North South Survey of Children’s
Height, Weight and Body Mass
Index, 2002
Whelton H, Harrington J, Crowley E, Kelleher V,
Cronin M, Perry I J
A collaborative project involving:
Republic of Ireland
The Department of Health and Children
The Eastern Regional Health Authority
Midland Health Board
Mid Western Health Board
North Eastern Health Board
North Western Health Board
South Eastern Health Board
Southern Health Board
Western Health Board
Northern Ireland
The Department of Health Social Services and Public Safety
Eastern Board
Northern Board
Southern Board
Western Board
The WHO Collaborating Centre for Oral Health Services Research
University College Cork
The Department of Epidemiology and Public Health
University College Cork
November 2004
H. Whelton, E. Crowley, I. Perry, M. Cronin, V. Kelleher.
Table of Contents
EXECUTIVE SUMMARY .................................................................................4
CHAPTER 1 INTRODUCTION .......................................................................7
What will this study tell us?...........................................................................9
CHAPTER 2 METHODS ................................................................................10
Ethical approval..........................................................................................10
Sample .......................................................................................................10
Training and Calibration of the Examining teams .......................................12
The fieldwork ..............................................................................................12
Measurement of Height and Weight ...........................................................13
Data management and analyses................................................................13
Definition of overweight and obesity .......................................................13
Other variables ...........................................................................................15
Presentation of Data – statistical analysis ..................................................16
Inferential Statistics ....................................................................................17
CHAPTER 3 RESULTS .................................................................................18
Response Rate...........................................................................................18
Number and age distribution of Children Examined................................18
The height of children and adolescents in Ireland ......................................21
The Body Mass Index (BMI) of children and adolescents in Ireland...........28
The Prevalence of overweight and obesity among children and adolescents
in Ireland ....................................................................................................32
Prevalence of overweight and obesity according to disadvantage in RoI
and NI .....................................................................................................37
Dietary behaviour and its association with overweight and obesity among
Irish children and adolescents. ...................................................................40
Overweight, obesity and snacking ..........................................................41
Sedentary Activities and BMI among Irish children and adolescents. ........43
The impact of demographic factors and selected behaviours on BMI ........45
Analysis of variance, factors associated with BMI. .....................................46
Logistic regression, the factors associated with overweight and obesity....47
Historical Trends ........................................................................................52
CHAPTER 4 DISCUSSION............................................................................56
Prevalence .................................................................................................56
Socio-Economic .........................................................................................57
Diet.............................................................................................................57
Sedentary Activities....................................................................................58
Secular Trends ...........................................................................................58
CHAPTER 5 CONCLUSIONS........................................................................59
Acknowledgements ....................................................................................60
APPENDICES................................................................................................61
Appendix 1: Training and Calibration of the Examining teams ...................62
Appendix 2 : Protocol for measuring height and weight .............................64
Appendix 3 Number and Mean Age of 5, 8, 12, 15 year old children
examined by health board, ROI and NI ......................................................65
Appendix 4: Mean height (M) by age, gender, and health board................66
Appendix 5: Mean weight (kg) by age, gender, and health board ..............67
Appendix 6: Mean BMI by age, gender, and health board .........................68
2
Appendix 7a: Percentage children overweight by age, gender and health
board region ...............................................................................................69
Appendix 7b: Percentage children obese by age, gender and health board
region .........................................................................................................71
Appendix 8a: Percentage children overweight using international BMI cut-off
points by gender, age, medical card status and health board region .........73
Appendix 8b: Percentage children obese using international BMI cut-off
points by gender, age, medical card status and health board region ........75
Appendix 9 a: Percentage of children overweight and obese using UK90
91st and 98th centile cut-offs; US (CDC) 85th and 95th centile cut-offs and
the IOFT cut off by age and gender, ROI ...................................................77
Appendix 9b: Percentage of children overweight and obese using UK90
91st and 98th centile cut-offs; US (CDC) 85th and 95th centile cut-offs and
the IOFT cut off by age and gender, NI ......................................................78
Appendix 10a: Weighted Mean BMI by Sweet Snacks or Drinks in second
class (ROI) .................................................................................................79
Appendix 10b: Weighted Mean BMI by Sweet Snacks or Drinks in junior
cert classes (ROI).......................................................................................80
Appendix 11: ROI: Weighted Mean BMI by Gender, Daily Soft Drink or
Juice, and Health Board Region.................................................................81
Appendix 12: ROI: Weighted Mean BMI by Gender, hours in front of a
screen, and Health Board Region ..............................................................82
Appendix 13: Funding, support, ethical approval and data protection ........83
Ethical approval and data protection ..........................................................84
Appendix 14: Contributors to the survey ...................................................85
TECHNICAL NOTES .....................................................................................89
Technical Note 1: Comparison of the UK 1990, US and the IOFT criteria for
defining BMI ...............................................................................................90
Technical Note 3a: Questionnaire Second /Primary Four Classes.............98
Technical Note 3b: Questionnaire Junior Certificate/Form Four Classes ...99
REFERENCES ............................................................................................100
3
EXECUTIVE SUMMARY
As part of a North South Survey of Children’s Oral Health conducted in Ireland
in 2001/’02 [1], the heights and weights of a representative sample of children
and adolescents age 4-16 years was measured. Data were collected by 34
teams of trained and calibrated dentists and dental nurses for 17,518 children
aged 4-16 in the Republic of Ireland (RoI) and 2,099 in Northern Ireland (NI).
This report presents the results of the study which provide a baseline
measurement of children’s height and weight against which future change can
be measured. By comparing these data with international norms we can
estimate the current prevalence of overweight and obesity among children
and adolescents in Ireland.
The results showed that males were taller than females, children in the
Republic of Ireland were taller than those in NI and the less well off were
smaller than the rest of the population.
Children’s weight is best considered in relation to their height, the Body Mass
Index (BMI) is an accepted method [2, 3] for doing this. The Body Mass Index
relates body weight to height and so is used to indicate whether people are
heavy relative to their height. It is commonly used to measure overweight and
obesity and it is used in this report. BMI is calculated as weight (kilograms)
divided by height (meters) squared.
There are no generally agreed BMI criteria for classifying overweight and
obesity in children. However, there is an emerging consensus in favour of
adopting criteria proposed by the International Obesity Task Force (IOTF).
Using these criteria, almost one in four boys (23% RoI and NI) and over one in
four girls (28% RoI, 25% NI) were either overweight or obese. About one in 20
boys (6% in RoI, 5% in NI) and about one in 15 girls (7% in RoI and NI) aged
2-16 years were obese in 2002, according to the International Classification.
The overall prevalence of overweight ∗ was higher among females than males
in the RoI (28% vs 23%) and NI (25% vs 23%). Similarly, the prevalence of
obesity was higher in girls in both jurisdictions (RoI 7%vs.6% and NI 7% vs.
5%).
Looking at the data by age group, in RoI, overweight was most common
among 13 year old girls (32%). The highest prevalence of obesity was found
among 7 year old girls (11%). In NI the highest prevalence of overweight and
obesity were found among 11 and 8 year old girls respectively (33% and
13%).
Data were also collected on snacking habits and time spent watching
television, computers or other screens. Frequent snacking was a common
habit among Irish children, with 11% (RoI) and 13% (NI) of Junior Cert / Year
4 adolescents consuming 4 or more sweet snacks per day compared to 7-8%
∗
In this document the statistics for overweight includes the obese subset.
of Second Class / Primary Four. It is likely that the greater independence of
Junior Cert / Year 4 facilitates greater access to sweet snacks.
No association was found between frequency of snacking and obesity, this
may be a feature of the data collection method and the cross sectional study
design. Daily consumption of soft drinks was more common among obese
adolescents in both the Republic and Northern Ireland (this question was not
asked relating to 8-year-olds)
Most children (RoI and NI) reported spending 1-2 hours in front of screens per
day (73 - 77%). In RoI, on average, boys and girls in the Second Class spend
2.5 and 2.4 hours per day respectively in front of a screen. In NI similar figures
are reported for the Primary 4 group the with boys spending 2.2 hours and
girls 2.6 hours respectively watching screens.
In RoI 6% of males and 5% of females (rounded percentages) were reported
to sit in front of screens for 5 or more hours per day on average. In NI this
figure was 3% for males and 4% for females. Those reported as spending 5 or
more hours per day on average in front of screens had higher mean BMI
relative to those who spent less time exposed to TV, game console or
computer. There were insufficient data from the NI sample to address this
issue.
Multivariate analysis identified a number of factors associated with obesity
these included; age, gender, disadvantage and time spent watching screens.
Obesity increased with age, females and children of less well off parents were
more likely to be obese as were those who spent a greater amount of time
watching screens.
Children’s heights and weights were compared with data from the 1948
National Nutrition Survey [4]. Children’s heights and weights have changed
considerably since 1948. Comparison of the current data with a nationally
representative sample of 14,835 4 – 14 year old children examined between
1946-1948 shows that children were taller and heavier in 2002 and that the
increase in weight was disproportionate to the increase in height. On average
four year old boys and girls were 6.1 cm and 6.8 taller respectively in 2002.
Fourteen year old boys and girls were 23.1cm and 15.6 cm taller respectively
in 2002, this represents a 16% increase for 14 year old boys and an 11%
increase for 14 year old girls over their average height in 1948.
Similar but more dramatic increases are seen in the weights of these children.
The mean weight of four year old boys increased from 17.9kg to 20.1kg
between 1948 and 2002 while the mean weight of four year old girls increased
from 17.1 kg to 19.7 kg over the same time period. More dramatically
however, is the weight gain in the older ages. The average weight of fourteen
year old boys in 2002 is 65% greater than that of 1948, (37.0 kg and 60.9 kg
respectively), while that of girls also increased substantially (by 49%) from
39.5kg in 1948 to 58.7kg in 2002.
5
The importance of appropriate information to the planning and evaluation of
measures to deal with overweight and obesity in Ireland is clear. The draft
results of this study have been used to inform the National Taskforce on
Obesity. This report serves to underpin the urgency of implementing the
recommendations of the report of the National Taskforce on Obesity (2005)
(http://www.dohc.ie/publications/report_taskforce_on_obesity.html).
6
CHAPTER 1 INTRODUCTION
North South Survey of Children’s Height, Weight and Body Mass Index
2002
Obesity is one of the major public health challenges of our time. In the US at
least one quarter of the adult population is obese. In Ireland current estimates
suggest that one in five adults is obese. Worldwide, approximately 2.6 million
deaths per annum are attributed to obesity [5] and the burden on health
services is growing [6]. Over the past decade there is evidence of an
emerging epidemic of childhood obesity worldwide [7, 8] and it is suggested
that children in established market economies, born at the start of the 21st
century, may have a shorter life expectancy than their parents as a result of
the health consequences of obesity. Obesity is a well established risk factor
for Type 2 Diabetes [9], Cardiovascular Disease [10, 11] and Cancer [12], the
major causes of death in developed and increasingly developing countries.
Obesity is also a major contributor to the burden of disability in adult life,
linked with diverse conditions including gallbladder disease [13] and arthritis
[14]. In Ireland obesity poses a particular threat to the population given our
high mortality from cardiovascular disease relative to other European
countries[15, 16].
The consequences of childhood obesity are far reaching and serious. Physical
health impacts of obesity among children and adolescents include;
Hyperlipidaemia. Hypertension and abnormal glucose tolerance. Obese
children can experience social difficulties, problems making friends, negative
self image, behavioural and learning difficulties and are often associated with
laziness and sloppiness amongst their peers [17]. In addition to the physical
and psychological impact of obesity in childhood approximately half obese
school-age children and adolescents become obese adults [18].
Previous surveys indicate that overweight and obesity are common in Ireland.
Ireland ranked amongst the countries with the highest levels of obesity in a
survey of self reported height and weight among 13 and 15 year olds in 13
European countries, Israel and the United States in 1997-1998 [19].
The
highest prevalence of overweight was found in the United States, Ireland,
Greece and Portugal. Data from the UK shows that an estimated 10% of 6year-olds and 17% of 15-year-olds are obese [20]. In Ireland as in other
countries a National Task force has been appointed by the Minister for Health
to review the obesity trends in Ireland and make health promoting policy
recommendations designed to address adverse trends. Establishment of
baseline data with regard to overweight and obesity among Irish children and
subsequent monitoring of these trends is important for the development of
appropriate health policy and for the subsequent monitoring of the outcome of
any interventions designed to tackle or prevent childhood overweight or
obesity.
The aim of this survey was to establish baseline data on the
prevalence and correlates of overweight and obesity among children and
adolescents in Ireland. The survey was carried out opportunistically as an
extension of the North South Survey of Oral Health of Irish children and
adolescents. The oral health survey involved the clinical dental examination of
a representative random sample of children and adolescents in the Republic
of Ireland and Northern Ireland. Some age groups in the survey also either
completed questionnaires themselves or had them completed on their behalf
by a parent or guardian. The effort involved in this marginal extension of the
fieldwork was considered to be well worth while in return for the generation of
an all Ireland database of the height and weight of children and adolescents.
Thus the North South Survey of Children’s Height, Weight and Body Mass
Index was the result of an interdepartmental alliance of health service
researchers in UCC, those in the Health Services Executive (RoI) and those in
the Department of Health Social Services and Public Safety (NI), good
communication with leaders in the dental services in RoI and NI and the good
will of the fieldworkers in both jurisdictions.
This report presents the results of the North South Survey of Children’s
Height, Weight and Body Mass Index conducted in Ireland in 2001/’02. The
study provides a baseline measurement of children’s height and weight
against which future change can be measured. By comparing these data with
international norms we can estimate the current prevalence of overweight and
obesity among children and adolescents in Ireland. The importance of
8
appropriate information to the planning and evaluation of measures to deal
with overweight and obesity in Ireland is clear.
Overweight is defined as increased body weight when compared to
established standards and obesity is defined as excessive body weight due to
an abnormal accumulation of fat compared to established standards.
