Ruth R Kipping

Obesity in children. Part 1: Epidemiology, measurement, risk factors, and screening

This article describes the prevalence of obesity in children, its underlying risk factors, its consequences, and how it can be measured; it also discusses whether children should be screened for obesity.

Patterns of alcohol use and multiple risk behaviour by gender during early and late adolescence: the ALSPAC cohort

BACKGROUND Adolescent risk behaviours such as smoking, alcohol use and antisocial behaviour are associated with increased risk of morbidity and mortality. Patterns of risk behaviour may vary between genders during adolescence. METHODS Analysis of data from a longitudinal birth cohort to assess the prevalence and distribution of multiple risk behaviours by gender at age 15-16 years with a focus on alcohol use at age 10, 13 and 15 years. RESULTS By age 15 years, over half of boys and girls had consumed alcohol and one-fifth had engaged in binge drinking with no clear difference by gender. At age 15-16 years, the most prevalent risk behaviours were physical inactivity (74%), antisocial and criminal behaviour (42%) and hazardous drinking (34%). Boys and girls engaged in a similar number of behaviours but antisocial and criminal behaviours, cannabis use and vehicle-related risk behaviours were more prevalent among boys, whilst tobacco smoking, self-harm and physical inactivity were more prevalent among girls. CONCLUSION Multiple risk behaviour is prevalent in both genders during adolescence but the pattern of individual risk behaviour varies between boys and girls. Effective interventions at the individual, family, school, community or population level are needed to address gender-specific patterns of risk behaviour during adolescence.

Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial

Objective To investigate the effectiveness of a school based intervention to increase physical activity, reduce sedentary behaviour, and increase fruit and vegetable consumption in children. Design Cluster randomised controlled trial. Setting 60 primary schools in the south west of England. Participants Primary school children who were in school year 4 (age 8-9 years) at recruitment and baseline assessment, in year 5 during the intervention, and at the end of year 5 (age 9-10) at follow-up assessment. Intervention The Active for Life Year 5 (AFLY5) intervention consisted of teacher training, provision of lesson and child-parent interactive homework plans, all materials required for lessons and homework, and written materials for school newsletters and parents. The intervention was delivered when children were in school year 5 (age 9-10 years). Schools allocated to control received standard teaching. Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day, accelerometer assessed minutes of sedentary behaviour per day, and reported daily consumption of servings of fruit and vegetables. Results 60 schools with more than 2221 children were recruited; valid data were available for fruit and vegetable consumption for 2121 children, for accelerometer assessed physical activity and sedentary behaviour for 1252 children, and for secondary outcomes for between 1825 and 2212 children for the main analyses. None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group. The difference in means comparing the intervention group with the control group was –1.35 (95% confidence interval –5.29 to 2.59) minutes per day for moderate to vigorous physical activity, –0.11 (–9.71 to 9.49) minutes per day for sedentary behaviour, and 0.08 (–0.12 to 0.28) servings per day for fruit and vegetable consumption. The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account: self reported time spent in screen viewing at the weekend (–21 (–37 to –4) minutes per day), self reported servings of snacks per day (–0.22 (–0.38 to –0.05)), and servings of high energy drinks per day (–0.26 (–0.43 to –0.10)) were all reduced. Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results. Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity, decreasing sedentary behaviour, and increasing fruit and vegetable consumption in primary school children. Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level, as well as at the school environment level. These findings have relevance for researchers, policy makers, public health practitioners, and doctors who are involved in health promotion, policy making, and commissioning services. Trial registration Current Controlled Trials ISRCTN50133740.

Randomised controlled trial adapting US school obesity prevention to England

Objectives: To determine whether a school obesity prevention project developed in the United States can be adapted for use in England. Methods: A pilot cluster randomised controlled trial and interviews with teachers were carried out in 19 primary schools in South West England. Participants included 679 children in year 5 (age 9–10). Baseline and follow-up assessments were completed for 323 children (screen viewing) and 472 children (body mass index). Sixteen lessons on healthy eating, physical activity and reducing TV viewing were taught over 5 months by teachers. Main outcome measures were hours of screen activities, body mass index, mode of transport to school and teachers’ views of the intervention. Results: Children from intervention schools spent less time on screen-viewing activities after the intervention but these differences were imprecisely estimated: mean difference in minutes spent on screen viewing at the end of the intervention (intervention schools minus control schools) adjusted for baseline levels and clustering within schools was −11.6 (95% CI −42.7 to 19.4) for a week day and was −15.4 (95% CI −57.5 to 26.8) for a Saturday. There was no difference in mean body mass index or the odds of obesity. Conclusions: It is feasible to transfer this US school-based intervention to UK schools, and it may be effective in reducing the time children spend on screen-based activities. The study has provided information for a full-scale trial, which would require 50 schools (∼1250 pupils) to detect effects on screen viewing and body mass index over 2 years of follow-up.

