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Alarming surge in severe obesity among adolescents in Ireland
Since 2018, Ireland has witnessed a tenfold increase in referrals of adolescents to specialised obesity clinics, highlighting a critical and worsening health issue among young people. Dr. Órla Walsh, a paediatric specialist at Children’s Health Ireland in Temple Street, has expressed deep concern over the rising number of young patients exhibiting severe symptoms of obesity. Over the past six years, the situation has escalated, with Dr. Walsh noting the overwhelming demand for treatment at her medically-led complex obesity clinic. “I’m running a clinic that is merely the tip of the iceberg. It is a tertiary clinic, which means we only see cases of severe complex obesity that also present with at least two other complications. Since its inception last year, our waiting list has grown to include 419 children,” Dr. Walsh explains.
The pervasive influence of obesity on both the physical and psychological well-being of children is profound. Dr. Walsh stresses that neither the child nor their family is at fault, pointing to genetic factors and an environment that promotes obesity. “The relentless marketing by food and beverage companies significantly contributes to the problem. Our children are inundated with advertisements daily, pushing fast food, processed items, and oversized portions,” she remarks.
A study presented in Dublin last year offered a glimmer of hope, showing promising results from weekly weight loss injections of semaglutide, a medication under the brand names Wegovy and Ozempic. Nearly half of the children treated no longer met the criteria for clinical obesity following the treatment. However, access to such medications is restricted; adolescents can only use these drugs if they are diabetic or if they can afford private treatment, costing approximately £200 a month.
Dr. Walsh highlights the inequality in access to treatment, especially among socioeconomically disadvantaged adolescents. She contrasts the situation in Ireland with international standards where adolescents have access to weight loss medications and bariatric surgery, which are not readily available in Ireland. Efforts have been made to urge the Health Service Executive (HSE) to provide weight loss medication freely to children suffering from complex obesity. “Treating these adolescents can prevent complications later in life. Investing in adolescent health yields a triple benefit: improving their current and future health, and potentially the health of their future children,” Dr. Walsh advocates.
The paediatrician also runs a general adolescent clinic and sees a troubling trend of obesity-related medical complications such as hypertension, pre-diabetes, and obstructive sleep apnoea, along with significant psychiatric comorbidities. “The stigma, shame, and bullying associated with obesity severely affect their mental health, leading to anxiety, depression, and often undiagnosed eating disorders,” she reveals.
Further stressing the urgency, a 2022 international report indicated that Ireland had the highest rate of risk factors for non-communicable diseases in European adolescents. The study surveyed nearly 500,000 children aged between 11 and 17, revealing that 63% of Irish adolescents exhibited four or more risk factors such as physical inactivity, poor diet, and substance use, compared to just 13% of their Swedish counterparts.
Dr. Walsh reflects on her recent observations in Sweden, where a healthier environment for children starkly contrasts with the situation in Ireland. “Sweden offers extensive support for child health, including widespread access to playgrounds, pools, and government-supported child care, which contributes to a healthier societal setup,” she notes.
The article concludes with the HSE’s response on the current status of obesity treatments under consideration for reimbursement, including medications like Saxenda and Wegovy, which are aimed at adults and potentially extendable to adolescents.
Dr. Walsh’s observations and the data presented underscore a dire need for systemic change to combat adolescent obesity in Ireland, a public health challenge that has only intensified in the wake of the global pandemic.
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New study finds financial rewards enhance obesity interventions for teens
A recent study has demonstrated that adolescents suffering from severe obesity achieve a more significant reduction in body mass index (BMI) when meal-replacement therapy is supplemented with financial incentives, as opposed to meal-replacement therapy alone. These findings have been documented in an article published by JAMA Pediatrics.
Justin Ryder, PhD, an associate professor involved in both the Surgery Division of Pediatric Surgery and Pediatrics, collaborated on this research. Ryder highlighted the importance of developing more effective treatments for severe obesity, which currently impacts approximately 20% of children and adolescents in the U.S. The Centers for Disease Control and Prevention defines severe obesity as having a BMI at or above the 95th percentile for one’s age and gender. This condition predisposes individuals to a host of future health issues including adult obesity, cardiovascular diseases, and type two diabetes.