The results of this study will establish the extent of the obesity problem among
children and adolescents in Ireland. The study also looks at the prevalence of
some behaviour that may be associated with overweight and obesity.
A novel aspect of the research is that it is the first time the height and weight
of
a
representative
sample
of
children
has
been
measured
contemporaneously, north and south of the border, using standardised
criteria. The cooperation of the Department of Health Social Services and
Public Safety in Northern Ireland (NI) made this approach feasible. As a result
it will be possible to compare the prevalence of overweight and obesity of
children and adolescents in the Republic of Ireland (RoI) with that of the same
age groups in Northern Ireland. The results will be helpful in monitoring the
impact of the services in the two different jurisdictions on levels of overweight
and obesity among children and adolescents in the future.
What will this study tell us?
This study will:
• Establish the prevalence of overweight and obesity among children and
adolescents in Ireland.
• Compare the prevalence of overweight and obesity among children and
adolescents in the Republic (RoI) and Northern Ireland (NI) in 2001 / ’02.
• Compare these levels with those measured in earlier surveys in Ireland.
• Report on levels of sedentary behavior among children in 2002
• Report on snacking habits among children and adolescents in 2002
• Examine the relationship between overweight and obesity and other factors.
9
CHAPTER 2 METHODS
Ethical approval
The Ethics Committee of the Cork Teaching Hospitals reviewed the protocols
for training and calibration of the examiners and for the main study. The
committee approved the study on 2nd October 2001. Ethical Approval was
also obtained from the Research Ethics Committee of Queen’s University,
Belfast for the Northern part of the study.
Sample
Children were selected randomly on the basis of age, gender, and
geographical location of the school attended and whether they attended a
school with fluoridated or non-fluoridated water supply (necessary for the oral
health survey). The age groups for inclusion in the survey were chosen to
allow comparison of oral health data with earlier Irish studies and with studies
conducted internationally. The groups chosen were children in Junior Infants,
Second Class, Sixth Class and Junior Certificate in RoI and Primary 1,
Primary 4, Year 1 and Year 4 in NI. Children in Junior Infants / Primary 1 are
on average five years old, however these classes also have four and six year
olds. Children in 2nd Class / Primary 4 are seven, eight and nine years old
with eight year olds being the most common. In sixth class / Year 1 children
are on average 12 years old but the class also has 11 and 13 year olds.
Similarly in Junior Certificate / Year 4, adolescents are 14, 15 and 16 years
old.
The Department of Education and Science provided information on numbers
of children in different classes in schools in the RoI. This allowed the random
selection of schools for inclusion in the survey. The primary sampling unit was
the school. A cluster sampling technique was used with schools as the
clustering unit. Schools were categorised according to, health board region
and size (to ensure representation of schools of various sizes) and whether
they were located in a fluoridated or non-fluoridated areas.
Within each
Community Care Area, schools were randomly selected to ensure a balance
for fluoridation status (where appropriate) and proportionally to the size of the
school. A list of children in each class in each year (Junior Infants, 2nd class,
6th class and Junior Cert.) was obtained from the selected schools.
The Department of Education for Northern Ireland provided information on
numbers of children in different classes in schools in the NI. This allowed the
random selection of schools for inclusion in the survey. The primary sampling
unit was the school. A cluster sampling technique was used with schools as
the clustering unit. Schools were categorised according to geographical
region, size and an income deprivation index assigned to each school (to
allow comparison with RoI within socioeconomic status).
Within each
geographical region, schools were randomly selected proportionally to the
size of the school. A list of children in each class in each year (years 1, 4, 8
and 11) was obtained from the selected schools.
All children within a class were included in the random selection irrespective
of whether they had special needs, but teams were told not to include in the
selection whole classes that were designated as special needs within a
school. Schools designated ‘special needs’ by the Department of Education
and Science were the subject of a separate survey of oral health conducted in
2003 (report in preparation). The required number of children was selected
randomly from each year and the consent forms were issued to only those
children. In instances where there was a number of different classes within the
one year e.g. four different 2nd classes in the same school, a class was
randomly selected and the children were randomly selected within this class.
If insufficient numbers of children were present in the first class selected,
another class was randomly selected until the required number of children to
issue consent forms was obtained.
The total target sample size required in the Republic of Ireland was 14,400.
The sample size was based on the desire to have 120 children per cell in
each of the four age groups in 30 community care areas (120 X 4 age groups
X 30 Community Care Areas = 14,400). The cell size of 120 would allow
reliable estimates of dmft / DMFT by fluoridation or disadvantage (medical card
or low income benefit) status. The total sample size had sufficient power to
11
demonstrate a difference in dmft / DMFT level of at least 0.5 in 5, 12 and 15
year olds and at least 0.2 in the 8 year olds between children from fluoridated
and non-fluoridated areas in the RoI. The target sample size of 2,390 in NI was
chosen to demonstrate the same differences in dmft / DMFT (in each age group)
between NI (non fluoridated) children and adolescents and those in fluoridated
areas in the RoI according to socioeconomic status.
Training and Calibration of the Examining teams
Before commencing the fieldwork, the teams of health board dentists and
dental nurses were trained and calibrated in standardised methodology to
ensure inter- and intra- examiner reliability on the measurement indices used
(Appendix 1).
The fieldwork
The Department of Education and the Irish Dental Association were notified of
the survey following which the examining teams were given details of the
schools. The fieldwork was conducted between October 2001 and June 2002.
For schools selected in the sample, the examiners contacted the chairpersons
of school boards of management and the school principals. They were
informed of the nature and aims of the study and were invited to participate.
When agreement was received, the examining teams contacted the schools
and the required number of children was randomly selected according to
software developed for the purpose. Consent forms, which complied with the
requirement for informed consent and included details of the survey
procedures, were issued to the selected children. The children were asked to
give the forms to their parents or guardians for completion. Parents or
guardians were asked to indicate whether they were in possession of a
Medical Card in the Republic of Ireland or whether they were in receipt of lowincome benefits in Northern Ireland. The consent forms also requested details
of the water supply to the child’s current and any previous home; this
information was used to determine the child’s lifetime exposure to domestic
water fluoridation. Children were asked to return the completed forms to
school. The right of children to refuse examination was observed and the
12
teams did not attempt to proceed to examine children who refused
examination.
Parents of Second Class / Primary 4 children and adolescents in Junior
Certificate / Year 4 classes themselves were asked to complete a
questionnaire. The questionnaire included details of snacking habits and for
the younger children; time spent watching screens (incl. television).
Measurement of Height and Weight
The weighing scales used to measure weight were Soehnle 7403 Mediscale
(Contact Medilink Services (Southern Ireland) Ltd. FREEPOST, Main Street,
Geashill, Co.Offaly). The weighing scales were calibrated using 75kg
calibration weights either in Cork by the OHSRC or by each team in their own
Health Board prior to the commencement of the study. The scales were
checked again at the end of the fieldwork. Leicester Height Measures, (CMS
Weighting Equipment, 18 Camden High Street, London) were used to
measure height. The protocol for measuring height and weight is detailed in
Appendix 2.
The teams were instructed to take measurements of height and weight in a
sensitive and confidential manner.
Data management and analyses
The data were recorded electronically and were processed and coded prior to
analysis at the Oral Health Services Research Centre. The SAS statistical
package was used for analysis.
Definition of overweight and obesity
The Body Mass Index is an accepted method [2, 21] for measuring childhood
obesity. The Body Mass Index relates body weight to height and so is used to
indicate whether people are heavy relative to their height. It is commonly used
to measure overweight and obesity and it is used in this report.
calculated as weight (kilograms) divided by height (meters) squared.
13
BMI is
Weight (kg)
BMI = ----------------------Height (m) 2
For adults a BMI of 25-30 kg/m2 is the accepted definition of overweight
(increased body weight when compared to established standards) and a BMI
of >30 kg/m2 is classified as obese (an abnormal accumulation of fat
compared to established standards) The situation for children is more
complex as weight changes with height and hence different cut-off points have
to be defined for children at different ages. There are limited population norms
for BMI for children in Ireland. There are no generally agreed BMI criteria for
classifying overweight and obesity in children. However, there is an emerging
consensus in favour of adopting criteria proposed by the International Obesity
Task Force (IOTF). The latter criteria are used in this report.
The International Obesity Task Force Standards (IOTF) are based on
reference points derived from an international (six country, over 190,000
subjects aged 0-25 from UK, Brazil, Hong Kong, The Netherlands, Singapore,
and the United States) survey [22]. The age and sex specific reference points
were derived as follows: the BMI percentile curves that pass through the
widely used values of 25 and 30 kg/m2 for overweight and obesity at age 18
(adult) were smoothed for each national dataset and then averaged. This
approach largely adjusted out the national differences in overweight
prevalence. The averaged curves were then used to provide age and sexspecific BMI cut-off points for children and adolescents aged 2-18.
Two further sets of criteria to define overweight and obesity in childhood are
used in the international literature: the UK 1990 reference standards and the
US Centers for Disease Control and Prevention (CDC) reference charts,
published in 2000. The IOTF criteria provide a conservative estimate of the
prevalence of overweight and obesity relative to the UK and US Criteria.
Appendix 2 provides a comparison of the three criteria, including the
respective BMI thresholds for overweight and obesity and the prevalence of
overweight and obesity by age and gender.
14
Other variables
Medical card ownership by the parents or guardians of the children and
adolescents in the sample was used as a surrogate for disadvantage in RoI.
Parents were asked to indicate whether they had a medical card, on the
consent form, which was returned to the school prior to the clinical
examination. For the general population under age 70 in RoI, medical card
issue is based on a means test unless the applicant has a disability. Medical
cards are issued to low-income applicants. In NI disadvantage was classified
according to whether the parents or guardians of the children or adolescents
in the sample were in receipt of any low-income benefits.
Information of the occupation of both parents was also collected. These
occupations were classified according to the Registrar Generals UK
classification system, which is also used by the central Statistics Office in RoI.
The occupations can be grouped into ten different classes (Table 1).
Table 1: Classification of Occupations
1-Managers/Administrators
2-Professional
3-Associate Professional/Technical
4-Clerical/Secretarial
5-Craft & Related
6-Personal & Protective Service
7-Sales
8-Plant & Machine Operatives
9-Other
Unemployed
These classes were further collapsed into 5 groups for analysis.
Parents of children in Second Class or Primary 4 (average age 8) and Junior
Cert or Year 4 adolescents (average age 15) completed a questionnaire as
part of the survey (Technical notes 3a and 3b). The questionnaire pertained
mainly to oral health knowledge, attitudes and behaviour and perceived
availability, accessibility and acceptability of services. It also included
15
questions on parental occupation, diet and sedentary behaviour, including
time spent sitting in front of television, game consoles and computers
(Appendices 3a-b).
Presentation of Data – statistical analysis
This report presents details of the number of children and adolescents
examined by age cohort for each year from 4 to 16 years, the average age of
the children in each age cohort together with summary data (mean, standard
deviation and standard error of the mean) on height, weight and BMI by age
cohort.
Data on habits and practices related to diet and sedentary behaviour are
presented by class or year in school as opposed to age in years as the cell
sizes were very small for some age groups.
The data are presented for the Republic of Ireland as a whole and for
Northern Ireland as a whole. Data are presented according to health board
region of residence in the appendices, for the Republic of Ireland. The sample
in Northern Ireland was selected at country level; hence the Northern Irish
data are not presented at health board level. All results are unweighted
because the sampling strategy did not allow for weighting for each year of
age. Weighting was carried out for 5, 8, 12 and 15-year-olds to determine if
the application of weights altered the results. The impact of weighting on the
results was minimal. Also once data were analysed by gender within medical
card, the cell sizes at sampling unit level (community care area) were too
small to allow weighting. Thus it was decided that the data would be more
reliable presented in their unweighted state.
In this report data for RoI and NI are presented in the body of the report and
health board level data are presented at the end of the report as appendices
to the main tables.
16
Inferential Statistics
Factors associated with variation in height were investigated using analysis of
variance (ANOVA), these data were not transformed.
Two approaches were taken with BMI. Firstly, variables which were
associated with variation in BMI as a continuous variable were analysed using
analysis of variance (ANOVA) after a logarithmic transformation of the BMI
scores. After this, children were classified according to whether their individual
BMI scores were in the overweight or obese category according to the
International Obesity Task Force (IOTF) criteria. The proportions of children
that were classified as being obese were analysed using a logistic regression
model. The proportions classified as being overweight were also analysed
using a logistic regression model. The factors included in these models were
Gender, Country, Medical Card Status and Age (to the nearest year).
Separate analyses of BMI, proportions obese and proportions overweight
were performed for 8 year-old children. These analyses included the child’s
reported snacking habits as a factor and the reported time spent watching
screens as a continuous covariate. Age was not included in these models.
Separate analyses of BMI (after logarithmic transformation), proportions
obese and proportions overweight were also performed for 15 year-old
adolescents. These analyses included reported snacking habits and
consumption of soft drinks at least once per day as factors. Age was not
included in these models.
In all models, all possible two-level interactions were also considered and
those that were not significant at the 5% level of significance were dropped
from the model. The adequacy of each model was confirmed by residual
analyses and diagnostic checks.
17
CHAPTER 3 RESULTS
Response Rate
The overall response rate for RoI was 68% (68%, 68%, 68% and 66% in the
5-, 8-, 12- and 15-year-old age groups, respectively). The overall response
rate for NI was 53% (56%, 63%, 59% and 43%, respectively).
Number and age distribution of Children Examined
The number of children examined and the distribution of the sample by age
and gender, for the Republic of Ireland and Northern Ireland are presented in
table 1 and 2 respectively. Although, data are available for a wide age range,
the modal ages examined were 5, 8, 12 and 15 year olds. In RoI the
numbers examined were large enough to provide data at national level for
the age groups at either side of the modal age (except for 10 year olds). At
health board level the numbers examined were insufficient to do this and
data are presented for the modal ages of 5, 8, 12 and 15 years only. For the
NI sample, data are presented for ages 4, 5, 8, 11, 12, 14 and 15 where
there were at least 47 children in each age / gender group.
