1. Dr S Saxena 1 Dr G Ambler 2 Prof. TJ Cole 3 Prof A. Majeed 1 1 Imperial College London, 2 UCLH Trust, 3 Institute of Child Health

2. England and Scotland have one of the fastest growing obesity rates in the world….more than doubled between 1980 and the early nineties...(2001 figures) show 21% of men and 23.5% of women over 16 years have a Body Mass Index of 30 or more in England.

3. Background Obesity epidemic world wide US rising faster in African-Americans British South Asians & Afro-Caribbean adults at risk of cardiac disease British South Asian children have worse biochemical risk profiles for cardiac disease

4. Interrelationships Diabetes Cardiovascular disease Black Caribbean S. Asian ethnicity Obesity

5. Aims To compare the percentage of obese or overweight children within different ethnic and socio-economic groups

6. Health Survey for England 1999 Annual cross sectional survey Focus on ethnic minority groups Random sampling of private households Interview & nurse visit for measurements

7. Sampling Ethnic boost n=3891 Ethnic groups n=4857 General Population n=6552 Core general pop n=2061 Chinese n=342 Ethnic groups n=354 postcode sectors household screening Systematic samplingRandom sampling

8. Ethnic group categories in HSE99 Chinese Bangladeshi Pakistani Indian Afro-Caribbean General population ETHNIC GROUPS COMPARED Irish

9. height 2 weight / BMI= (kg) (m) (kg/m 2 ) Body Mass Index Measure

10. *US reference population # UK growth reference charts (1991) Defining obesity in children Adults overweight: BMI 25 kg/m2 obese: BMI 30 kg/m2* In children, BMI rapidly changes with age In US, 85th and 95th centile for OW and OB* UK growth reference charts adopt this #

11. IOTF standard 2000 Overweight Obesity

12. % Response rates Gen PopEthnic boost Household7671 Interview9792-96 Nurse visit8986

13. Results : Socio-economic status of ethnic groups SocialEthnicity class G.PopAC IndPak BangChinIrish I+II3422281893739 IIIn132210671615 IIIm31223040353129 IV+V20282823331016

14. Results : Socio-economic status of ethnic groups Social Ethnicity class G.PopAC IndPak BangChinIrish I+II3422281893739 IIIn132210671615 IIIm31223040353129 IV+V20282823331016

15. Risk of being overweight in girls by social class Social class

16. Risk of being overweight in boys by social class Social class

17. Risk overweight in boys by ethnic group Ethnic group Adjusted odds ratio

18. Risk overweight in girls by ethnic group Ethnic group Adjusted odds ratio

19. Risk of obesity in boys by ethnic group Ethnic group Adjusted odds ratio

20. Risk of obesity in girls by ethnic group Ethnic group Adjusted odds ratio

21. Strengths of study Power:Large Representative:Population based study Measure: Objective (BMI)

22. Ethnic group comparisons: limitations Different heights for same BMI Different fat composition for same BMI Ethnic group reported by parent Data cross sectional

23. Conclusions Ethnicity strong determinant of obesity in children British Afro-Caribbean & Pakistani girls at increased risk of obesity Indian and Pakistani boys more likely to be overweight Social class differences do not contribute to obesity in children

24. Possible explanations

25. Future studies Longitudinal studies for cumulative risk Develop standards for child obesity Include ethnicity in assessing cardiac risk