Childhood Overweight and Obesity Developing a PCT strategy John McBride Senior Lecturer Institute of Health and Community Studies Bournemouth University

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.

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).

Findings from Literature Review

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

BMI Cole et al’s (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.

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)

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

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)

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).

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

Problem Identification Monitor children’s 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.

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