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Welcome to [[Current and Emerging Roles in Physiotherapy Practice|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!!<div class="editorbox">
<div class="editorbox">'''Original Editors ''' - [[User:User Name|Alexander Dow]], [[User:User Name|Andrea Civitarese]], [[User:User Name|Lynne Turner]], [[User:User Name|Alison O’Brien]], [[User:User Name|Rachael Le Page]], [[User:User Name|Courtney Ferguson]] as part of the [[Current_and_Emerging_Roles_in_Physiotherapy_Practice|Queen Margaret University's Current and Emerging Roles in Physiotherapy Practice Project]]<br>
'''Original Editors ''' - Alexander Dow, Andrea Civitarese, Lynne Turner, Alison O’Brien, Rachael Le Page, Courtney Ferguson  


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Introduction ==
[[Obesity]] is the excessive or abnormal accumulation of fat or [[Adipose Tissue|adipose]] tissue in the body that may impair health.


&nbsp;
The obesity epidemic around the world affects not only adults but also children. About 50% of the time, obesity in childhood is carried into adulthood in a phenomenon known as "tracking." Per the latest data from the World Health Organization, the number of overweight and obese children under five years of age is estimated to be close to 39 million.


</div>
* By 2030 some epidemiologists suggest that 20% of the world's population will be obese, i.e., having a body mass index ([[Body Mass Index|BMI]]) of more than 30 kg/m² in adults, or a BMI ≥95th percentile for age and sex in children aged 2 to 18 years. See also [[Waist Measurement|waist measurement]] and [[Body Composition|body composition]]
* Obesity as a disease itself is multifactorial and occurs due to complex interactions occurring between genetics and the environment.<ref>Tirthani E, Said MS, Rehman A. [https://www.statpearls.com/ArticleLibrary/viewarticle/131519 Genetics and Obesity]. StatPearls [Internet]. 2021 Aug 4.Available:https://www.statpearls.com/ArticleLibrary/viewarticle/131519 (accessed 13.11.2021)</ref>
* Overweight and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity needs high priority<ref name=":7">World Health Organization. [https://www.who.int/news-room/q-a-detail/noncommunicable-diseases-childhood-overweight-and-obesity Noncommunicable diseases: Childhood overweight and obesity]. Available: https://www.who.int/news-room/q-a-detail/noncommunicable-diseases-childhood-overweight-and-obesity (accessed 9.10.2021)</ref>.


[[File:Screen Shot 2018-03-14 at 11.02.59 AM.png|center|frameless|1108x1108px]]
=== Why Does This Matter? ===
[[File:Group3.png|center|474x474px|frameless]]
Obese children carry an increased risk of [[asthma]], [[Diabetes Mellitus Type 2|type 2 diabetes]], and orthopedic disorders.  Studies have also found a link between childhood obesity and poor academic performance.


== '''WELCOME''' ==
* The roots of childhood obesity can begin in utero.  Maternal obesity and excessive weight gain during pregnancy, for example, both correlate with a higher risk of childhood obesity.  Moreover, other determinants of childhood obesity, eg rapid weight gain during infancy, are well established before age five.
* Obese children are more likely to become obese adults.  As obese adults, they will have a higher risk of many of the major causes of adult mortality, including [[Coronary Artery Disease (CAD)|coronary artery disease]], [[hypertension]], [[stroke]], [[Chronic Kidney Disease|chronic kidney]] and [[Liver Disease|liver]] disease as well as many types of cancer.  <ref>ASN Childhood Obesity Prevention Strategies Must Start Early Available:https://nutrition.org/childhood-obesity-prevention-strategies-must-start-early/ (Accessed 13.11.2021)</ref>


== Who is this page for? ==
The goal this page is 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... ==
[[File:Thought_bubble_pink.png|left|frameless|234x234px|link=#What Are The Benefits Of Physical Activity For My Child?]]
[[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)]]
This less than 2 minute video is a worthwhile watch.{{#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>
[[File:Thought orange.png|center|frameless|266x266px|link=#When to ask for help... And who to ask]]
 
<br />
== Etiology ==
[[File:Junk food.jpg|right|frameless]]
The fundamental cause of childhood overweight and obesity is an energy imbalance between calories consumed and calories expended.


'''Click on a bubble above to jump to that section!'''
Global increases in childhood overweight and obesity are attributable to several factors.


