Obesity Discussion Forums

[Obesity Discussion]

Background
Recent official publications have highlighted obesity as one of the biggest threats to
public health and the prevalence of obesity in children is widely believed to be rising rapidly.
However, there are no data on the prevalence of childhood obesity at a local level. We have developed
a simple low-cost method of gaining such data by working with local schools.
Method
We designed our method on the observation that numeracy and data handling skills are
often taught in schools by getting children to measure their height and weight. We recruited seven
schools and offered them a numeracy lesson plan suitable for year 5 (aged 9–10) children together
with healthcare staff to attend the lesson. As part of the lesson, each child’s height and weight was
measured and recorded anonymously. Parental consent was obtained on an ‘opt out’ basis. The
method was evaluated by questionnaire.
Results
We gained data on body mass index for 252 children. In total, 20% of the children were
overweight, and 7% obese. The brief questionnaire survey indicated that both teachers and
school nurses were happy with the method and would repeat it. Weighing was carried out
sensitively.
Conclusion
Our findings were in line with national studies of the prevalence of childhood
obesity. The method was simple, low-cost and acceptable to schools and school nurses. There
seems no reason why this project cannot be used more widely across the Primary Care Trust
(PCT) and beyond. We now propose to roll out the method across all primary schools in
Birmingham.
Keywords
obesity, childhood, schools,
prevalence, measurement
Introduction
Recent official publications (Department of Health
2004; House of Commons Select Committee 2004)
have highlighted obesity as one of the biggest
threats to public health. The prevalence of obesity
in children is widely believed to be rising rapidly
(Chief Medical Officer 2003), though the scale of
the problem may have been overestimated (Social
Issues Research Centre 2005). An obese child is
likely to grow into an obese adult, and adult obesity
reduces life expectancy by 9 years (National Audit
Office 2001) mainly due to cardiovascular disease
and the complications of diabetes. Paediatricians in
the UK have started to see cases of obesity-related
metabolic syndromes such as insulin resistance,
hypertriglyceridaemia and type 2 diabetes in early
adolescence (Pontiroli 2004).
240
K. Routh
et al
.
© 2006 Blackwell Publishing Ltd,
Child: Care, Health & Development
,
32
, 2, 239–245
The UK government has therefore set a target for
health and local authorities to ‘halt, by 2010, the
year on year increase in the prevalence of obesity
in children under 11’ (Department of Health
2004).
However, there are no data on the prevalence of
childhood obesity at a local level. The Office for
National Statistics produces country estimates, but
they are not helpful in deciding where to direct
public health action or to judge local progress
towards the target.
Birmingham City Council’s Scrutiny Committee
on children’s nutrition and obesity (Health Overview
and Scrutiny Committee 2004) stated their
belief that, ‘… it is vital that local data on childhood
obesity prevalence is collected and analysed,
both to monitor the size of the problem and also
to estimate the impact of actions to reduce obesity
on population health’.
In order to address this need, we decided to
estimate the population prevalence of obesity in
children aged 9–10 years by trying out a simple
low-cost method that harnessed the enthusiasm
and capabilities of schools in our area. In doing so,
we believe that we have hit upon a method that can
be rolled out to all schools.
Aims and objectives
The aims and objectives of the project were:
• to gather baseline data on the body mass index
(BMI) in a sample of year 5 (aged 9–10) school
children;
• to develop and try out a simple low-cost method
of obtaining data on childhood obesity;
• to determine whether schools would find the
method acceptable and easy to use regularly.
Method
We designed our method on the observation that
numeracy and data handling skills are often
taught in schools by getting children to measure
their height and weight. We decided to work in
partnership with schools to allow us to be part of
such a lesson, and to let us use the data
anonymously.
We approached all the primary schools in north
Birmingham; seven were keen to take part in the
project. These included some from the most disadvantaged
parts of the Primary Care Trust (PCT)
and others from the most affluent.
We arbitrarily chose the year 5 class (aged 9–10)
for our pilot. At this age, children are at the threshold
between childhood and adolescence. Pragmatically,
