Background/ Why Is This Important?
In general, Canadians are among the healthiest people in the world, and British Columbia is often considered the healthiest province in Canada. However, despite encouraging reports that British Columbians are more physically active and consume more fruits and vegetables than Canadians in many other provinces, rates of obesity among children in the province continue to rise.
Over the past 30 years, the rates of overweight and obesity have been climbing in affluent countries around the world. More than half of Canadians are overweight or obese. Approximately 30 percent of Canadian children, and in British Columbia specifically, over 26 percent of youth aged 12 to 17, are overweight or obese.
Overweight and obese children are already experiencing chronic diseases and conditions, such as type 2 diabetes, historically seen only in adults. Obese children have an eighty percent or higher probability of becoming obese adults. Emerging evidence also indicates that an unhealthy weight increases the risks to an individual's overall health and mental well-being. In addition, obesity follows a gradient pattern based on socio-economic status; people with lower income levels tend to have higher rates of obesity than those who have higher incomes.
It is increasingly clear that the issue of overweight and obesity is a complex phenomenon deeply entrenched in our social and cultural fabric. While it is understood that there may be value in considering a focus on improved metabolic health for people of all weights, sizes and shapes through healthful eating and moderate physical activity, there are health issues that are related to overweight and obesity that need to be addressed.
There is an increased focus is on supporting populations and individuals to be actively engaged in lifestyles that optimize their mental and physical well-being. The goal is to achieve the healthiest weight one can while living the healthiest lifestyle possible. This approach is often characterized as "health-centred" and actions are grounded in health promotion principles that are oriented towards well-being.
In 2012, the World Health Organization released new growth charts for children and youth. It was recognized that with the introduction of the new growth charts there was a need for a structured approach for the identification, care and management of overweight and obese children and youth in BC. This approach will assist healthcare providers in supporting BC families with children identified as at risk, or for those that are overweight/obese with related complications.
What Actions Have Already Been Taken?
Where did this work start? In March 29, 2012 Child Health BC brought together representatives from key partner groups such as primary care, acute care and public health, as well as community-based organizations, social service programs and schools, to determine the key components of a health focused care pathway for overweight and obese children and youth in BC. The "Pathway for the Identification, Assessment and Management of Overweight and Obese Children and Youth" and the 3 Stage Approach were developed using feedback from participants at this provincial meeting. The Pathway and the 3 Stage Approach enhances physicians and other healthcare providers understanding of appropriate assessment and referral protocols for children and youth who are leaving their normal weight trajectory and provides actions that support the management and treatment of overweight and obese children in British Columbia.
In 2009, Child Health BC provided funding to support the implementation of a community-based approach to address healthy childhood body weight. Through an integrated approach, Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE), works to prevent childhood obesity by supporting community-based and community-driven action facilitated by the best evidence and, where appropriate, shared strategies across communities. The SCOPE mission is to bring people together from all sectors of British Columbia (BC) communities to "make the healthy choice the easy choice" for children, towards our vision of a future where children eat nutritious diets, are physically active, and are supported by a healthy community environment.
In BC, SCOPE endorses the LIVE 5-2-1-0 message. Child Health BC provided funding to SCOPE to support the development of tools and resources based on the LIVE 5-2-1-0 message that are used to build community partnerships to create healthy environments for kids to LIVE 5-2-1-0.
The 5-2-1-0 message is evidence-based and is endorsed by the Canadian Pediatric Society. Live 5-2-1-0 offers four simple rules to help kids and families adopt healthy habits every day; Enjoy 5 or more fruits and vegetables a day; Power down — no more than 2 hours of screen time per day; Play actively at least one hour a day; Choose healthy — 0 sugar sweetened drinks.
In British Columbia, there are currently multiple efforts to create supportive environments that increase access to physical activity and healthy eating where children live, learn and play. Child Health BC worked with the Ministry of Health and the Canadian Obesity Foundation to develop the Continuum British Columbia's Continuum for the Prevention, Management, and Treatment of Health Issues Related to Overweight and Obesity in Children and Youth. The Continuum includes elements that promote physical activity and healthy eating for all children and youth, weight surveillance and identification of children and youth leaving their optimal weight trajectories, early intervention for those who are at-risk, and management and specialized treatment for those who are overweight or obese and experiencing complications. While these initiatives promote healthy living for all children and youth, there is also a need to address impacts on health related to overweight and obesity in children and youth.
The Continuum provides a common language for all health professionals and other partners working together to facilitate productive dialogue and partnership. The Continuum enables partners to understand how the work they are doing both contributes to the work others are doing and to the overall goal of promoting healthy weights and reducing overweight and obesity in children and youth.
The Continuum aligns with federal, provincial and local efforts to address the increasing rates of childhood overweight and obesity. And recognizes that we must all work together to ensure that BC's children and youth have the best possible opportunities to live a long and healthy life.
Where Are We Now?
Child Health BC has evaluated the feasibility of implementing the Pathway into various practice settings. Healthcare providers such as family physicians, pediatricians, nurse practitioners, and dietitians/community nutritionists have provided feedback on the usability and feasibility on implementing the Pathway in their practice settings. Information gathered from this project will assist Child Health BC in determining ways to support the utilization of the Pathway by healthcare providers.
The LIVE 5-2-1-0 message is being used in a variety of ways to provide the public with an easy to understand healthy living message. Some examples include: incorporating the message into the ACTION Schools BC program; as a foundational part of an early years resource for First Nations populations; and, Fraser Health is adopting the message into pediatric acute care and public health programs.
The Continuum represents BC's approach for the promotion of healthy weights and management of overweight and obesity related health issues in children and youth. It is intended that the Continuum will enhance the coordination and integration of current efforts, and will encourage conversation around considerations and directions for future growth.