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Record: 1
  Title:Childhood obesity: should primary school children be routinely screened? 
  A systematic review and discussion of the evidence (Structured 
  abstract)Author:Centre for Reviews and Dissemination (CRD)Document 
  Information:This Structured Abstract is unmodified; commented this issue. 
  First published: 2007.Includes CRD COMMENTARY section.Feedback or comments on 
  the data can be sent to:Centre for Reviews and DisseminationUniversity of 
  YorkYork, EnglandYO10 5DDFax: (+44)-1904-433661email: revdis@york.ac.ukReview 
  Information:Title: Childhood obesity: should primary school children be 
  routinely screened? A systematic review and discussion of the 
  evidenceReviewer(s): Westwood, M; Fayter, D; Hartley, S; Rithalia, A; Butler, 
  G; Glasziou, P; Bland, M; Nixon, J; Stirk, L; Rudolf, MSource: Archives of 
  Disease in Childhood ISSN: 00039888; 2007; v. 92(5), p416, (416-422)Document 
  URL: URL for original research: 
  http://adc.bmj.com/cgi/content/full/92/5/416/DC1Source(s) of Support:Review 
  Funding Body: NIHR Health Technology Assessment Programme (project number 
  04/09/02).Implications:Practice: The authors stated that effective 
  interventions were required to justify a move from population monitoring to 
  screening to identify and treat individual children. Policy makers should 
  consider the validity of the National Screening Committee criteria as a 
  measure against which general health monitoring programmes were assessed. 
  Research: The authors stated that further large‐scale well‐designed studies 
  were required to identify effective preventative measures and weight‐reducing 
  interventions for overweight children and obesity in children. Long‐term 
  studies were warranted to identify outcomes of obesity in adulthood and thus 
  clarify the predictive value of diagnostic tools.CRD Commentary:This 
  well‐conducted review answered a clear research question supported by 
  appropriate inclusion criteria. Attempts were made to identify all the 
  relevant literature by searching several electronic databases and other 
  sources without language limitations. Validity was assessed according to 
  published criteria and attempts were made to minimise errors and bias at each 
  stage of the review process. Appropriate methods were used to analyse the 
  data. There were a number of limitations (such as the small number of studies 
  included in the review and the poor reporting within the studies), which made 
  it difficult to assess the reliability and generalisability of the results. 
  The authors acknowledged the limitations and their conclusions and 
  recommendations are likely to be reliable.Cochrane Source Information:This 
  document should be cited as: Childhood obesity: should primary school children 
  be routinely screened? A systematic review and discussion of the evidence 
  [Database of Abstracts of Reviews of Effects DARE-12007001666]. In: The 
  Cochrane Library, Issue 1, 2011. Chichester, John Wiley & Sons Ltd. Abstract 
  of: Childhood obesity: should primary school children be routinely screened? A 
  systematic review and discussion of the evidence. Westwood, M; Fayter, D; 
  Hartley, S; Rithalia, A; Butler, G; Glasziou, P; Bland, M; Nixon, J; Stirk, L; 
  Rudolf, M. Archives of Disease in Childhood 2007:92(5): 416-422.Accession 
  Number:DARE-12007001666Database: Database of Abstracts of Reviews of Effects


