ࡱ> (*#$%&'G 5bjbjَ ]03]88880,\L8T5n  " 5555555$79l?5|?5 8 0R 5885j "!2"5 $t88Ll4HSunday, April 23, 2006 SUBMISSION To the Health Committee on the Inquiry into Obesity and Type Two Diabetes in New Zealand Introduction 1. This submission is from Professor Barry Taylor on behalf of the Paediatric Society of New Zealand. 2. I wish to appear before the committee to speak to our submission. I can be contacted at: 021 616 229 or 03 4740 999 ext 8222. We wish that the following also appear in support of our submission: Dr David Graham, Community and General Paediatrician, Waikato DHB, tel 07 839 8899, mobile 0274 521 989. 2. Dr Nikki Blair, Community Paediatric Registrar, Auckland DHB contact 021 376 455. The Paediatric Society of New Zealand is a multi-disciplinary organisation of Child Health Professionals. Its Mission Statement is: The Paediatric Society of New Zealand believes all children and young people have the right to attain optimal physical, mental and social health and well being. By working as a co-ordinated national network of health professionals the Society dedicates its efforts and resources to this end. Our motto is: Health of our children: wealth of our nation We have a total membership of 383 consisting of Paediatricians 268, Nurses 60, Physiotherapists 6, Speech Therapists 2, Psychologists 4, Pharmacists 3, Midwives 1, GP's 1, Surgeons 2, Psychiatrists 7, Teachers 3, Social Workers 11, Librarian 1, Occupational Therapist's 7, Paediatric Dentistry 3, Dietitian 1, Research/Financial/Admin/Other 3. Summary Escalation of obesity with health consequences within childhood as well as for adulthood combine active monitoring of the epidemic with recruitment into studies to determine what works and what doesnt. The rapid escalation of childhood overweight and obesity in NZ (see figure 1), which mirrors that in most OECD countries, poses major problems both in childhood (self image, teasing, bullying, obstructive sleep apnoea, type 2 diabetes), but even more concerning and costly, is a major threat to long-term health in adult life. In 2003, the rates of over-weight and obesity in children have reached 30% of the childhood population (see figure 2). The need for NZ government and regional authorities, as well as NGOs and all citizens to begin to address this issue is clear. Methods of monitoring the epidemic more actively, possibly linked with primary health care and the giving of vaccinations, are needed and could also be used to identify those who might enter studies to determine what is effective or not. This is needed as most parents do not recognise their children as over weight. Effective interventions are not clear but must especially address Maori and Pacific children The evidence base for effective intervention to prevent or treat childhood obesity is not well developed. In this context, it is important that as much attention is paid to evaluation and research into effective programs as it is to plan and put in place a co-ordinated national strategy. If this is not done, potentially a lot of money will be wasted and we will not learn from the experience. It is important to design programmes which may be effective for Maori and Pacific families, as prevalence of over-weight and obesity, and the consequences thereof, appear larger in this group. Research and evaluation required The PSNZ recommends that research and evaluation should be funded as part of all programmes developed with public money at this stage and that there should be a central co-ordinating group for research and evaluation of nutrition and activity programmes that address the obesity issue. We have members of our society who would be usefully part of such a group. Bold steps by government required in schools, with advertising, and with low income families In the area of public health, there is probably enough evidence to justify the banning of all sugar containing drinks and fatty food (eg crisps and pies) from school premises, the recommendation to parents to limit the TV watching of their children to 1 hour or less per day, and to ban the advertising of fatty and sugary food and drink products during peak times for children's viewing of TV. We support more time for physical activity within the school day at all school grades. Local bodies should be developing urban environments that encourage activity and walking and not support services to develop where they have to be driven to. As fatty foods cost less than healthy fruit and vegetables, we stress the importance of looking for mechanisms to enable low-income families to purchase nutritious food for their children. Coordination required Many members of our society are dealing currently with children with severe obesity, often with secondary complications, which may be immediately lifethreatening (eg obstructive sleep apnoea, affecting some preschool children). The current evidence on effective treatment(s) is reviewed below. There is currently no co-ordination between different treatment programmes across NZ and no clear flow pattern for children who are in this difficult position. Dr Nikki Blair has compiled a list of programmes addressing childhood obesity across NZ and this report is