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Work with overweight young people.
Professor Paul GatelyCarnegie Weight ManagementLeeds Metropolitan University
Outline
Levels of obesity and some challenges
Physical literacy in the obese child?
Carnegie Weight Management
Results and Evaluation
Capacity and capability
Levels of obesity and some challenges
Physical literacy in the obese child?
Carnegie Weight Management
Results and Evaluation
Capacity and Capability
EU Trends1980-2005Males
Males 1980-1984
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Males 1985-1989
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Males 1990-1994
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Self Reported data
Males 1995-1999
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Self Reported data
Males 2000-2005
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Self Reported data
EU Trends1980-2005Females
Females 1980-1984
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Females 1985-1989
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Females 1990-1994
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Self Reported data
Females 1995-1999
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Self Reported data
Females 2000-2005
© International Obesity TaskForce 2005
% Obesity
< 5 %
5-9.9%
10-14.9%
15-19.9%
20-24.9%
≥ 25%
Self Reported data
0
5
10
15
20
25
30
1960 1970 1980 1990 2000
Overweight children 7-11
Trends in the last three decades
Pre
vale
nce
%
IOTF 2004
0
5
10
15
20
25
30
1960 1970 1980 1990 2000
Germany Netherlands
Pre
vale
nce
%Overweight children 7-11
Trends in the last three decades
IOTF 2004
0
5
10
15
20
25
30
1960 1970 1980 1990 2000
Poland
Pre
vale
nce
%Overweight children 7-11
Trends in the last three decades
Spain
IOTF 2004
Yugoslavia
Czech Republic
NCMP….
2005-2006 • (participation = 48%)
2007-2007 • (participation = 80%)
Deprivation
Ethnicity
Overweight (%)
Obese
(%)
Overweight + Obese (%)
Boys 14.2 19.0 33.2
Girls 14.1 15.8 30.0
Combined 14.4 17.8 31.6
Rugby and Athletics Development Survey RADS Partnership with city council and education authority. 4 cross sectional studies of year 7 children. (n=18,000)
• 85% of schools• 96% of pupils within schools
1 longitudinal study at 2.5 years (n=2500) Assessment tools
• Sports skills• Anthropometry (BMI, Waist, % body fat)• Demographics, educational attainment, ethnicity, deprivation, etc.• Geographical investigations• Psychology – Short Harter on (n=2000)
Between schools - Waist>85th
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
School
Pre
vale
nce
(%
)
Gately (2006) www.carnegieweightmanagement.com
Can you see risk?
• This boy is 3 years, 3 weeks old.
• Is his BMI-for-age
- below the 5th percentile:underweight?
- 5th to <85th percentile: normalweight?
- >85th to <95th percentile: overweight?
- >95th percentile: obese? Photo from UC Berkeley Longitudinal
Study, 1973
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
Plotted BMI-for-Age
Boys: 2 to 20 years
BMI BMI
BMI BMI
“How can someone let their child get to that size?”
Parental perceptions
0
10
20
30
40
50
60
70
80
90
% c
orr
ect
ly id
en
tifi
ng
w
eig
ht
statu
s
Normalweight Overweight Obese
Actual weight status of children
Distorted perceptions by parents of childrens weight status (J effery et.al. 2005)
MothersFathers
Health Care Professional recognition
0%
10%
20%
30%
40%
50%
60%
70%
80%
9th to 50th centile 50th to 91stcentile
91st to 98th centile(overweight)
>98th centile(obese)
Weight categories
% o
f ch
ildre
n in
corr
ectl
y id
enti
fied
No. estimated to be slimmer
No. estimated to be fatter
Smith, Rudolf and Gately (in press)
Why is this a concern?
