Maja Engsner: Preventing Childhood Obesity: Monitoring BMI Growth and Evaluating an Early Intervention

Abstract

The overarching objective of this thesis was to improve early detection and prevention of childhood obesity through better monitoring of BMI development and by exploring whether early family focused interventions can support healthy BMI development. 

Paper I reviews commonly used growth references for monitoring children with severe obesity and describes the development of the “Reference point BMI from adjusted World Health Organization (WHO) population” (R-BMI). R-BMI was designed to avoid SD-score compression, align paediatric cut-offs with adult BMI thresholds, and provide a clearer and more accessible growth-chart format for clinical use. 

Paper II describes early BMI growth corresponding to the time period of the Swedish CHS program for children in the ULSCO cohort. Children were within normal BMI range from birth to one year. Divergence among patients appeared around 1.5 years of age, followed by an accelerated BMI increase. By the final five-year visit more than half of patients (53%) had exceeded the obesity threshold. 

Paper III evaluates potential spillover effects on childhood BMI, in a cluster randomised controlled trial, of the Safe Environment for Every Child (SEEK) model. Children in the intervention condition demonstrated a healthier BMI development, closer to the median of the WHO growth standard, over two years compared with controls (ßinteraction = -0.48 SD, 95% CI -0.60, -0.29, p < 0.001). 

Conclusion Taken together, these studies show how monitoring tools, early growth patterns, and family focused interventions are important for childhood obesity prevention. Paper I highlights the need for improved methods for monitoring severe paediatric obesity and introduces R-BMI growth charts as an alternative. Paper II shows that, within the CHS program timeframe, most children begin life within normal BMI ranges but that divergence toward obesity often emerges in the second year of life. Paper III indicates that interventions targeting parental psychosocial risks when children are very young, such as the SEEK model, can promote healthy BMI development. These findings collectively underscore the importance of growth monitoring and preventive strategies for all children.