available from her or Dr Pat Tuohy, Chief advisor to the Ministry of Health on child health. The document is also available on the Paediatric Society website (HYPERLINK "http://www.paediatrics.org.nz/documents/2006%20documents%20denise/DHBobesity-stocktake.doc"http://www.paediatrics.org.nz/documents/2006%20documents%20denise/DHBobesity-stocktake.doc) We recommend the funding and development of co-ordinated approach to severe obesity in children. The PSNZ offers the potential to host and develop such a group, which needs to be multi-disciplinary and evidence based. The PSNZ is able to link such a group using resources such as the TelePaediatrics video-conferencing network and the use of list-servers and a developing web-based virtual clinic for use across Australia and New Zealand. The society also has established the NZ Child and Youth Epidemiology service, which could be involved in monitoring and evaluation. For the already obese child, current resources are inadequate At the current time, for the obese or overweight child there is considerable evidence that programmes that utilise simple advice giving are relatively in-effective. Practitioners in the area need to be trained in methods that are more effective such as motivational interviewing, and work in multi-disciplinary teams. Overseas experience is that multi-faceted family based programmes involving nutrition, exercise, behavioural components show some efficacy with the key being a motivated family and child. There are few such programmes in New Zealand. Support for the current evolving ones as demonstration projects, with clearer research linkages for evaluation is needed. There is considerable evidence now that bariatric surgery (stomach stapling or gastric bypass) is an effective option for the severely obese teenager, but again this needs to be assessed carefully and performed as a national co-ordinated service with careful evaluation of long-term outcomes. Figure 1: Trends in childhood obesity including New Zealand  Figure 2: Current prevalence on overweight and obesity in NZ Children (childrens Nutrition survey)  Background information The current epidemic of obesity in the child population is predicted to increasingly burden the health system, so much so that in the USA there is concern that for the first time, future generations of adults are likely to have a lower life expectancy than previous generations ADDIN EN.CITE Poirier200695995917Poirier, P.Giles, T. D.Bray, G. A.Hong, Y.Stern, J. S.Pi-Sunyer, F. X.Eckel, R. H.Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and MetabolismCirculationCirculation898-9181136American Heart AssociationCardiovascular Diseases/diet therapy/*etiology/therapyHumansObesity/complications/*physiopathologyWeight Loss2006Feb 1416380542http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16380542 (Poirier, Giles et al. 2006). This is likely to be so because of evidence that persistent over-weight status through childhood and into adult life confers increased risk of cardiovascular morbidity compared to development of overweight status in adulthood ADDIN EN.CITE Whitaker RC199791091017Whitaker RC,Wright JA,Pepe MS,Seidel KD,Dietz WH,Department of Pediatrics, Children's Hospital Medical Center and the University of Cincinnati College of Medicine, OH 45229-3039, USA.Predicting obesity in young adulthood from childhood and parental obesity.New England Journal of MedicineNew England Journal of Medicine869-7333713post hocObesityChildparentsheritabilitypredictors1997Sep 259302300024Journal Article"caution against interventions to treat overweight children less that 3 y old whose parents are not obese." "because many obese children, if left untreated, will not become obese adults, treatment trials should be designed to consider the benefits and risks, both physical and psychological, of any interventions"Dietz199883283217Dietz, W. H.Health consequences of obesity in youth: childhood predictors of adult diseasePediatricsPediatrics518-251013 Pt 2AdolescentAdultAge FactorsBody ConstitutionComorbidityDiabetes Mellitus, Type II/ep [Epidemiology]Female*Health StatusHumanObesity/co [Complications]*Obesity/ep [Epidemiology]Obesity/pc [Prevention & Control]Obesity in Diabetes/ep [Epidemiology]Polycystic Ovary Syndrome/ep [Epidemiology]PrevalenceProbabilityRisk FactorsSocializationUnited States/ep [Epidemiology]1998(Whitaker RC, Wright JA et al. 1997; Dietz 1998). Very high overweight status in children and adolescence is associated with proxy outcome measures of cardiovascular morbidity (eg increased aortic intimal thickening ADDIN EN.CITE Reinehr200693093017Reinehr, T.Kiess, W.de Sousa, G.Stoffel-Wagner, B.Wunsch, R.Department of Pediatrics, University of Witten/Herdecke, 45711 Datteln, Germany. t.reinehr@kinderklinik-datteln.deIntima media thickness in childhood obesity: relations to inflammatory marker, glucose metabolism, and blood pressureMetabolismMetabolism113-8551AdolescentBlood Glucose/*metabolismBlood Pressure/*physiologyBody Composition/physiologyBody Mass IndexC-Reactive Protein/metabolismCardiovascular Diseases/epidemiology/physiopathologyCarotid Artery, Common/*pathology/ultrasonographyChildFemaleHumansInflammation Mediators/*bloodInsulin/bloodLipids/bloodLipoproteins, HDL Cholesterol/bloodMaleObesity/*blood/*pathology/ultrasonographyPuberty/physiologyTriglycerides/blood2006Jan16324929http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16324929 (Reinehr, Kiess et al. 2006)) as well as up to 50% having impaired glucose tolerance ADDIN EN.CITE Weiss200493493417Weiss, R.Dziura, J.Burgert, T. S.Tamborlane, W. V.Taksali, S. E.Yeckel, C. W.Allen, K.Lopes, M.Savoye, M.Morrison, J.Sherwin, R. S.Caprio, S.Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA.Obesity and the metabolic syndrome in children and adolescentsN Engl J MedN Engl J Med2362-7435023AdiponectinAdolescentAdultC-Reactive Protein/analysisChildChild, PreschoolFemaleFollow-Up StudiesGlucose Tolerance TestHumansInsulin Resistance/physiology*Intercellular Signaling Peptides and ProteinsInterleukin-6/bloodLogistic ModelsMaleMetabolic Syndrome X/*complications/epidemiologyObesity/blood/classification/*complicationsPrevalenceProteins/analysisResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, P.H.S.Risk FactorsSeverity of Illness Index2004Jun 315175438http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15175438 Sinha200293593517Sinha, R.Fisch, G.Teague, B.Tamborlane, W. V.Banyas, B.Allen, K.Savoye, M.Rieger, V.Taksali, S.Barbetta, G.Sherwin, R. S.Caprio, S.Department of Pediatrics, Yale University School of Medicine, New Haven, Conn 06520, USA.Prevalence of impaired glucose tolerance among children and adolescents with marked obesityN Engl J MedN Engl J Med802-1034611AdolescentAfrican Continental Ancestry GroupBlood Glucose/metabolismC-Peptide/bloodChildChild, PreschoolCross-Sectional StudiesDiabetes Mellitus/*epidemiology/metabolismEuropean Continental Ancestry GroupFemaleGlucose/*metabolism*Glucose Tolerance TestHispanic AmericansHumansInsulin/blood/secretionMaleObesity/blood/ethnology/*metabolismPrevalenceProinsulin/bloodResearch Support, U.S. Gov't, P.H.S.Risk Factors2002Mar 1411893791http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11893791 (Sinha, Fisch et al. 2002; Weiss, Dziura et al. 2004). Consequently, strategies to deal with the early development of over-weight status in children are high priority, and likely to be more efficacious than interventions in adults where long-term outcomes are notoriously poor (except perhaps for surgical interventions ADDIN EN.CITE Inge200593893817Inge, T. H.Zeller, M. H.Lawson, M. L.Daniels, S. R.Division of Pediatric General and Thoracic Surgery, Center for Epidemiology and Biostatistics, University of Cincinnati, Cincinnati, OH, USA. inge@cchmc.orgA critical appraisal of evidence supporting a bariatric surgical approach to weight management for adolescentsJ PediatrJ Pediatr10-91471AdolescentBariatrics/methodsDigestive System Surgical Procedures/*methods/mortalityGastric Bypass/methods/mortalityGastroplasty/methods/mortalityHumansObesity, Morbid/*surgeryPatient SelectionPostoperative ComplicationsResearch Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, P.H.S.2005Jul16027686http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16027686 (Inge, Zeller et al. 2005)). There are three levels of intervention possible interventions in individuals and their families that are already over weight (in primary care or in special clinics), interventions at the school level, and population level interventions or social marketing. Research in these areas, suggest that a focus on family involvement (almost excluding the child from involvement because of potential harm) is important ADDIN EN.CITE Steinbeck200593793717Steinbeck, K.Endocrinology and Adolescent Medicine, Royal Prince Alfred Hospital and the Faculty of Medicine, University of Sydney, Camperdown, Sydney, Australia. kss@email.cs.nsw.gov.auChildhood obesity. Treatment optionsBest Pract Res Clin Endocrinol MetabBest Pract Res Clin Endocrinol Metab455-69193AdolescentAnti-Obesity Agents/therapeutic useBehavior TherapyChildChild BehaviorCyclobutanes/therapeutic useDiet, ReducingDietary Fats/administration & dosageHumansLactones/therapeutic useMotor ActivityObesity/*therapyParents2005Sep16150386http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16150386 (Steinbeck 2005), that some specific school interventions can be effective (e.g. removal of glucose containing drinks from the school environment ADDIN EN.CITE James200494094017James, J.Thomas, P.Cavan, D.Kerr, D.Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Dorset BH7 7DW. janet.james@rbch-tr.swest.nhs.ukPreventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trialBmjBMJ12373287450Body Mass IndexCarbonated Beverages/*adverse effects/statistics & numerical dataChildCluster AnalysisConfidence IntervalsFemaleHumansMaleObesity/*prevention & controlPatient Education/*methodsResearch Support, Non-U.S. Gov't2004May 2215107313http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15107313 (James, Thomas et al. 2004)), and that so far there is considerable evidence about negative effects from social marketing ADDIN EN.CITE Youth20069489486Committee on Food Marketing and the Diets of Children and YouthFood Marketing to Children and Youth: Threat or Opportunity?5002006New YorkNational Academies