Childhood obesity: should primary school children be routinely screened? A 
systematic review and discussion of the evidence (Structured abstract)
Westwood M, Fayter D, Hartley S, Rithalia A, Butler G, Glasziou P, Bland M, 
Nixon J, Stirk L, Rudolf M. Childhood obesity: should primary school children be 
routinely screened? A systematic review and discussion of the evidence 
(Structured abstract). Archives of Disease in Childhood, ISSN: 00039888; 2007; 
92,(5) p416, (416-422) CRD summary 
This well‐conducted review concluded that there was insufficient evidence to 
determine the effectiveness of population monitoring and screening for 
overweight and obesity in primary school children. Various methodological and 
reporting issues made it difficult to assess the reliability and 
generalisability of the results, but the authors considered the limitations and 
their conclusions and recommendations are likely to be reliable.
Authors' objectives 
To determine the clinical effectiveness of monitoring for obesity and overweight 
in primary school children.
Searching 
MEDLINE, EMBASE, CINAHL, DARE, Cochrane Controlled Trials Register and other 
electronic databases were searched through to July 2005. Experts in the field 
were contacted for unpublished and audit data. Inclusion was not restricted by 
language. The search strategy was available on request.
Study selection 
All study types except case reports were eligible for inclusion. 
Studies that used assessment tools to monitor or screen for overweight children 
and obesity as part of a population‐level assessment of children’s health were 
eligible for inclusion. Included studies used the following indices with varying 
thresholds: (relative) body mass index (BMI); (relative) weight; percentage body 
fat; or skinfold measures (scapular or triceps).
Included studies reported one of the following outcomes: effects on management 
and outcome; comparison of diagnostic and reference standard tests; measures of 
attitudes towards monitoring; and implications on human resources. Studies with 
a primary objective to study prevalence were excluded. Included studies reported 
sensitivity and specificity for accuracy of tests, attitudes towards monitoring 
and human resource implications of monitoring. Data were collected directly from 
study participants or from external sources.
Studies involving children aged four to 11 years who lived in Western Europe, 
North America or Australia/New Zealand were eligible for inclusion; studies 
involving aboriginal populations were excluded. Included studies assessed 
children with weighed ages ranging between three and 20 years from various 
ethnic backgrounds living in the United States of America, Australia and Canada. 
The proportion of males ranged from 41% to 52%.
Two reviewers independently screened studies for relevance. Disagreements were 
resolved through discussion or by consultation with a third reviewer.
Validity assessment 
Studies had to use a reference standard that provided a direct measurement of 
the percentage body fat. Included reference standards used x‐ray densitometry 
(thresholds greater than or equal to the 85th, 90th or 95th centile), 
hydrostatic weighing (threshold greater than or equal to 20% or 25%) or isotope 
dilution (threshold greater than 20% or 30%).
Study quality was assessed by one reviewer and checked by a second using the 
QUADAS tool; disagreements were resolved through consensus or consultation with 
a third reviewer.
Data extraction 
One reviewer extracted data, which were checked by a second reviewer. Agreement 
was reached through consensus or by consultation with a third reviewer. Data 
were extracted for each outcome and sensitivity, specificity and 
positive/negative predictive values were calculated, with 95% confidence 
intervals (CIs) where appropriate.
Methods of synthesis 
Due to their heterogeneous nature, studies were reported separately by outcome 
intervention. Results were reported as a narrative synthesis and presented in 
tables. Differences between the studies were discussed in the review text and 
tables.  
Results of the review 
Eleven studies (n=13,388 children weighed) plus two additional studies (n=252 
children weighed for one study) that reported on human resource implications of 
monitoring and attitudes to monitoring were reported in the review. The analysis 
focused on five studies (n=2,203) that reported on the diagnostic performance of 
indices of overweight and obesity. None of the studies were controlled trials 
and none assessed the effectiveness of monitoring. 
Study quality: The five studies included in the analysis met between 5 and 9 of 
the 12 QUADAS criteria and did not meet the National Screening Committee (NSC) 
criteria for monitoring in individual children. 
BMI was used most often to measure overweight and obesity. Sensitivity analysis 
for diagnostic accuracy ranged between 0.00 and 0.94 and specificity ranged 
between 0.83 and 1.00. Sensitivity and specificity analyses for diagnostic 
accuracy of weight ranged between 0.17 and 0.58 (sensitivity) and 0.95 and 0.98 
(specificity) and for skinfold measures between 0.23 and 0.97 (sensitivity) and 
0.82 and 1.00 (specificity). CIs were reported. Significant heterogeneity 
between studies was reported.
Authors' conclusions 
There was insufficient evidence to determine the effectiveness of population 
monitoring and screening for obesity; further research was required. 
CRD commentary 
This well‐conducted review answered a clear research question supported by 
appropriate inclusion criteria. Attempts were made to identify all the relevant 
literature by searching several electronic databases and other sources without 
language limitations. Validity was assessed according to published criteria and 
attempts were made to minimise errors and bias at each stage of the review 
process. Appropriate methods were used to analyse the data. There were a number 
of limitations (such as the small number of studies included in the review and 
the poor reporting within the studies), which made it difficult to assess the 
reliability and generalisability of the results. The authors acknowledged the 
limitations and their conclusions and recommendations are likely to be reliable.
Implications of the review for practice and research 
Practice: The authors stated that effective interventions were required to 
justify a move from population monitoring to screening to identify and treat 
individual children. Policy makers should consider the validity of the National 
Screening Committee criteria as a measure against which general health 
monitoring programmes were assessed.
Research: The authors stated that further large‐scale well‐designed studies were 
required to identify effective preventative measures and weight‐reducing 
interventions for overweight children and obesity in children. Long‐term studies 
were warranted to identify outcomes of obesity in adulthood and thus clarify the 
predictive value of diagnostic tools.
Funding 
NIHR Health Technology Assessment Programme (project number 04/09/02).
URL for original research 
http://adc.bmj.com/cgi/content/full/92/5/416/DC1 
Record status 
This record is a structured abstract produced by CRD. The original has met a set 
of quality criteria. Since September 1996 abstracts have been sent to authors 
for comment. Additional factual information is incorporated into the record. 
Noted as  [A:....].
CRD database number 
DARE‐12007001666
Index terms Medical Subject Headings (MeSH) 
[Subject indexing assigned by NLM]


Copyright Statement
Copyright © 2011 University of York. Published by John Wiley & Sons, Ltd.
Source:  This document should be cited as: Childhood obesity: should primary 
school children be routinely screened? A systematic review and discussion of the 
evidence [Database of Abstracts of Reviews of Effects DARE-12007001666]. In: The 
Cochrane Library, Issue 1, 2011. Chichester, John Wiley & Sons Ltd. Abstract of: 
Childhood obesity: should primary school children be routinely screened? A 
systematic review and discussion of the evidence. Westwood, M; Fayter, D; 
Hartley, S; Rithalia, A; Butler, G; Glasziou, P; Bland, M; Nixon, J; Stirk, L; 
Rudolf, M. Archives of Disease in Childhood 2007:92(5): 416-422.
Item: DARE-12007001666


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