In common with most of the developed world, Scotland is experiencing the obesity epidemic. Scotland has one of the highest levels of obesity in OECD countries; only the USA and Mexico having higher levels. In 2008, 26.8% of adults in Scotland were obese and 65.1% were overweight; for children the corresponding rates were 15.1% and 31.7%.1 In a BMA Scotland survey of members earlier this year, doctors ranked obesity as the most important public health challenge among children in Scotland.2
Overweight and obesity pose a serious threat to long-term health1. During childhood, obesity can be associated with asthma, type 2 diabetes, musculoskeletal problems and psychosocial impacts relating to stigma and bullying. There is also evidence of a high rate of unhealthy weight continuing into adulthood. Worryingly, the prevalence of type 2 diabetes is increasing rapidly in Scotland, with the largest part of the increase likely to be due to poor diet (specifically excess energy intake), low levels of physical activity and the resulting increase in levels of obesity.3
To give children the best start in life, early life interventions need to begin before and during pregnancy, continue through infancy, in early years settings such as nurseries and childminders and onto school. The early years offer the best opportunity to put in place healthy behaviours around food and physical activity which will be sustained into adulthood. Central to this is the involvement of families.1
In infancy there is evidence that breastfed babies show slower growth rates which may contribute to the reduced risk of obesity later in life shown by breastfed babies.4 Infants who gain weight rapidly in the first two years of life are more likely to be overweight later in childhood. There is also evidence to suggest that infants who are weaned onto solid foods at an early age (before 15 weeks) are more likely to be overweight later in childhood.5
The Government are committed to encouraging healthy behaviours around food and physical activity in the early years, including the implementation the forthcoming Maternal and Infant Nutrition Strategy1. In addition, NHS Boards have been tasked to deliver on a health improvement target for child healthy weight from 2008 to 2011 as part of the HEAT6 targets. The Heat 3 (H3) target, 'Achieve agreed completion rates for child healthy weight intervention programme', requires delivery of a specified number of child healthy weight interventions to children identified as being overweight (i.e. between the 91st and 99.6th body mass index (BMI) centile). This is a developmental target and a key component is the evaluation of interventions in order to contribute to the existing evidence base.
To support achievement of this target, NHS Grampian has developed an intervention for primary school aged children. This family centred, healthy living programme is called 'Eat, Play and Grow Well' (EPGW), it incorporates diet modification, physical activity and behaviour change. The programme in the city is being delivered by trained NHS staff e.g. community dietitians and school nurses, as either a 'one to one' or group programme. We continue to accept referrals for EPGW from general practice staff, school nurses, community paediatricians and RACH and families can self-refer.
In addition to this targeted programme, a whole class workshop, which covers key messages around physical activity and nutrition and incorporating a simple behaviour change tool, was delivered in schools. Examples of further work in the city to promote child healthy weight include:
If you require any information about child healthy weight work in the city please contact Hilary Bell, HEAL Co-ordinator, firstname.lastname@example.org, 551536.
1 Preventing Overweight and Obesity in Scotland - A route map towards healthy weight. Scottish Government 2010, www.scotland.gov.uk/Resource/Doc/302783/0094795.pdf
4 For example, Von Kries R et al. Breastfeeding and obesity: cross sectional study. BMJ 1999; 319:147-50, Gillman MW et al.
Risk of overweight among adolescents who were breastfed as infants. JAMA 2001; 285:2461-7, Singhal A, Lanigan J.
Breastfeeding, early growth and later obesity. Obesity Reviews 2007;8 (Suppl 1): 51-54.
5 Wilson AC, Forsyth JS, Greene SA et al. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 1998; 316:21-5.
6 Health improvement, efficiency, access and treatment (HEAT)