Prevention of child obesity: 'First, do no harm'

Abstract

The prevalence of child obesity has steadily increased in Western and developing countries over the last two decades, and child obesity prevention is now firmly on the agendas of nearly all major governments. We are now confronted with the challenge of what to do about the problem, and the general consensus among various academics, researchers, practitioners and administrators worldwide is that prevention needs to begin. Before governments and other agencies leap into actions that they assume to be beneficial in the battle against child obesity, we must remember to employ one of the most important principles of modern medicine and prevention science, ‘First, do no harm’. An examination of potentially unhelpful or dangerous outcomes of child obesity prevention efforts is required before prevention activities begin. There are many examples of perfectly reasonable and well-intentioned health messages being partially misconstrued or misunderstood by members of the general public, resulting in the inadvertent production of undesirable effects in the implementation of supposedly health-promoting activities. The uptake of dieting and slimming among girls and young women is one example of a health message gone wrong. The moderate and sensible government dietary guideline of the late 1970s was taken up by the target audience who required it least—young women, who adhered to the ‘control your weight’ message most vehemently. The exponential rise in disordered eating that followed these early messages has left health educators with the huge challenge of normalizing body image and eating behavior among a large proportion of our young population. The government message to control weight within reasonable limits was clearly exploited by cigarette advertisers who utilized the belief that cigarette smoking could be an effective slimming agent. This is an example of a health-related message going astray. What we failed to achieve as health educators, was to clarify this situation, that yes, controlling your weight is important, but not at the expense of other health behaviors. Multi-national corporations and marketers of the 1950s to 1980s clearly delivered the ‘smoking is slimming message’ and this well entrenched way of thinking has placed current health educators in the uneasy predicament of having to encourage quitters to believe that the benefits of quitting despite the expected risk of weight gain outweigh the perceived benefits of slimness. A huge challenge indeed! Similarly, the early ‘control your weight’ messages of the past, and those of today, clearly identify people who were overweight as failures, deviants or moral outcasts who needed some sort of ‘treatment’, most of which, when undertaken by the overweight person, resulted in further failure, defeat and humiliation, leaving us with the current prevalence of obesity of today. Is our message to overweight people and obese children any different today? Are our current preventive strategies any different or any more likely to succeed? To whom is child obesity prevention targeted? We must make certain that our preventive efforts are well conceived and based on a sound knowledge of prevention principles. The first step in approaching any health education problem or planning any prevention program is to be very clear about what it is that we are trying to achieve and to have a clear definition of what we are trying to prevent. In the case of child obesity, we need to be clear from the outset that our role as health educators and prevention specialists is not in the diagnosis or treatment of child obesity. Health professionals and health educators involved in the prevention of child obesity need to understand the difference between treatment and prevention. The treatment of child obesity should only occur in a supervised clinical setting after a thorough and appropriate clinical assessment. Prescription of weight control programs, dietary advice or other individual interventions for the obese child should remain the role of the pediatrician, general practitioner, dietitian or other clinically trained staff. Community-based professionals such as health educators, nutritionists, nurses, teachers, youth workers, sports coaches and others working with children and youth must understand the difference between child obesity treatment and prevention, and must act accordingly using appropriate referrals without confusing their clinical and community roles. Health and education professionals should also be acutely aware of the fact that a child's health status encompasses several different dimensions including physical, mental, social and spiritual health, and not merely the absence of disease. Likewise, the absence of obesity does not necessarily ensure a healthy child. Child obesity prevention should not dominate the overall picture of child health. There are many essential aspects of child health, including sound nutrition for growth, development, immunity, brain function