Royal College of Obstetricians and Gynaecologists | November 2018 | RCOG recommends specialist multi-disciplinary care to manage obesity in pregnancy
New clinical guidance published by the Royal College of Obstetricians and Gynaecologists (RCOG) advises that women who are obese should be supported to lose weight before conception and between pregnancies to ensure the healthiest possible outcome for mother and baby.
The guidelines state that although being obese is itself not a reason to be admitted to a consultant-led unit, women who are obese are more likely to require an induction of labour, emergency caesarean birth or a vaginal birth that requires a medical intervention.
Even slight weight gain after pregnancy is associated with greater risk of problems in subsequent pregnancies, the guidance notes. It suggests women who are obese should be offered referral to weight management services after giving birth to help them achieve a healthy weight before embarking on a future pregnancy (Source: RCOG).
Further details are available from RCOG
Read the guidance here
Wyatt K, Lloyd J, Creanor S, et al. Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children. Public Health Res. 2018;6(1).
The Healthy Lifestyle Programme delivered to 9-10-year-old school children did not reduce their weight over the course of two years. Around a third remained overweight or obese, the same as in schools that followed the standard syllabus.
This trial, funded by the NIHR, assigned schools across Devon to follow a lifestyle programme in Year five. The comprehensive curriculum included drama and activity workshops, personal goal setting and parental involvement.
Children made better food choices, but this did not affect weight outcomes. It was almost certain the programme wouldn’t give value for money.
Programmes addressing the wider school environment or delivered at the community or population level may have greater scope for preventing obesity.
O’Connor EA, Evans CV, Burda BU, et al. Screening for Obesity and Intervention for Weight Management in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017;317(23):2427-44.
Obese children and adolescents can lose up to seven pounds over six to 12 months when they engage in at least 52 hours of behaviour-based lifestyle interventions. Minimal benefit was seen with shorter contact time, with less than 25 hours ineffective. The control group gained weight.
Rising obesity in the young is a global concern, which may lead to high rates of obesity-related diseases in adulthood. This review identified trials covering various weight management strategies. Lifestyle-based-interventions with sufficient contact time – as recommended by UK guidelines – showed clear benefits with no evidence of harms.
Investing in effective strategies to manage child obesity will ultimately save healthcare costs. Behaviour-based support should now be assessed for long-term weight loss and maintenance.
The evidence is still lacking whether universal child screening for obesity should be performed in the UK.
Guidance for local commissioners, providers and schools on running the national child measurement programme (NCMP) as part of the government’s commitment to tackling the public health challenge of excess weight.
The publication of the Childhood Obesity Plan: A Plan for Action, in August 2016 shows that tackling child obesity is a priority for the Government. The plan aims to significantly reduce England’s rate of childhood obesity within the next ten years. Most local authorities have also identified addressing childhood obesity as a key issue in their health and wellbeing strategies, and reducing obesity is prioritised in many Sustainability and Transformation Plans.
The NCMP is key to monitoring the progress of the Government’s Childhood Obesity Plan. It provides the data for the Public Health Outcomes Framework indicators on “excess weight in children aged four to five years and ten to 11 years.” Because the data is valid at local level, it can also be used to inform the development and monitoring of local childhood obesity strategies.
National child measurement programme operational guidance
National child measurement programme: information for schools
Two Cochrane reviews, published today, show that a combination of diet, physical activity and behavioural change interventions may reduce weight in children and adolescents | OnMedica
The two reviews look at the effects of diet, physical activity and behavioural interventions in treating children with overweight or obesity from six years old to early adulthood. They summarise the results of 114 studies which involved over 13,000 children and young people.