National child measurement programme: does it work?

Abstract

For many decades, the family has been considered to be the most important institution in society, and it has been proposed that this is where public health begins.1 Family is inclusively defined as dual-parent, single-parent, grandparent, adoptive and gay and lesbian units,2 while Gruber and Haldeman3 add that a family includes a parent-child connection and a sharing of responsibilities that functions for the welfare of both individual and group members.The family provides the primary environment and setting that can influence children's health-related behaviour through exposure to food choices, eating habits and physical activity opportunities. Families shape children's dietary and physical activity behaviour, and parents have a role by providing support, promoting healthy eating and physical activity or modelling healthy lifestyle behaviours.4 The family can effect change on its members, and their health behaviours can be determined by group dynamics such as rules, emotional support, encouragement, reinforcement and participation from other members.5 In light of this, the family unit has a major role to play in determining engagement in health-promoting activities.6Parental weight status is linked to child weight status. Obesity in one or both parents influences the risk of obesity7 in their children because of shared genes and environmental factors. Parental obesity can also predict children's risk of obesity in adulthood, where Whitaker et al.8 found that the child's risk of adult obesity was significantly greater if either the mother or father was obese.Childhood obesity is a global issue, and as overweight and obesity are largely preventable, this is currently a priority. In 2004, the World Health Organization (WHO) developed the Global Strategy on Diet, Physical Activity and Health which aims to reduce the prevalence of non-communicable disease, such as type II diabetes and its primary risk factors, unhealthy diet and physical activity. Nationally, in 2011, the Department of Health published Healthy lives, healthy people: a call to action on obesity in England with the ambition to achieve a sustained downward trend in the level of excess weight in children by 2020. For local public health teams, responsibilities have now shifted from the National Health Service to local authorities, where excess weight in children is a public health outcome. To support the delivery of this, the mandatory National Child Measurement Programme (NCMP) has been implemented which encourages physical activity and healthy eating behaviour modification interventions that aim to tackle childhood obesity as part of an overarching local obesity strategy.In 2011, the Health Survey for England asked parents of children aged 4-15 years about their perceptions of their child's weight and found that half of parents whose child was obese misjudged them to be about the right weight.9 Although research has been undertaken to identify factors that affect parental recognition and awareness,10,11 it is unknown whether parental acceptance of child weight status translates into taking steps to engage with behaviour change programmes. Initial research suggests that parental recognition of the child as overweight or obese is related to greater readiness to make behavioural changes.12 Although policy and priorities have been identified, translating these to successful local services and engagement with families to make behaviour changes has been challenging. Assumptions are made that parents will recognise unhealthy weight gain in their children and access the appropriate support.13The NCMP, which involves the annual weighing and measuring of all eligible children in reception year (4 to 5 year olds) and year 6 (10 to 11 year olds) and provides parents with a feedback letter of the result, appears to be an opportunity to increase parental recognition of their child's weight status and for parents to seek advice and support. However, the majority of parents do not engage with support from health professionals or child weight management services. …