National Child Measurement Programme Data Research Articles

Tracking changes in weight status in primary school children in Birmingham: an analysis of the National Child Measurement Programme – a retrospective cohort study

One-in-four 4–5 years and more than one-in-three 10–11 years have excess weight in England.AimTo identify characteristics associated with (1) having overweight, obesity and severe obesity at 11 years and (2)...

Is obesity more likely among children sharing a household with an older child with obesity? Cross-sectional study of linked National Child Measurement Programme data and electronic health records

Background/objectivesWe identified household members from electronic health records linked to National Child Measurement Programme (NCMP) data to estimate the likelihood of obesity among children living with an older child with...

Are children living with obesity more likely to experience musculoskeletal symptoms during childhood? A linked longitudinal cohort study using primary care records

ObjectiveTo assess whether there is a higher incidence of musculoskeletal consultations in general practice among children with obesity.DesignLongitudinalSetting285 north-east London general practitioners (GPs).Participants63 418 (50.9% boys) Reception and 55 364...

Trends in inequalities in childhood overweight and obesity prevalence: a repeat cross-sectional analysis of the Health Survey for England

ObjectiveTo examine trends in socio-economic and ethnic inequalities in childhood overweight and obesity in the England between 1995 and 2019 in survey data and to compare these to administrative data.DesignObservational...

S14-5 Girls Active and Change4Life Sports Club - two effective programmes to increase physical activity in schools and colleges

Abstract Purpose Girls Active aims to tackle declining participation in physical activity of girls aged 10 to 18 and its associated implications on health, wellbeing and education. Change4Life Sports Clubs are designed to address inactivity in 7 to 11 year olds and improve healthy lifestyle behaviours with exercise, food and hydration. Both projects aim to reduce physical inactivity of those children suffering the greatest challenges to achieving the recommended daily physical activity level of an average of 60 minutes of moderate to vigorous physical activity every day. Project description Both programmes were developed from evidence reviews and principles that work to engage, inspire and motivate targeted groups of children to be active. They were both developed by the children’s charity Youth Sport Trust, who have used sport and play to improve the lives of children and young people since 1995. They were co-designed with children and implemented through a national network of 450 School Games Organisers. Youth Sports Trust’s ‘content, delivery, structure’ model was used. For Girls Active we used the Active Lives Children Data from Sport England and Change4Life Sports Clubs were aligned to the Department of Health’s National Child Measurement Programme data to target where the programmes were most needed and to ensure that the right groups of children and young people were included in the interventions. Both programmes have been externally evaluated through academic partners using pre and post survey data, case studies and control elements and achieved high quality evidence scores. Both programmes have been scaled through a variety of funding streams including London 2012 Olympic Legacy, Sport England Lottery, Corporate Social Responsibility budgets and local public health funding. Girls Active has been adopted in Wales, Scotland and Northern Ireland. Conclusions We will share the evidence-based principles that have made these two approaches highly effective in addressing inactivity in primary school aged children and adolescent girls that can be applied in multiple contexts and will share resources and content that can be accessed following the session.

Prevalence of PErioperAtive CHildhood obesitY in children undergoing general anaesthesia in the UK: a prospective, multicentre, observational cohort study

