1. Insert name of presentation on Master Slide A Secondary Analysis of the Cross-Sectional Data Available in the ‘Welsh Health Survey for Children’ to Identify Risk Factors Associated with Childhood Obesity in Wales. Presented by :Claire Beynon Supervisor :Professor David Fone, Cardiff University

2. Claire Beynon Why is childhood obesity a problem? Prevalence of childhood obesity in Wales 12%. Impacts on both quality and quantity of life. Immediate effects: low self esteem; bullying; depression; type II diabetes. Long term effects: Premature mortality; adult morbidity. Obesity costs £73 million per annum in Wales.

3. Claire Beynon Why is childhood obesity a problem? Lobstein and Jackson Leach in Foresight Report, UK Government Office for Science, 2007.

4. Claire Beynon The Data Choice in the UK Childhood Measurement Programme Millennium Cohort Study Welsh Health Survey English Health Survey Collecting new data

5. Claire Beynon Welsh Health Survey Adult Survey Children's Survey Geography Question development Sampling frame Sampling technique Response rate

6. Claire Beynon Research Question What are the important risk factors for childhood obesity for children aged 4 to 15 years in Wales? Research Objectives Identify and quantify cross-sectional associations between obesity in children in Wales aged 4-15 years and the risk factors available in the Welsh Health Survey. Make recommendations for policy where appropriate.

7. Claire Beynon 1032 records excluded on basis of non- English; not relevant; not in age range; incorrect outcome; data not collected in WHS 1086 titles and abstracts screened using inclusion criteria 41 full-text articles excluded on basis of non-English; not relevant; not in age range; incorrect outcome; data not collected in WHS 13 articles included in review of the literature 54 full-text articles assessed for eligibility using inclusion criteria Total of 1086 records identified using ‘Childhood Obesity’ and ‘Risk Factors’ from four electronic databases 754 records identified through EMBASE electronic database 281 records identified through MEDLINE electronic database 41 records identified through PSYCHINFO electronic database 10 records identified through Cochrane Library Literature review

8. Claire Beynon Study Design Secondary Analysis of Data from the WHS. Dataset included n=11,279 children (aged 4-15 years) between 2008 and 2011. Descriptive statistics, and logistic regression.

9. Claire Beynon Risk Factors Socio-demographic/socioeconomic variables: Sex, age, National Statistics Social Classification (NSSEC), housing tenure and Welsh Index of Multiple Deprivation (WIMD). Lifestyle variables: Unhealthy food consumption; sugar sweetened beverages; physical activity (PA) levels Illness: Currently treated illnesses.

10. Claire Beynon Results Body Mass Index classifications for children by year of WHS

11. Claire Beynon Results Body Mass Index classifications for children’s age group

12. Claire Beynon Odds Ratios How to calculate: OR =Odds of exposure in cases Odds of exposure in control How to interpret: OR>1 increased risk OR=1 no difference OR<1 decreased risk Confidence intervals, if they cross 1 not significant

13. Claire Beynon Results Significant association between childhood obesity and the following factors denoted with *

14. Claire Beynon Results

15. Claire Beynon Results

16. Claire Beynon Results No significant association between childhood obesity and the following factors:

17. Claire Beynon Differences from CMP data

18. Claire Beynon Strengths of the study WHS uses stratified random sampling. Results for 3000 children achieved per annum. Good response rate at 75%. Known confounding accounted for by use of multivariable analysis. Provides new insights into existing data. Information from Wales on which to base Welsh policy.

19. Claire Beynon Limitations of the study Risk of bias, e.g. recall bias; reporting of food consumption and physical activity reporting. Non response bias. Reverse causality possible due to study design. Selection bias, private homes surveyed (not institutions). Unknown confounding possible (not all risk factors measured). Interactions not explored.

20. Claire Beynon Conclusions Some risk factors associated with childhood obesity are not modifiable (e.g. sex and age of the child). Some risk factors are not easily modifiable in the short term, e.g. the circumstances of the family (NS-SEC classification of the parent and housing tenure). Two findings are potentially more easily modifiable: –the association between childhood obesity and not meeting the PA recommendations –the NHS response to the care planning of children with a long term condition.

21. Claire Beynon Recommendations Increase physical activity in schools to an hour a day, so all children have levels of PA that protect them from obesity without increasing inequalities in health. Utilise the CMP feedback to provide advice on relevant physical activity options that are affordable and accessible e.g. green spaces; walks; free swimming. Ensure all children with a long term condition get help to avoid or manage obesity through an holistic care package.