Epidemiologic approach to planning health promotion health services

Childhood fleshiness is making a major public wellness threat across different states in the universe ( Wang, 2001, WHO, 2000 ; WHO, 2003 ) .It is presently considered as a worldwide epidemic which is spread outing drastically in both the western and the underdeveloped universe ( WHO, 1998 ) . It is linked with legion hazard factors which could take to bosom disease and other chronic diseases afterwards ( Berenson et al. , 1993 ; Berenson et al. , 1998 ; Mahoney et al. , 1996 ) .

Fleshiness is defined as:

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“ an extra accretion of organic structure fat or adipose tissue and is a upset where energy intake inveterate exceeds energy outgo ” ( McArdle et al. , 2001 ) .

Some other factors like endocrinal disfunction or familial factors may besides lend to being overweight ( FAO, 1997 ) .

Fleshiness is normally measured by organic structure mass index ( BMI ) and specific charts are available for kids, which put into consideration tallness and weight fluctuations with age and gender ( Fit -futures, 2006 ) .

A little figure of research have examined the planetary state of affairs sing childhood fleshiness, chiefly due to the fact that no exact step has being established internationally ( Wang, 2001 ) .

This present fleshiness epidemic shows an intense alteration in the general populace over the past 20 – 30 old ages.This have produced an ambiance that promotes an inactive manner of life and feeding of high fat energy dense nutrient ( International Obesity Task Force, 2004 ) .If the rapid acceleration in childhood fleshiness experienced in the last decennary continues, the predicted prevalence will be in surplus of 50 % by 2020 ( Royal College Physicians, 2004 ) .

Background Knowledge

Consequences of an addition in degree of fleshiness among kids

The questions made by ( fit hereafter, 2006 ) confirmed that fleshiness cause a diminution in life anticipation by at least nine old ages. It can besides take to a drastic addition in non-communicable diseases like coronary bosom disease, malignant neoplastic disease, Type II diabetes and high blood pressure.It was established that fleshiness can impact kids self-esteem and emotional wellbeing. Finally ( fit hereafter, 2006 ) testified that corpulent kids are apt to go corpulent grownup. It was besides stated in the ( main medical study, 2008 ) that fleshiness is said to convey approximately about 450 deceases in Northern Ireland every twelvemonth.

Epidemiologic Surveies of childhood fleshiness

World Health Organisation audience on fleshiness concluded that the recent deficiency of uniformity and conformance between diverse surveies over the classification of fleshiness in kids and striplings makes it difficult to give an overview of the world-wide incidence of fleshiness ( WHO 1998 ) .

Obesity Measurement

Fleshiness in childhood was defined by the Centre of disease control and bar as above 95th percentile of BMI for age and at hazard of corpulence as between 85-95 percentiles. Besides the European research workers classified fleshy as or above 85th percentile and fleshiness every bit at or above 95th percentile of BMI ( Cole et al. , 1995 ; Cole et al. , 2000 ) .

Demographic Tendencies

The prevalence of fleshiness varies between cultural groups and is higher in Black Africans ( 39 % ) , Black Caribbean ( 32 % ) , and Pakistani ( 28 % ) adult females ( HSE 2004 ) .

In 2007 an estimated 42 million kids under the age of 5yrs were overweight or corpulent and more than 35 % of corpulence and corpulent kids live in low and in-between income states ( WHO, 2010 ) . Levels of fleshiness are 5 % higher in kids populating in the most deprived countries of the UK compared to the least deprived ( HSE, 2003 ) .

Fleshiness in kids have increased radically in England where about 19 % of male childs between the ages of 2 and 15 old ages are found to be corpulent and 18 % of misss in the same age scope were besides corpulent ( Health for England,2004 ) .This tendency was besides observed among age-group 2-10 old ages, in which they recorded an addition in corpulent kids from 10 % to 16 % in male childs between 1995 and 2004, but at that place was another tendency in misss of the same age by holding 14 % fleshy addition and 12 % corpulent rise in the same twelvemonth with no important difference ( Health Survey for England,2004 ) .


