Overweight and obese children: Texts

Text A

Growth Monitoring
The monitoring of children’s growth (and weight in particular) is an important role of all health
professionals. At every consultation (or at least yearly), health professionals need to have a
conversation with families and carers around children achieving a healthy weight.

“Ask and Assess – use percentile charts to monitor growth”

Growth status in children and adolescents (age 0-18 years old) needs to be assessed using
age- and sex-specific reference values, as the appropriate ratio of weight to height varies
during development.

Reference values for assessing and monitoring weight, length/height and BMI have been developed
by the World Health Organisation (WHO) and Centres for Disease Control and Prevention (CDC) in
the form of the childhood growth charts. The choice of chart depends on the age and gender of the
child. For children aged less than two years the WHO growth charts should be used. For children
between 2 and 18 year either the WHO or the CDC growth charts can be used. However, it is
important to ensure that the same chart is used over time.

Text B

Steps for discussing weight with families or carers

1. Make the family feel welcome and at ease.

2. Ask permission to discuss growth and development with the family.
3. Normalise the discussion of growth and development. Reassure the child and family that it is
standard practice in primary care.
4. Explain what is measured and why? (Weight, Height, BMI).
5. Encourage involvement of parents/carers when measuring weight and height.
6. Explain how the child’s growth tracks against the growth of all children. Engage the family in
plotting and interpreting the growth chart, using the growth charts as a tool.
7. Advise parents or carers of child’s growth status. Be sensitive and nonjudgmental but don’t
sugar-coat it. For example: “Tom’s BMI is… which places him above the healthy weight range.”
8. Use positive terminology to reinforce key concepts and advice:
• Use “healthy eating”, “eating” or “eating plan” rather than “diet” or “dieting”.
• Do not use ‘good’ or ‘bad’ to describe food or drinks – these terms reinforce a dieting
mentality and create blame and guilt.
• Let the family do most of the talking rather than you.
• Be realistic - make sure everyone in the room understands that long term changes have to be
made if the child is above the healthy weight range and that it will take time.
• Avoid inappropriate words, such as “Tom is obese.”
9. For adolescents, if appropriate, consider speaking to them without parent or carer present.
10. Agree on and develop an action plan.

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 Text C

More than 25% of children and adolescents are overweight or obese. For obese children,
complications are more likely to develop because they are obese longer.

Risk factors for obesity in infants are low birth weight and maternal obesity, diabetes, and smoking.
After puberty, food intake increases; in boys, the extra calories are used to increase protein
deposition, but in girls, fat storage is increased.

For obese children, psychologic complications (eg, poor self-esteem, social difficulties, depression)
and musculoskeletal complications can develop early. Some musculoskeletal complications, such
as slipped capital femoral epiphyses, occur only in children. Other early complications may include
obstructive sleep apnea, insulin resistance, hyperlipidaemia, and non-alcoholic steatohepatitis.
Risk of cardiovascular, respiratory, metabolic, hepatic, and other obesity-related complications
increases when these children become adults.

Text D

The possibility of obesity persisting into adulthood depends partly on when obesity first develops:

• During infancy: Low possibility

• Between 6 months and 5 yrs.: 25%
• After 6 yrs.: > 50%
• During adolescence if a parent is obese: > 80%

In children, preventing further weight gain, rather than losing weight, is a reasonable goal. Diet
should be modified, and physical activity increased. Increasing general activities and play is more
likely to be effective than a structured exercise program. Participating in physical activities during
childhood may promote a lifelong physically active lifestyle. Limiting sedentary activities
(eg, watching TV, using the computer or handheld devices) can also help. Drugs and surgery are
avoided but, if complications of obesity are lifethreatening, may be warranted.

