Childhood obesity prevalence and incidence are continuing to rise in Canada. The proportion of Canadian children and youth who are obese increased from five per cent in 1981 to 16.6 per cent for boys and 14.6 per cent for girls in 1996.1  Given the existing number of children and youth who are overweight and obese, and that the social and environmental factors that perpetuate this trend continue to exist, it is imperative to look at the issue from prevention and treatment perspectives.

From a prevention perspective, there are a number of ways that physicians can get involved.

Used with permission from Elsevier
 (The Lancet, 2002, Vol 360, p. 475)

• At every patient visit, ask the child how much physical activity she/he is getting every day; this will convey its importance — to both the child and parent or caregiver. Emphasize the social and health benefits of being active rather than making the link between regular physical activity and body weight.
• Encourage less screen time. The average Canadian child watches 15 hours of television each week; this does not include Internet or video game time, which is on the rise. The Canadian Paediatric Society 2  recommends children spend a maximum of one to two hours a day in front of a screen.
• Ask about eating habits at every patient visit. Provide the family with specific examples of how they can incorporate whole grain products, vegetables, fruit, lower fat milk products (in school aged children only) and leaner meats into their daily meals and snacks instead of relying on fast foods and soft drinks.
• Deliver a consistent message. Distribute and encourage families to follow Health Canada’s Physical Activity Guides for Children and Youth and Canada’s Food Guide to Healthy Eating.
  Emphasize that being a role model for physical activity and nutrition is the most important way that parents can support their children.

Treatment of childhood obesity in your practice:
While the best management of juvenile obesity is prevention, one third of our children are already overweight or obese and at risk of developing a number of chronic diseases, such as type II diabetes. When prescribing physical activity to an overweight or obese child, keep the following principles in mind:

• Activities should use large muscle groups and cause movement of the whole body (walking, swimming, dancing, cycling, skating).
• Begin slowly, particularly if patients have been sedentary. Start with one or two gentle walks or bicycle rides weekly, 10 to 15 minutes in duration. Both frequency and duration can increase
  gradually until the child is active five or six days of the week for at least 30 minutes daily.
• Activity does not need to be intense, as patients are less likely to adhere to high-intensity programs. The educational message for patients should be: be active on a daily basis.
• Choose activities that the child likes the most.
• The key to physical activity is fun! Children, especially those under 10, benefit from a play-like, recreational atmosphere compared with structured activities.
• Children are considerably more active outdoors than indoors, where there are more tempting sedentary pursuits.
  

Key nutrition messages:

• Encourage families to eat together on a regular basis as they are more likely to consume healthy meals. Research shows that children ages 11 to 18 who ate meals with their family consumed higher amounts of fruits, vegetables, grains and nutrient-dense foods than those who ate separately.3
   
• Avoid eating in front of a television or computer screen. Total energy intake is positively associated with hours of television watched, even after adjusting for age, BMI, ethnic origin, family income, and weekly bouts of physical activity.4
   
• Keep portions appropriate for children, and avoid rewarding good behaviour with food, especially unhealthy options.
   
•  Reduce the number of times fast foods are consumed. People who eat fast food two or more times a week are at a 50 per cent greater risk of obesity than those who eat out once a week or less.
   
• Reduce the soft drinks and sport drinks that are consumed; replace with healthier options, such as lower fat milk and water.
   
• Encourage eating at a slower pace. If seconds are requested, parents should try to wait 20 minutes. This allows time for the child to assess if he/she is full or still hungry.

Overweight and obesity prevention and treatment strategies focus on supporting and nurturing every child while avoiding harm. 5 The aetiology of childhood obesity is a complex interaction of genetics, food intake, and physical activity levels. Family involvement is required in the treatment of an obese child in order to provide a supportive environment in which enhanced physical activity, dietary changes and behaviour modification need to occur. 6

References:

1. Tremblay, MS, Willms JD. Secular trends in the body mass index of Canadian children. Canadian Medical Association Journal 2000; 163: 1429-1433.
 
2. Canadian Paediatric Society. Position Statements: Healthy active living for children and youth, www.cps.ca; retrieved January 15, 2004.

3. Neumark-Sztainer, D., Hannan, PJ., et al. Family meal patterns: Associations with sociodemographic characteristics and mproved dietary intake among adolescents. J Am Diet Assoc, 2003; 103: 317-322.

4. Anderson, RE. The spread of the childhood obesity epidemic. CMAJ 2000: 163: 1461-1462.

5. Weight Realities Division. Guidelines for childhood obesity prevention programs: Promoting Healthy Weight in children. Journal of Nutrition Education and Behavior. 2003; 35: 1-4.

6. Bar-Or, Oded. Prescribing activity. Managing juvenile obesity with enhanced physical activity. Canadian Family Physician. 2001; 47: 2165-2167.

Oded Bar-Or is Professor Emeritus of Pediatrics and Director of the Children's Exercise & Nutrition Centre at McMaster University and Hamilton Health Sciences.

Christa Costas-Bradstreet is a Physical Activity Specialist for the City of Hamilton's Public Health & Community Services Department.

Sandy Skrzypczyk is a Public Health Dietitian for the City of Hamilton's Public Health & Community Services Department.