Dehghan et Al ( 2005 ) declared that 25 % 0f kids in the United States are fleshy and11 % are corpulent.Also the National Childhood Obesity Database 2005-2006 found that in England 12.3 % of misss and 13.4 % 0f male childs were found to be overweight when get downing school. This was likely to be underestimated. In Northern Ireland fleshiness degrees are increasing every twelvemonth with 20 % male childs and 25 % misss overweight or corpulent in primary one ( FitFutures,2006 ) .In the western universe about 14 million kids are diagnosed as being overweight. This consist of 3 million corpulent kids, which signifies that the epidemic is impacting over 1 in 4 kids ( International Obesity Task Force,2004 ) .This information is tantamount to around 10-20 % and 20-35 % kids affected in both the Northern and Southern Europe severally ( IOTF,2004 ) .

Demographic Trends Worldwide

Beginning: International Obesity Task Force ( 2005 )

Northern Ireland Trends on Childhood Obesity Fit Futures ( 2006 )

Demographic Tendencies: Prevalence of Obesity and Overweight among 5years olds, England 2005-2006

Hazard Factors of Childhood Obesity

Hardman and Stensel ( 2009 ) claimed that there are two major types of hazard factor that could predispose person to going corpulent in life. They are the non-modifiable and the modifiable hazard factor. The non-modifiable factors consist of gender, age, socio-economic position, cultural background, environment and familial factors, while the modifiable include dietetic consumption, exercising, and behavior.

Epidemiological informations have shown that there are possible relationship between fleshiness and the following modifiable hazard factors. The factors include physical-activity, nutrient consumption and behavior ( WHO, 2001 ) .The Chief medical officer for England confirmed that the kids entire physical activity is affected by the addition in the usage of vehicles, unequal allowance to play outside the place because of traffic and alien concern and the celebrated exposure to computing machine and telecasting every bit good as other inaction ( CMO, 2004 ) .

This written assignment will concentrate on critical assessment of physical activity as a signifier of hazard factor in developing childhood fleshiness.

Rationale for taking physical activity as a hazard factor

This menace on fleshiness was chosen as a hazard factor for childhood fleshiness by seting into consideration past research done by Prentice and Jebb ( 1995 ) where he approximated that the current fleshiness epidemic ( from1980 ) is mediated more by stationariness than by over ingestion of nutrient. The National Centre for Health Statistics ( 2004 ) besides agreed to this fact by reasoning that it is universally accepted by bookmans that the addition in fleshiness is due in portion to the decrease in the degree of physical activity carried out by kids. This was besides supported by ( Boreham, 2001 ) where he agreed that kids today disburse over 600kcal per twenty-four hours which is less than what they expend 50 old ages ago.

Critical Appraisal of literature

First paper

This is a instance control survey carried out by Ochoa et Al ( 2007 ) titled “ Predictor factors for childhood fleshiness in a Spanish case-control survey ” .

The Appropriateness of the survey to the Epidemiological inquiry

The subject is an analytical survey which is analyzing the relationships between wellness position ( fleshiness ) and some other variables like physical activity, household history of fleshiness, dietetic form, breastfeeding and sedentary behaviors. The case-control survey design was made usage of in the research for foretelling hazard factors.


The topics were recruited from the pediatric sections at the Virgen del Camino University Hospital and some other primary attention Centres in Spain.

They included 370 Spanish kids and striplings of ( 6-18 old ages of age ) with 185 instances and 185 control groups which I think covers the kids and adolescent age they meant to utilize.

The anthropometric measurings were taken by trained research workers utilizing standard processs of measuring of tallness and weight to the nearest centimeter and 100g severally.

Face-to-face interviews were conducted in a medical environment with small or no clip force per unit area ; this was performed by trained research workers who gathered the information in an accurate manner.

Exclusion standards

Childs that were exposed to hormonal intervention or development of secondary fleshiness which was due to endocrinopathy or serious intercurrent unwellness were excluded from the survey.

Strengths of the survey

The instances were matched good with the control by taking awareness of the topics ‘ age and gender and they were of equal sample size, with BMI being their lone difference.

