Review of the routine monitoring of growth in children of primary school age to identify growth-related conditions

No sound evidence supports weight monitoring to identify and treat obese children, according to a review of worldwide research published this month in the United Kingdom.

“The relative benefits and harms of monitoring have not been determined, and the effectiveness of current treatments is doubtful,” say review authors led by Marie Westwood, Ph.D., of the University of York.

Nevertheless, U.S. experts issued recommendations on June 8 to fight the growing epidemic of childhood obesity. The committee — made up of representatives from 15 organizations of health professionals — urges clinicians to assess children's weight and height annually and then use a staged approach to treatment of overweight youths.

In the United Kingdom, all children are weighed twice in primary school, around ages 5 and 11. Anonymous data go into a national database to track population trends. In 2004, an influential parliamentary committee recommended the additional step of informing parents about their children's results and offering specialist treatment for youngsters who are too heavy.

This objective of the latest review was to determine the effectiveness of the program.

The review is published in the latest issue of Health Technology Assessment, the international journal series of the Health Technology Assessment programme, part of the National Institute for Health Research in the United Kingdom.

The authors analyzed 31 studies on the use of height and weight monitoring to identify growth-related conditions in children. However, none of the studies included were randomized controlled trials comparing monitoring to no monitoring. Instead, existing research focuses on the accuracy of various techniques for measuring and diagnosing conditions such as obesity and growth hormone deficiency, the authors say.

Eleven studies provided data on the performance of measures to identify obesity such as weight, body mass index and skin-fold thickness. The studies were not of adequate size or quality to resolve uncertainties regarding when and how to evaluate children.

Data on the relative benefits and harms of screening versus prevention are needed, the reviewers say. Stigmatization of overweight children and anxiety concerning growth disorders are two possible disadvantages of growth monitoring. Recently, some U.S. school systems have begun to alert parents to their children's BMI numbers, which has led to controversy.

“The value of moving from population monitoring to screening remains at best questionable,” Westwood said. “It's difficult to see how screening to identify individual children can be justified until evidence for the long-term impact of interventions to treat obesity can be demonstrated.”

Even so, the U.S. committee recommends that American health care providers treat overweight children based on their age, body mass index, related medical conditions and family health history. Guidance on healthy dietary and activity patterns is encouraged.

The American Academy of Pediatricians, members of which served on the expert committee, acknowledges the lack of evidence on prevention and early identification of obesity in children. Their policy statement adds, “The enormity of the epidemic, however, necessitates this call to action for pediatricians using the best information available.”

Fayter D, et al. A systematic review of the routine monitoring of growth in children of primary school age to identify growth-related conditions. Health Technology Assessment 11(22), 2007.

The HTA programme is part of the National Institute for Health Research and produces high quality research information about the effectiveness, costs and broader impact of health technologies, with 360 projects published since its inception. About 50 are published each year, all available for free download. It is coordinated by the National Coordinating Centre for Health Technology Assessment, based at the University of Southampton. Visit http://www.hta.ac.uk for more information.