The gender distribution was balanced in the Republic of Ireland while slightly
more females than males were examined in Northern Ireland (51% and 49%)
(Table 1).
Table 1: Number of children examined (with height and weight recorded) by
class and gender in the Republic of Ireland and Northern Ireland
CLASS
Junior Infants
Second Class
Sixth Class
Junior Cert
TOTAL
RoI
Male
(N)
3327
1872
1859
1748
8806
Female
(N)
3151
1867
1968
1726
8712
CLASS
Primary One
Primary Four
Year One
Year Four
TOTAL
NI
Male
(N)
408
158
162
307
1035
Female
(N)
419
144
181
320
1064
NOTE: above numbers only include children with both height and weight recorded
The high numbers in the Junior Infant Class group were due to a request from the North Eastern Health
Board (NEHB) to do a population survey of the 5-year-old group in that area.
18
As height and weight are age-related it is important to ensure that the mean
age of the children in groups under comparison is similar. As can be seen in
Table 2, the mean age of the children was comparable allowing meaningful
comparisons of RoI and NI data.
Table 2: Number and mean age by age group and gender, of children
examined in ROI and NI
ROI
Ages (years)
NI
Male
Female
Male
Female
N
Mean Age
N
Mean Age
N
Mean Age
N
Mean Age
4
630
4.8
722
4.8
50
4.9
54
4.9
5
2,474
5.4
2,278
5.4
356
5.4
365
5.4
6
224
6.2
152
6.2
3
6.4
7
338
7.8
451
7.8
25
7.9
25
7.9
8
1,372
8.5
1,327
8.5
131
8.4
119
8.5
9
152
9.3
85
9.2
1
9.4
10
11
10.4
8
10.5
1
10.9
11
327
11.8
438
11.8
47
11.8
57
11.9
12
1,325
12.5
1,381
12.4
115
12.3
122
12.4
13
206
13.3
154
13.2
1
13.1
1
13
14
608
14.7
708
14.7
108
14.8
86
14.8
15
1,051
15.4
935
15.4
198
15.4
231
15.4
16
88
16.3
73
16.3
3
16.4
ALL AGES
8,806
8,712
1,035
1,064
Note: Data not reported where cell numbers<30 – but mean ages are reported above for cells < 30
Details of number and mean age of children examined across the Health
board regions in RIO are presented in Appendix 3.
19
As the majority of children in the survey were 5, 8, 12 and 15 years old, the
analysis at health board level is confined to these age groups. The geographic
location of the health boards is shown in Fig 1.
Figure 1: Geographical map of the Health Board Regions in the Republic of
Ireland
The NI sample was representative of NI as a whole and analysis of smaller
geographic units would not have been valid.
20
The height of children and adolescents in Ireland
Height is a fundamental indicator of growth and development with well
documented secular and geographic trends linked to nutrient intakes and
other markers of socioeconomic status.
For boys and girls in both
jurisdictions height was an approximately linear function of age from age 4
until age 14 for girls and age 15 (NI) or 16 (RoI) for boys (Figure 3a and 3b).
In RoI height increased steadily for girls from 108.9 cm at age four to 162.7
cm at age 14 (mean age 14.7) after which it leveled off (Table 3, Figure 3a).
For boys height increased from 109.5 cm at age four to 173.7 at age 16 with
no sign of leveling off. Boys were slightly taller than girls up to age 9. From
age 12-13 girls were slightly taller than boys. Gender height differences were
not marked until age 14 when boys’ height diverged from girls going from no
difference at age 13 to boys being 7% taller than girls at age 16. At 14 years
males were taller than females by 6.6 cm on average this difference increased
to 12.7 cm by age 16. The pattern was similar in NI (Table 3, Figure 3b) with
height increasing from 109.5 and 108.9 cm in males and females respectively
at age four to 171.9 and 161.7 cm in males and females respectively at age
15. NI boys were on average 6% or 10.2 cm taller than girls at age 15.
21
Table 3: Mean and standard deviation of height and weight by age in years
and gender for the ROI and Northern Ireland
Republic of Ireland
Height
Age
yrs
4
n
630
5
2474
6
224
7
338
8
1372
9
152
11
327
12
1325
13
206
14
608
15
1051
16
88
Age
yrs
4
50
5
356
8
131
11
47
12
115
14
108
15
198
22
n
Male
Mean
(std)
109.5
(4.7)
113.2
(4.8)
116.4
(5.6)
128.4
(5.6)
131.5
(6)
134.4
(5.5)
150.4
(6.7)
153.9
(7.8)
157.6
(8.4)
168.9
(8.6)
171.8
(7.8)
173.7
(7)
Female
95%
n
Mean 95%
n
CI
(std)
CI
109.1- 722 108.9 108.5- 630
109.9
(4.8) 109.2
113- 2278 112.3 112.1- 2474
113.4
(4.9) 112.5
115.6- 152 115.7 114.8- 224
117.1
(5.5) 116.5
127.8- 451 127.4 126.9- 338
129
(5.4) 127.9
131.2- 1327 130.8 130.4- 1372
131.8
(5.8) 131.1
133.585
133.8 131.9- 152
135.3
(8.6) 135.6
149.7- 438 151.1 150.4- 327
151.1
(7)
151.8
153.5- 1381 154.2 153.8- 1325
154.3
(7)
154.5
156.4- 154 156.9 155.9- 206
158.7
(6.3) 157.9
168.2- 708 162.7 162.3- 608
169.6
(5.9) 163.1
171.3- 935 162.7 162.3- 1051
172.2
(6.2) 163.1
172.273
161
159.388
175.2
(7)
162.6
Northern Ireland
Height
Male
Female
Mean 95%
n
Mean 95%
n
(std)
CI
(std)
CI
108.7 107.754
106.6 105.550
(3.6) 109.7
107.7
112.3 111.8- 365 111.3 110.8- 356
(4.6) 112.7
111.8
129.6 128.6- 119 130.8 129.5- 131
(5.8) 130.6
132.1
148.9 146.757
149.6 147.847
(7.5) 151.1
151.4
151.1 149.7- 122 153.3 151.9- 115
(7.4) 152.4
154.7
169.2 167.786
162.3 160.9- 108
(8)
163.7
170.7
171.9 170.9- 231 161.7
161198
(6.8) 172.9
162.5
Weight
Male
Mean
(std)
20.1
(2.9)
21.3
(3.1)
22.9
(4.2)
28.4
(5.3)
30.7
(6.6)
32.5
(7.1)
44.5
(9.6)
47.4
(10.6)
50.3
(11.5)
60.9
(13)
64.1
(11.7)
66.1
(12.6)
95%
CI
19.920.3
21.221.5
22.323.4
27.929
30.431.1
31.333.6
43.445.5
46.948
48.751.9
59.961.9
63.364.8
63.468.7
n
722
2278
152
451
1327
85
438
1381
154
708
935
73
Female
Mean
95% CI
(std)
19.7
(3.1) 19.5-19.9
21
(3.4) 20.9-21.1
22.3
(3.9) 21.7-23
28.8
(6.2) 28.2-29.4
30.8
(6.5) 30.5-31.2
33
(9.4) 30.9-35
46.6
(10.8) 45.6-47.6
48.6
(11.1) 48-49.2
51.6
(11.5) 49.8-53.5
58.7
(11.2) 57.9-59.5
58.8
(11.1) 58.1-59.5
58.2
(11.7) 55.4-60.9
Weight
Male
Mean
(std)
19.8
(2.6)
21 (3)
28.9
(5)
43.1
(8.9)
45.2
(9.2)
62.3
(13.2)
64.3
(12.5)
95%
CI
19.120.6
20.621.3
28.129.8
40.445.7
43.546.9
59.864.8
62.566.0
n
54
365
119
57
122
86
231
Female
Mean
95% CI
(std)
18.4
(2.2) 17.9-19.0
20.6
(3.3) 20.3-21.0
31.4
(8.6) 29.9-33.0
45.9
(10.9) 43.0-48.8
47.7
(11.4) 45.7-49.8
55.6
(9.3) 53.6-57.6
58.2
(11)
56.7-59.6
height in cm
Figure 3a: Mean height by age and gender, ROI
190
Male
180
170
160
150
Female
140
130
120
110
100
4
5
6
7
8
9
10
11
12
13
14
15
16
17
age in years
There was evidence that socioeconomic disadvantage as measured by
Medical Card status (RoI) and receipt of Low Income Benefits (NI) was
associated with shorter stature across the age range in both jurisdictions and
in the sample as a whole (Table 4a). For example in RoI children whose
parents did not have Medical Cards were 1.3 cm taller on average at age 8
(both boys and girls). Similarly in NI children whose parents were not in
receipt of Low Income Benefits were 3.2 cm taller in the case of boys and
1.7cm taller in the case of girls.
23
Table 4a: Number of children examined, mean height and standard deviation
by medical card status, gender and age
Republic of Ireland
Age
Male
(Yrs)
Female
No MC
N
Yes MC
Mean (std)
N
No MC
Yes MC
Mean (std)
N
Mean (std)
N
Mean (std)
4
437
109.8 (4.5)
188
108.9 (5.1)
518
108.9 (4.8)
201
108.6 (4.6)
5
1,903
113.4 (4.8)
543
112.3 (4. 8)
1,789
112.6 (4.8)
473
111.1 (4.9)
6
175
116.4 (5.7)
48
116.0 (5.2)
114
115.7 (5.7)
38
115.5 (5.2)
7
263
128.3 (5.6)
73
128.6 (5.8)
346
127.7 (5.4)
98
126.5 (5.1)
8
1,055
131.8 (5.9)
309
130.5 (6.4)
1,021
131.0 (5.8)
296
129.7 (5.7)
9
99
134.8 (5.6)
52
133.6 (5.5)
56
134.9 (9.6)
29
131.6 (5.9)
11
259
151.0 (6.5)
67
148.3 (7.3)
358
151.1 (7.0)
79
151.0 (7.2)
12
1,027
154.1 (7.8)
292
153.2 (7.7)
1,084
154.5 (7.1)
295
152.8 (6.8)
13
116
158.0 (9.0)
88
156.8 (7.6)
87
157.5 (6.4)
67
156.0 (6.1)
14
435
169.7 (8.4)
168
166.7 (8.8)
524
163.0 (6.0)
182
161.7 (5.6)
15
792
171.9 (8.0)
251
171.4 (7.1)
659
163.0 (5.8)
272
162.0 (7.0)
16
56
173.9 (7.4)
32
173.4 (6.4)
39
161.0 (7.9)
33
160.4 (5.2)
Northern Ireland
Age
Male
(Yrs)
Female
No LIB
N
Mean (std)
Yes LIB
N
Mean (std)
No LIB
N
Mean
Yes LIB
N
Mean
4
31
109.1 (3.8)
19
108.0 (3.3)
36
105.9 (4.1)
18
108.1 (3.9)
5
202
112.7 (4.5)
150
111.6 (4.6)
224
111.7 (4.6)
136
110.7 (4.4)
8
70
131.1 (5.6)
59
127.9 (5.6)
68
131.6 (7.0)
50
129.9 (6.9)
11
30
147.9 (6.9)
13
149.0 (7.4)
34
149.5 (6.6)
23
149.7 (7.3)
12
72
151.1 (7.2)
36
150.5 (8.4)
67
153.4 (7.4)
54
153.2 (8.4)
14
78
169.6 (7.3)
25
167.8 (8.5)
55
162.0 (6.8)
30
163.1 (5.9)
15
124
171.9 (6.8)
67
171.7 (7.1)
143
162.1 (6.1)
86
161.3 (6.1)
The mean height for boys in NI was slightly lower than in RoI up to age 12
(Table 3), the mean difference ranged from 0.8 cm at age 4 to 2.8 cm at age
12. At age 14 boys in NI were marginally taller by 0.3 cm. The mean
difference for girls ranged from 0.4 for 14 year olds to 2.3 for four year olds. At
age 15 NI boys were 0.1 cm taller.
height in cm
Figure 3b: Mean height by age and gender, NI
190
Male
180
170
160
Female
150
140
130
120
110
100
4
5
6
7
8
9
10
11
12
13
14
15
16
17
age in years
The distribution of height according to age and gender is presented by health
board region in Appendix 4.
Factors associated with variation in height – analysis of variance
In multivariate analysis with adjustment for age (to nearest year), gender,
country and medical card status the differences in height by gender, medical
card / low income benefit status and country remained significant (p<0.0001).
Thus, males were taller than females; children in the Republic of Ireland were
taller than those in NI and the less well off were smaller than the rest of the
population.
The weight of children and adolescents in Ireland
The pattern for weight differed slightly to that for height (Table 3, Figure 3c
and 3d) in both RoI and NI. The increase in weight was less linear and
followed a more S shaped curve, with periods of greater weight gain between
age 6-8 and 9-12 for both sexes. For girls weight leveled off after age 15. For
boys weight gain from age 13 increased at a greater rate than that for girls the
period of fastest weight gain was between age 13 and 15 after which weight
gain continued to increase but at a slower pace. Boys and girls were a similar
weight until age 9, girls are heavier than boys from age 9-13, at age 13, girls
were 1.3 Kg or 3% heavier than boys. However, from age 14 boys took the
lead and by age 16 were 7.9 Kg or 12% heavier than girls. Weight in RoI
increased from 20.1 and 19.7 kg for four-year-old boys and girls respectively
to 66.1 and 58.2 kg respectively for 16-year-old boys and girls. In NI the
weights were similar, four-year-old boys and girls weighed on average 19.8
and 18.4 kg respectively and 15-year-old boys and girls weighed 64.3 and
58.2 kg respectively. As with RoI the difference in weights emerged at age 14,
in NI at age 15 boys were on average 6.1 kg or 10% heavier than girls. The
leveling off in weight seen for RoI girls between age 14 and 16, was not seen
among the NI girls although by age 15 they were the same weight as RoI girls.