== Obesity Overview ==
# There has been a global shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals and other healthy micronutrients.
# There is also a trend towards decreased [[physical activity]] levels due to the increasingly sedentary nature of many forms of recreation time, changing modes of transportation and increasing urbanization.


==== <u>What is Childhood Obesity?</u> ====
The problem is societal and therefore it demands a population-based multisectoral, multidisciplinary and culturally relevant approach.
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 [https://www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx 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. Along with BMI, 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.<ref>Mayo Clinic. Childhood Obesity Diagnosis. https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833 (accessed 31 March 2018). </ref>
* Unlike most adults, children and adolescents cannot choose the environment in which they live or the food they eat. They also have a limited ability to understand the long-term consequences of their behaviour. They therefore require special attention when fighting the obesity epidemic<ref name=":7" />.


==== <u>Why does this matter?</u> ====
== Fighting the Epidemic ==
{{#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>
[[File:Parent_image_4.png|frameless|499x499px|alt=|right]]
WHO recommends the following to reduce and prevent childhood overweight and obesity:


<br />
# Increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts
# Limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats
# Limit the intake of sugars
# Be physically active and accumulate at least 60 minutes of regular, moderate- to vigorous-intensity activity each day that is developmentally appropriate.
Image 3: Eat well guide for parental guidance .


[[File:8cxno4MKi-e1485551903975.png|left|frameless|150x150px]]
See also
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 />
# [[Physiotherapy communication approaches in management of obesity and overweight]]
# [[Promoting Active Living in Young People Through Behaviour Change]]
# [[Fostering Behaviour Change in Obese Adolescents]]


== '''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.  
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 will benefit their body and mind health in a variety of ways<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>:
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]]  
<br />
<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, however this leads 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 following major diseases due to childhood inactivity<ref name=":1" />:
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. It is important to be aware of the higher risk of developing non communicable 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 Artery Disease (CAD)|coronary arterial disease]]
* Stroke
*[[Stroke]]
* Diabetes
* Diabetes
* Cancer
*[[Oncology|Cancer]]
* 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:
[[File:Infograph.png|alt=|right|frameless|779x779px]]
* 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 health?</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>
</ref>.   
</ref>.   


[[File:Infograph.png|frameless|779x779px]]
'''Moderate Activity'''[[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:
==== <u>Moderate Activity</u>  ====
* Cycling on flat ground
Moderate activity raises your heart rate and can make you sweat.
* Walking to school
 
[[File:30440825_10160213199190285_6406574266132725760_n.png|frameless|156x156px]]<br />
 
===== '''Examples of activities which involve moderate exertion for children include:''' =====
* Cycling on flat ground  
* Walking to school  
* Playing in the playground
* Playing in the playground
* Walking the dog
* Walking the dog
* Riding a scooter
* Riding a scooter
* Rollerblading<ref name=":5" />  
* Rollerblading<ref name=":5" />
 
'''Vigorous Activity'''[[File:30414685_10160213199510285_1474170515588382720_n.png|right|frameless|232x232px]]
==== <u>Vigorous Activity</u> ====
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" />. eg
Vigorous activity is known to improve individuals general health, increase bone and muscle strength and improve self-esteem.  
* Swimming
 
* Running
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 execration for children include:''' =====
* Swimming  
* Running  
* Gymnastics
* Gymnastics
* Football  
* Football
* Karate  
* Karate
* Rugby<ref name=":5" />  
* Rugby<ref name=":5" />
'''Three days a week children should include bone and muscle strengthening exercises.'''
'''Bone Strengthening Activities'''[[File:Screen_Shot_2018-04-09_at_00.05.49.png|right|frameless|215x215px]]
 
Children should include [[bone]] and muscle [[Strength Training|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" />. eg
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 />
===== '''Examples of suitable bone strengthening activities for children''' =====
* Body weight lifting exercises
* Body weight lifting exercises
* Jumping and climbing activites
* Jumping and climbing activites
* Hopscotch
* Hopscotch
* Rope Skipping
* Rope Skipping
 
Examples of suitable muscle-strengthening activities for children:
[[File:Screen_Shot_2018-04-09_at_00.05.49.png|frameless|215x215px]]
 
===== '''Examples of suitable muscle-strengthening activities for children''' =====
* Sit-ups and Press-ups
* Sit-ups and Press-ups
* Gymnastics  
* Gymnastics
* Resistance band exercises  
* Resistance band exercises
* Rock Climbing<ref name=":5" />
* Rock Climbing<ref name=":5" />


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 fact sheet 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]]
== Managing Childhood Obesity ==
See [[Management of Obesity]][[File:Parent 1 image.png|frameless|620x620px|alt=|right]]Encourage parents to take proactive steps in managing 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>'''.''' Once they have identified problems it is important to take steps to effect change.


