1. Dr Aniva Lawrence

2. National Issues RGPN conference 13/03/2015 New Minister of Health’s priorities: 1. Fiscal responsibility of DHBs 2. Shifting of services into communities 3. Child Obesity

3. How Big is the Problem? 2012/3 NZ Health Survey 1 in 9 children (aged 2–14 years) were obese (11%) a further 1 in 5 children were overweight (22%) 19% of Māori children were obese 27% of Pacific children were obese children living in the most deprived areas were 3 times as likely to be obese as children living in the least deprived areas. This finding is not explained by differences in the sex, age or ethnic composition of the child population across areas of high and low deprivation the childhood obesity rate has increased from 8% in 2006/07 to 11% in 2012/13.

4. And this is why it’s just getting worse…. Figure 96. Proportion of Children Aged 5–14 Years Who Usually Use Active Transport to and From School by Gender and Ethnicity, 2006/07 and 2011/12 NZ Health Surveys

5. Figure 97. Proportion of Children Aged 5–14 Years Who Usually Use Active Transport to and From School by Gender, Age, Ethnicity and NZ Deprivation Index Decile, 2011/12 NZ Health Survey

6. Northland factors??

7. Proportion of Secondary School Students Aged 13–17+ Years who Spend 3+ Hours Each Day on Selected Sedentary Leisure Activities, New Zealand Youth’12 Survey Source: Youth’12 Survey; Note: Computer games excludes physically interactive computer games like Wii

8. But look at what’s at our doorstep…

9. Then there’s nutrition… FIZZY DRINKS! 20% children aged 2–14 years had a fizzy drink three or more times in the past week. Boys were more likely to have had three or more fizzy drinks in the past week than girls. In addition, older children (10–14 years) were more likely to have consumed three or more fizzy drinks in the past week (28%) than those aged 2–4 years (13%).

10. SOFT DRINKS Children living in the most deprived areas were more likely to have had a fizzy drink three or more times in the past week (25%) than children living in the least deprived areas (15%). After adjusting for ethnic group, age and sex, children living in the most deprived areas were 1.8 times as likely to have had three or more fizzy drinks as children living in the least deprived areas.

11. FAST FOOD 7% children aged 2–14 years ate fast food three or more times in the past week. Māori children were nearly twice as likely as non-Māori Pacific children were three times as likely to have eaten fast food more than three times in the past week as non-Pacific children. Children living in the most deprived areas were more likely to have eaten fast food three or more times in the past week (12%) than children living in the least deprived areas (2%) again adjusting for age, sex and ethnicity!

12. But really it’s….

13. National Comparison Data 2006/7 NZHS Regional Differences - The prevalence of obesity in children living in Counties Manukau was significantly higher than the national rate, while the prevalence of obesity amongst children living in Waitemata and the Bay of Plenty / Taranaki / MidCentral was significantly lower (5.2-5.9 prevalence) Counties Manukau Prevalence of Child Obesity 12.7 (95% CI) Northland Prevalence 8.9 (6.6-11.2)

14. Northland Data 2011-2013 NZHS Usually watched 2+ hours of television each day (2–14 years)52.852.50.91 Obesity (2–14 years)10.310.80.83 Asthma (medicated) (2–14 years)17.414.20.30 Diagnosed emotional or behavioural problems (depression, anxiety disorder, ADHD/ADD) (2–14 years)5.93.80.36 Visited a GP in the past 12 months (0–14 years)75.574.30.65 Visited a practice nurse (without seeing a GP at the same visit) in the past 12 months (0–14 years)27.225.60.61 Visited an after-hours medical centre in the past 12 months (0–14 years)22.820.90.49 Experienced unmet need for primary health care in the past 12 months (0–14 years)26.119.60.10 Northland NZ

15. Local Case Examples Young Maori boy (10 yrs. old) referred by school due to falling asleep in class – always tired, seen by PHN at school but not referred so principal came in physically to clinic to book him in to be seen. Morbid obesity – signs of acanthosis nigricans already Mum very difficult to engage – has 5 children, this son only one obese, eventually disclosed that he has always eaten everyone’s left overs, lots of encouragement to agree to referral, grandmother diabetic in 50’s, grandfather MI 55yo. Referred to paeds – Severe OSA – on CPAP now Requires regular medical monitoring re: BP and Bloods

16. Paihia

17. Local case examples 9yr old Maori female with asthma and hearing loss – keep in mind children/youth with ongoing health conditions esp. with asthma re: steroid use, exercise induced asthma. Chronic conditions can be an excuse for parents to excuse them from PE. Monitored from 2011 (started ht 127, wt 42kg) -2013 – tried Motivational Interviewing and changes to activity, lunches and food with mum. Growth monitored 3mthly with prescriptions. 2013 due to Ht 140cm, Wt 56kg BMI 28.8. Healthy Lifestyle Program referral. 2015 – BP 116/75, WC 100cm, Ht 148, Wt 67.2, BMI 30.7

18. Local Case Examples 12 year old Pacific student seen in school based health services – retrospective review of previous GP’s notes… Seen in 2006 Ht 111.5cm, Wt 36kg. Next seen in 2011 due to injury and documented “obese child” in notes and sent for xray to exclude SUFE but no height and weight taken Seen in Nov 2013 at school clinic due to sore foot. Ht 159cm, Weight 101, BMI 40. Mum involved re: weight and referral for podiatric input as not participating in PE due to sore foot. Represented Feb 2015 – Ht 166cm, Weight 110kg, BMI 39.9. Parental consent. Referral to Healthy Lifestyles Loves to swim – not allowed to join gym with mum at aquatic centre until she is 13. Doesn’t play any other sports, Mum works full time so time with nana after school some days. No other hobbies or interest in sport.

19. Recognition of Concern in Primary Care Growth charts – How often should we be reviewing children's weight and height – annually at least? Dashboard reminders? Active recalls? Early Free Under 13 rollout initial trends Children with Health conditions Maori and Pacific children School based clinics / Relationships with SMT and teachers

20. Growth Charts

21. How to combat an epidemic? Plunket / Tamariki Ora / B4School checks Child and Youth Friendly City Initiative Project Energize / Enhanced school based health services Cycle-ways Children’s Green Scripts Fiscal responsibility of food retail outlets – Northland wide Voluntary levy from any sales of sugar Accessibility to bariatric surgery for young adults who meet criteria FUNDING?!!

22. Next Steps ANY OTHER IDEAS – open discussion ? Creation of a Child specific strategy this year collectively for Northland and some key evidence based projects. Application to SIF