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84
APPENDIX E
An Approach to the Treatment of Overweight Adolescents
by
Phyllis M. Gibbons, M. B. , B. S., D. R. C. 0. G.,
(School Medical Officer)
At the inception of the School Health Service the nutritional
problems encountered by the Medical Officer were predominantly
those of malnutrition. During the past decade, however,
he has become increasingly confronted by those of obesity.
Various surveys to show the incidence of childhood obesity have
been carried out, and show that 5 - 15% of schoolchildren are
now at least 10% above the mean weight for their age, height,
and body build: (the standards used in this paper are based on
Scott's survey of L.C.C. schoolchildren in 1955).
The full cause of this increase is not known but a change in
eating habits since 1945 with a higher standard of living, has
certainly contributed. The illnesses precipitated by obesity
occur predominantly after the child-bearing age, and, since
there are marked hereditary tendencies to obesity, the incidence
of this condition is likely to rise steadily if unchecked.
Although the majority of doctors agree that obesity is
detrimental to health and should be treated, opinions differ
about the age at which such treatment should commence. While a
few physicians do not treat obesity in pre-pubertal children,
most now believe that, once a child is diagnosed as being overweight,
he should be treated, no matter how young. Recent investigations
have confirmed this, and show that spontaneous
return to a satisfactory weight is the exception rather than the
rule, and that as the patient becomes older the obesity will
tend to get even worse. There are differing opinions also about
the ideal therapeutic approach; various ancillary forms of
treatment, such as the use of anorectic drugs, are being carried
out, but most agree that reduction of the total calorie intake
should be the prime objective.
There are, many thousands of overweight children being treated
in Britain at the present time; a few hospitals and many Local
Authorities have established special clinics devoted to the
problem. Almost without exception the approach is an individual
one with regular dietetic supervision and follow-up.