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Solution to weighty problems lie with the family

Tuesday 4th December 2007

In June 2003, Dr Brian Gaffney, chief executive of the Health Promotion Agency, called attention to what was becoming a major public health problem worldwide in the 21st century - obesity.

He warned of the " gathering pace" of this epidemic in Northern Ireland, emphasising increasing concern for children.

Surveys indicated then that one in three boys and one in four girls of 12-years-old in Northern Ireland carried excess weight. More recently, a 2005/06 Health and Social Well-being Survey indicated that more than a quarter of children aged between two and 15 were overweight.

Last June's results of a UK- wide survey, facilitated by the Institute of Child Health at University College London, not only indicated that one in four children were overweight or obese by the age of three, but that children in Northern Ireland and Wales were more likely to be overweight than those in England or Scotland.

All of this supports what the Ministerial Group on Public Health reported earlier this year - that levels of obesity are rising "year on year" in Northern Ireland.

Some of the serious medical conditions that may result from being overweight as a child are: Type 2 diabetes, hypertension, dyslipidemia, and early heart disease; together these are referred to as the Metabolic Syndrome (Miller and Silverstein, 2005). According to the Northern Ireland Taskforce on Diabetes, the incidence of Type 2 diabetes - once considered an exclusive disease of adulthood until the late 1970s - is increasing in younger people.

Other significant health concerns include degenerative joint disease, obstructive sleep apnea, obesity hypoventilation and eating disorders.

Exercise, along with nutrition education and behavioural intervention, is a mainstay of treatment for overweight children and their families.

However, the question is often asked: "Why, with the same energy expenditure and intake of calories, does one child gain weight while another does not?" One study (Hernandex et al, 1998) found that a low metabolic rate and increased fat cell numbers are two genetic factors that may influence childhood obesity. Fat cells, or adipocytes, develop prenatally and increase in size during infancy and childhood and by adolescence, reach adult levels.

The onset of childhood obesity is associated with an increased number of adipocytes. As caloric intake is increased, the number of adipocytes increases. The size of the adipocyte may be involved in appetite control and weight loss maintenance as an adult, if the adult had childhood-onset obesity.

This means that the potential for weight gain will always exist in addition to the lifelong difficulty of losing weight.

However, no child is doomed to be overweight and certainly not today in Northern Ireland. The primary objective of the Government's Fit Futures Programme is to stop the 'year on year' trajectory of increasing levels of childhood obesity by 2010 and decrease child obesity by 50% by 2025.

The policies and strategies to tackle obesity reflect the importance of the role of parents and families in establishing and supporting good nutrition and active living, particularly during the first few years of a child's life.

Indeed, the fundamental approach of the programme is that parents have primary responsibility for ensuring the health and well-being of their children.

Ultimately, the success of the Fit Futures Programme and the resolution for Northern Ireland's child overweight problem lies in the hands of the parents.

Professor Shahryar Sheikh, president of the World Heart Federation, says: " Children's habits are learned through observing others. Children as young as 10 reflect the health habits of their family."