Previous studies have shown that meal replacement therapy (MRT), which replaces regular meals with controlled, pre-portioned meals totalling 1,200 calories per day, tends to be more effective than traditional lifestyle changes for reducing BMI in young people with severe obesity. In light of these findings, the recent study aimed to assess whether the addition of financial incentives would enhance the effectiveness of MRT.
“There’s literature for adults that supports that tying in financial incentives to weight loss or physical activity programs increases adherence, and so we wanted to see whether or not adding financial incentives to a behavioural/nutrition weight loss program using meal replacement therapy would increase adherence and through adherence, increase the efficacy of the treatment,” explained Ryder.
The research involved 126 adolescents, divided into two groups of 63 participants each. For one year, one group received MRT along with financial incentives based on their weight reduction from baseline, while the other group received only the MRT. At the end of the 52-week period, the group that received both MRT and financial incentives exhibited a greater decrease in BMI—by 6 percentage points—and a higher reduction in total body fat mass—4.8 kilograms compared to their counterparts who only received MRT.
Ryder added, “Using a cost-effectiveness analysis, we looked at mean fat mass lost between the two treatments and found that despite providing the additional meal replacements for per pound lost, it was cost-effective to do so.”
The study’s authors also noted the need for the development of interventions that maintain effectiveness beyond a one-year timeframe. “While financial incentives plus MRT appears to be a longer-term strategy than MRT alone, treatment withdrawal will likely result in BMI increase. As such, research is needed to identify strategies that are scalable and feasible in the long term given the chronic nature of obesity,” they mentioned.
This pivotal research was funded by multiple grants from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health National Center for Advancing Translational Sciences. Financial support for the meal programs was provided by Healthy For Life Meals, contributing to the resources necessary for this comprehensive study.
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New clinic for childhood obesity to open in Surrey, UK
Surrey is set to benefit from a pioneering initiative aimed at combating childhood obesity, as revealed by the BBC. The newly established Complications from Excess Weight (CEW) clinic, a part of Ashford and St Peter’s Hospitals NHS Foundation Trust, is preparing to welcome its first referrals in early autumn, 2024.
This service forms part of a broader national strategy, initiated by NHS England in 2022, to open 30 dedicated clinics across the country. These clinics are designed to offer comprehensive support services, including mental health care and nutritional guidance, to children grappling with obesity.
The teams at these clinics will consist of multidisciplinary professionals such as consultant paediatricians, dietitians, and psychologists, who are committed to a holistic treatment approach for the affected children and their families.
Vicky Williams, the Associate Director of Women and Children’s Services at Surrey Heartlands Integrated Care System, highlighted the urgent need for such services: “Obesity affects one in four children in the UK and it can increase the likelihood of a child developing serious health issues.” She emphasised the importance of early intervention and continuous support to prevent future complications. Williams expressed optimism about the local availability of the service, stating, “It means that, in future, children and young people will be referred to a specialist service in Surrey, closer to home, instead of having to travel further away – so it’s good news for families in Surrey.”
Furthermore, the NHS Frimley Integrated Care Board mentioned that currently, children eligible for the CEW clinic’s services in its area are receiving care from consultants based in Southampton. Plans are underway to establish a similar clinic closer to home for patients from Surrey Heath and Farnham, North East Hampshire, and East Berkshire.
The urgent need for such clinics is underscored by alarming statistics; NHS leaders have noted that obesity impacts one in four children in the UK, potentially leading to severe health problems such as Type 2 diabetes, liver disorders, and early onset heart disease. Data from the latest child measurement programme in schools indicates that nearly 13% of children assessed in Surrey during the 2022/23 school year were living with obesity by the time they reached year six of primary school.
Previous governmental measures include the 2018 imposition of a tax on high-sugar soft drinks and limitations on the promotion of unhealthy products in supermarkets across England.
The new Labour government has expressed a firm commitment to addressing this health crisis. A Department for Health and Social Care spokesperson detailed forthcoming measures: “We will introduce tight restrictions on advertising junk food, alongside banning children from being able to purchase sugary, high caffeine energy drinks. By building a healthier society, we will help to build a healthy economy.” This statement underscores the government’s proactive stance on cultivating a healthier future for the next generation.
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US panel advises intensive behavioural counselling for children with obesity
A panel of experts in the United States has revised its guidance for paediatric obesity screening, with new recommendations highlighting the necessity for intensive behavioural interventions for children over the age of six who have a high body mass index (BMI). This update, issued by the U.S. Preventive Services Task Force, was published in the Journal of the American Medical Association (JAMA) Tuesday, 18th of June, 2024.
