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Re: Thank goodness children can be cruel

Dear Editor,

The childhood obesity debate continues, with polarised views from clinicians and academics (1), Ministers (2) and journalists (3). The opinion divide between clinicians (favouring case identification and ‘treatment’) and academics with public health overview (favouring primary prevention) has not been uncommon across the spectrum of health and disease. For chronic conditions like diabetes and heart disease (where there is interplay of genetic, environmental and lifestyle factors), early detection and risk management are integrated with primary prevention (4). Childhood obesity should be treated no different.

The systematic review and discussion about childhood obesity by Westwood and colleagues (5) does not favour screening to identify individual overweight and obese children. It takes a rather purist evidence based view and attempts to take the debate back to the drawing board by suggesting that primary prevention of childhood obesity is unproven and effectiveness of current treatments is doubtful. Little consolation to clinicians and public health specialists who are struggling to devise effective pathways for multidisciplinary management of childhood obesity based upon best available evidence.

Current Department of Health Guidance to PCTs (The National Child Measurement Programme) (6) aims primarily to assist with local tracking against the childhood obesity target and enable performance management of PCTs in relation to this target. Considering the amount of resources that will be mobilised by the health and education services to implement the programme, this will be another missed opportunity to truly contribute to the childhood obesity prevention and treatment programme. Simply providing height and weight measurements to parents without interpretation or guidance will only cause unnecessary concern for some and create a ‘false sense of security’ for those with overweight or obese children.

Westwood and colleagues suggest that ‘current models of self-referral appear the best basis for attempts to treat obesity and should continue’. We certainly have enough evidence about the effectiveness of the current referral pathway where an overweight child is rapidly ‘screened’ by peers and singled out, with significant emotional consequences, but at least hopefully reaching the health service for intervention at some stage. Thank goodness children can be cruel!

References:

1. Child Growth Foundation. Annual BMI checks in schools workshop at the Institute of Child Health, London. 17 June 2005 http://www.childgrowthfoundation.org/Pdf%20Files/J-17Report.pdf

2. Government response to the Health Select Committee’s Report on Obesity.December 2004 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4098721.pdf

3. The Sunday Times, February 25 2007.Focus: the thin line between poor diet and child abuse http://www.timesonline.co.uk/tol/news/uk/health/article1434671.ece

4. Muir Gray JA. Vascular disease control programme. May 2006 http://www.library.nhs.uk/screening/ViewResource.aspx?resID=143394

5. Westwood M, Fayter D, Hartley S, et al. Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence. Arch Dis Child 2007; 92: 416-422