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Obesity in children: Severity should be based on health issues, not just BMI, say researchers

Gauging the severity of a child’s obesity based only on body mass index (BMI) fails to identify health issues — particularly mental health — of those seeking care, shows a new study with University of Alberta ties.

Researchers showed that using a plan called the Edmonton Obesity Staging System for Pediatrics (EOSS-P) was more useful for understanding health issues of affected children than BMI, which just measures weight against height.

Details of the study, called the Canadian Pediatric Weight Management Registry (CANPWR), were published Tuesday in The Lancet Child & Adolescent Health.

“We found that social and mechanical health issues were more common in those with the highest body mass index. However, mental health issues, for example, are consistent across the BMI groups,” said Katherine Morrison, principal investigator of the CANPWR study, and professor of pediatrics at McMaster University.

“If you are only using BMI to identify the youth who need the most care, you would be presuming the kids with the lowest BMI class would be the least likely to have mental health issues or metabolic issues, but our findings suggest this is not true. This study suggests that using a clinical staging system, one that evaluates the health of the child and not just the BMI, is likely the best approach.”

The three-year CANPWR study — including clinics in Edmonton, Calgary, Vancouver, Toronto, Hamilton, Ottawa and Montreal — aims to identify and improve what influences the success children in weight management programs achieve.

The paper used information from 847 children aged five to 17 with obesity. Their health issues were determined at the initial visit to one of the multidisciplinary weight management clinics across Canada.

Obesity-related health issues were common, with mental health concerns the most prevalent at 90 per cent, followed by metabolic at 85 per cent, social at 65 per cent, and mechanical at 62 per cent.

“Our results match what most health professionals working in weight management see in their clinics every day — mental heath concerns are very common among children with obesity,” said Geoff Ball, CANPWR co-investigator, Alberta Health Services Chair in Obesity Research, and professor of pediatrics at the University of Alberta in Edmonton.

“This highlights the need to have mental health professionals such as psychologists and social workers available and accessible for families, both in clinical and community settings.”

The greatest mental health issue identified in the study was anxiety.

The most commonly identified metabolic health complication was dyslipidemia, followed by non-alcoholic fatty liver disease.

Bullying was the most commonly identified social health factor, followed very closely by low household income.

More than one-third of children in the highest obesity group came from low-income homes, significantly higher than those with lower levels of obesity.

Those with the most severe obesity by BMI were more likely to have experienced bullying, and more likely to report difficulties with peer relationships, compared to the less severe obesity groups.

Researchers suggest that using a clinical staging system will better assist the design of health care interventions for children with obesity.

The study is funded by the Canadian Institutes of Health Research (CIHR), McMaster University’s Faculty of Health Sciences, McMaster Children’s Hospital Foundation, and the Ontario Ministry of Health and Long-Term Care.