Children and Youth with Obesity—a growing global epidemic

shutterstock_197361479

According to the US Centers for Disease Control (CDC), obesity has more than doubled in children and quadrupled in adolescents in the last 30 years.1 In 2012, more than a third of children and adolescents in the US were overweight or obese.1 Obesity is not limited to developed countries or older children, the World Health Organization (WHO) estimated that in 2013, 42 million children under the age of 5 years were overweight and close to 31 million of these children were living in developing countries.2 The global nature and steady increase has led the WHO to declare childhood obesity as “one of the most serious public health challenges of the 21st century.”2

Obesity can have wide ranging effects both in the short-term and long-term. In the short term, it can affect social, psychological and physical health. For example, children and adolescents with obesity are more likely to have cardiovascular risk factors, pre-diabetes, bone and joint problems, sleep apnea, stigmatization and poor self-esteem.1 In the long-term, children and youth with obesity are more likely to grow up to be adults with obesity, which increases the risk for a number of chronic conditions including heart disease, stroke, diabetes, osteoarthritis, and many forms of cancer.1

According to the CDC, the cause of obesity is quite simple: caloric imbalance.1 That means “too few calories are expended for the amount of calories consumed.” This can be “affected by genetic, behavioral, and environment factors.” 1 Many prevention and treatment programs aim to address this caloric imbalance through increased physical activity and healthy eating.

These aims appear straightforward; however, the growing epidemic, the volume of research, and the number of complex programs to address the problem highlight that these goals are difficult to achieve. There are two general approaches to many public health problems—prevention and treatment. As a starting point, we examine the evidence on preventing obesity in children and youth.

A Cochrane review examined 55 comparative studies conducted in countries around the globe.3 Most of the studies involved children between the ages of 6 and 12 years. The authors found that many programs improved nutrition and physical activity, and a meta-analysis of 37 studies with 27,964 children showed an overall significant reduction in adiposity (a measure of body fat). However, there was a very wide range of effects across the programs, with some programs on their own not showing an effect.

The authors indicated that the results of the review should be interpreted cautiously. They suggested that the results may be biased as the review may have missed small studies with negative findings. Further, there was little information available on the long-term impact of these programs. Finally, the evidence did not allow us to understand which components within the different programs may have the greatest effect on preventing obesity in children.

On a positive note, the authors did not find any harms associated with the interventions, such as unhealthy dieting practices or body image. Further, the authors were able to tease out the following “promising policies and strategies”:

  • “school curriculum that includes healthy eating, physical activity and body image
  • increased sessions for physical activity and the development of fundamental movement skills throughout the school week
  • improvements in nutritional quality of the food supply in schools
  • environments and cultural practices that support children eating healthier foods and being active throughout each day
  • support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)
  • parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities.”3

Dr. Geoff Ball, Director of the Pediatric Centre for Weight and Health at the Stollery Children’s Hospital in Edmonton, Alberta, works with children aged 2 to 17 and their families on a regular basis and offers the following perspective:

When ‘success’ in treating or managing obesity is defined based on weight status, the effects of most lifestyle and behavioral interventions are modest. This reality highlights two points:

  1. The health and well-being of children should be defined using a number of different metrics. Weight status, usually determined using the body mass index (BMI) percentile or z-score, is one of several indicators that can include data regarding lifestyle habits (e.g., dietary quality, physical activity, sedentary behaviors) and psychosocial health (e.g., self-esteem, quality of life).
  2. ‘Upstream’ initiatives that promote and support healthy lifestyle habits and cognitions to prevent unhealthy weight gain are needed for the primary prevention of childhood obesity.

In addition, most strategies to prevent obesity in children have their genesis in health care and education settings. More recently, initiatives that take a broader perspective of preventing obesity have included communities, municipalities and other jurisdictions (provinces, states, nations) that have key roles to play in setting policies that influence everything from community zoning bylaws (that influence the location and availability/quality of grocery stores and sidewalks, respectively) to agricultural subsidies of some foods over others to food labeling policies that influence the information consumers have access to at the point-of-purchase in restaurants and grocery stores. The current ‘big picture’, systems view of obesity highlights the complexity and inter-relatedness of the causes and consequences of unhealthy weight gain. The old axiom ‘eat less and move more’ may be a catchy phrase, but it fails to acknowledge the most up-to-date perspective on obesity (prevention and management) as a chronic condition that requires long-term, multi-sector strategies in order to enable healthy lifestyle choices in healthy environments for healthy families.

