Childhood Obesity: Difference between revisions

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'''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]]
<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>


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Introduction ==
== Introduction ==
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:
[[Obesity]] is the excessive or abnormal accumulation of fat or [[Adipose Tissue|adipose]] tissue in the body that may impair health.
* Healthy weight: BMI = 18.5-24.9
 
* Overweight: BMI = 25-29.9
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.  
* Obese: BMI = 30-39.9
 
* Severely Obese: BMI = ≥40
* 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]]
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>  
* 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>.


=== Why Does This Matter? ===
=== 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><br />
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.
 
* 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>
 
 
 
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>
 
== 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.
 
Global increases in childhood overweight and obesity are attributable to several factors.
 
# 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.
 
The problem is societal and therefore it demands a population-based multisectoral, multidisciplinary and culturally relevant approach.


== '''The Benefits Of Physical Activity'''  ==
* 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" />.
 
== Fighting the Epidemic ==
[[File:Parent_image_4.png|frameless|499x499px|alt=|right]]
WHO recommends the following to reduce and prevent childhood overweight and obesity:
 
# 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 .
 
See also
 
# [[Physiotherapy communication approaches in management of obesity and overweight]]
# [[Promoting Active Living in Young People Through Behaviour Change]]
# [[Fostering Behaviour Change in Obese Adolescents]]
 
== The Benefits Of Physical Activity==
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.   
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 ===
=== Regular Activity ===
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:
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]]
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{{#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>  
=== Inactivity ===
=== Inactivity ===
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.  
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
== Physical Activity Guidelines for Children (Age 5-12) ==
== Physical Activity Guidelines for Children (Age 5-12) ==
[[File:Infograph.png|alt=|right|frameless|779x779px]]
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 ===
[[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:
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  
* Cycling on flat ground
* Walking to school  
* 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]]
=== Vigorous Activity ===
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
[[File:30414685_10160213199510285_1474170515588382720_n.png|right|frameless|232x232px]]
* Swimming
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:
* Running
* Swimming  
* Running  
* Gymnastics
* Gymnastics
* Football  
* Football
* Karate  
* Karate
* Rugby<ref name=":5" />  
* Rugby<ref name=":5" />
 
'''Bone Strengthening Activities'''[[File:Screen_Shot_2018-04-09_at_00.05.49.png|right|frameless|215x215px]]
=== Bone Strengthening Activities ===
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
[[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
* Hopscotch
* Hopscotch
* Rope Skipping
* Rope Skipping
 
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
* 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>.


== Barriers and Facilitators to Managing Childhood Obesity ==
== 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.
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.  


=== Barriers ===
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>.  
[[File:Image_of_Barrier.png|right|frameless]]
</ref>.   
 
==== Resources Barriers ====
* 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<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 ====
* 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>.
 
==== Emotional Barriers ====
* 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 <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>  
* Embarrassment - vulnerability, disappointment and shame at appearing physically incapable are just some of the emotions your child may experience<br />
 
=== Facilitators ===
[[File:Image_facilitator.png|right|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 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>.
* 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 [https://www.mytimeactive.co.uk/cwm MEND] and [http://www.more-life.co.uk/ More Life].  
 
===== Access to Resources =====
* 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 =====
* The use of consistent encouragement by providers needs to be a key component of successful weight management.
== Stages of Change Model ==
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)
[[File:SCM1.png|frameless|576x576px]]
== 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>'''.'''
[[File:Parent 1 image.png|frameless|620x620px|center]]
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]]
<br />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<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]]
== Apps ==
== Apps ==
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.
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.
# '''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])
=== 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.


== 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. 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.  
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]
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[[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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