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thirteen - Childhood overweight and obesity
- Kirstine Hansen, University College London Institute of Education, Heather Joshi, University College London, Shirley Dex, University College London
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- Book:
- Children of the 21st century (Volume 2)
- Published by:
- Bristol University Press
- Published online:
- 01 September 2022
- Print publication:
- 17 February 2010, pp 217-234
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Summary
Introduction
The rising prevalence of being overweight and obese is well recognised. According to the World Health Organization (WHO), 1.2 billion people are overweight, 300 million of whom are obese (Government Office for Science, 2007). The most startling increases have taken place in the US and UK where the prevalence of overweight and obesity has almost doubled in the last 25 years (Wardle and Boniface, 2008). These increases are not just confined to adult populations. Data from the Health Survey for England, using the UK national body mass index (BMI) percentile classification, indicates that the prevalence of overweight (including obesity) among 2- to 10-year-olds rose from 23% in 1995, to 28% in 2003, with the prevalence of overweight and obesity, and the rate of increase, being similar for boys and girls (Jotangia et al, 2005). These secular changes appear to be accelerating (Stamatakis et al, 2005; Jackson-Leach and Lobstein, 2006), and the age at onset of obesity is occurring at ever younger ages.
The health problems associated with adult obesity are well described and include type 2 diabetes, hypertension and coronary artery disease, sleep apnoea, pulmonary hypertension, hepatobiliary disease, cancers and reproductive and musculoskeletal disorders (Kopelman, 2007). Childhood obesity also has major implications in the short term for child health, development and well-being, and in the longer term for health in young and later adult life. However, the consequences of an increasingly early onset of childhood obesity are less clear (Reilly et al, 2003). Kimm and Obarzanek (2002) have consequently emphasised the need for prospective studies to delineate the morbidities associated with childhood obesity. Data from the Millennium Cohort Study (MCS) provide the ideal opportunity to examine the development of obesity and its consequences from a very young age.
Tackling childhood obesity is a priority for the UK government, given the substantial rise in obesity and overweight among very young children. In 2007, a long-term public service agreement (PSA) target for addressing childhood obesity was set, with the aim to ‘reduce the proportion of overweight and obese children to 2000 levels by 2020 in the context of tackling obesity across the population’ (HM Government, 2007)
The impact of maternal employment on breast-feeding duration in the UK Millennium Cohort Study
- Summer Sherburne Hawkins, Lucy Jane Griffiths, Carol Dezateux, Catherine Law and the Millennium Cohort Study Child Health Group
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- Journal:
- Public Health Nutrition / Volume 10 / Issue 9 / September 2007
- Published online by Cambridge University Press:
- 01 September 2007, pp. 891-896
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Objective
To examine the relationship of maternal employment characteristics, day care arrangements and the type of maternity leave pay to breast-feeding for at least 4 months.
DesignCohort study.
SettingBabies aged 9 months in the Millennium Cohort Study, born between September 2000 and January 2002.
SubjectsA total of 6917 British/Irish white employed mothers with singleton babies.
ResultsMothers employed part-time or self-employed were more likely to breast-feed for at least 4 months than those employed full-time (adjusted rate ratio (aRR) and 95% confidence interval (CI) 1.30 (1.17–1.44) and 1.74 (1.46–2.07), respectively). The longer a mother delayed her return to work postpartum, the more likely she was to breast-feed for at least 4 months (P for trend < 0.001). Mothers were less likely to breast-feed for at least 4 months if they returned to work for financial reasons (aRR 0.86, 95% CI 0.80–0.93) or used informal day care arrangements rather than care by themselves or their partner (aRR 0.81, 95% CI 0.71–0.91). Mothers were more likely to breastfeed for at least 4 months if their employer offered family-friendly (aRR 1.14, 95% CI 1.02–1.27) or flexible work arrangements (aRR 1.24, 95% CI 1.00–1.55), or they received Statutory Maternity Pay (SMP) plus additional pay during their maternity leave rather than SMP alone (aRR 1.13, 95% CI 1.02–1.26). These findings were independent of confounding factors, such as socio-economic status and maternal education.
