Childhood Obesity: Difference between revisions

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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
 
== Introduction ==
== Learning Outcomes ==
In recent years childhood obesity has risen<ref>Han, J. C., Lawlor, D. A., & Kimm, S. Y. (2010). ''Childhood obesity. The Lancet, 375(9727), 1737–1748''</ref>.  In 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, the formula is kg/m<sup>2</sup>. BMI ranges are listed below:
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[[File:Screen Shot 2018-03-20 at 1.55.18 PM.png|right|frameless|244x244px|link=#Obesity Overview]]
[[File:Thought red.png|right|frameless|249x249px|link=#Local Opportunities for Physical Activity in Edinburgh]]
[[File:Thought blue.png|center|frameless|234x234px|link=#Managing Childhood Obesity as a Parent]]
 
[[File:Thought purple.png|left|frameless|266x266px|link=#Physical Activity Guidelines for Children (Age 5-12)]]
[[File:Thought orange.png|center|frameless|266x266px|link=#When to ask for help... And who to ask]]
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'''Click on a bubble above to jump to that section!'''
 
== Obesity Overview ==
 
==== <u>What is Childhood Obesity?</u> ====
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  
* Healthy weight: BMI = 18.5-24.9  
* Overweight: BMI = 25-29.9  
* Overweight: BMI = 25-29.9  
* Obese: BMI = 30-39.9  
* Obese: BMI = 30-39.9  
* Severely Obese: BMI = ≥40  
* Severely Obese: BMI = ≥40  
Calculate your child's BMI using the [https://www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx 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.<ref>Mayo Clinic. Childhood Obesity Diagnosis. https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833 (accessed 31 March 2018). </ref>  
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.<ref>Mayo Clinic. Childhood Obesity Diagnosis. https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833 (accessed 31 March 2018). </ref>  


==== <u>Why does this matter?</u> ====
=== Why Does This Matter? ===
{{#ev:youtube|5Km1fFLX6T8|600}}&nbsp;<ref>Childhood Obesity in the UK Available from: https://www.youtube.com/watch?v=5Km1fFLX6T8 [last accessed 15/03/18]</ref>
{{#ev:youtube|5Km1fFLX6T8|600}}&nbsp;<ref>Childhood Obesity in the UK Available from: https://www.youtube.com/watch?v=5Km1fFLX6T8 [last accessed 15/03/18]</ref><br />
 
<br />
 
[[File:8cxno4MKi-e1485551903975.png|left|frameless|150x150px]]
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
 
<br />


== '''What Are The Benefits Of Physical Activity For My Child?''' ==
== '''The Benefits Of Physical Activity''' ==
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.   
Physical activity and inactivity can have a big effect on a 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 a child between the ages of 5 - 12 years old.   


==== <u>Regular activity</u> ====
=== 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 <ref>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)</ref><ref>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)</ref><ref name=":0">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)</ref><ref name=":1">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/<nowiki/>(accessed 02 April 2018)</ref><ref>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) </ref>. These benefits are detailed below:
Encouraging a 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 <ref>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)</ref><ref>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)</ref><ref name=":0">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)</ref><ref name=":1">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/<nowiki/>(accessed 02 April 2018)</ref><ref>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) </ref>. These benefits are detailed below:
[[File:Screen Shot 2018-03-28 at 19.36.55.png|left|381x381px|frameless]]
[[File:Screen Shot 2018-03-28 at 19.36.55.png|left|381x381px|frameless]]
[[File:Screen Shot 2018-03-28 at 19.37.03.png|centre|381x381px|frameless]]  
[[File:Screen Shot 2018-03-28 at 19.37.03.png|centre|381x381px|frameless]]  
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<br />
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.  
The video below provides more details of the top 5 benefits of physical activity for children.  


