BMJ  2006;333:1171 (2 December), doi:10.1136/bmj.39045.412593.1F

Letters

Physical activity to prevent obesity in young children

Dietary and behavioural modifications in managing childhood obesity

The article by Reilly et al provided conclusive evidence that other interventions besides enhanced physical activity are necessary for decreasing the BMI (body mass index).¹ The management of childhood obesity needs a multidimensional approach including dietary modifications, behavioural modifications, and physical exercise. Only in conjunction with the former two will physical activity have an impact in reducing obesity. Dietary modifications include avoiding eating in restaurants, decreasing soft drink intake,² decreasing portion sizes, avoiding dried and calorie rich foods, and increasing the fibre content of diet. Behavioural modification strategies include educating children and parents about healthy diets, encouraging children to keep food diaries and avoiding habits such as eating while watching television. Reinforcement of these strategies along with regular physical exercise is likely to produce significant results rather than using one approach exclusively. The management of childhood obesity is especially important to prevent complications such as low self esteem,³ hypertension, hyperlipidaemia, sleep apnoea,⁴ slipped femoral epiphyses,⁵ and diabetes mellitus.

Besides it needs to be remembered that though rare, there are genetic causes of obesity—such as Alstrom syndrome and Prader Willi syndrome—as well as endocrine causes such as hypothyroidism that need to be excluded before the above mentioned approaches are used.

¹ UIC, Chicago, IL 60612, USA skapoor5@uic.edu

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Competing interests: None declared.

References

1. Reilly JJ, Kelly L, Montgomery C, Williamson A, Fisher A, McColl JH, et al. Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ 2006;333:1041-3. (18 November.)[Abstract/Free Full Text]
2. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001;357:505-8.[CrossRef][ISI][Medline]
3. Davison KK, Birch LL. Weight status, parent reaction, and self-concept in five-year-old girls. Pediatrics 2001;107:46-53.[Abstract/Free Full Text]
4. Mallory GB Jr, Fiser DH, Jackson R. Sleep-associated breathing disorders in morbidly obese children and adolescents. J Pediatr 1989;115:892-7.[CrossRef][ISI][Medline]
5. Kelsey JL, Acheson RM, Keggi KJ. The body build of patients with slipped capital femoral epiphysis. Am J Dis Child 1972;124:276-81.[Medline]

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Relevant Article

Physical activity to prevent obesity in young children: cluster randomised controlled trial

John J Reilly, Louise Kelly, Colette Montgomery, Avril Williamson, Abigail Fisher, John H McColl, Rossella Lo Conte, James Y Paton, and Stanley Grant
BMJ 2006 333: 1041. [Abstract] [Full Text] [PDF]