Failing of the survey

The accurate appraisal of entire energy consumption was hard to accomplish in corpulent people because it relies on ego reported information. Besides it was pointed out in the survey that there was deficiency of information on the household socioeconomic position or the maternal educational degree. It was besides stated that causal illations on the disease ( fleshiness ) patterned advance are non allowed because predicted variables could be causes or the punishment.

Potential Confounder

The lone confounder found in relation to the survey was nutrient consumption which was adjusted for entire energy consumption.


The decision of the writer was in relation to the consequence quoted

Logistic arrested development produced an uneven ratio ( O.R )

Multivariate conditional logistic arrested development theoretical account of hazard factors for fleshiness was used for variables that showed a statistically important O.R for fleshiness in the theoretical account adjusted for entire energy consumption.


95 % CI


Family fleshiness



& lt ; 0.01

Leisure clip physical activity ( per Met-h/wk )



& lt ; 0.01

Energy consumption ( for100kcal )



& lt ; 0.01

Sugar-sweetened drink ( for each extra serving/d




Watching telecasting ( & gt ; 11.7h/wk )




It is obvious from the above that leisure clip physical activity ( per Met-h/wk ) , energy consumption ( for 100kcal ) had a less than 1 uneven ratio bespeaking that the status of childhood fleshiness is less likely to happen in the instances. This means that if the instances have engaged in a batch of exercising there is likeliness that they avoid being corpulent and besides if the instances have reduced their Calories intake, it is likely that they do n’t develop the status of fleshiness. This was term a “ defensive factor ” against fleshiness in this survey.


95 % CI


Family fleshiness



& lt ; 0.01

Breastfeeding ( for those suckled & gt ; 3mon )




Low birth weight ( & lt ; 2.800kg )




Leisure clip physical activity ( per Met-h/wk



& lt ; 0.01

Sleep ( per h/wk )




Watching telecasting ( & gt ; 11.7h/wk



& lt ; 0.01

It was shown in this consequence that watching telecasting for greater tha11.7h/wk, household history of fleshiness, taking sugar-sweetened drinks is more likely to be a prognostic factor for childhood fleshiness. This is because the uneven ratio that reflected in the survey is greater than one, which indicates that the status is more likely to happen in the instances.

Second Paper This is an ecological survey carried out by Hawkins et Al ( 2009 ) titled “ An Ecological Systems Approach to Examining Risk factors for early Childhood Overweight: Findingss from the UK Millennium Cohort Study ” .

The issue dealt with in this survey was good established by utilizing an ecological system method to place the hazard factors of corpulence and fleshiness in 3-years old kids in the Millennium Cohort survey ( MCS ) in the U K. It is a prospective survey of offspring born in the UK in this new epoch.

The first phase of the survey included about 18 819 three old ages old kids from ( 18 553 households ) , who were given birth to between the period September 2000 and January 2002, and holding a average age of 9.2 months, while the 2nd stage covered about 80 % of the singleton kids that is ( 14 630/18 296 ) .This took topographic point during September 2003 and January 2005 in the four parts of the UK.


All Singleton Children in the MCS were eligible to take part in the survey. The informations were collected from the UK Data Archive, at the University of Essex which include 80 % of all singleton kids ( 14630/18 296 ) .Analysis was carried out on 72 % ( 13 188 ) of singleton kids whose informations were all available.

The coverage was high.The anthropometric information was taken by trained forces utilizing the laid down principle involved in mensurating tallness and weight and recorded to the nearest 0.1cm and 0.1kg severally. The information was gathered on 26 possible hazard factors, which are divided into the undermentioned – Individual ( 6 ) -Birth weight, gender, ethnicity, suckling continuance, debut of solid nutrients and telecasting screening, household ( 13 ) -maternal socio economic position, instruction, lone maternity position, age at first unrecorded birth, age at MCS birth, para, smoke, employment, household income, pre-pregnancy corpulence, parental corpulence, no of kids in family, regular repasts for kids, Community ( 5 ) – easy entree to nutrient stores and supermarkets, neighbourhood conditions, satisfaction with country, entree to safe resort area, entree to garden, Area ( 2 ) -Country, ward type. All this sub-divided hazard factors degrees were reported by parents.


