Diagnosis and management of childhood obesity: a survey of general practitioners in South West Sydney

Aim: To describe general practitioners' (GPs) diagnosis and management of overweight and obesity in children, their attitudes regarding obesity and their awareness of National Health and Medical Research Council (NHMRC) clinical practice guidelines. Method: A cross‐sectional written survey of members of the Liverpool Division of General Practice (located in South West Sydney, Australia). Results: Of 137 questionnaires sent, 85 (62%) were returned. Although the majority prescribed the correct interventions, there was variability in complications screening, ranging from 75% screening for psychosocial problems to 30% for fatty liver. Less than a third (28%) of GPs used NHMRC guidelines in their practice and only 9% used body mass index charts to correctly diagnose childhood obesity. GPs felt that childhood obesity was a significant issue and identified parental denial and lack of community support as barriers to treatment. Conclusion: Although NHMRC guideline adherence was far from universal, the GPs in our survey are motivated and aware of the importance of managing childhood obesity. If the primary care approach is to work, then GPs need support and education in an environment where there is greater community awareness of the impact of childhood obesity.     

Pediatrician's office: a solution in the prevention of childhood obesity

A mother's ability to correctly perceive her child's weight status and her concern toward the overweight status of her child are important in the prevention of childhood obesity. Mothers should have adequate nutrition knowledge that enables them to plan and provide nutritious meals to their children.

Conclusion: Pediatricians may play a role in childhood obesity prevention interventions by helping mothers understand growth charts and by providing mothers with appropriate nutrition guidance for planning a balanced diet.     

Policies to support obesity prevention for children: a focus on of early childhood policies

Policies at many levels may help to shape environments that promote healthy weight and prevent obesity. We present policies to support obesity prevention for young children. We highlight policy Sand environmental systems change examples in the areas of promoting breastfeeding and providing healthy affordable food and information about food in community and child care settings and promoting physical activity in child care and the community. We address the role of the health care system and health care professionals to shape and advocate for policy and environmental systems change and provide resources for pediatric health care professionals to engage in community-based advocacy.     

Action, prevention and epidemiology of paediatric obesity

The overall aim of this paper is to describe important issues regarding paediatric obesity as a public health problem. This paper focuses on actions taken, and on the prevalence of obesity in children, teens and adults in Denmark. In addition, the paper describes some important prevention studies, all of which are performed outside Denmark. Thus, this paper is not a classical review but rather a highlight of some aspects that the author finds important. The latest Danish national figures show a marked increase in the prevalence of obesity, especially among young men—a sevenfold increase from 1987 to 2000 (0.7 to 4.9%). Among young women aged 16–24, the increase is threefold in the same period. Among teens, the prevalence has increased by 2–3 times in recent decades. Nevertheless, compared to other European countries and the US, Denmark has a relatively low prevalence of obesity in adolescents. The present paper also covers results from prevention studies performed in both preschool and school settings. Some of these focus on the reduced intake of carbonated drinks, whereas others focus on both diet and physical exercise. Finally, this paper demonstrates that Denmark is at the forefront regarding a national action plan against obesity.
Conclusion: This paper highlights some important aspects of the epidemiology, prevention and actions in the field of paediatric obesity with special focus on Denmark.     

Engaging parents in child obesity prevention: Support preferences of parents

Helping parents engage in practices that are likely to prevent childhood obesity is a considerable challenge for health professionals, policy makers and researchers. The aim of the study was to determine who is likely to use services designed to help parents prevent overweight and obesity and what types of services they prefer. Two hundred and forty randomly selected parents of children 4–15 years from the Hunter New England region of New South Wales completed a 15 min telephone survey. Most parents would use a service to help them prevent obesity in their children but particularly parents of households from higher socioeconomic areas, female parents, parents of younger children and parents of children who are not consuming sufficient serves of fruits and vegetables, or are less active. Parents preferred personalised mailed print materials (85%), specialist appointments (61%) and emailed information (58%). Parents are interested in using a range of services to support them to encourage their children to eat healthily and be active. Researchers should test the efficacy of promising services.     

An update in prevention and treatment of pediatric obesity

Background  Obesity prevalence is growing as well as its severity with increasing morbidity and mortality. This “globesity” also affects developing countries where under nutrition and stunting frequently coexist with overweight and obesity. One third of obese adults began to be so in the pediatric ages. There are two main types of prevention: general one representing greater actions from health authorities and the individual one carried out by the pediatrician and the patient at risk. Once the state of obesity is reached (relative body mass index, rBMI >121%) the longer lasting care becomes more complex and frequently unsuccessful. The treatment of obesity is aimed to care for the present and silent disorders and for preventing its further tracking to adulthood. Data sources  Identification of pediatric population at risk which is the one with an rBMI of 111%–120% plus other risk factors. Specific individual actions include reduction of food intake, increase of energy expenditure, involvement of parents, and the child-adolescent himself in the prevention. Therapy is based on some principles plus the important medical and emotional approach. Results  A Cochrane study based on only 10 appropriate studies showed a predominant poor efficacy of the undergone preventive action. Treatment guides are presented after our own experience with a group of 400 kids with an average follow-up of 7 years and other individual prevention studies. Conclusions  Involving motivated pediatricians with a minimum of time for visits and better follow-up in the frame of a general national preventive programme could be a rational outcome. Treatment of obesity should never be postponed whatever the clinical care is.     

