Childhood ObesityChildhood Obesity

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Introduction.Introduction. What is Overweight & Obesity?What is Overweight & Obesity? Childhood obesity is one of the most serious Childhood obesity is one of the most serious

public health challenges of the 21st century. public health challenges of the 21st century. The problem is global and is steadily affecting The problem is global and is steadily affecting many low- and middle-income countries, many low- and middle-income countries, particularly in urban settings. The prevalence particularly in urban settings. The prevalence has increased at an alarming rate. In 2007, has increased at an alarming rate. In 2007, an estimated 22 million children under the an estimated 22 million children under the age of 5 years were overweight throughout age of 5 years were overweight throughout the world. More than 75% of overweight and the world. More than 75% of overweight and obese children live in low- and middle-income obese children live in low- and middle-income countries. countries.

Causes?Causes? The fundamental causes behind the rising The fundamental causes behind the rising

levels of childhood obesity are a shift in diet levels of childhood obesity are a shift in diet towards increased intake of energy-dense towards increased intake of energy-dense foods that are high in fat and sugars but low foods that are high in fat and sugars but low in vitamins, minerals and other healthy in vitamins, minerals and other healthy micronutrients, and a trend towards micronutrients, and a trend towards decreased levels of physical activity. decreased levels of physical activity. Medical Medical research carried out to help determine the research carried out to help determine the genetic cause of obesity is yet a relatively genetic cause of obesity is yet a relatively new field of research however a medical new field of research however a medical research by Loos, research by Loos, et al,et al, (2003) (2003)

Consequences?Consequences? Overweight and obese children are likely to Overweight and obese children are likely to

stay obese into adulthood and more likely to stay obese into adulthood and more likely to develop noncommunicable diseases like develop noncommunicable diseases like diabetes and cardiovascular diseases at a diabetes and cardiovascular diseases at a younger age. Overweight and obesity, as well younger age. Overweight and obesity, as well as their related diseases, are largely as their related diseases, are largely preventable. Prevention of childhood obesity preventable. Prevention of childhood obesity therefore needs high priority. therefore needs high priority.

World Health Organization (2009).World Health Organization (2009).

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Recent Trends.Recent Trends.

Prevalence within different nations, Prevalence within different nations, socio-economic, cultural, gender issues, socio-economic, cultural, gender issues, ……

Back this up with graphs and statistics. Back this up with graphs and statistics. (last 20 year developments)(last 20 year developments)

Hypotheses involved in assessing Hypotheses involved in assessing childhood obesity (set-point / fat cell childhood obesity (set-point / fat cell theory)theory)

Somatotypes.Somatotypes.

UK StatisticsUK Statistics: : In 2006, 16% of children aged 2 to 15 were classed as obese. This represents an overall increase from 11% in 1995. Despite the overall increase since 1995, the proportion of girls aged 2 to 15 who were obese decreased between 2005 and 2006, from 18% to 15%. There was no significant decrease among boys aged 2 to 15 over that period. Among children aged 2 to 10, 15% were classed as obese in 2006.

• Boys were more likely than girls to be obese (17% compared to 15%). Which is not a common finding

• Of children aged 8 to 15 who were classed as obese, two thirds (66%) of girls and 60% of boys thought that they were too heavy. (NHS, 2006)

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National Statistics.National Statistics.

In 2006, boys were more likely than girls to meet the recommended levels of physical activity with 70% of boys and 59% of girls reporting taking part in 60 minutes or more of physical activity on all 7 days in the previous week.

• During 2006/07, 86% of pupils took part in at least two hours of high quality PE and sport a week, a gradual increase since 2003/04 when the figure was 62%.

(HSE, 2006) Summary

Increasing obesity from 1995-2006 whilst overweight has remained similar. (2006 3/10 children obese or obese)

Girls in the lowest income quintile were two and half times more likely to obese than high income counterparts.