we felt that it would be the easiest age group
to work with, and it would give us a snapshot of
the levels of childhood obesity in children before
they enter puberty.
We saw the involvement of school nurses as vital.
The school nurse for each of the participating
schools was invited to take part. All agreed and a
meeting was held to tell them more about the
project and answer their queries and concerns. It
was agreed that, where possible, school health link
workers would also attend the lessons to help with
measurements.
At a convenient time before the lesson, the
school nurse compiled a class list and allocated a
number to each child. For each child we recorded
date of birth, gender and postal area of residence.
Lesson plan
Working with an educational advisor, we developed
a lesson plan suitable for the Key Stage 2
numeracy curriculum (designed for children aged
9–11, see Box 1). This plan was offered to the
school, along with a member of healthcare staff
(usually the school nurse, plus a link worker) to
attend the lesson and help take the measurements
thus ensuring consistency of results.
Potential concerns
In developing this method, we had to address two
issues of potential concern – parental consent, and
the possibility of stigmatization of overweight
children.
We obtained parental consent on an ‘opt out’
basis. We wrote to all parents telling them of the
project and explaining our reasons for doing it. We
explained that parents could withdraw their child
from the lesson by completing and returning a
tear-off slip (see Box 2).
A simple low-cost method to measure prevalence of childhood obesity
241
© 2006 Blackwell Publishing Ltd,
Child: Care, Health & Development
,
32
, 2, 239–245
To deal with the potential for stigmatization, we
avoided an emphasis on weight. The lesson was
specifically designed to be about numbers and
graphs rather than health. Weighing was just one
of a range of activities during the lesson. We also
ensured that each child was weighed separately and
the weight kept private from the rest of the class.
The lesson
We explained to the class teacher that the lesson
plan was offered merely as a guide. They could
freely change the lesson, or use only part of the plan
if they wished so long as we had the chance to
measure the children in a sensitive way.
Box 1
Lesson outline
The lesson plan is based on the concept of continuous and discontinuous data and how they can be
plotted using line graphs and bar charts.
The introduction involves an explanation of the lesson by the teacher and an activity where the
children organize themselves into ‘living graphs’.
In the main part of the lesson the pupils move in groups between six ‘stations’ where a variety of
measurements and recordings are taken. These include shoe size, eye colour, foot length, hand span
and, of course, height and weight. The height and weight stations are manned by healthcare staff.
The other recordings and measurements are done by the children themselves.
The data so recorded are used for plotting graphs – either then or in subsequent lessons. Dummy data
on height and weight are given to the teacher to use for these purposes so allowing us to keep our
measurements private.
Box 2
Parental consent letter
Dear parent
I am writing to tell you about a project that your child’s school has agreed to help us with.
As you probably know, there is a lot of worry at the moment about the levels of obesity in our children.
We would like to try and find out how serious this problem is in our area, that served by the North
Birmingham Primary Care Trust.
We are working with seven schools across this area to run a year 5 lesson during which the children
will be weighed and have their height measured.
This will be done in such a way that no child will be made to feel uncomfortable about their size and
each child’s weight will be kept private. The lesson will be based around number work and graph
plotting – there will be no mention of obesity. The weighing and measuring will form only a small
part of the lesson, which should be interesting and enjoyable for all.
The school nurse (and probably one or two other healthcare staff) will be present during the lesson,
to help with the measuring.
Although we will take away the results these will be anonymous – your child will not be identifiable.
We are just looking at numbers – how many children fall into each weight category, not at
individuals.
I hope you will be happy for your child to take part in this lesson but if not you may ask for him/her
to be withdrawn by completing and returning the slip below.
Finally, if you have a particular concern about your child’s height and weight don’t forget you may
contact the school nurse for advice via the school.
242
K. Routh
et al

