Dr Helen Vickerstaff Consultant Community Paediatrician, RCHT Rachael Brandreth RD Children’s Dietitian, Children’s Community Therapy Service, RCHT Julie.

Dr Helen Vickerstaff Consultant Community Paediatrician, RCHT

Rachael Brandreth RDChildren’s Dietitian, Children’s Community Therapy

Service, RCHT

Julie BensonNippers Nutrition, Cornwall Council

HEALTHY WEIGHT IN THE EARLY YEARS

Outline

• Set the scene – national and local figures

• Outline the LEAF programme

• Case studies

• Prevention – Nippers Nutrition

Why should we be worried?

10.7%

9.1%

19.0%

15.8%

10.4%

8.8%

20.0%

16.6%

10.3%

8.9%

20.0%

16.5%

10.5%

9.2%

20.4%

17.0%

10.1%

8.8%

20.6%

17.4%

Reception boys Reception girls Year 6 boys Year 6 girls

Year of measurement

2006/07 2007/08 2008/09 2009/10 2010/11

Prevalence of obesity among children by school year and sexNational Child Measurement Programme 2006/07 – 2010/11

Child obesity: BMI ≥ 95th centile of the UK90 growth reference © NOO 2012

Child prevalence by BMI statusNational Child Measurement Programme 2010/11

This analysis uses the 2nd, 85th and 95th centiles of the British 1990 growth reference (UK90) for BMI to classify children as underweight, healthy weight, overweight and obese. These thresholds are the most frequently used for population monitoring within England.

Healthy Weight65.3%

Underweight1.3%

Overweight14.4%

Obese19.0%

Year 6(aged 10-11 years)

Healthy Weight76.4%

Underweight1.0%

Overweight13.2%

Obese9.4%

Reception(aged 4-5 years)

© NOO 2012

NCMP local data

• Increase in overweight reception 15.1%

• (SHA 14.3%, ENG 13.2%), 1.1% increase

• Obesity rate fallen 9% from 10.8%

© NOO 2012

Prevalence of obesity by deprivation decile National Child Measurement Programme 2010/11

Child obesity: BMI ≥95th centile of the UK90 growth referenceDeprivation deciles assigned using the Index of Multiple Deprivation 2010

12.7%

14.8%16.0%

16.6%18.0%

19.6%20.6%

22.1%23.6% 23.8%

6.3%7.0% 7.6% 8.1% 8.4%

9.4%10.3% 10.7%

11.7% 12.2%

Least deprived

Most deprived

Year 6 Reception

• Extrapolation from 2 year check data (total for age group 1-6)– 26% above 91st centile– >98th centile 545 children– >3.5 SD 110 children

– Preliminary recent audit outpatients Treliske

34% overweight or obese group

Snapshot Data locally

• Parental obesity• Very early (by 43months) adiposity rebound• Obese children go on to become obese

adults• >8 hours screen time/week at 3 years• Catch up growth• SD score at 8 months and 18 months in top

quarter, weight gain in first year• Birth weight• Short (<10.5 hours) sleep duration at 3

years

ALSPAC

• Foresight report, 2007

• Healthy Lives, Healthy People: A call to action on obesity 2011– A sustained downward trend in the level

of excess weight in children by 2020– Tailored support on weight management– Part of life course approach

Government reports

Overview• Who are we?• Who do we see?• Format of the LEAF Programme• Course outline

LEAF

(Lifestyles, Eating & Activity for Families)

Who are we?Dr Helen Vickerstaff, Community Paediatrician with Specialist Interest in Public Health (Child Health, RCHT)

Rachael Brandreth, Children’s Community Dietitian (Children’s Community Therapies, Child Health, RCHT)

Kate Laity, Physical Activity Advisor (Healthy Weight Team, Health Promotion,

CIOSPCT)

Contact the team on [email protected] for more info or advice

LEAF

(Lifestyles, Eating & Activity for Families)

Tier 3 weight management for overweight children 6yrs & under.

Referral criteria:Under 2 years: concerns about rapid weight gain / large size 2 - 6 years: BMI > +3.5sd or BMI >98th centile & co-morbidities or a strong suspicion of an underlying cause.

& Ideally worked with key professional e.g. Health Visitor or School Nurse for at least 6 months and obesity progressive (if concerns before / whilst working with the family please contact us for advice).

LEAF

(Lifestyles, Eating & Activity for Families)

Format of the LEAF programme:Initial engagement sessionMDT clinic (one appointment to see us all)Group sessions (6 x mornings)MDT clinic follow-upReferral back to primary care for longer-term follow-up with support from the MDT team

If not able to participate in group follow-up then one-to-one with Dietitian & Health Visitor / team or School Nurse / team & localised follow-up

• Principles of making changes• Getting the balance right – energy balance, nutrient balance• Promoting positive behaviour• Getting tuned in & me sized meals – portion sizes, hunger & fullness cues & cravings• Getting over barriers – problem solving, external triggers • How thoughts & feelings affect our intake• Hidden fats & sugars• Food labelling, shopping, budgeting, snacks & recipe adaption.• Getting the kids involved – keeping active & widening food preferences

Group sessions: What do we cover?

Case Studies

Case 1 – ‘Katy’

• GP referral to paediatrician and dietitian (Feb ’12)

• BMI 22.6 at 2 years and 23.2 at 2yr 6mth• FH of diabetes and thyroid disease• Normal development• Worked with health visitor for 6 months• www.cornwallhealthyweight.org.uk

Case 1 – ‘Katy’

LEAF clinic– Pre clinic visit (RB) 10/10 importance and

confidence– Multi-disciplinary clinic +3.5SD– Co-morbidity ?Sleep apnoea– Risk factors – father T2 diabetes, strong

FH diabetes and thyroid, paternal g’mother MI age 39

Case 1 ‘Katy’

• Examination– Height 89cm (9-25th)– Weight 18.5kg (99.6th)– Normal examination including BP

– No clear nutritional contribution at 1st assessment

Case 1 ‘Katy’

• TSH• Cortisol• IGF-1, IGF-BP3• Prolactin• Prader-Willi• Turner• Bone age

• FBC• Ferritin• Lipids• Glucose• LFT’s

Case 1 ‘Katy’

• Respiratory opinion – apnoea with desats , ENT referral large tonsils

• Bloods – raised triglycerides, low HDL• Clinic follow up – raised parental concern,

increase in BMI• In depth dietetic – extra snacks family

members• Previous reluctance to join LEAF

programme – increase motivation with raised lipids

• LEAF Sept

• Follow up Nov

• Aim return to primary care follow up

Case 1 ‘Katy’

Case 2 ‘Ruby’

• GP referral April 2012, aged 2 yr 7/12

• BMI 22.4 (+ 3.5SD)

• Ht centile 98th, Wt 99.6th

• Home Visit – Importance 8, Confidence 2

• No HV input

• FH Type 1 diabetes and early cardiac death 43

• Drinks diary 1350-1800mls milk

• Offered LEAF - DNA

• Discharge to health visitor

Case 2 ‘Ruby’

Summary

• Influential time for child and family • Good age to modify behaviour• Majority can be delivered in primary

care• www.cornwallhealthyweight.org.uk

• Contact the team on [email protected] for more info or advice

THANKYOUANY QUESTIONS?