1 February 2009

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.


CLW said...

I have a 12 year old who is battling obesity from her father's side of the family (genetics) and she sometimes gets violent when she can't have her sugar/fat/crap food. I need to find snacks that taste good and are fullfilling for her (other than fruits and veggies) and it is tough when you work all of the time. I appreciate your bringing up this topic with your links to articles.

GI Group said...


Here are a couple of links to online fact sheets that may help you.



If you want to buy a cookbook, check out The Low GI Family Cookbook (Kaye Foster-Powell et al.

Anonymous said...

I have two children, a girl aged 10 and a son aged 7.My son has struggled with obesity and other self-esteem issues. As parents, we realised that it is our responsibility to train our son in good eating habits, exercise and NOT to give in whenever he wanted a snack food. We start every dinner with pureed vegetable soup which curbs the appetite and helps him feel full. The first few nights were horrendous and he went to bed hungry because he refused to eat it. We stood our ground and now he loves the soup. The hardest times are afternoon tea after school. good nutritious snacks are hard to find that also taste like 'fast food' with the crap. so, thanks for the updates.

Anonymous said...

I was a obese child and am an obese adult. But what I have realized is that if nothing is done the problem gets worse. Parents must take action with regards to food and physical activity.

Anonymous said...

I agree & disagree with Prof Potkin. He is right, he says 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.
Then he makes the idiotic comment that Parents and kids aren’t to blame, and they can’t change the way they eat & drink. Just who is responsible for their childrens health? Some beauracrat 2000 miles away, or some Ivy league professor.

Anonymous said...

I second your opinion on this matter. Personally I have a child that suffers from ADD, and this aspect of child development has left me puzzled on the options that I can take up. Sometimes I am just at my wit's end.

GI Group said...

CLW: One of our dietitians has suggested these snacks that your 12-year-old may enjoy.

Corn on the cob
½ English muffin topped like a pizza with low fat mozzarella and vegies
Frozen fruit
Small (ie 110g) tin baked beans – mix in mushies, carrot
Toasted pita bread with cottage cheese
Homemade popcorn (ie not the microwave type), lightly salted
Vitawheats with vegemite
Diet (Nestle diet, Yoplait no fat) with frozen berries

She says, think outside the square. Inevitably a lot of snacks do contain fruit and veg, but it's how you present them that will make the difference!

Good luck