END OF PART A

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 Text D

The possibility of obesity persisting into adulthood depends partly on when obesity first develops:

• During infancy: Low possibility

• Between 6 months and 5 yrs.: 25%
• After 6 yrs.: > 50%
• During adolescence if a parent is obese: > 80%

In children, preventing further weight gain, rather than losing weight, is a reasonable goal.
Diet should be modified, and physical activity increased. Increasing general activities and play is more
likely to be effective than a structured exercise program. Participating in physical activities during
childhood may promote a lifelong physically active lifestyle. Limiting sedentary activities (eg, watching
TV, using the computer or handheld devices) can also help. Drugs and surgery are usually avoided but, if
complications of obesity are life threatening, may be warranted.

END OF PART A

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OET ONLINE – READING
TEST 2

A2
Questions 1 – 6
For each of the questions 1 – 6, decide which text (A, B, C or D) the information comes from. You
may use any letter more than once.
In which text can you find information about

1. how to approach giving advice about overweight children? _________

2. how often to discuss a child's weight? _________

3. possible causes for obesity in infants and adolescent females? _________

4. the standards used to measure the development of children? _________

5. other conditions which are associated with obesity in children? _________

6. strategies to help stop children's weight increasing? ________

Answer each of the questions, 7-13, with a word or short phrase from one of the texts. Each answer
may include words, numbers or both.

7- If a mother has _________________ , smokes, or is herself obese it increases the risk of obesity in her child.

8- You should discuss healthy weight in children with parents _________________at a minimum.
9- Make sure to clarify the types of areas that are_________________and the reasons why.
10- The family should be encouraged to participate in the use of the _________________ .
11- Convey information about the_________________of children in an understanding way.
12- If a child is obese for a length period of time, then they are more likely to experience_________________ .
13- The family needs to appreciate that_________________changes must occur in children whose weight
exceeds what is healthy.

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Questions 14 – 20
Answer each of the questions, 14 – 20, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.

14- What influences the type of chart used to calculate a child's growth status?

________________________________________________________

15- What does the WHO and CDC assess and monitor when forming childhood growth charts?

________________________________________________________

16- What increases in children once they reach pubescence?

________________________________________________________

17- If it is already in the family, what is the likelihood that a teenager will remain obese?

________________________________________________________

18- What needs to be agreed upon and developed with the family of an obese child?

________________________________________________________

19- What psychological symptoms are known to appear early in obese children?

________________________________________________________

20 If the situation is serious enough, what might be required in some children?

________________________________________________________

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 B2
In this part of the test, there are six short extracts relating to the work of health professionals. For questions 1
to 6, choose the answer (A, B or C) which you think fits best according to the text.

The instructions explain that when making emergency phone referrals

A. GRACE must always be contacted first.

B. a referral must always be faxed right away.
C. the On-call Registrar must always grant approval.
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To eliminate the risk of contamination from infectious agents or certain types of fluids, aprons and gowns should
be

A. worn over all clothing.

B. changed when they become soiled.
C. discarded if they are damaged.

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The purpose of the email about oral health clinical indicators is to

A. explain why the reports were introduced.

B. highlight what the reports have achieved.
C. provide future details about upcoming reports.
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The policy informs us that doctors treating athletes at sporting events in the UK

A. must be appropriately licensed.

B. are expected to have adequate training.
C. cannot treat anyone from another country.

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The purpose of the guidelines on remote consultations is to

A. help practitioners decide an appropriate course of action.

B. advise practitioners about a growing trend in modern medicine.
C. recommend a series of questions for practitioners to ask their patients.
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According to the extract, prescription medicines

Select one:
A. are often unavailable due to stock shortages.
B. can be purchased as special orders from manufacturers if required.
C. may show as being unavailable even though they can still be bought.

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 C2.1
For questions 1 to 8, choose the answer (A, B, C or D) which you think fits best according to the text.

The phrase 'the first camp' refers to dental professionals who

Select one:
A. cannot agree on the effectiveness of fluoride.
B. believe keeping teeth clean prevents cavities.
C. feel that no amount of brushing reduced plaque.
D. are certain about how the entire process works.