[Obesity Discussion]

A simple, and potentially low-cost method for measuring the prevalence of childhood obesity
K. Routh*, J. N. Rao* and J. Denley*

Abstract

Background Recent official publications have highlighted obesity as one of the biggest threats to public health and the prevalence of obesity in children is widely believed to be rising rapidly. However, there are no data on the prevalence of childhood obesity at a local level. We have developed a simple low-cost method of gaining such data by working with local schools.

Method We designed our method on the observation that numeracy and data handling skills are often taught in schools by getting children to measure their height and weight. We recruited seven schools and offered them a numeracy lesson plan suitable for year 5 (aged 9–10) children together with healthcare staff to attend the lesson. As part of the lesson, each child's height and weight was measured and recorded anonymously. Parental consent was obtained on an 'opt out' basis. The method was evaluated by questionnaire.

Results We gained data on body mass index for 252 children. In total, 20% of the children were overweight, and 7% obese. The brief questionnaire survey indicated that both teachers and school nurses were happy with the method and would repeat it. Weighing was carried out sensitively.

Conclusion Our findings were in line with national studies of the prevalence of childhood obesity. The method was simple, low-cost and acceptable to schools and school nurses. There seems no reason why this project cannot be used more widely across the Primary Care Trust (PCT) and beyond. We now propose to roll out the method across all primary schools in Birmingham.

[Obesity Discussion]

Recent official publications (Department of Health 2004; House of Commons Select Committee 2004) have highlighted obesity as one of the biggest threats to public health. The prevalence of obesity in children is widely believed to be rising rapidly (Chief Medical Officer 2003), though the scale of the problem may have been overestimated (Social Issues Research Centre 2005). An obese child is likely to grow into an obese adult, and adult obesity reduces life expectancy by 9 years (National Audit Office 2001) mainly due to cardiovascular disease and the complications of diabetes. Paediatricians in the UK have started to see cases of obesity-related metabolic syndromes such as insulin resistance, hypertriglyceridaemia and type 2 diabetes in early adolescence (Pontiroli 2004).

The UK government has therefore set a target for health and local authorities to 'halt, by 2010, the year on year increase in the prevalence of obesity in children under 11' (Department of Health 2004).

However, there are no data on the prevalence of childhood obesity at a local level. The Office for National Statistics produces country estimates, but they are not helpful in deciding where to direct public health action or to judge local progress towards the target.

Birmingham City Council's Scrutiny Committee on children's nutrition and obesity (Health Overview and Scrutiny Committee 2004) stated their belief that, '… it is vital that local data on childhood obesity prevalence is collected and analysed, both to monitor the size of the problem and also to estimate the impact of actions to reduce obesity on population health'.

In order to address this need, we decided to estimate the population prevalence of obesity in children aged 9–10 years by trying out a simple low-cost method that harnessed the enthusiasm and capabilities of schools in our area. In doing so, we believe that we have hit upon a method that can be rolled out to all schools.

Aims and objectives

The aims and objectives of the project were:

• to gather baseline data on the body mass index (BMI) in a sample of year 5 (aged 9–10) school children;

• to develop and try out a simple low-cost method of obtaining data on childhood obesity;

• to determine whether schools would find the method acceptable and easy to use regularly.

[Obesity Discussion]

We designed our method on the observation that numeracy and data handling skills are often taught in schools by getting children to measure their height and weight. We decided to work in partnership with schools to allow us to be part of such a lesson, and to let us use the data anonymously.

We approached all the primary schools in north Birmingham; seven were keen to take part in the project. These included some from the most disadvantaged parts of the Primary Care Trust (PCT) and others from the most affluent.

We arbitrarily chose the year 5 class (aged 9–10) for our pilot. At this age, children are at the threshold between childhood and adolescence. Pragmatically, we felt that it would be the easiest age group to work with, and it would give us a snapshot of the levels of childhood obesity in children before they enter puberty.

We saw the involvement of school nurses as vital. The school nurse for each of the participating schools was invited to take part. All agreed and a meeting was held to tell them more about the project and answer their queries and concerns. It was agreed that, where possible, school health link workers would also attend the lessons to help with measurements.

At a convenient time before the lesson, the school nurse compiled a class list and allocated a number to each child. For each child we recorded date of birth, gender and postal area of residence.

Lesson plan

Working with an educational advisor, we developed a lesson plan suitable for the Key Stage 2 numeracy curriculum (designed for children aged 9–11, see Box 1). This plan was offered to the school, along with a member of healthcare staff (usually the school nurse, plus a link worker) to attend the lesson and help take the measurements thus ensuring consistency of results.

Potential concerns

In developing this method, we had to address two issues of potential concern – parental consent, and the possibility of stigmatization of overweight children.

We obtained parental consent on an 'opt out' basis. We wrote to all parents telling them of the project and explaining our reasons for doing it. We explained that parents could withdraw their child from the lesson by completing and returning a tear-off slip (see Box 2).

Box 1 Lesson outline

The lesson plan is based on the concept of continuous and discontinuous data and how they can be plotted using line graphs and bar charts.