Child playing outside

Source: Wikimedia Commons

 

References & Resources:

  1. Centers for Disease Control and Prevention. Childhood Obesity Facts. http://1.usa.gov/1xdoxQu
  2. World Health Organization. Childhood overweight and obesity. http://www.who.int/dietphysicalactivity/childhood/en/%20accessed%2009%20March%202015.
  3. Waters E, de Silva-Sanigorski A, Burford BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD001871. DOI: 10.1002/14651858.CD001871.pub3. See summary here.
  • Preventing Childhood Obesity: Tips for Parents and Caretakers (2015). American Heart Association webpage

 

A normal day at school…Cystic Fibrosis and me

Cystic Fibrosis (CF) is the most common fatal genetic disease affecting Canadian children and adolescents, with estimates of up to 100,000 people globally with the condition. Average life expectancy is about 35-40 years, but may be much lower for people in countries with poor or no developed healthcare. Currently, there is no cure for CF. Early diagnosis is key, as well as preventive treatment for a longer, and better quality of, life.

The Cochrane Cystic Fibrosis & Genetic Disorders Group aims to put together quality evidence from randomised controlled trials to help individual patients and their families, spanning interventions from medications to physical activity, and everything in-between.

This week’s blog is by Tess, a nine year old girl from the UK, who talks about what it’s like to have CF, and some of the challenges and successes of navigating her condition at school.

tess

People think I’m a normal, healthy girl when they look at me. That’s wrong. I have Cystic Fibrosis (CF). It’s a little like having asthma because they’re both to do with your lungs, and with CF you’ve got it for life. On my first day of my new school, like most new kids are, I was scared and worried. You see, I had only just started year 4. My class didn’t have a clue that in their class was one of the 10,000 people with CF. They only found out that I had it when I did a presentation about it! After that, it was questions, after questions, after questions until the teacher hauled me to safety. Since that day, nobody teased or bullied me or my friends. I knew they knew that really, underneath the disease, I was just a normal fun loving child.

With Cystic Fibrosis comes responsibility, treatment, and medicine

Tess PEP_cropped

This is me with the PEP

There are several things I have to do at school to prevent illness. My first is anti-bacterial gel. It’s gloop-doopy stuff that (apparently) kills 99.9% of bacteria. Next, water. You’re thinking I might have to do a strange ritual, but no, all I have to do is drink gallons of it!!! Then, the school day goes on and it’s lunch time. Drink another gallon of water and juice from my lunchbox and go outside to play. Me and my friends play EXTREMELY energetic games and this is good for my health. You need to be fit if you have CF!

After lunch, I’ve got to head back inside for my physio. I don’t get pummelled on the back, no, I blow in a mysterious plastic machine called a “PEP”. Boring right? Well, imagine blowing into that 10 times, huffing and coughing and then repeat that sequence SIX times!!!!! I float into the land of boredom whenever I do it. Then, I get back to class and get changed for PE (Physical Education). As I said earlier, anything energetic = big thumbs up for CF. I put my best efforts into this. Then, back at the classroom, I get changed and learn about music or the terms topic. And that, my friends, is a complete day at school for a person who has Cystic Fibrosis! 🙂

There are lots of dangers for me at school
When I started school at The Batt, I went round the school with Mrs. Smart (the teaching assistant in my class) and pointed out hazardous zones. Some were drains or plants in the class. When I went round school, I did my very best to avoid these places. The teachers helped by moving the plant out of the class room and into 3P (the neighbouring class). Mr. Peacey was very kind and said he would look after it. I’ll let my Mum and Dad explain more about this:

“Each time Tess or Zac (who also has CF) move school or class we go in to meet with the class teacher and other adults involved in their care. We also invite the CF nurse to attend to give the school opportunity to ask questions and feel they have access to support if they are unsure of anything. Really it is just about keeping open communication between us, the school and Tess or Zac so that everyone is happy.

The main things we have to make them aware of are:

Hand hygiene – hands need to be washed after playing outside, touching shoes, seating on the floor, touching soil or animals or similar things. After going to the toilet and before eating anything. If they can be encouraged to use anti-bacterial hand gel as well all the better.

Tess,Erin,Zac edit

Tess with Zac and sister Erin and some of their equipment

Drinking – it is important that they keep well hydrated as they sweat more than other kids and it helps with their bowels. This is always the hardest one to encourage.

