Waist-to-height ratio detects fat obesity in children and adolescents better than BMI, study finds
Ameasure of obesity in children and adolescents that could replace body mass index (BMI) has been identified in a new study as waist circumference-to-height ratio. This detected excess fat mass and distinguished fat mass from muscle mass in children and adolescents more accurately than BMI. The study, published in Pediatric Research, was conducted in collaboration between the universities of Bristol, Exeter and Eastern Finland.
The authors say that, for nearly a generation, weight-to-height ratio charts and BMI for age and sex have been used to diagnose children with obesity. However, these assessment tools are inaccurate in childhood and adolescence as they do not distinguish fat mass from muscle mass. Two children with similar BMI might have different proportions of fat and muscle mass, which makes obesity diagnosis difficult.
Tools such as the DEXA scan accurately measures fat and muscle content of the body, but this device is not readily available in primary healthcare centres. Recently, the American Academy of Pediatrics published a clinical guideline on childhood obesity and requested urgent research on inexpensive and accurate alternative measures of obesity. Emerging studies in adults appear to suggest that waist circumference-to-height ratio predicts premature death better than BMI and could be a potential added tool to BMI measure in improving the diagnosis of obesity. However, there has been no evaluation of how much waist circumference-to-height ratio measurements agree with DEXA-measured fat mass and muscle mass during growth from childhood to young adulthood.
The research included 7237 children (51% females) aged 9 years who were followed up until age 24 years from Children of the 90s data. Their BMI and waist circumference-to-height ratio were measured at ages 9, 11, 15, 17, and 24 years. Waist circumference-to-height ratio had a very high agreement of 81–89% with DEXA-measured total body fat mass and trunk fat mass, but a low agreement with muscle mass (24–39%). BMI had a slightly high agreement with total fat mass and trunk fat mass (65–72%) and muscle mass (52–0.58%). As BMI had a slightly high agreement with DEXA-measured muscle mass, it is difficult to specify whether BMI measures excess fat or muscle mass, the study found.
Dr Andrew Agbaje, Physician and Pediatric Clinical Epidemiologist at the University of Eastern Finland, said: ‘This study provides novel information that would be useful in updating future childhood obesity guidelines and policy statements. The average waist circumference-to-height ratio in childhood, adolescence, and young adulthood is 0.45, it does not vary with age and among individuals like BMI. Waist circumference-to-height ratio might be preferable to BMI assessment in children and adolescent clinics as an inexpensive tool for detecting excess fat. Parents should not be discouraged by the BMI or weight of their children but can inexpensively confirm whether the weight is due to increase in excess fat by examining their child's waist circumference-to-height ratio.’
Looking after the NHS workforce ‘must be a top priority’, says workforce commission
Looking after the NHS workforce is not only an ethical imperative but also a sound investment and must be a top priority, say experts in the third report of The BMJ Commission on the Future of the NHS.
From improving basic working conditions to planning for the impact of AI, the authors set out a vision to enhance the stewardship of the NHS workforce.
In the most recent (2023) NHS Staff Survey, only a quarter (26.4%) of respondents said there were enough staff at their organisation for them to do their job properly, just over a quarter (25.6%) are satisfied with their pay, and only 42% say they are satisfied with the extent to which their organisations value their work.
The Commission brought together leading experts from medicine and healthcare to identify the key challenges and priorities and make recommendations aimed at ensuring that the vision of the NHS is realised.
The recommendations include making workforce stewardship a key priority at all levels, improving workplace conditions, and improving workforce planning.
Calling for a collaboratively designed national framework for NHS employers to improve working environments for all NHS staff, the report identifies the need for more effective people management, proactively enforced standards relating to antidiscrimination and anti-racism, and better systems for addressing problematic culture and behaviour. Stressing the importance of operational management to support the effective running of the NHS, it notes the strong evidence from other areas, such as manufacturing, about the contribution of effective management to organisational success and employee wellbeing. The report strongly emphasises the need for workforce planning, new technologies, and new roles to be treated as major, novel interventions that require consultation and rigorous design and evaluation.
‘The future of the NHS depends on the people who work in it,’ write the authors, led by Mary Dixon-Woods from the Healthcare Improvement Studies Institute at the University of Cambridge. ‘But at the moment the NHS simply does not have enough staff to deliver on its goals and commitments: it remains underdoctored, under-nursed, and undermanaged in comparison with other countries. Staff are routinely exposed to very challenging workplace conditions, yet organisations demonstrate significant weaknesses in addressing the problems – ranging from adequate toilet facilities and water access through to bullying and harassment.
‘Quite apart from the ethical imperative to look after the NHS workforce, there are strong arguments that doing so will improve efficiency, productivity, and patient experience and outcomes. As the largest workforce in Europe, investing in the staff of the NHS is also a sound investment in population health’.
They note that some of their recommendations can be managed at organisational level while others will need to be led from the top of government and the NHS centre. However, they conclude: ‘Much stronger leadership and accountability for people and their development at all levels, from Whitehall downwards, is now needed.’
Latest measles statistics published for England
The latest number of laboratory confirmed measles cases in England have been published in an updated epidemiological overview by the UK Health Security Agency.
It says that since the last update the previous week, there have been a further 66 laboratory confirmed measles in England, bringing the total number of cases confirmed since 1 October 2023 to 934.
Although the outbreak in the West Midlands initially drove the increase in cases, in recent weeks there has been an increase in activity in London, with smaller clusters ongoing in the East Midlands and the North West.
