Overweight at the GP surgery What do we need to proceed?

The bad news We know little about what is going on We know less about why We know even less about what to do about it

The good news We know little about what is going on – GP’s can contribute to develop our knowledge We know less about why – GP’s can contribute to develop our knowledge We know even less about what to do about it – GP’s can contribute to develop our knowledge

How can the GP contribute? Share routine data on growth – Understanding overweight – Evaluate interventions Identify children in risk of overweight early Develop preventive programs

How do we measure children BMI? 1-5 years Norway – Only height Sweden – 5 years Island – 1½ and 2½ years Finland – Every year Denmark – Every year

Electronic patient files GP’s in Denmark

Centralised datacollections Denmark – Prospectively data probably systematically collected at the National Board of Health – A project to retrive previously data is being established Sweden and Finland: on their way Norway and Island?

Growth-pattern of Finnish children Data from Northern Finnish Birth Cohorts. Marjo Riita Järvellin et al.

Identifying children in risk of overweight In their report from 2008 The National Board for Physical activity and Nutrition (’Motions- og Ernæringsrådet’) suggested: – establishment of a system to identify children in risk of developing adiposity before the adipsosity is manifest – That this system should be part of the routine health examinations when the children are 3, 4 and 5 year old

Can we find and treat at risk children? The national college of general practitioners From 2006

What more do we need? A tool to estimate the childrens risk of being overweight early? Development of programs to approach the child at risk of being overweight and its family?

The Whitaker studies 854 individuals BMI retrospectively collected Endpoint BMI at year of age Overweight definition adults: BMI > 27.8/27.3 Overweight definitions children 15th centile

Combining parents and child overweight No Parents overweightOne Parent overweight > 15th %<15th %> 15th %<15th % Based on ’Whitaker et al NEJM 1997;37:869-73’

Adiposity rebound

Adiposity rebound and parentalt overweight Early Intermed. Late No Parents overweightOne Parent overweight Based on ’Whitaker et al. Pediatrics 1998;101:e5’

Developing a Nordic algoritme for estmating risk of overweight early Cohorts – Aarhus Birth Cohort (90-92)- development – Northern Finnish Birth Cohort (85-86)-test Some of the potential predictive variables – Both parents BMI – Maternal smoking – Birthweight and gestational age at birth – Breastfeeding – Childs growthpattern

Plan To integrate the algoritm in the datacapture module – Clinical tool for GP’s – Evaluation To develop an intervention model – The GP surgery – Municipallity setting

Waist circumference