For both RoI and NI boys, weight continued to increase at age 15 (NI) or 16
(RoI).
weight in kg
Figure 3c: Mean weight by age and gender, ROI
Male
80
70
60
50
Female
40
30
20
10
4
5
6
7
8
9
10
11
12
13
14
15
16
17
age in years
Boys in NI tended to be lighter than boys in RoI until age 14 when they were
slightly heavier. By age 15 the weights were the same. Girls in NI were lighter
at age 4, the same weight at ages 5 and 8, slightly lighter at age 11 and 12,
lighter at age 14 (3.2 kg) and the same weight at age 15.
weight in kg
Figure 3d: Mean weight by age and gender, NI
80
Male
70
60
50
Female
40
30
20
10
4
5
6
7
8
9
10
11
12
13
14
15
16
17
age in years
The distribution of weight by age and gender is presented by health board
region in Appendix 5.
The Body Mass Index (BMI) of children and adolescents in Ireland
The mean BMI by age and gender is shown in Table 4b and Figure 4a and 4b
for both RoI and NI. Among RoI and NI males BMI decreased by 0.1 kg/m2
between age 4 (16.7 kg/m2) and 5 (16.6 kg/m2) as weight increased faster
than height. In RoI males, BMI started to increase from age 5 to age 16 (21.8
kg/m2). For females in RoI, weight increased at the same rate as height from
age 4-6 after which weight gain surpassed height increase and the mean BMI
increased with age from 16.6 kg/m2 at age six to 22.5 kg/m2 at age 16. Among
NI girls, BMI increased from 16.1 kg/m2 to 16.6 kg/m2 between age 4 and 5
and from 16.6 at age 5 to 22.2 kg/m2 at age 15.
Table 4b: BMI Mean and standard deviation by age and gender for the
Republic of Ireland and Northern Ireland
Age (Yrs)
4
5
6
7
8
9
11
12
13
14
15
16
Age (Yrs)
4
5
8
11
12
13
14
15
50
356
131
47
115
Republic of Ireland
Female
Mean
95% CI
N
(Std)
16.7 (1.6)
16.6-16.8
772
16.6 (1.6)
16.5-16.7
2278
16.8 (2.1)
16.5-17.0
152
17.1 (2.2)
16.9-17.4
451
17.6 (2.8)
17.5-17.8
1327
17.9 (3.3)
17.4-18.4
85
19.5 (3.4)
19.2-19.9
438
19.9 (3.6)
19.7-20.1
1381
20.1 (3.5)
19.6-20.6
154
21.2 (3.7)
20.9-21.5
708
21.7 (3.5)
21.5-21.9
935
21.8 (3.4)
21.1-22.5
73
Northern Ireland
Female
Mean
CI
N
(Std)
16.7 (1.4)
16.3-17.1
54
16.6 (1.7)
16.4-16.8
365
17.1 (1.9)
16.8-17.4
119
19.3 (2.9)
18.4-20.1
57
19.7 (3.3)
19.1-20.3
122
108
198
21.6 (3.8)
21.7 (3.6)
Male
N
630
2474
224
338
1372
152
327
1325
206
608
1051
88
Male
N
20.9-22.4
21.2-22.2
86
231
Mean
(Std)
16.6 (1.9)
16.6 (2)
16.6 (1.9)
17.6 (3)
17.9 (2.9)
18.2 (3.6)
20.3 (3.8)
20.3 (4)
20.9 (3.9)
22.1 (3.8)
22.2 (3.8)
22.5 (4.4)
95% CI
16.5-16.7
16.5-16.7
16.3-16.9
17.3-17.9
17.7-18.1
17.4-19
19.9-20.7
20.1-20.5
20.2-21.5
21.9-22.4
21.9-22.4
21.4-23.5
Mean
(Std)
16.2 (1.2)
16.6 (1.9)
18.1 (3.3)
20.3 (3.8)
20.2 (3.8)
CI
15.9-16.5
16.4-16.8
17.5-18.7
19.3-21.4
19.5-20.8
21.1 (3)
22.2 (3.6)
20.4-21.7
21.7-22.6
The mean BMI is plotted against the actual mean age in decimal years for
each year of age in Figures 4a and 4b. The mean ages were very similar for
boys and girls. There was a tendency for girls to have higher BMI levels than
boys and the increase in mean BMI with age is evident.
bmi (kg/m2)
Figure 4a: Mean bmi by age and gender, ROI
30
28
Female
26
24
22
20
18
Male
16
14
12
10
4
5
6
7
8
9
10
11
12
13
14
15
16
17
age in years
bmi (kg/m2)
Figure 4b: Mean bmi by age and gender, NI
30
28
Female
26
24
22
20
18
Male
16
14
12
10
4
5
6
7
8
9
10
11
12
13
14
15
16
17
age in years
Mean (sd) BMI by age, gender and Medical Card / Low Income Benefit is
shown in Table 4b. No consistent differences were observed in univariate
comparisons.
Table 4b: Number of children examined, mean BMI and standard deviation by
medical card status, gender and age
Republic of Ireland
Age
Male
(Yrs)
Female
No MC
Yes MC
No MC
Yes MC
4
437
16.7(1.6)
188
16.7(1.7)
518
16.5(1.8)
201
16.8(2.3)
5
1903
16.6(1.6)
543
16.5(1.7)
178
9
16.6(2)
473
16.6(1.9)
6
175
16.7(2)
48
17.1(2.2)
114
16.6(1.8)
38
16.5(2.1)
7
263
17(2.2)
73
17.6(2.5)
346
17.6(3.1)
98
17.7(2.8)
8
1055
17.6(2.8)
309
17.7(2.9)
102
1
17.9(2.8)
296
17.9(3)
9
99
17.8(2.9)
52
18.1(3.9)
56
18.5(3.8)
29
17.6(3)
11
259
19.3(3.1)
67
20.3(4.2)
358
20.2(3.8)
79
20.8(4)
12
1027
19.8(3.5)
292
20.3(3.8)
108
4
20.2(3.8)
295
20.8(4.4)
13
116
20.3(3.6)
88
19.7(3.4)
87
20.7(3.5)
67
21(4.3)
14
435
21.2(3.6)
168
21.4(4)
524
22.1(3.7)
182
22.3(4.1)
15
792
21.8(3.5)
251
21.2(3.4)
659
22.1(3.6)
272
22.3(4.1)
16
56
21.3(2.9)
32
21.6(4.1)
33
23.5(4.7)
Age
22.6(4)
39
Northern Ireland
Male
(Yrs)
Female
No LIB
N
Yes LIB
Mean (std)
N
Mean (std)
No LIB
N
Mean
Yes LIB
N
Mean
4
31
16.6(1.5)
19
16.9(1.4)
36
16.2(1)
18
16.2(1.6)
5
202
16.7(1.9)
150
16.5(1.4)
224
16.6(1.9)
136
16.5(1.9)
8
70
17.1(1.8)
59
17.1(2)
68
18.4(3.6)
50
17.7(2.9)
11
30
19.6(3.4)
13
18.7(1.8)
34
20(3.8)
23
20.9(3.8)
12
72
19.5(3.4)
36
20.3(3)
67
19.9(3.6)
54
20.4(4.1)
14
78
22(4.1)
25
20.7(2.7)
55
21(2.8)
30
21.3(3.5)
15
124
21.7(3.4)
67
21.5(4)
143
21.8(3.6)
86
22.8(3.7)
Comparing RoI and NI, there were no consistent differences in BMI by age
and gender according to jurisdiction (Fig 4a).
Factors associated with variation in BMI – analysis of variance
An analysis of variance was carried out to examine the impact of gender
(M/F), country (RoI / NI), Disadvantage (Medical Card or Low Income Benefit
status of parents) yes / no and Age (to nearest year) on BMI (after natural log
transformation).
There was a significant difference between males and females (p < 0.0001),
with females having higher mean BMI. There was also a significant difference
between the disadvantaged and others (p = 0.0062). The less well off, had a
higher mean BMI. There was a significant effect for age, with BMI increasing
with age (p < 0.0001). The increase in BMI with age was greater for females
than males (p < 0.0001) and for medical card holders than non-medical card
holders (p = 0.0008). There was no difference in mean BMI between RoI and
NI (p = 0.1317). The Mean BMI according to age and gender is presented by
health board region in Appendix 6.
The Prevalence of overweight and obesity among children and
adolescents in Ireland
The prevalence of overweight and obesity according to IOTF classification are
presented by age and gender for RoI and NI, in Table 5 and Figures 5a-f.
(Data by health board region are presented in Appendices 7a-b).
Overall, almost one in four boys (23% RoI and NI) and over one in four girls
(28% RoI, 25% NI) were either overweight or obese. About one in 20 boys
(6% in RoI, 5% in NI) and about one in 15 girls (7% in RoI and NI) aged 2-16
were obese in 2002, according to the International Classification. The overall
prevalence of overweight was higher among females than males in the RoI
(28% vs 23%) and NI (25% vs 23%). Similarly, the prevalence of obesity was
higher in girls in both jurisdictions (RoI 7%vs.6% and NI 7% vs. 5%).
Looking at the data by age group, in RoI, overweight was most common
among 13 year old girls (32%) and the highest prevalence of obesity was
found among 7 year old girls (11%). In NI the highest prevalence of
overweight and obesity were found among 11 and 8 year old girls respectively
(33% and 13%).
Table 5: Percentage of children overweight and obese using IOTF criteria by
age and gender in the Republic of Ireland and Northern Ireland
Republic of Ireland
Male
Age (Yrs)
N
Female
% Overweight
% Obese
N
% Overweight
(incl. obese)
% Obese
(incl. obese)
4
630
26
7
722
29
7
5
2474
22
5
2278
29
7
6
224
18
5
152
29
7
7
338
20
7
451
30
11
8
1372
24
7
1327
30
8
9
152
22
9
85
31
9
11
327
27
6
438
29
8
12
1325
25
6
1381
25
6
13
206
20
4
154
32
5
14
608
22
6
708
27
7
15
1051
22
5
935
22
5
16
88
20
5
73
21
5
8795
23
6
8704
28
7
ROI
Northern Ireland
Male
Age (Yrs)
N
% Overweight
Female
% Obese
N
% Overweight
(incl. obese)
% Obese
(incl. obese)
4
50
28
4
54
22
0
5
356
22
5
365
28
7
8
131
18
1
119
23
13
11
47
23
4
57
33
9
12
115
23
6
122
27
7
14
108
26
7
86
14
1
15
198
25
6
231
23
6
NI
1005
23
5
1034
25
7
% overweight / obese
Figure 5a: Percent overweight and obese using IOTF criteria - males, ROI
50
overweight
obese
45
40
35
30
25
20
15
19
17
17
19
7
9
7
7
6
7
8
9
224
338
1,372
152
5
5
4
5
630
2,474
17
16
17
6
5
5
16
13
10
5
21
13
13
15
6
6
10
11
12
13
14
15
16
17
ROI
n<30
327
1,325
206
608
1,051
88
n<30
8,795
4
6
0
age in years
% overweight / obese
Figure 5b: Percent overweight and obese using IOTF criteria - females, ROI
50
overweight
obese
45
40
35
30
25
19
20
22
22
22
22
22
21
27
19
15
21
20
17
16
5
5
10
5
11
7
7
7
4
5
6
722
2,278
152
8
9
7
8
9
10
451
1,327
85
n<30
8
7
7
6
5
11
12
13
14
15
16
17
ROI
438
1,381
154
708
935
73
n<30
8,704
0
age in years
% overweight / obese
Figure 5c: Percent overweight and obese using IOTF criteria - males, NI
50
overweight
obese
45
40
35
30
25
20
15
19
24
17
19
10
17
19
18
17
5
5
4
5
6
7
8
9
10
11
12
50
356
n<30
n<30
131
n<30
n<30
47
115
4
1
7
6
13
14
15
16
17
NI
n<30
108
198
n<30
n<30
1,005
6
4
0
5
age in years
% overweight / obese
Figure 5d: Percent overweight and obese using IOTF criteria - females, NI
100
overweight
obese
90
80
70
60
50
40
30
20
10
22
0
0
24
10
21
20
13
7
5
6
7
8
9
10
54
365
n<30
n<30
119
n<30
n<30
18
6
7
13
9
4
17
7
1
11
12
13
14
15
16
17
NI
57
122
n<30
86
231
n<30
n<30
1,034
age in years
% obese
Figure 5e: Prevalence of obesity by gender, ROI
15
Male
Female
11
10
9
9
8
7
7
7
7
7
8
7
7
6
5
6
6
7
6
5
6
5
5
5
5
5
5
4
0
4
5
6
7
8
9
10
11
12
13
14
15
16
ROI
age in years
% obese
Figure 5f: Prevalence of obesity by gender, NI
15
Male
Female
13
10
9
7
7
7
7
6
6
6
5
5
5
4
4
1
1
0
0
4
5
6
7
8
9
10
age in years
11
12
13
14
15
16
NI
On the whole NI children appear to be better off than RoI children, in terms of
lower prevalence of obesity for boys (5% vs 6%) and overweight for girls (25%
vs 28%).
A comparison of the prevalence of overweight and obesity according to three
widely used criteria to define obesity (IOTF 2000, UK 1990 and US 2000), is
shown in Appendices 9a and 9b (See technical note 1 BMI cut-off definitions
using the three criteria). The cut off points for overweight and obesity using
the IOTF (2000) standards are higher than those used in the UK (1990) and
US (2000). Thus as expected, obesity estimates derived using both the UK
and US standards are much higher. Using the UK 1990 standards the
prevalence of obesity among boys was 17% (RoI) and 16.0% (NI) and for
girls, 15% (RoI) and 14% (NI). Using the UK 1990 standard one third of males
and a slightly lower percentage of females are classified as overweight or
obese. Using the US Center for Disease Control standard, 10-12% of those
age 4-16 were obese and 28-30% were overweight. Interestingly, a trend
towards decreasing levels of overweight and obesity with age is more
apparent with the US standard than with the IOTF or UK standards.
