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| Better hydration How1 #348685 Government initiatives should include a greater focus on the importance of good hydration in weight management and health outcomes. | - By focusing primarily on healthy eating and food choices, existing guidance overlooks the undermining effect that poor hydration choices can have – and equally the benefits of good hydration choices such as water.
- The Eatwell plate, for example, could be usefully re-designed replacing soft drinks with water and incorporating reduced carbohydrates and a redefinition of fats.
The European Food Safety Agency (EFSA) recommends a total water intake of 2.0 litres a day for adult women and 2.5 litres a day for adult men under normal conditions. A greater intake is needed for those taking part in intense exercise, those who are pregnant or sick, or when the weather is particularly hot or humid. While some fluid in the diet will come from food, the majority of this will come from drinks throughout the day. There are two related issues to consider: (1) The importance of adequate fluid intake to maintain good health. Studies have proven that poor hydration can affect brain function. The benefits of an adequate fluid intake – particularly water – include maintaining a proper fluid balance within the body, maintaining normal bowel and kidney function, controlling hunger and maintaining an optimum cognitive ability. It is also an essential element of exercise. - Yet it is not clear that the people of the UK are remaining properly hydrated. The initial findings of the UK Fluid IntakeStudy, published in 2012, found that 30 per cent of adults had inadequate intakes of fluid – as did more than 50 per cent of children. The study also found low levels of water consumption in relation to hot beverages and sugar sweetened beverages.
- These figures are backed by separate studies commissioned by the Department of Health and Food Standards Agency. This body of research has shown that children aged four to ten years typically consume 276ml of water per day and 620ml from other beverages (of which216ml was milk). Children and young people aged 11 to 18 years were found to consume 453ml of water per day and 680ml of other beverages, of which 150ml was milk.
(2) The contribution of fluid intake to calorie consumption. The initial findings of the UK Fluid Intake Study found that on average, sugar sweetened beverages provided 175 kcal per day of the calorie intake of children. This demonstrates the contribution that sugar sweetened beverages are making to rising levels of obesity. - A study published by the British Journal of Nutrition in 2012 showed that, in 2008/09, beverages accounted for 21%,14% and 18% of daily energy intake for children aged 1.5–18 months, 4–18 years, and adults (19–64 years) respectively.
- The study noted that, since the 1990s, there had been an increased consumption of fruit juices (as well as reduced-fat milk) among children, while adults saw similar trends but additionally saw an increased consumption of alcohol. The study highlighted that using water as a substitute for caloric beverages may reduce overall energy intake.
- From a policy perspective, this leads to an imperative to acknowledge the contribution of sugar sweetened beverages to the diet and take steps to reduce this level. Many people will pay attention to what they eat, while overlooking the fact that sugar sweetened beverages can make a significant contribution to the amount of calories they consumer. In particular, there is a tendency to overlook the contribution that fruit juices and smoothies can make to sugar intake. While such drinks can provide one portion of the daily fruit and vegetable intake, the amount of sugar contained is similar to many carbonated beverages, the acidity can have a negative impact on dental health, and many of the juices lack the fibre content of fruit and vegetables, lessening the benefits to digestive health.
- Policy should focus on reducing the amount of sugar in beverages, reducing the amount of sugar sweetened beverages that are consumed, and promoting water or low calorie alternatives as the best way of remaining hydrated.
- Change4Life acknowledges this need, recommending that “all the family swapping to water, milk (ideally semi-skimmed, one per cent or skimmed), or sugar free drinks can really make a difference.” However, there is a need to make this more prominent in public health messaging.