Obesity in children. Part 2: Prevention and management

#### Summary points In the first part of this article we described how obesity in children is measured, its prevalence, whether children should be screened, and the risk factors for and consequences of obesity.1 In this part we review the current evidence on the prevention and management of childhood obesity. #### Sources and selection criteria This review draws on the Foresight report, guidance from the National Institute for Health and Clinical Excellence and the Australian National Health Medical Research Council, and Cochrane review. In April 2008 we searched the Cochrane Library database of reviews and the Centre for Reviews and Dissemination databases using the search term “obesity”. We also conducted a Medline search ((Child

Economic evaluation of lifestyle interventions to treat overweight or obesity in children

or paediatric or pediatric or adolescent) and (Obes

Multiple risk behaviour in adolescence.

or overweight)) limited to 1 January 2005 to 6 May 2008 and “review articles”; this identified 1105 articles. We read the abstracts of these articles and retrieved relevant papers. We also used articles from our own bibliographies collected over the past 10 years. The evidence to support the measurement, prevention, and management of obesity in children is still relatively weak, with few randomised controlled trials or systematic reviews. The strength of evidence is developing and the updated Cochrane review that will be published in 2009 …

Multiple risk behaviour in adolescence and socio-economic status: findings from a UK birth cohort

Objective:To estimate lifetime cost effectiveness of lifestyle interventions to treat overweight and obese children, from the UK National Health Service perspective.Design:An adaptation of the National Heart Forum economic model to predict lifetime health service costs and outcomes of lifestyle interventions on obesity-related diseases.Setting:Hospital or community-based weight-management programmes.Population:Hypothetical cohorts of overweight or obese children based on body mass data from the National Child Measurement Programme.Interventions:Lifestyle interventions that have been compared with no or minimal intervention in randomized controlled trials (RCTs).Main Outcome Measures:Reduction in body mass index (BMI) standard deviation score (SDS), intervention resources/costs, lifetime treatment costs, obesity-related diseases and cost per life year gained.Results:Ten RCTs were identified by our search strategy. The median effect of interventions versus control from these 10 RCTs was a difference in BMI SDS of −0.13 at 12 months, but the range in effects among interventions was broad (0.04 to −0.60). Indicative costs per child of these interventions ranged from £108 to £662. For obese children aged 10–11 years, an intervention that resulted in a median reduction in BMI SDS at 12 months at a moderate cost of £400 increased life expectancy by 0.19 years and intervention costs were offset by subsequent undiscounted savings in treatment costs (net saving of £110 per child), though this saving did not emerge until the sixth or seventh decade of life. The discounted cost per life year gained was £13 589. Results were broadly similar for interventions aimed at children aged 4–5 years and which targeted both obese and overweight children. For more costly interventions, savings were less likely.Conclusion:Interventions to treat childhood obesity are potentially cost effective although cost savings and health benefits may not appear until the sixth or seventh decade of life.

Weight loss from three commercial providers of NHS primary care slimming on referral in North Somerset: service evaluation

The onset of multiple risk behaviours, such as smoking, anti-social behaviour, hazardous alcohol consumption and unprotected sexual intercourse, cluster in adolescence and are associated with increased risk of poor educational attainment, future morbidity and premature mortality....

Variation in childhood and adolescent obesity prevalence defined by international and country-specific criteria in England and the United States

Background. Patterns of risk behaviour during teenage years may vary by socio-economic status (SES). We aimed to examine possible associations between individual and multiple risk behaviours and three measures of SES in mid-adolescence. Methods. The sample (n = 6406) comprised participants from the Avon Longitudinal Study of Parents and Children, a UK birth cohort. Thirteen risk behaviours spanning sexual health, substance use, self-harm, vehicle-related injury, criminality and physical inactivity were assessed in mid-adolescence (age 15–16 years). Associations between three measures of SES (maternal education, household income and parental social class) and (i) individual risk behaviours and (ii) the total number of risk behaviours were examined. Results. For a one-category reduction in social class, maternal education or income, the odds of having a greater number of multiple risk behaviours increased by 22, 15 and 12%, respectively. At the individual level, there was evidence of a strong relationship with decreasing SES across all three measures of SES and criminality, car passenger risk, TV viewing, scooter risk, early sexual behaviour and weekly tobacco use but insufficient evidence of a relationship for physical inactivity, cycling without a helmet and illicit substance use. There was weak evidence of association between SES and hazardous drinking, self-harm, cannabis use and unprotected sex, but this was not consistent across the SES measures. Conclusion. The association between multiple risk behaviours and SES suggests that prevention strategies should apply the principal of proportionate universalism with a focus on more deprived populations, within a population-wide strategy, to prevent widening of social inequalities.