Transcript Engaging inactive young people after school

Causes,
Consequences and
Tackling obesity.
Professor Paul Gately
Carnegie Weight Management
Leeds Metropolitan University
What is overweight ?
• This boy is 3 years, 3 weeks old.
• Is his BMI-for-age
- below the 5th percentile?
- 5th to <85th percentile:
normalweight?
- >85th to <95th percentile:
overweight?
- >95th percentile:
obese?
Photo from UC Berkeley Longitudinal Study,
1973
Plotted BMI-for-Age
BMI
BMI
Boys: 2 to 20 years
Measurements:
Age=3 y 3 wks
Height=100.8 cm (39.7 in)
Weight=18.6 kg(41 lb)
BMI=18.3
BMI-for-age= >95th
percentile = obese
BMI
BMI
BMI distribution curves over time
Probability density
O/WT
OBESE
0.10
0.05
0.00
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
Body Mass Index (kg/m2)
Source: Rose, G. (1991) .
GLOBAL PREVALENCE OF OBESITY (defined as BMI >30)
Year *
Women
Men
Age range
25-69
18+
25-64
20-74
15+
25-69
20-65
16-64
18-74
20-59
20-69
15-64
25-64
20+
20-45
W.Samoa (urban)
Kuwait
East Germany
USA
Saudi Arabia
W. Germany
Czech Republic
England
Canada
Netherlands
Australia
Brazil
Japan
China
80
70
60
* Most recent available data. Surveys
conducted between 1988 and 1994.
50
40
30
20
10
0
10
% population
20
30
40
50
60
70
80
Changes in prevalence
Why is this a concern?
Pulmonary disease
abnormal function
obstructive sleep apnea
hypoventilation syndrome
Nonalcoholic fatty liver
disease
Idiopathic intracranial
hypertension
Stroke
Cataracts
Steatosis
Steatohepatitis
cirrhosis
Coronary heart disease
Diabetes
Dyslipidemia
Hypertension
Gall bladder disease
Severe pancreatitis
Gynecologic abnormalities
Cancer
abnormal menses
infertility
polycystic ovarian syndrome
breast, uterus, cervix
colon, esophagus, pancreas
kidney, prostate
Osteoarthritis
Skin
Source: www.obesityonline.org
Gout
Phlebitis
venous stasis
Psycho social factors
12-year old girls and boys
3.2
3
2.8
2.6
2.4
2.2
2
Self-worth
Obese boys
Obese girls
School
Normal wt
Athletic
* p<.01 **p<.001
Behaviour
Fat-teasing in boys & girls
(Murphy & Hill, 2003)
3.2
**
3
*
**
**
**
2.8
2.6
2.4
2.2
2
1.8
Self-worth
Non victimised
Fat teased girls
School
Social
Fat teased boys
Athletic
Appearance
* p<.05 **p<.001
Behaviour
Toxic or obesogenic environment
Obesity is a normal response to an abnormal
environment
 side-effect of technological advances
 reflects natural human preferences (eg easy, convenient, fast,
low effort, value for money)

key factors
•
•
energy-saving machines, passive recreation
energy-dense foods & drinks, large portion sizes
Biological and cultural mismatches to
the modern environment
FOOD






Strong signals to eat
Weak signals to stop
Increased availability
Eating is rewarding
No viable alternatives
Eating well is high status
ACTIVITY






Weak activity signal
Strong signals to stop
Reduced availability
Inactivity is rewarding
Inactivity is a viable alternative
Inactivity is high status
Where should the focus be?
1 in 3 children are overweight or obese.
1 in 3 children who will become overweight or obese
adults.
1 in 3 children who are and will remain normalweight
/underweight?
NORMAL WEIGHT
OVERWEIGHT
4,563,865
9,266,033
33%
77%
Health costs
↑ 20%
Gately (2007)
OBESE
2,765,980
20%
13%
1797887
Health costs
↑ 50%
Gately (2007)
OBESE +++
138,299
553196
691495
1%
4%
5%
10%
13%
1797887
Health costs
? Min ↑100%
1382990
Gately (2007)
Is policy having an impact on
weight change?
Initiative
Cost
Impact
Measurement/evaluation
Sahota (UK)
?
No Impact
BMI
Gortmaker (US)
?
No Impact
BMI
Lupeka (US)
?
No Impact
BMI
Fruit and Veg Field (US)
?
No impact
BMI
PESSCL
?
No evidence
No evaluation
School Food Programme
£235m?
No evidence
No evaluation
Healthy Schools
?
No evidence
No evaluation
Play
£155m?
No evidence
No evaluation
Social Marketing
?
No evidence
No evaluation
Extended schools
£125m?
No evidence
No evaluation
Prevention
Results of process research

