Preventing Childhood Obesity - Evidence Policy and Practice.pdf

CHAPTER 31
Working in p rimary c are
C. Raina Elley 1 and Karen Hoare 2
1 Department General Practice and Primary Care, School of Population Health, University of
Auckland, Auckland, New Zealand
2 School of Nursing and Goodfellow Unit, School of Population Health, University of
Auckland, Auckland, New Zealand
Summary and recommendations
for research and practice
• Primary care is an important setting to assess and
reduce risk of childhood obesity during the antenatal,
infancy, childhood and adolescent stages.
• Maternal nutritional advice, smoking cessation and
early detection and management of gestational diabetes
during the antenatal period, as well as infant
nutritional advice and breastfeeding promotion,
address risk factors of childhood and subsequent
obesity.
• Trajectories of weight gain in infants, and body
mass index ( BMI ) gain in children and adolescents,
are the best available assessment tools to identify the
risk of childhood obesity.
• There is little evidence of effective interventions in
primary care to prevent or treat childhood obesity
long term, but effective interventions to improve
nutrition, increase physical activity and reduce
sedentary behaviors in the short to medium term
exist.
• Multi - component programs in health care settings
with intensive and long - term follow - up and family
involvement seem most promising, but more
research is needed.
• Systematic screening and implementation of evidence
- based management of children at risk of
obesity are needed in primary care, which may
Preventing Childhood Obesity. Edited by
E. Waters, B.A. Swinburn, J.C. Seidell and R. Uauy.
© 2010 Blackwell Publishing.
require changes at a policy, as well as practice,
level.
• Primary care collaboration with community groups,
schools, industry and local authorities may be effective
in reducing the risk of childhood obesity at a
community level.
Introduction
Childhood obesity is of central concern to primary
care professionals, both for the immediate psychological
and physical effects it may have for the child, but
also for the increased likelihood of the child developing
adult obesity and the increased risk of diseases such
as Type 2 diabetes, cardiovascular disease and cancer.
The risk of childhood obesity begins prior to the birth
of the child, with genetics as well as the antenatal environment
influencing risk of later obesity. Primary care
has a potential role to play at this stage. During infancy
and childhood, primary care professionals also have
numerous opportunities to assess, manage and
monitor potential overweight and obesity in children,
from the times of postnatal care and breastfeeding to
immunization visits, preschool checks and during
visits for minor illnesses. This chapter addresses each
stage, discussing assessment, and suggesting ways of
translating evidence into primary care at a practice and
policy level to reduce childhood obesity.
Antenatal and i nfancy
Assessment and m onitoring
Maternal nutrition and well - being are areas where
health professionals may influence subsequent
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