National Child Measurement Programme Research Articles

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...

Taking action in early years is essential for children's health and well-being

More than one in five children aged four to five years old are currently overweight or obese according to the National Child Measurement programme. Stella Ziolkowski, director of Quality & Training at NDNA, highlights how important this issue is and shares her thoughts for how settings can help combat the situation.

Association of child weight with attendance at a healthy lifestyle service among women with obesity during pregnancy.

Women with obesity during pregnancy are at increased risk of excessive gestational weight gain (GWG) and other maternal and infant adverse outcomes, which all potentially increase childhood obesity. This study explored infant weight outcomes for women with a body mass index (BMI) ≥ 35 kg/m² who were offered an antenatal healthy lifestyle service. A retrospective cohort study, including linking data from two separate health care Trusts, was undertaken. Data werecollected from maternity records for women with a BMI ≥ 35 kg/m2 referred to an antenatal healthy lifestyle service from 2009 to 2015. The respective child's weight outcome data was additionally collected from health and National Child Measurement Programme records. Univariate logistic regression determined the odds of childhood overweight, obesity and severe obesity according to attendance at the antenatal healthy lifestyle service, GWG and sociodemographic characteristics. Factors significant (p < 0.05) within the univariate analysis were entered into multiple logistic regression models. Among women with a BMI ≥ 35 kg/m², 30.4% of their children were obese at school entry and 13.3% severely obese. Healthy lifestyle service attendance was not associated with childhood overweight or obesity at any point within the univariate analysis. At school age multiple regression analysis showed the odds of overweight and obesity increased with excessive GWG and the odds of obesity decreased with a parent in a professional occupation, additionally having a mother who smoked in pregnancy increased severe obesity. Women should be supported to optimise their BMI before pregnancy. Additionally, rather than exclusively focusing on changing an individual's behaviour, future interventions should consider external influences such as the woman's family, friendsand sociodemographic background.

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...

A longitudinal analysis comparing the proportion of children with excess weight before and during the COVID-19 pandemic

Background The National Child Measurement Programme (NCMP) reported an increase in the prevalence of children in Reception (4–5 years) and Year 6 (10–11 years) with overweight/obesity during the coronavirus disease 2019 (COVID-19) pandemic compared to the previous year. This prompted us to conduct a longitudinal analysis to compare weight status before and during the pandemic. Methods We compared the change in overweight/obesity status of children in Year 1 (Y1) (during the pandemic) who had also been measured as part of the NCMP in Reception (the year before the pandemic), with the change in a sample of children during a two-year ‘pre-pandemic’ period. Results Overweight/obesity increased by 1.2% to 24.8% (p=0.582) between Reception and Y1 in the pre-pandemic group and by 5.4% to 28.5% (p=0.002) in the pandemic group. This was mainly driven by an increase in the proportion of overweight/obese boys in the pandemic group (22% to 30%) compared to the pre-pandemic group rates (~24% at both time-points). Rates in girls increased by 2.0% to 24.8% in the pre-pandemic group and by 3.3% to 27.6% in the pandemic group. A higher proportion of Reception-aged White children in the pre-pandemic group were overweight/obese compared to the pandemic group, but by Y1 the rates were higher in the pandemic group. In children of South Asian (SA) heritage, the proportion with excess weight in Reception was 18.3% in the pre-pandemic group, increasing to 21.6% by Y1. The increase was substantially higher in the pandemic group of SA children, with an increase from 22.9% in Reception to 30.3% by Y1. Conclusions We observed a marked increase in the proportion of children with an unhealthy body mass index (BMI) during the first year of the pandemic, suggesting that the societal disruptions caused by lockdown may have adversely affected children’s diet and levels of physical activity.

Is obesity more likely among children sharing a household with an older child with obesity?