Press0-309-09713-4file:///C:/Documents%20and%20Settings/Barry/My%20Documents/food%20marketing%20to%20children-%20threat%20or%20opportunity%20iof%20exec%20summary.pdf(2006). This leaves little hope for dramatic changes in the status of NZ childrens weight status over the next few years and puts a strong obligation on NZs social institutions trying to deal with this problem, to consider implementation within a research paradigm and to insist on rigorous long-term evaluation of outcome. Unfortunately, this is not happening. National monitoring of change will be to a large degree dependant of 5 yearly national nutrition surveys ADDIN EN.CITE Health200594994927Ministry of HealthThe New Zealand Health Monitor: Updated strategic plan. 452005WellingtonMinistry of Health.ISBN 0-478-29667-3 (Health 2005). There is a lot of evidence to suggest that child obesity rates are increasing (perhaps rapidly) rather than staying static or decreasing ADDIN EN.CITE Hedley A200490590517Hedley A,Ogden CL,Johnson CL,Carroll MD,Curtin LR,Flegal KM,Prevalence of Overweight and Obesity Among US Children, Adolescents, and Adults, 1999-2002Journal of the American Medical Association. Vol 291(23) Jun 2004, 2847-2850. http://jama.ama-assn.org/2004139this is a study that kerry recommended.Belanger-Ducharme200595195117Belanger-Ducharme, F.Tremblay, A.Division of Kinesiology, Laval University, Quebec G1K 7P4, Canada.Prevalence of obesity in CanadaObes RevObes Rev183-663AdolescentAdultAged*Body Mass IndexCanada/epidemiologyChildChild, PreschoolEmigration and ImmigrationFemale*Health SurveysHumansMaleMiddle AgedObesity/*epidemiologyPrevalenceResearch Support, Non-U.S. Gov't2005Aug16045630http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16045630 Mayor200595295217Mayor, S.Obesity in children in England continues to riseBmjBMJ10443307499ChildChild, PreschoolEngland/epidemiologyFemaleHumansMaleObesity/*epidemiologyPrevalence2005May 715879387http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15879387 Wedderkopp200495395317Wedderkopp, N.Froberg, K.Hansen, H. S.Andersen, L. B.Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense University, Odense NV, Denmark. nwedderkopp@health.sdu.dkSecular trends in physical fitness and obesity in Danish 9-year-old girls and boys: Odense School Child Study and Danish substudy of the European Youth Heart StudyScand J Med Sci SportsScand J Med Sci Sports150-5143Cardiovascular Diseases/epidemiologyChildDenmark/epidemiologyExercise TestFemaleHumansMaleObesity/*epidemiology*Physical FitnessRisk Factors2004Jun15144354http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15144354 Lazarus200095495417Lazarus, R.Wake, M.Hesketh, K.Waters, E.Faculty of Medicine, University of Sydney, Camperdown, New South Wales 2006, Australia.Change in body mass index in Australian primary school children, 1985-1997Int J Obes Relat Metab DisordInt J Obes Relat Metab Disord679-84246Adipose TissueAustralia/epidemiologyBody Composition*Body Mass IndexChildCross-Sectional StudiesFemaleHumansMaleObesity/epidemiologyResearch Support, Non-U.S. Gov't2000Jun10878673http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10878673 Turnbull200495595517Turnbull, A.Barry, D.Wickens, K.Crane, J.Healthcare Hawkes Bay, Hastings, New Zealand. amandat1@cdhb.govt.nzChanges in body mass index in 11-12-year-old children in Hawkes Bay, New Zealand (1989-2000)J Paediatr Child HealthJ Paediatr Child Health33-7401-2Body Mass IndexCatchment Area (Health)ChildFemaleHumansMaleNew Zealand/epidemiologyObesity/*epidemiologyPrevalenceResearch Support, Non-U.S. Gov'tSex Distribution2004Jan-Feb14718001http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14718001 Jones200595695617Jones, S. E.James-Ellison, M.Young, S.Gravenor, M. B.Williams, R.Department of Child Health, Swansea NHS Trust, Swansea, UK.Monitoring trends in obesity in South Wales using routine dataArch Dis ChildArch Dis Child464-7905Body Height*Body Mass IndexBody WeightChild, PreschoolFemaleHumansMaleObesity/*epidemiologyRegression AnalysisSex DistributionSex FactorsWales/epidemiology2005May15851426http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15851426 (Lazarus, Wake et al. 2000; Hedley A, Ogden CL et al. 2004; Turnbull, Barry et al. 2004; Wedderkopp, Froberg et al. 2004; Belanger-Ducharme and Tremblay 2005; Jones, James-Ellison et al. 2005; Mayor 2005). Our recent study (2004/5) of three year old children in Otago showed 20% as over-weight and 5% as obese using internationally agreed standards ADDIN EN.CITE Cole TJ200091291217Cole TJ,Bellizzi MC,Flegal KM,Dietz WH,Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH. tim.cole@ich.ucl.ac.ukEstablishing a standard definition for child overweight and obesity worldwide: international survey.