In this series featuring information for patients and professionals taken from SIGN’s evidence based guidelines, we reproduce the key messages for patients and parents from SIGN guideline number 69, on management of obesity in children and young people.
These key messages are not intended for direct dissemination to patients, but are provided for possible use by clinicians in discussing treatment options with patients and their parents. They may be incorporated into local patient information materials.
- Obesity in children is becoming more common.
- Obesity is due to an imbalance between energy consumption and energy expenditure. Obese children do not have low energy needs. They have high energy needs to support their high body weight.
- 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.
- An obese child tends to become an obese adult.
- There is no evidence that any drug treatment is effective in treating obesity in children.
- Obesity in children may be prevented and treated by making lifestyle changes such as:
- increasing physical activity
- decreasing physical inactivity (e.g.TV watching) and
- encouraging a well balanced and healthy diet.
- Lifestyle change involves making small gradual changes to behaviour.
- Family support is necessary for treatment to succeed.
- Generally, the aim of treatment is to help children maintain their weight (so they can ‘grow into it’).
- A medical cause of obesity is more likely in the child who is obese and short for their age.
- Most children are not obese because of an underlying medical problem but as a result of their lifestyle.
Healthy eating advice for children
The guidance presented below is based upon the work of many experts (referenced in the guideline) and should be considered equivalent to grade D recommendations.
Birth to 5 years
Breast milk is the food of choice for newborn infants as it offers significant health benefits for babies, for example, reduced risk of repiratory, gastrointestinal, urinary tract and ear infections, allergy and asthma. Introduction of solid foods should be avoided until infants are at least four to six months of age. Weaning is best done gradually, starting with small amounts of pureed fruit or vegetables, or rice or other gluten free cereal.
From six months the range of foods offered should be gradually increased. To ensure children up to the age of two consume adequate energy for growth and development in relatively small volumes of food, full fat versions of dairy products are recommended and starchy foods very high in fibre should be avoided. From two years gradual introduction of low fat dairy products should be considered for children who are growing well and eating a varied diet, so that by the age of five most children are eating in accordance with the ‘Eating for Health’ plate model. Children from approximately one year would normally be expected to eat three meals a day and two between-meal snacks. Foods particularly high in fat and sugar are not necessary.
Further information on nutrition from birth to 5 years is available in HEBS paper Evidence into Action: Nutrition in the Under Fives (www.hebs.com/research/pd). This link was correct at the time of publication, but please check the SIGN website for updates.
Patient information leaflets about breastfeeding and weaning are available from the health promotion department of the local NHS Board and local paediatric dietetic department. Patient information leaflets are also available from the Paediatric Group of the British Dietetic Association, c/o 5th Floor, Charles House, 148/9 Great Charles Street Queensway, Birmingham B3 3HT.
Children over 5 years
The ‘Eating for Health’ plate model makes healthier eating easier to understand by showing the types and proportions of foods needed to make a well balanced and healthy diet. The patients, parents and health visitor or dietitian should discuss it.
This model applies to children over the age of 5 years, as well as to adults. It is recommended that foods eaten over a day be consumed in the relative proportions set out on the plate. In other words, approximately one third of a child’s intake by volume should comprise starchy carbohydrate foods, one third fruits and vegetables, with smaller amounts of foods from the meat, fish and alternatives group and low fat dairy products. Although not necessary for good health, fatty, sugary foods in small amounts can be part of a normal healthy diet. It is also important that fluid intake is adequate. Suitable drinks are water, low fat milk, very well diluted low calorie diluting juices and diluted fruit juice.
The following guidelines reflect the core elements of healthy eating and can be used to complement the ‘Eating for Health’ plate model:
- Eat regularly
- Include bread, pasta, cereals, rice or potatoes at every meal
- Eat some form of fruit and vegetables at each meal
- Limit foods high in sugar such as sweets and chocolate
- Limit foods high in fat such as crisps, chips and pastries
- Limit fried foods (including deep fried foods).
Advice on changing eating behaviours for children and their families
The way in which food is provided and used is also important. The following advice should be provided, as appropriate, according to existing behaviours of the child/family in question, and at the discretion of the individual health professional:
- Take plenty of exercise and limit time spent watching TV or playing computer games
- Provide meals and snacks at regular times; avoid grazing all day long
- Separate eating from other activities such as watching TV or doing schoolwork
- Offer healthy options but agree one to two treats a week
- Encourage the child to listen to internal hunger cues and to eat to appetite
- Instead of offering food as a reward to a child, try alternatives such as giving stickers, going to the cinema, a new book or toy, or having a friend to stay overnight
- Comfort with attention, listening and hugs instead of food
- Ask for help from friends and family in supporting behaviour changes
- Keep foods that the child should be avoiding out of the house
- Avoid classifying foods as good or bad
- The approach a parent takes to a child’s behaviour should always be consistent.
Further practical information for health professionals about healthy eating for children who are overweight or obese is available from the HEBS website: www.hebs.com/learningcentre/weightmanagement. Leaflets that have been produced by dietitians nationally are available from Scottish Nutrition and Diet Resources Initiative. For further information please contact Alison Horne, Project Manager, at Alison.Horne@gcal.ac.uk or visit the website at www.sndri.gcal.ac.uk.
Activity and inactivity levels are important. Children should be encouraged to be less inactive by restricting the amount of time spent on the telephone, watching TV and playing computer games to less than two hours per day.
Advice on increasing physical activity
Children should be encouraged to be more physically active and aim for an average of 30 minutes of physical activity per day.
This may include:
- Walking instead of taking the bus
- Using stairs instead of escalators or lifts
- Going for walks, visits to parks and playgrounds
- Swimming, cycling, rollerblading
- Team activities such as football, dancing, Brownies/Cubs and Guides/Scouts
- Attending PE lessons/outdoor education.
Reproduced from SIGN 69. Management of obesity in children and young people. Edinburgh: Scottish Intercollegiate Guidelines Network, 2003.