{{#ev:youtube|nD-0Wc6eSUE|600}}&nbsp;<ref name=":2">5 Reasons Why Physical Activity is Important for Children Available from: https://www.youtube.com/watch?v=nD-0Wc6eSUE [last accessed 28/03/18]</ref>  
{{#ev:youtube|nD-0Wc6eSUE|600}}&nbsp;<ref name=":2">5 Reasons Why Physical Activity is Important for Children Available from: https://www.youtube.com/watch?v=nD-0Wc6eSUE [last accessed 28/03/18]</ref>  
==== <u>Inactivity</u> ====
=== 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<ref name=":0" /><ref name=":1" />. 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<ref name=":1" /> and encourage regular physical activity to help reduce and prevent your child developing them in adulthood.  
It is common to find children playing video games and watching television, however,  this leads to a lot of sitting and therefore to an inactive lifestyle which can have a detrimental effect on on children's future health<ref name=":0" /><ref name=":1" />. 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<ref name=":1" /> and encourage regular physical activity to help reduce and prevent a child developing them in adulthood.  
* Obesity
* Obesity
* Heart disease eg coronary heart disease
* Heart disease eg coronary heart disease
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* Mental health disease eg anxiety, depression and dementia
* Mental health disease eg anxiety, depression and dementia
* Earlier death
* Earlier death
[[File:8cxno4MKi-e1485551903975.png|left|frameless|150x150px]]Check point:
== Physical Activity Guidelines for Children (Age 5-12) ==
* 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)''' ==
 
==== <u>How much physical activity do children (aged 5-12) need to be doing to stay healthy?</u> ====
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<ref name=":5">NHS., 2015. ''Physical Activity Guidelines for Children and Young People'' [online]. [viewed 9<sup>th</sup> April 2018]. Available from: <nowiki>https://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-young-people.aspx</nowiki>
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<ref name=":5">NHS., 2015. ''Physical Activity Guidelines for Children and Young People'' [online]. [viewed 9<sup>th</sup> April 2018]. Available from: <nowiki>https://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-young-people.aspx</nowiki>
</ref>. Amounts of physical activity greater than 60 minutes, provides additional heath benefits to your child<ref>World Health Organization., 2016. ''Physical Activity and Young People'' [online]. [viewed 9<sup>th</sup> April 2018]. Avaiable from: <nowiki>http://www.who.int/dietphysicalactivity/factsheet_young_people/en/</nowiki>
</ref>. Amounts of physical activity greater than 60 minutes, provides additional heath benefits to your child<ref>World Health Organization., 2016. ''Physical Activity and Young People'' [online]. [viewed 9<sup>th</sup> April 2018]. Avaiable from: <nowiki>http://www.who.int/dietphysicalactivity/factsheet_young_people/en/</nowiki>
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[[File:Infograph.png|frameless|779x779px]]
[[File:Infograph.png|frameless|779x779px]]


==== <u>Moderate Activity</u> ====
=== Moderate Activity  ===
Moderate activity raises your heart rate and can make you sweat.
[[File:30440825_10160213199190285_6406574266132725760_n.png|right|frameless|156x156px]]
 
Moderate activity raises the heart rate and can make a person sweat.  Examples of activities which involve moderate exertion for children include:
[[File:30440825_10160213199190285_6406574266132725760_n.png|frameless|156x156px]]<br />
 
===== '''Examples of activities which involve moderate exertion for children include:''' =====
* Cycling on flat ground  
* Cycling on flat ground  
* Walking to school  
* Walking to school  
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* Rollerblading<ref name=":5" />  
* Rollerblading<ref name=":5" />  


==== <u>Vigorous Activity</u> ====
=== Vigorous Activity ===
Vigorous activity is known to improve general health, bone and muscle strength and self-esteem.  
[[File:30414685_10160213199510285_1474170515588382720_n.png|right|frameless|232x232px]]
 
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 <ref name=":5" />. Examples of activities which involve vigorous exercise for children include:  
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 <ref name=":5" />.
 
[[File:30414685_10160213199510285_1474170515588382720_n.png|frameless|232x232px]]<br />
===== '''Examples of activities which involve vigorous exercise for children include:''' =====
* Swimming  
* Swimming  
* Running  
* Running  
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* Karate  
* Karate  
* Rugby<ref name=":5" />  
* Rugby<ref name=":5" />  
'''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<ref name=":5" />.<br />
=== Bone Strengthening Activities ===
===== '''Examples of suitable bone strengthening activities for children''' =====
[[File:Screen_Shot_2018-04-09_at_00.05.49.png|right|frameless|215x215px]]
Children should include bone and muscle strengthening exercises at least 3 days a week.  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<ref name=":5" />. Examples of suitable bone strengthening activities for children:
* Body weight lifting exercises
* Body weight lifting exercises
* Jumping and climbing activites
* Jumping and climbing activites
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* Rope Skipping
* Rope Skipping


[[File:Screen_Shot_2018-04-09_at_00.05.49.png|frameless|215x215px]]
===== Examples of suitable muscle-strengthening activities for children: =====
 
