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Obesity: the public health timebomb

Prompted by startling figures that show most of the UK will be obese by 2050, experts met at the National Obesity Forum to discuss how to not only cure, but prevent obesity. Nursing in Practice news reporter Nadine Woogara explains …

Nadine Woogara
BSc(Hons) PgDip
Reporter
Nursing in Practice

Obesity in the UK has a long history of being ignored. Up until the millennium, report after public health report failed to get any government cogs moving. Today, what with Jamie's school dinners and blaring obesity headlines that shout "Everyone fat by 2050" it's less a case of getting the problem noticed, but getting someone to take responsibility for it.
"Successive governments have turned a blind eye against obesity," said Professor Philip James speaking at the National Obesity Forum.
"But is it the responsibility of the individual or the government? Yes of course it's down to the individual, but not only the individual. You can focus on health education, but the highest social economic groups need to be doing something as well."
Hoping to make everyone accountable for the nation's expanding waistlines, the fifth annual conference of the National Obesity Forum this October discussed practical obesity solutions.

The role of the school nurse
Standing right on the edge of the frontline are the UK's school nurses. They play a vital role in the prevention of childhood obesity. But Rosalind Godson, professional officer for school health and public health for AMICUS/CPHVA, said a lot has changed in recent years.
Each school used to have its own school nurse, with the time to talk to and recall children with weight problems, and even flag up problems with their parents. But today serious shortages in school nurses mean those who remain are overworked and find it impossible to prioritise their workload.
Staff shortages are not helped by the government's new focus on checking the weight and height of every 11-year-old in every school.
Instead of weighing every child, she believes that random sampling across the UK would free up nurses to get to the root of the obesity problem. Not only is it an ineffective method, Rosalind said there are ethical concerns about targeting the weight of children so young. Some think it unfair to concern an 11-year-old child already stressed about their entry into secondary school with weight problems. Is it morally responsible to worry children about conforming to the "norm" weight? Privacy is also paramount; school nurses are not often assigned their own room to weigh children, but are given a corridor, or as Rosalind pointed out, a broom cupboard.
There are also exist logistic concerns about a school nurse turning up out of context to take children out of the classroom to be weighed. The method inconveniences and aggrieves teaching staff and is not presented in the context of a healthy living educational programme. "We understand monitoring is necessary, but it doesn't appear to be part of a strategy, it's just a bean-counting exercise and can't offer any help," said Rosalind. The alternative is to tie weight monitoring into the school agenda in a "whole school approach", where it is presented in a way that children can learn about healthy living.
"We are measuring failure," says Rosalind. "There are solutions: better resources; better local planning; and better school nurse leads."

Back to the beginning: infants, pregnancy and obesity
The problem of childhood obesity can be traced back further than school years. Research shows obese infants have 10 times the risk of becoming obese in later life compared with thinner infants.
Professor Mary Rudolf pointed out that obesity in infancy goes beyond simple cosmetic problems, but poses significant health risks. Obese babies are more likely than others to develop physiological problems, asthma, early signs of cardiovascular disease and more. "If we found a solution for obesity in the very young it would help make great strides in tackling the whole obesity epidemic," she said.

Breastfeeding
One simple way to reduce the risk of obesity is to breastfeed babies. Even if babies are breastfed for just six to eight weeks it will significantly reduce their risk of obesity, and this needs to be promoted as a method of kick-starting a healthy life. Research that compared breastfed with bottlefed preschoolers found that more of those who grew up with the bottle were overweight. The link between breastfeeding and obesity then reemerges as youths enter adolescence, with those reared on the breast more likely to be a healthy weight.
Mothers often prepare more than 6oz of feed for babies to drink from a bottle, and research shows that baby bottle finishers are six times more likely than those who don't finish to become obese. But breastfeeding can teach babies to regulate how much milk they drink, and discourage overfeeding. Breastfed babies therefore have lower levels of insulin, which then determines their reduced risk of subsequent obesity as they grow up. Mary Rudolf suggested that if mothers can be taught to introduce the bottle in a way that mimics breastfeeding, then bottlefed babies would have improved foreseeable waistlines.

Flavours and food preferences
Anyone who has had any contact with children, be it their own or someone else's, knows that it's difficult to get a child to change what they like to eat. In order to avoid the torture of rejected greens Mary Rudolf suggested that mothers eat healthy foods while pregnant as this increases the chances that their unborn baby will like them too.
A study examined three groups of pregnant women: one that drank carrot juice; one that drank no carrot juice, but ate carrots; and one that neither ate carrots nor drank carrot juice. Babies born to women who had drunk carrot juice while pregnant more readily took up eating carrots in infancy than babies born to women who did not drink carrot juice. "This is a pointer to what we could be doing to encourage young mums to help children battle against obesity and give a fighting chance to our nation's dietary consumptions," said Mary Rudolf.
As children grow up it is also important to educate them about their food preferences. "You provide, they decide," said Mary. She adds that it is wise not to use food as a reward, bribe or comfort in order to discourage bad habits in later life.

Conclusion
Trying to decide where the responsibility lies for our nation's obesity isn't easy - family, community, individual or the government? If the 2005 Foresight Report is to be believed then half of the population will be obese by 2025 if current trends continue. As Alan Johnson said: "There is no single solution to tackle obesity and it cannot be tackled by government action alone. We will only succeed if the problem is recognised, owned and addressed at every level and every part of society."(1)

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References

  1. NiP Online. Ministers bid to tackle obesity. 15 October 2007. Available from: /default.asp?title=Ministersbidtotackleobesity&page=article.display&article.id=5699&category.id=32
  2. National Obesity Forum. Available from: http://www.nationalobesityforum.org.uk


Your comments:
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"I agree with the points made about school nurses carrying out mass weighing and measuring of 11 year-olds. I would go even further in saying that the National Child Measurement Programme is a misguided and wasteful intervention in the quest to reduce childhood obesity.  School nurses time could be better spent for example in having regular and reliable school drop-in services where pupils can access support and advice for all kinds of health concerns, including being overweight" - Name and address supplied

"School nurses could certainly play a role in preventing and reducing childhood obesity, but, as Ros Godson outlined, they are in short supply in many areas. The imposition of mass weighing and measuring of 11 year olds in schools has been time consuming and wasteful of school nurse time. Surely it would be more effective to monitor obesity using representative sampling techniques? This would free up school nurses to more involved in the other Government initiative such as the Healthy Schools Programme, Food in Schools Programme, School Fruit and Vegetable Scheme. Eating in the school dining room once or twice per term could be interesting too." - Cath Gleeson, Respiratory Practice Nurse