Replacing their 2017 advice, the Task Force previously suggested that primary care providers merely screen children for obesity. The urgency of the update is underscored by data showing that nearly 20% of U.S. children are classified as having obesity, a condition defined as having a BMI at or above the 95th percentile for a child’s age and sex. The prevalence of obesity is notably higher among Latino, Native American, and Black children, as well as those from lower-income backgrounds.
Dr. Wanda Nicholson, Chair of the Task Force and a professor of prevention and community health at George Washington University, emphasised the complexity of factors contributing to childhood obesity but pointed to strong evidence supporting intensive counselling. “Fortunately, we know that there are proven ways that primary care clinicians can help many children and teens to address the high BMI,” Dr. Nicholson stated. She highlighted that “Our evidence shows that the behavioural counselling intervention of 26 or more hours can help them achieve a healthy weight and improve their quality of life.”
Notably, the new recommendations do not advocate for the prescription of weight-loss drugs such as Ozempic or other GLP-1 medications for children, citing insufficient research on the benefits and potential harms of such treatments in younger populations. “We’re calling for more research into both the benefits and potential harms of medication therapy for kids and teens,” Dr. Nicholson explained.
The advised behavioural interventions typically encompass three core elements: education on healthy eating habits, counselling on weight-related behavioural changes—including goal-setting—and supervised exercise sessions.
The Task Force has awarded these recommendations a ‘B’ grade, reflecting a high degree of confidence in the moderate benefits of the interventions. Importantly, this grade also mandates that the recommended services be covered by most private health insurance plans in the U.S. without a copayment, as per federal law.
Despite the clear benefits, Dr. Nicholson acknowledged the challenges these recommendations might pose for affected families. “Twenty-six hours of counselling is a commitment both by the child or teen and their parents,” she remarked, noting that obstacles such as finding a provider who offers intensive counselling or reliable transportation to sessions could limit access to these essential services.
Dr. Nicholson expressed optimism about the potential outcomes of these investments in health. She mentioned that most of the research reviewed by the Task Force spanned six to twelve months of counselling, but stressed the need for further studies to explore the impacts of longer-term counselling initiatives.
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Research reveals fathers’ diet affects child health before birth
A pioneering study conducted by Helmholtz Munich and the German Center for Diabetes Research has shed new light on the significant influence of paternal diet and body mass on the health of future generations even before conception occurs. This groundbreaking research offers vital insights that could lead to the development of targeted preventive health strategies for men planning to father children. The crux of the findings suggests a direct correlation between a father’s nutritional habits and the reduced risk of offspring developing metabolic conditions such as obesity and diabetes in later life.
Dr. Raffaele Teperino, who leads the Environmental Epigenetics research group at Helmholtz Munich, spearheaded this inquiry along with his team. Their research primarily focused on mitochondrial tRNA fragments (mt-tsRNAs) present in sperm, which are crucial in the epigenetic transmission of health characteristics, effectively regulating gene expression that impacts the health trajectory of children.
The empirical evidence was derived from the LIFE Child cohort data, encompassing over 3,000 families. Analysis from this cohort illustrated a clear link between paternal body mass and children’s propensity towards obesity and metabolic diseases, a connection that remains irrespective of maternal weight, genetic factors, or environmental influences.
To corroborate these findings, Dr. Teperino’s team undertook experimental studies on mice. These experiments involved feeding mice a high-fat diet and observing the resultant effects on their reproductive systems, particularly focusing on the epididymis where sperm matures. The findings were striking: offspring of mice fed a high-fat diet exhibited a marked increase in susceptibility to metabolic diseases.
Further laboratory studies involved creating embryos via in-vitro fertilisation using sperm from these diet-affected mice. Remarkably, mt-tsRNAs from the sperm of high-fat diet mice were detected in the early stages of these embryos, significantly altering gene expression which, in turn, influenced the development and health of the resulting offspring.
Professor Martin Hrabě de Angelis, co-author and Research Director at Helmholtz Munich, emphasised the importance of these findings: “Our research confirms that acquired phenotypes, like diabetes and obesity, can be epigenetically transmitted across generations. This underscores epigenetics as a molecular bridge that connects environmental factors with genetic frameworks across generational lines, a process evident not only through maternal lineage but, importantly, through paternal contributions as well.”