BackgroundChildhood obesity has become a serious global healthcare challenge. No UK data currently define its anaesthetic and perioperative implications. We aimed to determine obesity prevalence amongst UK children undergoing general anaesthesia and the incidence of predefined adverse perioperative events, and to compare perioperative obesity rates with National Child Measurement Programme (NCMP) data. MethodsDuring a site-selected consecutive 7-day study period, all children (2–16 yr) undergoing general anaesthesia were included. Anonymised hospital, surgical, and procedural details; demographic data; and adverse perioperative events were collected prospectively by Paediatric Anaesthesia Trainee Research Network (PATRN) collaborators. ResultsFor this study, 102 UK hospitals participated and 4232 cases were included in the final analysis; 76% of hospitals did not routinely calculate BMI. In addition, 3030 (71.6%; 95% confidence interval [CI]: 70.2–73.0%) children of healthy weight were compared with 537 (12.7%; 11.7–13.7%) children who were overweight and 478 (11.3%; 10.3–12.2%) children with obesity. Children with obesity (n=71; 14.9%) more commonly underwent (adeno)tonsillectomy than children of healthy weight (n=282; 9.3%; P<0.001; odds ratio [OR] 2.15; 95% CI: 1.58–2.92). Fewer children with obesity (n=365; 77% vs n=2552; 85%) were anaesthetised by consultant anaesthetists (OR 0.62; 95% CI: 0.48–0.79). Mask ventilation was difficult for 3.7% of children with obesity vs 0.6% of children of healthy weight (difference 3.0%; 95% CI: 1.3–4.7%; P<0.001). Comparison with NCMP data demonstrated an over-representation of obesity amongst the paediatric surgical population. ConclusionsThis large multicentre cohort study suggests a concerning prevalence of children with obesity presenting for anaesthesia. These results should be used to inform optimal provision of care for this population and support perioperative healthcare initiatives to address the burden of childhood obesity. Clinical trial registrationClinicalTrials.gov Identifier: NCT03994419.

Impact of cuts to local government spending on Sure Start children’s centres on childhood obesity in England: a longitudinal ecological study

BackgroundChildhood obesity is rising in disadvantaged areas in England. Sure Start children’s centres provide community-based services for children <5 years and their parents, including many services that can support healthy...

Is child weight status correctly reported to parents? Cross-sectional analysis of National Child Measurement Programme data using ethnic-specific BMI adjustments.

BackgroundBMI underestimates and overestimates body fat in children from South Asian and Black ethnic groups, respectively.MethodsWe used cross-sectional NCMP data (2015–17) for 38 270 children in three inner-London local authorities: City & Hackney, Newham and Tower Hamlets (41% South Asian, 18.8% Black): 20 439 4–5 year-olds (48.9% girls) and 17 831 10–11 year-olds (49.1% girls). We estimated the proportion of parents who would have received different information about their child’s weight status, and the area-level prevalence of obesity—defined as ≥98th centile—had ethnic-specific BMI adjustments been employed in the English National Child Measurement Programme (NCMP).ResultsHad ethnic-specific adjustment been employed, 19.7% (3112/15 830) of parents of children from South Asian backgrounds would have been informed that their child was in a heavier weight category, and 19.1% (1381/7217) of parents of children from Black backgrounds would have been informed that their child was in a lighter weight category. Ethnic-specific adjustment increased obesity prevalence from 7.9% (95% CI: 7.6, 8.3) to 9.1% (8.7, 9.5) amongst 4–5 year-olds and from 17.5% (16.9, 18.1) to 18.8% (18.2, 19.4) amongst 10–11 year-olds.ConclusionsEthnic-specific adjustment in the NCMP would ensure equitable categorization of weight status, provide correct information to parents and support local service provision for families.

The association between area-based deprivation and change in body-mass index over time in primary school children: a population-based cohort study in Hampshire, UK.

Childhood obesity is a serious public health challenge. Cross-sectional evidence indicates that childhood obesity is strongly linked to area deprivation level, yet longitudinal research is scarce. We assessed the association of home-based and school-based deprivation indices with change in childhood body-mass index (BMI) z-score and BMI status over 6 years in Hampshire, England. This longitudinal study linked the National Child Measurement Programme data for children aged 4-5 years (2007-08 to 2009-10) to 10-11 years. The dataset was stratified into two groups: 18,733 children for whom home deprivation quintiles, according to the Index of Multiple Deprivation (IMD), remained constant, and 6153 children who moved home deprivation quintiles between the two time points. The associations between IMD quintiles and change in BMI z-score and status were analysed. 63.7% of children remained a healthy weight, 3.1% remained overweight, 5.3% remained with obesity, 8.3% became overweight, and 10.3% developed obesity. Children living in the most deprived quintile increased their BMI z-score by 0.13 units more than those in the least deprived quintile (95% CI: 0.08-0.19). Home-based deprivation displayed associations with change in BMI status. (Relative risk for the most deprived quintile: become overweight 1.47, 1.21-1.78, remain obese 1.82, 1.34-2.40, become obese 2.07, 1.73-2.48.) School-based deprivation was not associated with change in BMI z-score or BMI status. Moving home to a more deprived quintile was associated with developing obesity (1.22, 1.04-1.43). More children living in deprived areas developed obesity over time. Home-based deprivation level is more strongly associated with adverse change in childhood weight than school-based deprivation. Scholarly settings can provide opportunities for interventions, however obesity prevention interventions should tackle the obesogenic environment combining family and area-based measures.