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+Citations (2) - CitationsAdd new citationList by: CiterankMapLink[1] State of the Nation's Wasitline - Obesity in the UK: Analysis and Expectations
Author: National Obesity Forum
Publication info: 2013 December
Cited by: David Price 6:57 PM 27 July 2014 GMT
Citerank: (37) 340964Tackling obesity in the UKWith concern growing that the Foresight analysis—that 50% of the UK population could be obese by 2050, at an annual cost to the nation of around £50 billion per year [2]—substantially underestimates the scale of the unfolding obesity crisis, the College of Contemporary Health is working with the wider policy community to develop a whole systems map of the obesity crisis and the potential responses.7F1CEB7, 348677Implement hard hitting campaigns, similar to those for anti-smokingHarder hitting campaigns, similar to those for anti-smoking, are required.1198CE71, 348678Incentivise GPs to improve patient outcomesThe Quality and Outcomes Framework should be amended to provide incentives for GPs to proactively offer advice to overweight and obese patients and refer them to weight management services where appropriate, rather than simply keeping a register of these patients. [1]565CA4D9, 348679Focus outcomes indicators on action by primary health professionalsThe Quality Outcomes Framework indicators on obesity should include, and focus on, indicators on the action taken by primary healthcare professionals on behalf of overweight or obese patients. [1]565CA4D9, 348680Need to make every contact with patients countGPs and other health professionals should be encouraged and required to make every contact with patients count. Very few patients will cite obesity or weight management as the reason for seeing their GP, and will instead present with conditions that are clearly a result of weight issues. GPs should talk with their patients about weight in these instances. [1]109FDEF6, 348684Improved GP training on obesityGPs should be provided with appropriate support and training to help them have the necessary conversations with patients. Better quality training should be provided both during GP training and for current GPs to help them provide better advice to patients. [1]109FDEF6, 348687More physical activity for kids within and beyond educational settingsThe introduction of compulsory physical education in schools is positive. However, greater promotion of physical activity outside of educational settings is also key to ensure any participation amongst pupils is not limited to school. Similarly, caution is needed to ensure that the promotion of competitive sport does not put off children less disposed to that sport. This could result in children either returning to or increasing their sedentary lifestyle.565CA4D9, 348688Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 24.9% of adults in England are obese—with a body mass index of over 30—62% of adults are either overweight or obese (with a BMI of over 25), and 32% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK is estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 348689Encourage physical activity in daily lifeThe Chief Medical Officer’s report (2011) recommends that adults aged 19-64 years undertake 150 minutes of moderate intensity physical activity per week in bouts of 10 minutes or more. [1]565CA4D9, 348695The Quality and Outcomes FrameworkThe QOF was introduced in 2004 as a voluntary incentive scheme for GP practices in the UK. It contains groups of indicators against which practices score points according to their level of achievement, with a higher score leading to higher financial rewards. The aim of the QOF is to highlight priorities for improving patient care and provide incentives for GPs to drive up quality in these areas.82AECCD8, 348704GPs should measure waist circumferenceGPs should measure waist circumference rather than just BMI to help them identify patients who are most at risk and identify the indicators of poor health outcomes. [1]109FDEF6, 348706National Obesity ForumThe National Obesity Forum (NOF) was established in May 2000 to raise awareness of the emerging epidemic of obesity and the effect that it was going to have on both individuals and the NHS.58D3ABAB, 348770Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 352713Who should improve obesity training for healthcare professionals?Who should improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 366828Shape the physical environment to encourage physical activity565CA4D9, 370326Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 371560British Heart Foundation recommends at least 60 minutes every dayThe British Heart Foundation recommends that to maintain their health, children take part in a minimum of 60 minutes of at least moderate intensity physical activity every day. This could include PE lessons, but also swimming, dancing, cycling, most other sports and brisk walking, as well as active play. 1198CE71, 371561Quality and prevalence of physical activity in schools is variableThe Ofsted Physical Education report published in February 2013 found that the physical aspect of physical education was not doing enough to tackle sedentary lifestyles amongst children and young people, with teachers often spending too much time talking and not enough time getting children moving.1198CE71, 396117Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399546Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 399553Shape the physical environment to encourage physical activity565CA4D9, 399556Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399584Incentivise GPs to improve patient outcomesThe Quality and Outcomes Framework should be amended to provide incentives for GPs to proactively offer advice to overweight and obese patients and refer them to weight management services where appropriate, rather than simply keeping a register of these patients. [1]565CA4D9, 399606Who should improve obesity training for healthcare professionals?Improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 