Children in households where the reference person had a semi-routine or routine occupations were nearly twice as likely to be obese compared with those in managerial and professional households.

Girls living in overweight or obese households more likely to be overweight or obese. Parental BMI does not correlate as well with boys.

Scotland found a higher rate of obesity among boys than in England, little difference found in girls.

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National Statistics (2).National Statistics (2).

Boys were more likely than girls to meet the recommended levels of physical activity. Participation levels amongst boys remained broadly consistent with age while for girls participation generally decreased with age.

Information on participation rates showed that for boys active play (biking, football, running etc) was the most common reported activity, whilst for girls walking was the most common activity.

Parental physical activity levels were associated with children’s physical activity levels.

Seven in ten pupils achieved at least 2 hours of physical activity a week as part of their curriculum. Those in years 10 and 11 were the least likely to participate in 2 hours of PE as part of the curriculum.

(HSE, 2006)

These findings correlate well with other findings such as the National Statistics Survey (2005). Again using the UK National BMI percentile classification. Which is based upon six countries averaged data The limitations of the international definitions, due to averaging data from different countries and the choice of reference age, need to be known. The UK cut-off points here presented are compatible with the current UK reference curves.

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UK BMI Table for Children.

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Socio-demographics Socio-demographics

www.dh.gov.uk (2009)

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Across the Globe.Across the Globe.

(BBC, 2009)

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Main Body.Main Body. What is overweight & obesity?What is overweight & obesity?- Overweight and obesity are defined as ''abnormal or excessive fat accumulation that presents a risk to health''.Overweight and obesity are defined as ''abnormal or excessive fat accumulation that presents a risk to health''.- Children aged 0 -5 years. (WHO Child Growth Standards)Children aged 0 -5 years. (WHO Child Growth Standards)- WHO Multicentre Growth Reference Study (MGRS) – developed 1997-2003. (The MGRS collected primary growth data and related WHO Multicentre Growth Reference Study (MGRS) – developed 1997-2003. (The MGRS collected primary growth data and related

information from approximately 8500 children from widely different ethnic backgrounds and cultural settings (Brazil, Ghana, India, information from approximately 8500 children from widely different ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman and the USA). Norway, Oman and the USA).

- How can this be quantified? How can this be quantified? - :: Length/height-for-age

:: Weight-for-age :: Weight-for-length :: Weight-for-height :: Body mass index-for-age (BMI-for-age) :: Head circumference-for-age :: Arm circumference-for-age :: Sub scapular skinfold-for-age :: Triceps skinfold-for-age :: Motor development milestones

5 – 19 years. (Growth Reference Data).5 – 19 years. (Growth Reference Data). MethodsMethods Data from the 1977 National Centre for Health Statistics (NCHS)/WHO growth reference (1–24 years) were merged with data from the Data from the 1977 National Centre for Health Statistics (NCHS)/WHO growth reference (1–24 years) were merged with data from the

under-fives growth standards’ cross-sectional sample (18–71 months) to smooth the transition between the two samples. State-of-the-under-fives growth standards’ cross-sectional sample (18–71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0–5 years), i.e. the Box-Cox power exponential (BCPE) art statistical methods used to construct the WHO Child Growth Standards (0–5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample.method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample.

FindingsFindings The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age

across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²).obesity (> 30.0 kg/m²).

ConclusionConclusion The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for

overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group.group.

The links below provide access to the reference charts and tables by indicator:The links below provide access to the reference charts and tables by indicator: :::: BMI-for-age (5-19 years)

:::: Height-for-age (5-19 years)

:::: Weight-for-age (5-10 years)