===== '''Examples of suitable muscle-strengthening activities for children''' =====
* Sit-ups and Press-ups
* Sit-ups and Press-ups
* Gymnastics  
* Gymnastics  
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Click [https://www.nhs.uk/Livewell/fitness/Documents/children-and-young-people-5-18-years.pdf <u>here</u>] to download a helpful factsheet on physical activity guidelines for children <ref>GOV.UK. 2011. ''UK Physical Activity Guidelines'' [online]. [viewed 9<sup>th</sup> April 2018]. Available from: <nowiki>https://www.gov.uk/government/publications/uk-physical-activity-guidelines</nowiki>
Click [https://www.nhs.uk/Livewell/fitness/Documents/children-and-young-people-5-18-years.pdf <u>here</u>] to download a helpful factsheet on physical activity guidelines for children <ref>GOV.UK. 2011. ''UK Physical Activity Guidelines'' [online]. [viewed 9<sup>th</sup> April 2018]. Available from: <nowiki>https://www.gov.uk/government/publications/uk-physical-activity-guidelines</nowiki>
</ref>.
</ref>.
[[File:8cxno4MKi-e1485551903975.png|left|frameless|150x150px]]
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 ==
== 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<ref>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).</ref>. 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.
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<ref>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).</ref>. 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.


==== <u>Barriers: are things that get in the way</u> ====
=== Barriers ===
[[File:Image_of_Barrier.png|frameless]]
[[File:Image_of_Barrier.png|right|frameless]]


===== '''Resources Barriers''' =====
==== Resources Barriers ====
* ''Financial resources:'' This can be a massive barrier to physical fitness especially for large families.  
* 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.  
* 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.  
* 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<ref name=":3">Keenan, J.; and Stapleton, H. (2010) Bonny Babies? Motherhood and Nurturing in Age of Obesity. ''Health, Risk&Society'', 12 (4).</ref> <ref name=":4">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).</ref>, regular activity benefits and risk of inactivity.  
* Knowledge gap -  incomplete knowledge surrounding healthy eating<ref name=":3">Keenan, J.; and Stapleton, H. (2010) Bonny Babies? Motherhood and Nurturing in Age of Obesity. ''Health, Risk&Society'', 12 (4).</ref> <ref name=":4">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).</ref>, regular activity benefits and risk of inactivity.  


===== '''Social Barriers''' =====
==== Social Barriers ====
* ''Cultural practices and expectations:'' cultural differences can contribute to difficulty in maintaining a healthy diet and activity levels.  
* 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<ref>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:</ref>.  
* Interpersonal dynamics: challenging family dynamics, such as shared custody, can make maintaining a healthy eating and exercise routine very challenging<ref>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:</ref>.


===== '''Emotional Barriers''' =====
==== Emotional Barriers ====
* ''Lack of confidence:'' uncertainty over the ability to control their child’s weight.  
* 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.
* 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.
* 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 <ref name=":3" /> <ref name=":4" />
* Denial - unwillingness of most parents in accepting their child has a weight issue is a big barrier despite their involvement in the medical system <ref name=":3" /> <ref name=":4" />
* ''Negative attitudes:'' these attitudes from parents, staff and peers can hinder your child’s interest in physical activity<ref>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</ref>  
* Negative attitudes - these attitudes from parents, staff and peers can hinder your child’s interest in physical activity<ref>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</ref>  
* ''Embarrassment:'' vulnerability, disappointment and shame at appearing physically incapable are just some of the emotions your child may experience
* Embarrassment - vulnerability, disappointment and shame at appearing physically incapable are just some of the emotions your child may experience<br />
[[File:8cxno4MKi-e1485551903975.png|left|frameless|150x150px]]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
<br />


==== <u>Facilitators: are what can make it easier</u> ====
=== Facilitators ===
[[File:Image_facilitator.png|frameless]]
[[File:Image_facilitator.png|right|frameless]]


===== '''Building Partnerships''' =====
===== Building Partnerships =====
* The importance of building strong partnerships between patients, families, schools and health care providers is essential<ref>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.</ref>
* The importance of building strong partnerships between patients, families, schools and health care providers is essential<ref>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.</ref>
* Specifically discussion and collaboration in goal setting with providers is a helpful element for weight management<ref>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).</ref>.
* Specifically discussion and collaboration in goal setting with providers is a helpful element for weight management<ref>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).</ref>.
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* GP or practice nurse can refer you to a local weight management programme for children, such as [https://www.mytimeactive.co.uk/cwm MEND] and [http://www.more-life.co.uk/ More Life].  
* GP or practice nurse can refer you to a local weight management programme for children, such as [https://www.mytimeactive.co.uk/cwm MEND] and [http://www.more-life.co.uk/ More Life].  


