APPENDIX 33
Memorandum by Dr Sheila McKenzie (OB 57)
I am writing as a consultant paediatrician with
an interest in respiratory medicine, and recently obesity, and
working at the Royal London Hospital. In the last three years,
the department of children's nutrition team and the respiratory
team have developed an obesity service for children. The waiting
list for these is 11 months, and considering the prevalence of
obesity in the community, this will continue to rise. The children
referred are those who have failed treatment in the community
and require the more refined services of a children's nutritionist,
dietician and clinical psychologist. It is difficult to judge
the effects of treatment without a comparative group not having
such intense therapy, but the initial results suggest that change
in weight for the group is nil whilst improvement for a few children
is modest.
My role is to identify medical problems associated
with obesity. In the last two years one child at the age of three
has died of heart failure secondary to extreme obesity. Four other
children also with severe obesity are managed at home with non-invasive
ventilatory assistance because they have severe obstructive sleep
apnoea (OSA) because of their obesity. In other words they are
being choked by their fat. Were we able to study all severely
obese children, I'm confident that we would identify many more
children with OSA. In addition, many of these children have abnormally
high insulin levels, a prelude to Type II diabetes.
What we know about childhood obesity can be
summarised as follows:
1. Obesity once established is virtually
untreatable.
2. The prevalence is increasing.
3. Obesity related medical conditions such
as heart disease, diabetes, orthopaedic problems, hypertension,
liver disease and OSA are likely to increase.
4. The cost of managing these conditions
is expensive. We have worked out that the management of OSA alone
would be £1,000 pa/patient. The cost of just investigating
all severely obese patients is substantial.
5. The consensus of opinion is that childhood
obesity is related to a diet high in sugar content and a reduction
in activity.
My colleagues and I urge you to consider the
following:
1. The only solution to childhood obesity
is prevention.
2. Availability of food high in sugar and
fat content must be reduced.
3. Sports and other exercise must be brought
back into the school curriculum.
4. Education about healthy eating together
with healthy lifestyle must be compulsory for all school children
in particular teenagers, the parents of the next generation.
I understand that the government is reluctant
to make childhood obesity a priority because government warnings
about the dangers of over consumption of high sugar content foods
and other high calorie foods would alienate the companies who
market such products. Similarly companies involved in the billion-dollar
diet and exercise industry would also be affected if there was
a downturn in obesity. Would decline in these huge industries
really affect the economy? The cost of protecting these industries
will be the obesity-related health problems. Obesity is the biggest
health challenge developed countries now face.
We urge the government to make childhood obesity
a priority, to provide health warnings about high calorie foods
on the labels of these foods (as there are on tobacco products),
to reconsider the place of sport and exercise in the school curriculum
and to make much more visible their commitment to healthy diet
and lifestyle.
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