Pre-school healthy kids check and immunisation: BMI, parent and nurse perception and parent level of concern.

NSW Rural Health and Research Congress October 2013 Monica Murray Lachlan Health Service Western NSW Local Health District Forbes and Parkes, NSW monica.murray@gwahs.health.nsw.gov.au

Introduction

Background

Methodology

Findings

Implications for practice

Session Outline

63.4% adults overweight or obese Australian Health Survey 2011/12

Excess weight gain increases the risks of developing chronic disease

Drivers - biology - environment - individual - socio-demographic factors - life stages

Introduction - Population health

Children aged 5-17 yrs 25 % overweight (18%) and obese BMI (8%) ( Australian Health Survey 2011/12)

Pre-school children 18.7% SPANS 2010

Weight at 5 years predictive of weight at 9 years (Gardiner et al 2009)

High BMI in childhood high risk of obesity in adulthood (Singh et al 2008, Baird et al 2005 Juonala 2011)

Less than healthy habits established in childhood, increases a child’s associated health risks such as cardiovascular disease, high blood pressure and Type 2 diabetes.

Introduction - Childhood prevalence

Poor uptake of Go4Fun, anecdotal ambivalence, normalisation of excess weight

Healthy Kids Check 3-5 years

Increased Federal government support through Medicare Locals

Local ‘real’ data

Background – rationale for study

Background – what is already known?

BMI of Australian children

Health professional estimations

Parent estimations

Parent level of concern

Body Mass Index (BMI) adjusted-age-gender

Comparison between the US Centre for Disease Control (US-CDC) and International Obesity Taskforce (IOTF) BMI classification systems for overweight and obesity in 2-18 year olds. Joliffe & Janssen 2006

Background – BMI

Research Question

“What are the BMI of rural children presenting for their four year old healthy kids check and immunisation and are there associations between actual BMI-for-age, nurse and parental estimation of BMI (or weight status) and parental concern regarding child weight?

Design Observational Study March 2012-2013 GP Practice & CHC Paper survey + nurse visual estimation +

measurement

Participants Children aged 3-5 years Practice Nurses and Community Health Nurses Parents (CHC)

Methodology

107 children BMI recorded (53 CHC and 54 GP clinic)

No statistical difference between children who presented at the CHC or GP clinic

53 parents completed survey (CHC)

53 Nurse ‘weight status estimations’ (CHC)

Results

BMI Classification for research (IOTF)

CHC group (n)

GP group (n)

Total (n) Total %

Underweight and healthy weight

41 38 79 73.8%

Overweight and obese

12 16 28 26.2%

Results: BMI demographicsBMI Classification for clinical settings (US-CDC)

CHC group (n)

GP group (n)

Total (n) Total %

Underweight and healthy weight

35 33 68 63.6%

Overweight and obese

18 21 39 36.4%

89% of parents expressed no concern about weight and 11% were concerned about underweight

Of the 11% concerned about underweight – 83% actually had healthy or overweight BMI

None of the parents of children with elevated BMI’s – expressed concern about their child’s weight status

Results: Parental Perceptions

By visual estimation alone (pre-measurement) on 53 children, community nurses;

correctly estimated 35 children with underweight and healthy BMI

incorrectly estimated all 18 children with overweight and obese BMI

Results: Nurse Perceptions

One in three pre-school children BMI in overweight or obese category (US-CDC), (1:4 using IOTF)

Parents are not aware and are not concerned

By visualisation alone, nurses have low recognition

Inconsistent awareness and use of BMI, detection and management of overweight and obesity in children

Implications for Practice

Where to from now? Consistent clinical practice across disciplines

Education and support to use BMI and enabling communication skills

Closer Integration

Local appropriate clinical pathways – based on Australian Guidelines

Community development strategies

Thank you!