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Main Body (2).Main Body (2). The WHO Child Growth Standards provide a technically robust tool for assessing the well-being ofinfants and young children. They were derived from children who were raised in environments thatminimized constraints to growth such as poor diets and infection. In addition, their mothers followedhealthy practices such as breastfeeding their children and not smoking during and after pregnancy. Thestandards depict normal early childhood growth under optimal environmental conditions and can beused to assess children everywhere, regardless of ethnicity, socioeconomic status and type of feeding.Replacing the NCHS/WHO growth reference, which is based on children from a single country, withone based on an international group of children recognizes the fact that children the world over growsimilarly when their health and care needs are met. In the same way, linking physical growth to motordevelopment underscores the importance of looking at child development comprehensively. Together,three new elements — a prescriptive approach that moves beyond the development of growthreferences towards a standard, inclusion of children from around the world, and links between physicalgrowth and motor development — provide a solid instrument for helping to meet the health andnutritional needs of the world’s children.

Current UK Policy – Early years, healthy start, sure start, and other school based initiatives.

Policy Priorities – (For George).

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Main Body (4).Main Body (4). Why does it matter?Why does it matter? cardiovascular diseases (mainly heart disease and stroke); cardiovascular diseases (mainly heart disease and stroke); diabetes; diabetes; musculoskeletal disorders, especially osteoarthritis; and musculoskeletal disorders, especially osteoarthritis; and certain types of cancer (endometrial, breast and colon). certain types of cancer (endometrial, breast and colon). These include problems with the joints and bones (such as slipped femoral These include problems with the joints and bones (such as slipped femoral

epiphysis and bow legs), a condition called benign intracranial hypertension epiphysis and bow legs), a condition called benign intracranial hypertension that produces headaches and affects vision, hypoventilation (leading to that produces headaches and affects vision, hypoventilation (leading to drowsiness during the day, snoring and even drowsiness during the day, snoring and even heart failure), gall bladder ), gall bladder disease, disease, polycystic ovary syndrome, high blood pressure, high levels of blood , high blood pressure, high levels of blood fats and fats and diabetes. .

There are also marked psychological effects leading to low self-esteem.There are also marked psychological effects leading to low self-esteem. At least 2.6 million people each year die as a result of being At least 2.6 million people each year die as a result of being

overweight or obeseoverweight or obese. .

What are the causes?What are the causes? A global A global shift in diet towards increased intake of energy-dense foods that are towards increased intake of energy-dense foods that are

high in fat and sugars but low in vitamins, minerals and other healthy high in fat and sugars but low in vitamins, minerals and other healthy micronutrients; micronutrients;

A trend towards A trend towards decreased physical activity levels due to the increasingly due to the increasingly sedentary nature of many forms of recreation time, changing modes of sedentary nature of many forms of recreation time, changing modes of transportation, and increasing urbanization. transportation, and increasing urbanization.

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Main Body Main Body (Consequences).(Consequences).

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Main Body (3).Main Body (3). The concept of energy balance? The concept of energy balance?

Energy Intake (Nutritional) - Fat, Energy Intake (Nutritional) - Fat, G.I., Sugar & sugar sweetened soft G.I., Sugar & sugar sweetened soft drinks, energy density & satiety, drinks, energy density & satiety, and ‘fast’ food & portion size. and ‘fast’ food & portion size. (Comparison of French, (Comparison of French, Mediterranean, & Italian diets).Mediterranean, & Italian diets).

Energy Output (Physical) – School Energy Output (Physical) – School Sport, Walking to school, Cycling Sport, Walking to school, Cycling to school, sedentary pastimes, to school, sedentary pastimes,

This is the factor that we are This is the factor that we are concerned with today. Healthy concerned with today. Healthy eating is of the utmost importance eating is of the utmost importance but only half the equation.but only half the equation.

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Main Body (…)Main Body (…) Exercise Prescription for obese children – Exercise Prescription for obese children – (AHA / American Academy of Paediatrics – 60 minutes of vigorous-moderate (AHA / American Academy of Paediatrics – 60 minutes of vigorous-moderate

activity each day).activity each day). 65%-80% of MHR. 65%-80% of MHR. Family influence is significant in making adequate long term adherence factors.Family influence is significant in making adequate long term adherence factors. Encourage him/her to walk to school or the shops, rather than always going by Encourage him/her to walk to school or the shops, rather than always going by

car or bus. car or bus. Try to get the whole family involved in activities such as bike rides and swimming. Try to get the whole family involved in activities such as bike rides and swimming.

