Primary paediatric health care is the foundation for preventative child health. In light of the recent obesity epidemic, paediatricians find themselves at the frontline of identification and management of childhood obesity. However, it is well recognized that evidence based approaches to obesity prevention and subsequent translation of this evidence into practice are critically needed. This paper explores the role of primary care in obesity prevention and introduces a novel application and development of a primary care research network in Canada—TARGet Kids!—to develop and translate an evidence-base on effective screening and prevention of childhood obesity.
References
[1]
Ogden, C.; Carroll, M. NCHS Health E-Stat: Prevalence of Obesity among Children and Adolescents-United States, Trends 1963–1965 through 2007–2008. Available online: http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08.htm (accessed on 22 October 2011).
[2]
Canning, P.M.; Courage, M.L.; Frizzell, L.M. Prevalence of overweight and obesity in a provincial population of Canadian preschool children. CMAJ 2004, 171, 240–242.
[3]
Shields, M. Overweight and obesity among children and youth. Health Rep. 2006, 17, 27–42.
[4]
Tremblay, M.S.; Willms, J.D. Secular trends in the body mass index of Canadian children. CMAJ 2000, 163, 1429–1433.
[5]
Sabin, M.A.; Ford, A.L.; Holly, J.M.; Hunt, L.P.; Crowne, E.C.; Shield, J.P. Characterization of morbidity in a UK, hospital based, obesity clinic. Arch. Dis. Child. 2006, 91, 126–130.
[6]
Hannon, T.S.; Rao, G.; Arslanian, S.A. Childhood obesity and type 2 diabetes mellitus. Pediatrics 2005, 116, 473–480.
[7]
Sorof, J.; Daniels, S. Obesity hypertension in children: A problem of epidemic proportions. Hypertension 2002, 40, 441–447.
[8]
Schwimmer, J.B.; Pardee, P.E.; Lavine, J.E.; Blumkin, A.K.; Cook, S. Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease. Circulation 2008, 118, 277–283.
[9]
Verhulst, S.L.; Schrauwen, N.; Haentjens, D.; Suys, B.; Rooman, R.P.; Van Gaal, L.; De Backer, W.A.; Desager, K.N. Sleep-disordered breathing in overweight and obese children and adolescents: Prevalence, characteristics and the role of fat distribution. Arch. Dis. Child. 2007, 92, 205–208.
[10]
Taylor, E.D.; Theim, K.R.; Mirch, M.C.; Ghorbani, S.; Tanofsky-Kraff, M.; Adler-Wailes, D.C.; Brady, S.; Reynolds, J.C.; Calis, K.A.; Yanovski, J.A. Orthopedic complications of overweight in children and adolescents. Pediatrics 2006, 117, 2167–2174.
[11]
Strauss, R.S.; Pollack, H.A. Social marginalization of overweight children. Arch. Pediatr. Adolesc. Med. 2003, 157, 746–752.
[12]
Strauss, R.S. Childhood obesity and self-esteem. Pediatrics 2000, 105, e15–e19.
[13]
Williams, J.; Wake, M.; Hesketh, K.; Maher, E.; Waters, E. Health-related quality of life of overweight and obese children. JAMA 2005, 293, 70–76.
[14]
Freedman, D.S.; Dietz, W.H.; Tang, R.; Mensah, G.A.; Bond, M.G.; Urbina, E.M.; Srinivasan, S.; Berenson, G.S. The relation of obesity throughout life to carotid intima-media thickness in adulthood: The Bogalusa Heart Study. Int. J. Obes. Relat. Metab. Disord. 2004, 28, 159–166.
[15]
Baker, J.L.; Olsen, L.W.; S?rensen, T.I. Childhood body-mass index and the risk of coronary heart disease in adulthood. N. Engl. J. Med. 2007, 357, 2329–2337.
[16]
Haemer, M.; Cluett, S.; Hassink, S.G.; Liu, L.; Mangarelli, C.; Peterson, T.; Pomietto, M.; Young, K.L.; Weill, B. Building capacity for childhood obesity prevention and treatment in the medical community: Call to action. Pediatrics 2011, 128, S71–S77.
[17]
Klein, J.D.; Sesselberg, T.S.; Johnson, M.S.; O’Connor, K.G.; Cook, S.; Coon, M.; Homer, C.; Krebs, N.; Washington, R. Adoption of body mass index guidelines for screening and counselling in pediatric practice. Pediatrics 2010, 125, 265–272.
