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Temporal trends in severe obesity prevalence in children and youth from primary care electronic medical records in Ontario: a repeated cross-sectional study

Sarah Carsley, Eliza I. Pope, Laura N. Anderson, Mark S. Tremblay, Karen Tu and Catherine S. Birken; for the Team to Address Bariatric Care in Canadian Children
May 19, 2019 7 (2) E351-E359; DOI: https://doi.org/10.9778/cmajo.20180174
Sarah Carsley
Department of Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Faculty of Medicine (Pope), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Anderson), McMaster University, Hamilton, Ont.; Healthy Active Living and Obesity Research (Tremblay), Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Family and Community Medicine (Tu), University of Toronto; Toronto Western Hospital Family Health Team (Tu), University Health Network; Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences (Birken), the Hospital for Sick Children; Pediatric Outcomes Research Team, Division of Paediatric Medicine, The Hospital for Sick Children; Department of Pediatric Medicine (Birken), University of Toronto, Toronto, Ont.
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Eliza I. Pope
Department of Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Faculty of Medicine (Pope), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Anderson), McMaster University, Hamilton, Ont.; Healthy Active Living and Obesity Research (Tremblay), Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Family and Community Medicine (Tu), University of Toronto; Toronto Western Hospital Family Health Team (Tu), University Health Network; Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences (Birken), the Hospital for Sick Children; Pediatric Outcomes Research Team, Division of Paediatric Medicine, The Hospital for Sick Children; Department of Pediatric Medicine (Birken), University of Toronto, Toronto, Ont.
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Laura N. Anderson
Department of Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Faculty of Medicine (Pope), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Anderson), McMaster University, Hamilton, Ont.; Healthy Active Living and Obesity Research (Tremblay), Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Family and Community Medicine (Tu), University of Toronto; Toronto Western Hospital Family Health Team (Tu), University Health Network; Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences (Birken), the Hospital for Sick Children; Pediatric Outcomes Research Team, Division of Paediatric Medicine, The Hospital for Sick Children; Department of Pediatric Medicine (Birken), University of Toronto, Toronto, Ont.
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Mark S. Tremblay
Department of Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Faculty of Medicine (Pope), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Anderson), McMaster University, Hamilton, Ont.; Healthy Active Living and Obesity Research (Tremblay), Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Family and Community Medicine (Tu), University of Toronto; Toronto Western Hospital Family Health Team (Tu), University Health Network; Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences (Birken), the Hospital for Sick Children; Pediatric Outcomes Research Team, Division of Paediatric Medicine, The Hospital for Sick Children; Department of Pediatric Medicine (Birken), University of Toronto, Toronto, Ont.
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Karen Tu
Department of Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Faculty of Medicine (Pope), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Anderson), McMaster University, Hamilton, Ont.; Healthy Active Living and Obesity Research (Tremblay), Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Family and Community Medicine (Tu), University of Toronto; Toronto Western Hospital Family Health Team (Tu), University Health Network; Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences (Birken), the Hospital for Sick Children; Pediatric Outcomes Research Team, Division of Paediatric Medicine, The Hospital for Sick Children; Department of Pediatric Medicine (Birken), University of Toronto, Toronto, Ont.
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Catherine S. Birken
Department of Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Faculty of Medicine (Pope), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Anderson), McMaster University, Hamilton, Ont.; Healthy Active Living and Obesity Research (Tremblay), Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Family and Community Medicine (Tu), University of Toronto; Toronto Western Hospital Family Health Team (Tu), University Health Network; Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences (Birken), the Hospital for Sick Children; Pediatric Outcomes Research Team, Division of Paediatric Medicine, The Hospital for Sick Children; Department of Pediatric Medicine (Birken), University of Toronto, Toronto, Ont.
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  • Figure 1:
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    Figure 1:

    Prevalence of overweight, obesity and severe obesity among children aged 18 years or less from 2004 to 2015. Shaded areas represent 95% confidence intervals.

  • Figure 2:
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    Figure 2:

    Multinomial regression model of the association between year (compared to 2004) and prevalence of overweight (top), obesity (middle) and severe obesity (bottom) among children aged 18 years or less. Error bars represent 95% confidence intervals.

