As levels of overweight and obesity in European children continue to rise, it is generally agreed that preventive action is needed urgently. However, there is still much debate over when and how to introduce interventions and what precise measures should be used. Here are some of the considerations.
The message
There are three main aspects of a child’s lifestyle that will make the environment obesity promoting or not; the diet, the level of physical activity and the level of sedentary behaviour, in particular the number of hours spent watching TV and playing computer games. Prevention programmes could provide a simple message and focus on one area like improving the diet or cutting down the number of hours watching TV, or include any combination of diet, activity and sedentary behaviour messages.
Tailoring the message
Apart from the actual messages it may be necessary to tailor the programme to suit the particular children involved. For example the type of sports and activities offered may need to vary between girls and boys. The age of the children will also determine what is possible and acceptable, many things change between primary to secondary school, not least access to sports facilities and school catering systems (canteen style, where children choose between different foods, or where they have a set dinner with no choice). Social class and ethnic differences in diet and behaviour may also need to be taken into consideration. Children who are already overweight or obese may need to be given special help.
Setting
Another key consideration is where the intervention takes place and who is involved. Schools are an obvious starting point because they have access to large numbers of children, have the potential to support healthy behaviour and are ideal for the delivery of health promotion programmes. But the school-based approach may falter if there is lack of support in the family or in the wider community. Thus parents and siblings may also need to be involved in activities perhaps through ‘action days’ or other special events so that there is continuity at home. Taking an even bigger step is to get the whole community involved including those involved in sports centres, community leaders and the food suppliers (food industry, caterers, retailers).
Sustainability
For any programme to be of benefit it needs to be viable in the long term. This means that any infrastructure that is put in place can be sustained with acceptable additional cost and effort. For example changes in a school canteen can be continued relatively easily if they are accepted by the school and catering staff. On the other hand a programme that requires a high level of additional staff or specialist input may be expensive and impractical in the long term.
Paying attention to adverse effects
Ideally such interventions will boost children’s self image, motivate them to follow a healthy lifestyle and help them to achieve and maintain the appropriate weight for their height into adulthood. However, it is important to consider whether an intervention might have any adverse effects on the psychological or physical health of the children. For example it should not cause normal-weight children to lose weight, cause an unexpected increase in fatness or exacerbate any existing self-esteem problems in children who are already overweight or obese.
The way forward
As shown above the possible scenarios in the design of obesity prevention programmes is extensive, but do we know what works? A number of intervention studies have already been carried out using different messages, approaches and social settings. It is now time to evaluate what we have learnt from these early studies and how to go forward. Recent reviews of school-based interventions have started this process (1,2) and in a series of articles in forthcoming issues of Food Today we will be looking at some of the success stories; what they achieved, why they worked and their recommendations for future action.
Reference
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Doak CM, Visscher TLS, Renders CM & Seidell JC (2006) The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obesity Reviews 7: 111-136
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Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, Tough SC (2006) Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with “best practice” recommendations. Obesity Reviews 7 Suppl 1:7-66
FOOD TODAY 10/2006
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