Childhood Overweight and Obesity Developing a PCT strategy

1
Childhood Overweight and ObesityDeveloping a PCT
strategy

• John McBride
• Senior Lecturer
• Institute of Health and Community Studies
• Bournemouth University

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Why Does it Matter?

• Significant and increasing problems.
• Likely to have long term adverse influences on
  the health of individuals and populations unless
  action is taken.

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Effects

• Poor health in childhood.
• Development of obesity and obesity related health
  problems in adulthood (Balaban and Silva 2004,
  Caballero 2001)
• Greater risk of psychological problems (Phillips
  and Hill 1998, Neumark-Sztainer and Hannan 2000).
  
• Habits and behaviours established in childhood
  are hard to change at a later stage (Caroli and
  Lagravinese 2002).

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Findings from Literature Review
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Definition

• Lack of a rigorous scientific definition of
  terms.
• Lack of clarity over assessment strategies
  (Livieri et al 2003).
• BMI
• Waist circumference
• Skinfold thickness

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BMI

• Cole et als (2000) tool reasonably accurate
  measure of obesity or overweight in children aged
  2-6 (Liveri et al 2003, Abrantes et al 2003,
  Rolland-Cachera 2003)
• Ruxton (2004) suggests 4 years as the lowest age
  for diagnosis.

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BMI Definitions

• Obese children BMI above the 98th age and sex
  specific percentile
• Overweight children BMI greater than or equal to
  the 91st age and sex specific centile (Harrell et
  al 2003, SIGN 2003)

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Clinical Vs Research Terms

• SIGN (2003) this contrasts with the
  international consensus used for research
  purposes which defines obesity as the 95th
  centile or above, and overweight as the 85th
  centile or above.

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Additional Considerations

• BMI may not accurately identify all obese
  children (Eto et al 2004).
• There are differences in normal BMI between
  ethnic groups (Karasalihoglu et al 2003, Liveri
  et al 2003)

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Triceps Skinfold Waist Circumference

• Obesity triceps skinfold higher than the 85th
  centile for age and gender (Livieri et al 2003).
• Requires practical training and use of equations
  to transform measurements into percentage body
  fat.
• Waist Circumference less reliable or valid a
  measure or predictor of obesity as BMI
  percentiles or subcutaneous skinfold thickness
  (SIGN 2003).

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Interventions Must

• Encompass the numerous possible causative or
  predisposing factors.
• Include child and family.
• Maximise the likelihood of compliance.

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Problem Identification

• Monitor childrens growth and development in
  order to identify those who are/ are at risk of
  becoming overweight or obese (Ariza et al 2004).
• Consider disease or genetic processes.
• Investigate dietary input, level of activity, and
  food related behaviour.

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Developing the strategy

• Partnership working
• Linking with existing projects
• NHSI
• Bournemouth health network
• Community development projects
• Collaborative working across health and social
  care and local authorities