Screening for obese children not justified on current evidence
The health aspects of obesity have been increasingly recognised in recent years. Children have been a particular target of government policy in an effort to catch and ameliorate the problem at a young age, so now their height and weight are measured at school at ages five and 10 years, and the anonymised information is fed into the National Childhood Obesity Database as part of a monitoring programme. There are moves afoot to feed this information back to parents with appropriate advice on healthy eating and exercise for their children. This paper looks at the evidence that such an approach could make a difference in reducing obesity in these children and comes up empty-handed.
The systematic review looked at papers examining aspects of clinical effectiveness of monitoring for overweight and obesity, including: what information was obtained and how; whether the results were accurate; what resources were needed; and whether monitoring made a difference to outcomes for children.
While there was valuable information concerning prevalence and the impact of interventions on populations of obese children, evidence to support many of the standard National Screening Committee criteria for screening was absent. Key points included: there is no agreed standard of obesity identifiable; there are no evidence-based policies about who should be treated; effective management has not been established; and the cost-effectiveness of primary prevention has not been proven.
The authors conclude that although preventive strategies can change behaviour, their long-term effects are not known. The case for screening to identify and treat individual children (as opposed to population monitoring) is unproven on current evidence, and the proposed measures do not meet established criteria.
In my view, it is in no one's interest to initiate programmes that identify ‘obese' children, who then turn up at GP practices expecting medical interventions that simply are not there.
Westwood M, Fayter D, Hartley S et al. Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence. Arch Dis Child 2007;92(5): 416-22Reviewer
Dr Peter Saul
GP, Wrexham and hospital practitioner in paediatrics (asthma and allergy)