Treatment and Prevention of childhood obesity through lifestyle change interventions

The 2008 government white paper, Healthy Weight, Healthy Lives; A cross-government strategy for England1 set out the ambition that ‘by 2020 we will have reduced the proportion of overweight and obese children to 2000 levels’. The strategy included a commitment to support local areas in commissioning weight management services for children and young people and provided guidance for those working in this area.2,3

The World Health Organisation (WHO) regards childhood obesity as one of the most serious global public health challenges for the 21st century.4 Being overweight or obese in childhood has consequences for health in both the short term and the longer term. Once established, obesity is notoriously difficult to treat, so prevention and early intervention are very important.

The latest figures from the National Child Measurement Programme (NCMP) in England show that in 2008/09 18.3% of children in Year 6 (aged 10 -11) were obese and a further 14.3% were overweight. Of children in Reception (aged 4 – 5), 9.6% were obese and another 13.2% were overweight. This means almost a third of 10 -11 year olds were overweight or obese, and over a fifth of 4 – 5 year olds.5

Evidence of potential benefits

Systematic reviews take a rigorous approach to identifying research and synthesising the findings in a particular area and provide a high level overview of current knowledge. The most recent systematic reviews of the evidence for tackling childhood obesity undertaken by the National Institute for Health and Clinical Excellence (NICE) and the Cochrane Collaboration justify well-targeted action on obesity.

They found that the most successful interventions are those which:

·     are multi-component and target both physical activity and diet together

·     involve carers, siblings or peers with similar weight issues

·     appropriately target the population group and consider the influence of age, sex, socioeconomic status and ethnicity

·     are fun and engaging, with a positive emphasis on managing a healthy lifestyle

·     are based on a strong theoretical framework.6,7

Evidence of potential risks

The evidence base for tackling obesity is large but tends to lack detail on the effectiveness of specific approaches or individual programmes. One problem that is apparent from the literature is that there is huge variation study design making findings difficult to compare.

Generally, there is a lack of evidence from UK studies and studies examining ways of working with vulnerable and minority groups. Evidence is also lacking in standard service settings, studies with long follow up (i.e. more than one year) and studies with robust cost effectiveness.8

The complex interplay of different environmental, biological and social determinants of obesity and can make it particularly difficult to demonstrate the effectiveness of specific interventions.

Studies that only follow participants for a short period of time do not provide important information about the long-term impacts of different types of interventions.

Health and well-being implications

Child and adult obesity are closely associated with increased risk of diseases that can cause premature illness, death, and disability including cardiovascular disease and some cancers.

Policies that are effective in reducing childhood obesity would result in a short term health benefits including a reduction in Type 2 diabetes. Longer term benefits of such policies would be to reduce the progression of childhood obesity into adulthood.

Author: Mary Gatineau, Senior Public Health Researcher, National Obesity Observatory

UK area affected: England only

NICE Guidance on this topic

National Institute for Health and Clinical Excellence (2006) Guidance on the prevention, identification, assessment and management of overweight and obesity in adults. http://www.nice.org.uk/nicemedia/pdf/CG43NICEGuideline.pdf

References