Avoiding coughs and colds – it is also impossible to avoid catching coughs and colds from other kids as they are taught to share so well. We do ask the teachers to advise us though if there is a child in class with a particularly bad cough or cold then we can decide whether to keep Tess or Zac at home to avoid it. This would depend on how fit they were at the time and how many colds they had had recently. Often we spend all autumn and winter going from one antibiotic to another.

Medicine and Physio – there are medications each day that are taken at school administered usually by office staff or a teaching assistant. These are syrups, capsules or mixed into drinks. They also have some physio at school to alleviate pressure on time at home.

Hospital time – we see specialists for various parts of their care pretty regularly. There are Physiotherapists, Dieticians, Gastro teams, Psychologists and the Specialist nurses and doctors. This can take quite a bit of time away from school, more if they are admitted, but we ask the school for flexibility in school work and work to take home if necessary.

Avoiding environmental bacteria and moulds – people with CF are susceptible to bacteria and moulds that others may not even be affected by. Pseudomonas is a big one. It’s so common as its found in all damp places and drains. We encourage the school to pour Milton (a sterilising fluid) down sinks regularly and not have taps that direct water straight into the plug hole as this can aerosol any bugs down there. We also encourage the schools to use disposable cloths rather than have damp ones lying around the classroom. No standing water anywhere on site, such as tyres in the playground, water butts, stagnant ponds but even water tubs for the kids to play in need changing every day. No fish tanks or any animals in the class at all. Moulds are also a hazard, so damp leaves, old buildings with damp walls can be a problem, hay is a definite no go area so farm trips we need to supervise.”

When my brother Zac got pseudomonas (he was 3 then) I wasn’t allowed in the same room, or eat with cutlery he used. I wasn’t allowed to hug, kiss or touch him in any way for a year. It was really scary when we found out, but I guess you want to know how it happened…

At Zac’s nursery, there was a water butt with a pump and the helpers there let the kids make mud pies with it. As Zac was only 3 then it was an option he couldn’t resist. Mum says “the CF nurse visited the nursery and advised us to pull Zac out as there were too many high risk hazards for them to change. We learnt a lot more as a family about the various risks we needed to avoid in all types of settings. Moving around though we have realised that some CF teams prioritise this knowledge more than others. I think they are afraid of scaring families when they first receive the news that their child has CF.”

Tess winning KB bout

Me winning a kickboxing bout. Anything energetic = big thumbs up for CF

My wish list for school

• that I don’t have to repeat myself over and over again
• that they understand that some hazards aren’t as bad as they think
• that no one thinks I’m strange and have a mental problem
• that it’s not a reason to be teased
• that visitors helping out in my class are told of my condition

 

Our awesome CF Fundraising event
While at school some children were really thoughtful and wanted to raise money for my charity (CF Trust). Alright, yes, I started the thoughts, but every fire has to start with a spark!

A group of girls went and asked our teacher about it and she was delighted! I phoned the CF Trust and the next day they sent me a package. It was full of banners, balloons, money collectors, stickers, AND 2 different types of leaflets! I brought the package to school and showed Mrs. Mason (my teacher). We had to think of the way to raise money as well, so we stuck a piece of paper and pen to the wall outside our classroom and wrote, “Ideas for CF Fundraiser” on top. By the end of 2 weeks we had millions of ideas to choose from. “Cake stall” was an instant winner, but we knew, to raise loads of money we had to have a lot of stalls. Art and crafts, penalty shoot out, agility course and pinata also got a contract. Me, Archie and Erin set up an info stall. All leaflets, remaining balloons and stickers were given a home on our table. If you gave a donation you got a stickers and the little kids got balloons too!

When the pinata had broken, the winner couldn’t eat the sweets inside so he sold them to passersby and he raised £5. Now, I want to tell you how much we raised, so, take that £5 and multiply by 100. Give or take a few pence and that is £500. AMAZING and even better, I felt special. Like all of that was for me. All that money, for people like me.

 

About Tess Griffin:

Hi, my names Tess, I’m nine and I go to The Batt CofE Primary school in Witney. I have Cystic Fibrosis (CF) and so does my little brither Zac (6) Erin (my little sister who’s 8) is lucky in that respect. Mum and Dad are really encouraging and get me into loads of energetic hobbies. I like these the most: dancing (I don’t go to a special dance school), Kickboxing (at Windrush Kickboxing Club), football (in the Witney Vikings football Club). I also like some non-energy hobbies such as: chess (I love my Dad’s board), drawing ( I adore Manga), writing ( and don’t forget reading too!).

Original source: Evidently Cochrane at http://www.evidentlycochrane.net/

Links: