Slides KateSteinbeck

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Published on August 11, 2007

Author: Flemel

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Treatment of Established Childhood and Adolescent Overweight and Obesity:  Treatment of Established Childhood and Adolescent Overweight and Obesity Kate Steinbeck PhD FRACP Metabolism andamp; Obesity Services Royal Prince Alfred Hospital, Sydney, Australia Childhood Obesity Summit - Sydney 10-12 September Why should overweight and obese children & adolescents be treated?:  Why should overweight and obese children andamp; adolescents be treated? So many children and adolescents are affected: 440,000 10-14 year olds in NSW (CHO 1998) 5% (current estimate of obesity prevalence) = 22,000 The condition does not usually resolve spontaneously Affected subjects have psychosocial dysfunction Affected subjects have medical problems which will improve if body fat is reduced Affected subjects are at higher risk of future ill health and early death The aim of weight management in children & adolescents:  The aim of weight management in children andamp; adolescents The overriding goal is reduction of body fat In children they may only have to maintain their body weight and they will reduce body fat by continuing height growth - they grow into their weight For adolescents who have finished most height growth weight loss is required Who could provide weight management for children & adolescents ?:  Who could provide weight management for children andamp; adolescents ? GPs have an important role in prevention, detection andamp; intervention (NHandamp;MRC Guidelines) Interventions do not need to be provided by specialist paediatricians Group interventions have many advantages Access is important as weight management is a long term intervention - community base Different communities may require different approaches The individual components of weight management:  The individual components of weight management Reduction of energy intake by dietary modification, and using conventional foods Increase in energy expenditure by an increase in physical activity both planned and incidental Decrease in sedentary behaviours in order to increase energy expenditure The individual components of weight management:  The individual components of weight management Modification of behaviours and habits associated with eating and activity Involvement of the family in the process of change Influences on physical activity in children and adolescents:  Influences on physical activity in children and adolescents Parental activity (Moore J Pediatr 1991) Parental inactivity (Fogelholm Int J Obesity 1999) Age Opportunity Prompting (Elder J Dev Behav Ped 1998) Socioeconomic status (Guillaume Obes Res 1997) Body fatness (Huttenen Int J Obesity 1986) Discretionary time available Change in Percentage Overweight in Obese Children Allocated to Four Experimental Physical Activity Groups :  Change in Percentage Overweight in Obese Children Allocated to Four Experimental Physical Activity Groups Change from baseline at all points p andlt;0.001 Adapted from Epstein Arch Ped Adol 2000 Outcome Indicators:  Outcome Indicators Primary Loss of body fat Secondary Improvement in medical disorders Improvement in blood fats etc Better exercise capacity and endurance Changed eating behaviours Better psychosocial function Better family function are multiple Long Term Weight Change in Obese Children and Parents:  Epstein et al Obesity Research 1995 Long Term Weight Change in Obese Children and Parents Is there a role for other therapies?:  Is there a role for other therapies? Other therapies in adults include very low energy diets, drugs and surgery All these are contra-indicated in children There is a limited place for these therapies in severe adolescent obesity, when it is complicated by medical disorders Barriers to weight management:  Barriers to weight management The belief that children will outgrow their overweight The concern that dietary restriction will induce eating disorders The fear that dietary restriction will impair growth The lack of knowledge about current and future health problems Not knowing what works best Treatment of Established Childhood and Adolescent Overweight and Obesity:  Treatment of Established Childhood and Adolescent Overweight and Obesity Kate Steinbeck PhD FRACP Metabolism andamp; Obesity Services Royal Prince Alfred Hospital, Sydney, Australia Childhood Obesity Summit - Sydney 10-12 September

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