Childhood Obesity is an increasing social concern. No-one denies this. Most studies have shown that up to one third of all adolescents have a weight problem. Many suggest that this generation will be the first to under-live their parents. And despite the formation of countless committees to address the issue no structured solution has been advocated other than to offer positive advice on nutrition and activity and negative advice on inactivity.
With most other health problems the strategy is to define what the condition is and then to direct assistance toward the target population. We don’t give blood pressure pills to the whole population. We give it to people with hypertension. And hypertension has a definition: it is a pressure in the arteries consistently above 140 mms Hg systolic and above 90 mms Hg diastolic. It can be measured. Most people do not know they have high blood pressure until someone measures it. Then they are offered a solution: a pill that normalizes the pressure. And we do not approach the problem by telling people with high blood pressure that it is their fault. Because in many cases it is genetic. It runs in their family.
Well obesity is very similar. Except that it begins at birth and is very easy to measure. You can do it yourself. Just measure your height and your waistline. The measurement is called the waist to height ratio. It should be under 0.5. Yes! Your waist should be under half of your height. And most adolescents with childhood obesity have abnormal WHtRs before they are ten years old.
Ergo: the target population for this medical condition can be established at a very early age. But to do so every Canadian child has to be measured at least by the time they reach grade 5. Those children who are measured as overweight or obese should require their parents and siblings to be measured as well. For every child who has one parent who is overweight will have a 50% chance of also being overweight and with two parents it is over 75%. This is a familial condition. It is not the child’s fault. It is not the parent’s fault. It is a metabolic abnormality in the storage of energy that involves the body’s fatty cells – adipose cells – absorbing more energy from ingested food than those individuals without the condition. There are many other factors, some genetic, some non-genetic but the bottom line is that some individuals are metabolically destined to have childhood obesity from the day they are born. Unless they receive treatment.
Just as every individual with high blood pressure has to take a pill to maintain normal blood pressure: every individual with childhood obesity has to take a treatment to maintain normal weight. So the first step in all this is to identify all the children and all the families who have this metabolic abnormality and refer them for treatment. This can only be done at school. And it can only be done with a one-on-one intervention with every child and their families. Not by lecturing to the whole population but by sitting down face-to-face with each child and their family.
The treatment is more difficult than taking a pill. But if it is followed it does work. It requires a Resource Centre to which families can be referred. A Resource Centre that provides motivation to change and direction on nutrition and access to activity. The nutritional advice needs to be directed individually targeting each family’s ability to purchase certain foodstuffs and permanently avoid others. Just like smoking cessation, childhood obesity carries a zero tolerance for certain foods. But there are plenty of other tasty options available if individuals are taught how to select them.
Finally, just like high blood pressure, re-measurement has to be done at regular intervals and children and their families should be re-assessed in school at Grade 7 and Grade 9.
By Dr. Stafford W. Dobbin
A graduate of Queens University Belfast, Dr. Dobbin founded Heart Niagara in 1977. He established the first Department of Emergency Services in Niagara at the Greater Niagara General Hospital in 1976. Through Heart Niagara he initiated the teaching of Citizen Cardio-Pulmonary Resuscitation in Niagara and of Advanced Cardiac Life Support for Critical care personnel prior to the establishment of the Regional Paramedic programme. His initial design for Heart Niagara included a Cardiac Rehabilitation Programme for survivors of Cardiac events staffed by qualified Physicians and Nurses for which he was the Medical Director to 2002. And through Heart Niagara he started the Niagara Schools’ Healthy Heart Programme in 1987 and is the Medical Director. His EMS system for coverage of Mass Participation events was first used at the US Olympic Marathon trials in 1980 and he served on the first Executive of the International Marathon Directors Association. He is presently a partner in the Niagara Medical Group, a Family Health Team, in Niagara Falls.
Disclaimer:The views and opinions expressed in blog entries are those of the author(s) and do not necessarily reflect the official policy or position of Heart Niagara.