Check Point:  
Remind parents they are not alone, they can consult their General Practitioner and other health professionals for advice<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>.  
* Take some time. Have a think.
</ref>.
* 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 ==
== Apps ==
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.
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.
 
==== <u>Barriers: are things that get in the way</u> ====
[[File:Image_of_Barrier.png|frameless]]
 
===== '''Resources Barriers''' =====
* ''Financial resources.'' financial barriers can be a massive barrier to physical fitness especially for large families.
* ''Limited time''. work hours for parents can be a barrier to family exercise, especially if having to work during evenings or on weekends,
* ''Access to programs.'' access to exercise programs 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>,
 
===== '''Social Barriers''' =====
* ''Cultural practices and expectations.'' cultural differences can contribute to difficulty in maintaining a healthy diet.
* ''Interpersonal dynamics.'' challenging family dynamics such as shared custody can make maintain a healthy eating and exercise routine can be 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''' =====
* ''Lack of confidence.'' uncertainty over their ability to control their child’s weight,
* ''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, According to <ref name=":3" /> <ref name=":4" />,most parents are unwilling to accept that their child has a weight issue.
* ''Negative 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
[[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> ====
[[File:Image_facilitator.png|frameless]]
 
===== '''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>
* specifically discussed goal setting in collaboration with providers as 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>.
* engaged as an entire unit, so that parents and children could better partner to achieve goals around healthy living.
* 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''' =====
* 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 a helpful resource and nutrition education classes
* access to free local community programmes and after school clubs
* 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
[[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.
 
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)
 
[[File:SCM1.png|frameless|576x576px]]
 
== Managing Childhood Obesity as a Parent ==
 
'''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]]
 
After you have thought about the reflective questions remember:
 
[[File:Parent_image_2.png|frameless|421x421px]][[File:Parent_image_3.png|frameless|459x459px]]
 
'''Note: ''Be aware parents that if you plan to change your child’s diet, remember to consult your GP or dietician first.''''' 
 
A useful image to help guide 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>.
</ref>:
[[File:Parent_image_4.png|center|frameless|499x499px]]
 
[[File:8cxno4MKi-e1485551903975.png|left|frameless|150x150px]]Checkpoint:
* Do you feel more empowered and reassured after asking yourself the reflective questions?
* Do you feel there are changes you could make?
* If you like make a list of some changes you could make to manage childhood obesity.
<br />
== 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 help you child 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])
# '''7-minute workout for kids:''' High intensity workouts with rests to develop strength, stability and balance. ([https://itunes.apple.com/gb/app/7-minute-workout-for-kids-make-fitness-fun-for-stronger/id994433500?mt=8 iOS])
# '''Habitz:''' Set up by Health Professionals to help parents to inspire their children to develop healthy habits and lifestyles. ([https://itunes.apple.com/us/app/habitz-kids-learn-good-habits/id1225446637?mt=8 iOS])
# '''Sworkit Kids – Fitness Meets Fun (7-14 year olds):''' Wide variety and duration of fun exercises to develop and enhance strength, agility and flexibility. ([https://itunes.apple.com/gb/app/sworkit-kids/id1043023032?mt=8 iOS] & [https://play.google.com/store/apps/details?id=com.sworkit.kids&hl=en_GB Android])
# '''Appu’s Yoga for Kids:''' Easy yoga poses for children to enhance and refresh your child's body and mind. ([https://itunes.apple.com/gb/app/appus-yoga-for-kids/id528508889?mt=8 iOS] & [https://play.google.com/store/apps/details?id=com.winjit.android.appuseries.yoga&hl=en Android])
# '''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])
== 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 and some ideas to help with your child’s weight or obesity.
 
