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A Secondary Analysis of the Cross-Sectional Data Available in the ‘Welsh Health Survey for Children’ to Identify Risk Factors Associated with Childhood Obesity in Wales.

Presented by :Claire BeynonSupervisor :Professor David Fone, Cardiff University

Claire Beynon

Why is childhood obesity a problem?• Prevalence of childhood obesity in Wales 12%.• Impacts on both quality and quantity of life.• Immediate effects:

low self esteem; bullying; depression; type II diabetes.

• Long term effects:Premature mortality; adult morbidity.

• Obesity costs £73 million per annum in Wales.

Claire Beynon

Why is childhood obesity a problem?

Lobstein and Jackson Leach in Foresight Report, UK Government Office for Science, 2007.

Claire Beynon

Research Question• What are the important risk factors for childhood

obesity for children aged 4 to 15 years in Wales?

Research Objectives• Identify and quantify cross-sectional associations

between obesity in children in Wales aged 4-15 years and the risk factors available in the Welsh Health Survey.

• Make recommendations for policy where appropriate.

Claire Beynon

Study Design• Secondary Analysis of Data from the WHS.

• Dataset included n=11,279 children (aged 4-15 years) between 2008 and 2011.

• Descriptive statistics, and logistic regression.

Claire Beynon

Risk Factors• Socio-demographic/socioeconomic variables:

Sex, age, National Statistics Social Classification (NSSEC), housing tenure and Welsh Index of Multiple Deprivation (WIMD).

• Lifestyle variables: Unhealthy food consumption; sugar sweetened beverages; physical activity (PA) levels

• Illness: Currently treated illnesses.

Claire Beynon

Results

Risk Factor Odds Ratio 95% CI P valueSex Male Reference

Female 0.79 0.70 to 0.89 p<0.001*

Age 4-6 Reference

7-9 1.42 1.19 to 1.70 p<0.001*

10-12 1.65 1.39 to 1.97 p<0.001*

13-15 1.44 1.20 to 1.73 p<0.001*

Significant association between childhood obesity and the following factors denoted with *

Claire Beynon

ResultsRisk Factor OR 95% CI P value

NSSEC 3 Professional/ Managerial Reference

Intermediate 1.17 0.98 to 1.38 0.08

Routine/ Manual 1.32 1.14 to 1.54 p<0.001*

WIMD Lowest Reference

Low 1.08 1.19 to 1.70 p=0.44

Mid 1.23 1.01 to 1.50 p=0.04*

High 1.33 1.09 to 1.62 p=0.005*

Highest 1.23 0.99 to 1.53 p=0.06

Claire Beynon

ResultsRisk Factor OR 95% CI P value

Illness No illness Reference

One illness 1.20 1.05 to 1.38 0.008*

Two or more illnesses 1.50 1.22 to 1.85 p<0.001*

Physical Activity

Meets recommendation Reference

Does not meet recommendation

1.33 1.17 to 1.52 p<0.001*

Claire Beynon

Results

Risk Factor OR 95% CI P valueFruit & Veg Not daily Reference

Both daily 0.96 0. 85 to 1.09 p=0.82

SSB Not daily Reference

Daily 1.02 0.83 to 1.27 p=0.82

Junk food Not daily Reference

Daily 0.89 0.79 to 1.01 p=0.08

No significant association between childhood obesity and the following factors:

Claire Beynon

Strengths of the study• WHS uses stratified random sampling.• Results for 3000 children achieved per annum.• Good response rate at 75%.• Known confounding accounted for by use of multivariable

analysis.• Provides new insights into existing data.• Information from Wales on which to base Welsh policy.

Claire Beynon

Limitations of the study• Risk of bias, e.g. recall bias; reporting of food

consumption and physical activity reporting. Non response bias.

• Reverse causality possible due to study design.• Selection bias, private homes surveyed (not

institutions).• Unknown confounding possible (not all risk factors

measured).• Interactions not explored.

Claire Beynon

Conclusions• Some risk factors associated with childhood obesity

are not modifiable (e.g. sex and age of the child). • Some risk factors are not easily modifiable in the short

term, e.g. the circumstances of the family (NS-SEC classification of the parent and housing tenure).

• Two findings are potentially more easily modifiable:

– the association between childhood obesity and not meeting the PA recommendations

– the NHS response to the care planning of children with a long term condition.

Claire Beynon

Recommendations• Increase physical activity in schools to an hour a day,

so all children have levels of PA that protect them from obesity without increasing inequalities in health.

• Extend the number and type of physical activity options available to children across Wales both in schools and out of school.

• Utilise the CMP feedback to provide advice on relevant physical activity options that are affordable and accessible e.g. green spaces; walks; free swimming.

• Ensure all children with a long term condition get help to avoid or manage obesity through an holistic care package.

Claire Beynon

Current Recommendations• Physical activity

Claire Beynon

ResultsSignificant association between childhood obesity

and the following factors: • being female OR 0.79 (95% CI: 0.70 to 0.89, p<0.001);• older age categories than the reference group (4-6

years) with ORs varying between 1.42 and 1.65 (all significant at p<0.001);

• parents being in the routine, manual, never worked or long term unemployed group OR 1.32 (95% CI: 1.14 to 1.54, p<0.001);

Claire Beynon

ResultsSignificant association between childhood obesity

and the following factors: • mid and high quintiles of the WIMD.

OR for mid 1.23 (95% CI: 1.01 to 1.50, p=0.04) and for high deprivation OR 1.33 (95% CI: 1.09 to 1.63, p=0.005);

• having one or two currently treated illnesses.OR for one illness 1.20 (95%CI: 1.05 to 1.38, p=0.008) and for two or more illnesses OR 1.50 (95% CI: 1.22 to 1.85, p<0.001)

• not meeting the PA recommendations OR 1.33 (95% CI: 1.17 to 1.52, p<0.001).