Philippe Hujoel’s comments in the first paragraph indicate that he believes

Select one:
A. no one knows how to prevent plaque.
B. everyone has plaque on their teeth.
C. only fluoride can remove plaque.
D. plaque is impossible to remove.

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 What does the word 'it' in the second paragraph refer to?
A. fluoride.
B. Hujoel's team.
C. cavity prevention.
D. the intensity of oral hygiene.
By examining clinical trials from the US and UK, Philippe Hujoel says his team established that
A. fluoride should be placed in all water supplies.
B. regular brushing is the best way to reduce cavities.
C. children need to be encouraged to brush their teeth.
D. intense oral hygiene is effective at cleaning teeth only.
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Matthew Messina from the American Dental Association suggests that

Select one:
A. scientific advances have reduced tooth decay.
B. fluoride isn’t as important as many people believe.
C. it takes a wide-ranging approach to prevent cavities.
D. increased life expectancy results in more dental disease.

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Darryl Bosshardt’s comments indicate that he believes
Select one:
A. it is up to individuals to make their own choice about fluoride.
B. fluoride is still the best way to protect teeth.
C. there are no alternatives to fluoride.
D. fluoride is a dangerous product.
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The writer includes the statement that fluoride-free toothpaste from Tom’s of Maine does not carry an anti-
cavity claim to suggest that
Select one:
A. this is the best toothpaste for people to buy.
B. some types of toothpaste may not prevent decay.
C. they don’t like offering this type of toothpaste.
D. it is difficult to decide which toothpaste works best.

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n the final paragraph, the writer uses Philippe Hujoel’s words to highlight that
Select one:
A. not everyone takes the same approach to oral hygiene.
B. some food can contribute to the problem.
C. fluoride is the best option.
D. not all diets are practical.

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 C2.2

STRESS AND BURNOUT

What concern does the writer express about ICM clinicians?

A. There are not enough of them to treat the rising number of sick people.
B. The numbers of those who work with children has increased.
C. Many may not be performing effectively because of a pressured work environment.
D. They usually work longer hours than is recommended.
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In the second paragraph, the writer suggests that burnout

A. poses problems for the intensive care setting.

B. has become more prominent in recent years.
C. isn’t currently able to be measured.
D. is very similar to depression.

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What does the writer say about burnout syndrome in Australian emergency medicine clinicians?

A. Not enough emphasis is placed on ways to relieve pressure.

B. Training will help ICU staff better understand how they’re feeling.
C. The situation is made worse by of the level of responsibility placed on ICU staff.
D. The impact of the condition is dependent on a range of personal choices.
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The writer uses the term ‘interconnected’ to indicate that burnout can
Select one:
A. make it difficult for staff to work well together.
B. impact on medical staff and patients.
C. cause some healthcare professionals to leave the industry.
D. affect clinicians for many years after they are first diagnosed.

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What does the writer suggest about the problem of burnout in the fifth paragraph?

A. It is being made worse by a reduction in healthcare professionals.

B. It is developing in line with broader societal issues.

C. It isn’t going to be solved any time soon.

D. It affects men more than women.

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What point does the writer make in the sixth paragraph?

A. It is difficult for staff to change their current behaviour.

B. The existing approach within hospitals is there for a reason.

C. Management should do more to improve working conditions.

D. There needs to be a multifaceted response to workforce welfare.

The writer explains that the College of Intensive Care Medicine and the Australian and New Zealand Intensive Care
Society

A. are integral in measuring the health of practitioners.

B. should take action before the situation worsens for practitioners.

C. require assistance from other sectors in order to help practitioners reduce their workload.

D. need to educate patients about how their actions affect practitioners.

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In the final paragraph, the writer users the word 'paucity' to suggest that
Select one:
A. not enough is being done to help practitioners.
B. practitioners need to do more to help themselves.
C. the ICU may not be a suitable place for all practitioners to work.
D. it is natural that some practitioners handle stress better than others.

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