Obesity campaigns are aimed at prevention but what if your child has gone beyond that stage -- what help is out there for children who are already obese?
PARENTS are being bombarded with information about the incidence of childhood obesity and what they should do to prevent their children from becoming obese.
But what if your child is already obese? What if you've tried everything you can think of and nothing has worked? What help is out there for you?
Not much, admits anti-obesity campaigner Professor Donal O'Shea, a consultant endocrinologist and physician based in St Vincent's University Hospital and St Columcille's Hospital.
Although some hospitals run services for children with obesity, there isn't enough help for the one-quarter of Irish children now said to be overweight or obese.
"We have a really underfunded situation in relation to children who are obese.
"The majority of focus and funding -- 80pc to 90pc -- goes into prevention. There's not that much support for people who are in the situation of trying to deal with obesity," observes Professor O'Shea.
The good news is that an agreed step-by-step guide to managing childhood obesity is to be launched shortly by the Irish College of General Practitioners and the faculty of paediatrics of the Royal College of Physicians Ireland, in association with the HSE.
"GPs will then have a road map to attempt to manage obesity," he says.
In the meantime, however, parents are under pressure to do something to help their obese offspring before the child's health is affected long-term by the onset of conditions such as blindness or heart or kidney disease.
"We know that if you are overweight or obese as a child, you have nearly an 80pc chance of being obese as an adult," says Professor O'Shea.
Take Clodagh*, whose 11-year-old daughter Saoirse* is nearly three stone overweight.
"The last time I weighed her, she was about nine-and-a-half stone, which is two or three stone more than she should have been," worries Clodagh.
Neither of Saoirse's two older siblings are overweight nor are her parents.
The problem is Saoirse eats too much and after years of battling the problem, Clodagh is at her wits' end.
"She doesn't seem to know when she's full or when she's had enough."
Clodagh brought Saoirse to the GP to see whether her excess weight was the result of hormonal problems -- it isn't. She also saw a dietician and, on her advice, reduced Saoirse's portion size and banned sweets, snacks, crisps and soft drinks from the family home.
"These things are not in our cupboards anymore," she says, adding that the dietician went through both the food pyramid and Saoirse's daily diet and explained correct portion sizes and healthy eating.
"She advised us to ban convenience foods, sweets and soft drinks and we do this as much as possible. We're focused on healthy eating and healthy portion sizes and encourage her to drink water and eat fruit."
Clodagh tries to encourage Saoirse to exercise, but it's a losing battle. "She swims and walks. She used to run but gave it up because she was always coming last. She was also involved in the GAA but has given that up too.
"It's very difficult to force her to go out walking. If you push too hard it'll turn into a row where you'll end up talking about her weight and you're terrified you'll give her a complex."
Saoirse goes to a child-minder after school and, says Clodagh, while some of the meals she eats there are healthy, "there is a certain amount of chicken nuggets and chips."
A demanding full-time job means that she cannot constantly monitor her daughter's food intake. "I've gone to work before she has her breakfast, which is usually Special K. I make her school lunch which is a sandwich and a piece of fruit or two.
"I know she's eating too much and not getting enough exercise, and while I send her to school with a bottle of water, it'll often come back half full."
The family live in Cork, and, as there's no service for children with obesity at Cork University Hospital, Clodagh would like some group support.
"I'd like to attend some kind of weight-loss group for children with Saoirse, somewhere that there'd be children in a similar situation. Saoirse doesn't listen to me when I talk about food anymore -- she sees me as a nag."
But she couldn't find one.
"I know we're not the only people out there with this problem but there doesn't seem to be any solution.
"It's a very difficult line to walk. There's always the worry that if she continues to gain weight, it will lead to medical conditions like diabetes."
Clodagh feels helpless and frustrated. "We're beyond the prevention campaigns at this stage and there's no help.
"When you turn on the radio or TV it's all about obesity but in reality, when you have an obese child there are no real guidelines about what you should do. I feel I'm in a no-win situation."
She's not the only parent to feel like this. About 25pc of Irish children are overweight or obese, says Professor O'Shea.
"This is a completely new problem. Twenty years ago we didn't have a paediatric obesity problem. There was a normal distribution of weight issues. There might have been up to five per cent of overweight or obese children back then."
Parents should focus on food intake and physical activity, he says.
"Frequently parents are unaware of the portion sizes for healthy eating for children and they are definitely unaware that the level of activity required for kids to be physically fit and normal weight is one-and-a-half hours a day, every day.
"Kids used to build that up easily with walking to school, chasing, kicking a ball about and running around -- now you have to plan it or it won't happen."
Parents take note: there's no point in sitting down with a child and explaining about diet and food intake. The whole family must get involved in a complete lifestyle change, or what experts call a family intervention.
"Everyone in the family has to be involved. The grocery shopping has to change, and the level of physical activity has to change for the entire family."
The whole family must agree to undergo a lifestyle change, and, when a child is severely overweight, it's best not to have any sweets or chocolate or cake in the house, he says, though the child should have a treat one day a week.
However, weight reduction is often difficult to achieve in children and adolescents, says Dr Declan Cody, a consultant paediatric endocrinologist at Our Lady's Children's Hospital, Crumlin.
He runs a service for children with obesity which sees up to 200 children annually, the majority of whom would be obese.
"Crumlin runs a service for children with obesity as do the two other hospitals at Tallaght and Temple Street. Children with obesity are referred to us for two reasons -- to make sure there's no underlying hormonal reason and to look for risks of potential complications."
Patients have access to the different professionals involved in the care and management of children with obesity -- dieticians, psychologist and social workers if necessary -- he says, but the goal is not necessarily to lose weight.
Weight reduction can be difficult to achieve in children or adolescents -- the aim is weight maintenance so that children can "grow into" their weight, thus allowing them to continue normal growth and development.
However, he says, for a lot of children, the reduction of portion sizes combined with banning snacks, convenience foods and fizzy drinks will inevitably result in losing weight.
"Diet and exercise go hand-in-hand. The main focus is family intervention -- we say the problem is not the child's problem but the family's problem.
"We give advice and hope they take it on board. We see them every three or four months and they have access to dieticians in between."
Families who have concerns about the weight of a child or children should first consult their GP, who may then decide to refer the child to a paediatrician for further investigation.
*Names have been changed