Introduction Background Methodology Findings Implications for practice

1. Pre-school healthy kids check and immunisation: BMI, parent and nurse perception and parent level of concern. NSW Rural Health and Research Congress October 2013Monica MurrayLachlan Health Service Western NSW Local Health District Forbes and Parkes, NSWmonica.murray@gwahs.health.nsw.gov.au

2. Session Outline IntroductionBackgroundMethodologyFindingsImplications for practice

3. 63.4% adults overweight or obese Australian Health Survey 2011/12 • Excess weight gain increases the risks of developing chronic disease • Drivers - biology - environment - individual - socio-demographic factors - life stages Introduction - Population health

4. Children aged 5-17 yrs25 % overweight (18%) and obese BMI (8%) ( Australian Health Survey 2011/12) • Pre-school children 18.7% SPANS 2010 • Weight at 5 years predictive of weight at 9 years (Gardiner et al 2009) • High BMI in childhood high risk of obesity in adulthood (Singh et al 2008, Baird et al 2005 Juonala 2011) • Less than healthy habits established in childhood, increases a child’s associated health risks such as cardiovascular disease, high blood pressure and Type 2 diabetes. Introduction - Childhood prevalence

5. Poor uptake of Go4Fun, anecdotal ambivalence, normalisation of excess weight • Healthy Kids Check 3-5 years • Increased Federal government support through Medicare Locals • Local ‘real’ data Background – rationale for study

6. BMI of Australian children • Health professional estimations • Parent estimations • Parent level of concern Background – what is already known?

7. Body Mass Index (BMI) adjusted-age-gender Comparison between the US Centre for Disease Control (US-CDC) and International Obesity Taskforce (IOTF) BMI classification systems for overweight and obesity in 2-18 year olds. Joliffe & Janssen 2006 Background – BMI

8. Research Question “What are the BMI of rural children presenting for their four year old healthy kids check and immunisation and are there associations between actual BMI-for-age, nurse and parental estimation of BMI (or weight status) and parental concern regarding child weight?

9. Design • Observational Study • March 2012-2013 • GP Practice & CHC • Paper survey + nurse visual estimation + measurement Participants • Children aged 3-5 years • Practice Nurses and Community Health Nurses • Parents (CHC) Methodology

10. 107 children BMI recorded (53 CHC and 54 GP clinic) • No statistical difference between children who presented at the CHC or GP clinic • 53 parents completed survey (CHC) • 53 Nurse ‘weight status estimations’ (CHC) Results

11. Results: BMI demographics

12. 89% of parents expressed no concern about weight and 11% were concerned about underweight • Of the 11% concerned about underweight – 83% actually had healthy or overweight BMI • None of the parents of children with elevated BMI’s – expressed concern about their child’s weight status Results: Parental Perceptions

13. By visual estimation alone (pre-measurement) on 53 children, community nurses; • correctly estimated 35 children with underweight and healthy BMI • incorrectly estimated all 18 children with overweight and obese BMI Results: Nurse Perceptions

14. One in three pre-school children BMI in overweight or obese category (US-CDC), (1:4 using IOTF) • Parents are not aware and are not concerned • By visualisation alone, nurses have low recognition • Inconsistent awareness and use of BMI, detection and management of overweight and obesity in children Implications for Practice

15. Consistent clinical practice across disciplines • Education and support to use BMI and enabling communication skills • Closer Integration • Local appropriate clinical pathways – based on Australian Guidelines • Community development strategies Where to from now?

16. Thank you!