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Childhood Overweight and Obesity
Developing a PCT strategy
John McBrideSenior 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 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.
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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 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.
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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