A High-Precision Protocol for Identification of Preschool Children at Risk for Persisting Obesity

Abstract

BackgroundRecent studies suggest that adolescent adiposity is established already in preadolescence. Earlier studies have confirmed a strong tracking of obesity from adolescence to adulthood. Our aim was to examine the diagnostic accuracy of a population-derived protocol for identification of preschool children at risk for obesity in preadolescence.Methodology/Principal FindingsWe analysed data obtained for child health surveillance up to age 5 from 5778 children born in a Swedish county in 1991. The basic data set included age, sex, and weight and height measurements from the regular checkups between ages 1.5 and 5. Data not routinely collected in the child health centre setting were disregarded. The children were at age 10 randomly assigned to protocol derivation and validation cohorts and assessed for obesity according to IOTF criteria. The accuracy of predicting obesity in the validation cohort was measured using decision precision, specificity, and sensitivity. The decision protocol selected 1.4% of preschool children as being at obesity risk. The precision of the protocol at age 10 was 82% for girls and 80% for boys, and the specificity was 100% for both boys and girls. The sensitivity was higher for girls (41%) than for boys (21%). The relative risk for obesity at age 10 estimated by the odds ratio for individuals selected by the protocol compared to non-selected peers was 212.6 (95% confidence interval 56.6 to 798.4) for girls and 120.3 (95% CI 24.5 to 589.9) for boys.Conclusion/SignificanceA simple and inexpensive decision protocol based on BMI values proved to have high precision and specificity for identification of preschool children at risk for obesity persisting into adolescence, while the sensitivity was low especially for boys. Implementation and further evaluations of the protocol in child health centre settings are warranted.

Importance of Age for 3-Year Continuous Behavioral Obesity Treatment Success and Dropout Rate

“…We regard the more pronounced decline in BMI-SDS in the youngest age group as an effect of treatment. This is supported by the very modest decline in 6- to 8-year-old controls and recent studies showing that from 6 to 7 years of age obesity and overweight have a poor prognosis [34,35,36]. In addition, our observations regarding the poor correlation between the results of 1 year of treatment and 3 years of continuous treatment, the association between the lost to follow-up and age at start of treatment and, finally, the lack of correlation between SES and outcome are all independent of control groups.…”

Prediction of obesity from infancy to adolescence

“…From the perspective of eventual health risks as adults, it would be worthwhile to identify at an early age and offer interventions to those relatively few children with substantially increased risk of maintaining obesity in adulthood, but also at the same time not to intervene when it is not necessary. To identify children at risk, a simple decision protocol that can be used at well-child centres and in school health care is needed to identify individuals who are on trajectories that will lead to persisting obesity (14). Correspondingly, research is needed on cost-effective treatment programmes for young obese children.…”

Age-Related Patterns of Anthropometric Characteristics in Young Wrestlers

“…The BMI is an assessment of BW relative to HT (kgIm j2 ) and has been used as an indirect indicator of body fatness in children and adolescents (3,10,23,24,27,28). The current sample of young wrestlers had significantly lower mean BMI (AG8 and AG12) and waist circumference (AG8, AG9, AG10, and AG12) values, as well as subscapular (AG8, AG9, AG10, AG11, and AG12) and triceps (AG8, AG9, AG10, AG11, AG12, and AG13) skinfold values compared with those of the national sample (16).…”