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Identifying and managing childhood obesity: We can do it better

children who are overweight or obese, it then becomes harder to judge an overweight child’s size as being different from that of his or her peers. And, even if the parents or the affected young person are concerned about the problem of obesity, there may be several barriers preventing them from seeking medical help. For example, they may believe that ‘nothing can be done’, or that it is their fault and hence they themselves who need to deal with it. Possibly, they may be embarrassed about the problem, or they may previously have had a negative experience when attempting to seek help from a health professional. Whatever the reasons, children and adolescents with the significant problem of obesity are unlikely to primarily present with this to their treating doctor. Second, primary care doctors and paediatricians do not readily recognise overweight, or even obesity, in children and adolescents on visual inspection alone. This is supported by a study presented in this issue of the Journal. 13 Spurrier et al. used body mass index (BMI)-standardised child images to determine whether GPs and paediatricians could reliably distinguish normal weight, overweight or obese images. While the study had some limitations (e.g. poor response rate from the general practitioners, low numbers of paediatricians, different study conditions in which GPs and paediatricians provided a response), it nevertheless showed that both GPs and paediatricians found it difficult to classify children as overweight or obese on visual inspection. These findings highlight the importance of regular measurements of height and weight by health professionals in order to objectively identify the overweight or obese child. Interestingly, while Spurrier’s study showed that paediatricians, unlike GPs, routinely measure height and weight, the calculation and plotting of BMI (weight/ height) appeared to be less routine. This is of concern, because the use of BMI for age charts is now well established as the primary screening tool for determining a child’s weight status. Spurrier’s study also identified some suboptimal areas of management of paediatric obesity by doctors when judged against the benchmark of the Australian National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines for the Management of Overweight and Obesity in Children and Adolescents. The NHMRC Clinical Practice Guidelines are the most extensive guide-lines for paediatric obesity to be found internationally. However, anecdotal evidence suggests that most GPs and paediatricians are unaware of them. This is perhaps not surprising given the huge amount of information bombarding health professionals on a daily basis. Guidelines are most effective when clinicians are trained in their use; unfortunately, there have been no such training programs officially instituted around the NHMRC guidelines dealing with paediatric obesity. And most medical practitioners are poorly trained at an undergraduate level, and even at a postgraduate level, in the assessment and management of child and adolescent obesity. While Spurrier et al. are ultimately optimistic in their view that GPs and paediatricians will improve in their ability to assess and manage paediatric overweight and obesity, my view is that this will not occur without concerted action. With obesity affecting such large The World Health Organization describes obesity as ‘one of today’s most blatantly visible – yet most neglected – public health problems’ and further comments that an ‘escalating global epidemic of overweight and obesity – “globesity” – is taking over many parts of the world’. These strong and emotive words are underpinned by data on the rising prevalence of obesity in many adult populations worldwide. Of perhaps even more concern, and certainly for those working in paediatrics, is the increased prevalence of overweight and obesity among children and adolescents. World-wide, approximately 10% of school-aged children and adolescents are overweight or obese, with very high rates being seen in the Americas, Europe and even the Middle East.