GPs need back-up in child obesity battle

Over 13 per cent of children in England are obese. Rachel Liddle asks if GPs have the tools to tackle the problem

Concerns about soaring rates of childhood obesity in the UK have resulted in a debate about how GPs can solve the problem.

But without significant funding for primary care, a stronger evidence base and a crack-down on industries that fuel the UK's obesogenic environment, some GPs see their role as futile.

The national figures on childhood obesity in England showed that 13.4 per cent of children aged between two and 10 years were obese in 2004, compared with 9.9 per cent in 1999.

Last week, a report from the House of Commons Public Accounts Committee said that attempts to tackle the issue by three government departments - health, education and culture, media and sport - have failed because of ‘dithering', ‘confusion' and ‘little co-ordination'.

It makes their target, set in 2004, to halt obesity in the under-11s by 2010 seem unrealistic.

Monumental task
Clinical director of the National Obesity Forum Dr David Haslam said the 2010 target was a ‘monumental task' and blamed failure on ‘too much discussion, not enough action'.

Dr Haslam has called for changes to the GMS quality framework to include points for registering obese children.

NICE also signalled a move for childhood obesity to be managed in primary care at the end of last year when it issued guidelines on obesity. GPs are advised to measure a child's BMI, if deemed necessary and related to gender and age- dependent data.

Under the guideline, if comorbidities are present, the child should be referred to secondary care. But for obese children without comorbidities, GPs should make the decision whether help with diet, eating behaviours and physical activity is needed.

Children's commissioner Professor Sir Albert Aynsley-Green is also looking at how primary care can help to halt the UK childhood obesity epidemic.

Last month he gathered representatives from primary care, academia and government departments to discuss the issue. But the group believed that GPs could only be part of the solution of childhood obesity.

DoH primary care czar Dr David Colin-Thomé said: ‘I don't think GPs should rush in. But we do need to look at focusing on patients where intervention might help.'

Achievable targets and the availability of specialist services are both vital if GPs are to take this forward, he said.

For example, practice-based commissioning could be used to fund MEND, a programme for overweight or obese children aged from seven to 13, said Ulla Stauch, director of MEND.

The programme, offered at 43 centres across the UK, uses a combination of family involvement, education in nutrition and physical activity.

Weight loss
Results from a pilot study of 65 children showed that three months after taking part in the programme, their BMI had decreased by an average of 0.9kg/m2.

But even broaching the subject of obesity with child patients can be a problem for some GPs.

RCGP spokeswoman Dr Sarah Jarvis said: ‘The problem is that we have to be very tactful in bringing the subject up so it can take a long time.'

Additionally, a lot of childhood complaints are dealt with as emergencies by out-of-hours GPs, she said.

With no prior contact with the parents, little opportunity of follow-up with the child and a busy schedule, it is unlikely these GPs will bring up the topic of obesity.

Even with regular contact with a child, GPs can often be fighting a losing battle.

Marketing campaigns from fast-food giants, manufacturers of computer games and a society that is scared to let children play outside unsupervised, all make it increasingly likely that children will gain excess weight, she said.

‘You add all these factors up and it's inevitable that GPs cannot make a difference. You need a concerted effort.'

Dr Jarvis also cast doubt on the value of weighing children to determine obesity.

A government attempt to audit the level of obesity in children starting school, aged between four and five and aged 10-11 years resulted in only 48 per cent of children being weighed.

‘We have to bear in mind that parents are highly overprotective of children and amazingly blind to their child's weight,' said Dr Jarvis.

She was also doubtful of the value of carrying this practice out in primary care until effective interventions were possible.

Ring-fenced funds for GPs to develop dedicated services may help, she said.

Fighting obesity

  • The government wants to halt rate of under-11 obesity by 2010.
  • NICE guideline advises GPs to use a multi-factor approach to weight loss.
  • Children's commissioner wants to find out how primary care can help.
  • PBC may be a way of commissioning specialist services.

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