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Overweight at the GP surgery. What do we need to proceed ?. The bad news. We know little about what is going on We know less about why We know even less about what to do about it. The good news. We know little about what is going on - PowerPoint PPT Presentation
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Overweight at the GP surgery
What do we need to proceed?
The bad news
• We know little about what is going on
• We know less about why
• We know even less about what to do about it
The good news
• We know little about what is going on– GP’s can contribute to develop our knowledge
• We know less about why– GP’s can contribute to develop our knowledge
• We know even less about what to do about it– GP’s can contribute to develop our knowledge
How can the GP contribute?
• Share routine data on growth – Understanding overweight– Evaluate interventions
• Identify children in risk of overweight early• Develop preventive programs
How do we measure children BMI?1-5 years
• Norway – Only height
• Sweden– 5 years
• Island – 1½ and 2½ years
• Finland– Every year
• Denmark– Every year
Electronic patient files GP’s in Denmark
0
10
20
30
40
50
60
70
80
90
100
%
97 98 99 20 O1 O2 O3 O4 O5 O6
GP - EDI USER
Priv. Spec. EDI USER
PartTime P. Spec.
MedCom - Danish Health data NetworkEDI-users
Centralised datacollections
• Denmark– Prospectively data probably systematically
collected at the National Board of Health – A project to retrive previously data is being
established• Sweden and Finland: on their way• Norway and Island?
Growth-pattern of Finnish children
Data from Northern Finnish Birth Cohorts. Marjo Riita Järvellin et al.
0 2 4 6 8 10 12 14 16 18 2014
15
16
17
18
19
20
21
22
23
NFBC 1966
NFBC 1986
Age (years)
BMI (kg/m2)
Identifying children in risk of overweight
• In their report from 2008 The National Board for Physical activity and Nutrition (’Motions- og Ernæringsrådet’) suggested: – establishment of a system to identify children in
risk of developing adiposity before the adipsosity is manifest
– That this system should be part of the routine health examinations when the children are 3, 4 and 5 year old
Can we find and treat at risk children?
• The national college of general practitioners
• From 2006
What more do we need?
• A tool to estimate the childrens risk of being overweight early?
• Development of programs to approach the child at risk of being overweight and its family?
The Whitaker studies
• 854 individuals BMI retrospectively collected• Endpoint BMI at 20-29 year of age• Overweight definition adults: BMI > 27.8/27.3• Overweight definitions children 15th centile
Combining parents and child overweight
1 2 3 40.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
No Parents overweight One Parent overweight
> 15th % <15th % > 15th % <15th %
Based on ’Whitaker et al NEJM 1997;37:869-73’
Adiposity rebound
Adiposity rebound and parentalt overweight
1 2 3 4 5 60
10
20
30
40
50
60
70
Early Early Intermed. Intermed. Late Late
No Parents overweight One Parent overweight Based on ’Whitaker et al. Pediatrics 1998;101:e5’
Developing a Nordic algoritme for estmating risk of overweight early
• Cohorts– Aarhus Birth Cohort (90-92)- development– Northern Finnish Birth Cohort (85-86)-test
• Some of the potential predictive variables– Both parents BMI– Maternal smoking– Birthweight and gestational age at birth– Breastfeeding– Childs growthpattern
Plan
• To integrate the algoritm in the datacapture module– Clinical tool for GP’s– Evaluation
• To develop an intervention model– The GP surgery– Municipallity setting
Waist circumference