In the 4 weeks since 4 March 2024, there have been 190 laboratory confirmed measles cases. The highest number of cases were reported from the West Midlands (67 of 190, 35%), London (63 of 190, 33%) and the East Midlands (21 of 190, 11%). During this period, all regions have had confirmed cases.
Since 1 October in England there have been 934 laboratory confirmed measles cases:
The majority (587 of 934, 63%) of these cases were in children aged 10 years and under and 29% (275 of 934) in young people and adults aged 15 years and over.
Dr Vanessa Saliba, UKHSA Consultant Epidemiologist, said: ‘We know that hundreds of thousands of children around the country, particularly in some inner-city areas are still not fully vaccinated and are at risk of serious illness or life-long complications but measles is completely preventable with vaccination. Our childhood vaccinations campaign is reminding parents of the importance of ensuring their children are vaccinated. Parents should check their child's Red Book now to ensure that children are up to date with their MMR and other routine vaccines. If you're unsure, contact your GP practice. They will bring your child up to date if necessary. If the NHS is in touch about catching up on missed vaccines, please respond as soon as possible.
Turn to page 127 in this issue for Bethany Boddy's Last Word article on vaccination uptake in children and the health visitor role.
QNI Ambition to Lead Programme open for applications
The Queen's Nursing Institute (QNI) has said it is rebranding its leadership programme for professionals working in the community, primary care and social care. The Ambition to Lead Programme, formerly known as Aspiring Nurse Leaders programme, is now also open to allied health professionals (AHPs), as well as nurses working in the community with a minimum of 5 years of experience. Areas of practice may include, but are not limited to, nurses working in district nursing, general practice nursing, community children's nursing, learning disability nursing, community matrons, community mental health and health visitors.
The programme is designed to support the professional development of participants to become future leaders in healthcare. Participants engage in a diverse range of learning experiences, including presentations, online sessions, lectures, and group work, collectively contributing to a transformative 12-month journey. With a strong emphasis on mentorship and hands-on projects, the programme aims to cultivate resilient and visionary professionals poised to make meaningful contributions to their communities. Dr Cate Wood, The QNI's Director of Nursing Programmes (Leadership & Standards), has expressed appreciation for the foundations laid by her predecessor, emphasising a commitment to building upon existing strengths while also refining the programme to meet current needs and incorporate feedback from past participants.
Dr Wood said: ‘At the QNI, we are dedicated to fostering a new generation of leaders who are equipped to navigate the complexities of modern healthcare. With the reimagined programme, we aim to empower nurses and AHPs from diverse backgrounds to unlock their full potential and drive positive change in healthcare in the community.’
Steph Lawrence MBE, Executive Director of Nursing and Allied Health Professionals from Leeds Community Healthcare and Leeds GP Confederation, highlights the transformative impact of the programme and benefits to the employing organisation:
‘Many of our staff have now been on the [renamed] Ambition to Lead programme and I would encourage all employers to consider sending their staff. Our staff learn new skills and really progress and develop their leadership skills. The programme is for nurses and AHPs and our organisation has benefitted hugely from it due to the enhanced skills and knowledge our staff have brought back to the organisation.
‘The staff themselves have also developed new networks and this in turn benefits them and the organisation, learning from others and sharing ideas. We continue to send our staff on this amazing programme.’
The Ambition to Lead programme is open to all nurses and allied health professionals working in community settings and interested in developing their leadership skills. Applications for 2024 are open from 2 April until 6 May 2024. Go to: https://qni.org.uk/explore-qni/leadership-programmes/ambition-to-lead-programme.
Public satisfaction with NHS at lowest ever level, survey finds
The National Centre for Social Research (NatCen) British Social Attitudes (BSA) survey has found satisfaction with the NHS has reached an all-time low.
The survey is conducted each year, and measures British people's levels of public satisfaction with health services. This year's report focuses on how society has changed over the last 40 years, exploring gender roles and work, sexual relationships, family and moral issues, class identity, the role of government, the generation and gender gap in politics, welfare and poverty trends. Only 24% of respondents said they were satisfied with the NHS, with their concerns being waiting times and staff shortages. In 2010, 70% said they were satisfied with the NHS.
Rory Deighton, Director of the Acute Network at the NHS Confederation, said: ‘While these stark findings make difficult but unsurprising reading, they should not take away from all the incredibly hard work of NHS staff caring for patients in the face of a pandemic, industrial action, staffing shortages and a flat revenue settlement in the Spring Budget. The fact that a large majority of respondents feel the NHS has a major or severe funding problem shows that the public recognises the challenges that the NHS faces. Despite satisfaction with the NHS dropping to a new low the British public still ultimately believe in what the NHS does and what it stands for, with nearly half of people surveyed saying they support the government increasing taxes and spending more on the NHS. This should be food for thought to politicians ahead of an election. In order to meet the challenges the NHS needs the right support and resources from government. That is why we are calling on the next government to put in place a 12-month stabilisation plan, boost capital funding to repair dilapidated buildings and invest in new equipment, and to commit to delivering and fully funding the workforce plan while drawing up an equivalent one for social care.’
Professor Pat Cullen, RCN General Secretary and Chief Executive said:
‘Nursing staff will respond with mixed emotion today – great sorrow that we have sunk this low and hope that the public shares their view that ‘enough is enough’. It did not have to be this way and it did not start with the pandemic either. Voters must now make NHS and care services the central issue of the general election.
‘Across the NHS and social care, nursing staff deliver the vast majority of care and there is no turning around the fortunes of either without them. The public understands this, but so must those in government. Bringing down waiting times and improving care requires investment in nursing to improve pay and conditions and stabilise the workforce. Any party wanting to be in Downing Street in a year must demonstrate clear intent.’