Source: www.obesityonline.org
Pulmonary diseasePulmonary disease
Fatty liver diseaseFatty liver disease Coronary heart diseaseCoronary heart disease
DiabetesDiabetes
DyslipidemiaDyslipidemia
HypertensionHypertension
Gynecologic abnormalitiesGynecologic abnormalities
OsteoarthritisOsteoarthritis
SkinSkin
Gall bladder diseaseGall bladder disease
CancerCancer
GoutGout
Brain pressureBrain pressure
StrokeStroke
Pancreas diseasePancreas disease
A toxic or obesogenic environment
Obesity as 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
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?
Barriers in treatment of obesity
NO SINGLE SOLUTION AWARENESS IDENTIFICATION RECRUITMENT PARENTAL ACCEPTANCE HCP RECOGNITION EXPERTISE SENSITIVITY – STIGMA FUNDING SUSTAINABILITY
Levels of obesity and some challenges
Physical literacy in the obese child?
Carnegie Weight Management
Results and evaluation
Capacity and capability
12-year old girls and boys
2
2.2
2.4
2.6
2.8
3
3.2
Self-worth School Social Athletic Appearance Behaviour
Obese boys Normal wtObese girls
* p<.01 **p<.001
Social network mapping
Strauss & Pollack, 2003
Fat-teasing in boys & girls (Murphy & Hill, 2003)
1.8
2
2.2
2.4
2.6
2.8
3
3.2
Self-worth School Social Athletic Appearance Behaviour
Non victimised Fat teased boysFat teased girls * p<.05 **p<.001
** **** ***
The reality
“My teacher told us that whoever finished last during the warm up (one lap of the
field) would have to do a further 10 laps. I thought I was going to be okay until all the
kids in my class sprinted off just before the line. I had to do my ten laps and
missed playing football.”
Percieved Benefits and Barriers of Physical activity
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Normalweight Overweight Obese
BenefitsBarriers
Deforche et al. In press
Percieved benefits of physical activity
0
1
2
3
4
5
6
Socialcontacts
Pleasures Competition Feelingbetter
Lookingbetter
Losingweight
Improvinghealth andphysicalcondtion
Normalweight
Overweight
Obese
*** * ***
Deforche et al. In press
Barriers to physical activity
0
0.5
1
1.5
2
2.5
3
3.5
4
Insecure aboutapperance
Not being good atit
Not liking it PhysicalComplaints
External Barriers
Normalweight
Overweight
Obese
*** *** ****
Deforche et al. In press
Anthropometry and sports performance variables (RADS 05)
Standing long jump (m)
Chest push
(m)
10 m sprint (sec)
20 m Sprint (sec)
Speed bounce
(n=)
Total score
Weight -0.28*** -0.32*** 0.20*** 0.26*** -0.25*** -0.18***
BMI -0.37*** 0.19*** 0.26*** 0.33*** -0.30*** -0.28***
% Body fat
-0.47*** 0.03 0.32*** 0.42*** -0.34*** -0.35***
Waist -0.30*** 0.25*** 0.24*** 0.28*** -0.33*** -0.26***
Exercise tolerance
Differences between absolute and relative.
Light, moderate and vigorous are often used to describe relative exercise intensity.
• However two individuals can be exercising at the same absolute energy expenditure, say walking together at a speed of 3mph (4.8 km.h-1, 3 METS).
• Least fit obese person - vigorous exercise relative to their aerobic fitness (> 60% VO2 max.)
• Fitter individual - light exercise intensity relative to their aerobic fitness (< 40% VO2 max.).
VO2 Peak of obese adults and data from the ADNFS
0
5
10
15
20
25
30
35
40
45
50
Obese adults 5th centile ADNFS Average ADNFS
VO
2 m
l.kg
-1.m
in-1
pea
k @
85%
pre
d hr
m
Males
Females
Cooke and Gately 2004
Data associated with exercise test of overweight and normal weight children (n=128)
0
5
10
15
20
25
30
35
40
45
50
VO2 ml.kg-1.min-1 @ 85%Pred HRM
Time (mins) to 85% HRM RPE @ 85% Pred HRM
OWCNWC
Gately et al 2003
****** *
Inter-Individual Variability
Arrival 15 30 45 60 75 Fatigue P15
Fe
elin
g S
cale
-5.0
-4.0
-3.0
-2.0
-1.0
0.0
1.0
2.0
3.0
4.0
5.0
Aggregate
Participant 1
Participant 2
Participant 3
Prolonged LIST to fatigue
Backhouse et. al. unpublished data 2004
VO2 Peak assessed at pre post and 1 year follow up
20
22
24
26
28
30
32
34
36
38
Pre camp Post camp 1 yr
VO
2 m
l.kg
-1.m
in-1
Pea
k @
85%
Pre
d H
RM
Campers
OWC
NWC
Gately et al. 2003
Levels of obesity and some challenges
Physical literacy in the obese child?
