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• The lost children
  brian mcnicholl
  Published on: 19 January 2017

• Published on: 19 January 2017

  The lost children

  • brian mcnicholl, doctor

  Wright and Wales highlight the issues of childhood obesity but there is a lack of clear guidance on who should deal with it. The suggestion to " opportunistically discuss a childs weight" is easier said than done. Whose responsibility is it ? There is little immediate consequence if it is not done. Obesity is rarely the presenting complaint to a doctor. So tackling obesity, in addition to the primary complaint is two co...

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  Wright and Wales highlight the issues of childhood obesity but there is a lack of clear guidance on who should deal with it. The suggestion to " opportunistically discuss a childs weight" is easier said than done. Whose responsibility is it ? There is little immediate consequence if it is not done. Obesity is rarely the presenting complaint to a doctor. So tackling obesity, in addition to the primary complaint is two consultations. With time pressures in healthcare this is challenging. The obesity diagnosis, for a child , and sometimes the parents is breaking bad news, it is traumatic and difficult, and often avoided for that reason. The family doctor hopes the Paediatrician will do it and vice versa. The Paediatrician rarely sees the long term consequences of obesity - hypertension, Type 2 diabetes, cardiovascular disease and arthritis and does not own these problems. By the time we see these patients it is often too late. The obese child is often from an obese family which requires the doctor to address the parents obesity as well, something that Paediatricians cannot do.

  They recommend walking ( may require a supervisor, some children dislike it and not easy in winter) cycling ( see walking) and use of sports centres ( requires transport and organization) "Encouraging" a child to play less video games is like asking an addict to use less drugs. Prescribe the following: unplug the television, turn off the wifi and put the kids out the door to the garden or street. If these fail refer to the enforcer for radical phonectomy!. This can result in hours of activity. The authors don't emphasize the difficulties of getting obese children active. In calorie burning sports the obese child is often the goalie ( with little calorie burning) or the substitute , or cannot compete e.g. running - where weight is a major disadvantage. The child often leaves the team after a time having had no matches and a feeling of inferiority. The indignity of always being last in the race will put any child off running. Coaches who focus on the elite and have a win at all cost mentality give little time , or worse , to the weaker children.

  Could I suggest that any sporting organization, club or school that receives government or municipal funding, is obliged to play every child on the team in every match for at least half an hour. They should allow every child to play on at least one team regardless of ability. Failure to comply should result in reduction of funds.

  There are too many lost kids. They are lost between the specialties and they are lost between the schools and clubs. Time to find them again.

  Brian McNicholl FRCEM FRCS FRCPI FFSEM MCh Consultant Emergency Medicine and amateur sports coach University College Hospital Galway Ireland

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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