The Impact of the 2007 Expert Committee Recommendations on Childhood Obesity Preventive Care in Primary Care Settings in the United States

ObjectivesIn this study we examined the impact of the Expert Committee Recommendations (ECRs) on childhood obesity preventive care during well-child visits in the United States.MethodsData from the 2006-2009 National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey–outpatient department were used to examine frequencies of diet/nutrition and exercise counseling during well-child visits by children aged 2 to 18 years. Differences in rates of the counseling before and after the ECRs were made were compared.ResultsOnly 37% and 22% of all patients in 2006-2007 and 33% and 18% of all patients in 2008-2009 were provided with diet/nutrition and exercise counseling, respectively. The frequencies of counseling for patients with a diagnosis of obesity showed no change. Socioeconomically disadvantaged children received counseling less frequently after the ECRs were made.ConclusionOverall, rates of obesity preventive care were low in all years, with no evidence of improvement after the ECRs were made. Systematic approaches are needed to improve delivery of obesity preventive care irrespective of the socioeconomic backgrounds of children.     

The primary prevention of asthma in children study: Design of a multifaceted prevention program

The PREVASC study addresses the primary prevention of asthma in infants and small children. The objective of this study is to investigate whether a multifaceted prenatally started intervention strategy in high-risk infants leads to a decrease in the occurrence of (severe) asthma and whether a refinement of the prevention strategy leads to an increase in the adherence to the prevention program. The primary prevention program includes house dust mite impermeable bed coverings, education on breast feeding, hypoallergenic feeding, timing of introduction of solid food and smoking cessation. A total of 888 infants were prenatally included. By the time of inclusion the mothers were 3-7 months pregnant. About 27 infants were excluded from the study and 18 dropped out. Of the remaining 843 infants 535 had a first-degree familial predisposition of asthma (high-risk group), whereas a reference group of 308 (162 boys) infants was not predisposed for asthma in the first-degree (low-risk group). To evaluate the (cost-)effectiveness of the preventive intervention, 222 (118 boys) infants of the high-risk group allocated to the intervention group and 221 (112 boys) allocated to a control group are followed up. The low-risk infants served as controls to evaluate the predictive value of high risk (first-degree familial predisposition of asthma). The infants are followed from the prenatal stage until they reach the age of 6 yr. The remaining 92 high-risk infants were included in an optimized randomized-clinical adherence trial (RCAT). Of these 92 infants, 45 (20 boys) were allocated to an intervention group and 47 (24 boys) to a control group. Until now all infants have been followed for at least 1 yr.     

The use of TeleMedicine in the treatment of paediatric obesity: feasibility and acceptability

To assess the feasibility of conducting empirically supported family-based paediatric obesity group treatment via TeleMedicine. Seventeen families were randomly assigned to one of two conditions (physician visit, TeleMedicine). Measures included feasibility, satisfaction and intervention outcome measures such as BMI percentile, and nutrition and activity behaviours. Measures were completed at baseline, post-treatment and at 1-year follow-up. Analyses indicate that both feasibility and satisfaction data regarding the TeleMedicine intervention were positive. Intervention outcome indicates no change in BMI percentile or nutrition and activity behaviours for either treatment group. A behavioural family-based weight loss intervention delivered via TeleMedicine was well received by both parents and providers. Due to the small sample size, null findings regarding intervention outcome should be interpreted with caution. Future research should focus on methods to increase the impact of this intervention on key outcome variables.     

Physical activity promotion and obesity prevention in Girl Scouts: Scouting Nutrition and Activity Program+

Background: A previous version of Scouting Nutrition and Activity Program (SNAP) resulted in greater physical activity (PA) during troop meetings, but no impact on girls' body mass index (BMI) or overall PA. The purpose of this study was to evaluate the effects of a 6‐month intervention that coupled the evidence‐based program SNAP with a channel of communication to parents using health report cards. Methods: Thirty‐two Girl Scouts (mean age = 9.5, SD = 1.4 years) received the SNAP+ intervention. Girls were measured before and after the intervention on body composition, BMI, and 7‐day step counts. Troop leaders were trained to implement an interactive obesity‐prevention curriculum. Parents received health report cards designed to provide personalized information about their daughters' PA and weight status. Results: The full sample of participants took more steps per day after the intervention (mean difference = 1741, P= 0.007). Results showed that lower values for body fat percentage (P= 0.620), BMI percentile (P= 0.100) and BMI z‐scores (P= 0.055) at intervention end were not statistically significant. In the subsample of girls at risk for overweight and obesity, there were lower values for BMI z‐score (P= 0.010), BMI percentile (P= 0.027), and body fat percentage (P= 0.053). Conclusions: From this preliminary study, the SNAP+ intervention appears to be effective for Scout‐based promotion of PA, and for the prevention of overweight and obesity in at‐risk Girl Scouts, but further evaluation through a fully powered randomized controlled trial is warranted.