[see comment]British Medical JournalBMJBritish Medical Journal1240-33207244BMIBody Mass Indexgrowth chartsepidemiologyChildObesityIOTF2000May 610797032002Journal Article(Cole TJ, Bellizzi MC et al. 2000). This is more than that expected from extrapolation from the national childrens nutrition survey (2002) which gave a prevalence for children who were 2 years older of 25% as over-weight or obese ADDIN EN.CITE Parnell200395895827Parnell, W.Scragg, R.Wilson, N.Schaaf, D.Fitzgerald, E. NZ Food NZ Children Key results of the 2002 National Childrens Nutrition Survey2892003WellingtonMinistry of Healthfile:///C:/Documents%20and%20Settings/Barry/My%20Documents/nzfoodnzchildren%202002%20chidlrens%20nutrtion%20survey.pdfISBN 0-478-25843-7(Parnell, Scragg et al. 2003). A recent presentation by a visiting sabbatical scholar from New Hampshire, USA (Professor Jim Lewis) reports from community surveys in that state that they have data suggesting ongoing and rapid increase in BMI levels in a largely white, advantaged community that live in New Hampshire. This appears to be occurring in the environment where TV watching time is static, there have been no changes to portion size, and where there is significant public concern about obesity and the increasing amounts of time playing computer games and texting as a major communication strategy for most children. Similar trends appear to be occurring in NZ. Thus, it would appear important to set up more real time monitoring of the growth status of our child population, both for public health monitoring as well as evaluation of current strategies to manage this situation. Research has clearly identified that parents often do not perceive their overweight or obese child to be overweight. Jeffrey et al., assessed parents awareness of the occurrence of overweight in their children, and found that only 25% recognised their childs overweight status ADDIN EN.CITE Jeffery200587887817Jeffery, A. N.Voss, L. D.Metcalf, B. S.Alba, S.Wilkin, T. J.Peninsula Medical School, University Medicine, Derriford Hospital, Plymouth PL6 8DH. alison.jeffery@pms.ac.ukParents' awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21)BmjBMJ23-43307481Adult*Attitude to HealthAwarenessBody ImageChildCohort StudiesCross-Sectional StudiesFemaleHumansMaleObesity/*psychologyParents/*psychologyResearch Support, Non-U.S. Gov't2005Jan 115567804http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15567804(Jeffery, Voss et al. 2005). This rate of recognition improved with increasing weight, yet even among parents of obese children, nearly half perceived their child to be normal weight  ADDIN EN.CITE Jeffery AN200512912917Jeffery AN,Voss LD,Metcalf BS,Alba S,Wilkin TJ,Peninsula Medical School, University Medicine, Derriford Hospital, Plymouth PL6 8DH. alison.jeffery@pms.ac.ukParents' awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21)BMJBMJ23-43307481recognitionobesityparentschildrenPerceptionparental perception2005Jan 115567804129Journal Articleonly a quarter of parents recognised overweight in their children. Even when obese, 33% mothers (57% fathers) saw their child's weight as 'about right'(Jeffery AN, Voss LD et al. 2005). Similar results have emerged from other recent studies, with 33% to 83% of parents perceiving their child to be normal weight when in fact they were overweight  ADDIN EN.CITE Maynard LM2003313117Maynard LM,Galuska DA,Blanck HM,Serdula MK,Chronic Disease Nutrition Branch, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. mmaynard@cdc.govMaternal perceptions of weight status of childrenPediatricsPediatrics1226-311115 Part 2maternal perceptionschildoverweightObesityweight Statusbody weightmother-child relationsfraggleParental perception2003May12728143031Journal Articleinvestigates whether mothers truly misclassify if so, to what extent, and the determinate as to why (or why not) covers well in discussion the real life caution required. While Overweight cannot be dealt with until a person is aware of it; using BMI can be misleading, and bringing up the issue needs to be done in a way that will not "harm a child's self concept or participation in physical activity". Baughcum AE2000252517Baughcum AE,Chamberlin LA,Deeks CM,Powers SW,Whitaker RC,Department of Pediatrics, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.Maternal perceptions of overweight preschool childrenPediatricsPediatrics1380-61066Obesitybody weightmotherschildpreschool childrenmother-child relationseducational statusweight perceptionperceived weightPerceptionparental Perceptions2000Dec11099592025Journal Articlegood questionnaire items here. this study showed association btw body size and educ/ SES status. "Among mothers of 99 overweight children, only 21% believed the overweight child was overweight" but HOW overweight were these kids...??Carnell S2005161617Carnell S,Edwards C,Croker H,Boniface D,Wardle J,Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London, UK.Parental perceptions of overweight in 3-5 y olds.