This research underscores the critical role of paternal health in the pre-conception phase and presents a compelling case for enhanced preventive health strategies targeting prospective fathers. These strategies, particularly focused on dietary guidance, could significantly mitigate the risk of obesity and diabetes in children, enhancing generational health outcomes.
The study also touches on the broader implications concerning mitochondrial functions. Commonly recognized as cellular powerhouses, mitochondria possess their own DNA (mt-DNA), which orchestrates protein production within mitochondria through mt-RNA and is traditionally inherited maternally. This research brings to light the lesser-known fact that fathers also contribute mt-tsRNAs during fertilisation, which play a role in the epigenetic regulation of gene expression in early embryos. This epigenetic influence by paternal mt-tsRNAs not only underscores their role in shaping the mitochondrial function but also highlights their indirect yet pivotal influence on the metabolic health of their children.
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Social media a “powerful” tool for obesity awareness amongst teenagers
Amid the rising global challenge of obesity, particularly among adolescents, there emerges an “urgent necessity” to leverage social media for disseminating scientific knowledge about obesity. This call to action was highlighted by Dr. Antonella Franceschelli, MD, PhD, at the European Congress on Obesity (ECO) 2024 in Venice, Italy. Dr. Franceschelli, affiliated with the UniCamillus International Medical University in Rome, stressed the significant influence that social media holds over young individuals.
Dr. Franceschelli’s team conducted an analysis focusing on the impact of obesity-related content on TikTok. Between 2021 and 2024, 108 videos from the account ‘Dr Anthos’ garnered a staggering 4631 views, averaging 42,495 views per video. A notable highlight was a video on the glucagon-like peptide 1 receptor agonist semaglutide, which achieved nearly a million views. This indicates a strong interest and engagement among the youth regarding obesity treatments and scientific discussions online.
The growing prevalence of obesity requires innovative strategies, particularly as over 90% of teenagers actively engage on social media platforms. Brands frequently target this demographic with food and beverage promotions, which can have mixed impacts on young consumers’ health, contributing to obesity, hypertension, and type 2 diabetes. However, Dr. Franceschelli suggests that this same medium offers immense potential to promote healthy eating and obesity awareness among youth.
Different platforms like TikTok, Instagram, and Facebook serve as powerful tools for medical professionals to reach out to the public and educate them on new therapeutic advancements. Each platform’s unique features provide distinct opportunities for effective communication. The ‘Dr Anthos’ TikTok account serves as a prime example, offering short videos about obesity management, including dietary advice, exercise tips, and medical treatments, alongside live Q&A sessions with healthcare experts. These videos especially resonate with audiences, with topics on obesity medication averaging 135,945 views per video and healthy eating tips reaching up to 10,262 views.
Live Q&A sessions have particularly facilitated direct interaction between specialists and the public, with some discussions attracting up to 2000 participants. These interactions have proven impactful, prompting significant increases in appointments for obesity treatment following these sessions. Dr. Franceschelli underscored the importance of creating tailored, constantly updated content on social media to maintain effective communication and engagement.
Additionally, Dr. Franceschelli advocated for the involvement of a social media consultant to refine the approach of health professionals online, ensuring that the content is communicated ethically and effectively. She also highlighted the personal commitment required, dedicating at least an hour daily to interact with patients and colleagues through these platforms.
Parallel research presented by Dr. Franceschelli at the congress explored the psychological aspects of obesity, particularly through the lens of social media profile images, such as those on WhatsApp. An analysis of 59 patients revealed a tendency among individuals with severe obesity to choose profile pictures that obscure their physical appearance, opting instead for images of pets, family, or landscapes. This behaviour suggests potential body dysmorphic disorder, a psychological condition where individuals perceive themselves as overweight, despite reality, often leading to shame and anxiety.
This insight into the psychological dimensions of obesity underscores the necessity of a holistic treatment approach, incorporating cognitive behavioural therapy and other psychological interventions along with medical and nutritional strategies.
Janet Lydecker, PhD, from Yale University, reflected on the broader implications of disseminating research via social media. She emphasised the importance of interrupting the flow of non-evidence-based content with scientifically validated information. However, she also cautioned about the potential for misinformation and the challenges audiences face in discerning reliable content online. Social media can propagate weight biases and misinformation, making it imperative for content creators to monitor how their contributions are interpreted and used.