ConclusionsCurrent policies may encourage mothers to enter or return to employment postpartum, but this may result in widening inequalities in breast-feeding and persistence of low rates. Policies should aim to increase financial support and incentives for employers to offer supportive work arrangements.
Comparing the clinical and economic effects of clinical examination, pulse oximetry, and echocardiography in newborn screening for congenital heart defects: A probabilistic cost-effectiveness model and value of information analysis
- Ingolf Griebsch, Rachel L. Knowles, Jacqueline Brown, Catherine Bull, Christopher Wren, Carol A. Dezateux
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 23 / Issue 2 / April 2007
- Published online by Cambridge University Press:
- 01 April 2007, pp. 192-204
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Objectives: Congenital heart defects (CHD) are an important cause of death and morbidity in early childhood, but the effectiveness of alternative newborn screening strategies in preventing the collapse or death—before diagnosis—of infants with treatable but life-threatening defects is uncertain. We assessed their effectiveness and efficiency to inform policy and research priorities.
Methods: We compared the effectiveness of clinical examination alone and clinical examination with either pulse oximetry or screening echocardiography in making a timely diagnosis of life-threatening CHD or in diagnosing clinically significant CHD. We contrasted their cost-effectiveness, using a decision-analytic model based on 100,000 live births, and assessed future research priorities using value of information analysis.
Results: Clinical examination alone, pulse oximetry, and screening echocardiography achieved 34.0, 70.6, and 71.3 timely diagnoses per 100,000 live births, respectively. This finding represents an additional cost per additional timely diagnosis of £4,894 and £4,496,666 for pulse oximetry and for screening echocardiography. The equivalent costs for clinically significant CHD are £1,489 and £36,013, respectively. Key determinants of cost-effectiveness are detection rates and screening test costs. The false-positive rate is very high with screening echocardiography (5.4 percent), but lower with pulse oximetry (1.3 percent) or clinical examination alone (.5 percent).
Conclusions: Adding pulse oximetry to clinical examination is likely to be a cost-effective newborn screening strategy for CHD, but further research is required before this policy can be recommended. Screening echocardiography is unlikely to be cost-effective, unless the detection of all clinically significant CHD is considered beneficial and a 5 percent false-positive rate acceptable.
five - Children’s health
- Edited by Shirley Dex, Heather Joshi
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- Book:
- Children of the 21st Century
- Published by:
- Bristol University Press
- Published online:
- 22 January 2022
- Print publication:
- 12 October 2005, pp 133-158
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Summary
Children in the UK are growing up against a background of changing family size and structure as well as changing demographic, economic and societal circumstances, which together have important implications for their health (Peckham, 1998). It is important to understand how the changes in patterns of caring for children and family context influence health in early childhood and the adoption of child health promoting behaviours by parents and carers. In recent years, there has been increasing interest in the contribution of these changes to obesity, asthma and related allergic diseases, autoimmune conditions, and disorders of social communication and behaviour (Gent et al 1994; Bach, 2002; Lobstein et al, 2004). The factors underlying these trends remain poorly understood, although they are clearly of great public health and human importance. The importance of an interdisciplinary perspective combining social, environmental and biological approaches to elucidate their causes is increasingly recognised.
Plan of this chapter
In this chapter, after considering the data sources in more detail, we describe the health during infancy of the cohort children through investigating the baby's birthweight, its infant weight at 8-9 months, and the early nutrition and patterns of breastfeeding. A range of parental and community influences on the baby's health are then considered – namely, parental smoking and alcohol use, immunisation, health problems and other use of services. Finally, the chapter examines indicators of good health in infancy and concludes with the implications of the findings for child health policy.
Data sources
At the first contact with the families when the children were aged around 9 months, information was obtained by parental (usually maternal) report on a wide range of measures. This included those relevant to the prevention of illness and promotion of health in the child, such as breastfeeding, parental smoking and immunisation status, and to conditions and illnesses that have implications for growth and development. Also included were measures which provide a baseline for examining later patterns and trajectories which will change with increasing age – for example, birthweight and bodyweight.
Data were also enhanced with respect to child health information by verifying maternal reports at the time of interview from information recorded in the personal child health record (Walton et al, 2005) and, subsequently, by linkage to routine birth registration records and health service information either at the individual or health service level (Bartington et al, 2005; Tate et al, 2005).