Whole-of-life approach to obesity

HEALTH professionals can help overweight and obese patients make healthier choices by advocating for change in physical environments, according to a leading obesity expert.

Urban design and infrastructure changes such as making streets safer and providing better access to parks and pools in less affluent areas are crucial, Associate Professor Anthea Magarey, from the department of public health at Flinders University, SA, writes in an editorial in the latest MJA. (1)

Her editorial is part of a series of articles in the MJA pinpointing physical activity as a key to health and weight control in a number of different age groups, including preschoolers.

A review article says even children aged between 3 and 5 years are not getting enough exercise. (2)

The authors said current data suggested that most preschoolers are falling short of exercise guidelines for their age group. However, there was little on which to base such guidance due to a dearth of data on the activity needs of young children, they wrote.

As a result, they are calling for further research to develop an accurate understanding of what intensity and amount of physical activity is required for positive health outcomes in young children.

“Given that early childhood is a critical period for the establishment of eating and activity behaviour, prevention strategies to ensure that children develop healthy physical activity behaviour should start as early in life as possible”, the authors wrote.

Research into the effects of inactivity among 12 188 adolescents found nearly one in four were either overweight (18%) or obese (5%). (3)

Students were considered to be engaging in low levels of physical activity if they did not meet the recommended 60 minutes of moderate-to-vigorous physical activity per day on at least 4 days in the previous week. The authors pointed to potential interventions, especially in lower socioeconomic areas.

“Creating supportive environments for physical activity may help to promote increased physical activity among young people and could possibly displace time spent in small-screen recreation”, the authors wrote.

The benefits of exercise go way beyond weight loss, according to the authors of a “Perspectives” article. (4)

The authors argued that even in the absence of weight loss, fitness carried big health benefits, and was actually better than obesity for predicting cardiovascular and all-cause mortality.

They said doctors who deal with overweight and obesity should “prescribe exercise because exercise is good for you, whether you lose weight or not”.

A recent consensus statement on obesity management had concluded that: “Continuing population-based efforts are essential to prevent the onset of obesity and type 2 diabetes”, they wrote.

In her editorial, Professor Magarey said health professionals could also contribute to the solution by advocating for policy and environmental change.

“At the individual level, they should promote the importance of healthy eating and activity, and an awareness of healthy growth, particularly in young children”, she wrote.

Weight management interventions should start even sooner — during pregnancy, according to the authors of a second research article in the MJA. (5)

“Data from pregnancies before and after bariatric surgery suggest that substantial weight reduction may reduce later infant adiposity and immediate pregnancy complications”, the authors wrote.

They found that although the overall the numbers of women who were overweight or obese had not changed significantly between 1998 and 2009, the number with the highest body mass index (35–40 kg/m2) had increased threefold.

“Ideally, interventions should begin before pregnancy as part of preconception care”, they wrote.

– Amanda Bryan

1. MJA 2012; 196: 152-153
2. MJA 2012; 196: 174-176
3. MJA 2012; 196: 189-192
4. MJA 2012; 196: 165-166
5. MJA 2012; 196: 184-188

Posted 20 February 2012