Carnegie Weight Management
Results and Evaluation
Capacity and capability
Carnegie Weight Management
Treatment programmesCamps (residential & day),
clubs
Multi mediaResearch,
ConsultancyTraining
Communication
Capacity &
Capability
CWM Research Objectives
1 Understanding the key ingredients of successful weight management in children.
2 Investigation of appropriate research methodologies for treatment of childhood obesity.
3 Basic science & validity of assessment methodologies.
4 Transfer to other contexts.
Weight loss journey
Carnegie International Camp
Carnegie Day Camp
Carnegie Clubs
ww
w.C
arne
gie
we
igh
tma
nag
em
ent.co
m
Severe obesity
Weight loss journey
Carnegie Day Camp
Carnegie Clubs
ww
w.C
arne
gie
we
igh
tma
nag
em
ent.co
m
Obese
Weight loss journey
Carnegie Clubs
ww
w.C
arne
gie
we
igh
tma
nag
em
ent.co
m
Overweight
Carnegie Curriculum
DietPhysical Activity Social Activities
BehaviourChangeTheory
&Tools
TheoriesSelf Determination•Competence
•Fun and friends•Autonomy •Relatedness
Solution focused
ToolsCBT
Curriculum sessions•Res. Camp - 48 •Day camp – 30•Club - 24
Levels of obesity and some challenges
Physical literacy in the obese child?
Carnegie Weight Management
Results and evaluation
Capacity and capability
Self Perception Profile for Children (SPPC)
1.6
1.8
2
2.2
2.4
2.6
2.8
3
3.2
Self-worth School Social Athletic Appearance Behaviour
Normal weight
Pre-camp
Post-camp
** ****
Source: Walker et al. (2002)** (P<0.01)
Salience of worries, Walker et al 2002
0
1
2
3
4
5
6
7
8
Fre
qu
ency
of
wor
ries
Campers pre
Campers post
NW Comp pre
NW Comp post
*P<0.05, ** P<0.01,***P<0.001
*
Mean (SE) change in valence of campers’ automatic thoughts about exercise, eating and appearance (Barton 2004) Boys
Start End
Girls Start End
Exercise
Negative
0.55
(0.16)
0.18
(0.14)
0.38
(0.10)
0.03
(0.03)
T**
Positive
0.91
(0.23)
1.91
(0.27)
1.69
(0.19)
2.56
(0.19)
T** G*
Eating
Negative
0.77
(0.21)
0.55
(0.14)
0.69
(0.13)
0.90
(0.13)
Positive
1.05
(0.19)
1.18
(0.22)
1.18
(0.17)
1.46
(0.16)
Appearance
Negative
2.05
(0.31)
1.18
(0.29)
2.41
(0.20)
1.41
(0.23)
T**
Positive
0.32
(0.19)
1.36
(0.32)
0.33
(0.11)
1.10
(0.22)
T**
T main effect of time, G main effects of gender, *p<.01 **p<.001
Hill et al 2004
0
0.5
1
1.5
2
2.5
3
3.5
Pre Post
Time
Ath
letic
Com
peta
nce
***
12 month outcomes for Athletic competence clubs programme
Skill based exercisePre and post scores for sports skills pre to post camp
0
10
20
30
40
50
60
Badminton Serve Basketball shot Football Dribbling(secs)
Volleyball Volley
Skills
Scor
e
Week 1
Week 6
***
***
*** P<0.001 pre to post
***
***
‘Being’Overweight AppearanceOver eaterSedentary‘Bad’ foods
‘Outsiderness’
‘Doing’‘Thin’ BehaviourDieterExerciser‘Good’ foods
‘Outsiderness’
“People stay normal weight & don’t really focus on it. They have their food and they live their life”
UNHEALTHY NORMAL ‘SUPER’HEALTHY
Looking
&
behaving
like
peers
Illustrative accounts of the discontinuities between current behaviour and appearance
Hester and Gately (2007)
“Even though I knew I had to eat I was finding
it hard to find something that I knew that was acceptable to eat.. I ended up eating
lunch at 4pm”
“My best friend told everyone I went on camp so I went mad at her… in case they thought like oh
my god you’re fat and everything. In case they made fun of me for going
