The TRENDS Project: Development of a methodology to reliably monitor the obesity epidemic in childhood

University of Leeds, Leeds, England, United Kingdom
Archives of Disease in Childhood (Impact Factor: 2.9). 05/2006; 91(4):309-911. DOI: 10.1136/adc.2005.078915
Source: PubMed


The government has set a target to halt the rise in childhood obesity in those aged under 11 by 2010, but no system is in place to ascertain if this has been achieved. We aimed to develop a simple and reproducible methodology to monitor trends in childhood obesity.
A purposive sample of 10 primary schools and three secondary schools was selected. Children were measured with parental "opt out" consent in reception class, year 4, and year 8 (ages 5, 9, and 13 years, respectively). Measurements were compared with those obtained locally in 1996-2001. Calculations were then performed to ascertain the sample size required to confidently identify a halt in the rise in obesity using three growth measures.
A total of 999 children were measured with ascertainment of 95% in primary and 85% in secondary schools. The proportion of overweight and obese children aged 9 and 13 years had increased since 1996-2001, although only 9 year olds showed a significant rise. A general trend of an increase in obesity was observed with increasing age. Calculations showed that 1900-2400 children per age group are needed to detect a halt in the rise in obesity based on mean body mass index (BMI) standard deviation scores (SDS) by 2010 with 90% power, whereas 4200-10 500 children are needed for other measures.
We have developed a simple, cost effective methodology for accurately measuring the epidemic and recommend the use of mean BMI SDS for demonstrating if a halt has been achieved.

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Available from: Mary Rudolf, Jan 31, 2015
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    • "This model was developed in Leeds and is suitable for use on a national basis. This work was initially developed as an academic exercise with support from research funding and in 2006 was piloted in a pragmatic setting by the school nursing service of the East Leeds PCT (Rudolf et al. 2005; Levine et al. 2008a,b). "
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    ABSTRACT: The UK Department of Health for England and Wales has issued guidance to all local Primary Care Trusts (PCTs), who have responsibility for school nursing services, for the annual weighing and measuring of all children on entry to primary school and in Year 6 (age 5 and 11 years respectively), known as the National Child Measurement Programme. The guidance places the responsibility for implementation and funding of this scheme onto the PCTs. This paper describes the conduct and evaluation of the 2006 monitoring exercise in a 10% sample of Leeds primary schools. The evaluation showed that the exercise can be carried out with little disruption in schools and minimal distress for children. Recommendations include: adequate staff training in measuring children, along with anticipation of the issues and problems they may encounter and best practice for dealing with them. A good working relationship must be established between the team and school before the measuring day. Schools need to ensure the availability of suitable accommodation and a screen to maintain privacy. Lightweight but robust and accurate scales conforming to the European Union standard should be used and routinely checked for accuracy. Where possible, children should not be lined up, but seen individually. This is considered essential for the older Year 6 children.
    Child Care Health and Development 02/2009; 35(3):365-8. DOI:10.1111/j.1365-2214.2008.00925.x · 1.69 Impact Factor
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    • "The steps involved in analysis of the growth data and development of the methodological model are shown in Fig. 1. BMI SDS was used, rather than percent obese children , as this is the preferred measure of obesity (Rudolf et al., 2006). "
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    ABSTRACT: This article explores the impact that schools have on their pupils' obesity and so identify those where targeted input is most needed. A modelling process was developed using data that had been collected over 2 years on a socio-economically and ethnically representative sample of 2367 school pupils aged 5 and 9 years old attending 35 Leeds primary schools. The three steps in the model involved calculating the "Observed" level of obesity for each school using mean body mass index standard deviation (BMI SDS); adjusting this using ethnicity and census-derived deprivation data to calculate the "Expected" level; and calculating the "Value Added" by each school from differences in obesity at school entry and transfer. We found there was significant variance between the schools in terms of mean BMI SDS (range -0.07 to +0.78). Residential deprivation score and ethnicity accounted for only a small proportion of the variation. Expected levels of obesity therefore differed little from the Observed, but the Value Added step produced very different rankings. As such, there is variation between schools in terms of their levels of obesity. Our modelling process allowed us to identify schools whose levels differed from that expected given the socio-demographic make up of the pupils attending. The Value Added step suggests that there may be a significant school effect. If this is validated in extended studies, the methodology could allow for exploration of mechanisms contributing to the school effect, and identify schools with the highest unexpected prevalence. Resources could then be targeted towards those schools in greatest need.
    Social Science & Medicine 08/2008; 67(2):341-9. DOI:10.1016/j.socscimed.2008.02.029 · 2.89 Impact Factor
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    • "Childhood obesity was defined using age and gender specific body mass index [weight (kg)/height (m 2 )] standard deviation scores (BMI SDS) using the British 1990 growth reference dataset (Freeman et al. 1995; Cole et al. 1995); overweight is defined as above the 91st centile and obesity as above the 98th centile (Cole et al. 1995). There are three key sources of child BMI data from Leeds used in this study: for 3–6 year olds data were obtained from primary care trusts' records of routinely collected data for children born since 1995; a sample of 5, 9 and 13 year olds collected as part of the 'Trends' study in 2004 and 2005 (Rudolf et al. 2006); and, a sample of 11 year olds collected as part of the 'RADs' study in 2005 and 2006. All data were anonymised. "
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    ABSTRACT: This paper describes global (whole of Leeds) and local (super output area) analyses of the relationship between childhood obesity and many ‘obesogenic environment’ variables, such as deprivation, urbanisation, access to local amenities, and perceived local safety, as well as dietary and physical activity behaviours. The analyses identify the covariates with the strongest relationships with obesity, and highlight variation in these relationships across Leeds, thus identifying ‘at-risk’ populations. This paper seeks to demonstrate the importance of analysis at the micro-level in order to provide health planners with additional information with which to tailor interventions and health policies to prevent childhood obesity.
    Area 05/2008; 40(3):323 - 340. DOI:10.1111/j.1475-4762.2008.00822.x · 1.37 Impact Factor
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