You could suggest going to the park for a game of football, cricket or Frisbee. You could suggest going to the park for a game of football, cricket or Frisbee. Visit a local leisure centre to investigate sports and team activities your child Visit a local leisure centre to investigate sports and team activities your child

could get involved in. Guides and Scouts are a good way to get your child could get involved in. Guides and Scouts are a good way to get your child involved in group activities and exercise. involved in group activities and exercise.

Make exercise into a treat by taking special trips to an adventure play park or an Make exercise into a treat by taking special trips to an adventure play park or an ice skating rink, for example. ice skating rink, for example.

Encourage active playtime activities such as dancing or skipping. Encourage active playtime activities such as dancing or skipping. Physically inactive pastimes, such as watching television or playing computer Physically inactive pastimes, such as watching television or playing computer

games, should be limited to less than two hours a day. Encourage your child to be games, should be limited to less than two hours a day. Encourage your child to be selective about what he/she watches to reduce the amount of time spent selective about what he/she watches to reduce the amount of time spent watching television.watching television.

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Main Body – Types of Main Body – Types of Exercise.Exercise. Cardio vs. Resistance – Cardio vs. Resistance –

Resistance training has been Resistance training has been found by Research Digest (2007; found by Research Digest (2007; Sothern Sothern et al.,et al.,1999) to be a 1999) to be a viable method of training to viable method of training to improve health, fitness and QoL. improve health, fitness and QoL. (Long term research is (Long term research is necessary) – Consider Table 2.necessary) – Consider Table 2.

A review by Sports Medicine A review by Sports Medicine author Watts et al., (2005) found author Watts et al., (2005) found that vascular improvements that vascular improvements outweighed direct weight loss. outweighed direct weight loss. Also that the preservation of Also that the preservation of lean body mass is crucial as it lean body mass is crucial as it accounts for 80% of RMR. accounts for 80% of RMR. (Improvements in endothelial (Improvements in endothelial function > decreases function > decreases atherosclerosis). Increased atherosclerosis). Increased insulin sensitivity (Nassis insulin sensitivity (Nassis et alet al., ., 2005).2005).

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Main Body – Types of Main Body – Types of Exercise (2).Exercise (2).

Key points on exercise – adherence, consistency, and FUN.Key points on exercise – adherence, consistency, and FUN. Less focus upon on mode of exercise & intensity.Less focus upon on mode of exercise & intensity. Maintaining weight loss is the challenge.Maintaining weight loss is the challenge. Any activity is good.Any activity is good. Aim for children is FUN and enjoyment.Aim for children is FUN and enjoyment. Aiming to monitor activity is a difficult process, direct observation is generally the Aiming to monitor activity is a difficult process, direct observation is generally the

best method according to a review by Sirard & Pate (2001), but can be difficult best method according to a review by Sirard & Pate (2001), but can be difficult across long periods so accelerometers are a promising alternative. across long periods so accelerometers are a promising alternative.

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Main Body (Critical Main Body (Critical Analysis).Analysis).

So is exercise enough? The general consensus is no, take for example the concept of energy So is exercise enough? The general consensus is no, take for example the concept of energy balance – Deckelbaum & Williams, (2001). Wrote that in an average 165 kg (75 lb) child balance – Deckelbaum & Williams, (2001). Wrote that in an average 165 kg (75 lb) child expenditure equalled, 90, 525, 135, & 180 for bicycling, running, walking & dancing respectively, expenditure equalled, 90, 525, 135, & 180 for bicycling, running, walking & dancing respectively, and that a regular McDonalds meal equated to ~600 calories and super sized meals ~1800 and that a regular McDonalds meal equated to ~600 calories and super sized meals ~1800 calories. These numbers show that to cover these requirements would take a significant proportion calories. These numbers show that to cover these requirements would take a significant proportion of time to achieve a balance.of time to achieve a balance.

