Slide set for Workshop 5
Child obesity challenges and opportunities
Acknowledgments R Pryke
WORKBOOK PAGES 39 - 47
Workshop 5
Child obesity challenges and
opportunities
Aims
Look at growth charts and how they can be
useful in everyday practice
• Use BMI look-up table – no calculator
required
• Interpreting growth through puberty
Look at suitable themes to bring into discussion
with families
Role play and cases – small group work
Growth trends shine a light on health
Growth is best indicator of health
Charts demonstrate normal growth by age and
stage of puberty - and in relation to parental
height
Identify disorders of growth
Assess obesity
Isolated readings of weight height or BMI are
inadequate – they must relate to the
appropriate age/sex reference ranges which
change throughout childhood
RCPCH UK 2-18 Growth chart
Parent
height
comparator
UK90 reference after age 4
Mid
parental
centile
scale
WHO standards
until age 4
Birth
centiles
Predicted
adult
height
scale
Breast-fed baby population trends
WHO produced charts that set breastfeeding
as the norm and described optimal rather than
average growth, that can be used worldwide.
Swap over from ‘breast-fed baby’ charts to UK90 chart at age 4. (note the centile lines alter
slightly at age 4)
There is a wider weight range in breast fed
baby populations indicating that lower weight
ranges can be normal
Body Mass Index (BMI) lookup
• Read weight and height
centiles from the growth
chart.
• Plot weight centile (left
axis) against the height
centile (bottom axis)
• Read off the
corresponding BMI centile
from the slanting lines
• Record centile on grid at
top of chart
• Accurate to ¼ centile
space
BMI =
91st
centile
BMI Interpretation
A child whose
weight is average for
their height will have
a BMI between the
25th and 75th
centiles
‘Growth’ continues
into early 20s e.g.
bone and muscle
mass. Caution re
restrictive dieting
For children yet to reach
adult height:‘Growing into one’s
weight’ means
slowing down the
rate of weight gain
whilst further
increase in height
helps to normalise
BMI
Children at full height
will require weight
loss in order for BMI
to normalise
BMI centile grid: plotting example
>91st centile suggests overweight
>98th centile is very overweight (clinically obese)
Pre-puberty ONLY
Puberty
starting before
8♀or 9 ♂ is precocious
Growth during Puberty
Plotting pubertal children on the UK 2-18
Growth charts
The 3 Phases of Puberty: from history
Girls
Pre-puberty
(Tanner stage 1)
In Puberty
(Tanner stage 2-3)
Completing Puberty
(Tanner stage 4-5)
If all of the
following:
No signs of pubertal
If any of the following:
Any breast enlargement
pubic or axillary hair
If all of the following
Started periods with signs
of pubertal
development
If any of the following:
Slight deepening of the voice
Early pubic or axillary hair
growth
Enlargement of testes or
penis
If any of the following:
Voice fully broken
Facial hair
Adult size of penis with
pubic and axillary hair
development
Boys If all of the
following:
High voice and
No signs of pubertal
development
Talking child obesity
It’s not only puppy fat...
‘Growing out’ of a weight problem requires
altering ‘energy in/out’ balance
Advising ‘eat less and exercise more’ should
work - but it doesn’t… Avoid simplistic advice
Obesity does not mean gluttony:- A small but
prolonged energy imbalance can lead to
obesity
Tools required
Time
Rapport
Entry point into the conversation …NCMP
letter?
Method for data recording on GP systems that
relates to UK/WHO reference ranges – note the
centiles
Guidance on what to say in a short consultation
Promote positives - 'do's'
rather than 'don'ts’
Focus on families not individuals - Encourage
parents and carers to model a healthy lifestyle
Explore feelings to test water non-judgmentally
Test kids on what they already know - build on
this
Relate lifestyle to a variety of health factors dental care, fitness, bone and muscle strength,
not just weight
Teach concepts
Eat together as whole family - siblings and
friends influence food preferences too
‘Do as I do rather than Do as I say’ - Children
gradually learn to copy parent behaviours –
diet and activity
Manage expectation of energy dense foods –
‘save for special times’
Reduce sugary drinks and increase
consumption of water and milk
Developing a ‘taste’
– varied diet
Children learn to accept new foods by repeated
exposure and seeing others enjoy them
It may take many calm exposures to a new food for it to
become ‘normal’ – food we eat and choose without
giving much thought
Never force food – it creates strong dislikes and
behaviour battles. Why do so many children dislike
‘greens!’
Use unusual settings, games and appealing presentation
to generate positive associations
Tuning in to appetite
Abandon ‘clear your plate’ concept – it teaches
children to ignore appetite signals and risks
eating whatever portion is served or simply to
please others.
Parent guides – child decides
Involve children in choosing appropriate portion
size – they know best how hungry they are and
need practice choosing right amount
Think of ‘portions’ as handfuls – little hands, little
portions
Screen time
Avoiding being sedentary (reducing
screen time) is strongly linked to
preventing obesity – due to both the
relation to activity and to exposure to
advertising
4 hours a day screen time doubles the risk
of overweight cf <1 hour
Having a TV in the bedroom is linked with
overweight in young children
Workshop 5 Cases – p 39
Divide into small groups
1. Plot the height and weight centile examples then
use the BMI Look up chart
2. Using ‘Bea’ as a case for role play, explain the
concept ‘growing into one’s weight’ to Bea’s parent
Choose a case
Try the opening few sentences as role play to test out
how phrases can come across. Discuss the other
questions as a group
Resources
•
Growth charts http://www.rcpch.ac.uk/childhealth/research-projects/uk-who-growthcharts/uk-who-growth-chart-faqs/uk-whogrowth-chart-faq
• Tackling obesity through the Healthy Child
Programme http://www.noo.org.uk/Mary_Rudolf