Prevalence of overweight and obesity according to disadvantage in RoI and
NI
Twenty four per cent of the total sample examined In RoI were dependants of
parents with medical cards. This figure is likely to be similar to the proportion
of children in the entire population who are dependants of medical card
holders as the General Medical Service (GMS) payments board estimated
that in 2001, 31% of the entire population of RoI was eligible for medical card
benefits [23]. In NI 38% of the sample were from families in receipt of lowincome benefits. This difference in the percentage classed as disadvantaged
arises because of the use of different measures of disadvantage in the two
regions. A measure of disadvantage applicable in the two regions would be
useful (See technical note 2).
Table 6 shows the prevalence of overweight and obesity according to gender
and disadvantage (MC status) in RoI and NI. No consistent differences in the
prevalence of overweight and obesity by Medical Card status or uptake of Low
Income Benefit were observed in RoI or NI.
The data were also analysed according to the occupational status of the
parents. No consistent trends were observed in either RoI or NI.
(Data by health board region are presented in Appendices 8a-b).
Table 6 Distribution of children according to overweight and obesity by gender, medical card status and age year, ROI
4
5
6
7
8
9
11
12
13
14
15
16
All
Female No MC
Overweight
Obese
N
%
N
144
27.8
33
521
29.1
116
31
27.2
8
106
30.6
38
309
30.3
81
20
35.7
6
103
28.8
27
259
23.9
63
25
28.7
3
138
26.3
35
138
20.9
34
6
15.4
1
1800
27.3
445
%
6.4
6.5
7
11
7.9
10.7
7.5
5.8
3.4
6.7
5.2
2.6
6.7
Females MC
Overweight
Obese
N
%
N
62
30.8
14
128
27.1
34
13
34.2
3
28
28.6
13
88
29.7
25
6
20.7
2
25
31.6
8
88
29.8
23
24
35.8
4
53
29.1
14
62
22.8
17
9
27.3
3
586
28.4
160
%
7
7.2
7.9
13.3
8.4
6.9
10.1
7.8
6
7.7
6.3
9.1
7.8
Male No MC
Overweight
Obese
N
%
N
115
26.3
26
421
22.1
86
30
17.1
8
46
17.5
15
258
24.5
70
23
23.2
7
70
27
11
246
24
56
26
22.4
6
89
20.5
25
186
23.5
41
8
14.3
1
1518
22.9
352
%
5.9
4.5
4.6
5.7
6.6
7.1
4.2
5.5
5.2
5.7
5.2
1.8
5.3
Males MC
Overweight
Obese
N
%
N
47
25
16
104
19.2
28
11
22.9
4
22
30.1
7
72
23.3
27
11
21.2
6
19
28.4
8
86
29.5
22
13
14.8
3
40
23.8
11
41
16.3
12
10
31.3
3
476
22.5
147
%
8.5
5.2
8.3
9.6
8.7
11.5
11.9
7.5
3.4
6.5
4.8
9.4
7
Distribution of children according to overweight and obesity by gender, medical card status and age year, NI
4
5
8
11
12
14
15
All
Female No LIB
Overweight
Obese
N
%
N
7
19.4
60
26.8
15
19
27.9
11
11
32.4
3
17
25.4
3
8
14.5
28
19.6
9
150
23.9
41
%
0
6.7
16.2
8.8
4.5
0
6.3
6.5
Females LIB
Overweight
Obese
N
%
N
5
27.8
39
28.7
10
8
16
4
8
34.8
2
15
27.8
5
4
13.3
1
24
27.9
5
103
25.9
27
%
0
7.4
8
8.7
9.3
3.3
5.8
6.8
Male No LIB
Overweight
Obese
N
%
N
7
22.6
1
46
22.8
13
11
15.7
8
26.7
2
13
18.1
5
22
28.2
8
31
25
7
138
22.7
36
%
3.2
6.4
0
6.7
6.9
10.3
5.6
5.9
Males LIB
Overweight
Obese
N
%
N
7
36.8
1
33
22
6
11
18.6
1
2
15.4
12
33.3
1
5
20
13
19.4
5
83
22.5
14
%
5.3
4
1.7
0
2.8
0
7.5
3.8
Dietary behaviour and its association with overweight and obesity
among Irish children and adolescents.
Questionnaire data were available for the Second Class / Primary Four and
Junior Cert / Year 4 children and adolescents in RoI and NI. These data are
presented according to school year rather than by age in years. Eighty five per
cent of parents of Second Class (RoI) and Primary 4 (NI) children reported
that their child ate sweet food or drank sweet drinks at least once per day. A
relatively high percentage of the Junior Cert (13%) and Primary 4 (12%) group
purported not to know how often they had sweet snacks or drinks, however,
only 8% responded that they consumed them less than once per day (table 7).
At the other end of the scale, summing the results for four and more sweet
snacks, 11% (RoI) and 13% (NI) of Junior Cert / Year 4 consumed 4 or more
sweet snacks per day compared to 7-8% of Second Class / Primary Four. It is
likely that the greater independence of Junior Cert / Year 4 facilitates greater
access to sweet snacks.
Table 7: Consumption of foods and drinks sweetened with sugar in the
Republic of Ireland and Northern Ireland
How often do you eat sweet food or sweet drinks (such as biscuits, cakes, sweets, CocaCola, Pepsi, 7-up, Fruit drinks, Ribena etc) between normal meals?
Second Class / Primary Four
Junior Cert / Year 4
Republic of
Northern Ireland
Republic of
Northern Ireland
Ireland
%
Ireland
%
%
%
Never
1
1
1
1
< once a day
13
14
8
8
1/day
32
29
23
21
2/day
32
31
28
29
3/day
15
16
16
17
4/day
4
6
6
6
5/day
1
2
2
2
>6/day
1
1
3
4
Don’t know
1
0
13
12
Blank
0
0
0
0
Total
100
100
100
100
Overweight, obesity and snacking
These data do not show any difference in the snacking habits of overweight
and obese children and adolescents relative to the general population (Table
8 a-d). Mean BMI and snacking habits across Health Board Region are
presented in appendices 10 a-b.
Table 8 a: IOTF Distribution of second class children by frequency of snacking
by class, ROI
Less than 1x per day
Once a day
2x or more per day
Don't know
Total
Overweight
N
%
145
14.9
299
30.8
515
53
13
1.3
972
100
Obese
N
46
91
148
8
293
Total
%
15.7
31.1
50.5
2.7
100
N
509
1154
1951
31
3645
%
14
31.7
53.5
0.9
100
Table 8 b: IOTF Distribution of junior certificate children by frequency of
snacking by class, ROI
Less than 1x per day
Once a day
2x or more per day
Don't know
Total
Overweight
N
%
88
11.1
193
24.4
417
52.7
94
11.9
792
100
Obese
N
14
40
111
32
197
Total
%
7.1
20.3
56.3
16.2
100
N
310
777
1901
444
3432
%
9
22.6
55.4
12.9
100
Table 8c: IOTF Distribution of primary four children by frequency of snacking
by class, NI
Less than 1x per day
Once a day
2x or more per day
Don't know
Total
Overweight
N
%
10
14.9
21
31.3
36
53.7
0
67
100
Obese
N
%
3
16.7
5
27.8
10
55.6
0
18
100
Total
N
42
87
168
1
298
%
14.1
29.2
56.4
0.3
100
Table 8d: IOTF Distribution of form four children by frequency of snacking by
class, NI
Less than 1x per day
Once a day
2x or more per day
Don't know
Total
Overweight
N
%
12
8.5
36
25.5
79
56
14
9.9
141
100
Obese
N
%
4
11.4
10
28.6
19
54.3
2
5.7
35
100
Total
N
53
129
359
75
616
%
8.6
20.9
58.3
12.2
100
However, daily consumption of soft drinks was more common among obese
adolescents in both the Republic and Northern Ireland (this question was not
asked relating to Second Class / Primary Four). It should be noted that this is
a limited cross sectional measure of dietary habits and thus these data should
be interpreted with caution. The breakdown according to Health Board area is
shown in appendix 11.
Table 9a: IOFT Distribution of children by daily soft drinks by class, ROI
No
Yes
Total
Overweight
N
%
248
31.2
546
68.8
794
100
Obese
N
%
53
26.9
144
73.1
197
100
Total
N
1050
2396
3446
%
30.5
69.5
100
Table 9b: IOFT Distribution of children by daily soft drinks by class, NI
No
Yes
Total
Overweight
N
%
38
26.8
104
73.2
142
100
Obese
%
5
14.3
30
85.7
35
100
N
Total
N
%
164
26.4
457
73.6
621
100
These results compare favourably with the 1998 HBSC results.
It is not
possible to make direct comparisons with the 2002 HBSC as the format of the
question relating to soft drink and sweet consumption changed from the
previous survey. Comparisons can be drawn however, between HBSC 1998
and the Oral Health Survey where similar questions were asked. Sweet and
chocolate consumption compares favourably, while soft drink consumption is
higher in the Oral Health survey.
Table 9c: Comparison of the Oral Health Survey with the 1998 and 2002
HBSC surveys.
HBSC 1998
HBSC 2002
Oral H 2002
% eating sweets or chocolate
every day
Female
Male
75
80
56
52
87
87
% drinking soft drinks every day
Female
51
41
85
Male
75
49
91
Sedentary Activities and BMI among Irish children and adolescents.
The mean number of hours per day spent in front of a TV, game console or
computer was estimated from responses to the question on average hours
spent in front of a screen on weekdays and the week-end (Table 10).
Table 10: Mean Hours spent in front of a TV, game console or computer as
reported by parents of children in Second Class/Primary Four, in the Republic
of Ireland and Northern Ireland
Male
Republic of Ireland
Northern Ireland
Female
N
Mean Hours (std)
N
Mean Hours (std)
1,721
2.5 (1.97)
1,719
2.4 (1.82)
148
2.2 (1.56)
138
2.6 (4.09)
Most children (RoI and NI) reported spending 1-2 hours in front of screens per
day (73 - 77%) (Figure 10a-b). In RoI 6% of males and 5% of females
(rounded percentages) were reported to sit in front of screens for 5 or more
hours per day on average. In NI this figure was 3% for males and 4% for
females.
In the RoI, on average, boys and girls in this age group spend 2.5 and 2.4
hours per day respectively in front of a screen. In NI the figures are similar
with boys spending 2.2 hours and girls 2.6 hours respectively watching
screens.
Figure 10a: Number of hours spent in fromt of screens-RoI 2nd class (average age 8)
40
38
37
36
34
35
30
%
25
Male
Female
20
15
14
15
10
5
5
5
3
2
3
2
3
3
0
<1
1
2
3
4
5
6+
Hours
Figure 10b: Number of hours spent in fromt of screens-NI Primary Four (average age
8)
45
41
40
38
38
36
35
30
25
%
Male
Female
20
16
15
12
10
5
4
5
2
1
4
1
0
1
0
<1
1
2
3
4
5
6+
Hours
Table 11 shows the mean BMI for boys and girls in the RoI according to the
amount of time they are reported to spend in front of screens. Those reported
as spending 5 or more hours per day on average in front of screens had
higher mean BMI relative to those who spent less time exposed to TV, game
console or computer. There were insufficient data from the NI sample to
address this issue.
Table 11: Number of children, mean BMI and standard deviation according to
gender and average reported time spent in front of screens, Second Class
children, RoI.
Male
N
Hours
Female
Mean BMI
N
(std)
Mean BMI
(std)
<1
39
17.5 (2.2)
55
17.8 (2.6)
1-2
1,255
17.5 (2.6)
1,250
17.7 (2.7)
3-4
328
17.5 (2.5)
332
17.8 (3.2)
5
45
18.3 (3.6)
29
18.8 (4.5)
6+
54
18.1 (3.4)
53
18.5 (3.3)
A detailed breakdown of mean BMI and hours in front of a screen across
health board region is shown in appendix 12.
The impact of demographic factors and selected behaviours on BMI
Additional multivariate analyses were carried out for Second Class / Primary
Four and Junior Cert / Year 4 children and adolescents as there were
additional variables available from the questionnaire for these two classes /
years in school. The questionnaires for the two age groups differed slightly.
Data on time spent in front of screens was available only for Second Class /
Primary Four children. Data on soft drink consumption were available only for
Junior Cert / Year 4 adolescents. Analysis of variance was used to estimate
the impact of different factors on BMI as a continuous dependent variable.
Logistic Regression was used to estimate the impact of these factors on the
likelihood of being in the overweight or obese categories. In this section
separate analyses are presented for the two age groups (school years) in
question. These analyses differ to the multivariate analysis already presented
for the entire sample where age in years was used as a categorical
independent variable, as the analysis below was carried out according to
school year age is not used as a variable.
Analysis of variance, factors associated with BMI.
In the case of Second Class / Primary Four, analysis of variance was carried
out with five factors: Gender, Country, Disadvantage, Snacking and Hours
Spent Watching Screens (continuous variable). Modeling BMI (after natural
log transformation) indicates that of these, Gender (p=0.0002) and Hours
Spent Watching Screens (p=0.0130) are related to BMI. Females had a higher
BMI than Males, children who spent more time watching screens also had a
higher BMI. The difference between the genders was not the same in RoI and
NI (p = 0.0214). The gender difference was larger in NI.
Neither country (p = 0.7533) nor Disadvantage had an impact (p = 0.8457).
Also, the pattern of snacking has no impact on BMI (p = 0.7820).
For Junior Cert / Year 4 adolescents, analysis of variance was carried out with
five factors: Gender, Country, Disadvantage and Snacking. Modeling BMI
(after natural log transformation) indicates that there was a significant
difference between males and females (p < 0.0001), with females having
higher mean BMI. The difference between the genders was not the same for
disadvantaged and non disadvantaged groups (p = 0.0249). The gender
difference was larger among the less well off.
Snacking (p<0.0001) was also related to BMI, those that report snacking more
often had lower BMI. The results for snacking and sweet drinks are difficult to
interpret and the need for additional detailed work in this area is warranted.
Clearly cross sectional studies are of limited value in elucidating the nature of
the association between diet and overweight and obesity. The data serve as
an example of the need for carefully designed studies for the exploration of
this complex field. Thus it would be inappropriate to draw conclusions on the
association between snacking behaviour and overweight from these data.
Neither country (p = 0.5018) nor medical card had an impact (p = 0.7696).
Drinking fizzy drinks, etc. at least once a day had no impact (p = 0.1480).
Logistic regression, the factors associated with overweight and obesity.
Overweight; all ages, both countries
Logistic regression was used to model the risk of being overweight according
to the IOTF criteria for the whole sample, i.e. all age groups in both countries.
Four covariates were used: Gender, Country, Age (to nearest year) and
Disadvantage as measured by eligibility for General Medical services (Medical
Card status) in RoI and receipt of any Low Income Benefits in NI.
The analysis revealed that the risk of being overweight was higher for females
(p < 0.0001) and that this risk relationship depended on age. Females were
more at risk than males from ages 4-11, equal at age 12, more at risk at 13
and 14, but at equal risk at ages 15 and 16.
There was no overall difference in the risk of being overweight according to
Disadvantage (p = 0.0834). However there was an interaction between Age
and Disadvantage. The risk of being overweight increased with age (p =
0.0056). This risk was dependent on the Disadvantage status, with nonDisadvantaged being less at risk at ages 6 and 7, more at risk at ages 8 and 9
and less at risk at ages 12 and 16. The risk was similar at all other ages.
There was no difference in the risk of being overweight between the two
countries (p = 0.2745).
Overweight; Second Class / Primary Four children (average age 8), both
countries
The logistic regression for overweight (according to IOTF criteria) was
repeated for the Second Class / Primary 4 children with five covariates:
Gender, Country, Disadvantage, Snacking and Hours spent watching screens
included as a continuous covariate.
The risk of being overweight was found to be higher for females compared to
males (p < 0.0001). There was also a difference between the countries (p =
0.0348), with children in the Republic of Ireland being more likely to be
overweight than children in Northern Ireland.
There was no significant difference in the pattern of snacking for overweight
children (p = 0.1762). Also, there was no difference in the risk of being
overweight according to Disadvantage (p = 0.5262). Neither was there a
significant difference in the time spent watching screens for overweight
children (p = 0.2241).
Overweight; Junior Cert / Year 4 adolescents (average age 15), both
countries
The logistic regression for overweight (according to IOTF criteria) was also
repeated for the Junior Cert / Year 4 adolescents. The five covariates used
were: Gender, Country, Disadvantage, Frequency of Snacking and whether
Sugared drinks (including soft drinks) were consumed at least once per day
(Yes/No) as factors.
The only significant factor was pattern of snacking (p = 0.0115). There was no
difference between those that snacked less than once, once, twice, four times
or more and those that did not know the frequency. However, those that
snacked three times daily were less likely to be overweight than those that
snacked less than once per day.
Obesity; all ages both countries.
Logistic regression was again used to model the risk of being obese according
to the IOTF criteria for the whole sample, i.e. all age groups in both countries.
Four covariates were used: Gender, Country and Medical Card and Age to
nearest year.
The results showed that, as with overweight, the risk of being obese was
higher for females (p = 0.0003). The risk of being obese was also higher for
those classified as Disadvantaged (p = 0.0067) and age was also a risk factor
(p = 0.0012), with the risk increasing between ages 7 to 9, decreasing
between ages 10-11 and constant thereafter.
There was no difference in risk of obesity between the countries (p = 0.5441).
Obesity; Second Class / Primary Four children (average age 8), both
countries
Again the logistic regression was repeated to estimate the effect of different
variables on the risk of being obese for Second Class / Primary 4 children, as
questionnaire data existed for this group and thus more covariates were
available for entry into the model. Five covariates were used: Gender,
Country, Medical Card, Snacking and Hours spent watching screens included
as a continuous covariate.
The analysis indicated that the risk of being obese was higher for females (p =
0.0044). In addition, the pattern of snacking was significant (p = 0.0028).
There was no difference between those that snacked once, three times, four
or more times daily and those that snacked less than once. Interestingly,
those that snacked twice daily were less likely to be obese than those that
snacked less than once. Furthermore, those whose parents said they did not
know how often the children snacked were more likely to be obese. Another
significant factor in the risk of being obese was, increased time spent
watching screens (p = 0.0240).
Neither Disadvantage (p = 0.2742) or Country (p = 0.4534) had an effect on
the risk of being obese for this group.
Obesity; Junior Cert / Year 4 adolescents (average age 15), both
countries
The logistic regression for risk of obesity for this age group included five
covariates: Gender, Country, Disadvantage, Frequency of Snacking and
whether Sugared drinks (including soft drinks) were consumed at least once
per day (Yes/No) as factors. None of the factors were significant.
Discussion
The determinants of Body Mass Index were investigated using two different
approaches for this report.
The first approach involved using Analysis of
Variance (ANOVA) to analyse the impact of different variables on the full
spectrum of BMI scores using BMI as a continuous variable. The second
approach Logistic Regression treated BMI as a categorical variable and
children were dichotomised into overweight and not overweight and obese
and not obese for two different sets of analyses. All analyses were carried out
for the entire sample, i.e. children of all ages in both countries and age was
used as a continuous variable. All analyses were also carried out for the
samples from two different school years, for those in Second Class / Primary
Four and those in Junior Cert / Year 4, in these cases age was used as a
categorical variable and data from the questionnaires completed in respect of
these children was added.
Table 12 Summary of factors independently associated with, BMI (ANOVA)
overweight and obesity (Logistic Regression)
BMI all
BMI 2nd
Class /
Primary 4
BMI
Junior Cert
/ Year 4
Overweight
All
Overweight
2nd Class /
Primary 4
Overweight
Junior Cert
/ Year 4
Obese
All
Obese
2nd Class /
Primary 4
Obese
Junior Cert
/ Year 4
Age
Gender
Country
p<0.0001
p<0.0001
p=0.0002
NS
NS
ANOVA
p=0.0062
NS
p<0.0001
NS
NS
p<
0.0001
p<
0.0001
p=
0.0012
Disadvantage
Snacking
Hours
watching
screens
NS
p=
0.0130
p<0.0001
NS
Logistic Regression
NS
p=
0.0348
NS
NS
NS
NS
NS
p=
0.0115
p=
0.0003
p=
0.0044
NS
p = 0.0067
NS
NS
p=
0.0028
NS
NS
NS
NS
Daily
sweet
drinks
NS
NS
p=
0.0240
NS
Table 12 summarises the results of the Logistic Regression and ANOVA
analyses. Age was a significant factor both for BMI and Obesity with BMI
increasing with age. Gender was a significant factor in all ANOVA analyses,
girls had higher BMI than boys. This was also the trend for the Logistic
Regression analyses except that there were no gender differences for
overweight and obesity among Junior Cert / Year 4 adolescents when they
were analysed as a group. Country had an effect only for overweight Second
Class / Primary 4 children where it was more common among those in RoI.
Disadvantage emerged as a significant variable across the spectrum of BMI
when all ages were analysed together, it was not significantly associated with
BMI when the age groups were looked at in isolation. However, overall the
less well off had higher BMI scores. This was also the case for obesity which
was found to be more common among the less well off when the sample was
analysed as a whole across all ages. The findings for frequency of snacking
were that Junior Cert / Year 4 adolescents who snacked more often, had a
lower BMI (ANOVA), this only held for the older age group. Similarly with
Logistic Regression overweight was less likely among those adolescents who
snacked three times per day than among those who snacked less than once
per day. For obesity, it was among the younger age group that obesity was
less likely among those who had two snacks per day than among those who
had less than one snack per day. Frequency of snacking was not found to be
related to obesity among the adolescent group.
Interestingly, hours spent watching screens was found to influence both BMI
and obesity for Second Class / Primary 4 children. These data were not
collected for the older age group.
No association was found between BMI, overweight or obesity for sweet drink
consumption among Junior Cert / Year 4 adolescents.
The results for snacking and sweet drinks are difficult to interpret and the
need for additional detailed work in this area is warranted. Clearly cross
sectional studies are of limited value in elucidating the nature of the
association between diet and overweight and obesity. In particular it should be
noted that this study was not designed to assess this relationship. The primary
purpose of the dietary questions was to establish the levels of reported
snacking behaviour in Ireland. A questionnaire such as the one used in this
study provides very limited information on dietary habits and the absence of
evidence of the expected links between diet and BMI should not be
interpreted as evidence of absence of an association. Rather, the data serve
as an example of the need for carefully designed studies for the exploration of
this complex field. Thus it would be inappropriate to draw conclusions on the
association between snacking behaviour and overweight from these data.
Historical Trends
It is possible to compare the current height and weight data for the Republic of
Ireland with historical data from the 1948 Irish Nutrition Survey to examine
trends over this time period. The 1948 Nutrition Survey measured the heights
and weights of 14,835 children between the ages of 4 and 14 years between
the years 1946 and 1948 (Table 13).
Table 13: Mean height and weight for children in RoI in 1948 (n = 14,835) and
2002 (n=17,518) by age and gender
Height (cm)
Boys
Age
4
5
6
7
8
9
11
12
13
14
1948
103.4
106.9
113.3
119.1
124.0
128.0
137.2
140.5
146.1
145.8
Weight (kg)
Girls
2002
109.5
113.2
116.4
128.4
131.5
134.4
150.4
153.9
157.6
168.9
1948
102.1
106.9
111.5
116.8
120.9
127.0
136.1
140.0
144.5
147.1
Boys
2002
108.9
112.3
115.7
127.4
130.8
133.8
151.1
154.2
156.9
162.7
1948
17.9
18.8
20.8
22.9
24.8
26.8
31.3
33.3
36.5
37.0
Girls
2002
20.1
21.3
22.9
28.4
30.7
32.5
44.5
47.4
50.3
60.9
1948
17.1
18.2
19.3
21.2
23.1
25.7
30.4
33.1
36.6
39.5
2002
19.7
21
22.3
28.8
30.8
33
46.6
48.6
51.6
58.7
In 1948 the mean height of a four year old and a fourteen year old boy was
103.4cm and 145.8cm respectively, while this had increased to 109.5 cm and
168.9 cm respectively by 2002.
Similarly for girls, height increased from
102.1cm and 147.1cm for a four year old and a fourteen year old to 108.9cm
and 162.7cm respectively (Figures 12a-b).
Figure 12a: Mean height (cm) for boys according to age between 1948 and
2002
180
160
169
1948
2002
150
Mean Height in Cms
140
120
110
103
113
107
113116
4
5
6
128
119
132
124
134
128
7
8
9
137
154
140
158
146
146
100
80
60
40
20
0
11
12
13
14
Age years
Figure 12b: Mean height (cm) for girls according to age between 1948 and
2002
180
160
1948
2002
151
Mean Height in Cms
140
120
109
102
112
107
116
112
4
5
6
127
117
131
121
134
127
8
9
136
154
140
157
145
163
147
100
80
60
40
20
0
7
11
12
13
14
Age (years)
Similar but more dramatic increases are seen in the weights of these children
(figures 12c-d). The mean weight of four year old boys increased from 17.9kg
to 20.1kg between 1948 and 2002 while the mean weight of four year old girls
increased from 17.1 kg to 19.7 kg over the same time period.
More
dramatically however, is the weight gain in the older ages. The weight of
fourteen year old boys in 2002 is almost double that of 1948, (37.0 kg and
60.9 kg respectively), while that of girls also increased substantially from
39.5kg in 1948 to 58.7kg in 2002.
Figure 12c: Mean weight (kg) for boys according to age between 1948 and 2002
70
60
1948
2002
61
Mean Weight in Kgs
50
50
47
45
40
31
28
30
20
37
37
18
20
21
19
21
23
33
31
27
25
23
33
10
0
4
5
6
7
8
9
11
12
13
14
Age (years)
Figure 12d: Mean weight (kg) for girls according to age between 1948 and
2002
70
60
1948
2002
59
Mean Weight in Kgs
52
50
49
47
40
40
37
20
31
29
30
17
20
21
18
22
19
21
33
23
33
30
26
10
0
4
5
6
7
8
9
Age (years)
11
12
13
14
Similar patterns can be seen when mean BMI is examined between 1948 and
2002 (figures 12e-f).
Figure 12e: Mean BMI by age for boys between 1948 and 2002
25
21
20
Mean BMI
17 17
16 17
16
17
18
18
17
16
17
17
17
17
16
16
20
20
20
15
1948
2002
10
5
0
4
5
6
7
8
9
11
12
13
14
Age (Years)
Figure 12f: Mean BMI by age for girls between 1948 and 2002
25
22
20
16
17
17
16
16
18
18
18
16 17
16
21
20
20
16
16
17
18
18
BMI
15
1948
2002
10
5
0
4
5
6
7
8
9
Age (Years)
11
12
13
14
CHAPTER 4 DISCUSSION
Obesity is one of the main risk factors for many chronic diseases, the
prevalence of which continues to increase in the Republic of Ireland. Figures
from the recent National Health and Lifestyle Survey, SLÁN indicate that
between 1998 and 2002 obesity rates rose by 3% and HBSC figures indicate
that 14% of 13 year old boys and 10% of 13 year old girls are either
overweight or obese [24]. To date however, no data exists to allow an allisland comparison. The aim of this survey was to establish baseline data with
regard to overweight and obesity amongst children on the island of Ireland.
Height, weight and body mass index (BMI) data are presented for children
North and South of Ireland.
This is the largest study of overweight and
obesity conducted in Ireland to date (n=19,617), it is also the first all Ireland
study of this nature.
Prevalence
Overweight and obesity in childhood have significant impact on both physical
and psychological health. Overweight children are at increased risk of being
overweight or obese adults, and consequently at higher risk of developing
many of the associated chronic diseases [25]. In the present study, almost a
quarter of all children measured were either overweight or obese. While not
significant, higher rates of overweight and obesity were seen in the Republic
of Ireland compared to Northern Ireland. This ties in with research by Friel
and colleagues [26] who estimated that two of the main determinants of
overweight and obesity (healthy food and physical activity) were less
expensive to purchase in Northern Ireland compared to the Republic of
Ireland.
