Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence

Westwood, Marie; Fayter, Debra; Hartley, Suzanne; Rithalia, Amber; Butler, Gary; Glasziou, Paul; Bland, Martin; Nixon, John; Stirk, Lisa; Rudolf, Mary

doi:10.1136/adc.2006.113589

Cited by 47 publications

(34 citation statements)

References 18 publications

(23 reference statements)

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“…11 12 We could locate two trials (one randomised, 13 one non-randomised 14 ) in which a brief primary care intervention was offered to young children whose overweight/obese status was ascertained through office surveillance; neither was effective in reducing BMI relative to controls. However, both were hampered by small sample sizes, and, given the clear policy imperatives to locate childhood obesity management in primary care, further research is clearly warranted.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial

Wake

Baur

Gerner

et al. 2009

BMJ

166

200

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Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children. Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment. Setting 45 family practices (66 general practitioners) in Melbourne, Australia. Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score ≥3.0) were excluded. Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials. Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI. Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention − control) at 6 and 12 months were, for BMI, −0.12 (95% CI −0.40 to 0.15, P=0.4) and −0.11 (−0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (−4 to 52, P=0.09) and 11 (−26 to 49, P=0.6); and, for nutrition score, 0.2 (−0.03 to 0.4, P=0

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Section: Introductionmentioning

confidence: 99%

Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial

Wake

Baur

Gerner

et al. 2009

BMJ

166

200

View full text Add to dashboard Cite

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“…A very clear example of this would be some of the measures being adopted in schools -such as periodic assessments of BMI -with the aim of identifying overweight children and reporting back to parents by letter, advising dietary changes and physical activity or that the child should see a doctor. Such measures are already in place in some states in the USA and Australia, despite the lack of data clearly supporting the preventive efficacy of this type of screening (59)(60)(61) . Such an approach, if not applied sensitively, could have counterproductive effects, such as parents encouraging their child to diet, increased stigmatization of obesity or the initiation of unhealthy weightcontrol behaviours in children and adolescents (59,(62)(63)(64)(65)(66) .…”

Section: Prevalence Of Eating-and Weight-related Problemsmentioning

confidence: 99%

Integrated prevention of obesity and eating disorders: barriers, developments and opportunities

Sánchez-Carracedo

Neumark‐Sztainer

López-Guimerà

2012

Public Health Nutr.

109

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AbstractObjectiveThe serious consequences of obesity and eating disorders (ED), difficulties encountered in treatment and the high prevalence of these conditions are important reasons to develop efforts aimed at their prevention. The implementation of integrated interventions aimed at preventing risk factors for both obesity and ED constitutes a very exciting development. In the present paper we discuss and review the main reasons for an integrated approach to the spectrum of eating- and weight-related problems, which include anorexia nervosa, bulimia nervosa, anorexic and bulimic behaviours, unhealthy dieting practices, body dissatisfaction, binge-eating disorder, overweight and obesity. Given differences between the fields with regard to current perspectives and objectives, key barriers to an integrated approach to prevention are discussed. In order to show the possibilities of development of this approach, we review the main contributions made to date in the fields of both obesity and ED prevention. In particular, environmental approaches in the prevention of obesity and ED are reviewed, given their potential for preventing a broad spectrum of eating- and weight-related problems. Furthermore, several examples of initiatives that have utilized an integrated approach to prevention are discussed.DesignNarrative review.ConclusionsWe recommend a scenario in which the two fields share knowledge to enhance the difficult work of preventing and treating both ED and obesity.

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“…Many potential issues and questions have been raised: the limitations of BMI screening 34 ; training of school personnel 37 ; privacy concerns 101 ; self-esteem concerns 37 ; possible increases in body dissatisfaction 37 ; where to refer children at high risk 56 ; how to interpret results 102 ; questions regarding schools as the appropriate screening site 37 ; parentally imposed food restrictions on children 24,34,38 ; increased disorderedeating behavior 34 ; increased stigmatization of obese children 37,39 ; and concerns about the availability of resources 103,104 have been voiced. Despite these concerns and the need for further research on the long-term impact of the benefits and potential harms of school-based weight monitoring, 105 the limited data available reflect support for the school-based screening and parent-notification programs. 24,106,107 Developing BMI-notification programs that recognize and respond to the cultural values and concerns of families represents a substantial challenge.…”

Section: Bmi Notification and Behavior Changementioning

confidence: 99%

The Role of Culture in the Context of School-Based BMI Screening

Fitzgibbon

Beech

2009

Pediatrics

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The high prevalence of overweight and obesity is a significant public health concern in the United States. Minority populations are disproportionately affected, and the impact of obesity on minority children is especially alarming. In this article we discuss school-based BMI reporting, which is intended to increase parental awareness of their children's weight status. This information could potentially lead parents of overweight and obese children to carefully examine and possibly change their children's diet and activity patterns. However, any program related to child weight status must consider culturally defined aspects of body size and shape. In other words, the cultural context in which information on child BMI is presented to and received by parents must be considered. In this article we review parental perceptions of child weight. Multiple studies have shown that parents of overweight or obese children often fail to correctly perceive their children as overweight. Possible reasons for, and implications of, this misperception of child weight status among minority parents are then explored within a cultural framework. The PEN-3 model is used to examine influences on health behaviors and could help inform the development of a culturally sensitive BMI-notification program for minority parents. Reporting materials congruent with the social and cultural values and practices of the target audience are likely to maximize program effectiveness. A culturally based BMI-notification program should be conceptualized as a small step in a comprehensive plan to reduce childhood obesity and improve the current and future health of minority children. Pediatrics 2009;124:S50-S62

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Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence

Cited by 47 publications

References 18 publications

Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial

Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial

Integrated prevention of obesity and eating disorders: barriers, developments and opportunities

The Role of Culture in the Context of School-Based BMI Screening

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