<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 ==
We hope that this page has provided you with tools and information that will be practical and useful for you and your family. Please see the "Useful Links" section below for further resources, and feel free to use this page as a reference whenever you need it.  
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 ==
== Useful Links ==
* [https://www.nhs.uk/Livewell/childhealth6-15/Pages/child-health-measurement-programme-very-overweight-advice.aspx NHS Choices: What can I do if my child is very overweight?]  
* [https://www.nhs.uk/Livewell/childhealth6-15/Pages/child-health-measurement-programme-very-overweight-advice.aspx NHS Choices: What can I do if my child is very overweight?]  
* [https://www.nhs.uk/news/obesity/tv-in-bedroom-risk-factor-for-child-obesity/ Article: TV in bedroom 'risk factor' for child obesity]
* [http://www.bbc.co.uk/news/health-37116611 BBC: What to do if your child is overweight]
* [http://www.bbc.co.uk/news/health-37116611 BBC: What to do if your child is overweight]
* [https://www.nhs.uk/change4life NHS: Change 4 Life]
* [https://www.nhs.uk/change4life NHS: Change 4 Life]
 
*[https://www.familiesonline.co.uk/child/child-wellbeing Families online: child-wellbeing]
* [https://www.nhs.uk/Livewell/childhealth6-15/Pages/child-health-measurement-programme-very-overweight-advice.aspx NHS Livewell: advice for children health ages 6-15]
*[http://www.more-life.co.uk/ More Life]
* [https://www.familiesonline.co.uk/child/child-wellbeing Families online: child-wellbeing]
*[https://www.helpguide.org/articles/diets/childhood-obesity-and-weight-problems.htm Childhood Obesity and Weight Problems Help Guide]
* [https://www.cdc.gov/obesity/childhood/causes.html CDC Government: Obesity causes]
*[https://www.eatright.org/health/weight-loss/overweight-and-obesity/how-to-talk-to-kids-about-weight-and-obesity. Kids eat right: How to Talk to Kids about Weight and Obesity]
* [http://www.mendfoundation.org/ MEND Foundation]  
* [http://www.more-life.co.uk/ More Life]  
* [https://www.helpguide.org/articles/diets/childhood-obesity-and-weight-problems.htm Childhood Obesity and Weight Problems Help Guide]  
* [https://www.eatright.org/health/weight-loss/overweight-and-obesity/how-to-talk-to-kids-about-weight-and-obesity. Kids eat right: How to Talk to Kids about Weight and Obesity]  
*[https://www.cdc.gov/healthyweight/children/index.html Tips for Parents – Ideas to Help Children and Maintain a Healthy Weight: Centers for Disease Control and Prevention]
*[https://www.cdc.gov/healthyweight/children/index.html Tips for Parents – Ideas to Help Children and Maintain a Healthy Weight: Centers for Disease Control and Prevention]
*[https://www.bbcgoodfood.com/recipes/collection/school-lunch Healthy Kids' Lunchbox Recipe Ideas]
*[https://www.bbcgoodfood.com/recipes/collection/school-lunch Healthy Kids' Lunchbox Recipe Ideas]


== References  ==
== References  ==
see [[Adding References|adding references tutorial]].


<references />  
<references />  


[[Category:Queen_Margaret_University_Project]] [[Category:Projects]]
[[Category:Queen_Margaret_University_Project]]
[[Category:Paediatrics]]
[[Category:Paediatrics - Conditions]]
[[Category:Paediatrics - Physical Activity]]

Latest revision as of 15:20, 15 November 2021

Original Editors - Alexander Dow, Andrea Civitarese, Lynne Turner, Alison O’Brien, Rachael Le Page, Courtney Ferguson as part of the Queen Margaret University's Current and Emerging Roles in Physiotherapy Practice Project
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]

Obesity is the excessive or abnormal accumulation of fat or adipose tissue in the body that may impair health.

The obesity epidemic around the world affects not only adults but also children. About 50% of the time, obesity in childhood is carried into adulthood in a phenomenon known as "tracking." Per the latest data from the World Health Organization, the number of overweight and obese children under five years of age is estimated to be close to 39 million.

  • By 2030 some epidemiologists suggest that 20% of the world's population will be obese, i.e., having a body mass index (BMI) of more than 30 kg/m² in adults, or a BMI ≥95th percentile for age and sex in children aged 2 to 18 years. See also waist measurement and body composition
  • Obesity as a disease itself is multifactorial and occurs due to complex interactions occurring between genetics and the environment.[1]
  • Overweight and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity needs high priority[2].

Why Does This Matter?[edit | edit source]

Obese children carry an increased risk of asthma, type 2 diabetes, and orthopedic disorders.  Studies have also found a link between childhood obesity and poor academic performance.

  • The roots of childhood obesity can begin in utero.  Maternal obesity and excessive weight gain during pregnancy, for example, both correlate with a higher risk of childhood obesity.  Moreover, other determinants of childhood obesity, eg rapid weight gain during infancy, are well established before age five.
  • Obese children are more likely to become obese adults.  As obese adults, they will have a higher risk of many of the major causes of adult mortality, including coronary artery disease, hypertension, stroke, chronic kidney and liver disease as well as many types of cancer.  [3]


This less than 2 minute video is a worthwhile watch.

