Obesity Iresearch Papers

HSE CHILDHOOD OBESITY services are “sparse or non-existent” across the majority of the country, it was revealed today.

The Irish Nutrition and Dietetic Institute (INDI) is now calling on Government to urgently devise a childhood obesity strategy and
implementation plan.

The call came as it launched the inaugural Nourish Children Week, a public awareness campaign that seeks to raise awareness and understanding of issues relating to childhood nutrition including childhood obesity, weaning and spoon feeding and nutritional support for children with disabilities.

At the launch of Nourish Children Week today, the organisation said that parents have little or no services to turn to in their community if their children are overweight or obese.

Obesity prevention

There are just three HSE childhood obesity prevention programmes across seven counties, and just two group treatment programmes exist, covering three counties.

Approximately 1 in 4 (30,000) primary school children in Ireland today are either overweight or obese, said INDI.

It completed a mapping exercise of childhood obesity services across the country, which showed that there are only three childhood obesity prevention programmes:

  • The ‘Lifestyle’ programme in Longford & Westmeath, Offaly and Laois (for children aged 5-10 years)
  • The ‘Cool Dude’ Food Programme in Dublin South East/ Wicklow (for children aged 8-12 years)
  • The ‘Bounce – Built to Move’ programme in Galway (for children aged 9 – 12 years)

Additionally, the two group intervention programmes for obese children operating across three counties are:

  • The ‘Way to Go Kids’ programme in Limerick (for children aged 9 – 14 years)
  • The SCOTT programme in Cork and Kerry (for children aged < 18 years old)

INDI said that Temple Street Children’s University Hospital is the only children’s hospital with an intervention programme (called W82GO) for obese children with co-morbidities, but it currently has a nine month waiting list.

There are no dedicated clinics for obese children at Our Lady’s Hospital Crumlin but limited access through endocrinology and other specialities. Obese children are seen by a dietitian in the National Children’s Hospital Tallaght but the waiting list is over a year.

Tackling child obesity

Richelle Flanagan, Dietitian and President, INDI said:

[D]espite the Departments of Health and Children constantly highlighting the ever increasing rise of childhood obesity, they have not grasped the nettle and devised a national strategy and implementation plan to tackle it.

In partnership with Temple Street Children’s University Hospital, the INDI has presented a Vision for Childhood Obesity Policy and Services.

It asks the Department of Children and Youth Affairs in partnership with Department of Health and other government departments to develop a national cross-sectoral strategy for childhood obesity prevention and intervention service.

It also wants the HSE to agree the best model for community based childhood obesity prevention and intervention programmes with reference to existing evidence-based best practice programmes.

It also suggests:

  • Parent education on weaning, spoon feeding and importance of physical activity (before and after pregnancy) to be prioritised
  • A Healthy Eating Flag for schools to be introduced to complement the existing Active Flag system.
  • Physical Education to be re-instated as part of core curriculum subjects in primary and post primary secondary schools
  • The retail sector to remove vending machines from schools.
  • The BAI to increase the watershed from 6pm to 9pm for advertising of high fat, salt and sugar foods (HFSS) and drinks

Dr Sinead Murphy, consultant paediatrician at Temple Street Children’s University Hospital, said: “The Irish Government has no choice but to work to prevent and treat this ‘disease’ and tackle the ‘toxic environment’ that simultaneously restricts activity and stimulates higher calorie intake.”

Read: Does promotion of child weight gain lead to disease later in life?>

Excerpt

Childhood obesity is highly prevalent in the United States (U.S.) and has become a global epidemic. The recent national survey, the 2007–2008 National Health and Nutrition Examination Survey (NHANES) data showed that 17 percent of U.S. children and adolescents (ages 2–19) years were obese, and over 30 percent were overweight or obese. Childhood obesity leads to obesity in adulthood and many other serious health conditions, such as cardiovascular, metabolic, and psychosocial illnesses.

To assess the effectiveness of existing childhood obesity prevention efforts, the Johns Hopkins University Evidence-based Practice Center completed a systematic review on childhood obesity prevention studies conducted in high-income countries. This report, funded by the Agency for Healthcare Research and Quality (AHRQ), systematically reviewed seven Key Questions.

The draft Comparative Effectiveness Review evaluated 96 intervention studies reported in 113 articles with the following main conclusions:

  • The majority of studies in high income countries are conducted in schools.

  • School-based intervention can prevent overweight and obesity, especially those with a home intervention that targets both diet and physical activity.

Though the strength of evidence is moderate to high for school-based interventions, the limited number of studies and insufficient or low strength of evidence to support interventions in other settings made it difficult to conclude that interventions in other settings could effectively prevent childhood obesity. Based on the evidence gaps in these settings, we identified the following as Future Research Needs:

Future research is needed on interventions delivered in settings other than schools or home. Thus, future research is needed for all of the Key Questions except for Key Questions 1 and 2, and especially needed are studies of environmental and policy changes.

While there have been other reviews on the effectiveness of interventions on food and nutrition policies at school on changes in children’s diet and school food environments, there are still gaps in the literature on some aspects, such as the impact of regulations on food availability and its impact on obesity prevention. Only a few studies that we reviewed used social marketing to deliver messages on nutrition, physical activity and health. This approach might be integrated with other intervention components to create an atmosphere favorable to healthy and active lifestyles and related behavioral changes. Additionally, further testing of the value of consumer health informatics products for obesity prevention is needed. In addition, there is a lack of evidence on the impact of regional or national policies on childhood obesity prevention, including agriculture policy and regulations on food retailing and distributions.

Furthermore, further research might be conducted with stratified analyses on subgroups, such as by gender, age, race/ethnicity, or socioeconomic status. This will help us learn how different groups may respond differently to the same intervention, and help tailor future interventions to maximize their benefits.

There were methodological limitations of the reviewed studies which suggest that future research might improve upon the methods. Few of the studies we reviewed reported process evaluation, which would provide useful insight regarding why some studies might detect desirable effect of the intervention. More vigorous analytic approaches are desirable in future studies, to better analyze the repeated measures collected during follow-up, to control for confounders, and to test effect modification.

The studies we reviewed typically had limited followup and we could not know the sustainability of these interventions. Future studies need to design innovative approaches that have a high likelihood of sustainability; for example, studies using a community-based participatory approach. This may be designed to take advantage of other existing public health, government or other organization supported programs or try to gain more support and engagement from related key stakeholders.

The objective of this report is to prioritize the needs for research addressing gaps in the existing literature on the effectiveness of childhood obesity prevention programs by engaging expert stakeholders using a modified Delphi method.

This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care researchers and funders of research make well-informed decisions in designing and funding research and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of scientific judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical research and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances.

None of the investigators have any affiliation or financial involvement that conflicts with the material presented in this report.

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