Introductory Certificate in Obesity, Malnutrition and Health

Slide set for Workshop 5Child obesity challenges and opportunities

Acknowledgments R Pryke

WORKBOOK PAGES 39 - 47

Workshop 5 Child obesity challenges and

opportunities

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

Aims

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

UK90 reference after age 4

WHO standards until age 4

Birth centiles

Predicted adult height scale

Parent height comparator

Mid parental centile 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 UK-90 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

Pre-puberty(Tanner stage 1)

In Puberty (Tanner stage 2-3)

Completing Puberty(Tanner stage 4-5)

Girls If all of the following:

No signs of pubertal

development

If any of the following:Any breast enlargement

pubic or axillary hair

If all of the followingStarted periods with signs

of pubertal development

Boys If all of the following:

High voice and No 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 brokenFacial hairAdult size of penis with pubic and axillary hair

Talking child obesity

It’s not only puppy fat...

‘Growing out’ of a weight problem requires altering ‘energy in/out’ balanceAdvising ‘eat less and exercise more’ should work - but it doesn’t… Avoid simplistic adviceObesity does not mean gluttony:- A small but prolonged energy imbalance can lead to obesity

Tools required

TimeRapportEntry point into the conversation …NCMP letter?Method for data recording on GP systems that relates to UK/WHO reference ranges – note the centilesGuidance 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 caseTry 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/child-health/research-projects/uk-who-growth-charts/uk-who-growth-chart-faqs/uk-who-growth-chart-faq

• Tackling obesity through the Healthy Child Programme http://www.noo.org.uk/Mary_Rudolf