Tables

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    Table 1:

    World Health Organization definitions of weight status for children14

    Age, yrBody mass index z-score category; weight status
    < −2≥ −2 to ≤ 1> 1 to ≤ 2> 2 to ≤ 3> 3
    ≥ 5UnderweightNormal weightOverweightObeseSeverely obese
    < 5UnderweightNormal weightAt risk for overweightOverweightObese
    • View popup
    Table 2:

    Baseline characteristics of children in EMRALD, Jan. 1, 2014–Dec. 31, 2015, and the Ontario population of children aged 18 years or less as of Jan. 1, 2015

    CharacteristicNo. (%) of childrenStandardized differencep value
    EMRALD cohort
    n = 31 272
    Ontario
    n = 2 824 213
    Age, yr
     ≤ 415 089 (48.2)591 178 (20.9)0.60< 0.001
     5–96907 (22.1)774 140 (27.4)0.12
     10–145616 (18.0)783 517 (27.7)0.23
     15–183660 (11.7)675 378 (23.9)0.32
    Sex
     Female15 476 (49.5)1 375 466 (48.7)0.020.006
     Male15 796 (50.5)1 448 747 (51.3)0.02
    Neighbourhood income quintile*
     1 (lowest)4255 (13.6)516 726 (18.3)0.13< 0.001
     25979 (19.1)507 046 (18.0)0.03
     36818 (21.8)562 377 (19.9)0.05
     47047 (22.5)639 624 (22.6)0.00
     5 (highest)7018 (22.4)585 113 (20.7)0.04
     Missing155 (0.5)13 327 (0.5)0.00
    Rural*
     No26 199 (83.8)2 522 659 (89.3)0.16< 0.001
     Yes5073 (16.2)300 371 (10.6)0.16
     Missing0 (0.0)1183 (0.04)0.03
    Immigration status
     Child is immigrant523 (1.7)220 095 (7.8)0.29< 0.001
     Mother is immigrant3365 (10.8)524 378 (18.6)0.22< 0.001
    Ethnicity*
     General population29 976 (95.9)2 568 987 (91.0)0.20< 0.001
     Chinese847 (2.7)135 869 (4.8)0.11
     South Asian442 (1.4)117 957 (4.2)0.17
     Missing7 (0.02)1400 (0.05)0.01
    Chronic disease
     Asthma3708 (11.9)547 603 (19.4)0.21< 0.001
     Diabetes76 (0.2)12 644 (0.4)0.03< 0.001
     Complex chronic or congenital condition1541 (4.9)114 769 (4.1)0.04< 0.001
    • Note: EMRALD = Electronic Medical Records Administrative data Linked Database.

    • ↵* Missing data are due to missing/incorrect postal code or missing/wrong name in patient’s record.

    • View popup
    Table 3:

