Treatment Strategies for Childhood Obesity

There has been a startling increase in rates of obesity and overweight in both adults and children in the past three decades. In high-income countries, some of the highest increases in childhood obesity prevalence have been in the United States, Australia and the United Kingdom.

Overweight and Obesity mean

According to the World Health Organisation (WHO), overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of their height in meters (kg/m2). The WHO definition is:

• a BMI greater than or equal to 25 and below 30 is defined as overweight
• a BMI greater than or equal to 30 is defined as obesity

This measure can be inaccurate for person's with high muscle to mass ratios, such as bodybuilders.

Health Risks of Being Overweight or Obese

Most of the health problems associated with obesity will become obvious in adulthood. Obese children in Australia have a 25 to 50% chance of becoming obese adults. This chance increases with an increasing degree of overweight and the later into adolescence the excess body weight is carried. It is also increased if one or both parents are overweight or obese. Potential health problems for obese children include:

• Type 2 diabetes – while this condition is most commonly seen in adults, it is now also being diagnosed in children
• Eating disorders such as bulimia or binge eating
• Orthopaedic disorders – problems with foot structure
• Liver problems, including fatty liver
• Respiratory disorders, such as blocked airways and restrictions in the chest wall, which cause breathlessness during exercise
• Sleep apnoea – this is a condition that causes difficulty breathing when sleeping. It also causes snoring, waking often and poor sleep. It makes people feel tired and contributes to poor concentration during the day
• Cardiomyopathy – a problem with the heart muscle, caused when extra effort is needed to pump blood.
• Stigmatisation, low self-esteem

Obesity can have a major impact on how children feel about themselves and how they interact with others. Obese adolescents are more likely to have low self-esteem, which may impact on other aspects of their lives, such as the development of friendships and competency at school.

Treating Overweight and Obesity

To address the worldwide problem of obesity, multiple contributing factors will need to be considered. Childhood obesity has been shown to be related to the amount of television viewing by children. Parental and societal controls of television viewing and childhood social networks, school educational programs, and governmental policies that take into account the physical and social environment will all be required to effect enduring change in the eating and activity behaviors of children and their families.

Screen time interventions

Childhood obesity has been positively associated with time spent watching TV. Hypothesised mechanisms for the relationship between screen time and weight include food and drink advertising, eating while watching TV, and displacement of physical activity. The Community Preventive Services Task Force recommends behavioral interventions to reduce recreational sedentary screen time among children aged 13 years and younger. The Community Preventive Services Task Force is an independent, nonfederal, unpaid panel of public health and prevention experts that was established in 1996 by the U.S. Department of Health and Human Services to identify population health interventions that are scientifically proven to save lives, increase lifespans, and improve quality of life.

The American Academy of Pediatrics recommends no more than 2 hours per day of screen time for children 2 years and older and none for children younger than 2 years. In the U.S., children aged 8-18 years report an average of 7 hours of screen time per day, of which 4.5 hours are spent watching TV content, that is, TV programs, DVDs, or movies, viewed on a TV, computer, cell phone, or other device. Children aged 5 years and younger spend an average of 2 hours per day with screen media (i.e. TV, DVDs, videos, video/computer games), of which approximately 1.5 hours are spent watching TV or videos. 

Behavioural interventions that aim to reduce recreational sedentary screen time teach behavioral self-management skills to initiate or maintain behavior change. Behavioral screen time interventions are classified into two types:

1. Screen-time-only interventions only focus on reducing recreational sedentary screen time.

2. Screen-time-plus interventions focus on reducing recreational sedentary screen time and increasing physical activity and/or improving diet.

Availability of electronic monitoring devices for various digital media has increased in recent years. For example, parents can limit screen time through low-cost apps that can be installed on mobile devices, and some cable providers and e-readers offer time controls. Evidence indicates that behavioral screen time interventions are effective in reducing recreational sedentary screen time, improving physical activity, improving diet, and improving or maintaining weight status. These interventions reduce obesity prevalence.

Physical and social environment perspectives

Any successful approach to addressing the overall burden of obesity must not rely solely on the healthcare system, but must include the implementation of policies that take into account the physical and social environment to change the eating and activity behaviors of children and their families. Examples of such policy efforts include the attempts to ban food marketing to children and to increase access to safe and appealing venues for exercise.

Much of the following information is taken from the American Heart Association’s Scientific Statement on obesity.

Social networks

Research shows strong associations between participation in social networks and preventive health behavior. Obesity-related health behaviours are also associated with adolescent social networks, including participation in organised sports, fast food consumption, and computer/video game screen time. Social networks therefore may be critical in shaping young people’s eating behaviours and body weight and vice versa, and their role suggests the potential of social network–based health promotion interventions. Research underscores strong associations between participation in social networks and preventive health behaviours. The association between social networks and participation in structured physical activity suggests that there is opportunity to develop school-based interventions within physical education classes to target obesity. 

The Chefs Move to Schools initiative within First Lady Michelle Obama’s "Let’s Move" campaign encourages chefs to partner with schools to support the creation of healthy, affordable meals and to educate children on healthy cooking and eating.

Future interventions could be based on the development of social networks purposefully developed to address obesity. In fact, this is the basis of the Weight Watchers program.

Another example is the Weigh2Rock program, which offers online health and weight loss education; an online support community of several thousand overweight kids, teens, and parents; and self-managed personal weight loss charts and goal setting, which may be viewed by a child’s healthcare provider.

Internet-based programs

Internet-based programs and other electronic technologies have been used in both the treatment and prevention of overweight and obesity in youth. Benefits of the form of these interactive electronic interventions include their widespread availability in the school and home, popularity among youth, ability to engage and immerse participants.

Social media: e-mail and texting interventions

Several studies have demonstrated the benefit of e-mail and texting interventions on weight loss in adolescents.

The ‘built environment’

The term built environment refers to the human-made surroundings that provide the setting for human activity, ranging in scale from buildings and parks or green space to neighbourhoods and cities. The built environment may modify the extent to which social networks affect childhood obesity. Features of the built environment such as unfavourable community design and poor transportation infrastructure are associated with decreased energy expenditure.

Improvements in the built environment include improving the condition of school fields, making them available for use outside of school hours, ensuring safe access, and providing supervision support the formation of social networks and involvement in structured physical activity both during and after school.

Policy interventions

To turn around the overwhelming trend of increasing childhood overweight and obesity will require actions at all levels of society including changes in governmental policy (e.g. shifting agricultural polices to incorporate health outcomes, banning unhealthy food marketing to children, healthy public sector food service policies), but some could be food industry policies (e.g. moving product formulation towards healthier compositions, self-regulation of marketing to children). The economic priorities and policies that promote consumption-based growth, and the regulatory policies that promote market and trade liberalisation have produced many benefits but are now increasingly regarded as contributing to the global crises of overconsumption in general. Obesity is but one of these crises. Some governments are making promising moves to combat obesity. For example, in the mid to late 2000s, England developed a series of initiatives such as the Foresight report, and restrictions on unhealthy food marketing to children.  Some other countries, notably Brazil, have made substantial steps in national monitoring programs, restricting marketing to children, and improving school food.

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