Increasing inequality in childhood obesity in primary schools in a northern English town

ObjectiveTo undertake an analysis of National Child Measurement Programme (NCMP) data to quantify the obesity prevalence gap over time between children in primary schools in the most and least deprived areas of Doncaster. Study designThe research design for this study was retrospective quantitative analysis of secondary data. MethodsThe study undertook secondary analysis of NCMP data on obesity prevalence in children in Reception Year and Year 6 in primary schools in Doncaster for the period 2006–2007 to 2014–2015. Data were combined into three 3-year periods (2006–2007 to 2008–2009; 2009–2010 to 2011–2012; and 2012–2013 to 2014–2015), and schools were grouped by deprivation based on the national Indices of Multiple Deprivation 2015. Analysis was undertaken to assess whether there is a difference in obesity prevalence for Reception Year and Year 6 children in schools in the most deprived areas compared with the least deprived (prevalence gap), over time. ResultsThe difference in obesity prevalence between children attending schools in the most and least deprived areas has increased over time. For Reception Year children, the prevalence gap has widened from a difference of 1.01% higher in the most deprived schools in 2006–2007 to 2008–2009 to 3.64% higher in 2012–2013 to 2014–2015. In the same time periods, for Year 6 children, the obesity prevalence gap has also increased over time from 2.82% to 5.08%. ConclusionsThere is inequality in relation to obesity in primary school children in Doncaster with those in schools in the most deprived areas carrying the greatest burden. Research is needed to understand why the plateau seen nationally is not reaching the most deprived children.

Patterns of childhood body mass index (BMI), overweight and obesity in South Asian and black participants in the English National child measurement programme: effect of applying BMI adjustments standardising for ethnic differences in BMI-body fatness associations

Background:The National Child Measurement Programme (NCMP) records weight and height and assesses overweight-obesity patterns in English children using body mass index (BMI), which tends to underestimate body fatness in South Asian children and overestimate body fatness in Black children of presumed African ethnicity. Using BMI adjustments to ensure that adjusted BMI was similarly related to body fatness in South Asian, Black and White children, we reassessed population overweight and obesity patterns in these ethnic groups in NCMP.Methods:Analyses were based on 2012–2013 NCMP data in 582 899 children aged 4–5 years and 485 362 children aged 10–11 years. Standard centile-based approaches defined weight status in each age group before and after applying BMI adjustments for English South Asian and Black children derived from previous studies using the deuterium dilution method.Findings:Among White children, overweight-obesity prevalences (boys, girls) were 23% and 21%, respectively, in 4–5 year olds and 33% and 30%, respectively, in 10–11 year olds. Before adjustment, South Asian children had lower overweight-obesity prevalences at 4–5 years (19%, 19%) and slightly higher prevalences at 10–11 years (42%, 34%), whereas Black children had higher overweight-obesity prevalences both at 4–5 years (31%, 29%) and 10–11 years (42%, 45%). Following adjustment, overweight-obesity prevalences were markedly higher in South Asian children both at 4–5 years (39%, 35%) and at 10–11 years (52%, 44%), whereas Black children had lower prevalences at 4–5 years (11%, 12%); at 10–11 years, prevalences were slightly lower in boys (32%) but higher in girls (35%).Interpretation:BMI adjustments revealed extremely high overweight-obesity prevalences among South Asian children in England, which were not apparent in unadjusted data. In contrast, after adjustment, Black children had lower overweight-obesity prevalences except among older girls.Funding:British Heart Foundation, NIHR CLAHRC (South London), NIHR CLAHRC (North Thames).

Association between area-based deprivation and change in body-mass index over time in primary schoolchildren: a population-based cohort study in Hampshire, UK

BackgroundChildhood obesity is a serious health challenge. Cross-sectional evidence indicates that the burden of obesity impacts most on more deprived children, yet longitudinal research is lacking. We aimed to assess the association of home-based and school-based deprivation indices with change in childhood body-mass index (BMI) z-score and BMI status over 6 years. MethodsThis cohort study linked the National Child Measurement Programme data for Hampshire children from age 4–5 years (2007–08 to 2009–10) to 10–11 years. The dataset was analysed in two groups: 18 733 children for whom home deprivation quintiles, according to the Index of Multiple Deprivation (IMD), remained constant, and 6153 children who moved home to more deprived quintiles over time. The associations between IMD quintiles and change in BMI z-score and status, defined using the British 1990 growth reference, were analysed with multiple linear regression and multinomial logistic regression, respectively, and adjusted for age, sex, ethnicity, and school Ofsted status. Ethics approval was granted by the University of Southampton. Findings11 924 children (63·7%) remained a healthy weight, 585 (3·1%) remained overweight, 990 (5·3%) remained obese, 1560 (8·3%) became overweight, and 1921 (10·3%) became obese. Children living in the most deprived quintile increased their BMI z-score by 0·13 units more than those in the least deprived quintile (95% CI 0·08–0·19). There was no significant difference for school-based quintiles. Children attending school in the most deprived quintile were significantly more likely to remain obese (relative risk 1·93, 95% CI 1·53–2·44) and become obese (1·90, 1·55–2·32). Home-based deprivation quintiles displayed stronger associations with change in BMI status than did school-based quintiles (relative risk for remaining obese 2·23, 95% CI 1·78–2·79; becoming overweight 1·36, 1·16–1·60; and becoming obese 2·42, 2·08–2·81). Moving home to a more deprived quintile was only associated with becoming obese (1·22, 1·04–1·43). InterpretationIn Hampshire, UK, home-based deprivation level is more strongly associated with negative change in childhood adiposity than school-based deprivation level. Although schools provide ample opportunities to deliver interventions, focus should not be lost on the obesogenic home environment. This study used robust measures, and a large sample size was analysed. However, consideration of familial influences of obesity is paramount. Further research of the obesogenic environment is required, combining individual and area-based measures. FundingMSc Public Health funded by Health Education England Wessex. The funding source had no role in writing the abstract or in the decision to submit it for publication.

General practice consultations with obese children–a missed opportunity? Cross-sectional study using linked national child measurement and primary care data

BackgroundA third of children leaving primary school are obese. Child weight status information from the National Child Measurement Programme (NCMP) is not routinely shared with general practitioners (GPs). We hypothesised that obese children were more likely to consult their GP for obesity or weight management than healthy-weight children. MethodsNCMP data from 2013–16 for City and Hackney, London, were linked to coded GP data using pseudonymised National Health Service numbers, resulting in 13 663 linked records (93%). NCMP-assigned weight status was based on the UK90 clinical reference, and obesity and weight-management consultations identified (read codes C38..; 66C..; 8HHH%; 9N1yK; 22A%). The odds of one or more obesity or weight-management consultations in the school year of NCMP measurement among obese compared with healthy-weight children were estimated with logistic regression. FindingsObesity was identified in 624 (8·6%) of 7275 children aged 5 years (3721 boys [51·2%]; median age 5·01 years, IQR 4·76–5·27) and 1220 (19·1%) of 6388 children aged 11 (3297 [51·6%]; 10·87, 10·59–11·11). Obesity was more prevalent in boys than girls (9·5% [353/3721] vs 7·6% [271/3554] and 19·5% [643/3297] vs 18·7% [577/3091] at ages 5 and 11 years, respectively). Obese children were more likely than healthy-weight children to consult for obesity or weight management (respectively at age 5 years, boys 19·8% [70/353] vs 13·5% [391/2900]; girls 16·2% [44/271] vs 11·8% [342/2895] and at age 11 years, boys 17·0% [109/643] vs 12·6% [265/2111]; girls 19·9% [115/577] vs 10·0% [200/1996]). The odds of one or more obesity or weight-management consultations in obese boys and girls, respectively, were 1·59 (95% CI 1·20–2·10) and 1·45 (1·03–2·04) at age 5 years, and 1·42 (1·12–1·81) and 2·24 (1·74–2·87) at age 11 years. InterpretationAlthough more likely to consult their GP for obesity or weight management in the period before or after identification of obesity in the NCMP, fewer than a fifth of obese children attending primary schools in a London borough with one of the highest child obesity rates in England do so. This is, to our knowledge, the first study linking NCMP to primary care data. Further work is needed to evaluate routine sharing of NCMP data with GPs and primary care-initiated weight-management support for children and their families. FundingNone.