    Prevalence estimates of weight status by age and sex, 2014–2015

    Age group, yrNo. of childrenBody mass index z-score category; % of children (95% CI)
    < −2≥ −2 to ≤ 1> 1 to ≤ 2> 2 to ≤ 3> 3
    All children
     ≤ 415 0894.8 (4.5 to 5.1)75.5 (74.8 to 76.1)14.7 (14.1 to 15.2)4.2 (3.9 to 4.5)0.9 (0.7 to 1.0)
     5–969072.3 (1.9 to 2.7)72.7 (71.7 to 73.8)15.1 (14.3 to 15.9)7.0 (10.6 to 12.1)2.7 (2.3 to 3.1)
     10–1456162.2 (1.8 to 2.6)62.9 (61.6 to 64.2)21.1 (20.0 to 22.2)10.8 (10.0 to 11.6)2.9 (2.4 to 3.3)
     15–1836601.9 (1.4 to 2.3)67.1 (65.6 to 68.6)18.1 (16.9 to 19.4)9.1 (8.2 to 10.1)3.7 (3.1 to 4.3)
     Total31 2723.4 (3.2 to 3.6)71.6 (71.1 to 72.1)16.3 (15.9 to 16.7)6.6 (6.3 to 6.8)2.0 (1.8 to 2.1)
    Boys
     ≤ 476835.0 (4.5 to 5.5)73.7 (72.7 to 74.7)15.3 (14.5 to 16.1)4.8 (4.3 to 5.3)1.2 (0.9 to 1.4)
     5–935522.2 (1.8 to 2.8)71.3 (69.7 to 72.7)15.3 (14.2 to 16.5)7.4 (6.5 to 8.3)3.5 (2.9 to 4.2)
     10–1428242.4 (1.9 to 3.1)61.5 (59.7 to 63.3)20.5 (19.0 to 22.0)12.2 (11.0 to 13.4)3.3 (2.7 to 4.0)
     15–1817372.8 (2.0 to 3.6)64.1 (61.8 to 66.4)19.2 (17.4 to 21.1)10.2 (8.9 to 11.8)3.5 (2.7 to 4.0)
     Total15 7963.7 (3.4 to 4.0)69.9 (69.2 to 70.6)16.6 (16.1 to 17.2)7.3 (6.9 to 7.7)2.3 (2.1 to 2.6)
    Girls
     ≤ 474064.5 (4.1 to 5.0)77.3 (76.3 to 78.3)14.0 (13.2 to 14.8)3.5 (3.1 to 4.0)0.6 (0.4 to 0.8)
     5–933552.3 (1.8 to 2.9)74.2 (72.7 to 75.7)14.8 (13.7 to 16.1)6.6 (5.8 to 7.5)1.7 (1.3 to 2.2)
     10–1427922.0 (1.5 to 2.6)64.4 (62.6 to 66.1)21.8 (20.2 to 23.3)9.4 (8.4 to 10.6)2.4 (2.0 to 3.0)
     15–1819231.0 (0.6 to 1.6)69.8 (67.7 to 71.8)17.2 (15.5 to 18.9)8.0 (6.9 to 9.4)3.8 (3.0 to 4.8)
     Total15 4763.2 (2.9 to 3.4)73.4 (72.7 to 74.1)16.0 (15.4 to 16.6)5.8 (5.5 to 6.2)1.6 (1.4 to 1.8)
    • Note: CI = confidence interval.

    • View popup
    Table 4:

    Adjusted linear regression model of the association of year on body mass index z-score, 2004–2015

    VariableUnadjusted estimate (95% CI)Adjusted estimate (95% CI)*
    Year−0.0146 (−0.0177 to −0.0115)−0.0153 (−0.0184 to −0.0123)
    Age0.049 (0.0476 to 0.0511)0.0496 (0.0478 to 0.0514)
    Income quintile
     10.0802 (0.0473 to 0.1131)0.1427 (0.105 to 0.1804)
     20.0734 (0.0430 to 0.1039)0.1162 (0.0843 to 0.1481)
     30.0627 (0.0338 to 0.0916)0.0931 (0.0645 to 0.1217)
     40.0383 (0.0145 to 0.0099)0.0644 (0.0365 to 0.0924)
     5ReferenceReference
    Sex
     Female−0.0609 (−0.0813 to −0.0404)−0.0703 (−0.0902 to −0.0503)
     MaleReferenceReference
    Residence
     Rural0.1174 (0.0915 to 0.1434)0.0911 (0.0656 to 0.1166)
     UrbanReferenceReference
    Ontario Marginalization Score (continuous)−0.0133 (−0.0261 to −0.0006)−0.0178 (−0.0328 to −0.0028)
    Ethnicity
     General populationReferenceReference
     Chinese−0.2745 (−0.3393 to −0.2097)−0.2063 (−0.2703 to −0.1424)
     South Asian−0.4649 (−0.5604 to −0.3694)−0.3954 (−0.4858 to −0.3049)
    Household immigrant status (reference = no)−0.0916 (−0.1241 to −0.0591)−0.0227 (−0.0552 to 0.0098)
    • Note: CI = confidence interval.

    • ↵* Adjusted for age, sex, rural residence, neighbourhood income quintile, Ontario Marginalization Index, immigration status and ethnicity.

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Temporal trends in severe obesity prevalence in children and youth from primary care electronic medical records in Ontario: a repeated cross-sectional study
Sarah Carsley, Eliza I. Pope, Laura N. Anderson, Mark S. Tremblay, Karen Tu, Catherine S. Birken
Apr 2019, 7 (2) E351-E359; DOI: 10.9778/cmajo.20180174

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Temporal trends in severe obesity prevalence in children and youth from primary care electronic medical records in Ontario: a repeated cross-sectional study
Sarah Carsley, Eliza I. Pope, Laura N. Anderson, Mark S. Tremblay, Karen Tu, Catherine S. Birken
Apr 2019, 7 (2) E351-E359; DOI: 10.9778/cmajo.20180174
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