- Obesity in children is becoming more common
- Obesity is a health concern in itself and also increases the risk of other serious health problems such as high blood pressure, diabetes and psychological distress
- The body mass index percentile should be used to identify childhood obesity
BMI = weight in kilograms/height in metres2
- Obese children have a BMI >=98th centile of the UK 1990 reference charts for age and sex*
- Overweight children have a BMI >=91st centile of the UK 1990 reference charts for age and sex*
- In most obese children, weight maintenance is an acceptable goal
* Recommended for clinical and epidemiological practice in the UK (available in the guideline)
A busy surgery is not the best place to raise difficult and complex medical issues, especially if they do not relate to the problem with which the patient has presented. Obesity in general, and in children especially, must come near the top of my list of things not to discuss on a hectic Monday morning, unless I am absolutely forced to.
Increasingly, however, GPs are being challenged to become much more proactive with regard to health promotion. We’re all familiar with the concept of seeking out and addressing risk factors for cardiovascular and respiratory conditions. Perhaps we should, where we can, offer advice in other important health fields.
The publication in April of the SIGN guideline Management of Obesity in Children and Young People offers advice on addressing this important problem and recommends effective interventions. The guideline recognises that advice and intervention in children can pay dividends in reducing obesity and ensuring better health in adulthood. Given the increasing incidence of childhood obesity – currently 17% of 15 year olds are obese – perhaps we ignore the issue at our children’s peril.
Until now, it has been difficult for GPs to identify children with true obesity. GP computer software and most printed material on the subject fails to interpret body mass index in a meaningful way. The SIGN guideline identifies age-related BMI centiles as tools to define childhood obesity. A child at or above the 91st centile is regarded as overweight and any child at or above the 98th centile is considered obese.
Now all we need to do is to make sure that a member of the primary care team – not necessarily the GP – measures and charts any child whose weight is giving rise to concern.
Once a problem has been identified, a major obstacle will be to get the child and his or her family to accept that weight is an issue. The guideline points out that without a commitment treatment is fruitless. In such a situation, the GP’s role might be limited to pointing out the problem, offering monitoring and indicating that advice is available if and when they want it.
For those families who do want to deal with their child’s obesity, weight maintenance is generally all that is required. The child’s normal growth will ensure that the BMI centile falls over time. To achieve this, the guideline identifies some key strategies: an increase in activity through lifestyle changes and exercise, healthier eating, and less sedentary behaviour (see Figure 1, below).
|Figure 1: Pages 2 and 3 of the quick reference guide|
However, I wonder if the GP is the best person to deliver these messages? Dieticians, health visitors and school nurses are often better placed to communicate them to families and to provide ongoing support and BMI centile monitoring.
The GP, however, does have a role in managing children who are very obese (BMI centile of 99.6 or above) or obese children who are short for their age. With these children, medical pathology needs to be excluded, and referral to a specialist is advised.
The guideline is useful, especially with respect to identifying diagnostic tools and referral criteria. Management will be familiar to most GPs who will be keen to involve the wider primary care team.
Childhood obesity is a major public health issue and any significant benefits are unlikely to be achieved by a clinical guideline alone. Instead, there must be fundamental changes in the way we bring up our children.
SIGN 69: Management of obesity in children and young people can be downloaded free of charge from the SIGN website: www.sign.ac.uk