ObjectivesWe used a dynamic method of identifying household members from Electronic Health Records (EHRs) linked to National Child Measurement Programme (NCMP) data to estimate the likelihood of children with obesity sharing a household with an older child with obesity, accounting for individual and household characteristics.&#x0D; MethodsWe included 126,829 NCMP participants in four London boroughs and assigned households from encrypted Unique Property reference Numbers (UPRNs) at NCMP date for 115,466 (91%). We categorised the ethnic-adjusted body mass index of the youngest and oldest household child (underweight/healthy weight&lt;91st, ≥91st to &lt;98th overweight, obesity≥98th centile) and explored associations of the youngest child’s weight status with: oldest child’s weight status, number of household children (two, three or ≥4), youngest child’s sex, ethnicity and school year of NCMP participation (reception or year 6). We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of obesity in the youngest child.&#x0D; Results19,702 UPRNs were shared by two or more NCMP participants (youngest children: 51.2% male, 69.5% reception). 10.4% of youngest (95% CI: 10.0,10.9) and 13.0% of oldest (12.5,14.3) children were living with obesity. One third of youngest children with obesity shared a household with another child with obesity (33.2%; 31.2,35.2), compared with 9.2% (8.8,9.7) of those with a healthy weight. Youngest children living with an older child with overweight (aOR: 2.33; 95% CI: 2.06,2.64) or obesity (4.59, 4.10,5.14), those from South Asian ethnic backgrounds (1.89; 1.64,2.19) or taking part in NCMP in year 6 (2.21; 2.00,2.43) were more likely, and girls (0.73; 0.67,0.81), children living with just one other child (0.87; 0.77,0.98) and from Black ethnic backgrounds (0.78; 0.66,0.93) less likely, to be living with obesity.&#x0D; ConclusionLinked EHRs can provide novel insights into the shared weight status of children sharing the same household. Further qualitative research is needed to understand how household food practices may vary by other household characteristics to improve our understanding of how the home environment influences childhood obesity.

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.

The acceptability of evidence-informed guidance for parents in talking to their children about weight

BackgroundMany parents express concern about the impact of talking to children about weight on their self-esteem and wellbeing. The aim of this study was to explore the perceived relevance, utility and acceptability of new guidance for parents on talking to children about weight, developed to apply theory, evidence and expert advice into practice.MethodsFor this qualitative study, parents and public health practitioners (PHPs) were recruited from ten local authorities in England, through the National Child Measurement Programme between June and September 2021. Participants were sent a copy of the guidance document and took part in an interview approximately one week later. Interviews were transcribed verbatim and explored using thematic analysis.Results12 parents and 15 PHPs took part, and were similar in their responses reporting the guidance to be acceptable, relevant and helpful. Theme 1 explored how the guidance reduced perceptions of stigma and blame through the perspective and tone that was adopted. Theme 2 explored how the guidance could provide reassurance and increase confidence as a result of case study examples, and specific tips and advice. Theme 3 explored the extent to which participants perceived the advice to be realistic and how it could fit with existing PHP practice. Suggestions for improvement included adapting for relevance for lower income families and providing separate advice for parents of older and younger children.ConclusionsThe guidance was perceived as relevant and needed; it showed potential to reduce parents’ negative affect and concerns, and improve confidence around talking to children about weight.

Socioeconomic correlates of childhood obesity in urban and rural England.

Physical access to food may affect diet and thus obesity rates. We build upon existing work to better understand how socio-economic characteristics of locations are associated with childhood overweight. Using cross-sectional design and publicly available data, the study specifically compares rural and urban areas, including interactions of distance from supermarkets with income and population density. We examine cross-sectional associations with obesity prevalence both in the national scale and across urban and rural areas differing in household wealth. Children in reception class (aged 4 to 5) from all state-maintained schools in England taking part in the National Child Measurement Programme (n=6,772). Income was the main predictor of childhood obesity (adj. R-sq=.316, p<.001), whereas distance played only a marginal role (adj. R-sq=.01, p<.001). In urban areas, distance and density correlate with obesity directly and conditionally. Urban children were slightly more obese, but the opposite was true for children in affluent areas. Association between income poverty and obesity rates was stronger in urban areas (7.59%) than rural areas (4.95%), the former which also showed stronger association between distance and obesity. Obesogenic environments present heightened risks in deprived urban and affluent rural areas. The results have potential value for policy making as for planning and targeting of services for vulnerable groups.