[18]
Perrin, E.; Finkle, J.; Benjamin, J. Obesity prevention and the primary care pediatrician’s office. Curr. Opin. Pediatr. 2007, 19, 354–361.
[19]
Olson, L.M.; Inkelas, M.; Halfon, N.; Schuster, M.A.; O’Connor, K.G.; Mistry, R. Overview of the content of health supervision for young children: Reports from parents and pediatricians. Pediatrics 2004, 113, 1907–1916.
[20]
International Council for the Exploration of the Sea (ICES). ICES Atlas—Primary Care in Ontario; ICES: Copenhagen, Denmark, 2002. Available online: http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=67&morg_id=0&gsec_id=0&item_id=3655&type=atlas (accessed on 22 October 2011).
[21]
Birch, L.L.; Fisher, J.O. Mothers’ child-feeding practices influence daughters’ eating and weight. Am. J. Clin. Nutr. 2000, 71, 1054–1061.
[22]
Wardle, J.; Guthrie, C.; Sanderson, S.; Birch, L.; Plomin, R. Food and activity preferences in children of lean and obese parents. Int. J. Obes. Relat. Metab. Disord. 2001, 25, 971–977.
[23]
Mikkila, V.; Rasanen, L.; Raitakari, O.T.; Pietinen, P.; Viikari, J. Consistent dietary patterns identified from childhood to adulthood: The cardiovascular risk in Young Finns Study. Br. J. Nutr. 2005, 93, 923–931.
[24]
Telama, R.; Yang, X.; Viikari, J.; Valimaki, I.; Wanne, O.; Raitakari, O. Physical activity from childhood to adulthood: A 21-year tracking study. Am. J. Prev. Med. 2005, 28, 267–273.
[25]
Reinehr, R.; Kleber, M.; Lass, N.; Toschke, A.M. Body mass index patterns over 5 year in obese children motivated to participate in a 1-year lifestyle intervention: Age as a predictor of long-term success. Am. J. Clin. Nutr. 2010, 91, 1165–1171.
[26]
Haemer, M.; Ranade, D.; Baron, A.; Krebs, N. Effectiveness of Multidisciplinary Clinical Obesity Treatment in Preschoolers and Children of Monolingual Spanish Speakers. In Proceedings ofPediatric Academic Societies Annual Meeting, Denver, CO, USA, 3 May 2011. Publication number: E-PAS2011:4501.42.
[27]
Robbins, J.M.; Khan, K.S.; Lisi, L.M.; Robbins, S.W.; Michel, S.H.; Torcato, B.R. Overweight among young children in the Philadelphia health care centers: Incidence and prevalence. Arch. Pediatr. Adolesc. Med. 2007, 161, 17–20.
[28]
Baird, J.; Fisher, D.; Lucas, P.; Kleijnen, J.; Roberts, H.; Law, C. Being big or growing fast: Systematic review of size and growth in infancy and later obesity. BMJ 2005, 33.
[29]
Guo, S.S.; Roche, A.F.; Churnlea, W.C.; Gardner, J.D.; Siervegel, R.M. The predictive value of childhood body mass index values for overweight at age 35 year. Am. J. Clin. Nutr. 1994, 59, 810–819.
[30]
Power, C.; Lake, J.K.; Cole, T.J. Body mass index and height from childhood to adulthood in the 1958 British Born cohort. Am. J. Clin. Nutr. 1997, 66, 1094–1101.
[31]
Srinivasan, S.R.; Myers, L.; Berenson, G.S. Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: The Bogalusa Heart Study. Diabetes 2002, 51, 204–209.
Kissebah, A.H.; Vydelingum, N.; Murray, R.; Evans, D.J.; Kalkhoff, R.K.; Adams, P.W. Relation of body fat distribution to metabolic complications of obesity. J. Clin. Endocrinol. Metab. 1982, 54, 254–260.
[34]
Whitlock, E.; Willams, S.; Gold, R.; Smith, P.; Shipman, S. Screening and interventions for childhood overweight: A summary of evidence for the US preventative services task force. Pediatrics 2005, 116, e125–e144.
[35]
Early Childhood Obesity Prevention Policies June 2011. Available online: http://www.iom.edu/Reports/2001/Early-Childhood-Obesity-Prevention-Policies.aspx (accessed on 10 November 2011).
[36]
Perrin, E.M.; Finkle, J.P.; Benjamin, J.T. Obesity prevention and the primary care pediatrician’s office. Curr. Opin. Pediatr. 2007, 19, 354–361.
[37]
Barlow, S.E. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics 2007, 120.