The necessary requirement is to prevent within the early stages of development, Denghan The necessary requirement is to prevent within the early stages of development, Denghan et al.,et al., (2005) recommendations are adequate but how realistic? (2005) recommendations are adequate but how realistic? Some interventions strategies that could be Some interventions strategies that could be considered for prevention of childhood obesity considered for prevention of childhood obesity I. Built environmentI. Built environment     1. Walking network     1. Walking network          a. Footpaths (designated safe walking path)          a. Footpaths (designated safe walking path)          b. Trails (increasing safety in trails)          b. Trails (increasing safety in trails)     2. The cycling network     2. The cycling network          a. Roads (designated cycling routes)          a. Roads (designated cycling routes)          b. Cycle paths          b. Cycle paths     3. Public open spaces (parks)     3. Public open spaces (parks)     4. Recreation facilities (providing safe and inexpensive recreation centers)     4. Recreation facilities (providing safe and inexpensive recreation centers)

II. Physical activityII. Physical activity     1. Increasing sports participation     1. Increasing sports participation     2. Improving and increasing physical education time     2. Improving and increasing physical education time     3. Use school report cards to make the parents aware of their children's weight problem     3. Use school report cards to make the parents aware of their children's weight problem     4. Enhancing active modes of transport to and from school     4. Enhancing active modes of transport to and from school          a. Walking e.g. walking bus          a. Walking e.g. walking bus          b. Cycling          b. Cycling          c. Public transport          c. Public transportIII. TV watchingIII. TV watching     1. Restricting television viewing     1. Restricting television viewing     2. Reducing eating in front of the television     2. Reducing eating in front of the television     3. Ban or restriction on television advertising to children     3. Ban or restriction on television advertising to children

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Main Body (Critical Main Body (Critical Analysis) (2).Analysis) (2). Studies on decreased sedentary behaviours as an adjunct within treatment have shown great Studies on decreased sedentary behaviours as an adjunct within treatment have shown great

promise (Epstein promise (Epstein et al.,et al., 2000). A 2 year study offered increased aerobic fitness, and lowered % 2000). A 2 year study offered increased aerobic fitness, and lowered % body fat.body fat.

School based interventions are an excellent way of aiding treatment as children spend a huge % School based interventions are an excellent way of aiding treatment as children spend a huge % of time in the taught environment. Conflicting evidence from OFSTED reports claim partnerships of time in the taught environment. Conflicting evidence from OFSTED reports claim partnerships schools are raising the standard (TeacherNet, 2009) with schools meeting targets at faster rates schools are raising the standard (TeacherNet, 2009) with schools meeting targets at faster rates than expected with the 5 hours per day target in 2010 coming ever closer. So can it be sustained than expected with the 5 hours per day target in 2010 coming ever closer. So can it be sustained or are misreporting of data effecting these outcomes according to opposition party (Lib Dems, or are misreporting of data effecting these outcomes according to opposition party (Lib Dems, 2009). 2009).

Targeting younger children has been shown to be more effective long term results in preventing Targeting younger children has been shown to be more effective long term results in preventing weight gain as weight loss is more difficult with adolescents, due to eating patterns and P.A weight gain as weight loss is more difficult with adolescents, due to eating patterns and P.A behaviour becoming more difficult to change as age progresses (Carter, 2002). behaviour becoming more difficult to change as age progresses (Carter, 2002).

Active Commuting to School initiatives.Active Commuting to School initiatives. Fat consumption has decreased over the last decade, but still obesity is rising, pre-disposition Fat consumption has decreased over the last decade, but still obesity is rising, pre-disposition

through genetics is inherent which causes a cycle of juvenile obesity with accompanying low PA through genetics is inherent which causes a cycle of juvenile obesity with accompanying low PA levels. levels.

