A High-Precision Protocol for Identification of Preschool Children at Risk for Persisting Obesity

BACKGROUND:Recent studies suggest that adolescent adiposity is established already in preadolescence. Earlier studies have confirmed a strong tracking of obesity from adolescence to adulthood. Our aim was to examine the diagnostic accuracy of a population-derived protocol for identification of preschool children at risk for obesity in preadolescence. METHODOLOGY/PRINCIPAL FINDINGS:We analysed data obtained for child health surveillance up to age 5 from 5778 children born in a Swedish county in 1991. The basic data set included age, sex, and weight and height measurements from the regular checkups between ages 1.5 and 5. Data not routinely collected in the child health centre setting were disregarded. The children were at age 10 randomly assigned to protocol derivation and validation cohorts and assessed for obesity according to IOTF criteria. The accuracy of predicting obesity in the validation cohort was measured using decision precision, specificity, and sensitivity. The decision protocol selected 1.4% of preschool children as being at obesity risk. The precision of the protocol at age 10 was 82% for girls and 80% for boys, and the specificity was 100% for both boys and girls. The sensitivity was higher for girls (41%) than for boys (21%). The relative risk for obesity at age 10 estimated by the odds ratio for individuals selected by the protocol compared to non-selected peers was 212.6 (95% confidence interval 56.6 to 798.4) for girls and 120.3 (95% CI 24.5 to 589.9) for boys. CONCLUSION/SIGNIFICANCE:A simple and inexpensive decision protocol based on BMI values proved to have high precision and specificity for identification of preschool children at risk for obesity persisting into adolescence, while the sensitivity was low especially for boys. Implementation and further evaluations of the protocol in child health centre settings are warranted

History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents

OBJECTIVE: To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification. less thanbrgreater than less thanbrgreater thanMETHODS: All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses. less thanbrgreater than less thanbrgreater thanRESULTS: Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4% of the adolescents were selected for intensive pediatric care, 1.4% for individual clinical interventions in primary health care, 14.0% for individual primary obesity prevention using the Internet and 82.1% for population-based interventions. Costs for the cross-sectional selection strategy were projected to USD463 581 per 1000 adolescents and for the trajectory-based strategy were USD 302 016 per 1000 adolescents. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Using projections from epidemiological data, we found that by basing the selection of adolescents for obesity prevention on weight trajectories, the load on highly specialized pediatric care can be reduced by one-third and total health service costs for obesity management among adolescents reduced by one-third. Before use in policies and prevention program planning, our findings warrant confirmation in prospective cost-benefit studies.Funding Agencies|Ostergotland County Council, Sweden||</p

Design of an online health-promoting community : negotiating user community needs with public health goals and service capabilities

Background An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities. Methods Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified. Results The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions. Conclusions OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users’ needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations

Protocol assessment according to the STARD procedure.

<p>Protocol assessment according to the STARD procedure.</p

Diagnostic accuracy of decision protocol to be used at the age 5 checkup for selection of children at risk for persisting obesity.

<p>OR = odds ratio</p><p>95% CI = 95% confidence interval</p

Diagnostic accuracy of the three best performing decision rules extracted from the derivation cohort for selection of children at risk for persisting obesity at the 5-year checkup. All other rule combinations displayed poorer decision preformance.

<p>OR = odds ratio</p><p>95% CI = 95% confidence interval</p

Univariate logistic regression analyses using derivation cohort data with regard to association to obesity at age 10.

<p>OR = odds ratio</p><p>95% CI = 95% confidence interval</p><p>Early adiposity rebound = Adiposity rebound before age 5 (y/n)</p><p>Age at adiposity rebound = Adiposity rebound at age 2½ years, 4 years or at age 5 years and later.</p><p>BMI change = BMI at 5 years/BMI at 1½ years</p

Diagnostic accuracy at the age 10 of obesity prediction at age 5 using cut-off points at BMI values 16–20.

<p>OR = odds ratio</p><p>95% CI = 95% confidence interval</p><p>The variables in final inductive model extracted from the derivation cohort using stepwise logistic regression were BMI at age 5 and sex. Variables not included in the model were BMI at the ages 1½, 2½, and 4 years, age at adiposity rebound, BMI change, BMI at adiposity rebound, and early adiposity rebound.</p