That is, it is cheaper to buy healthy food and participate is physical
activity e.g. cost of going to swimming pool, in Northern Ireland.
The pattern of overweight and obesity found in this survey (2002) is very
similar to that observed in the Health Survey for England 2002 [27]. In the
latter survey, according to IOTF criteria, 6% of boys and 7% of girls aged 2-15
were obese and 22% of boys and 28% of girls were either overweight or
obese. Similarly in the 4-16 age group, in the Republic of Ireland in 2002, 6%
of boys and 7% of girls were obese and in Northern Ireland these figures
were 5% and 7. Furthermore, almost one in four boys (23% RoI and NI) and
over one in four girls (28% RoI and 25% NI) were either overweight of obese.
Socio-Economic
The public health community has long been alert to the fact that diseases,
which make a major contribution to the socio-economic gradient in health,
have their origins in risk factors in both early and later life.
This total
lifecourse perspective is being increasingly used in developing the social
inequalities on health debate [28].
Previous studies have shown a class
difference in the prevalence of overweight and obesity, where higher
prevalence rates exists amongst the most disadvantaged in our society [29].
In the present study less well off children age 4-16 had higher BMI than the
rest of the age group, were more likely to be obese and were also
considerably smaller than others.
Diet
Foods and drinks high in sugar are consumed frequently by children in the
present survey. Over half of all children consume sweet foods or drinks at
least once a day (50% in NI and 55% in RoI). While direct comparisons
cannot be made with the most recent HBSC figures [24] due to the nature of
the questions, the results compare favourably with the Irish data from the
previous HBSC study [30]. The high consumption of these energy dense
foods is a major public health concern. Our results indicate that daily
consumption of soft drinks was more common amongst already overweight or
obese adolescents. This is in keeping with international literature linking high
soft drink consumption with increased energy intake and overweight or
obesity. For example,
Harnack and colleagues estimate that children who
drink one regular carbonated drink a day have an average 10% more total
energy than non-consumers [31]. Ludwig and colleagues surveyed soft drink
consumption in 548 eleven year old school children, prospectively over a 19
month period, and concluded that consumption of sugar-sweetened drinks is
associated with obesity in this age group [32].
Sedentary Activities
The health benefits of physical activity are now well established [33-35].
Figures from HBSC survey data indicate that 12% of school-going children
exercise less than weekly.
This increase in childhood inactivity has
implications for these children’s health and the risk of being overweight and
obese into adulthood with the associated risk factors.
Coupled with the
decrease in physical activity, increased time spent on sedentary activities e.g.
television viewing and playing video games for long periods of time promotes
obesity in children. In the present study, increased time in front of a screen
(TV or computer) was associated with a higher BMI. This finding is in keeping
with other studies both nationally [36] and internationally [37, 38].
Secular Trends
In Ireland, as is evident from data presented here, there has been a dramatic
increase in height and weight of school-going children between the years of
1948 and 2002. This secular trend to increasing height and weight is mirrored
in the UK [39] and further a field as documented by Cole [40] and others [41].
Observations of Norweigan schoolgirls since 1920 show that while height has
somewhat stabilized since 1975, weight has continued to increase, [42]. This
disproportionate increase in weight is seen in the Irish data, particularly so for
14-year old boys where, there has been an increase in weight of 24kg
between 1948 and 2002.
Coupled with increases in mean height and weight
between 1948 and 2002, mean BMI also increased, though not as
dramatically as height and weight. Padez and colleagues [43], examining
trends in BMI in Portuguese children observed that mean height and weight
also increased at different velocities with weight increasing faster than height,
and consequently causing BMI increases.
Examination of the Irish data indicate that the more dramatic increases occur
from age 11 years, for both boys and girls which coincides with the age of
puberty. This increased weight disproportionate to increased height reflects
the growing epidemic of obesity in Ireland, as in the rest of the world.
CHAPTER 5 CONCLUSIONS
This survey presents data on the height, weight and body mass index of a
nationally representative sample of children aged 4-16 years in the Republic
of Ireland and Northern Ireland. Comparison of these data with a previous
national survey in RoI shows that children are now taller and heavier than they
were in 1948, the increase in weight being disproportionately greater than that
in height. Using international norms, on average 23% of boys and 28% of girls
were found to be overweight in RoI. In NI these figures were 23% and 25%
respectively. Comparing these data with those from other countries where
data were collected between 2000 and 2003, RoI ranks second for the
proportion of overweight girls and third for overweight boys. The situation in NI
is similar. Obesity levels are also worrying affecting 6% of boys and 7% of
girls in RoI and 5% and 7% respectively of NI girls and boys. While obesity is
itself an avoidable chronic disease, it is a substantial risk factor for others. The
costs of obesity have been estimated at up to 8% of overall health budgets
and represent an enormous burden both in individual illness, disability and
early mortality as well as in terms of the costs to employers, tax payers and
society [44].
Whilst the cause of obesity is an imbalance between energy intake and
expenditure, numerous factors influence these variables including family
factors, lifestyle, environment, culture, advertising, economic factors and
social factors. These influences have been considered in depth by the recent
Taskforce on Obesity which reported in 2005 [45]. Its recommendations, over
eighty in all, relate to actions across six broad sectors: high-level government;
education; social and community; health; food, commodities, production and
supply; and the physical environment.
Future trends in overweight and obesity in Ireland, will be determined by the
success or otherwise of these recommendations in turning the tide in relation
to excessive weight gain among our population, the database summarized
and reported here provide a valuable baseline for monitoring the future impact
of the measures proposed. In view of the alarming figures reported here
immediate implementation of the recommendations is strongly recommended
along with planning for ongoing systematic monitoring using the same
methods and sampling strategy used in this study.
Acknowledgements
Fulfilling the aims of the survey required the clinical examination of almost
20,000 children and adolescents over a six-month period. The scale of the
survey required contributions from a large number and wide variety of people
from many different disciplines and sectors of society. We would like to thank
everybody who contributed to the survey and to the production of this report.
The parents of 19,950 children and adolescents consented to the clinical
examination and completed questionnaires. This survey would not have been
possible without the generous contribution of their time and effort and the kind
cooperation of the children and adolescents themselves. We would like to
thank the chairpersons of the school boards of management, school principal
teachers, class teachers and caretakers who facilitated the conduct of the
clinical examinations in schools all over the Republic and Northern Ireland.
We would particularly like to thank the four schools (mentioned in the main
body of the report) who hosted the training and calibration exercises which
took place prior to the start of the survey. The assistance of the Departments
of Education in both jurisdictions in providing data for the sample frame is also
acknowledged. Thirty-nine survey teams carried out the clinical examinations
with energy and enthusiasm. Their dedication is greatly appreciated. Their
names along with those who trained them will be found at the end of this
report.
The availability of the 1948 National Nutrition Survey data allowed us to
compare the height and weight of children in 2002 with 1948. We are very
grateful to Dr Bernard Cousins the medical officer who carried out the
fieldwork for the 1948 survey who provided us with a copy of the report and to
Dr Brendan Cousins for bringing the survey report to our attention.
APPENDICES
Appendix 1: Training and Calibration of the Examining teams
Health board dentists and dental nurses conducted the fieldwork for the
survey. (Appendix 14). As part of the process, staff at the OHSRC trained 36
dentists and 36 dental nurses in survey methods and in the use of computers
and computer software for the collection of survey data. Hence, development
of new skills for health board staff was an integral part of the survey.
Thirty-two teams from the RoI and 4 teams from Northern Ireland conducted
the fieldwork for the survey. Training took place in groups of 10 teams. Initially
for the RoI teams, three training courses were conducted in June 2001 in two
schools in Cork: Scoil Aiseirí Chríost, Farranree and Scoil Oilibheír Primary
School, Ballyvolane. Further training and the final calibration of the Republic
of Ireland teams took place in September 2001 in three schools: Scoil Mhuire
Primary
School,
Tullamore,
St.
Philomena’s
National
School,
Bray,
Co.Wicklow and Scoil Aiseirí Chríost, Farranree, Cork City (Three of the four
teams from Northern Ireland were trained and calibrated with 8 of the RoI
teams in Cork in September 2001). An additional team was recruited from
Northern Ireland and trained in Cork in January 2002 to assist in the fieldwork.
The principal trainer was involved in the training of the examiners in the 1984
National Survey in the Republic of Ireland and also trained the teams for the
subsequent regional surveys in the 1990s. She was assisted by four assistant
trainers who were experienced in the survey examination criteria (Appendix
13). The level of agreement between the examiners and the gold standards in
the various indices was calculated and measures of agreement were
generated. Additional calibration exercises took place during the training
courses between the trainers and the principal examiner to monitor and
ensure standardisation among the trainers in the training programme.
A validation exercise was conducted during the fieldwork to monitor examiner
agreement and consistency during the course of the survey.
During the training sessions the teams were trained in the use of direct data
entry on to laptop computers using software written for the survey (Appendix
16). Systematic instructions on the return of data electronically were also
given.
Communication was ongoing between the fieldworkers and the OHSRC
headquarters team throughout the fieldwork. The OHSRC provided advisory
support for both the epidemiological and technical aspects of the data
collection. A number of primary schools around the country assisted with the
training and calibration of the examining dental teams.
Appendix 2 : Protocol for measuring height and weight
The following protocol was adopted and all examiners were trained and
calibrated in the method prior to the fieldwork.
Weight
•
Instruct child to remove any excess clothing e.g. overcoats etc
•
Remove shoes
•
Empty pockets containing keys, money, coins etc
•
Remove any heavy jewellery
•
Scales viewfinder should read (0.0) kgs
•
Instruct pt. to stand on scales free of any objects and walls etc
•
Record weight to one decimal point in kgs
Height
•
Wipe head part of the measure with alcohol wipes between subjects
•
Remove shoes
•
Hairstyles should allow height measure to fit comfortably on head
•
Stand with heels together against backstop
•
The spine at pelvis and shoulder level should touch the upright
•
Stand as tall as possible unsupported and clear of any furniture
•
Position head in Frankfurt Plane position (i.e. the lower border of the left
orbit and the upper margin of the external auditory meatus are horizontal)
•
Place measure on head
•
Take deep breath in during the measurement
•
Record height in cms to one decimal point
•
Repeat to check accuracy
The teams were instructed to take measurements of height and weight in a
sensitive and confidential manner.
The scales used in the study could be set to kilogrammes or pounds. The
protocol required the scales to be set to kilogrammes; however some
recorders advised that they had entered some measurements in pounds
inadvertently. The data set was checked for sequences of very high weights, a
kilogram being 2.2 pounds, if a series of data were entered with the scales set
to pounds, it was easily identified and a correction factor introduced.