399642Implement hard hitting campaigns, similar to those for anti-smokingHarder hitting campaigns, similar to those for anti-smoking, are required.1198CE71, 399667Better hydrationGovernment initiatives should include a greater focus on the importance of good hydration in weight management and health outcomes.565CA4D9, 399668Encourage physical activity in daily lifeBuild exercise into daily life to promote energy balance. Adults are recommended to take part in 150 minutes of moderate intensity activity every week.565CA4D9, 399695Focus outcomes indicators on action by primary health professionalsThe Quality Outcomes Framework indicators on obesity should include, and focus on, indicators on the action taken by primary healthcare professionals on behalf of overweight or obese patients. [1]565CA4D9, 399734Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 399737Improved GP training on obesityGPs should be provided with appropriate support and training to help them have the necessary conversations with patients. Better quality training should be provided both during GP training and for current GPs to help them provide better advice to patients. [1]109FDEF6, 399768More physical activity for kids within and beyond educational settingsThe introduction of compulsory physical education in schools is positive. However, greater promotion of physical activity outside of educational settings is also key to ensure any participation amongst pupils is not limited to school. Similarly, caution is needed to ensure that the promotion of competitive sport does not put off children less disposed to that sport. This could result in children either returning to or increasing their sedentary lifestyle.565CA4D9, 399787The Quality and Outcomes FrameworkThe QOF was introduced in 2004 as a voluntary incentive scheme for GP practices in the UK. It contains groups of indicators against which practices score points according to their level of achievement, with a higher score leading to higher financial rewards. The aim of the QOF is to highlight priorities for improving patient care and provide incentives for GPs to drive up quality in these areas.82AECCD8, 399831Need to make every contact with patients countGPs and other health professionals should be encouraged and required to make every contact with patients count. Very few patients will cite obesity or weight management as the reason for seeing their GP, and will instead present with conditions that are clearly a result of weight issues. GPs should talk with their patients about weight in these instances. [1]109FDEF6, 399832GPs should measure waist circumferenceGPs should measure waist circumference rather than just BMI to help them identify patients who are most at risk and identify the indicators of poor health outcomes. [1]109FDEF6, 399840British Heart Foundation recommends at least 60 minutes every dayThe British Heart Foundation recommends that to maintain their health, children take part in a minimum of 60 minutes of at least moderate intensity physical activity every day. This could include PE lessons, but also swimming, dancing, cycling, most other sports and brisk walking, as well as active play. 1198CE71, 399841Quality and prevalence of physical activity in schools is variableThe Ofsted Physical Education report published in February 2013 found that the physical aspect of physical education was not doing enough to tackle sedentary lifestyles amongst children and young people,with teachers often spending too much time talking and not enough time getting children moving.1198CE71, 399972Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 23% of adults are obese—with a body mass index of over 30—61% of adults are either overweight or obese (with a BMI of over 25), and 33% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK economy has been estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179 URL:
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Link[2] Association between water consumption and body weight outcomes in children and adolescents: A systematic review
Author: R. Muckelbauer, C. L. Barbosa, T. Mittag, K. Burkhardt, N. Mikelaishvili, J. Müller-Nordhorn
Publication info: 2014 December, Obesity (Silver Spring). 2014 Dec;22(12):2462-75. doi: 10.1002/oby.20911
Cited by: David Price 4:13 PM 4 December 2014 GMT
Citerank: (1) 399667Better hydrationGovernment initiatives should include a greater focus on the importance of good hydration in weight management and health outcomes.565CA4D9
URL: | | Excerpt / Summary > OBJECTIVE: Water is recommended to replace sugar-containing beverages for prevention of childhood obesity. Because this recommendation is not evidence-based yet, the existing evidence on the association between water consumption and body weight outcomes was summarized.
> METHODS: In a systematic review, studies were retrieved from four electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane) and further search methods. Studies including children aged 2-19 years on the association between water consumption and any body weight-related outcome were eligible.
> RESULTS: Out of 3,023 retrieved records, 13 studies were included: four longitudinal and nine cross-sectional studies. One cross-sectional analysis in one longitudinal study was additionally included, resulting in ten cross-sectional analyses. One non-randomized controlled study and two observational longitudinal studies showed that increased water consumption reduced the risk of overweight or body mass index. Another observational longitudinal study did not indicate this association. Six cross-sectional analyses found a direct association between water consumption and at least one body weight outcome. Four cross-sectional analyses did not show any association.
> CONCLUSIONS: On the cross-sectional level, higher water consumption seems to be associated with higher weight status. In contrast, longitudinal studies suggest a weight-reducing effect of water consumption, but evidence for a causal association is still low. |
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