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Revised draft Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Children and Adolescents

ID: 
25
Personal Details
Organisation Name: 
Centre of Physical Activity Across the Lifespan, ACU
Additional Information
In regard to your comments, do you have a Conflict of Interest to disclose?: 
No
Specific questions
Question 2: What would help you implement these recommendations into practice?: 

Well supported professional dissemination - with many practical examples and an on-going network of electronic support

Specific comments
Comments: 
PART C - CHILDREN AND ADOLESCENTS
The health enhancing benefits of light exercise (minimum of 15 minutes per day)1 I believe comprises more sustainable and achievable advice for children and adolescents seeking weight management support. Building to a moderate intensity may initially be less important than establishing the frequency with which exercise is experienced in young people. I understand the necessity to increase the exercise intensity to a zone that may best stimulate metabolic activity, but (unlike the highly commercialised media images of overweight adults working suddenly and intensively at extreme intensity) the sustainability and safety of young individuals’ exercise opportunities are a major concern. Only under strict and professional supervision should vigorous exercise be imposed on young people with weight management issues. The psychological risks could be as great as the physical. Sustainability is the major issue in exercise regimes for overweight and obese young people.2 Resistance training has evidence of effectiveness particularly among adolescent males, but again supervision and professional support are required. Not all families will be able to support programs associated with costs and transport, but we suspect (from the LEAP intervention) that some sort of organised program is more acceptable to families than encouraging the creative unstructured play. The intermittent moderate to vigorous intensity of many popular sports for youth may provide a developmentally appropriate exercise bout for some overweight or obese children, but not all children find sport attractive. In the best of all worlds, sport offers other benefits such as social connectedness and opportunities for self efficacy in physical activity because of its many ways to perceive success. However, it is unlikely that one or two exposures to sport per week are of a sufficient volume to improve metabolic health. Supplementary activities and or, alternatives to playing sport must be discussed for those children who play a minimum of sport. Physical educators talk about the need for a Girly Girls curriculum3 to be more inclusive and consultative about what girls really like doing – we really know little about recognising differences in physical activity preferences of boys and girls. While the exact intensity, duration and frequency of prolong exercise programs for overweight and obese children is yet to have a strong evidence base2, the principle of first do no harm must resonant in health professionals making recommendations to young people. Strategies to make exercise a positive experience for young children include: recruiting the support of a more active “health buddy” to make the walks, the dance, the circuits less obvious and more fun. Suggested activities should be progressive and achievement of short term goals (e.g. weekly improvements of 10% more time / load) should be celebrated. Low cost, local activities must be considered. What’s possible? What’s repeatable? What’s necessary to make it happen? 1Wen CP, Man, Wai JP, Tsai MK, Yang YC, Cheng TYD, Lee MC, Chan HT, Tsao CK, Tsai SP, Wu X. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet, Volume 378, Issue 9798, Pages 1244 - 1253, 2http://www.health.gov/PAGuidelines/Report/pdf/G9_youth.pdf 3 Oliver KL. Hamzeh M, McCaughtry N. Girly Girls Can Play Games / Las Niñas Pueden Jugar Tambien: Co-Creating a Curriculum of Possibilities With Fifth-Grade Girls. Journal of Teaching in Physical Education, 2009, 28, 90-110

Page reviewed: 6 September, 2012