Introduces the use of the CARES mnemonic to engage dental care professionals in conversations about weight with children and their families.
Childhood obesity remains one of the largest health challenges faced in the United Kingdom (UK). Recent data from England (2022/23) have stated that the prevalence of obesity in 4-5-year-olds is 9.2%. For 10-11-year-old children, the prevalence rises to 22.7%. There are marked variations in rates of obesity depending on sex, deprivation and ethnicity. While there is minimal difference between rates of obesity by sex at a younger age, this difference increases with age (4-5-year-olds: 9.3% M vs 9.0% F; 10-11-year-olds: 25.1% M vs 20.1% F).
Health inequalities are abundant within England, where obesity prevalence varies with deprivation. The rates of obesity are higher in the most deprived areas (12.4% for 4-5-year-olds) compared to the least deprived (5.8% for 4-5-year-olds). This is also seen in 10-11-year-olds, with 30.2% in the most deprived areas compared to 13.1% in the least deprived.
Variation in prevalence of obesity was also evident when categorising by ethnicity. For 4-5-year-olds, Black children had the highest rates of obesity (13.6%) compared to Chinese children (4.2%). Similarly, for 10-11-year-olds, prevalence of obesity in Black children (31.6%) was over twice that for Chinese children (15.2%). Most children included in the Children Measurement Programme 2022/23 were white, representative of the national picture, with 8.9% of 4-5-year-olds and 21.4% of 10-11-year-olds being reported as obese. Increasing access to social media and potentially unachievable appearance aspirations highlights the importance of being mindful that underweight prevalence in 10-11-year-olds was 1.6% in 2022/23, which is the highest recorded rate since 2009/10.
Individuals who live with obesity in childhood are more likely to live with obesity in adulthood. Obesity is associated with serious health consequences including type 2 diabetes, cardiovascular disease (including health disease and stroke), some cancers (including endometrial, breast and colon) and musculoskeletal disorders (including osteoarthritis), which can result in significant disability and early death.
Furthermore, obesity-related conditions place an increased financial burden to the NHS (National Health Service) and wider economy, costing the UK £6.5 billion per year. Upstream government initiatives aim to reduce the prevalence of obesity in adults and children, including the Soft Drinks Industry Levy, restrictions on the placement of less healthy food in shops and online, and calorie labelling. These measures cost millions of pounds but aim to reduce the burden of obesity on our healthcare services and the wider economy.
Due to shared risk factors and their largely preventable natures, obesity and dental caries are often closely associated. The most recent National Dental Epidemiology Programme for England in 2022 assessed the oral health of five-year-old children and found that almost one-in-three (29.3%) five-year-olds had enamel and/or dentinal caries. Focusing on the 23.7% of five-year-olds with dentinal caries, each child had a mean of 3.5 teeth with dentinal caries experience. Geography, deprivation and ethnicity were both reported as significant markers of variation. Children living in North West England were more likely to have enamel and/or dentinal caries than those in South West England (38.7% vs 23.3%). Children in the most deprived areas in England were almost three times more likely to experience dentinal caries than those living in the least deprived areas (35.1% vs 13.5%), further highlighting the impact of health inequalities. Children of 'Asian or Asian British' and 'Other' ethnicity had significantly higher prevalence of dentinal caries than other ethnic groups (44.8% and 37.7%, respectively). Research suggests a correlation between obesity and dental caries instead of a causation, with children who are underweight, overweight, or very overweight being more likely to experience dental caries than those of a 'healthy' weight. Similarly, one study based in the Netherlands could not find a relationship between body mass index (BMI) and dental caries.
With similar risk factors and demographic disparity, dental healthcare professionals are well placed to be proactive in observing children's weight and signpost or refer to medical practitioners where appropriate and when consent is granted. The British Society of Paediatric Dentistry support the interdisciplinary working between medical and dental colleagues to facilitate onward referral and raise awareness of known shared risk factors. They advised that paediatric dentists should 'be supported to have "healthier weight" conversations with children and their families'.
Dental secondary care centres receive a high number of referrals for children with dental caries per year. Due to complexity of treatment and/or patient co-operation, a high proportion of these children will be listed for a dental general anaesthetic (DGA). Dental extractions remain the most common reason for a hospital admission in children aged 6-10 years old. Prior to their DGA, children will have their height and weight recorded to allow appropriate prescription of anaesthetic drugs. To aid this process and allow appropriate DGA listing, a quality improvement project (QIP) was conducted at a London dental hospital.