===== '''Access to Resources''' =====
===== Access to Resources =====
* Primary care centres directly providing programs, including fitness classes, nutrition courses, and cooking classes.
* 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.   
* Showing parents and children how to create a healthy snack that not only looks good but tastes good.   
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* Clearer signposting to available resources
* Clearer signposting to available resources


===== '''Consistent Encouragement''' =====
===== Consistent Encouragement =====
* The use of consistent encouragement by providers needs to be a key component of successful weight management.
* 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 ==
[[File:8cxno4MKi-e1485551903975.png|left|frameless|150x150px]]
 
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
 
==== <u>Stages of Change Model</u> ====
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.
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.


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[[File:SCM1.png|frameless|576x576px]]  
[[File:SCM1.png|frameless|576x576px]]  


== Managing Childhood Obesity as a Parent ==
== Managing Childhood Obesity ==
 
It is important to encourage parents to take proactive steps in managing their child's weight.  Below are some useful tips and resources that can be used when talking to parents.  Ask parents to reflect on how they currently manage their child's weight.<ref>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 Practice'', ''29''(4), pp.476-481.</ref>'''.'''
'''Before you read this section, it could be beneficial to think of how you are managing now'''<ref>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 Practice'', ''29''(4), pp.476-481.</ref>'''.'''
 
Ask yourself some of these reflective questions to help you determine any area that you feel you need help or advice with:


[[File:Parent 1 image.png|frameless|620x620px|center]]
[[File:Parent 1 image.png|frameless|620x620px|center]]


After you have thought about the reflective questions remember:
Reflection alone is not enough, once they have identified problems it is important to take steps to effect change.  Encourage parents to follow the steps below:


[[File:Grouped reflection.png|center|1052x1052px|frameless]]
[[File:Grouped reflection.png|center|1052x1052px|frameless]]
<br />
<br />And remind parents they are not alone, they can consult their General Practitioner and other health professionals for advice.    
'''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<ref name=":6">ACADEMY OF NUTRITION AND DIETETICS., 2017. ''How to Talk to Kids about Weight and Obesity'' [online]. [viewed 30 March 2018]. Available from:  ''<nowiki>https://www.eatright.org/health/weight-loss/overweight-and-obesity/how-to-talk-to-kids-about-weight-and-obesity</nowiki>.'' </ref> <ref>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: <nowiki>https://www.cdc.gov/healthyweight/children/index.html</nowiki>.  
This is a useful image you can share with parents to help guide them on how much food their child should be eating from each food group<ref name=":6">ACADEMY OF NUTRITION AND DIETETICS., 2017. ''How to Talk to Kids about Weight and Obesity'' [online]. [viewed 30 March 2018]. Available from:  ''<nowiki>https://www.eatright.org/health/weight-loss/overweight-and-obesity/how-to-talk-to-kids-about-weight-and-obesity</nowiki>.'' </ref> <ref>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: <nowiki>https://www.cdc.gov/healthyweight/children/index.html</nowiki>.  
</ref>:
</ref>:
[[File:Parent_image_4.png|center|frameless|499x499px]]
[[File:Parent_image_4.png|center|frameless|499x499px]]
<br />
== Apps ==
[[File:8cxno4MKi-e1485551903975.png|left|frameless|150x150px]]Checkpoint:
We are in the age of technology and it may be easier to encourage children to get active by the use of free online Apps. Below is a list of free apps online that may help parents to engage their child in 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.
* 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.
 
==== <u>Gyms, activities and sports teams</u> ====
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;''' =====
# '''[https://www.virginactive.co.uk/our-difference/families Virgin Active Gym] –''' have plenty of fun varied classes for you and your kids such as swimming, balloon volleyball, musical games and crafts
# '''[http://www.energygym.co.uk/kids/ 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.
# '''[https://www.edinburghleisure.co.uk/activities 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:''' =====
# '''[http://www.clubsportedinburgh.org/ Sports Club Edinburgh]''' - which lets you find your nearest sports club to your location and what facilities they have to offer.
# '''Dance classes-''' the link to the website below lets you search for local dance classes in your area.
# '''[http://www.edinburgh.gov.uk/info/20014/schools_and_learning/474/play_for_families Activities for under 5s]''' - provide fun play activities ideas from ages 0-10.
# '''[http://www.edinburgh.gov.uk/info/20179/activities_and_events/369/play_facilities 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 [http://www.edinburgh.gov.uk/info/20228/keeping_fit_and_getting_active/1152/activities_for_children/ Edinburgh City Council website] with additional information and all the details on the different sports and activities that are available in your area.'''
 
