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202 7.2 Childhood Obesity
Many toddlers and young children spend a lot of
time being babysat by a TV/DVD/video when
parents are busy doing chores.
Getting enough sleep
Several studies have reported an association
between inadequate sleep and obesity (Chaput
et al. 2011). The mechanism by which less sleep
might affect growth and predispose young children
towards obesity is not clear but it may be via
hormonal influences on growth.
Changing lifestyles in families with
children at risk of obesity
Initiatives to improve lifestyles in families at risk of for investigation.
obesity need to be undertaken sensitively and should
involve support for parents to improve their parenting
skills. Preschool children learn by copying, so parents
need to adopt healthy lifestyle patterns themselves.
Home visits during pregnancy and infancy may be a
time when parents are receptive to advice on healthy
eating for young children (Bull et al. 2004).
Changing eating habits is usually difficult but
particularly so for parents who:
●● do not understand the principles of healthy
eating
●● do not have the cooking skills necessary to
prepare simple home-cooked food and instead
rely on convenience foods which are usually
higher in energy, fat, sugar and salt
●● do not have set mealtimes either as a family or
for their children so that frequent snacking
forms part of their eating pattern.
Childcare settings
NICE guidance (2006) recommends that all
nurseries and childcare facilities should:
●● minimize sedentary activities during play time,
and provide regular opportunities for enjoyable
active play and structured physical activity sessions the issue. Parents could be asked how they feel
●● implement Government guidance on food
procurement and healthy catering
●● ensure that children eat regular, healthy meals
in a pleasant, sociable environment free from
other distractions (such as television). Children
should be supervised at mealtimes and, if
possible, staff should eat with children.
Activity 1
Make a list of obesity-prevention measures to
be included in obesity-prevention programmes
for families with children.
Treating Obesity
Most NHS Trusts have a locally agreed protocol for
treating childhood obesity. Scottish guidance
recommends that children with a BMI over the
99.6th centile should be referred to a paediatrician
In pre-pubertal obese and overweight children,
weight loss may not be required but weight gain
should be slowed or stopped temporarily through
lifestyle changes so that BMI declines as the child
grows taller. Older children who have already been
through their pubertal growth spurt and very
obese pre-pubertal children will require weight
loss to reduce their BMI. Bariatric surgery is
available in some areas for post-pubertal children
who have tried lifestyle change.
The most effective way of managing overweight
and obesity in children remains uncertain as the
evidence base is limited (Ross et al. 2010).
Successful interventions include a combination of:
●● change in dietary habits to reduce energy intake
but maintain a balanced, nutritious diet
●● increase in physical activity
●● decreasing sedentary behaviour
●● ensuring adequate sleep for growth
●● family-based behavioural therapy.
Engaging parents
Most parents do not recognize that their children
are overweight or obese so healthcare
professionals need to be sensitive when discussing