We can learn from studies across the Atlantic a representative sample of Canadian children We can learn from studies across the Atlantic a representative sample of Canadian children (n=7216), Tremblay & Willms, (2003) studied the links between P.A., obesity & overweight & (n=7216), Tremblay & Willms, (2003) studied the links between P.A., obesity & overweight & sedentary behaviours with SES, and family backgrounds. It positively identified low SES and sedentary behaviours with SES, and family backgrounds. It positively identified low SES and single parent families, along with sedentary behaviours. Contrary to this Wang (2001) found that single parent families, along with sedentary behaviours. Contrary to this Wang (2001) found that it varies internationally.it varies internationally.

Consensus is drawn to parent and school initiatives, with children & schools in low income areas Consensus is drawn to parent and school initiatives, with children & schools in low income areas receiving priority to reduce socioeconomic inequalities in health (Veugelers & Fitzgerald, 2005)receiving priority to reduce socioeconomic inequalities in health (Veugelers & Fitzgerald, 2005)

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Future Research.Future Research.

What can be done? Action & Prevention. (Change 4 Life, NHS 2009)What can be done? Action & Prevention. (Change 4 Life, NHS 2009) Overweight and obesity, as well as related noncommunicable Overweight and obesity, as well as related noncommunicable

diseases, are largely diseases, are largely preventablepreventable. . It is recognized that prevention is the most feasible option for It is recognized that prevention is the most feasible option for

curbing the childhood obesity epidemic since current treatment curbing the childhood obesity epidemic since current treatment practices are largely aimed at bringing the problem under control practices are largely aimed at bringing the problem under control rather than effecting a cure. The goal in fighting the childhood rather than effecting a cure. The goal in fighting the childhood obesity epidemic is to achieve an energy balance which can be obesity epidemic is to achieve an energy balance which can be maintained throughout the individual's life-span. maintained throughout the individual's life-span.

increase consumption of fruit and vegetables, as well as legumes, increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts; whole grains and nuts;

limit energy intake from total fats and shift fat consumption away limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats; from saturated fats to unsaturated fats;

limit the intake of sugars; and limit the intake of sugars; and be physically active - be physically active - at least 60 minutes at least 60 minutes of regular, moderate- to of regular, moderate- to

vigorous-intensity each day that is developmentally appropriate and vigorous-intensity each day that is developmentally appropriate and involves a variety of activities. More activity may be required for involves a variety of activities. More activity may be required for weight control. weight control.

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Future Research (2).Future Research (2).

Maintaining a healthy weightMaintaining a healthy weight In most cases, experts recommend that overweight children should not be In most cases, experts recommend that overweight children should not be

encouraged to actually lose weight. Instead they should be encouraged to encouraged to actually lose weight. Instead they should be encouraged to maintain their weight, so that they gradually "grow into it" as they get taller.maintain their weight, so that they gradually "grow into it" as they get taller.

Children should never be put on a weight loss diet without medical advice as Children should never be put on a weight loss diet without medical advice as this can affect their growth. Unregulated dieting - particularly in teenage girls this can affect their growth. Unregulated dieting - particularly in teenage girls - is thought to lead to the development of eating disorders. - is thought to lead to the development of eating disorders.

There isn't much evidence for the best ways to treat weight problems in There isn't much evidence for the best ways to treat weight problems in children, but research indicates that focusing on making long-term children, but research indicates that focusing on making long-term improvements to diet and increasing physical activity may be the effective improvements to diet and increasing physical activity may be the effective solution.solution.