Impact of cuts to local authority spending on cultural, environmental and planning services on inequalities in childhood obesity in England: A longitudinal ecological study.

Almost 20% of children in England are living with obesity by the end of primary school, with marked and growing inequalities driven by increasing prevalence in more deprived areas. Neighbourhood environments are upstream determinants of childhood weight status. Cultural, Environmental and Planning (CEP) services delivered by local authorities (LAs) in England include various services that contribute to these local environments, e.g. leisure centres, parks, playgrounds, libraries, community safety and environmental protection. Children in deprived areas potentially benefit most from the provision of these universal services. Spending on CEP services has been cut dramatically over the past decade, especially in more deprived areas. Given the potential link between these services and childhood obesity, we examined whether recent cuts in LA spending on CEP services are associated with trends and inequalities in obesity. We compiled annual data (2009-2017) on CEP spending in 324 LAs in England, from Ministry of Housing, Communities and Local Government reports. Obesity prevalence data for Year 6 children were obtained from the National Child Measurement Programme, for LAs and Middle-layer Super Output Areas (MSOAs). Following descriptive and pooled OLS analyses, we used fixed effects panel regression to estimate associations between CEP spending and obesity prevalence, within LAs over time, adjusting for potential confounding by local economic conditions and spending on other public services. Final models included an interaction term between area deprivation (2015 IMD) and year to account for differential background trends in obesity across deprivation levels. We tested for effect modification by deprivation and, using MSOA-level obesity data, explored associations between spending and within-LA obesity inequalities. In unadjusted pooled OLS analyses, areas with higher CEP spending had higher prevalence of obesity, reflecting the strong social gradient in childhood obesity and the higher levels of central government funding allocated to more deprived areas. Deprivation, other spend, and local economic conditions explained this relationship. In the fixed effects analysis, designed to isolate average within-area change in obesity associated with changing spend, we observed a 0.10 percentage point increase in obesity prevalence for each 10% reduction in spend (95%CI: 0.04,0.15; p<0.001), but this disappeared after accounting for differential background trends in obesity across deprivation levels (-0.02; 95%CI: 0.07,0.03; p=0.39). Similar results were observed for obesity inequalities, although sensitivity analyses suggest spending on Environmental Services in particular may affect inequalities in urban local authorities. CEP spending levels may influence local childhood obesity risk, but the increasing prevalence and widening inequalities in obesity of the past decade seem to have been driven mainly by factors other than CEP spending cuts, that are also unevenly distributed across deprivation levels. The influence of specific services might be obscured by grouping CEP services for analysis.

Weighing up the future: a meta-ethnography of household perceptions of the National Child Measurement Programme in England

ABSTRACT The English National Child Measurement Programme (NCMP) is a nationally mandated public health programme. It provides data for child excess weight indicators in the Public Health Outcomes Framework, part of the government’s approach to reducing childhood obesity. Drawing on a meta-ethnographic synthesis of household members’ experiences of the programme, we conceptualise the NCMP as a ‘technique of futuring’ to generate new insights into how it (re)shapes and (re)imagines past, present, and future responsibilities and practices for overweight children, parents, and carers, in potentially harmful ways. For children categorised by the NCMP as overweight, the NCMP is an emotionally significant event, driving new bodily practices, new food practices and changed relationships with peers. This paper outlines how parents come to resist and reframe the programme and its results, to protect their children from a weight-focused future. They consider the potential risks of bullying, dysfunctional eating, and mental health consequences more important than future risks of overweight. We show how parents of children categorised as overweight preserve their claim to ‘responsible’ and ‘good’ parenting amongst peers, whilst shifting the blame for childhood obesity to other, ‘irresponsible’ parents, thus reproducing moralising and responsibilising discourses inherent within the ‘behaviour change’ messaging of the NCMP and associated research. Finally, we consider a central paradox of this programme and the use of NCMP population level monitoring data to (re)shape lives at the individual and social level – the children it sets out to help are the most likely to experience harm as a result of it.

