Overweight and obesity development and school health care interventions over primary school years
Year: 2021
Type: dissertation
Study design: Observational Study
Abstract: The objective of this thesis was to analyse obesity screening and treatment practices in school health care, patterns of overweight and obesity development of primary school children, and the associations of psychosocial family- and school-related characteristics to overweight and obesity development. School health care stands crucial for primary prevention of obesity and offers a natural setting for childhood obesity interventions. Yet, screening and treatment of obesity in primary health care has been revealed to be inadequate and prospective longitudinal studies in unselected populations and in Finland are lacking. Additionally, data on childhood obesity consistency, progress and, especially, resolution remain scarce yet are all fundamental for risk evaluation. Furthermore, targeted prevention and treatment of obesity calls for methods for identifying children with potential to develop obesity without natural resolution. The study cohort of this longitudinal retrospective register study consisted of 2000 randomly selected primary school sixth graders aged 12-14 who studied in Helsinki in 2013. Of these, using weight-for-height references, 402 children were affected by overweight at least once since their first grade, 172 by obesity, and 1278 held normal weight over primary school. Electronic health record (EHR) data on growth measurements of the 574 children were manually collected for the study. These were enhanced with the entries of their visits at primary health care and from their pre-seventh grade school health checks. Development of the children’s overweight and obesity during six primary school years was explored by 1) comparing weight categories between early-life and primary school age (Study I), 2) utilising flexible latent class mixed models (LCMM) on body mass index standard deviation score (BMI SDS) to explore groups (latent classes) of children with similar weight development (Study III), and 3) applying Markov multistate models to examine rates of transitioning between BMI SDS categories of normal weight, overweight and obesity (Study IV). Associations of psychosocial family- and school-related factors with weight categories were examined in Study I, and with transition rates in Study IV. School health care personnel’s ability to screen, diagnose and offer overweight-related interventions was analysed in Study II. Whether the actualised interventions were associated with resulting latent classes was investigated in Study III. Obesity started early in primary school and was fairly consistent. The identified overweight trajectories, five for girls and four for boys, converged around age 10, after which only some continued into obesity. Of the yearly transitions from one weight category to another, the highest 1-year probability for girls was staying in overweight category and for boys in obesity category. Compared to children with overweight, a larger fraction of children with obesity had experiences of crises or being bullied or had special needs in studying (Study I). Among girls, transitions into obesity were associated with divorced or single parent families, and decreased resolution from obesity was associated with non-native families (Study IV). Among boys, experiences of crises and being bullied were related to obesity development and to decreased resolution from overweight. Annual nurse assessments actualised well, and school physicians met almost all children with obesity at grade 5 health checks. Of overweight-related extra visits to school physicians, half took place without parents (Study II). Parents accompanied their children at 6% of extra visits to school nurses. Merely a third of the children with obesity received a diagnosis for obesity, even though overweight and obesity were well detected. Overweight-related interventions were mostly offered to children with obesity, less to children of ascendant trajectories (Study III). Typical overweight development patterns, along with their associations with family- and school-related factors, should be noticed when planning individual treatments or health check programs. By doing so, individual treatments could actualise better, and we could benefit more from the limited resources of school health care. Health check programs should be carefully scrutinised, as one of the conclusions of the study points to potential advantages if extensive health checks at 5th grade were actualised earlier or scheduled more flexibly. Working methods, long-term treatment plans, involvement of parents and diagnosis of obesity were found to be areas requiring development and further studies.
Source: Työväentutkimus Vuosikirja
Author: Paula Häkkänen
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3122790724