Prevention before management

It seems almost de rigueur to end medical and nutritional texts with a section on prevention of the problem under discussion. Yet is this intelligent planning? The editors had lengthy discussions on the most logical order for the chapters in this book. No current programme for the treatment of obesity is particularly successful. Thus, control of the epidemic of obesity sweeping many countries in the developed world, and indeed beginning to affect countries in the developing world, is likely to depend more on effective prevention than on ‘cure’ of obesity. For this reason, priority in the management of childhood obesity has been given to this chapter on prevention.

Why prevention?

There are many reasons for promoting obesity prevention in childhood:

1. the prevalence of obesity is rising in industrialized countries (Chapter 2);

2. childhood obesity is likely to lead to obesity in adult life (Chapter 2);

3. it limits physical activity (Chapter 5);

4. it is associated with psychosocial disadvantage (Chapter 6);

5. it is associated with a higher risk of adult conditions such as Type II diabetes mellitus and hypertension (Chapters 7, 8, 10 and 11);

6. it is difficult to treat successfully (Chapters 13–20).

Primary prevention

The focus for preventive health programmes operates at three levels (WHO, 1998):

• primary prevention, aimed at reducing the number of new cases (incidence);

• secondary prevention, aimed at reducing the numbers of established cases (prevalence);

• tertiary prevention, aimed at reducing the degree of disability associated with the condition (treatment).