Associations between trajectories of obesity prevalence in English primary school children and the UK soft drinks industry levy: An interrupted time series analysis of surveillance data.

Sugar-sweetened beverages (SSBs) are the primary source of dietary added sugars in children, with high consumption commonly observed in more deprived areas where obesity prevalence is also highest. Associations between SSB consumption and obesity in children have been widely reported. In March 2016, a two-tier soft drinks industry levy (SDIL) on drinks manufacturers to encourage reformulation of SSBs in the United Kingdom was announced and then implemented in April 2018. We examined trajectories in the prevalence of obesity at ages 4 to 5 years and 10 to 11 years, 19 months after the implementation of SDIL, overall and by sex and deprivation. Data were from the National Child Measurement Programme and included annual repeat cross-sectional measurement of over 1 million children in reception (4 to 5 years old) and year 6 (10 to 11 years old) in state-maintained English primary schools. Interrupted time series (ITS) analysis of monthly obesity prevalence data from September 2013 to November 2019 was used to estimate absolute and relative changes in obesity prevalence compared to a counterfactual (adjusted for temporal variations in obesity prevalence) estimated from the trend prior to SDIL announcement. Differences between observed and counterfactual estimates were examined in November 2019 by age (reception or year 6) and additionally by sex and deprivation quintile. In year 6 girls, there was an overall absolute reduction in obesity prevalence (defined as >95th centile on the UK90 growth charts) of 1.6 percentage points (PPs) (95% confidence interval (CI): 1.1, 2.1), with greatest reductions in the two most deprived quintiles (e.g., there was an absolute reduction of 2.4 PP (95% CI: 1.6, 3.2) in prevalence of obesity in the most deprived quintile). In year 6 boys, there was no change in obesity prevalence, except in the least deprived quintile where there was a 1.6-PP (95% CI: 0.7, 2.5) absolute increase. In reception children, relative to the counterfactual, there were no overall changes in obesity prevalence in boys (0.5 PP (95% CI: 1.0, -0.1)) or girls (0.2 PP (95% CI: 0.8, -0.3)). This study is limited by use of index of multiple deprivation of the school attended to assess individual socioeconomic disadvantage. ITS analyses are vulnerable to unidentified cointerventions and time-varying confounding, neither of which we can rule out. Our results suggest that the SDIL was associated with decreased prevalence of obesity in year 6 girls, with the greatest differences in those living in the most deprived areas. Additional strategies beyond SSB taxation will be needed to reduce obesity prevalence overall, and particularly in older boys and younger children. ISRCTN18042742.

Patient and family involvement in designing and evaluating a simulation programme to combat childhood obesity

14.4% enter school reception obese [1]. The Paediatric Emergency Department (PED) offers opportunities for professionals to identify obesity and provide support to children and young people (CYP). Our PED launched an Obesity Toolkit: a medical education project created to help Make Every Contact Count, and to increase opportunistic diagnosis and sensitive communication about obesity (2). This includes teaching resources including communication scenarios and videos. Staff focus groups identified the main barrier for professionals was fear around communicating about obesity in a sensitive way. We aimed to collaborate with CYP to develop our communication simulation programme within the Toolkit. In addition, we aimed to involve families in the evaluation of the project. We developed written patient leaflets, written and filmed communication scenarios incorporating feedback given by focus groups with Youth Empowerment Squad (YES), our local Trust CYP forum. The feedback included preferred language, which was emphasised in the debriefings of simulated sessions. The educational role-play scenario videos, which can be debriefed in teaching sessions, were filmed with a CYP taking on the role of a patient. After the release of the toolkit and accompanying simulation programme, 10 patients diagnosed as overweight or obese were randomly selected 2 to 4 months after attendance, as part of a patient experience survey. This telephone call explored parent opinions about the obesity discussion. Learning from CYP in YES helped us explore their preferred language, such as focussing on healthy living over the concept of obesity and explaining what is meant by body mass index (BMI). We included this in our debriefings. Our role-play videos are used in training to give examples of obesity discussions with CYP. These were semi-scripted to allow the CYP to incorporate their own voice and provide their insight into how they or their peers might react. In the patient experience survey, all parents were positive about the approach, rating the conversation on average 7.6/10 for being helpful (10 most helpful). Notable comments from parents included ‘the approach was sensitive, they spoke about positive change, not negative’. Parents talked positively about conversations that they had about obesity with staff trained using our simulation programme designed following CYP collaboration. It is encouraging that these conversations have been useful for CYP and families. Based on this feedback, we will continue to engage CYP and parents. Feedback from CYP is planned. The Obesity Toolkit is made free and Open Access for any interested departments. 1. NHS Digital. National Child Measurement Programme, England 2020/21 School Year – NHS Digital. NHS Digital. 2022. 2. Health Education England. Making Every Contact Count (MECC). 2022.

