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While we greatly enjoyed Mary C J Rudolph’s “Best Practice” article on “The Obese Child”,1 we cannot agree with her conclusion that obesity fulfils most of the criteria for a condition that justifies screening. Our own local experience in Solihull, West Midlands, might illustrate this point.
Using a grant from the Children’s Fund (www.cypu.gov.uk/corporate/childrenstrust/index,cfm) we aimed to set up a “Fit Club” serving children aged 7–11 in seven wards in Solihull, with DETRI deprivation indices ranging from 7.53 to 54.49. All seven wards contain enumeration districts with deprivation indices in the worse 15% of the country.
We attempted to recruit 20 children, for an initial consultation phase, in which they and their families would be able to discuss with our multidisciplinary team the kinds of services they would like to tackle the child’s weight. They would be able to try out various exercise programmes if they wished, as well as receiving dietetic advice, and as an incentive we also offered £10.00 worth of fresh fruit and vegetables. The only criterion for recruitment was that the child should be perceived to have a weight problem both by their family and professionals.
We attempted to recruit children via contact with school nurses, recommendation from general practitioners, and an advertisement in the local paper. To our disappointment, we found that we were able to recruit only four children. GPs had forwarded seven names, of whom one actually made contact with the service, while the school nurses informally fed back that families felt that their child’s weight was not an issue on which they needed to take action. A final attempt at recruitment, based on one large primary school with support of teaching staff, was similarly completely unsuccessful. It would seem likely that a difference in perception of the seriousness of overweight and the need for action between parents and professionals explained our disappointing outcomes.2
Our experience thus leads us to believe that detecting obese or overweight children by screening will not substantially alter the scale of these problems on a population basis, although services for those that do request them are clearly justified.
Author’s reply
Drs Haisman, Matyka, and Stanton describe their disappointing and frustrating experience of offering a programme for obese children. However this experience cannot be used to argue that screening would have no value.
My comment that obesity fulfils most of the criteria for screening was based on the fact that: it is a common condition with serious consequences; it can be identified in its early stages; and it is potentially reversible. If it was reversed the costs of identifying obese children would be more than offset by the savings in health care later. The big “but” is the one (and very major) problem that we cannot offer effective treatment. If we can resolve that, then undoubtedly we should be screening our school age population.
The Solihull experience is not universal. With current sympathetic media interest the climate is changing and we are finding that families are seeking help. Our WATCH IT community based programme in Leeds has 65 children enrolled with good attendance and we now have a waiting list.
Rather than dismiss the idea of screening at some point in the future, let us argue for more resources to develop clinically effective interventions.