Management of weight in adolescence

Dr Rachel Pryke assesses the impact of teenage obesity and how to tackle it through diet and physical activity.

The importance and impact of weight problems in all age groups has hit the nation's consciousness, but particular concern stems from the rapid growth of child obesity since the early 1990s.

Encouragingly, the most recent child obesity data for England hint at a potential change to what had been an alarmingly steep rise. It is too early to say whether these data (collected in 2006 and published in 2008) accurately reflect future trends and it is certainly no time for complacency.

It would be heartening to think that perhaps current initiatives, which include a major emphasis on general public awareness of basic healthy eating and lifestyle information, as well as specific initiatives in schools, are beginning to have some effect.

Impact of obesity
Obesity in adolescence raises several specific concerns. It affects physical health, with, for example, reports of type-2 diabetes now being diagnosed in teenagers. Increasing body mass index correlates with higher prevalence of asthma. Joint and posture problems are more common.

Metabolic sequelae of obesity that may present in adolescence include menstrual irregularities arising from polycystic ovarian syndrome.

Emotional health and self esteem are often affected to some degree. Anxiety and depression rates are 3-4 times higher in obese people, with an increased risk of suicide. This is not helped by the practical difficulties that obese people experience, such as difficulty with appropriate seating, bullying at school or work-place discrimination and reduced job opportunities.

Children whose parents are obese are twice as likely to become obese too. Childhood obesity is likely to persist into adulthood in at least half of obese children.

Trends in adulthood show that the nation is gaining an average of 0.8kg per year. This puts us all at risk of becoming overweight unless we take active steps to keep weight controlled.

Prevention messages
There is good evidence to support a series of quite simple messages that can be incorporated into advice on both treatment and prevention of obesity.

Reduce sweetened fizzy drink consumption. Strong evidence links soft drink intake with weight problems.

While diet versions are an improvement (with no convincing evidence that artificial sweeteners carry any health risks), unsweetened drinks are preferable. Consuming sweet-tasting drinks encourages a sweet tooth and diet alternatives are not always available. It only takes a few weeks to get used to unsweetened drinks.

Start the day with breakfast. Skipping breakfast leads to increased hunger and risk of snacking on calorie-dense foods later in the morning, and is consistently linked to weight problems. A fortified cereal with milk plus a fruit portion provides nutritionally important fibre, vitamins and minerals.

Encourage family meals and eating at home. Frequently eating out, fast foods and eating 'on the hoof' risks inappropriate portion sizes. People tend to eat whatever is served regardless of hunger, but choose more appropriate amounts at home.

Home-cooked meals are more likely to match nutritional recommendations (such as given in the Eatwell Plate). The more a family shares meals together the lower the risk of weight problems.

Reduce TV watching time to less than two hours per day. Studies show that four hours a day of screen time doubles the risk of being overweight compared with less than one hour and having a TV in the bedroom as a youngster is strongly linked with weight problems. Doing anything else seems to be better than staring fixedly at a screen.

Physical activity is great for health. Studies show exercise plus calorie controlled eating benefit those with established obesity. Evidence is less clear for prevention of weight problems. However, exercise is fantastic for general health even if weight does not alter. Studies show improved BP, lipids, bone density and mass, self-esteem and lower risk of depression.

Parents play an important role. Studies confirm that inactive parents predict inactive children. However, parental support is even more beneficial; being interested, helping with transport, kit, organisation and enthusiasm, means busy or perhaps disabled parents can still motivate their children.

Explore motivation, barriers to change and ambivalence in young people in order for healthy lifestyle information to feel relevant and workable.

Goal setting for adolescents
It is vitally important that we help young people set appropriate targets and encourage appropriate measures of success. Measure exercise benefits by assessing improvements in fitness and health rather than weight loss otherwise static weight might imply failure despite likely health gains. Dieting is out, health lifestyle is in.

  • Dr Pryke is a GP trainer in Redditch, Worcestershire

Why obesity is common

  • Our energy expenditure is markedly less but our appetites have not altered.
  • Mechanisation of life - machines, remote controls, transport.
  • We burn less fat for heat - better clothing.
  • Communication - we phone friends rather than walk to see them.
  • The food industry has a big impact on portion sizes and the balance of our diet: we are eating too much food and we are not getting the right nutritional balance. Fruit and vegetable intake is too low.
  • Eating is a major form of entertainment.

References

  • Davis M M, Gance-Cleveland B, Hassink S et al. Recommendations for prevention of childhood obesity. Pediatrics 2007; 120: S229-53.
  • Weight Matters for Young People. Pryke R. Radcliffe Publishing, 2006.
  • Pryke R, Docherty A. Obesity in primary care: evidence for advising weight constancy rather than weight loss in unsuccessful dieters. Br J Gen Pract 2008; 58(547): 112-7.
  • The Eatwell Plate. www.eatwell.gov.uk/healthydiet/eatwellplate/

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