==== <u>Apps</u> ====
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.
# '''HOOP:''' Find and book fun things to do in your local area for children aged 0-11 years old. ([https://itunes.apple.com/gb/app/hoop-whats-on-for-families/id996073365?mt=8 iOS] & [https://play.google.com/store/apps/details?id=uk.co.hoop.android&hl=en_GB Android])
# '''HOOP:''' Find and book fun things to do in your local area for children aged 0-11 years old. ([https://itunes.apple.com/gb/app/hoop-whats-on-for-families/id996073365?mt=8 iOS] & [https://play.google.com/store/apps/details?id=uk.co.hoop.android&hl=en_GB Android])
# '''Kiddy Keep Fit by Scotty & Lulu:''' Uses music and games to get children moving and exercising. ([https://itunes.apple.com/qa/app/kiddy-keep-fit-by-scotty-lulu/id374900798?mt=8 iOS])
# '''Kiddy Keep Fit by Scotty & Lulu:''' Uses music and games to get children moving and exercising. ([https://itunes.apple.com/qa/app/kiddy-keep-fit-by-scotty-lulu/id374900798?mt=8 iOS])
Line 259: Line 155:
# '''Wuf Shanti Yoga Fun Machine:''' Yoga app using games and music to promote health and happiness for your child through yoga, meditation and mindfulness. ([https://itunes.apple.com/us/app/wuf-shanti-yoga-fun-machine/id1296345752?mt=8 iOS])
# '''Wuf Shanti Yoga Fun Machine:''' Yoga app using games and music to promote health and happiness for your child through yoga, meditation and mindfulness. ([https://itunes.apple.com/us/app/wuf-shanti-yoga-fun-machine/id1296345752?mt=8 iOS])


==== <u>Physical activities that involve minimal cost</u> ====
=== 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.
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 ==
[[File:Screen_Shot_2018-03-16_at_1.27.56_PM.png|frameless|800x800px]]
[[File:8cxno4MKi-e1485551903975.png|left|frameless|150x150px]]
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.
 
<br />
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 ==
== 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.
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. It is important to recognise and understand childhood obesity and how to encourage children to become more active and make changes to help manage a 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 ==
== Useful Links ==
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== References  ==
== References  ==
see [[Adding References|adding references tutorial]].


<references />  
<references />  

Revision as of 22:52, 15 June 2019

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

Introduction[edit | edit source]

In recent years childhood obesity has risen[1]. In 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, the formula is kg/m2. 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

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.[2]

Why Does This Matter?[edit | edit source]

 [3]

The Benefits Of Physical Activity[edit | edit source]

Physical activity and inactivity can have a big effect on a 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 a child between the ages of 5 - 12 years old.

Regular activity[edit | edit source]

Encouraging a 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 [4][5][6][7][8]. These benefits are detailed below:

Screen Shot 2018-03-28 at 19.36.55.png
Screen Shot 2018-03-28 at 19.37.03.png


The video below provides more details of the top 5 benefits of physical activity for children.

 [9]

Inactivity[edit | edit source]

It is common to find children playing video games and watching television, however, this leads to a lot of sitting and therefore to an inactive lifestyle which can have a detrimental effect on on children's future health[6][7]. 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[7] and encourage regular physical activity to help reduce and prevent a 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

Physical Activity Guidelines for Children (Age 5-12)[edit | edit source]

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[10]. Amounts of physical activity greater than 60 minutes, provides additional heath benefits to your child[11].