Are children living with obesity more likely to consult their general practitioner for knee pain? Longitudinal analysis of linked primary care and National Child Measurement Programme (NCMP) records.

ObjectivesMore than one in four 11-year-old children in England are living with obesity. The implications for future musculoskeletal health remain unclear. We assessed whether general practitioner consultations for knee pain were more likely among children with obesity, and how this varied by sex, ethnic background, and area-level deprivation.&#x0D; ApproachOf 61,478 11-year-old NCMP participants (2013-19), we linked 60,723 (98.8%) to their primary care records. 58,761 children (50.9% male) had no recorded knee pain consultation (including arthralgia and Osgood-Schlatter’s disease) prior to the NCMP measurement date. We calculated the proportion with a consultation for knee pain by ethnic-adjusted weight status (underweight&lt;2nd; overweight≥91st; obese≥98th centile), sex, ethnic background and Index of Multiple Deprivation quintile. We studied time to first general practitioner consultation for knee pain after the NCMP date by fitting Cox proportional hazards models, estimating mutually-adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for boys and girls separately.&#x0D; ResultsWe identified 2503 (4.3%) children with at least one consultation for knee pain after the NCMP date. Boys were more likely to consult than girls (mean difference 1.5%; 95% CI: 1.2,1.9). Median time to first knee pain consultation was 1.88 years (IQR: 0.94,2.93). In adjusted analyses, boys with underweight (aHR 0.16; 95% CI: 0.05,0.51), from South Asian ethnic backgrounds (0.80; 0.69,0.92) and living in less deprived areas (Wald test statistic: 11.41; p-value=0.0223) were less likely, and those from Black ethnic backgrounds (1.31; 1.13,1.51) more likely, to consult with knee pain. Girls from South Asian ethnic backgrounds (0.70; 0.59,0.84) and those living in less deprived areas (15.44; p-value=0.0039) were less likely, and those with a BMI considered obese (1.30; 1.10,1.54) more likely to do so.&#x0D; ConclusionAdolescent girls, but not boys, living with obesity are more likely to consult their general practitioner with knee pain. Ethnic differences in knee pain consultations merit further study. Linkage of primary care and NCMP records enables greater understanding of health service utilisation by children by weight status and demographic characteristics.

Challenges and opportunities of remote public involvement and community engagement during a pandemic: refining the MapMe childhood healthy weight intervention.

Aims:Including parents and other stakeholders in the development of interventions to address the sensitive public health issues such as childhood obesity, through public involvement is critical. However, the Covid-19 pandemic has created a challenge for public involvement and engagement activities (PICE). The aim of this paper is to describe the process and challenges of setting up, maintaining, evaluating, and recording impact of three public and stakeholder groups via remote methods in the context of the MapMe2 study during the Covid-19 pandemic. Parental reaction to result letters received as part of the National Child Measurement Programme (NCMP) informing parents of their child’s overweight status is often one of hostility or disbelief. As a result, parents often do not act on these letters to address child overweight. The MapMe2 study is working in collaboration with the NCMP and local authorities, building on previous work (MapMe) and aims to support parents of primary school–aged children to recognise and maintain a healthy weight in their child. The existing MapMe Intervention includes an enhanced NCMP child weight result letter, supplemented with Body Image Scales (BIS), and an intervention website with material to support healthy eating, physical activity, and signposting supporting information. The intervention was to be refined and the evaluation informed with PICE input.Methods:Covid-19 restrictions meant that planned face-to-face PICE methods had to be altered with all recruitment, all correspondence, and activities taking place remotely. A Parent Involvement Panel (PIP), a child panel, and an expert panel were established. Several adaptations were made to accommodate a new way of involving the public in research.Results/Conclusions:Working remotely created many challenges and was a learning experience for all involved. However, an active group was successfully established. Using continuous assessment and evaluation methods, we were able to demonstrate successful involvement and engagement in the refinement of the MapMe2 study. Through the sharing of PICE methods practice, this paper adds to the literature, the value of partnership working.

A longitudinal analysis comparing the proportion of children with excess weight before and during the COVID-19 pandemic

Background: The National Child Measurement Programme (NCMP) reported an increase in the prevalence of children in Reception (4-5 years) and Year 6 (10-11 years) with overweight/obesity during the coronavirus disease 2019 (COVID-19) pandemic compared to the previous year. This prompted us to conduct a longitudinal analysis to compare weight status before and during the pandemic. Methods: We compared the change in overweight/obesity status of children in Year 1 (Y1) (during the pandemic) who had also been measured as part of the NCMP in Reception (the year before the pandemic), with the change in a sample of children during a two-year ‘pre-pandemic’ period. Results: Overweight/obesity increased by 1.2% to 24.8% (p=0.582) between Reception and Y1 in the pre-pandemic group and by 5.4% to 28.5% (p=0.002) in the pandemic group. This was mainly driven by an increase in the proportion of overweight boys in the pandemic group (22% to 30%) compared to the pre-pandemic group rates (~24% at both time-points). Rates in girls increased by 2.0% to 24.8% in the pre-pandemic group and by 3.3% to 27.6% in the pandemic group. A higher proportion of Reception-aged White children in the pre-pandemic group were overweight/obese compared to the pandemic group, but by Y1 the rates were higher in the pandemic group. In children of South Asian (SA) heritage, the proportion with excess weight in Reception was 18.3% in the pre-pandemic group, increasing to 21.6% by Y1. The increase was substantially higher in the pandemic group of SA children, with an increase from 22.9% in Reception to 30.3% by Y1. Conclusions: We observed a marked increase in the proportion of children with an unhealthy body mass index (BMI) during the first year of the pandemic, suggesting that the societal disruptions caused by lockdown may have adversely affected children’s diet and levels of physical activity.

Preventing childhood obesity with combined hypothetical interventions on interpregnancy maternal smoking and weight: applying the parametric g-formula to a UK population-based cohort

