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Overweight at the GP surgery

Overweight at the GP surgery. What do we need to proceed ?. The bad news. We know little about what is going on We know less about why We know even less about what to do about it. The good news. We know little about what is going on

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Overweight at the GP surgery

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  1. Overweight at the GP surgery What do weneed to proceed?

  2. The bad news • Weknowlittleaboutwhat is goingon • Weknowlessaboutwhy • Weknowevenlessaboutwhat to do about it

  3. The goodnews • Weknowlittleaboutwhat is goingon • GP’scancontribute to developourknowledge • Weknowlessaboutwhy • GP’scancontribute to developourknowledge • Weknowevenlessaboutwhat to do about it • GP’scancontribute to developourknowledge

  4. Howcan the GP contribute? • Shareroutine data ongrowth • Understandingoverweight • Evaluate interventions • Identifychildren in risk of overweightearly • Developpreventive programs

  5. How do wemeasurechildren BMI?1-5 years • Norway • Onlyheight • Sweden • 5 years • Island • 1½ and 2½ years • Finland • Everyyear • Denmark • Everyyear

  6. Electronic patient files GP’s in Denmark

  7. Centraliseddatacollections • Denmark • Prospectively data probablysystematicallycollected at the National Board of Health • A project to retrivepreviously data is beingestablished • Sweden and Finland: ontheirway • Norway and Island?

  8. Growth-pattern of Finnishchildren Data from NorthernFinnishBirthCohorts. MarjoRiitaJärvellin et al.

  9. Identifyingchildren in risk of overweight • In theirreport from 2008 The National Board for Physicalactivity and Nutrition (’Motions- og Ernæringsrådet’) suggested: • establishment of a system to identifychildren in risk of developingadipositybefore the adipsosity is manifest • Thatthis system shouldbe part of the routinehealthexaminationswhen the childrenare 3, 4 and 5 yearold

  10. Canwe find and treat at riskchildren? • The national college of general practitioners • From 2006

  11. What more do weneed? • A tool to estimate the childrensrisk of beingoverweightearly? • Development of programs to approach the child at risk of beingoverweight and itsfamily?

  12. The Whitaker studies • 854 individuals BMI retrospectivelycollected • Endpoint BMI at 20-29 year of age • Overweight definition adults: BMI > 27.8/27.3 • Overweight definitions children 15th centile

  13. Combiningparents and childoverweight > 15th % <15th % > 15th % <15th % NoParentsoverweight One Parentoverweight Basedon ’Whitaker et al NEJM 1997;37:869-73’

  14. Adiposityrebound

  15. Adiposityreboundand parentaltoverweight Early Intermed. Late Early Intermed. Late NoParentsoverweight One Parentoverweight Basedon ’Whitaker et al. Pediatrics 1998;101:e5’

  16. Developing a Nordic algoritme for estmatingrisk of overweightearly • Cohorts • Aarhus BirthCohort (90-92)- development • NorthernFinnishBirthCohort (85-86)-test • Some of the potential predictive variables • Bothparents BMI • Maternal smoking • Birthweight and gestational age at birth • Breastfeeding • Childsgrowthpattern

  17. Plan • To integrate the algoritm in the datacapturemodule • Clinicaltool for GP’s • Evaluation • To develop an intervention model • The GP surgery • Municipallitysetting

  18. Waistcircumference

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