A third of children finishing primary school in England are overweight or obeseBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8488 (Published 13 December 2012) Cite this as: BMJ 2012;345:e8488
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The latest figures from the National Childhood Measurement Programme (NCMP) for overweight and obese children make for salutary reading, with evidence that the prevalence of overweight and obesity by Year 6 of primary school continues to increase with a figure now of 33.9% (1). THE NCMP produces excellent robust data with ascertainment around 93%. There is evidence that both parents and healthcare professionals are poor at recognising obesity in their own or other children (2, 3) and thus methods of alerting both families and health care services to this important health issue might be considered useful and even mandatory. However, individual feedback on NCMP data to parents is patchy and in some places non-existent whilst no information is provided to primary care professionals. We have recently identified that one of the barriers to engagement with weight management services either within primary care or onwards referral is the absence of Body Mass Indices data available to primary care teams for the vast majority of children (4). The oft cited reason for the non-uniform feedback of information on children’s weight status to parents or general practice is that the NCMP was developed for surveillance rather than screening. Possibly another factor mitigating against universal feedback was the widespread and adverse media coverage that the occasional misclassification of an individual child’s weight status caused despite the fact that the little evidence to date, has shown that the majority of parents find such feedback helpful (5).
Whilst there is no overall figure available for the cost of the NCMP in England, it is likely to be a quite resource intensive exercise. A very conservative estimate of the annual cost of NCMP surveillance using data solely regarding direct nursing costs (£17,000) from one PCT (Bath and North East Somerset: personal communication), extrapolating this to the 152 PCTs across England and adding Department of Health central costs of £187,525 (FOI advice: DoH 11/1/13) is around £2,800,000. As such, this is a very costly surveillance tool, the results of which could more simply and cheaply be delivered by a purposive but random sampling methodology across the country.
Given its cost, surely it is time to re-evaluate the aims and objectives of the NCMP. If it continues, universal feedback of data to parents to alert them to the possible health issues of overweight and obesity should be implemented. In addition, providing data to primary care, will make it more likely that the professional at the first point of contact is aware of the issue and might even be able to proffer some targeted information to engage families in seeking further assistance?
This is an independent opinion from a Biomedical Research Unit in the National Institute for Health Research Biomedical Research Centre and Unit Funding Scheme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
(1) The National Child Measurement Programme: England 2011/12. December 2012: The Health and Social Care Information Centre. Department of Health.
(2) Jones AR, Parkinson KN, Drewett RF, et al. Parental perceptions of weight status in children: the Gateshead Millennium Study. Int J Obes (Lond) 2011; 35(7): 953-62.
(3) Smith SM, Gately P, Rudolf M. Can we recognise obesity clinically? Arch Dis Child 2008; 93(12): 1065-6.
(4) Banks J, Shield JPH, Sharp D. Barriers engaging families and general practitioners in childhood weight management strategies. British Journal of General Practice. 2011: August; 61(589):492-7.
(5) Grimmett C, Croker H, Carnell S, Wardle J. Telling parents their child's weight status: psychological impact of a weight-screening program. Pediatrics 2008; 122(3): e682-8.
Competing interests: No competing interests