This detailed examination at ECO 2024 illustrates the critical role of social media in confronting the obesity epidemic by fostering informed discussions and providing accessible educational content to the youth, potentially steering public health in a positive direction.
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Severe obesity in early childhood could halve life expectancy, study shows
A groundbreaking study revealed at the European Congress on Obesity in Venice, Italy, on 12-15 May, 2024, has provided a quantitative analysis on how childhood obesity affects life expectancy and long-term health. This research, conducted by stradoo GmbH, a life sciences consultancy based in Munich, Germany, involved collaboration with experts from universities and hospitals across the UK, Netherlands, France, Sweden, Spain, the U.S., and Germany. Dr. Urs Wiedemann of stradoo presented these findings, highlighting the critical influence of obesity’s onset age, its severity, and its duration on lifespan.
The study shows that early-onset obesity has particularly severe consequences. For instance, a four-year-old with severe obesity (BMI Z-score of 3.5), who does not manage to reduce their weight, is projected to have a life expectancy of just 39 years, nearly half the average lifespan.
Dr. Wiedemann noted the sporadic nature of existing data on the significant lifespan reduction associated with childhood obesity and its potential health complications, such as cardiovascular diseases and type 2 diabetes. The study aimed to refine our understanding of these impacts to better shape preventative strategies and treatment approaches, ultimately extending lifespan and enhancing quality of life.
To achieve this, the research team developed a model focused on early-onset obesity. This model considered several critical variables, including the age when obesity begins, the duration of obesity, irreversible health risks that persist despite weight loss, and the severity of obesity, measured by BMI Z-scores.
BMI Z-scores, which adjust body mass index values for age and gender, were central to the analysis. For example, a 4-year-old boy with a typical height of 103 cm and a weight of 19.5 kg would have a BMI Z-score of 2, marking the onset of obesity. More severe cases, like a child of the same age and height weighing 22.7 kg, would have a BMI Z-score of 3.5, indicative of severe obesity.
The findings were supported by data from 50 clinical studies involving over 10 million participants, with approximately 2.7 million aged between 2 and 29. This large-scale data analysis underscored the heightened risk of developing comorbidities such as type 2 diabetes and cardiovascular diseases with higher and earlier BMI Z-scores.
For instance, a child with a BMI Z-score of 3.5 at age 4, without weight loss, faces a 27% likelihood of developing type 2 diabetes by age 25 and a 45% chance by age 35. In comparison, a child with a BMI Z-score of 2 at the same age would have significantly lower risks (6.5% by age 25 and 22% by age 35).
The research also demonstrated the life-extending potential of early weight loss. A child with severe early-onset obesity (BMI Z-score of 4 at age 4) who does not lose weight would have an expected lifespan of 37 years and a 55% risk of developing type 2 diabetes by age 35. Conversely, reducing their BMI Z-score to 2 by age 6 could increase their lifespan to 64 years and lower their diabetes risk to 29%.
The findings also highlighted the greater benefits of earlier weight loss over delaying weight reduction. However, the model did not consider certain variables such as the underlying causes of obesity, genetic factors, or the complex interplay of different comorbidities, which may affect the outcomes.
In conclusion, Dr. Wiedemann stressed the severe impact of childhood obesity on longevity and health, advocating for early intervention and consistent management to prevent the onset of severe health conditions. The study reinforces the critical nature of childhood obesity as a life-threatening condition that requires immediate and sustained medical attention.
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Study reveals heart damage risks in sedentary children
A recent study has highlighted alarming trends in heart health among children and young adults, revealing that excessive sedentary behaviour, commonly referred to as being a ‘couch potato’, could lead to an enlarged heart. This condition significantly increases the risk of heart attacks, strokes, and premature mortality.
Researchers have identified that sedentary habits account for up to 40% of the total increase in heart size from the ages of 17 to 24. The study also discovered that limited physical movement contributes to the enlargement of teenagers’ hearts independently of other contributing risk factors such as obesity or hypertension.
Andrew Agbaje, an associate professor of clinical epidemiology and child health at the University of Eastern Finland in Kuopio, referred to childhood and teenage sedentary behaviour as a “ticking time bomb.” Agbaje, in a recent press release, stressed the severity of the health threats posed by inactivity during youth. “There is growing evidence that childhood sedentariness is a serious health threat that warrants urgent attention,” he stated.
