This is the last in the series of articles examining the prevention of childhood obesity and will look at the overall guidance gleaned from earlier studies which can be used to inform and improve future interventions.
Extensive analyses to identify best practice in the prevention of childhood obesity have recently been undertaken. 1,2 However, these expert reviews have failed to come up with a specific ‘blueprint’ for future interventions. This is not surprising considering the diversity in scope and design of individual studies. Nevertheless a number of key considerations have been highlighted that will help guide future childhood obesity prevention programmes.
To avoid weight reduction for those who are already lean as well as unhealthy slimming practices and to prevent stigmatization of children who are already overweight, any intervention aimed at the general child population must focus on healthy eating, active living and positive self-esteem rather than weight loss or the achievement of ideal body weight.1 Experts reviews found that including physical activity was an essential component of any intervention for reducing body fatness. The reduction of time spent being sedentary was also thought to show promise. Doak et al 2 highlighted the success of interventions aimed at reducing the time children spend watching television and recommended this component should be included where children’s TV viewing and computer gaming is extensive.
Stakeholder involvement
The reason why no single measure for obesity prevention can be identified is that different approaches are required in different situations. The most successful initiatives are those that adapt the intervention programme to the specific needs of the child (in terms of their age, sex and ethnicity), work creatively taking into consideration the facilities and expertise available and most importantly seek stakeholder’s input during programme development, implementation and evaluation. Stakeholders are those directly affected by the intervention programme like children, teachers, parents and community leaders. Their involvement not only helps tailor the programme to their specific needs but also creates a sense of ownership and a will to succeed. Stakeholder’s involvement is especially important for programmes targeting minority groups.
Scope and setting
Schools have emerged as a pivotal setting for the promotion of healthy weight as they have access to the majority of the child population. 1,2 Apart from being an obvious place to educate children on healthy living, schools can provide practical, positive changes in diet and exercise behaviour by offering healthy food in the canteen and creating opportunities for physical activity during lesson time, break-times and after-school clubs. But ideally the school should act as a hub for a more extensive programme involving families and the wider community. The influence of parents and family cannot be underestimated and the education and active involvement of parents should be built into the programme. Similarly public participation is at the heart of a wider community involvement and should be called upon to harness skills, knowledge and resources to act on community identified health issues.
It’s the way that you do it!
Flynn et al 1 highlight that the programme leader and/or facilitator’s personal characteristics are likely to have a very important effect on the success of the programme. Apart from good communication and motivational skills, the facilitator must be culturally acceptable and serve as a positive role model. It is recommended that facilitator qualities should be considered during study design and set up of the intervention.
Towards positive change
The vast majority of studies to date have, in the short-term, demonstrated change towards improvement and although concern has been voiced that the promotion of healthy weights amongst children could have negative effects on body image and cause stigmatisation of those already overweight and obese, there is little evidence that this is the case. 1,2 Flynn et al 1 also suggest that large scale programmes to tackle childhood obesity could maximise resources by addressing other chronic diseases like heart disease and cancer at the same time as the strategies to prevent them are broadly the same.
References
1. Flynn M.A.T. et al (2006). Reducing obesity and related chronic disease risk in children and youth: a syntheses of evidence with best practice recommendations. Obesity Reviews 7 (suppl 1): 7-66
2. Doak C.M. et al (2006). The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obesity Reviews 7: 111-136
FOOD TODAY 05/2007
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