Key Messages on Physical Activity & Obesity in Children
Key Messages for Fitness Practitioners from the
International Conference on Physical Activity & Obesity in Children
Toronto, June 24-27, 2007
By P. Douglas Lafreniere
| Information from both the scientific and medical communities world-wide tells us that our children are at risk of a poor quality of life and a shorter lifespan from chronic diseases associated with obesity. Obesity in children and youth has more than tripled in Canada in the past 15 years, and there is no indication that this epidemic is slowing down.
Evidence is mounting yearly that the combination of increased sedentary behaviours (like TV watching and video games), poor nutrition (from fast foods) and unhealthy lifestyle habits (like lack of daily physical activity) are negatively impacting the health and wellbeing of Canadian children and youth. Last week, Canadian exercise scientists hosted representatives from around the world at the International Conference on Physical Activity & Obesity in Children held in Toronto. The conference focused on developing answers to important questions about what needs to be done to change these alarming trends. This article summarizes the key messages and provides recommendations for fitness practitioners. |
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The conference speakers addressed five pre-specified themes. Each theme took the form of a question that groups of speakers addressed within their individual presentations. The presenters were some of the top childhood obesity researchers in the world, so some excellent points made. The initial session set the stage by giving a global perspective of the problem.
Dr. Phillip James and Dr. William Dietz provided the overview and made the following key points respectively:
First, the childhood obesity epidemic worldwide is thought to have begun in 1970 (+/- 10 years), and it is estimated that an additional 350,000 children worldwide have become obese each year since then. Focusing prevention measures on females who are of childbearing age is of the utmost importance if we are to give future generations of children a chance at a life free of chronic disease.
Second, we now have a good method to assess the extent of childhood overweight and obesity based on the work of Cole et al. Cole and his colleagues developed age and gender sensitive charts that identify overweight and obese children from birth to young adulthood based on body mass index (BMI) scores. BMI is calculated as weight in kilograms divided by height in metres squared has been adjusted to take into account growth in children and youth. These charts can be used effectively by fitness practitioners to objectively assess child weight status and to bring this information to parents because early onset of overweight in children may carry additional health risks for them as adults. Caution should be exercised when interpreting BMI scores of children and youth because they measure the degree of heaviness, not the extent of body fatness.
The remaining five theme questions for the conference were:
1) Are children and youth more or less active than previous generations?
2) Is physical inactivity contributing to obesity in Canadian children and youth?
3) What are the practical implications of the physical activity deficit?
4) What are the public policy and public health implications of the physical activity deficit?
5) Are there successful, innovative community-based physical activity interventions?
As well, Dr. Mark Tremblay, chair of Active Healthy Kids Canada, presented the 2007 version of Canada’s Report Card on Physical Activity for Children and Youth 2. These are the key messages and recommendations for fitness practitioners based on the presenters’ responses to the theme questions:
Theme Question 1
Are children/youth more or less active than previous generations?
A: |
Based on the research conducted in the past ten years or so, children and youth may or may not be less active. To obtain a clear answer to this question, we need more research that collects objective data on daily physical activity (DPA) and daily physical inactivity (DPIA) levels amongst this group. Most of the recent research has used self-reports of DPA and DPIA, and the data within these studies is highly suspect. We need studies that use objective measures of DPA, like accelerometry, and are longitudinal in design with data collection on large cohorts of children/youth.
These studies will give us a clear understanding of what ratio of DPA/DPIA significantly contributes to increasing body weight and obesity in children. There may well be a stalling or decline in the amount of structured physical education provided in schools, but we are not sure of this either. The decline seems to be driven by the lack of appropriate resources and increased expectations for curriculum delivery on the part of all teachers. Ongoing levels of DPA in schools also need to be objectively measured in order to answer this question. |
Theme Question 2
Is physical inactivity contributing to obesity in Canadian children and youth?
A: |
Probably. This conclusion is based on our knowledge of genetics and the effects of poor lifestyle choices when humans are surrounded by an “obeseogenic environment.” As Paleolithic hunter-gathers, we naturally have the predisposition to store body fat in our genes so that we can survive as a species. This adaptation enabled us to survive in times of famine by storing energy in times of feast. Resting metabolic rate decreases (or increases) in proportion to human muscle mass. Therefore, physical inactivity (causing muscle atrophy from disuse) reduces resting metabolic rate and is thought to significantly contribute to the net positive caloric balance which causes us to slowly gain weight as body fat over time. Physical inactivity has also been identified as a primary risk factor for heart disease and stroke in humans. On the basis of this information, the current understanding in the field is that DPIA probably contributes to childhood obesity.But more well-designed research is required to establish any type of a direct, cause-effect relationship between the two. |
Theme Question 3
What are the practical implications of the physical activity deficit?