Conversely, the study noted that children who participate in regular light physical activity can mitigate the risk of heart enlargement significantly. Such activities have been found to reduce the increase in heart mass by 49%. “Engaging in three to four hours of light physical activity daily is an effective countermeasure to sedentary habits,” Agbaje explained.
Activities beneficial for cardiovascular health include playing outdoor games, walking pets, running errands on foot, cycling to local destinations, strolling in parks, gardening, and playing casual sports like basketball, soccer, and frisbee.
The study also observed that children who engage in more intense workout routines might see an approximate 5% increase in heart mass, which is attributed to strengthening of the heart muscle rather than harmful enlargement.
This research followed nearly 1,700 participants in the UK from the age of 11 to 24. To monitor their physical activity levels, participants wore motion-tracking devices around their waists for periods ranging from four to seven days at ages 11, 15, and 24. Initial data showed that children spent an average of six hours a day in sedentary activities, which alarmingly increased to nine hours by young adulthood.
The study further incorporated echocardiograms taken at ages 17 and 24 to assess heart structure and function, revealing significant insights into the impact of lifestyle on cardiac health.
Published on the 7th of May, 2024 in the European Journal of Preventive Cardiology, this study underscores the critical need for integrating more physical activity into the daily routines of young people to combat the adverse effects of a sedentary lifestyle on heart health.
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Research shows effective parental approaches to managing children’s avid eating behaviours
A recent study, published in the journal Appetite, provides an in-depth exploration of how parents cope with their preschool-aged children’s intense eating behaviours, which are often characterised by an elevated responsiveness to food cues. These eating patterns are closely associated with risks of overweight and obesity in children, making the understanding of parental experiences and strategies essential for developing tailored interventions aimed at promoting healthy eating habits.
The research highlights the significance of recognising eating behavioural patterns in children rather than focusing solely on individual eating behaviours. Through the use of Latent Profile Analysis, researchers have identified various eating profiles among preschoolers. These profiles are typically marked by a pronounced enjoyment of food, emotional overeating, minimal fussiness, reduced sensitivity to satiety signals, and a rapid pace of eating. Genetic factors play a substantial role in these appetitive traits, which are also influenced by environmental interactions, thereby affecting the expression of eating behaviours and the potential for obesity.
Parental feeding practices are pivotal in shaping these behaviours, with key practices involving coercive control, structured feeding, and the support of child autonomy. Qualitative research underscores the challenges parents face in managing feeding interactions, especially with children prone to obesity.
The study forms part of the “Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively” (APPETItE) programme. It adheres to pre-registration and qualitative research reporting guidelines, involving parents of 3-5-year-old children who exhibit these intense eating behaviours. A group of 15 parents participated, providing valuable insights through interviews conducted via video calls. Data collected included demographics, food security, and detailed eating behaviour profiles.
Thematic analysis was employed to inductively scrutinise the interview transcripts, with a focus on parental experiences. This process was rigorous, involving regular discussions and maintained reflexivity to ensure integrity in the analysis. The approach followed the systematic six-step process outlined by Braun and Clarke, fostering a comprehensive understanding of the feeding practices applicable to children with intense eating behaviours.
Four primary themes emerged from the analysis:
- Persistent Hunger: Parents noted their children’s continuous requests for food, with some perceiving this as a natural trait, while others expressed concern. Despite frequent eating, the level of satiety control varied among children, with some lacking a clear ‘stop button’.
- Duty of Parenthood: Parents expressed a strong sense of responsibility to keep their children sufficiently fed and to limit exposure to unhealthy foods. They employed various strategies to regulate food intake, focusing on health implications and setting boundaries.
- Instilling Healthy Habits: There was a concerted effort by parents to foster healthy lifelong eating patterns, provide balanced diets, and educate children on the impact of food on health. Monitoring of food intake throughout the day was common, alongside promoting healthier alternatives and encouraging children’s autonomy in food choices.
- Navigational Strategies: Parents described ‘picking their battles’ by establishing clear rules for eating times and occasionally using coercive feeding practices to alleviate personal stress. They balanced routine with flexibility, sometimes allowing children autonomy in food choices.