to a fat camp”
“I knew I was being good so why should people mind that I
was eating but NOW it’s like people see me eating bad food and they know I’m being BAD…I feel bad when
I’m being bad”
“I just want to be in a healthy, forgivable and easy routine
that is just sort of is normal to me..just being in a routine and not knowing anything else.. I
don’t like having to try and do something that I shouldn’t
have to try and do”
“Even if you lose a pound a week that’s like 3 stone in a year.
You’ve still got 3 years (until) you’re down to your ideal
weight”
I’ll just get stuck into it all. I’ll be like (Dave) is
now. I mean he does everything…he has raw
eggs! He drinks raw eggs to build his muscles up-……I couldn’t do that!”
“My (teacher) used to give me a set dinner meal every week. She used to hand it to the dinner staff and the dinner staff would give me a meal and I wouldn’t be able to choose anything
else”
I’d probably turn around and go hold on a minute, I can do
something with my life here and then get stuck into exercising
and dieting, get the weight out of the way and then go for a job and get a job, get married and
have kids like every other person”
“I hope to get to the stage where I’m a good
sort of role model. Where I can do like a
magazine thing where I’ve lost 8 stone- look
at me now!”
“It’s frustrating when (parents), if I was having 3 slices of toast and cereal
and 2 glasses of fruit juice, are like, What are you
doing? Don’t talk rubbish you (didn’t) have that sort stuff at camp- you wouldn’t
have lost weight”
“I know it could be 6 months down the line
and I’ve put on 4 stone.. which is what happened last year… there’s not a day that I don’t think about my
weight”
“I hope to get down and go into normal
shops and get all the kinda (clothes) that I
want to get. Like (now), when I walk
into shops, I’m like I can’t get anything in
here!”
Long term results of residential programme
1
1.5
2
2.5
3
3.5
4
Pre 1 Post 1 Pre 2 Post 2 Pre 3 Post 3 Pre 4 Post 4
Time
Stan
dard
ised
BM
I sc
ore
Mean one year follow up data
Mean two year follow up data
Mean three year follow updata
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, having fun with friends.”
Comments on lifestyle:• “His eating is better now because he has his own microwave meals.”• “We never see him now he is always out with his friends.”
Comments on support:• “Dr. told me I was going to die, I don’t go to him anymore”.• “Parents are always nagging me, not helping me”.
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
BMI SDS -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
Fitness (l.min-1) 0.2 + 0.4 0.3 + 0.3
Levels of obesity and some challenges
Physical literacy in the obese child?
Carnegie Weight Management
Results and evaluation
Capacity and capability
Building Capacity and Capability Obesity Care Pathway Implementation
• Since 2002 partnership with children and PCT’s Training
• Vocational Certificate in Weight Management.• One day awareness training programme.
CWM Partnership• Scaleable and support for direct delivery
Communication• How to identify, recruit and refer?
Evaluation• Does it work? What can we do to find out? Ethics?
Carnegie Weight Management
The GrangeHeadingley Campus
Leeds Metropolitan UniversityLeeds
LS6 3QSTel. +441138123579