[see comment]International Journal of Obesity353-5294childhood obesitymaternal perceptionsparentspreschool childrenperceived weightAwareness2005Apr15768040014Journal Article(Baughcum AE, Chamberlin LA et al. 2000; Maynard LM, Galuska DA et al. 2003; Carnell S, Edwards C et al. 2005). Additionally, there is evidence that parents tend to be unaware of the health risks associated with childhood obesity  ADDIN EN.CITE Young-Hyman D20009917Young-Hyman D,Herman LJ,Scott DL,Schlundt DG,Department of Pediatric Endocrinology, University of Maryland School of Medicine, Baltimore 21201, USA. dyoung@umaryland.eduCare giver perception of children's obesity-related health risk: a study of African American familiesObesity ResearchObesity Research241-883childhood obesityhealth risk appraisalHealth riskminority healthparental health awarenessAwareness2000May10832767009Journal ArticleAdams AK20057717Adams AK,Quinn RA,Prince RJ,Department of Family Medicine, University of Wisconsin Madison, 777 South Mills Street, Madison, WI 53715, USA. alex.adams@fammed.wisc.eduLow recognition of childhood overweight and disease risk among Native-American caregiversObesity ResearchObesity Research146-52131childparentsParental PerceptionsNative AmericanWeight PerceptionHealth riskawareness2005Jan15761174007Journal Article(Young-Hyman D, Herman LJ et al. 2000; Adams AK, Quinn RA et al. 2005). Given that parents are unaware of their childs obesity, and indeed unaware of the health risks associated with obesity, identifying the potential consequence of addressing these mis-perceptions is important. This especially applies to the potential harms that may be done to family relationships, feelings of self-worth and the possibility of increased risk of eating disorders ADDIN EN.CITE Epstein200110210217Epstein, L. H.Paluch, R. A.Saelens, B. E.Ernst, M. M.Wilfley, D. E.Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York 14214-3000, USA.Changes in eating disorder symptoms with pediatric obesity treatmentJ PediatrJ Pediatr58-651391Body Mass IndexChildChild Behavior Disorders/diagnosisEating Disorders/diagnosis/*psychology*Feeding BehaviorFemaleHumanMaleMultivariate AnalysisObesity/*psychology/*therapyProblem SolvingQuestionnaires2001Jul11445795Filedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11445795(Epstein, Paluch et al. 2001). Recent research suggests that there is also an element of lack of recognition of overweight children in health professionals that is best overcome by direct measurement of height and weight. What are effective methods to change habits of eating and activity? There is no arguing with the fact that over-weight habitus being related to an imbalance of the energy equation which requires energy in to balance energy out. Most of the research looking at whether different children are more efficient than others at storing energy or have different basal metabolic rates thus determining different energy in requirements are inconclusive ADDIN EN.CITE Roberts198817017017Roberts, S. B.Savage, J.Coward, W. A.Chew, B.Lucas, A.Dunn Nutrition Unit, Cambridge, England.Energy expenditure and intake in infants born to lean and overweight mothersN Engl J MedN Engl J Med461-63188Body WeightEating*Energy MetabolismFemaleHumanInfantInfant, NewbornMale*Obesity/metabolismPregnancy*Pregnancy ComplicationsProspective StudiesSkinfold ThicknessSupport, Non-U.S. Gov't1988Feb 253340127Filedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3340127Saris199676576517Saris, W. H.University of Maastricht.Physical inactivity and metabolic factors as predictors of weight gainNutr RevS110-5544 Pt 2Basal MetabolismEnergy Metabolism*ExerciseHuman*MetabolismNutritionObesity/etiology*Weight Gain1996Apr8700437Filedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8700437Ekelund200276776717Ekelund, U.Aman, J.Yngve, A.Renman, C.Westerterp, K.Sjostrom, M.Unit for Preventive Nutrition, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden. ulf.ekelund@ioh.oru.sePhysical activity but not energy expenditure is reduced in obese adolescents: a case-control studyAm J Clin Nutr935-41765AdolescentCase-Control Studies*Energy Metabolism*ExertionFemaleHumanMaleObesity/*metabolism/*physiopathologyReference ValuesSupport, Non-U.S. Gov'tTime Factors2002Nov12399263Filedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12399263(Roberts, Savage et al. 1988; Saris 1996; Ekelund, Aman et al. 2002). Thus the central questions that require answers at present are related to methods of education and support that are most effective in promoting long-term changes in both activity and food intake. The current Cochrane Review of this area states there is a limited amount of quality data on the components of programs to treat childhood obesity that favour one program over another. Further research that considers the psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required ADDIN EN.CITE Summerbell200392492417Summerbell, C. D.Ashton, V.Campbell, K. J.Edmunds, L.Kelly, S.Waters, E.School of Health and Social Care, University of Teesside, Parkside West, Middlesbrough, Teesside, UK, TS1 3BA.Interventions for treating obesity in childrenCochrane Database Syst RevCochrane Database Syst RevCD0018723ChildHumansLife StyleObesity/*therapyRandomized Controlled Trials200312917914http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12917914 (Summerbell, Ashton et al. 2003). There is some evidence for the main strategies used in the Otago DHB clinic for children who are overweight a focus on minimising TV watching ADDIN EN.CITE Robinson199912312317Robinson, T. N.Department of Pediatrics, Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, Calif 94304, USA. tom.robinson@stanford.eduReducing children's television viewing to prevent obesity: a randomized controlled trialJama1561-728216Body Mass IndexChildExerciseFemaleFood HabitsHumanMaleObesity/*prevention & controlStatistics, NonparametricSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.