The research highlights the effectiveness of an authoritative feeding approach that blends control with warmth and responsiveness. However, some parents also resorted to emotional feeding and the use of food as a reward, which could reinforce intense eating behaviours.
Despite providing rich qualitative insights, the study’s findings are limited by a lack of diversity in the sample and potential self-selection bias, which may affect the generalisability of the results. Future research should incorporate objective measures, such as body mass index, to enhance understanding.
In conclusion, this study illuminates the complex dynamics of feeding children with intense eating behaviours and advocates for responsive, nuanced approaches to foster healthy dietary habits.
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Study reveals pandemic’s role in escalating childhood obesity in Europe
A recent study, spanning 17 European nations and encompassing over 50,000 children surveyed between 2021 and 2023, illuminates the stark consequences of the COVID-19 pandemic on childhood obesity. This period, following the initial global shutdowns in March 2020, witnessed significant shifts in children’s lifestyles, particularly among those aged seven to nine.
The findings reveal a distinct trend towards increased sedentary behaviour, with a notable rise in screen time and a corresponding decline in outdoor activities. Specifically, 36% of children reported spending more time engaging with televisions, online games, and social media during weekdays, while 34% noted increased recreational screen use over weekends. Simultaneously, there was a 28% reduction in outdoor activities during weekdays.
Dr. Kremlin Wickramasinghe, the WHO/Europe’s Regional Adviser for Nutrition, Physical Activity and Obesity, expressed a nuanced view of the data. While some positive developments, such as enhanced family cohesion through increased home-cooked meals and shared meal times, were reported, he also highlighted worrying trends. These include not only the rise in sedentary lifestyles but also a marked decline in children’s happiness and well-being, with 42% feeling less content and one in five children experiencing heightened frequencies of sadness.
The regional disparities underscored by the report prompted Dr. Wickramasinghe to call for immediate action across Europe to address these concerns through the promotion of healthier environments that encourage nutritious eating and physical activity.
Dr. Ana Rito, Head of the WHO Collaborating Centre for Nutrition and Childhood Obesity and co-author of the study, stressed the importance of the findings. She believes that providing tangible evidence of the negative outcomes stemming from pandemic-induced behavioural changes is crucial for preparing more effectively for future health crises. This evidence, she argued, is vital for deploying strategies that are both more sympathetic and more robust.
As the pandemic has accentuated the urgency of tackling childhood obesity, WHO emphasised the need for comprehensive strategies that prioritise healthy eating and physical activity among children. Among the recommended interventions are the implementation of marketing restrictions and taxes on unhealthy food products, the introduction of clear nutritional labelling, and the development of school-based programmes aimed at improving diets and encouraging physical activities.
The report serves as a critical tool, according to WHO, for informing and enhancing current policies, as well as shaping necessary plans to manage future emergencies and pandemics that might disrupt educational processes or lead to school closures. The overarching goal is to ensure that the strides made in combating childhood obesity are not only maintained but accelerated in the face of global challenges.
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Heightened risk of iron deficiency in children with overweight and obesity
A comprehensive study conducted by the University of Leeds’ nutritional scientists has revealed a significant correlation between overweight and obesity in children and young people and an increased risk of iron deficiency. The research, spearheaded by the School of Food Science and Nutrition, involved a meticulous analysis of numerous medical studies across 44 countries, focusing on individuals under 25 years old. These studies assessed levels of essential vitamins and minerals, including iron, in relation to body weight.
The findings indicated that iron deficiency is prevalent among both underweight and overweight youths. Professor Bernadette Moore of the School of Food Science and Nutrition highlighted the broader implications of these findings, suggesting that “Iron status may be the canary in the coalmine, signalling deeper health issues like prolonged inflammation, which is linked to serious conditions including heart disease, diabetes, and fatty liver.”
Unlike deficiencies in zinc and vitamin A, which were primarily found in undernourished children, iron deficiency in overweight children appears to stem from inflammation that disrupts iron absorption. This research, funded by the UK Biotechnology and Biological Sciences Research Council and published in the ‘BMJ Global Health’ journal on 10 May 2024, marks a significant advancement in understanding the nutritional challenges faced by children with obesity.
The impact of iron deficiency on cognitive functions such as attention, concentration, and memory is well-documented, with potential links to conditions like autism and ADHD. This study is pioneering in its focus on the association of iron deficiency with childhood obesity, an area previously unexplored.
