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
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