[38]
Rattay, K.T.; Ramakrishnan, M.; Atkinson, A.; Gilson, M.; Drayton, V. Use of an electronic medical record system to support primary care recommendations to prevent, identify, and manage childhood obesity. Pediatrics 2009, 123, S100–S107, doi:10.1542/peds.2008-1755J.
[39]
Ray, R.; Lim, L.H.; Ling, S.L. Obesity in preschool children: An intervention programme in primary health care in Singapore. Ann. Acad. Med. Singapore 1994, 23, 335–341.
[40]
McCallum, Z.; Wake, M.; Gerner, B.; Baur, L.A.; Gibbons, K.; Gold, L.; Gunn, J.; Harris, C.; Naughton, G.; Riess, C.; et al. Outcome data from the LEAP trial: A randomized controlled trial of a primary care intervention for childhood overweight/mild obesity. Int. J. Obes. 2007, 31, 630–636.
Sobko, T.; Svensson, V.; Ek, A.; Ekstedt, M.; Karlsson, H.; Johansson, E.; Cao, Y.; Hagstr?mer, M.; Marcus, C. A randomised controlled trial for overweight and obese parents to prevent childhood obesity—Early STOPP (STockholm Obesity Prevention Program). BMC Public Health 2011, 11.
Wasserman, R.C.; Slora, E.J.; Bocian, A.B.; Fleming, G.V.; Baker, A.E.; Pedlow, S.E.; Kessel, W. Pediatric research in office settings (PROS): A national practice-based research network to improve children’s health care. Pediatrics 1998, 102, 1350–1357.
[45]
Moyer, V.A.; Klein, J.D.; Ockene, J.K.; Teutsch, S.M.; Johnson, M.S.; Allan, J.D. Screening for overweight in children and adolescents: Where is the evidence? A commentary by the childhood obesity working group of the US Preventive Services Task Force; Childhood Obesity Working Group, US Preventive Services Task Force. Pediatrics 2005, 116, 234–238.
[46]
StatsCan. Canadian Community Health Survey. 2004. Available online: http://www.statcan.gc.ca/concepts/health-sante/content-contenu-eng.htm (accessed on 22 October 2011).
[47]
Putnam, S.P.; Rothbart, M.K. Development of short and very short forms of the Children’s Behavior Questionnaire. J. Pers. Assess. 2006, 87, 102–112.
[48]
Randall Simpson, J.A.; Keller, H.H.; Rysdale, L.A.; Beyers, J.E. Nutrition Screening Tool for Every Preschooler (NutriSTEP): Validation and test-retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers. Eur. J. Clin. Nutr. 2008, 62, 770–780.
[49]
Abidin, R.R. Parenting Stress Index, 2nd ed.; Pediatric Psychology Press: Charlottesville, VA, USA, 1986.
[50]
Third National Health and Nutrition Examination (NHANES III). Anthropometric Procedures Video; Centers for Disease Control and Prevention and National Center for Health Statistics: Pittsburgh, PA, USA, 2003.
[51]
The Hospital for Sick Children (SickKids) Research Ethics Board Blood Sampling Guidelines. 2010. Available online: http://www.sickkids.ca/Research/REB/guidelines-procedures-and-policies/index.html (accessed on 21 October 2011).
[52]
Birken, C.S.; Maguire, J.; Mekky, M.; Manlhiot, C.; Beck, C.E.; Jacobson, S.; Peer, M.; Taylor, C.; McCrindle, B.W.; Parkin, P.C. Parental factors associated with screen time in pre-school children in primary-care practice: A TARGet Kids! study. Public Health Nutr. 2011, 5, 1–5.
[53]
Maguire, J.L.; Birken, C.S.; Jacobson, S.; Peer, M.; Taylor, C.; Khambalia, A.; Mekky, M.; Thorpe, K.E.; Parkin, P. Office-based intervention to reduce bottle use among toddlers: TARGet Kids! Pragmatic randomized trial. Pediatrics 2010, 126, e343–e350.
[54]
Birken, C.S.; McCrindle, B.W.; Beck, C.; Mekky, M.; Jacobson, S.; Peer, M.; Taylor, C.; Manlhiot, C.; Smith, K.; Parkin, P. TARGet Kids! A Randomized Controlled Trial to Reduce Screen Time in Preschoolers in the Physician Office Setting: The Media Use in Preschoolers Study. In Proceedings of the Pediatric Academic Society Conference, Baltimore, MD, USA, 2-5 May 2009. Abstract # 2817.178.