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

ID: 
28
Personal Details
First Name: 
Dympna
Last Name: 
Leonard
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?: 

Clinical practice in remote north Queensland locations is guided by the Queensland Health and RFDS Chronic Disease Guidelines and Primary Clinical Care Guidelines which are routinely updated.  The draft guidelines for management of overweight and obesity in adults, adolescents and children - once finalised - will be used in the update process

 

 

Specific comments
Comments: 
1.3 High risk groups

the draft guidelines describe the increased risk of overweight and obesity among Aboriginal and Torres Strait Islander populations.  It would be useful to note also that the negative effects of overweight and obesity appear to occur at lower BMI among Aboriginal people including Aboriginal children (see reference below)

It woudl also be useful to note that childhood obesity and concurrent early signs of metabolic syndrome are particularly prevalent among Torres Strait Islander children in the Torres Strait.  (There is a published paper describing this which I am unable to locate -one of the  authors is Moloney A)

 

Sellers EA, Singh GR, Sayers SM (2008)

Large waist but low body mass index: the metabolic syndrome in Australian Aboriginal children.

The Journal of Pediatrics; 153(2):

1.3 High risk groups

One high risk group that is not identified are children of pregnancies where the mother was diabetic durign the pregnancy (either pre-pregnancy diabetes or gestational diabetes.)  These children are at increased risk of obesity and early onset type 2 diabetes

 

This intergenerational effect of diabetes is important among the Indigenous populations of north Queensland as early onset diabetes means many young Indigenous women have diabetes during their child bearing years.

The impact of diabetes in pregnancy on the future health of the child as increased risk of obesity and early onset type 2 diabetes

 

Yogev Y and Visser GH, Obesity, gestational diabetes and pregnancy outcome. Seminars in Fetal & Neonatal Medicine, 2009. 14(2): pp. 77–84.

 

McDermott R, Campbell S, Li M, McCulloch B (2009)

The health and nutrition of young Indigenous women in north Queensland – intergenerational implications of poor food quality, obesity, diabetes, tobacco smoking and alcohol use.

Public Health Nutrition; online

Retrieved from http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=5830928

 

Introduction

the summary tables on p xiv for adults shows that active management is initiated when BMI =30 or more.  It woudl be better to actively interven when BMI = 25 and is increasing rather that delay intervention until a patient is obese

1 Trends in overweight and obesity

The significant energy intake increase is described in terms of numbers of slices of bread - one for adults and 3 or 4 for children.  I suggest this is also described in terms of %increase to give a better idea of how these results compare with previous intakes.  (I understand the increased energy intake in 1995 as compared to 1985  for children is ~11% more energy which is an enormous increase)

9 Ask and assess

Children and Adolescents; it is very useful to have this guidance in respect of wasit circumference in children

 

Also is it pleasing to see the support given for use of the WHO growth charts to assess growth in early childhood.  These have not yet been adopted in Queensland though there is widespread support for their use

 

Similarly it is good to see that the protective effect of breastfeeding for at least 6 months is noted (p38)

11.3 Weight management interventions

There are many Indigenous childen in the Torres Strait and increasing numbers of children in Cape York who are extremely obese.  These children have not yet reached puberty.   The guidelines suggest only lifestyle interventions for these children which seems inadquate for these children who urgently need effective treatments.  If there is no known effective treatment for these children at present, please note this as an area where research is required

Page reviewed: 6 September, 2012