathi A, Keogh E et al. Raising the topic of weight in general practice: perspectives of GPs and primary care nurses. BMJ Open, 2015.
3. Skouteris H, McCabe M, Swinburn B et al. Parental influence and obesity prevention in pre-schoolers: a systematic review of interventions. Obesity Reviews 2011;12:315-28.
Ayela Spiro, Helena Gibson-Moore and Sarah Coe are all nutrition scientists at The British Nutrition Foundation. All three work together to be expert bloggers in the Nursing in Practice nutrition resources centre. Individual descriptions are below:
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