*Television1999Oct 2710546696Filedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10546696(Robinson 1999), decreasing portion size ADDIN EN.CITE Rolls200016116117Rolls, B. J.Engell, D.Birch, L. L.Nutrition Department, Pennsylvania State University, University Park, USA.Serving portion size influences 5-year-old but not 3-year-old children's food intakesJ Am Diet Assoc232-41002Age FactorsBody HeightBody WeightChild, Preschool*Eating/physiology/psychologyEnergy IntakeFemaleFood PreferencesHumanHungerMaleSupport, U.S. Gov't, P.H.S.2000Feb10670398Filedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10670398McConahy200218518517McConahy, K. L.Smiciklas-Wright, H.Birch, L. L.Mitchell, D. C.Picciano, M. F.Departments of Nutrition and Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.Food portions are positively related to energy intake and body weight in early childhoodJ PediatrJ Pediatr340-71403AnthropometryBody Weight/*physiologyCross-Sectional Studies*EatingEnergy Intake/*physiology*Feeding Behavior/ethnologyFemaleHumanInfantLongitudinal StudiesMaleSocioeconomic FactorsSupport, Non-U.S. Gov't2002Mar11953733http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11953733(Rolls, Engell et al. 2000; McConahy, Smiciklas-Wright et al. 2002), avoidance of sugar containing drinks ADDIN EN.CITE Ebbeling200697697617Ebbeling, C. B.Feldman, H. A.Osganian, S. K.Chomitz, V. R.Ellenbogen, S. J.Ludwig, D. S.Division of Endocrinology, Department of Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA.Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot studyPediatricsPediatrics673-801173AdolescentBeverages/*adverse effects/analysisBody Mass IndexBody WeightDietDietary Sucrose/*adverse effectsExerciseFemaleHumansMaleObesity/etiologyResearch Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov't2006Mar16510646http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16510646 (Ebbeling, Feldman et al. 2006) and use of low GI food choices  ADDIN EN.CITE Flynn200692392317Flynn, M. A.McNeil, D. A.Maloff, B.Mutasingwa, D.Wu, M.Ford, C.Tough, S. C.Nutrition and Active Living, Healthy Living, Calgary Health Region, Calgary, Canada.Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendationsObes RevObes Rev7-667 Suppl 12006Feb16371076http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16371076 Summerbell200392492417Summerbell, C. D.Ashton, V.Campbell, K. J.Edmunds, L.Kelly, S.Waters, E.School of Health and Social Care, University of Teesside, Parkside West, Middlesbrough, Teesside, UK, TS1 3BA.Interventions for treating obesity in childrenCochrane Database Syst RevCochrane Database Syst RevCD0018723ChildHumansLife StyleObesity/*therapyRandomized Controlled Trials200312917914http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12917914 (Summerbell, Ashton et al. 2003; Flynn, McNeil et al. 2006). There is some suggestion that approaches using parents only as agents of change are more effective than strategies that involve the children themselves. ADDIN EN.CITE Golan199878178117Golan, M.Fainaru, M.Weizman, A.Sackler Faculty of Medicine, Tel Aviv University, Israel.Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of changeInt J Obes Relat Metab DisordInt J Obes Relat Metab Disord1217-242212*Behavior TherapyChildEatingEnergy IntakeExerciseFeeding BehaviorFemaleHumanLongitudinal StudiesMaleObesity/psychology/*therapy*ParentsPatient EducationProspective StudiesTelevisionTime FactorsWeight Loss1998Dec9877257Filedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9877257(Golan, Fainaru et al. 1998) Overall, however, in 2005 the U.S. Preventive Services Task Force found insufficient evidence for the effectiveness of behavioural counselling or other preventive interventions with overweight children and adolescents that can be conducted in primary care settings or to which primary care physicians can make referrals ADDIN EN.CITE Whitlock200589189117Whitlock, Evelyn P.Williams, Selvi B.Gold, RachelSmith, Paula R.Shipman, Scott A.Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task ForcePediatricsPediatricsPediatricsPediatricse125-14411612005July 1, 2005http://pediatrics.aappublications.org/cgi/content/abstract/116/1/e125(Whitlock, Williams et al. 2005). Of special interest is their review of studies, which show no long-term effect of lifestyle interventions. References:  ADDIN EN.REFLIST Adams AK, Quinn RA, et al. (2005). "Low recognition of childhood overweight and disease risk among Native-American caregivers." Obesity Research 13(1): 146-52. Baughcum AE, Chamberlin LA, et al. (2000). "Maternal perceptions of overweight preschool children." Pediatrics 106(6): 1380-6. Belanger-Ducharme, F. and A. Tremblay (2005). "Prevalence of obesity in Canada." Obes Rev 6(3): 183-6. Blair N. (2004). "A stock-take of interventions and programmes aimed at childhood obesity prevention and management in New Zealand." HYPERLINK "http://www.paediatrics.org.nz/documents/2006%20documents%20denise/DHBobesity-stocktake.doc"http://www.paediatrics.org.nz/documents/2006%20documents%20denise/DHBobesity-stocktake.doc Carnell S, Edwards C, et al. (2005). "Parental perceptions of overweight in 3-5 y olds.