Childhood obesity is becoming much more common. The most recent Health Survey for England found that 22-31% of 6 to 15 year olds were overweight and 10-17% were obese.1 SIGN has recently published a guideline on the management of obesity in children,2 which emphasises diet and exercise as the main areas for lifestyle change.
I do not disagree with any of the advice given in the guideline, but would sound a note of caution. I am not sure that we can offer to ‘manage’ any but the few cases with an underlying medical disorder. Obese patients often find it hard to accept that their problem is caused by lifestyle, and medicalising it can be a way of making the doctor, not the patient, responsible for failure to improve. There is no validated intervention for obesity caused by lifestyle, and this is reflected in the grades of recommendation (all Cs and Ds) in the guideline.
Health advice is helpful, but the implications for society are much broader. Children, and adults, are being encouraged to eat more. Standard-size portions are a thing of the past; a sandwich ‘meal deal’ comes with crisps and a sweetened drink; and chocolate bars often have 25% extra free. In the burger bar, ‘going large’ doubles calorie intake for a few pence. The importance of exercise, meanwhile, has been undermined. Children no longer walk or cycle to school because of the perceived dangers from road traffic and paedophiles. The loss of playing fields has reduced the opportunities for school sports. Many children now spend more time playing virtual sports on a computer than with a real ball.
Medical advice is competing with powerful commercial and social pressures. This should not stop us advising obese patients, but we should be careful not to become responsible for a problem we cannot control. Doctors should lobby for an end to aggressive marketing of fast food, especially to young people, and for education to encourage children to eat healthily and exercise regularly, for example the British Dietetic Association’s current campaign, ‘Eat 2b Fit’. We should use the SIGN guideline as a jumping off point for more initiatives of this type.
Dr Matthew Lockyer, GP, Suffolk
- Prescott-Clark P. Health Survey for England 1995. London: The Stationery Office, 1997.
- Scottish Intercollegiate Guidelines Network. SIGN 69: Management of obesity in children and young people. Edinburgh: SIGN, April 2003.