Why weight wait? Dr Harriette Carr Deputy Director of Public Health Population Health and Prevention Ministry of Health February 2019 - Health ...
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Why weight wait?
Dr Harriette Carr
Deputy Director of Public Health
Population Health and Prevention
Ministry of Health
February 2019
Why Weight?
In 2016/17 NZHS
Adults Mean 10 Years ago Mean height Mean BMI
weight (kg/m2)
Male (15+) 87kg 84.7kg 175.8cm 28.1
Female (15+) 75.3kg 72.1kg 162.5cm 28.5
Children (aged 14
yrs)
Boys 62kg ns 168.3cm
Girls 61.4kg ns 163.2cm
Where is the weight going? Waist circumference: Across all population groups and ages waist circumference has slowly increased: Males: 97.1 cm (95.1 cm in 2006/07) Females: 88.4 cm (85.2 cm in 2006/07))
Clinical Weight Management Guidelines 2016/17
3 Changes:
• a shift in emphasis to regular monitoring and early intervention;
• key recommendation for primary care being to regularly monitor
height, weight and growth for all, and to provide brief advice if trending
towards excess weight rather than waiting until a person is obese
before intervening
• the introduction of a new growth chart for five to eighteen year olds (under
development), and
• the inclusion of sufficient sleep as an aspect of weight management.
Update on Growth Charts The Growth Charts will be based on the WHO growth reference population/ WHO growth standards. Obesity definitions: >3sd on z-score for 2-5 year olds >2sd on z-score for 5-18 year olds The change to the growth charts will impact on rates of overweight and obesity, BUT the focus should be on individual change over time rather than a single point in time
Growth Chart Project
Goal:
All New Zealanders regularly have their growth (children and young people),
and weight measured, with BMI monitored
- Facilitated by patient management systems that provide the functionality to
record, monitor and plot trend lines
- Enable/support healthy weight conversations between practitioners and
patients
Stocktake Aim – to determine current practice for monitoring growth and identify essential and recommended features of a patient management system Method Mixed method – interviews with PMS vendors - 3 key user interviews - Online survey of users (using Citizen space)
Results 173 responses – range of individuals, practices and organisations - All DHBs represented - Plunket – one combined response
Work setting and role
Where do you work? What3.47%
is your role?
5.78%
3.47%
0.58%
7.51% 7.51%
24.28%
11.56% 45.66%
67.05% 31.21%
Nurse
DHB
GP
For children and young people, when do you
record height and weight?
What parameters related to their growth
do you record?
13.29%
31.79%
5.78%
33.53%
94.22%
12.72%
56.65%
26.59% 23.70%
91.33%
At every appointment
At least once a year Weight Height
Only when concerned about their growth/weight BMI Head circumference
Only when prescribing medication Waist circumference Not applicable
Not applicable Waist-to-height ratio Surface area measurement
Not Answered All of the above4.62%
For adults, when do you record weight? What parameters related to their
growth do you record?
6.36%
24.86%
65.90%
39.88%
30.64%
23.70%
61.85%
62.43%
35.84%
At least once a year
Not applicable Weight Height
Only when concerned about their growth/weight BMI Not Applicable
Only when prescribing medication Waist circumference Waist-to-height ratio
Surface area measurement All of themDo you use electronic or paper-based Why do you use a printed/paper-based
(printed) growth charts? growth chart?
1.73%
10.40%
8.09%
11.56% 21.39%
8.67%
47.40%
12.14%
30.64%
15.03%
It helps me explain things to patients
I have no access to an electronic version
Only electronic growth charts It is handy
Both Other
Only paper-based growth charts The one from PMS doesn't offer what I want
I don’t use growth charts I think it is more accurateWhen your patients are transferred or referred to/from
another health practitioner, do you receive/provide records of
height, weight and BMI
10.40%
2.31%
15.03%
4.62%
12.72% 64.74%
20.23%
46.82%
23.70%
33.53%
Online (PMS functionality) 35.26%
Printed copies
Sometimes By fax
Always By email
Only when relevant
Never Patient book/copybook of records
Not Answered Not AnsweredWhich PMS do you normally use?