A: |
Children see, children do. If parental levels of DPA are low, it follows that children will have low levels of DPA. Therefore, role modeling of physically active parents can play a role in reducing DPIA among children. However, there is presently a paucity of sound research that suggests that family-based interventions around DPA actually work. We may intuitively feel that the home is the ideal spot for promoting DPA, but we do not have the research to back this intuition up yet. It is important to remember that ecological models of intervention have exhibited some degree of success. This means that the child, family, school and community at large are all considered important parts of interventions to change weight status. Simple parental choices like rules to reduce TV viewing time, better nutrition habits and walking or riding a bike to school daily, may have a huge effect on long term weight status among our children. Our society has become one of convenience rather than physical activity. Children and their parents are strongly influenced by marketing of fast foods on TV, violence in the streets and labour saving devises. Parents can and should influence their children’s behaviour at home so that DPA, healthy eating, reduced TV and computer gaming time become the norm. Schools can help by providing supervised DPA and by using creative and colourful environments that encourage active rather than passive play at school. It is the combination of school activity and home-based activity that can effect changes in a child’s individual weight status. It was suggested that preventing weight gain amongst children is a far more effective strategy than attempting to reduce weight with specific interventions like diet and DPA. |
Theme Question 4
What are the public policy and public health implications of the physical activity deficit?
A: |
A sedentary lifestyle increases the risk of childhood obesity. Obesity increases the risk of chronic diseases like type 2 diabetes, heart disease and stroke. Chronic diseases cost countries billions of dollars in direct and indirect costs each year, and these costs are steadily escalating. Public health policy makers must look closely at the impact that obese children and youth currently have on world healthcare systems. Policy decisions around banning sophisticated child-focused advertising of unhealthy food choices, taxation of fast foods and sugared drinks, tax incentives for equipment and activities that support DPA amongst children and youth may all need close consideration if we are to have a meaningful effect on population obesity around the world. An alliance with the environmentalist movement and the promotion of carbon free transportation may be an important contributor in future. Public health policy could influence how towns and cities are designed by insisting that more be done to promote walking, biking and the use of public transportation. Also, promotion of the benefits and best-practice methodologies for increasing DPA in schools, families and communities should be vigorously undertaken by governments in attempts to engage people to examine their lifestyle choices and to facilitate healthy changes. At present there are limited incentives and substantial risks for private sector companies to be involved with the childhood obesity initiative. But, impending social and political change may help facilitate their involvement as time goes by. |
Theme Question 5
Are there successful, innovative community-based physical activity interventions?
A: |
There seems to be more evidence supporting the contention that decreasing sedentary behaviours may have a greater long term effect on obesity rates that increasing DPA. Research indicates that comprehensive models that use the family, school and community environments to influence sedentary behaviours in children and youth get promising results. Again, large cohort research with children who are followed over a number of years during these multi-level interventions are required to equivocally show that they actual work. Parental limit-setting around food choices, TV time and reducing sedentary activities at home in combination with supervised, creative and fun activities at school are promising intervention strategies. Providing the opportunity and means for children and youth to engage in community sports and recreation groups is important as well. It would seem that the combination of home, school and community interventions may prove to be most effective at promoting and sustaining healthy weights in this group. |
Canada’s Report Card on Physical Activity for Children and Youth 2
The 2007 version of the Report Card demonstrated that for the third straight year in a row Canada has failed to improve the physical activity levels and obesity rates among our children and youth. Fully 91% of Canadian children and youth do not get the amount of daily physical activity prescribed in Canada’s Physical Activity Guidelines for Children and Youth. There has been no change in sedentary behaviours in this group either. The average TV viewing time for children 10-16 years of age is six hours a day, and there is a suggestion that increased screen time can pose as a risk factor for child depression, anxiety, a low sense of belonging and a low self-esteem. To make matters worse, the number of obese children and youth in Canada increased by over 35% from 2003 to 2006, with even higher rates among aboriginal children. ParticipACTION has been resurrected by the federal government and has a mandate to focus on children and youth as its key target market.
Fitness practitioners can use the information in this article to identify children and youth at increased health risks by utilizing the BMI charts referred to previously. You can also pass the word to parents, school teachers and community leaders about developing partnerships focused on reducing sedentary behaviours, improving healthy eating and providing appropriate levels of DPA for their children and youth. Hopefully this synergistic approach will work to improve the weight and physical activity profiles of all young Canadians.
Douglas Lafreniere, MSc (Kinesiology) is active at the provincial and national levels as a professional member of the Canadian Society for Exercise Physiology. Doug is a CSEP Certified Exercise Physiologist and a national examiner for the new CSEP-PFT personal fitness trainer designation. Doug has taught at Loyalist College in Belleville, Ontario for over 20 years.
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