Childhood obesity in Mertonincluding an update on the NCMP programme

Eva van Velzen, Public Health registrar NHS Sutton and MertonJulia Groom, Public Health consultant Merton27 April 2012

Merton

• One in five children in Reception year is overweight or obese

• One on three children in Year 6 is overweight or obese

So what?• Children experience psychological effects: teasing and discrimination by

peers; low self-esteem; anxiety and depression

• Childhood obesity is associated with a higher chance of premature death and disability in adulthood from:– cardiovascular diseases – diabetes– musculoskeletal disorders– certain types of cancer (e.g. breast and colon)

• Many overweight children will become overweight adults (and parents!)

Sources: NOO, WHO

Outline

• Causes of childhood obesity• Background NCMP• National results• Merton results• NCMP actions• Local support programme: Alive ‘n Kicking• Discussion

Determinants of Obesity

Source: http://www.cdc.gov/pcd/issues/2009/jul/09_0013.htm

In words:• Childhood obesity is mainly associated with unhealthy eating and low

levels of physical activity, but the problem is linked not only to children's behaviour but also, increasingly, to social and economic development and policies in the areas of agriculture, transport, urban planning, the environment, food processing, distribution and marketing, as well as education

• The problem is societal and therefore it demands a population-based multi sectoral, multi-disciplinary, and culturally relevant approach.

• Children and adolescents cannot choose the environment in which they live or the food they eat. They also have a limited ability to understand the long-term consequences of their behaviour.

Source: WHO

Background• National Child Measurement Programme (NCMP) is a

national programme to measure the weight of children in Reception and Year 6 in English state schools

• Aim: to monitor overweight and obesity to guide effective policy making to reduce obesity

• Parents receive individual feedback about measurement• Measure used = BMI, adjusted for normal growth variation

between Reception and Year 6, and sex.

National child measurement results 2010 - 2011

© NOO 2012

Merton child measurement results 2010 - 2011

© NOO 2012

Lower than UK

Higher than UK

NCMP results – action

• National data for monitoring and policy

• Local feedback of measurements• to parents (NHS community services)• to headmasters (NHS Public Health)• referrals to treatment programme ‘Alive n Kicking’

What is Alive ‘N’ Kicking?• Specialist healthy weight programme for

children aged 4-19

• Physical activity sessions for children

• Interactive nutrition workshops for parents, focusing on practical ways to improve the family diet.

Group programmes for 4-6yrs, 7-11yrs, 12-15yrs and 16-19yrs, with capacity of 20 participants per group

Results so far March 2012...

• 70% of graduates reduced their BMI

• 84% of graduates reduced their waist circumference

• Average weight loss was -1.05 kg

Discussion

• One in five Merton children in Reception year is overweight or obese

• One on three Merton children in Year 6 is overweight or obese

Extra slides

Obesity trend data

Merton – England, NCMP 2007/08 to 2010/11

Reception Year

Year 6

Prevalence of obesity by Local AuthorityYear 6 children (age 10-11 years) resident in London, NCMP 2009/10

Low prevalence

High prevalence

Child obesity: BMI ≥ 95th centile of the UK90 growth reference © NOO 2011

http://www.noo.org.uk/visualisation/eatlas

Uptake and trends

Training: 88 local candidates trained including EY staff and Health

Completers:Jul ’09 - Mar ‘11 = 105 / yrApr’11 – June ‘12 = 161 / yr53% increase in completers

Referrals: on average 26 referrals per month

We’re aiming for 70 this term

Local feedback to schools

• National guidelines: detailed school data may not be shared with schools

• We use a national but ‘Mertonised’ tool for feedback about the 2010-2011 results to Merton headmasters

• The letter will include information about local support to help children and their families to keep a healthy weight

• Participation rate Merton - England: – 87.1% Reception = lower than nationally– 91.2 % Year 6 = same as nationally

School prevalence indicator:

No data or insufficient

data

Below the regional average

Similar to the regional average

Higher than the regional average

   

Reception

Underweight2 2 2 2

Overweight2 2 2 2

Obese2 2 2 2

           

Year 6

Underweight2 2 2 2

Overweight2 2 2 2

Obese3 3 3 3

Example feedback from 09-10 data

Note: big increase in overweight and obesity between Reception and Year 6!

23.6%22.9%

21.7%

20.5%

18.9%17.9%

16.6%15.7%

14.6%

12.6%12.6%12.0%

11.4%10.7%

9.7%9.0%

8.3% 7.9% 7.5%6.8%

Mostdeprived

Leastdeprived

© NOO 2011

Prevalence of obesity by deprivation decile Children in Reception and Year 6 (National Child Measurement Programme 2009/10)

Child obesity: BMI ≥95th centile of the UK90 growth referenceDeprivation deciles assigned using the Index of Multiple Deprivation 2010

Reception Year 6