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.A study of a select group of general practitionerswho had expressed interest in managing obese adults indicated that very fewspent more than 10 minutes with each obese subject (Counterweight ProjectTeam 2004; Laws 2004).Much longer is needed.Thus a specific obesityfacility needs to be developed.If such a facility can be demedicalized thiscould encourage attendance but inspiration may be needed for this.Children can present with significant weight problems at any age, butmany present in adolescence.Adolescents pose problems to children s hos-pitals whenever they require help since paediatric units are often morefocused on younger age groups.Small chairs, toys and the presence of many Forms of management 39uncontrolled youngsters are not cool.Ideally facilities should provide dif-ferent sessions for adolescents and for younger children.Facilities should alsobe comfortable both for large children and for their possibly larger parents.For example, some armless chairs in clinic and waiting rooms allow for theobese to overlap the chairs rather than be squashed into them.Some generalpractices are involved in the Counterweight programme (Broom and Haslam2004; Broom et al.2004; Counterweight Project Team 2004; McQuigg et al.2005) for the management of adult obesity.Here trained practice nursesimplement obesity management in groups, clinics or opportunistically andare supported by educational materials and backed up by weight manage-ment advisors.Evaluation is only just beginning but the support offered topractitioners by this programme would seem likely to make practices moreactive in the management of obesity.Similar programmes are needed forchildhood weight problems.The WATCH IT programme based at the Uni-versity of Leeds is one such programme still at a relatively early stage ofdevelopment (Rudolf et al.2006).Group managementCommunity weight management groups, directed towards helping over-weight children and their families, open up less medically orientatedopportunities for these children.Few such programmes for children currentlyexist in the UK.Private slimming groups are geared towards adults.Thegoals and expectations of such groups together with their often middle-agedfemale clientele make them unsuitable for the management of obese children.In the UK there are few health service based groups for children.Evidencelargely from North America indicates that groups focusing on behaviouraland personality changes amongst obese children and their families have littleeffect unless the programmes are supported by advice on diet and activity aswell (Foster et al.2005; Savoye et al.2005).Multifaceted research programmes such as the MEND (Mind, Exercise,Nutrition and Do it) programme developed at the Institute of Child Health atGreat Ormond Street Hospital in London seem comparatively successful(Sacher et al.2005).The MEND programme is directed at children between 7and 13 years old and uses techniques and goals that aim to create behaviouralchanges which modify energy intakes, encourage enjoyable activity, improveunderstanding of behavioural change and give practical help to families fordiet, physical activity and family functioning.Children attend for weekly 2-hour sessions over 12 weeks.This programme is gathering momentum withsupport from the National Lottery, Sport England, Sainsbury s and severalprimary care trusts (PCTs).The outcome of intervention on this scale couldbe very informative.There are a number of similar programmes developingin the UK which focus on making dietary change and activity enjoyable and 40 Where should overweight/obese children be managed?which encourage children to control their weight change themselves as far aspractical.Many are research programmes.Translating successful researchprojects into programmes that are financially viable and sustainable withincommunities is not easy.Residential managementSummer camps for overweight children have had a lot of publicity in themedia (Gately et al.2005).The camps are successful in helping children s self-esteem, improving their activity levels and to some extent reducing theirweight but many families are not prepared to send their obese children awayfrom home.The camp ambience does not suit all children.Camps are tooexpensive and short term to be major players in the management of child-hood obesity.Nevertheless, the lessons learned from the experiences withoverweight children at these camps can be useful when planning strategies forthe management of childhood overweight in other spheres.In France very overweight children are sometimes admitted long term tounits run by paediatricians (Frelut 2002).The admission may be for manymonths and interventions cover many aspects of the child s and the family slife.Health services in the UK are unlikely to be persuaded that such units arenecessary or cost effective.For a very few children showing severe compli-cations of obesity (see Chapter 6), hospital admission for urgent weightreduction can be lifesaving.Computer-based weight control adviceSeveral adult slimming groups offer help and advice through computer-based services as well as, or as alternatives to, their group sessions.Advice forchildren through web pages is less well developed and we are a little reluctantto encourage something which leads children to the television or computerscreen when this sedentary occupation is one we are recommending shoulddecrease (see Chapter 10).Children very addicted to the internet mightpossibly follow guidance from a website with more enthusiasm than listeningto advice from a live individual and the experience of interventionists in theUSA shows this approach should be developed further [ Pobierz całość w formacie PDF ]