[see comment]." 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"Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations." Obes Rev 7 Suppl 1: 7-66. Golan, M., M. Fainaru, et al. (1998). "Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change." Int J Obes Relat Metab Disord 22(12): 1217-24. Health, M. o. (2005). The New Zealand Health Monitor: Updated strategic plan. . Wellington, Ministry of Health.: 45. Hedley A, Ogden CL, et al. (2004). "Prevalence of Overweight and Obesity Among US Children, Adolescents, and Adults, 1999-2002." Journal of the American Medical Association. Vol 291(23) Jun 2004, 2847-2850.  HYPERLINK "http://jama.ama-assn.org/" http://jama.ama-assn.org/. Inge, T. H., M. H. Zeller, et al. (2005). "A critical appraisal of evidence supporting a bariatric surgical approach to weight management for adolescents." J Pediatr 147(1): 10-9. James, J., P. Thomas, et al. (2004). "Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial." Bmj 328(7450): 1237. Jeffery AN, Voss LD, et al. (2005). "Parents' awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21)." BMJ 330(7481): 23-4. Jeffery, A. N., L. D. Voss, et al. (2005). "Parents' awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21)." Bmj 330(7481): 23-4. Jones, S. E., M. James-Ellison, et al. (2005). "Monitoring trends in obesity in South Wales using routine data." Arch Dis Child 90(5): 464-7. Lazarus, R., M. Wake, et al. (2000). "Change in body mass index in Australian primary school children, 1985-1997." Int J Obes Relat Metab Disord 24(6): 679-84. Maynard LM, Galuska DA, et al. (2003). "Maternal perceptions of weight status of children." Pediatrics 111(5 Part 2): 1226-31. Mayor, S. (2005). "Obesity in children in England continues to rise." Bmj 330(7499): 1044. McConahy, K. L., H. Smiciklas-Wright, et al. (2002). "Food portions are positively related to energy intake and body weight in early childhood." J Pediatr 140(3): 340-7. Parnell, W., R. Scragg, et al. (2003). NZ Food NZ Children Key results of the 2002 National Childrens Nutrition Survey. Wellington, Ministry of Health: 289. Poirier, P., T. D. Giles, et al. (2006). "Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism." Circulation 113(6): 898-918. Reinehr, T., W. Kiess, et al. (2006). "Intima media thickness in childhood obesity: relations to inflammatory marker, glucose metabolism, and blood pressure." Metabolism 55(1): 113-8. Roberts, S. B., J. Savage, et al. (1988). "Energy expenditure and intake in infants born to lean and overweight mothers." N Engl J Med 318(8): 461-6. Robinson, T. N. (1999). "Reducing children's television viewing to prevent obesity: a randomized controlled trial." Jama 282(16): 1561-7. Rolls, B. J., D. Engell, et al. (2000). "Serving portion size influences 5-year-old but not 3-year-old children's food intakes." J Am Diet Assoc 100(2): 232-4. Saris, W. H. (1996). "Physical inactivity and metabolic factors as predictors of weight gain." Nutr Rev 54(4 Pt 2): S110-5. Sinha, R., G. Fisch, et al. (2002). "Prevalence of impaired glucose tolerance among children and adolescents with marked obesity." N Engl J Med 346(11): 802-10. Steinbeck, K. (2005). "Childhood obesity. Treatment options." Best Pract Res Clin Endocrinol Metab 19(3): 455-69. Summerbell, C. D., V. Ashton, et al. (2003). "Interventions for treating obesity in children." Cochrane Database Syst Rev(3): CD001872. Turnbull, A., D. Barry, et al. (2004). "Changes in body mass index in 11-12-year-old children in Hawkes Bay, New Zealand (1989-2000)." J Paediatr Child Health 40(1-2): 33-7. Wedderkopp, N., K. Froberg, et al. (2004). "Secular trends in physical fitness and obesity in Danish 9-year-old girls and boys: Odense School Child Study and Danish substudy of the European Youth Heart Study." Scand J Med Sci Sports 14(3): 150-5. Weiss, R., J. Dziura, et al. (2004). "Obesity and the metabolic syndrome in children and adolescents." N Engl J Med 350(23): 2362-74. Whitaker RC, Wright JA, et al. (1997). "Predicting obesity in young adulthood from childhood and parental obesity." New England Journal of Medicine 337(13): 869-73. Whitlock, E. P., S. B. Williams, et al. (2005). "Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force." Pediatrics 116(1): e125-144. Young-Hyman D, Herman LJ, et al. (2000). "Care giver perception of children's obesity-related health risk: a study of African American families." Obesity Research 8(3): 241-8. Youth, C. o. F. M. a. t. D. o. C. a. (2006). Food Marketing to Children and Youth: Threat or Opportunity? New York, National Academies Press.  THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz  PSNZ Submission to Health Select Committee Page  PAGE 9 Health of our children: Wealth of our nation $?F  Et L(?z{|Zk l ""''''(((4)4Y4Z455<<<<<; jU jU jU0JCJjCJU jCJUCJOJQJ566B*CJOJQJ6B*CJOJQJ0J0J55CJE$%>?yz*+  5H$7$8$ & F 0$$%>?yz*+  56tu JKLĿw!  6!  78 !    LMwx -56tu JKL]&  & F!]&'(>?YZ* + , - i j k m n o MMKgLgOWX#$%&2Ⱦ g!  hipCDZ!  [\%  !  fg6&'(>?YZ* + , - i j k m n o $  & F! 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Submissions

The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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