15.03%
1.16% 4.05%
2.89%
3.47%
3.47%
62.43%
4.62%
9.83%
Medtech 1 Concerto Mypractice
Intrahealth Plunket HER Indici
Best Practice (BPGold) I don't know OtherWhat are the features you consider a PMS should contain to
monitor the growth and weight journey of your patients?
Weight
Height
Gender
Age
BMI
Date of birth
Graphs
Connectivity with other PMS (can send records online)
Graphs can be printed/faxed
Calculate percentiles and standard deviation
Previous records (history)
Ability to plot or print a letter with measurement records (to…
Waist circumference
Head circumference
Predicted future weight/growth
Display growth chart for a medical condition (i.e. trisomy 21,…
Growth velocity
Zoom in-out on graphs
Capture current treatment (e.g. growth hormone)
Display bone age measurements with actual age measurements
Display midparental height
Data capture from measurement devices (eg digital scales)
0% 20% 40% 60% 80% 100%Why is sleep important? Sleep is essential for growth and development Inadequate good-quality sleep is associated with: • Weight • School performance • Driver safety • Emotional and behavioural difficulties • Risky behaviour • Dietary intake Children regularly sleeping less than the recommended amount 2x as likely to be overweight or obese
Sleep problems
Common
• Up to 1/3 of parents of infants and toddlers report their child has a sleep
problem that negatively impacts on the family
• 2/3 of adolescents report their sleep needs not met
• Note that sleep apnoea may be caused by obesity
Proposed mechanisms:
• Sleep deprivation impacts both sides of energy balance equation
• Greater time awake -> more time to eat more, and affects appetite
regulation ->greater energy intake
• Less sleep -> feeling more tired -> less physical activity and decreased
energy expenditureInterventions to improve sleep • Evidence linking sleep to obesity is strong, • BUT - evidence on effective interventions is limited. • Promoting sleep hygiene (practices) is recommended approach
Sleep
Age group (years) Recommended Percentage
hours meeting
(rounded down to the recommendation
nearest hour)
(%)
Toddlers (2) 11 to 14 66
Preschoolers (3-4) 10 to 13 84
School-aged children
9 to 11 77
(5-13)
Teenagers (14-17) 8 to 10 79
Young adults (18-25) 7 to 9 79
Adults (26-64) 7 to 9 74
Older Adults (65+) 7 to 8 53Adult Weight Management Guidelines Supporting resources Summary of the Guidelines Popular diets review Sleep tips for adults Getting started with your weight loss plan Also: Healthy Weight Gain during Pregnancy
Supporting resources Healthy Conversation Skills Training: Particularly aimed at conversations with pregnant women and parents/caregivers of young children re nutrition and physical activity http://www.healthystartworkforce.auckland.ac.nz/en/our-education- programmes/healthyconversations.html
Spotting a good and poor diet
A good diet … A poor diet …
aims for reasonable weight loss (less than 1 kg per week) promises rapid or unrealistic weight loss (more than 1 kg per week)
excludes some key food groups, such as grains and cereals or dairy
includes all major food groups (vegetables and fruit, grains and
products, and is at odds with current Ministry of Health healthy
cereals, low- or reduced-fat dairy products, some protein foods)
eating advice
is rigid and doesn’t provide you with enough energy (less than 800
is flexible and provides a realistic amount of food
kcals / 3350 kjoules per day)
doesn’t fit your lifestyle, and is hard to follow long term. Limits your
fits your lifestyle and is easy to follow long term
opportunities to share food with friends and family
promotes the use of a specific company’s foods or supplements only
promotes the use of normal, affordable whole foods
(eg, shakes or bars)
requires you to make major changes that are not sustainable long
helps you make small changes that are sustainable long term
term
does not include physical activity. Includes a special supplement or
includes regular physical activity
gadget that claims to help you burn fat or lose weight
makes you feel satisfied, in control and happy makes you feel hungry, irritable, constipated or depressed
results in other benefits, such as lower cholesterol, lower blood
results in disadvantages such as increased cholesterol, poor sleep
pressure, smaller waist circumference, better sleep and improved
and concentration, and low moods
mood
allows you all foods either in moderation or as a treat (eg,
bans certain foods
recommends portion control)How We Eat An issue based document in the EAG Series A graded review of the evidence on selected food and eating behaviours related to diet and body size (S Gerritsen and C Wall): • breastfeeding • parental feeding practices and parenting style • adult role modelling • responsive eating • mealtimes • food literacy
Eating and activity guidelines Commencing update of maternity and 0-2 Eating and Activity Guidelines For more information visit: http://www.health.govt.nz/our- work/eating-and-activity-guidelines
Sit Less, Move More, Sleep Well: Physical Activity Guidelines for Under-Fives
Regular active play, limited sitting, and enough good-quality sleep are important for a child’s health
and development.
