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.Primary care trusts should perhaps consider developing linkswith such gyms/clubs if they do not already exist perhaps through specialcategory membership.It should always be made clear to discharged children and families thatthose who find their weight getting out of control again are welcome back forfurther help and advice.RecommendationsFirst review after weight control advice should be within 2 to 4 weeks fromthe first visit.The overarching aim is for families to change their behaviours to livehealthier lifestyles.For children, learning sustainable change involves parents encouragingthem in appropriate for age autonomy and responsibility so they cangradually become independent of external motivation when effectinglifestyle change.Progress and difficulties with diet and activity change should be discussedat each visit.Weight, height and BMI of the children should be measured, calculatedand recorded at each attendance.The weight and BMI findings should be shown to the family and discussed,preferably using weight and BMI for age charts to illustrate the changessince the previous attendance.Even small changes should be applauded and lack of change should betreated as perhaps an indication that a little longer is needed before changewill show or that there is need for greater lifestyle change.The need and desire for further changes should be considered with childand family and new targets set for lifestyle changesFurther follow-up should be planned but some goal should be developed asprogress is made so attendance does not drag on indefinitely.It may be helpful for the weight control clinic/group to establish a specialrelationship with sports clubs and gyms in the area so children can pursue Recommendations 167PA and possibly have their weight kept under review once discharged fromthe clinic/group set-up.Children who control their weight well may be reassured by veryinfrequent e.g.annual reviews once they have achieved sufficientBMI change.Groups and clinics dealing with overweight subjects need exit strategiesboth for non-cooperative attendees and for successful attendees. 13What can we do to prevent childhoodoverweight and obesity?The rapidly rising incidence of overweight/obesity amongst both adults andchildren in many westernized countries suggests that control of the obesityepidemic will depend on effective programmes to prevent overweightdeveloping rather than on more effective management, important thoughthis latter aspect is.Yet, just as there is no consensus view on the specificdetails for management of overweight/obesity in childhood, so there is noconsensus view on effective prevention.A review of studies, many of whichwere from North America, on the prevention of overweight/obesity in chil-dren found some studies which fulfilled the Cochrane criteria for objectiveanalysis and, of those included in the review, none came out with impres-sively effective plans for prevention (Summerbell et al.2005).However someinterventions were at early stages in their implementation.Many showedsome evidence of changes in behaviours (Summerbell et al.2005).Thus thereis plenty of opportunity for properly conducted, randomized control studiesdesigned to reduce the prevalence of overweight/obesity in present-day childpopulations.Some overweight prevention studies have focused on only one contributorto overweight, for example diet.Sustainable weight control and overweightprevention needs broad changes in lifestyles for most families.Measures toprevent overweight should impact on behaviours around diet and activity butalso include the family environment.Intervening to modify only diet or onlyactivity is largely ineffective (Anderson 2002).Constructing effective preventive programmes is complicated by the widerange of stakeholders who are, or could be, involved in programmes forweight control in childhood.As well as children, these include families,schools, communities, local and national governments, the media, commerce and others (Figure 13.1).A range of geographical and social differencesimpact on weight status so that for a particular child, or for children in onecommunity, the immediate risk factors for overweight in home and envir-onment may be very different from those affecting other children and other168 Who is at risk? 169nsmPCT SchoolMultinationals CulturalattitudesFoodTransportoutletsMediaCurriculaShops TrafficAdvertisingEnvironmentOpenSecurityspacesFigure 13.1 Societal pressures on children which influence weight and weight control.communities.In many cases we do not know which are the specific riskfactors for particular groups but just that some groups have increased risk.For example, we have no easy explanation for the differences in prevalence ofoverweight/obesity amongst children from different ethnic groups (Whincupet al.2002; Viner et al.2006).Genetic endowment may be one factor butenvironmental issues and family aspirations and expectations are probablymore important for most of these children.The scope of preventive inter-ventions needs to be wide in the hope of encompassing all unrecognizedcontributory factors in change.Who is at risk?Prevention can be interpreted as primary prevention which aims to reducethe incidence of a condition; secondary prevention which aims to reduce theprevalence of the condition; and tertiary prevention which aims to reduce theseverity and complications of the conditions (World Health Organization1998).Our aim here is to discuss primary prevention since secondary andtertiary prevention have, in effect, been covered by earlier chapters on themanagement of childhood overweight and obesity
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