Childhood fleshiness was defined based on the standard cut-offs for BMI. Logistic arrested development analysis was used to gauge adjusted uneven ratios for fleshiness and hazard factors.

Consequences and Interpretation

It shows in the analyse informations that ( 2410 ) of kids which is approximately 18 % were fleshy and an extra ( 691 ) that about 5 % were corpulent at the age of 3years.

Hazard factors Associated with Childhood Overweight and Obesity were: Birth weight, black ethnicity, early debut of solid nutrients ( & lt ; 4months ) , lone maternity, smoking during gestation, parental corpulence, pre-pregnancy corpulence and maternal employment ( 21 hours per hebdomad ) and populating in Wales.

Physical Inactivity and Obesity

No of hours of Television Watching and Obesity

Hours of Television screening

Model 1-individual

Model 2-Family


Model 4-Area

& lt ; 1





a‰?1and & lt ; 3

1.11 ( 0.99-1.25

1.08 ( 0.96-1.22 )

1.08 ( 0.95-1.22 )

1.07 ( 0.97-1.19 )


1.17 ( 1.00-1.36 ) *

1.07 ( 0.91-1.27 )

1.07 ( 0.90-1.26 )

1.08 ( 0.95-1.23 )


In the tabular array above the column on Television screening that shows an Odd Ratio of 1.17 signifies that the corpulent topic were 1.17 times more likely to hold watched & gt ; 3 hour of Television.

Protective factors include Indian ethnicity and breastfeeding ( & gt ; =4 months )

Internal cogency

The possible hazard factors ( single, household, community ) were reported by parents and could be imprecise or endure from callback prejudice.

The survey rely entirely on BMI as an result step, but they could hold measured organic structure fat for a sample of the kids

There was no other informations collected on dietetic intake apart from suckling

Besides there was no other step of physical activity aside from Television observation and this was merely collected at one specific point in clip which could deny us of the temporalty of the collected information.

External cogency

The survey focused on the millenary Cohort survey of kids which can be interpreted to be a representative of all kids in the UK. Due to some restriction the findings can be applied to 3 old ages old kids in the UK.

Third paper This survey was conducted by ( Tremblay and Willms, 2003 ) and titled “ Is Canadian childhood fleshiness epidemic related to physical inaction? ”

This is an epidemiological survey turn toing a clearly focussed issue, which was to analyze the dealingss among kids ‘s physical activity, sedentary behaviors and BMI. It covered 7-11 old ages old but could hold used a larger age-range as original study looked at newborn to 11years old kids.


The research sample was obtained from Canada ‘s Labour Force study which is a representative of Canada ‘s population.

The informations used was gathered from the “ National Longitudinal Survey of Children and young person ( NLSCY ) ” ( Statistics Canada Catalogue 1994 ) .The study was a national representative of Canadian kids but it excluded kids populating in Indian militias, kids in establishments, and kids in distant parts. This research was assessed in a pilot survey prior to informations aggregation.

Strength and failings

The survey did non turn to how families were contacted and whether studies were conducted via interview, by station or other methods

There was 86 % respondent rate which a big figure of respondents ( 13,439 )


The BMI was reported by “ a intelligent individual ” . Some were self-reported utilizing the kid ‘s tallness and weight. Others were assessed straight but the per centum was unknown.

The truth of the ego and parental studies would hold to be queried. Through this, the BMI could hold being underestimated as a consequence of measuring prejudice in the recorded weight and tallness.

BMI is said to be a unsmooth estimation step of fleshiness and non the most accurate, but is normally accepted as a valid index of organic structure composing.

The fleshiness was defined by utilizing the international age and gender specific cut-off points for BMI.

The physical activity measured by the study was broken down distinctively into organised athletics, unorganized athletics, physical activities. The dislocation was good because it was non generalised, but should be careful in picturing decision, because the inquiry stated was “ in the last 12 months ” . There was callback prejudice in some of the reported informations, so nonsubjective steps ( accelerometer ) could be incooperated but on a smaller sample to verify consequences.

Analysis and Interpretation

Logistic arrested development does non presume that the relationship between the variables is a additive relationship..This besides produces an Odds Ratios ( O.R ) .



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