This book offers practitioners and researchers detailed insight and a practical step-by-step approach to developing and evaluating programmes for the management of childhood obesity. It describes evidence-based and clinically relevant approaches that are currently available and offers guidance on developing, setting up, implementing and evaluating weight-management programmes for children and adolescents in both clinical and research settings.
The introduction discusses the problem of childhood obesity from a global perspective. Existing approaches for the management of childhood obesity are discussed in terms of their success but it is acknowledged that this is a challenging area for all involved. It considers where the focus should lie and argues that if it is accepted that the current epidemic is due to the effect of an ‘obesogenic’ environment exerted on those who are more genetically susceptible, then the environment should be targeted. It concludes that effective prevention must therefore be the goal.
Section 1 describes clinical management strategies, challenges, business plans and, importantly, the evaluation methods. This section is refreshing compared to other texts in the field as it combines scientific and medical knowledge with principles of health promotion and applies them to the development and evaluation of weight-management programmes.
Section 2 discusses the risks and consequences associated with childhood obesity and their effect on present, immediate future and long-term future (adult) health. The medical complications and co-morbidities commonly observed in clinical practice childhood are described and the author makes the poignant comment that as prevalence of childhood obesity has increased, so has the incidence and severity of medical complications. The role of the physician is described within the context of a specialist centre within a clinical setting and apart from reference to dietetic support, there is little reference to a multi-disciplinary team approach. The medicalised approach also seems to be at odds with the early reference to the application of health promotion principles to weight management programmes.
The chapter on psychosocial considerations during treatment suggests that an assessment of psychosocial status should be regarded as an important clinical outcome and that tools such as cognitive behavioural therapy, behavioural counselling and motivational interviewing should be utilised to enhance the efficacy of weight-management.
Methods for clinical evaluation, including diagnosis, medical testing and follow-up, are detailed. The section also covers nutritional assessment methods to employ with the aim of helping the practitioner develop an appropriate treatment plan. The guidance on dietary assessment acknowledges the major problem of under-reporting in overweight children and adults and recommends the use of global assessment, which consists of self-administered 3-d diaries, nutrition questionnaires and a dietary interview undertaken by a dietitian. A comprehensive description of behavioural and psychosocial assessment tools is also presented and detailed guidance on exercise testing is provided.
Guidance on evidence-based dietary approaches concludes that successful approaches are those that are implemented in conjunction with promotion of physical activity and behavioural counselling. This is a particularly useful section, which offers dietary strategies by medical history, age and level of obesity. Additionally, the evidence of effectiveness of low-glycaemic index or very low energy diets in adolescents is discussed and strategies to employ in nutrition education and techniques to promote behaviour change are outlined. A comprehensive table of evidence from RCT family-based and individual intervention studies illustrates the success of family-based behavioural counselling in achieving healthy dietary and physical activity behaviours within clinical settings. A range of motivational techniques to increase physical activity is discussed and the evidence of the link between exercise training programmes and metabolic health is covered. A useful section on components of successful exercise programmes is also included. A chapter on advances in technology examines the role of Internet-based childhood obesity treatment programmes. The evidence for pharmacological treatment and the role of bariatric surgery in adolescent obesity is assessed and suggestions for clinical practice are offered. A useful example of an interdisciplinary, interactive childhood obesity weight-management programme with details of the sessions and guidance on monitoring and evaluation is included. Furthermore, practical details on programme content, techniques and approaches to use in group weight-management programmes are provided. A useful appendix is provided in the book and is divided into three sections: clinical management forms; testing and measurement protocols; examples of educational materials. The chapters within the book constantly refer to the materials within the appendices, which enhance the practical and applied nature of this book.
In conclusion, although based on American standards, this book is well-written and provides practitioners and researchers with a comprehensive, evidence-based, practical guidance on developing, implementing and evaluating obesity management programmes within the clinical setting. In particular, the incorporation of health promotion principles in the design of weight management programmes is both useful and refreshing.
