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Weight Management in Children and
Adolescents
Kay Gibbons FDAA
Nutrition Royal Children’s Hospital
Prof. Geraldine Naughton
CoPAAL, Australian Catholic University
Outline
1. Australian context
2. Evidence based study
3. Applications for coaching
4. Learnings
Young people in Australia, 2007
100
75
percentage
underw eight
50 normal w eight
overw eight
obese
25
0
2 to 3 4 to 8 9 to 13 14 to 16 2 to 3 4 to 8 9 to 13 14 to 16
Age (y)
boys (n = 4,487)
girls
CSIRO 2007 Aust. National Children’s Nutrition and Physical Activity Survey
Australia’s Health Check –
Obesity remains a concern
Obesity in all children
1995 2007/8
All 5.2% 7.8%
girls 5.8% 5.8%
boys 4.5% 9.7%
May 11, 2009
Activity in Young People in Australia
2007 Australian National Nutrition and Physical Activity Survey
Who’s at Risk of Decreased
Physical Activity?
• Ethnic minorities,
especially adolescent
girls
• Living in poverty
• Children with
disabilities
• High rise housing
• Extreme climate
• Unsafe or
inadequate outdoor
areas
American Academy of Pediatrics, 2006
Sedentary behaviour
Non-productive Productive
playing video games sleep
television reading
sleeping in home work
talking on telephone work/chores
1 in 3 children (5-12 yrs) spent excessive time (>2 hrs) watching
TV or using a computer for leisure Spinks et al. 2006
Excessive TV and computer usually associated with insufficient
activity levels Spinks et al. 2006
Screen time in young people in
Australia
2007 Australian National Nutrition and Physical Activity Survey
Non participants
%
ies
Gende
r Famil
% 36%
Males ren t
O ne pa 5%
Femal 31%
par ents 2
es C ouple
42%
Pla
% c eo
Aus f bi
en t tral rth
Employm 49% O/s ia
ent Eng
Unemploym 23% O/s lish %
ing No
1+ parent work n-E 26%
ngl
is h
27%
44%
ABS • CHILDREN’S PARTICIPATION IN CULTURAL AND LEISURE
ACTIVITIES • 490 1 . 0 • APR 2006
Barriers to out of school activity
no time not into sport
too much homework parents not
supportive
friends not involved
no coach
transport
unfit
too expensive
too embarrassed
health or injury
problems too competitive
Facilitators
play buddies
non-competitive activities
low cost or free activities
self-determined activities
opportunities to play after
local community activities
school
child-centred play
family encouragement
safe play environments
variety of play items
better transport
Overweight and obesity
far more complex than energy balance
behavioural change
multi-disciplinary, multi-agency
much uncertainty remains
Obese children become the target of early
and systematic discrimination
As they mature, the effects of
discrimination become more-culture-
bound and insidious (Dietz, 1998)
Childhood overweight and obesity
Physical Medical Psychosocial
-hyperlipidaemia -sleep apnoea -early & later
-hypertension -poor pulmonary discrimination
-insulin function
resistance -hepatic steatosis
-abnormal -polycystic ovary
glucose tolerance disease
-orthopaedic
complications
-cholelithiasis
-asthma
Reilly JJ.
Luttikhuis, Cochrane Review 2009: Issue 2
Best treatment?
• Increase awareness
• Small, progressive
change
• Big changes all at
one?
• Whole of village
approach?
Cochrane Review: Paediatric
Obesity Treatment
64 RCT’s
drugs* 12 phys activity + sedentary
6 diet alone
dietary
36 behaviour: change thinking
- dietary intake
behaviour - eating patterns
- family food
- physical environment
lifestyle
Drugs (*adolescents)
- metformin
- orlistat
- sibutramine
Littikhuis Cochrane Reviews, 2009, Issue 2
Meta analysis results
Children <12 yr Children >12 yr Drugs as an
Family behaviour Stronger effect adjunct to
programs better of behaviour behaviour
than usual care program change in
adolescents
Improvements to
Overall effects Better adiposity
not sustained at sustainability at +
12 months 12 months
range of adverse
events
Littikhuis Cochrane Reviews, 2009, Issue 2
Developmentally appropriate
communication
Phone Saelens et al 2002
Internet-based facilities Williamson et al 2003
Peer-enhanced training Jelalian et al 2006
Prevention messages
• Food & nutrients
– Eating behaviours –
breakfast, snacks,
portions, sweet drinks
– Family interactions
about food & meals
– Parental
empowerment
• Physical activity and
sedentary behaviour
Davis et al Pedatrics 2007. 120: S229-S253
Can communities support prevention
messages?
The need to include
In the worst case scenario, being overweight or
obese can make young people approach activity
with dread, alienation, and disembodiment
(Sykes H, and McPhail D. Unbearable lessons: Contesting fat phobia in
physical education. Sociology of Sport Journal 2008, 25: 66-96)
Reality check ….
I was tired ….. of not being as good as some of (the
other kids) and being made fun of for it ….. and feeling
stupid in front of everybody. Everyone would stand
around and watch, and if you missed …. everyone
laughed
I dropped gym because I was afraid …. afraid of looking
dumb and feeling worse about myself
(van Daalen C. Girls’ Experiences in Physical Education: Competition, Evaluation &
Degradation. The Journal of School Nursing. 2005, 21(2):115-121)
So … how can coaches INCLUDE?
Level playing field – rotation of roles and
opportunities, code of ethics to parents and players
Games – everyone touches before score counts / 6
passes before goals, self-select maximal efforts
Offer social opportunities – community events,
treasure hunts, movie nights
Prescription of exercise to help
overweight children
may or may not meet 60 min per day - recommendation
prescription very different from FREQUENCY x
DURATION x INTENSITY of adult exercise prescription
start with what’s possible ….. remain developmentally
appropriate and patient ……. look at opportunities
might not see activity as fun
Not so sporty kids
approximately 40%
in greatest need of activity
skills emphasis?
comparisons?
fitness tests?
For those who don’t find activity fun…
•low competitive nature
•opportunities for friendships
•more important to improve self-worth
before increased activity
•stress the satisfaction from attaining
highly achievable goals
•recognise and discuss effort
Independent of skills, fitness and fatness,
… is it possible for coaches to have a lasting
impact on children’s beliefs in physical activity?
Big can be fit, and slenderness is
not always healthy!
Prevention = role of community
…. facilitating an innate belief and satisfaction in
physical activity to all children, independent of
size, shape, or skills
Learnings
Goals for increased physical
activity
SHORT TERM LONG TERM
- Energy expenditure - Behavioural change
What might be
adequate?
too structured inclusive, non-
judgemental focus
high skill requirement
flexible simple tasks,
punishment moderate intensity
segregation shared decisions,
empowerment
high likelihood of failure
effort recognition
Prescribed activities
motor skills
programs
non-competitive
games
adventure
Enjoyable therapy
team sports
walk
dance swim
Individualised programs
If we don't stand up for children,
then we don't stand for much
-- Marian Wright Edelman