Xiaomian Tan, a doctoral researcher at the University, emphasised the importance of this study, stating, “While the link between undernutrition and deficiency of crucial micronutrients in children’s growth is established, the risks posed by obesity—leading to what can be described as a hidden form of malnutrition—are less understood.”
The study also addresses the broader socio-economic implications. Historically, nutrient deficiencies have been associated with hunger, especially in lower- and middle-income countries where they contribute significantly to child mortality. However, the phenomenon of ‘hidden hunger’—nutrient deficiencies in the context of an energy-dense but nutrient-poor diet—is becoming more prevalent in both affluent and developing nations. This is often linked to diets dominated by ultra-processed foods in wealthier countries and limited dietary variety in poorer regions.
The dual burden of malnutrition and overnutrition is particularly pressing in regions like Africa and Asia, which are undergoing rapid economic changes and dietary shifts towards Western high-sugar, high-fat foods. Between 2000 and 2017, the number of overweight children under five years old rose significantly in these continents, alongside an increase in stunting.
Professor Moore also pointed out the alarming trend in the UK, where one in three children by age 11 have overweight or obesity, which compounds the risk of inflammation-driven iron deficiencies. She advocates for increased physical activity and dietary improvements to mitigate these risks.
The call for further research is clear, with an emphasis on the need for more comprehensive studies that address micronutrient deficiencies within the context of the growing global epidemic of obesity, particularly in regions currently lacking detailed data.
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Healthcare professionals struggle to tackle childhood obesity due to insufficient training
In the face of the escalating childhood obesity crisis, healthcare professionals are encountering significant hurdles, primarily due to a glaring deficiency in training and operational bandwidth. This predicament was illuminated through a study published in the British Journal of General Practice, wherein researchers from the University of Birmingham conducted thorough interviews with healthcare professionals (HCPs) to delve into their experiences with aiding families in the battle against childhood obesity.
One revealing testimony from the study highlighted the practical challenges faced by HCPs: “I had one mum and her child was overweight, but she was a young parent and she actually didn’t know how to cook the dinners and, yeah… we spent a lot of time with her giving her worksheets, how to cook, make potato and beans rather than going to the fish and chip shop.” This account underscores the multifaceted nature of the obesity issue, which extends beyond medical intervention to encompass educational and lifestyle components.
The research unearthed several themes that have frustrated healthcare professionals in their efforts to support families. Among these was the constrained time and training available to HCPs, compounded by a scarcity of specialist services and limited access to routinely collected data on children’s weight. A poignant concern was the risk of eroding trust by broaching the sensitive subject of weight, alongside the need to navigate cultural sensitivities carefully.
Miranda Pallan, Professor of Child and Adolescent Public Health at the University of Birmingham and senior author of the paper, brought to light the pressures faced by healthcare professionals. “This study brings a fresh awareness about the pressures that healthcare professionals face, including the limitations that they face in trying to provide preventative care for young people,” she remarked, emphasising the barriers to offering effective guidance and support.
Echoing these concerns, Dr Ellen Fallows, a sessional GP with a keen interest in childhood obesity, noted a pervasive reluctance to address the root causes, primarily due to a lack of time, knowledge, and incentives among healthcare professionals. “Everyone thinks it is everyone else’s problem, no one is actually talking about the root causes with parents – which is predominantly food quality,” Dr Fallows observed. She advocated for the wider availability of quality training resources as a vital first step in equipping HCPs to tackle this issue.
The study also touched upon the contentious use of BMI centiles for assessing children’s weight issues, revealing a division among healthcare professionals. Some, including doctors and primary care nurses, admitted to being less familiar with BMI centiles and questioned its suitability for younger children. One participant noted, “We used to use the [height and weight] centile charts and actually the BMI will put a lot more children in an overweight category than the centile charts will.”
The collective insights from this study underscore a pressing need for a strategic overhaul in how childhood obesity is approached within the healthcare system. While the direct teaching of nutritious cooking to families might be beyond the scope of HCPs, the findings advocate for an enhanced support framework, enabling practical advice and referrals to specialist services. As childhood obesity continues to pose a serious, multifaceted challenge, the call for a comprehensive strategy that includes better training, resources, and a unified effort to address its root causes has never been more urgent.
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