Comments on exercise:
“I prefer to do sports than watch TV, just don’t get the chance, I’m too
fat.”
• “I don’t like walking or running its boring, just never do it.”
• “I like doing sports, because I’m having fun with friends.”
•

Potential of extended schools and PESSCL?
“I would get laughed at it I turned up for an afterschool sports club, they
are not for kids like me”
• “After I lost weight and got fitter I felt more like joining in PE and clubs”
•
Carnegie Weight Management
Treatment programmes
Camps (residential & day),
clubs
Research,
Consultancy
Training
Multi
media
Broadcast
Carnegie Curriculum
Behaviour
Change
Theory
&
Tools
Diet
Physical
Activity
Social
Activities
Carnegie Weight Management
Interventions
Prevention
Practice
based
Research
Broadcast
Consultancy
Web
Community clubs
Training
Web
Community
camps
Web
Residential
Campsschools
Web
Research
evidence
No Evidence
No Evidence
1%↓ BMI SDS 6m
4 %↓ BMI SDS
10%↓ BMI SDS
1-3 yr
Costs ratio
1.0
1.2
1.5
2.0
?
UK n= (SDS)
8.5m (<1.04)
4.5m (>1.04)
2.7m (>1.69)
691k (>2.5)
140K (>3.0)
Pre and post camp scores for sports skills (Gately 2005)
60
Skill
based exercise
***
Week 1
Week 6
50
Score
40
***
30
20
***
***
10
0
Badminton Serve
Basketball shot
*** P<0.001 pre to post
Football Dribbling
(secs)
Skills
Volleyball Volley
Self Perception Profile for Children (SPPC)
**
**
**
3.2
3
Normal weight
Pre-camp
2.8
Post-camp
2.6
2.4
2.2
2
1.8
1.6
Self-worth
School
Social
Source: Walker et al. (2002)
** (P<0.01)
Athletic
Appearance
Behaviour
Long term results of residential
programme
Community club outcomes
Change
Children
Parents
Body mass (kg)
0.7 + 2.3
-1.1 + 2.5
BMI (kg.m-2)
-0.19 + 1
-0.31 + 0.8
-0.11 + 0.23
NA
Waist (cm)
-8.7 + 4.2
-5.9 + 4.2
% Body fat
-1.75 + 2.6
-1.2 + 5.3
0.2 + 0.4
0.3 + 0.3
BMI SDS
Fitness (l.min-1)
Impact of obesity interventions on
participants
Surgery
(e.g. Sibutramine,
Orlistat)
Whole
School
Approach¹

x
x
x
x

x
x
x
x
?
?
?
?

Drugs
Reduces BMI z-score
Increases fitness
Improves self-esteem
Improves family
relationships
Builds capacity within
communities
1 Very
Prevention
CWM
x
?
?
?
?





little published evidence on the effectiveness of whole-school obesity interventions in the UK. What
exists is not overwhelmingly positive
Comparative attributes of obesity
interventions
Surgery
(e.g. Sibutramine,
Orlistat)
Whole
School
Approach
x
x

x


x

x
x

x



Failure rate
Low
Medium
n/a
?
Low
Health risk
High
Medium
Low
Low
Low
£5,665
£444 & £386
(9 months)
No UK
data
?
Varies
High
Low
x
x
High
Drugs
Positive experience
Scalable
Evidence-based
Cost of intervention
(£/person)
Sustainability of weight
loss
Prevention
CMW
Carnegie Weight Management
The Grange
Headingley Campus
Leeds Metropolitan University
Leeds
LS6 3QS
Tel. +441138123579
[email protected]
www.carnegieweightmanagement.com