BackgroundMaternal exposures during pregnancy have been linked to offspring adiposity, and the interpregnancy period is an opportunity to intervene on modifiable risk factors. We considered combinations of interpregnancy interventions and effects on rates of childhood obesity (≥95th centile) in second children. MethodsWe examined records of 5612 women from a population-based cohort of routinely collected antenatal health-care records at University Hospital Southampton (2003–2014), linked to measured child body-mass index (BMI) at age 4–5 years from the National Childhood Measurement Programme. We applied the parametric g-formula to estimate the effects of interventions between first (P1) and second (P2) pregnancies and to calculate estimated second child obesity and population risk ratio reduction (PRRR), compared with the estimated natural-course scenario (without intervention). Analysis was undertaken using the gfoRmula package in R This analysis is part of the SLOPE study which has been approved by the National Health Service Health Research Authority. FindingsObserved frequency of obesity in the second child at age 4–5 years was 8·5% (479 of 5612 children). We estimated that if all mothers started P2 with a BMI of 18·5–24·9 kg/m2 and all smokers stopped smoking by confirmation of P2, then, compared with a natural course estimate of 8·3% (95% CI 7·6–9·1), there would be a PRRR of second child obesity of 25·8% (21·0–30·8) to a second child obesity prevalence of 6·2% (5·5–7·0). For mothers who started P1 with BMI 18·5–24·9 kg/m2, if all smokers stopped smoking, then, compared with a natural course estimate of 5·9% (5·0–6·7), there would be a PRRR of second child obesity of 16·6% (10·0–23·2) to a prevalence of 4·9% (4·1–5·7). If BMI was also maintained between 18·5 and 24·9 kg/m2 there would be a PRRR of 21·3% (15·3–28·2) to a prevalence of 4·6% (3·9–5·4). For mothers who started P1 with BMI of 30 kg/m2 or greater, if weight was reduced to being either 18·5–24·9 kg/m2 or 25–29·9 kg/m2 by the start of P2, then, compared with a natural course estimate of 17·7% (15·1–20·9), there would be PRRRs of second child obesity of 29·4% (4·7–53·4) to a prevalence of 12·5% (8·3–17·4) and 17·6% (2·6–35·1) to a prevalence of 14·6% (11·1–17·7), respectively. InterpretationInterventions between pregnancies could reduce obesity rates in the second child, with the most effective interventions varying by maternal BMI during the first pregnancy. FundingNIHR Southampton Biomedical Research Centre, University of Southampton Primary Care, Population Sciences and Medical Education PhD studentship, and an Academy of Medical Sciences and Wellcome Trust grant.

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.

Regional differences in short stature in England between 2006 and 2019: A cross-sectional analysis from the National Child Measurement Programme.

Short stature, defined as height for age more than 2 standard deviations (SDs) below the population median, is an important indicator of child health. Short stature (often termed stunting) has been widely researched in low- and middle-income countries (LMICs), but less is known about the extent and burden in high-income settings. We aimed to map the prevalence of short stature in children aged 4-5 years in England between 2006 and 2019. We used data from the National Child Measurement Programme (NCMP) for the school years 2006-2007 to 2018-2019. All children attending state-maintained primary schools in England are invited to participate in the NCMP, and heights from a total of 7,062,071 children aged 4-5 years were analysed. We assessed short stature, defined as a height-for-age standard deviation score (SDS) below -2 using the United Kingdom WHO references, by sex, index of multiple deprivation (IMD), ethnicity, and region. Geographic clustering of short stature was analysed using spatial analysis in SaTScan. The prevalence of short stature in England was 1.93% (95% confidence interval (CI) 1.92-1.94). Ethnicity adjusted spatial analyses showed geographic heterogeneity of short stature, with high prevalence clusters more likely in the North and Midlands, leading to 4-fold variation between local authorities (LAs) with highest and lowest prevalence of short stature. Short stature was linearly associated with IMD, with almost 2-fold higher prevalence in the most compared with least deprived decile (2.56% (2.53-2.59) vs. 1.38% (1.35-1.41)). There was ethnic heterogeneity: Short stature prevalence was lowest in Black children (0.64% (0.61-0.67)) and highest in Indian children (2.52% (2.45-2.60)) and children in other ethnic categories (2.57% (2.51-2.64)). Girls were more likely to have short stature than boys (2.09% (2.07-2.10) vs. 1.77% (1.76-1.78), respectively). Short stature prevalence declined over time, from 2.03% (2.01-2.05) in 2006-2010 to 1.82% (1.80-1.84) in 2016-2019. Short stature declined at all levels of area deprivation, with faster declines in more deprived areas, but disparities by IMD quintile were persistent. This study was conducted cross-sectionally at an area level, and, therefore, we cannot make any inferences about the individual causes of short stature. In this study, we observed a clear social gradient and striking regional variation in short stature across England, including a North-South divide. These findings provide impetus for further investigation into potential socioeconomic influences on height and the factors underlying regional variation.