Obese toddlers and a system under pressure

INTERVENTION: The Hunter is home to some of the fattest suburbs in NSW and now demand for dietetics weight management services for obese children is so high, many will remain on a waiting list for at least six months. One in four NSW children are now overweight or obese.
INTERVENTION: The Hunter is home to some of the fattest suburbs in NSW and now demand for dietetics weight management services for obese children is so high, many will remain on a waiting list for at least six months. One in four NSW children are now overweight or obese.

CHILDREN as young as 18 months old are presenting to John Hunter Children’s Hospital as overweight or obese.

And it has been revealed families can wait six months or longer to access childhood obesity services at the hospital, such is the demand for intervention.

The Hunter is already home to some of the fattest suburbs in the state, and paediatricians are warning that the childhood obesity crisis could mean this generation of children may have shorter lifespans than that of their parents – “a situation not experienced for the past 200 years”.

University of Newcastle laureate professor Nicholas Talley wants the Australian government to adopt a plan for action on obesity – a plan which recognises it as a chronic disease.

He also recommends a tax on sugar sweetened beverages and a reduction of unhealthy food marketing to children.

“We have had very young children who are significantly overweight or obese. We’ve seen children as young as 18 months. Being overweight or obese as a child significantly increases your risk of being overweight or obese as an adult.

Julie Adamson

He said the tax should be used to support a national obesity strategy.

More than 60 children are currently on the waiting list for dietetics weight management service at John Hunter Children’s Hospital.

A new project involving the hospital and the University of Newcastle aimed at helping obese children earlier will soon begin.

Dr Julie Adamson, the director of general paediatrics at John Hunter Children’s Hospital, said obesity was affecting some children in the very first few years of their lives. “We certainly see preschoolers,” Dr Adamson said.

“We have had some very young children who are significantly overweight or obese. We’ve seen children in from as young as 18 months and two years old.”

Dr Adamson said this was seen across NSW in all populations, and it was a “major concern.”

“With a preschool child, the child is not in control of what they buy, what they eat, what they prepare, or what they do,” she told the Newcastle Herald.

“It is family-driven, which is why preventative strategies that help families to understand, and make it easier for them to make good, healthy choices are really important.

“We know that being overweight or obese as a child significantly increases your risk of being overweight or obese as an adult.”

Nutrition and dietetics professor Clare Collins said the University of Newcastle had partnered with the hospital to trial a 12-week early intervention program that offers consultations via the internet.

CHANGES: Nutrition and dietetics professor Clare Collins said portion sizes had increased in recent years and we were moving less, with more time spent online.

CHANGES: Nutrition and dietetics professor Clare Collins said portion sizes had increased in recent years and we were moving less, with more time spent online.

“Some people would have been put off because the waiting list is so long,” Professor Collins said.

“But what this means is that even if that waiting list is pretty big, families are going to get offered an appointment fairly quickly once our program gets up and running.”

Children on the hospital’s waiting list for obesity services were referred to the clinic by a GP.

“The problem is there are more referrals than appointments, so there is a waiting list,” Professor Collins said.

An after-school program called Go 4 Fun is offered to people aged seven to 13.

But if a child is younger than seven, older than 13, or the program is not offered in their area, they are placed on the hospital’s waiting list.

“You might be on the waiting list for six months or longer if you are not eligible for that program,” Professor Collins told the Herald.

The telehealth program would have a major focus on changing the family’s eating habits, and would offer advice on meal planning, parenting support, and physical activity.

“We’ll give consultations through the computer, and using some smart technology tools, we can assess people’s dietary intake, give personalised feedback, and give them access to some good information on meal planning,” Professor Collins said.

“We want to be able to give more people more services. Thanks to an nib Foundation grant, very soon we’ll outreach this to the Upper Hunter regions, like Tamworth and Armidale, where it can be even more challenging to access services.”

Professor Collins said the world had changed with regard to what we eat and how much we move.

Portion sizes had increased, and even our cups and plates were larger. 

“It’s an environment where there is too much nice food, and too many fun things to do where you just sit down and go online,” she said. “All of those factors all have a subtle effect, but they are all happening to kids at once in this current generation.

“It is why we need to come up with some new approaches to support parents to help their kids grow optimally and be healthy, and not have them on this trajectory that becomes very hard to change the older they get.”

The Newcastle Herald has previously reported the Hunter is home to some of the fattest suburbs in NSW, with Raymond Terrace and Scone claiming the dubious honour of having 70.8 per cent of its adults recorded as overweight or obese.

In the latest issue of Australian Medical Association’s The NSW Doctor magazine, Westmead Children’s Hospital paediatrician Dr Shirley Alexander writes that this current generation may have a shorter lifespan than its parents – “a situation not experienced for the past 200 years.”

Dr Alexander says children with obesity are at increased risk of both immediate and long term physical and mental health issues, and without intervention, their obesity would likely affect them in their adult life.

About 25 per cent of children from kindergarten through to Year 10 in NSW were affected by the epidemic, and the Hunter’s rates were comparable, said Dr Adamson.

“In 1985 it was one in 10 children that were either overweight or obese, and now it is almost one in four,” Dr Adamson said.

“There have been a lot of community-based changes in that time,” she said.

“We are more concerned about safety for children now, and they are restricted in more ways. 

“They are not walking to school as much, or running around in the bush in the afternoon as much, or playing as much sport. 

“Eating habits have changed. 

“We’re not sitting down for family meals or exercising together as much as we did in the past, and advertising and social media are actively targeting children as a population of consumers.”

Dr Adamson confirmed there was a waiting list for dietetics weight management services at the children’s hospital.

There was about 64 children currently on the waiting list, because the majority of obese or overweight children had been redirected to their GP, private dietitians, or to community service programs such as the Go 4 Fun initiative.

“The hospital setting is predominantly for children with severe obesity and/or complications,” she said.

“The majority of children who have obesity would be managed in the community, and so most of the efforts to help them are coming through preventative health initiatives within the primary and community health settings.”

Given that 25 per cent of children in the local area were considered overweight or obese, Dr Adamson said it was just not possible for the hospital’s dietitians to see every child, which was why community support was so vital. 

But the telehealth collaboration with the university would be a great way to offer help and advice to families earlier, she said.

“It’s about helping families to change behaviours to make healthier lifestyle choices as quickly as possible,” Dr Adamson said.