Reassessing patterns of childhood body-mass index, overweight, and obesity in South Asian and black participants in the English National Child Measurement Programme: use of ethnicity-specific body-mass index adjustments

BackgroundThe National Child Measurement Programme (NCMP) assesses patterns of overweight–obesity in English children. It uses body mass index (BMI), which overestimates body fatness in South Asian children and underestimates body fatness in black children of presumed African ethnicity. Using previously derived BMI adjustments, ensuring that adjusted BMI was similarly related to body fatness in South Asian, black, and white children, we reassessed population body fatness, overweight, and obesity patterns in these ethnic groups in the NCMP. MethodsAnalyses were based on 2012–13 NCMP data in 582 899 children aged 4–5 years and 485 362 children aged 10–11 years. Standard centile-based approaches defined weight status in each age-group before and after applying BMI adjustments, derived previously with the deuterium dilution method, for South Asian and black children. FindingsAmong white children, overweight–obesity prevalences were 23% (45 508/197 691) for boys and 21% (39 411/188 663) for girls in 4–5 year olds and 33% (52 635/160 278) and 30% (45 978/151 146), respectively, in 10–11 year olds. Before adjustment, South Asian children had lower overweight–obesity prevalences at 4–5 years (19% of boys [4485/23 191], 19% of girls [4176/22 109]; both p<0·0001) and higher prevalences at 10–11 years (42% of boys [8105/19 406], 34% of girls [6379/18 636]; both p<0·0001), whereas black children had higher overweight–obesity prevalences both at 4–5 years (31% of boys [4459/14 468], 29% of girls [4041/13 970]; both p<0·0001) and at 10–11 years (42% of boys [4788/11 347], 45% of girls [5048/11 319]; both p<0·0001). After adjustment, overweight–obesity prevalences were markedly higher in South Asian than in white children both at 4–5 years (39% of boys [9125/23 191], 35% of girls [7711/22 109]; both p<0·0001) and at 10–11 years (52% of boys [10 120/19 406], 44% of girls [8125/18 636]; both p<0·0001), whereas black children had a lower prevalence at 4–5 years (11% of boys [1526/14 468], 12% of girls [1700/13 970]; both p<0·0001); at 10–11 years, black boys had a slightly lower prevalence (32% [3619/11 347]; p=0·04) but girls a higher prevalence (35% [3937/11 319]; p<0·0001) than white children. InterpretationAdjusted BMI data reveal a substantial excess of overweight–obesity among English South Asian children (at 4–5 years and especially at 10–11 years) and among black girls (aged 10–11 years), with important implications for prevention. These patterns are not apparent with the use of unadjusted BMI data, which systematically underestimated overweight–obesity prevalences in South Asian children and overestimated them in black children. FundingBritish Heart Foundation, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (South London & North Thames).