The introduction involves an explanation of the lesson by the teacher and an activity where the children organize themselves into 'living graphs'.

In the main part of the lesson the pupils move in groups between six 'stations' where a variety of measurements and recordings are taken. These include shoe size, eye colour, foot length, hand span and, of course, height and weight. The height and weight stations are manned by healthcare staff. The other recordings and measurements are done by the children themselves.

The data so recorded are used for plotting graphs – either then or in subsequent lessons. Dummy data on height and weight are given to the teacher to use for these purposes so allowing us to keep our measurements private.


Box 2 Parental consent letter

Dear parent

I am writing to tell you about a project that your child's school has agreed to help us with.

As you probably know, there is a lot of worry at the moment about the levels of obesity in our children. We would like to try and find out how serious this problem is in our area, that served by the North Birmingham Primary Care Trust.

We are working with seven schools across this area to run a year 5 lesson during which the children will be weighed and have their height measured.

This will be done in such a way that no child will be made to feel uncomfortable about their size and each child's weight will be kept private. The lesson will be based around number work and graph plotting – there will be no mention of obesity. The weighing and measuring will form only a small part of the lesson, which should be interesting and enjoyable for all.

The school nurse (and probably one or two other healthcare staff) will be present during the lesson, to help with the measuring.

Although we will take away the results these will be anonymous – your child will not be identifiable. We are just looking at numbers – how many children fall into each weight category, not at individuals.

I hope you will be happy for your child to take part in this lesson but if not you may ask for him/her to be withdrawn by completing and returning the slip below.

Finally, if you have a particular concern about your child's height and weight don't forget you may contact the school nurse for advice via the school.



To deal with the potential for stigmatization, we avoided an emphasis on weight. The lesson was specifically designed to be about numbers and graphs rather than health. Weighing was just one of a range of activities during the lesson. We also ensured that each child was weighed separately and the weight kept private from the rest of the class.

The lesson

We explained to the class teacher that the lesson plan was offered merely as a guide. They could freely change the lesson, or use only part of the plan if they wished so long as we had the chance to measure the children in a sensitive way.

One of us (K.R.) and a school nurse attended each lesson. In some cases, an additional link worker was also present.

At the beginning of the lesson, the children were given colourful cardboard wristbands on which was written their personal number (corresponding to the previously complied class list).

The class teacher led the lesson. At some point, the children were divided into groups that went around six 'stations' in turn – these were to measure and record shoe size, hand span, eye colour, foot length and, of course, height and weight. The healthcare staff measured each child's height and weight and recorded it against the number on a pre-prepared results sheet.

Weight was measured, and recorded to the nearest 0.1 kg, using a Salter digital scale, the same set being used in each of the seven lessons. The scales had been calibrated 1 month before the first lesson. The children wore light indoor clothing (shoes and jumper/sweatshirt were removed). Care was taken to keep the weights private – the other children in the group were asked to keep at a distance during weighing. The results sheet was kept covered.

Seca Leicester Portable Height Measures were used to measure height, recording this to the nearest 0.1 cm. The children removed their shoes and were measured in socks.

The healthcare staff in attendance helped the children with their other tasks as required. We felt it was important to be a useful part of the lesson.

The length of the lessons ranged from the usual 1-h numeracy lesson to, in two cases, the whole of the school afternoon (in one of these latter 60 children were measured). In several cases, our weighing and measuring was completed within half an hour and we withdrew quietly as the class teacher began leading the plenary section of the lesson.

At the end of the lesson, the class teacher kept the results sheets for eye colour, shoe size, foot length and hand span. They were given a set of 'dummy' results on height and weight while we took away our real results for these.

Anonymous data on each child's height, weight, age, gender and postal area were recorded and brought away for analysis.

Statistical methods

Each child's height and weight data were converted into a BMI value using the standard formula. We used standard UK BMI reference charts (Child Growth Foundation 1996) to compare the BMI with the reference ranges and to classify each child as normal, overweight and obese using the cut-off percentile points suggested by Cole and colleagues (2000). Further analysis was limited to frequency counts of cases in each category by gender group.

Evaluation

A few weeks after the lesson, we sent out a letter thanking the teachers, together with a questionnaire asking them to evaluate the method. Questionnaires were also sent to the school nurses.