A needs assessment for obesity-related anticipatory guidance in the paediatric emergency department

Childhood obesity in the ED: A prospective Australian study

OBJECTIVE

To determine (i) the prevalence of overweight and obesity among children presenting to all EDs in a large regional Australian city and (ii) whether age, sex, socioeconomic status (SES) or hospital setting (public vs private) were associated with overweight and obesity.

METHODS

This prospective observational study included children aged ≥2 and <18 years who presented to any of three EDs over an 18 month period who had their height and weight measured. Age, sex and residential postcode were collected. Weight category was determined by sex and age standardised body mass index (BMI) z-score. Weight category was assessed by sex, age, SES and hospital setting with chi-squared tests, and ordinal logistic regression with cluster sandwich error estimators. Results were reported using odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

Data were collected for 3827 children, of which 11.6% were obese and 19.8% overweight. The prevalence of obesity was highest in those aged 8-14 years and in those from lower SES postcodes. The likelihood of obesity was higher in the public than the private hospitals (OR 0.66, 95% CI 0.51-0.86), whereas the likelihood of overweight was similar (OR 1.00, 95% CI 0.83-1.22).

CONCLUSIONS

Almost one-third of children who presented to EDs were overweight or obese. Obesity was particularly high in those aged 8-14 years and those from lower SES postcodes. In the evolving obesity crisis, the high proportion of children presenting to EDs above a healthy weight might represent an opportunity for EDs to identify and refer children for body weight and lifestyle management.

Obesity management in a Paediatric Emergency Department

Increasing numbers of children are either overweight or obese, which has a significant negative impact on their current quality of life and their future health. The results of England's National Child Measurement Programme 2012-13 revealed that approximately one fifth of 4- to 5-year-olds and one third of children aged 10 to 11 years were overweight or obese. Emergency departments (EDs) see large numbers of children every year and therefore represent a potential opportunity to address the obesity issue. A pathway was devised to guide referral of overweight or obese children attending the ED to an existing local healthy living programme. Training sessions on the referral process were provided to ED staff. Audits of ED attendance records were undertaken before and after the implementation of the pathway, and the local programme uptake rate for the first 25 referrals was assessed. Of the first 25 children referred, two (8%) had participated in a programme, six (24%) were on a waiting list, and four (16%) were referred on to services in their local area, giving an overall engagement rate of 48%. Further work needs to be undertaken to increase referrals; however, addressing childhood obesity by accessing existing local services from the ED remains a valuable endeavour.