Management of Childhood Obesity PDF
Preview Management of Childhood Obesity
This page intentionally left blank Management of Childhood Obesity ElizabethPoskitt has practised andtaught paediatrics intheUK and overseas. Herexperience includes over 20 yearsrunning clinics forobese children, firstinBirmingham andthen Liverpool. Sheis co-founder ofthe EuropeanChildhood Obesity Group.She wasawardedan OBEin1998. LaurelEdmundshasworkedwithchildrenandtheirfamiliesforover16years andhas researched childhood obesityissues for thepast 14years, including twoinpractice. Shewasone offiveSpecialist Advisors to theHouseof CommonsHeathCommittee’senquiryintoobesityandwasaCo-optedExpert for theNICEGuidelines. Management of Childhood Obesity Elizabeth Poskitt and Laurel Edmunds CAMBRIDGEUNIVERSITYPRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB28RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521609777 © E. Poskitt and L. Edmunds 2008 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2008 ISBN-13 978-0-511-38853-8 eBook (NetLibrary) ISBN-13 978-0-521-60977-7 paperback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to- date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Contents Foreword by David W. Haslam page vii Preface ix Acknowledgements xi List of abbreviations xii 1 Introduction 1 2 How fat is fat? Measuring and defining overweight and obesity 15 3 Where should overweight/obese children be managed? 33 4 Howdoweapproachtheoverweight/obesechildandfamily? 46 5 The clinical assessment: what are the special points? 58 6 What complications should we look for now and later? 72 7 How does psychology influence management? 83 8 Management: what do we mean by lifestyle changes? 96 9 How can we reduce energy intake? 108 10 How can we increase energy expenditure? 132 11 What else can be done? 153 12 How can we sustain healthy weight management? 161 13 Whatcanwedotopreventchildhoodoverweightandobesity? 168 References 188 Index 207 v Foreword Childhood obesity is one of the most serious problems facing the developed world. It is damaging to the medical and psychological well-being of our children, and casts a shadow on their future health as adults, leading to serious illness and ultimately premature death. This book, written by world-renowned leaders in the field, should be used as a practical tool in the management of the overweight child rather thanleftontheshelftogatherdustlikesomemedicalbooks.Itspagesshould becomewell-thumbedbyfront-linehealthcareprofessionals,commissioners andpolicy-makersalike.Itwouldevenbeacceptabletoturnbackthecorners of the pages, and use light pencil markings on the margin to highlight important passages, because unlike many volumes, this represents first-hand experiences of practical childhood obesity management, combined with a profound scientific, clinical and social appreciation of the condition and its ramifications. Weight management in children is one of the most difficult challenges facedbyhealthcareprofessionalswhocannotchangetheenvironmentwhich leads to the weight problems in the first place. Only the government, food, retail, advertising industry, schools, planners and other authorities can do that. Sweets and chocolates still appear at supermarket check-outs, fast food outletsstillsellvastportionsofcheap,unhealthyfoodatalltimesofdayand night on every street corner. Many schools still provide inappropriate meals and too little physical activity for their students; many food and drink companiesstillusesportsandentertainmentidolstoflogtheirwares,thereby putting enormous pressure on children to obey what is already a powerful instinct; to eat more and more. Whilst we are waiting for the environment to change, primary and secondary care workers have the job of managing thechildhoodobesity epidemicinourclinics,oneperson,andone family at a time. Asageneralpractitioner,Iencounterchildhoodobesityeveryday,anditis oneofthemostdifficult challengesIface.However,asuccessfulresultanda healthy and happy child are the most rewarding and satisfying outcomes for the primary care team and for the family. As well as providing the scientific andacademicbackgroundtochildhoodweightissues,theauthorssharetheir vii viii Foreword immense practical experience of what actually works in the management of theoverweightchild inasympatheticand practical way, andfor this reason, the book should be required reading for everyone involved with childhood weight problems. David W. Haslam, MB BS General Practice Principal Clinical Director, National Obesity Forum
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