The big problem facing little kids

Overweight and obesity affects one in four school-aged children and one in five pre-schoolers in Australia – rates which rank us amongst the top Westernised societies, just behind the US and UK. Prevalence is even higher in certain subgroups including the Indigenous community, those with intellectual disabilities and children from very low socioeconomic backgrounds. Children with obesity are at increased risk of both immediate and long term physical and mental health issues, and without intervention their obesity will continue to affect them in their adult life. There have even been suggestions that this current generation may have a shorter lifespan than their parents, a situation not experienced for the past 200 years. Yet despite presenting to healthcare professionals more frequently than children within normal weight status, very few children with obesity are offered any form of intervention. Why would this be the case?

The reality is that the majority of healthcare professionals find childhood obesity a difficult and sensitive topic to broach. Healthcare workers are not immune to stigma and bias, both explicitly and implicitly. Research gives insight into the challenges that doctors and other health professionals face in the management of childhood obesity, and the word “lack” repeatedly raises its head. Lack of time, lack of resources or support services (including lack of bariatric surgery for severe obesity), lack of effective interventions, lack of parental and/or patient motivation and lack of reimbursement are some of the more common reasons cited to account for reduced initiation of treatment.

Inadequate training in childhood obesity means that many feel unable to provide the necessary care and lack of recognition of the weight status of a child (by both parents and health professionals) compounds the situation. For many, raising the issue is a significant barrier with concerns about offending parents, especially as presentations to health professionals are not usually for weight concerns per se – even though the presenting condition may well be exacerbated by excessive weight gain. But excessive weight is a significant health risk and there are few, if any, other adverse health conditions that would not be brought to the attention of the patient/parent and addressed in order to improve patient wellbeing.

What can be done to address the challenges within paediatric bariatric care? Certainly as causes and consequences of childhood obesity are multifactorial and complex, a multipronged approach is needed across the spectrum – preventative measures on the one hand concurrently with treatment for those already affected. Education and training of healthcare professionals in the assessment and management of childhood obesity is essential along with developing standardised models of care and health pathways to facilitate management and enable improved and greater equitable access to care. A family-wide approach to sustainable behavioural change in the areas of activity and nutrition is the aim of most treatment programs, this being shown to be the most effective intervention. Many clinicians, researchers and policy makers have been strong advocates for action within the childhood obesity realm for several years and their efforts are being realised. Since the inception of the NSW Premiers Priorities on tackling childhood obesity, in NSW at least, there has never been a better time to take on the challenges and break down many of the aforementioned barriers. Collaboration between much-needed new, and already well-established, multidisciplinary clinics is paving the way to improved patient care. Development of educational packages, such as Weight4KIDS, and access to community intervention programs, such as Go4Fun, are changing the paediatric bariatric medicine landscape. Translational grants are being utilised to determine what works at the coalface. And the RACGP is dealing head-on with the issue of obesity in both adults and children through its recently formed Obesity Management Network and by including bariatric medicine in its training curriculum.

It is encouraging to see so much happening in this space. Although there is some suggestion that prevalence rates may be plateauing, there is still much work to be done with no time to rest on our laurels, as of major concern is the continued and increased rise in the number of children with severe obesity. Encouraging a culture whereby assessment of growth is core business of paediatric care, and using every opportunity to encourage healthy lifestyle practices independent of weight status, will contribute markedly to de-stigmatising a condition that disadvantages those affected in so many ways. Childhood obesity is highly prevalent and dealing with it is everyone’s business.

Dr Shirley Alexander is a paediatrician  and Department Head of CHISM and Weight Management Services at the Children’s Hospital at Westmead. For the past eight years she has been working within a multidisciplinary team helping families with children and young people who have obesity.