Hospital steps in to tackle the child obesity epidemic

Turn up at Temple Street Children’s University Hospital on certain evenings during the week and you’d be forgiven for thinking you were at a sports camp, not in a hospital.

Whoops of laughter ring out as children race each other, play dodgeball and work on their technique with a football. The children are taking part in a healthy lifestyle programme run by the hospital’s obesity service.

And far from being sports mad, many have avoided exercise for years.

“Part of it is just the way they feel. They are too self-conscious,” says Dr Sinéad Murphy, consultant paediatrician at Temple Street.

“It would break your heart to hear the children saying, ‘I get all red and sweaty and everyone looks at me and I don’t want to do it.’ An hour of each programme is dedicated to exercise, and that’s really to give these children back the confidence to exercise.”

Temple Street started its obesity service for children in 2004 and the following year set up a group programme, the W82GO programme, which treats children in conjunction with their families.

Multi disciplinary team
It involves the input of a multidisciplinary team, including a dietitian and a psychologist, who work together to help the children manage their weight by changing their diets and getting active.

For the first six weeks children attend the hospital on a weekly basis, here they do PE and they and their families take part in information sessions and learn, among other things, how to read food labels and to shop healthily.

Since its inception, demand for the service, which is the only one of its kind in the State, has grown steadily.

Some 110 children attended the service between January and the end of October 2013, compared with around 20 back in 2004, and there are more than 140 children on the waiting list.

The age at which children are presenting is also getting lower.

Of the 200 children currently undergoing treatment, the youngest is just 18 months old, while the W82GO team reported a 400 per cent increase in referrals of children aged five and under between 2011 and 2013.

Many of the children are already suffering the medical consequences of being overweight.

More than 60 per cent have pain, either in the hip, back or knee, which stops them from moving. Others have high cholesterol, high blood pressure and sleep apnoea.

More than half have experienced bullying.

Biggest childhood epidemic
Chartered paediatric physiotherapist and W82GO program me director Grace O'Malley describes obesity as the "biggest childhood epidemic of this century ".

“Not having a healthy eating pattern, lack of physical activity and lack of adequate sleep are the most likely causes of simple obesity.”

She says the numbers of children who regularly consume sports drinks is a big concern for clinicians, while the amount of time children spend at screens, including playing video games and using phones, is also an issue.

“We’ll have some babies with sports drinks in their bottles. You can’t blame [the parents] . They don’t think it’s bad.

“Why would you think it’s bad if your favourite sports star is saying this is a great thing to have?” asks O’Malley, who adds that surgery drinks should be a weekly treat.

“Children over five should be getting an hour of activity a day for minimum health. Only 30 per cent of children are getting that.”

The physiotherapist says adequate sleep is really important in the fight against obesity.

“If children don’t sleep enough, they tend to be hungrier and to crave high -fat, high-sugar foods.

“We do a lot of education for parents, making sure that their primary school kids get 12 hours a night and between nine and 11 hours after that.”

The physiotherapist says that after they begin to treat children, the first thing they see changing is not weight, but their confidence. They have more friends, they are doing better in school and the dynamic of the family is better.

Things can change
She says it can be hard to get from day one, where you are eating processed foods in high volumes, to a balanced diet, but that it is possible.

“We have to get the message out that these things can change. By making small changes, you can have a huge effect.”

Murphy says they are having such a definite increase in younger children attending the service that they are setting up a parent-focused session to educate the parents of these very tiny children to avoid it becoming an issue.

"The younger we see the children, the better the outcome," says Murphy, who adds that more than half of the children she sees in her general paediatric clinic are overweight.

Completely preventable
"Being overweight is becoming the norm. The biggest tragedy is that all of this is completely preventable."

She says educating people about the kind of lifestyle they should be leading is one part of the jigsaw, but that both the food industry and Government have big roles to play in tackling the obesity issue.

“There are many families who would like to walk to school, who would like to go and play in the park, but they can’t.

“There might not be a footpath between the school and where they live or there isn’t a park for miles around.

"The environment needs to be set up to enable this to happen."

W82GO.ie

Case study Healthy lifestyle changed Conor’s life ‘dramatically for the better’

Conor Doyle from Glasnevin had always been "big" so being described as overweight was "nothing new ".

But when a doctor at Temple Street Children’s Hospital told him that he was at risk of developing type 2 diabetes, during a hospital admission for cellulitis, alarm bells began to ring.

Conor (17), a fifth-year student at Belvedere College, was just 15 at the time.

“My dad had developed type 2 diabetes a few years previously. When I was told, I got worried. It sparked in me a desire to change my lifestyle because I didn’t want to develop it,” he says.

And so when asked if he wanted to participate in a trial of a smartphone app as part of a healthy lifestyles programme run by the obesity service, Conor readily agreed.

“I was way more worried about having diabetes, so I was sort of agreeing to anything,” he says.

After completing his Junior Cert , Conor was assessed by a multi disciplinary team to see if he was suitable and after getting the green light, began working with the W82GO healthy lifestyles team in early 2013.

Changing eating habits
And so began the slow process of changing Conor's eating habits and upping his activity levels.

Last June he was given a phone with the app for 12 months, which enables him to set goals, monitor his progress and through which he receives daily motivational tips.
Life changed dramatically
Eight months later and Conor, who hopes to study science at third level, has lost an impressive three stone and his life has "changed dramatically for the better ".

“Nothing about losing weight has had a negative effect on my life except for the fact that I have to throw out old clothes and I did that with a happy heart.

“Everything has been positive. I’ve got great support from all my friends. My diet has greatly improved.

"My confidence has gotten a lot better. I'm fitter, I'm healthier and I feel better. I've achieved something that has changed my life ," he says.

Georgina O’Halloran

Smartphone app the way to go for programme at Temple Street

Temple Street Children’s University Hospital is looking at the long-term possibility of using a smartphone app to make its weight management programme more accessible to teenagers who live outside the capital.

The W82GO Healthy Lifestyles Programme aims to help children get their weight under control by helping them change their diet and increase their activity .

Some 134 teenagers between the ages of 13 and 17 are taking part in a randomi sed trial to test the efficacy of the Reactivate smartphone app, which is a collaborative project between Temple Street Children's University Hospital, the Department of Epidemiology and Public Health at UCC, and City University London.

All participants in the clinical trial attend the hospital for six weeks of treatment. For the following 46 weeks, half of the participants attend the hospital every three months for follow-up care, while the others use the app.

The app, which is aimed at adolescents, enables users to monitor their eating, drinking, activity and sleeping patterns, and to set goals.

They receive daily tips and reminders and can connect with each other using the social networking element .

The director of the W82GO programme chartered paediatric physiotherpist, Grace O'Malley, who is carrying out the research as part of her PHD, s ays there are about 97,000 apps out there that are related to exercise, fitness and health, and that very few of them appear to be "evidence based ".

"We want to be really sure that if we were to think about using mobile health technology that we base it on fact ; on what we know works," she sa ys.

“Overall, they are very happy with the app. They are using it. That’s the most important thing.”

The 12 -month trial, which is funded by the Health Research Board and by the Children's Fund for Health – the fundraising arm of Temple Street – is expected to finish in early 2015.