Comparison of current trends in obesity in patients with type 1 diabetes in Nottingham with a historical cohort and 2013-2014 national child measurement programme data in the UK

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Recalibration of overweight–obesity prevalence from body-mass index in UK children of South Asian and black African origin: cross-sectional study based on National Child Measurement Programme data

BackgroundThe accurate assessment of overweight–obesity prevalence in UK children of South Asian and black African origin (in whom its consequences are especially adverse) is an important challenge. However, body-mass index (BMI), the marker of body fatness used in most national surveys, differs in its association to body fatness between ethnic groups, which biases ethnic comparisons of body fatness based on BMI. We recalibrated BMI values for ethnicity to assess overweight–obesity prevalence more accurately in UK South Asian and black African children in recent survey data from the National Child Measurement Programme (NCMP), an inclusive assessment programme in English primary schools. MethodsDeuterium dilution measurements of body fat and BMI were collated from four recent UK population-based studies (three in schools selected to provide balanced ethnic representation) in 873 children of South Asian, black African, and white European origin aged 9−11 years. Data were analysed with linear regression models to determine the age-adjusted and sex-adjusted BMI differences in South Asian and black African children compared with white Europeans at an equivalent level of body fatness (denoted by fat mass index [kg/m5], which is uncorrelated with height). These BMI adjustments were applied to NCMP 2012–13 survey data in 489 146 children aged 10–11 years to determine ethnic-specific overweight–obesity prevalences; standard NCMP overweight–obesity definitions were used. FindingsBMI adjustments for equivalent body fatness were +1·11 kg/m2 and +0·98 kg/m2 for South Asian boys and girls, respectively, and −1·20 kg/m2 and −1·66 kg/m2 for black African boys and girls, respectively; these adjustments were applied to NCMP data for South Asian and black African children. Overweight–obesity was recorded in 14 538 of 38 201 South Asian children (38·1%, 95% CI 37·6–38·5) and 9839 of 22 672 black African children (43·4%, 42·8–44·0) before BMI adjustment and in 18 145 of 38 201 (47·5%, 47·0–48·0) and 7065 of 22 672 (31·2%, 30·6–31·8), respectively, after adjustment; overweight–obesity was recorded in 92 002 of 292 467 white European children (31·5%, 95%CI 31·3–31·6). InterpretationUse of ethnic-specific BMI adjustments to obtain comparable assessments of body fatness substantially changed observed overweight–obesity prevalences in ethnic minority groups. Adjusted BMI particularly emphasised the substantial overweight–obesity burden in South Asian children, an important priority for prevention. FundingThis research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London and by grants from the British Heart Foundation (PG/11/42/28895), the Child Growth Foundation (GR 10/03), and the Wellcome Trust (WT094129MA).

Socioeconomic variation in height: analysis of National Child Measurement Programme data for England

ObjectiveShort stature is associated with increased risk of ill health and mortality and can negatively impact on an individual's economic opportunity and psychological well-being. The aim of this study was...

A repeated cross-sectional study examining the school impact on child weight status

ObjectiveThe aim of this study is to examine whether there is a differential impact of primary schools upon children's weight status. MethodsA repeated cross-sectional study was undertaken using five years (2006/07–2010/11) of National Child Measurement Programme data, comprising 57,976 children (aged 4–5 (Reception) and 10–11 (Year 6) years) from 300 primary schools across Devon, England. Examining each year separately, the schools were ranked according to their observed and residual (having accounted for school and neighbourhood clustering and pupil ethnicity and socioeconomic status) school mean body mass index standard deviation score (BMI-SDS). Subtracting the Reception from the Year 6 mean residuals gave ‘value-added’ scores for each school which were also ranked. The rankings were compared within and across the years to assess consistency. ResultsAlthough pupil BMI-SDS was high, >97% of the variation in BMI-SDS was attributable to environments other than the school. The ‘value-added’ by each school was only poorly correlated with the observed and residual pupil BMI-SDS; but none of the rankings were consistent across the five years. ConclusionThe inconsistency of the rankings and the small variation in BMI-SDS at the level of the school suggests that there is no systematic differential impact of primary schools upon pupil weight status.

Looking at the latest data on childhood obesity levels

Since 2005, nearly 7 million children have participated in the National Child Measurement Programme (NCMP). The latest NCMP data, released late last year, showed a small decrease in childhood obesity and overweight.

PS42 Inequalities in Child Obesity: Where Do These Occur and is the Gap Widening?

BackgroundChild obesity is an important public health problem. Of particular concern are the considerable inequalities in obesity prevalence between socioeconomic and ethnic groups. The Department of Health’s recently published Call...