Infograph.png

Moderate Activity[edit | edit source]

30440825 10160213199190285 6406574266132725760 n.png

Moderate activity raises the heart rate and can make a person sweat. 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[10]

Vigorous Activity[edit | edit source]

30414685 10160213199510285 1474170515588382720 n.png

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 [10]. Examples of activities which involve vigorous exercise for children include:

  • Swimming
  • Running
  • Gymnastics
  • Football
  • Karate
  • Rugby[10]

Bone Strengthening Activities[edit | edit source]

Screen Shot 2018-04-09 at 00.05.49.png

Children should include bone and muscle strengthening exercises at least 3 days a week. 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[10]. Examples of suitable bone strengthening activities for children:

  • Body weight lifting exercises
  • Jumping and climbing activites
  • Hopscotch
  • Rope Skipping
Examples of suitable muscle-strengthening activities for children:[edit | edit source]
  • Sit-ups and Press-ups
  • Gymnastics
  • Resistance band exercises
  • Rock Climbing[10]

Click here to download a helpful factsheet on physical activity guidelines for children [12].

Barriers and Facilitators to Managing Childhood Obesity[edit | edit source]

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[13]. 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[edit | edit source]

Image of Barrier.png

Resources Barriers[edit | edit source]

  • 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 gap - incomplete knowledge surrounding healthy eating[14] [15], regular activity benefits and risk of inactivity.

Social Barriers[edit | edit source]

  • 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[16].

Emotional Barriers[edit | edit source]

  • 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 [14] [15]
  • Negative attitudes - these attitudes from parents, staff and peers can hinder your child’s interest in physical activity[17]
  • Embarrassment - vulnerability, disappointment and shame at appearing physically incapable are just some of the emotions your child may experience

Facilitators[edit | edit source]

Image facilitator.png
Building Partnerships[edit | edit source]
  • The importance of building strong partnerships between patients, families, schools and health care providers is essential[18]
  • Specifically discussion and collaboration in goal setting with providers is a helpful element for weight management[19].
  • 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[edit | edit source]
  • 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[edit | edit source]
  • The use of consistent encouragement by providers needs to be a key component of successful weight management.

Stages of Change Model [edit | edit source]

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)

SCM1.png

Managing Childhood Obesity[edit | edit source]

It is important to encourage parents to take proactive steps in managing their child's weight. Below are some useful tips and resources that can be used when talking to parents. Ask parents to reflect on how they currently manage their child's weight.[20].

Parent 1 image.png

Reflection alone is not enough, once they have identified problems it is important to take steps to effect change. Encourage parents to follow the steps below:

Grouped reflection.png


And remind parents they are not alone, they can consult their General Practitioner and other health professionals for advice.  

This is a useful image you can share with parents to help guide them on how much food their child should be eating from each food group[21] [22]:

Parent image 4.png

Apps[edit | edit source]

We are in the age of technology and it may be easier to encourage children to get active by the use of free online Apps. Below is a list of free apps online that may help parents to engage their child in 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[edit | edit source]

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.

Conclusion[edit | edit source]

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. It is important to recognise and understand childhood obesity and how to encourage children to become more active and make changes to help manage a child’s weight and maintain a healthy lifestyle.

Useful Links[edit | edit source]

References[edit | edit source]

  1. ↑ Han, J. C., Lawlor, D. A., & Kimm, S. Y. (2010). Childhood obesity. The Lancet, 375(9727), 1737–1748
  2. ↑ Mayo Clinic. Childhood Obesity Diagnosis. https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833 (accessed 31 March 2018).
  3. ↑ Childhood Obesity in the UK Available from: https://www.youtube.com/watch?v=5Km1fFLX6T8 [last accessed 15/03/18]
  4. ↑ 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)
  5. ↑ 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)
  6. ↑ 6.0 6.1 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)
  7. ↑ 7.0 7.1 7.2 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)
  8. ↑ 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)
  9. ↑ 5 Reasons Why Physical Activity is Important for Children Available from: https://www.youtube.com/watch?v=nD-0Wc6eSUE [last accessed 28/03/18]
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 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
  11. ↑ 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/
  12. ↑ GOV.UK. 2011. UK Physical Activity Guidelines [online]. [viewed 9th April 2018]. Available from: https://www.gov.uk/government/publications/uk-physical-activity-guidelines
  13. ↑ 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).
  14. ↑ 14.0 14.1 Keenan, J.; and Stapleton, H. (2010) Bonny Babies? Motherhood and Nurturing in Age of Obesity. Health, Risk&Society, 12 (4).
  15. ↑ 15.0 15.1 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).
  16. ↑ 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:
  17. ↑ 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
  18. ↑ 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.
  19. ↑ 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).
  20. ↑ 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 Practice, 29(4), pp.476-481.
  21. ↑ 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. 
  22. ↑ 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.
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