Journal of Public Health Advance Access originally published online on May 10, 2007
Journal of Public Health 2007 29(2):210-212; doi:10.1093/pubmed/fdm014
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Correspondence |
Measuring children and monitoring childhood obesity
Karen Gully, Medical Director
Caerphilly Local Health Board, Ystrad Mynach Hospital,
Caerphilly Road, Ystrad Mynach, Hengoed, Caerphilly CF82 7XU,
UK
Rhys Williams, Professor of Clinical Epidemiology
The School of Medicine, University of Wales Swansea,
Swansea SA2 8PP, UK
Nathan Lester, Public Health Information Manager
National Public Health Service for Wales, Temple of Peace and Health, Cathays Park, Cardiff CF10 3NW, UK
Sarah Aitken, Consultant in Public Health Medicine
National Public Health Service for Wales, Mamhilad House,
Mamhilad Park Estate, Pontypool NP4 0YP, UK
Email: d.r.r.williams{at}swansea.ac.uk
Patterson et al.1 draw a useful and clear distinction between height and weight measurements made ‘for detecting [individual] children with abnormal growth patterns’ and measuring children for ‘public health surveillance’ of the national epidemic of childhood obesity which is currently affecting the UK. Although, for the first of these aims, the routine measurement of children's heights and weights has been legitimately called into question;2 these measurements should be a vital means of tracking the obesity epidemic and judging the effectiveness, if any, of local and national policies to reverse the rising trends. Such potential can only be realised if (1) coverage is high, (2) measurements are accurately taken and recorded, and (3) the anonymised data are made available to bona fide investigators. Patterson et al.1 in their surveys of English Primary Care Trusts (PCTs) found that these organisations varied considerably in the ages at which length and weight or height and weight were recorded, coverage was also variable (and unrealistically estimated at 100% by some PCTs) and the data were held in 26 different information systems and, therefore, not readily amenable to national analysis.
At around the same time as height and weight data for children entering schools in Swansea, Neath and Port Talbot (south Wales) were being analysed for eventual publication,3 we embarked on a national survey of the 13 NHS Trusts holding routinely collected height and weight data and the Powys Local Health Board (LHB) (the near equivalent, in Wales, of a PCT in England) in order to determine (1) what anthropometric data were gathered and at what ages and (2) whether these data allowed estimates to be made of the prevalence of childhood obesity in Wales and in different parts of Wales. This work comprised the successful Master in Public Health dissertation4 of one of the authors (KG) and was set against the finding3 of a doubling of the prevalence of obesity in both boys and girls entering Swansea, Neath, and Port Talbot schools over the 16 years 1986/87 to 2001/02. The method used was a postal enquiry to these NHS Trusts and the LHB with follow-up telephone calls as reminders. Trusts and the LHB were asked if they could provide data for a national analysis of obesity and overweight in pre-school and/or children at school entry over the 2-year period 1 April 1998 to 31 March 2000.
Half (seven) of the organisations approached were able to provide data and 24,459 records were anonymously reviewed. Coverage ranged from 35 to 74% (with a mean of 54% overall). It was not possible for the organisations concerned to state whether the lack of coverage was the result of some communities not being included at all or the result of large sections of all communities not being included. For the children who were seen, 66% (range 46–81%) had a body mass index (BMI) result recorded on the computer system. Five percent of these BMI results were deemed to be invalid, probably as a result of faulty entry of raw data into the computer system. The ages at which children were measured were highly variable across Wales. Regional comparisons (see Fig. 1 and Table 1 for data for girls) could be produced but were highly unlikely to be valid.
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We concluded from this study that (1) a significant number of the NHS Trusts holding important data on heights and weight of children were either unwilling or unable to divulge it, (2) managers assumed heights and weights were measured and recorded, (3) there is wide variation in data quality between NHS Trusts with clinical staff making their own judgments as to whether and when measurements are taken, (4) many of the data items are missing for a large number of children and that it is impossible to judge to what extent this biases any national analysis or regional comparison, (5) information is rarely, if ever, fed back to clinical staff, and (6) therefore, the quality of routinely collected data currently available is not fit for the purpose of surveillance of overweight and obesity in children.
Significant improvement in quality and usefulness could be obtained by increased population coverage or by adequate sampling methods, by more accurate recording of height and weight and by more accurate data entry. Practitioners need clear guidance on the requirements and purpose of data collection. Feedback of aggregated data to clinical staff would highlight issues of data quality and identify how these might be improved. Associated with these changes, there needs to be a readiness on behalf of those who ‘own’ the data to share these with investigators after, of course, the confidentiality and security of the data have been adequately assured.
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References |
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- Patterson L, Jarvis P, Verma A, et al. Measuring children and monitoring obesity: surveys of English Primary care Trusts 2004–06. J Public Health (2006) 28:330–36.[CrossRef]
- Banerjee S, Morgan RJH, Rees SA, et al. Height screening at school: ineffective without high standards and adequate resources. Arch Dis Child (2003) 88:477–80.
[Abstract/Free Full Text] - Jones SE, James-Ellison M, Young S, et al. Monitoring trends in childhood obesity in South Wales using routine data. Arch Dis Child (2005) 90:464–7.
[Abstract/Free Full Text] - Gully K. The big issue? Estimating the prevalence of childhood overweight and obesity in Wales (MPH Dissertation). (2004) December. Cardiff University.
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