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 2013 Monica Murray Lachlan Health Service Western NSW Local Health District Forbes and Parkes, NSW monica.murray@gwahs.health.nsw.gov.au NSW Rural Health and Research Congress October 2013 Monica Murray Lachlan Health Service Western NSW Local Health District Forbes and Parkes, NSW monica.murray@gwahs.health.nsw.gov.au

2. Introduction Background Methodology Findings Implications for practice Session Outline

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 - environment - individual - individual - socio-demographic factors - socio-demographic factors - life stages - life stages Introduction - Population health

4.  Children aged 5-17 yrs 25 % overweight (18%) and obese BMI (8%) ( Australian Health Survey 2011/12)  Pre-school children 18.7%  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 support through Medicare Locals Locals  Local ‘real’ data Background – rationale for study

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

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. Where to from now?  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 based on Australian Guidelines  Community development strategies

16. Thank you! Thank you!