 [4]

Etiology[edit | edit source]

Junk food.jpg

The fundamental cause of childhood overweight and obesity is an energy imbalance between calories consumed and calories expended.

Global increases in childhood overweight and obesity are attributable to several factors.

  1. There has been a global shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals and other healthy micronutrients.
  2. There is also a trend towards decreased physical activity levels due to the increasingly sedentary nature of many forms of recreation time, changing modes of transportation and increasing urbanization.

The problem is societal and therefore it demands a population-based multisectoral, multidisciplinary and culturally relevant approach.

  • Unlike most adults, children and adolescents cannot choose the environment in which they live or the food they eat. They also have a limited ability to understand the long-term consequences of their behaviour. They therefore require special attention when fighting the obesity epidemic[2].

Fighting the Epidemic[edit | edit source]

WHO recommends the following to reduce and prevent childhood overweight and obesity:

  1. Increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts
  2. Limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats
  3. Limit the intake of sugars
  4. Be physically active and accumulate at least 60 minutes of regular, moderate- to vigorous-intensity activity each day that is developmentally appropriate.

Image 3: Eat well guide for parental guidance .

See also

  1. Physiotherapy communication approaches in management of obesity and overweight
  2. Promoting Active Living in Young People Through Behaviour Change
  3. Fostering Behaviour Change in Obese Adolescents

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 [5][6][7][8][9]. 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.

 [10]

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[7][8]. These effects may not show until later life. It is important to be aware of the higher risk of developing non communicable diseases due to childhood inactivity[8] and encourage regular physical activity to help reduce and prevent a child developing them in adulthood.

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[11]. Amounts of physical activity greater than 60 minutes, provides additional heath benefits to your child[12].

Moderate Activity

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[11]

Vigorous Activity

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 [11]. eg

  • Swimming
  • Running
  • Gymnastics
  • Football
  • Karate
  • Rugby[11]

Bone Strengthening Activities

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[11]. eg

  • Body weight lifting exercises
  • Jumping and climbing activites
  • Hopscotch
  • Rope Skipping

Examples of suitable muscle-strengthening activities for children:

  • Sit-ups and Press-ups
  • Gymnastics
  • Resistance band exercises
  • Rock Climbing[11]

Click here to download a helpful fact sheet on physical activity guidelines for children [13].

Managing Childhood Obesity[edit | edit source]

See Management of Obesity

Encourage parents to take proactive steps in managing their child's weight[14]. Once they have identified problems it is important to take steps to effect change.

Remind parents they are not alone, they can consult their General Practitioner and other health professionals for advice[15] [16].

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. 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)

Conclusion[edit | edit source]

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. ↑ Tirthani E, Said MS, Rehman A. Genetics and Obesity. StatPearls [Internet]. 2021 Aug 4.Available:https://www.statpearls.com/ArticleLibrary/viewarticle/131519 (accessed 13.11.2021)
  2. ↑ 2.0 2.1 World Health Organization. Noncommunicable diseases: Childhood overweight and obesity. Available: https://www.who.int/news-room/q-a-detail/noncommunicable-diseases-childhood-overweight-and-obesity (accessed 9.10.2021)
  3. ↑ ASN Childhood Obesity Prevention Strategies Must Start Early Available:https://nutrition.org/childhood-obesity-prevention-strategies-must-start-early/ (Accessed 13.11.2021)
  4. ↑ Childhood Obesity in the UK Available from: https://www.youtube.com/watch?v=5Km1fFLX6T8 [last accessed 15/03/18]
  5. ↑ 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)
  6. ↑ 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)
  7. ↑ 7.0 7.1 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)
  8. ↑ 8.0 8.1 8.2 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)
  9. ↑ 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)
  10. ↑ 5 Reasons Why Physical Activity is Important for Children Available from: https://www.youtube.com/watch?v=nD-0Wc6eSUE [last accessed 28/03/18]
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 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
  12. ↑ 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/
  13. ↑ GOV.UK. 2011. UK Physical Activity Guidelines [online]. [viewed 9th April 2018]. Available from: https://www.gov.uk/government/publications/uk-physical-activity-guidelines
  14. ↑ 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.
  15. ↑ 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. 
  16. ↑ 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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