Helping children to achieve and maintain a healthy weight involves a Helping children to achieve and maintain a healthy weight involves a threefold approach that encourages them to:threefold approach that encourages them to:

eat a healthy, well-balanced diet eat a healthy, well-balanced diet make changes to eating habits make changes to eating habits increase physical activity - in 2004 the Chief Medical Officer recommended at increase physical activity - in 2004 the Chief Medical Officer recommended at

least 60 minutes of at least moderate physical activity a day for children least 60 minutes of at least moderate physical activity a day for children The good news is that it is probably easier to change a child's eating and The good news is that it is probably easier to change a child's eating and

exercise habits than it is to change an adult's.exercise habits than it is to change an adult's. ((www.bupa.co.uk, ,

2009)2009)

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Conclusion.Conclusion.

Role of Parents

Role of Schools

Role of Member States

Role of WHO

Role of Civil Society and NGOs

Role of the Private Sector

‘interventions at the family or school level will need to be matched by changesin the social and cultural context so that the benefits can be sustained and

enhanced.Such prevention strategies will require a coordinated effort between the medicalcommunity, health administrators, teachers, parents, food producers and

processors,retailers and caterers, advertisers and the media, recreation and sport planners,

urbanarchitects, city planners, politicians and legislators’. (BMA, 2009)

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Conclusion (2).Conclusion (2).

HomeHome Set aside time for Set aside time for Healthy mealsHealthy meals Physical activityPhysical activity Limit television viewingLimit television viewing School School Fund mandatory physical education Fund mandatory physical education Establish stricter standards for school lunch programmesEstablish stricter standards for school lunch programmes Eliminate unhealthy foods—e.g., soft drinks and candy from vending Eliminate unhealthy foods—e.g., soft drinks and candy from vending

machines machines Provide healthy snacks through concession stands and vending Provide healthy snacks through concession stands and vending

machinesmachines Urban designUrban design Protect open spaces Protect open spaces Build pavements (sidewalks), bike paths, parks, playgrounds, and Build pavements (sidewalks), bike paths, parks, playgrounds, and pedestrian zonespedestrian zones Health careHealth care Improve insurance coverage for effective obesity treatment Improve insurance coverage for effective obesity treatment Marketing and mediaMarketing and media Consider a tax on fast food and soft drinks Consider a tax on fast food and soft drinks Subsidise nutritious foods—e.g., fruits and vegetablesSubsidise nutritious foods—e.g., fruits and vegetables Require nutrition labels on fast-food packagingRequire nutrition labels on fast-food packaging Prohibit food advertisement and marketing directed at childrenProhibit food advertisement and marketing directed at children Increase funding for public-health campaigns for obesity preventionIncrease funding for public-health campaigns for obesity prevention Politics Politics Regulate political contributions from the food industry Regulate political contributions from the food industry

(Ebbeling et al., 2002)

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Reference List.Reference List.

Baird, J., Fisher, D., Lucas, P., Kleijnen, J., Roberts, H., and Law, C. (2005). Being big Baird, J., Fisher, D., Lucas, P., Kleijnen, J., Roberts, H., and Law, C. (2005). Being big or growing fast: systematic review of size and growth in infancy and later obesity or growing fast: systematic review of size and growth in infancy and later obesity

Cole, T.J., Bellizzi, M.C., Flegal, K.M., & Dietz, W.H. (2000). Establishing a standard Cole, T.J., Bellizzi, M.C., Flegal, K.M., & Dietz, W.H. (2000). Establishing a standard definition for child overweight and obesity worldwide: international survey. definition for child overweight and obesity worldwide: international survey. British British Medical Journal. Medical Journal. 320, 320, 1240.1240.

Deckelbaum, R.J., & Williams, C.L. (2001). Deckelbaum, R.J., & Williams, C.L. (2001). Childhood Obesity: The Health Issue. Childhood Obesity: The Health Issue. Obesity Research.Obesity Research. 99, s239–S243 , s239–S243

Ebbeling, C.B., Pawlak, D.B., & Ludwig, D.S. (2002). Ebbeling, C.B., Pawlak, D.B., & Ludwig, D.S. (2002). Childhood obesity: public-Childhood obesity: public-health crisis, common sense cure. health crisis, common sense cure. The Lancet. 360, 473-482.

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