Food for Thought

Child obesity – why don’t they just do something about it?
The problem with child obesity is not the lack of explanations, but the abundance of them – genes, diet, lack of activity, TV and anything with a screen, junk food, eating out, relatively cheap energy-dense processed foods piled high on our supermarket shelves, sugar-laden drinks from fruit juices to soft drinks … and the lack of solutions.



In fact, there’s a marked disparity between the widespread, hand-wringing about the rising rates of overweight and obesity and sound evidence on how best to treat childhood obesity and which elements of dietary intervention are actually effective long term to roll out appropriate intervention programs. Back in 2006, Assoc. Prof. Clare Collins’ team reviewed 37 randomised controlled trials (Archives of Pediatric Adolescent Medicine) and reported that it’s hard to evaluate the effectiveness of dietary treatments in those published studies because they don’t report enough details on the one hand and there simply aren’t enough high quality ones with longer term results on the other. Jump to January 2009 and the latest Cochrane Review that looked at 54 studies reports that children and teens can lose weight with lifestyle changes (diet and physical activity) 6 and 12 months after beginning a program.

Which program? There are numerous (often impressive and well run and pricey) commercial child obesity intervention programs for those who can afford them. But what's needed to make a real difference are accessible, affordable (or free) and effective community-based programs to support all families and young people in the self-care of overweight/obesity. And here, initial results from three Australian trials designed for Australian conditions are very promising and should be rolled out more widely.

HIKCUPS (Hunter Illawarra Kids Challenge Using Parent Support) was a randomised controlled trial involving 165 overweight children aged 5–9 years who were allocated one of three intervention programs: a parent-centered nutrition lifestyle program; a child-centered physical activity skill development program; or both programs. ‘All treatment groups appear to be equally efficacious in improving dietary intake in overweight and obese children,’ write the authors in The International Journal of Obesity. The results of the study provide much needed information about the effectiveness and feasibility of treating childhood overweight and obesity.

PEACH™ (Parenting Eating and Activity for Child Health) looked at the effectiveness of adding a parenting skills training program to a family-focused healthy lifestyle intervention for managing overweight 5–9 year olds. One hundred and sixty-nine children in Adelaide and Sydney took part in this randomised controlled trial over 2 years. A sneak preview of the key finding (currently under review for publication in an international journal) was that relative weight loss of 8–12% (both BMI and waist circumference) was observed at the end of the 6-month intervention and that this weight loss was maintained for a further 18 months with no further contact (other than measuring the children). Check out the details of this program in Nutrition and Dietetics.

Loozit is an ongoing weight loss and healthy living program developed by staff at The Children's Hospital at Westmead, Sydney, for young people aged 13–16 who are struggling with their weight. Group sessions focus on healthy meals and snacks, becoming more active and building self-esteem. Participants meet once a week for 9 weeks and then once a school term in the following 2 years. Findings from the pilot study reported in Nutrition and Dietetics showed that the self-esteem of young people increased, their waist circumference decreased and their ‘good’ cholesterol improved.

But no matter how successful community based programs like these are, they are just the tip of the iceberg. ‘Over the last half century, we’ve experienced rapid and widespread changes in how we eat, drink and move,’ says Prof Barry Popkin in The World Is Fat, his new book that looks at the fads, trends, policies and products that are fattening the human race. He shows how rapid changes inside and outside the home have changed the entire environment in which we live and shifted control from the parents to the broader community. Talking to GI News, Popkin says: ‘Parents and kids aren’t to blame, and they can’t change the way they eat, drink and move on their own.’ See our Healthy Kids page in this issue for some tips from Prof Louise Baur and her colleagues.

– GI News would like to thank Prof Louise Baur, Assoc Prof Clare Collins, Dr Anthea Margarey and Prof Barry Popkin for their input and for reviewing this article.