Work with overweight young people. Professor Paul Gately Carnegie Weight Management Leeds Metropolitan University

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





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


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Males 1990-1994


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Self Reported data

Males 1995-1999


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Self Reported data

Males 2000-2005


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Self Reported data

EU Trends1980-2005Females

Females 1980-1984


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Females 1985-1989


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Females 1990-1994


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Self Reported data

Females 1995-1999


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Self Reported data

Females 2000-2005


% 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


IOTF 2004

0

5

10

15

20

25

30

1960 1970 1980 1990 2000

Poland

Pre

vale

nce

%Overweight children 7-11


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




Results and evaluation


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


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

*** * ***


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

*** *** ****


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







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

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Severe obesity

Weight loss journey

Carnegie Day Camp

Carnegie Clubs

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Obese

Weight loss journey

Carnegie Clubs

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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






Self Perception Profile for Children (SPPC)

1.6

1.8

2

2.2

2.4

2.6

2.8

3

3.2


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






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?


The GrangeHeadingley Campus

Leeds Metropolitan UniversityLeeds

LS6 3QSTel. +441138123579

[email protected]

Documents

Work with overweight young people. Professor Paul Gately Carnegie Weight Management Leeds Metropolitan University