Sit Less Move More Sleep Well
1. Provide regular activity 1. Provide fun activities (at least 1. Babies: 14 to 17 hours
breaks to limit the three hours every day for toddlers 2. Infants: 12 to 15 hours
amount of time a child and pre-schoolers, spread 3. Toddlers: 11 to 14 hours
spends sitting. throughout the day). 4. Pre-schoolers: 10 to 13 hours
2. Discourage screen time 2. Include plenty of opportunities
for under-two year olds for active play.
and limit to less than one
hour every day if two
years or older – less is
best!
3. Limit time in equipment
that restricts free
movement.Posters
11 - 14 hours
per daySit Less, Move More, Sleep Well
Physical Activity Guidelines for Children and Young People aged 5-17
A healthy 24-hours for children and young people includes:
• 9 to 11 hours per night (for those aged 5 to 13 years) and 8 to 10 hours per
night (for those aged 14 to 17 years), with consistent bed and wake-up times
• at least 1 hour per day of moderate to vigorous physical activity - variety
Vigorous and muscle-strengthening physical activities at least 3 days a week
• no more than 2 hours per day of recreational screen time
• breaking up sitting time and participating in a variety of light physical
activities for several hours.Health Promotion Agency Series of videos with advice on: Starting the Obesity Conversation (Prof Hayden McRobbie) Food in Pacific cultures (Mafi Funake-Tahifote) Building relationships with Maori and whanau (Dr Kiriana Bird) The role sleep plays in obesity (Assoc Prof Barbara Galland) Getting children moving more (Jo Collin) What is healthy eating (Angela Berrill) http://nutritionandactivity.govt.nz/talking-about-childhood-obesity
Healthy Weight Being a healthy weight Learn about the factors affecting your weight and what you can do to achieve and maintain a healthy weight. Read more Measuring weight Health professionals use the BMI calculator and other tools to measure and categorise a person’s weight into obese, overweight, healthy or underweight. Read more Healthy weight BMI calculator Use our BMI calculator to find out if you or your child are a healthy weight. Read more https://www.health.govt.nz/your-health/healthy-living/food-activity-and- sleep/healthy-weight
Help with managing your weight
Whatever your weight management goal, it helps to have a plan. Information
about weight management for adults. Read more
Healthy weight gain during pregnancy
It’s normal to gain some weight during pregnancy due to the growth of the
baby, placenta and fluid around the baby. But too much extra weight can
increase your risk of complications. Read more
Healthy eating for young children
Weight is a sensitive issue, even for small children. Here are some ideas to help
you eat healthy food as a family. Read more
Healthy eating for children
Tips to help 5–12 year olds to eat a healthy and balanced diet. Read more
Healthy eating for teenagers
Tips for teenagers on eating a healthy and balanced diet. Read moreWeight Management at HIIRC Keep up to date with the latest research on nutrition, physical activity, obesity, and weight management. The Weight Management site at HIIRC has been running since 2008, and focuses on New Zealand nutrition, physical activity and obesity/weight management research — including unpublished and published reports and articles, and in-progress research. There is information on New Zealand researchers, news and upcoming conferences, New Zealand health promotion resources, links to useful tools and relevant international research. The site allows New Zealand researchers, evaluators, policy makers and service providers to interact and collaborate — post information, start discussions, and leave comments. Open access. Sign up to receive email updates. https://weightmanagement.hiirc.org.nz/
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