Appendix 3 Number and Mean Age of 5, 8, 12, 15 year old children
examined by health board, ROI and NI
N
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
ROI
NI
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
ROI
NI
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
ROI
NI
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
Male
Mean
73
115
101
289
104
157
1,238
98
202
240
146
2,474
356
5.4
5.4
5.4
5.4
5.4
5.5
5.5
5.4
5.4
5.4
5.5
5.4
5.4
85
136
120
341
111
152
134
80
194
219
141
1,372
131
8.4
8.4
8.5
8.4
8.4
8.5
8.4
8.4
8.5
8.5
8.5
8.5
8.4
80
127
116
323
116
137
115
91
204
210
129
1,325
115
12.4
12.4
12.4
12.4
12.5
12.5
12.5
12.4
12.5
12.5
12.5
12.5
12.3
62
15.4
110
15.4
90
15.4
ERHA
262
15.4
MHB
68
15.5
MWHB
91
15.4
NEHB
110
15.4
NWHB
71
15.4
SEHB
154
15.4
SHB
202
15.4
WHB
93
15.5
ROI
1,051
15.4
NI
198
15.4
Note: Population survey carried out in NEHB for 5 year olds
Std
N
age= 5 years
0.27
62
0.26
98
0.25
96
0.26
256
0.26
112
0.30
128
0.27
1,108
0.25
98
0.28
183
0.26
250
0.28
143
0.27
2,278
0.25
365
age= 8 years
0.23
67
0.26
118
0.26
117
0.25
302
0.27
89
0.30
140
0.27
121
0.27
83
0.27
207
0.26
257
0.27
128
0.27
1,327
0.25
119
age= 12 years
0.27
60
0.24
111
0.23
100
0.24
271
0.28
117
0.27
157
0.28
120
0.26
94
0.26
204
0.27
295
0.28
123
0.26
1,381
0.22
122
age=15 years
0.27
55
0.23
93
0.28
97
0.26
245
0.27
70
0.26
96
0.26
88
0.23
59
0.23
105
0.26
183
0.27
89
0.26
935
0.25
231
Female
Mean
Std
5.4
5.4
5.4
5.4
5.4
5.4
5.4
5.4
5.4
5.5
5.5
5.4
5.4
0.23
0.26
0.25
0.25
0.27
0.25
0.26
0.25
0.26
0.27
0.27
0.26
0.25
8.4
8.4
8.4
8.4
8.4
8.5
8.4
8.5
8.4
8.5
8.5
8.5
8.5
0.22
0.29
0.24
0.26
0.26
0.27
0.27
0.26
0.27
0.27
0.28
0.27
0.27
12.4
12.4
12.4
12.4
12.4
12.5
12.4
12.4
12.4
12.5
12.5
12.4
12.4
0.23
0.28
0.24
0.26
0.26
0.26
0.26
0.25
0.24
0.27
0.28
0.26
0.22
15.3
15.4
15.4
15.4
15.4
15.4
15.4
15.3
15.4
15.4
15.4
15.4
15.4
0.27
0.25
0.25
0.26
0.27
0.26
0.23
0.25
0.24
0.27
0.27
0.26
0.24
Appendix 4: Mean height (M) by age, gender, and health board
Health Board
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA-TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
ROI TOTAL
Age
(Years)
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
Male
Mean
112.9
130.7
154.3
170.9
112.7
131.1
153.6
171
112.7
130.3
152
171.1
112.7
130.7
153.1
171
113.5
131.6
154.1
171.3
113.5
130.9
154.2
170.3
113.1
130.7
151.8
171.7
113.2
132
154.3
173.4
112.6
132.4
154.2
172.4
114
132.5
155
171.8
114.1
131.5
154.5
173.8
113.2
131.4
153.8
171.7
Female
Std
4.7
5.4
7.4
7.6
5.1
5.8
6.8
7
4.4
6.2
7.1
8
4.8
5.9
7.1
7.5
4.7
6.4
8.2
7.2
4.9
5.6
7.6
8.4
4.2
5.4
8.4
8.1
4.8
5.7
7.6
7.4
4.7
6.2
7.8
7
4.8
5.8
7.9
8.1
4.6
6
7.4
7.4
4.7
5.9
7.7
7.7
Mean
112.7
129.9
154
163.2
112.7
130.1
155
162.1
111.7
129.3
153.8
162.2
112.3
129.7
154.3
162.4
112.8
131
154.7
161.9
113
131.5
153.9
163.1
112
130.6
153.6
161.3
112.3
131.9
155
162.6
111.6
130.4
153.8
162.4
112.9
131.4
154.1
163.6
112.8
131.1
153.6
162.3
112.4
130.6
154.1
162.5
Std
5.9
6.3
6.2
5.8
4.7
5
6.2
5.3
4.7
5.8
5.9
6.1
5.1
5.7
6.1
5.8
7.5
5.9
8
6.1
4.5
6.2
7.7
5.6
4
6.1
7.2
5.8
4.3
6.1
6.3
5.4
4.5
5.3
6.3
6.8
4.8
5.3
7.3
5.5
4.8
5.6
7.2
8.5
4.8
5.7
7
6.1
Appendix 5: Mean weight (kg) by age, gender, and health board
Health Board
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA-TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
ROI TOTAL
Age
(Years)
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
Male
Mean
21.5
30.2
47.1
63.1
20.6
30.7
47.5
62.2
21.2
30.1
46.1
63.3
21.1
30.3
46.8
62.9
21
30.5
46.4
63.9
21.2
30.2
48.6
64.1
21.4
30.3
45.9
63.4
21.7
30.7
47.3
64.8
21
31.6
48.1
66.1
21.5
31.1
46.9
63.8
21.7
30.5
47.1
64.6
21.3
30.6
47.1
63.9
Female
Std
3.5
7.2
10.2
12.9
3.2
7.1
9.4
12
3
5.6
10.7
11.1
3.2
6.7
10.1
11.9
21
30.5
46.4
63.9
21.2
30.2
48.6
64.1
21.4
30.3
45.9
63.4
21.7
30.7
47.3
64.8
21
31.6
48.1
66.1
21.5
31.1
46.9
63.8
21.7
30.5
47.1
64.6
21.3
30.6
47.1
63.9
Mean
22.1
29.6
47.4
57.9
20.7
29.8
49.4
58.5
20.1
30
48.9
57.6
20.7
29.8
48.8
58
21.1
30.8
48.6
59.7
21.1
31.7
49.4
58.7
21
30.6
49.6
58.9
21.6
31.9
50
58
20.9
30.7
48
57.5
21.2
30.9
47.9
58.8
20.7
30.9
46.9
60.7
21
30.6
48.5
58.6
Std
6.9
6.2
9.9
10.4
2.9
5.9
10.4
9.6
2.6
5.4
9.9
11.8
4.2
5.8
10.1
10.7
21.1
30.8
48.6
59.7
21.1
31.7
49.4
58.7
21
30.6
49.6
58.9
21.6
31.9
50
58
20.9
30.7
48
57.5
21.2
30.9
47.9
58.8
20.7
30.9
46.9
60.7
21
30.6
48.5
58.6
Appendix 6: Mean BMI by age, gender, and health board
Health Board
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA-TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
ROI TOTAL
Age
(Years)
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
5
8
12
15
Male
Mean
16.8
17.6
19.6
21.5
16.2
17.7
20.1
21.2
16.6
17.6
19.9
21.5
16.6
17.6
19.9
21.4
16.3
17.5
19.4
21.7
16.4
17.5
20.3
22.1
16.7
17.7
19.8
21.5
16.8
17.5
19.7
21.5
16.5
17.8
20.1
22.2
16.5
17.6
19.5
21.6
16.6
17.6
19.6
21.3
16.5
17.6
19.8
21.6
Female
Std
2
3.3
3.2
3.5
1.6
3
3.3
3.2
1.7
2.3
3.7
3
1.76
2.84
3.47
3.19
1.3
3
3.5
3.1
2.2
2.4
3.5
4.2
1.4
3.1
3.7
3.1
1.7
2.4
3
3.1
1.4
3.1
3.6
3.7
1.5
2.5
4.1
3.8
1.5
2.2
3.3
3.4
1.6
2.74
3.57
3.47
Mean
17.3
17.4
19.9
21.7
16.2
17.5
20.5
22.3
16.1
17.9
20.6
21.8
16.4
17.6
20.4
21.9
16.6
17.8
20.2
22.7
16.5
18.2
20.8
22.1
16.7
17.8
20.9
22.6
17
18.2
20.7
21.9
16.7
18
20.2
21.8
16.6
17.8
20.1
21.9
16.2
17.9
19.8
23
16.5
17.8
20.3
22.1
Std
4.7
2.5
3.4
3.3
1.6
2.9
3.6
3.4
1.6
2.6
3.4
3.8
2.71
2.71
3.48
3.59
2.1
2.4
4
3.9
1.9
3.7
3.7
3.7
1.7
2.6
4.9
4
1.8
3.3
3.5
3.2
1.9
2.9
3.4
4.1
1.7
2.5
4.5
3.4
1.5
2.5
3.6
4.4
1.93
2.82
3.91
3.73
Appendix 7a: Percentage children overweight by age, gender and health
board region
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
ERHA-ECAHB
Male
22.8
21.5
18.4
22.8
ERHA-NAHB
Male
Female
27.6
22.6
23.6
18.1
Female
16.8
25.7
29.4
20.5
ERHA-SWAHB
Male
26.8
22.5
26.3
15.8
ERHA Total
Male
22.8
23.4
25.8
19
MHB
Male
13.1
21.3
19.4
25.1
MWHB
Male
17.1
27.1
27.3
24.1
NEHB
Male
22.6
23.4
24.9
19.9
NWHB
Male
26.9
23.1
23.3
21
26.7
24.3
27.6
25.2
Female
23.3
24.4
30.1
17.5
Female
25.3
24
27.8
20.2
Female
31.6
28.2
22.1
28.9
Female
26.8
31.1
27.5
20
Female
28.7
33.4
29.2
32
Female
39.6
33.4
27.3
12.6
Appendix 7a contd
SEHB
Age (years)
5
8
12
15
Male
18.2
21.1
27.5
23.2
Female
30.6
32.1
25.2
16.6
Male
19.3
26
24.8
20.4
Female
28.2
29.5
24
15.3
SHB
Age (years)
5
8
12
15
WHB
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Male
23
22.6
17.6
21
TOTAL ROI
Male
20.8
23.6
24.5
21
Female
23.1
30.2
16.8
28.8
Female
27.9
28.7
25.5
21.1
Appendix 7b: Percentage children obese by age, gender and health
board region
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
Age (years)
5
8
12
15
ERHA-ECAHB
Male
6.9
5.1
4.3
5.2
ERHA-NAHB
Male
2.5
10.8
6.3
2.4
ERHA-SWAHB
Male
4.6
6.5
6.7
4.7
ERHA Total
Male
4.5
7.7
6.1
4
MHB
Male
2.8
8.3
3.5
4.3
MWHB
Male
3.4
6.5
7.8
7.9
NEHB
Male
5.3
6.2
6.8
3.8
NWHB
Male
6.7
5.9
3.6
3.8
SEHB
Male
3.4
10.8
5.8
9.1
Female
7.9
5.2
4.4
4.5
Female
4.2
6.3
5.3
3.6
Female
3.4
7.1
6
6.8
Female
4.7
6.4
5.4
5.2
Female
6.8
4.7
8.5
11.7
Female
7.8
14.9
11.3
4.9
Female
6.9
6.5
10
4.1
Female
11.2
13.3
7.2
2.1
Female
7.4
7.4
3
4.1
Appendix 7b contd.
SHB
Age (years)
5
8
12
15
Male
4.7
5.2
4
2.7
Female
6.1
6.8
4.5
3.9
Male
2.2
3.7
6.2
2.1
Female
3.2
5.3
4.6
7.5
Male
4.2
7
5.6
4.5
Female
6.1
7.5
6.2
5.2
WHB
Age (years)
5
8
12
15
TOTAL ROI
Age (years)
5
8
12
15
Appendix 8a: Percentage children overweight using international BMI
cut-off points by gender, age, medical card status and health board
region
ERHA-ECAHB
5
8
12
15
INT25
5
8
12
15
INT25
Male
No MC
21.3
21.7
18.4
24.9
Male
No MC
18.4
27
28.2
20.8
5
8
12
15
Male
No MC
23.4
24.6
26.1
15.8
5
8
12
15
Male
No MC
21.4
24.8
25.2
19.6
Yes MC
68.9
25
10.9
8.3
ERHA-NAHB
Yes MC
15.7
17.2
29.7
20.7
ERHA-SWAHB
Yes MC
29
16.6
25.2
17.1
ERHA-TOTAL
Female
No MC
23.1
18.3
24.7
18.3
Female
No MC
30.3
25
23.8
26.9
Female
No MC
25.9
25.8
21.6
19.7
34.2
17.7
23.9
17.8
Female
No MC
26.6
23.9
23
21.8
14.2
18
32.2
26.7
Female
No MC
35.2
27.6
23.5
23.1
2.1
25.6
35
45.1
Female
No MC
30.4
36.8
28.6
20
Yes MC
Yes MC
66.7
50
4.8
17.5
Yes MC
7.2
26.9
47.4
12.6
Yes MC
12.6
24.7
77.6
13.9
Yes MC
23.4
31
51.3
14.3
MHB
5
8
12
15
Male
No MC
12.9
21.3
16.8
25.6
5
8
12
15
Male
No MC
19.1
26.5
24.1
21
Yes MC
Yes MC
27.5
27
17.6
38.1
MWHB
Yes MC
Yes MC
5.8
15.1
26.8
22
Appendix 8a contd.
NEHB
5
8
12
15
Male
No MC
23.3
26.7
27.7
21
5
8
12
15
Male
No MC
29.5
26.7
19.6
29.5
Yes MC
21.2
11.2
19.2
14.5
Female
No MC
27.6
34.5
23.5
29.2
Yes MC
33.4
30.1
40.8
34.3
NWHB
Female
No MC
Yes MC
20.6
19.4
26.4
4.9
41
39
27.6
13
16.4
26.1
33.1
15.1
Female
No MC
31.7
30.8
23.4
12.8
13.2
34.9
38.2
13.2
Female
No MC
28.6
30
23.1
14.7
Yes MC
32.4
22.7
26.3
12.6
SEHB
Male
No MC
5
8
12
15
19
20.4
26.7
24.9
5
8
12
15
Male
No MC
19.8
24.9
24.1
22
Yes MC
Yes MC
25.6
32.3
34.4
26.7
SHB
Yes MC
Yes MC
26.3
26.2
25.5
13.9
WHB
5
8
12
15
Male
No MC
25.3
20.2
16.2
23.3
5
8
12
15
Male
No MC
21.2
24.1
23.5
22.2
Yes MC
16.4
30.2
21.6
18.5
TOTAL ROI
Female
No MC
23.2
27.6
17.6
33.3
Female
No MC
Yes MC
20.8
23
28.1
18.9
29
29.2
23.4
20.9
Yes MC
24.7
33.9
14.1
22.4
Yes MC
24.4
28.5
34.7
20.4
Appendix 8b: Percentage children obese using international BMI cut-off
points by gender, age, medical card status and health board region
ERHA-ECAHB
INT30
Male
No MC
5
8
12
15
Yes MC
6.4
6
3.9
5.2
Male
No MC
5
8
12
15
Male
No MC
Male
No MC
0
17.2
11.6
0
ERHA-SWAHB
Yes MC
Female
No MC
0
5.4
15
3.2
Yes MC
4.1
8.7
4.3
6.9
Female
No MC
Yes MC
45.8
15.4
0
0
5
6.2
3
3.3
6.4
11.2
17.6
10
ERHA Total
3.7
6.8
5.8
2.9
Yes MC
3.9
3.6
4.6
5.7
Female
No MC
Yes MC
2.3
6
7.3
1.7
5
8
12
15
6.2
0
5.5
8.3
ERHA-NAHB
Yes MC
3.7
8.4
5.1
2.9
5
8
12
15
Female
No MC
4.4
12.6
12.8
5.8
0
1.2
11.7
12.3
Yes MC
4.3
6.7
3.9
5.4
10.6
5.8
10.4
6.3
MHB
Male
No MC
5
8
12
15
Female
No MC
Yes MC
3.6
7.9
2.1
3.7
0
9
10.9
6.8
Yes MC
7.8
4
9
11
0
9
6.6
11.3
MWHB
Male
No MC
5
8
12
15
Female
No MC
Yes MC
3.4
6.6
8.7
5.5
0
6.2
5.4
19.8
9.3
18.2
13.4
4.4
Yes MC
0
3.9
4.2
7
Appendix 8b contd.
NEHB
Male
No MC
5
8
12
15
Female
No MC
Yes MC
5.1
6.1
8.7
5
6.2
6.8
2.2
0
Yes MC
6.4
8.3
8.7
1.4
8.8
0
12.1
9.3
NWHB
Male
No MC
5
8
12
15
Female
No MC
Yes MC
4.5
4.5
3.7
5.8
8.1
9.6
3
0
Yes MC
8.4
12.2
6.8
4.2
15
18
8.6
0
SEHB
Male
No MC
5
8
12
15
Female
No MC
Yes MC
3.9
9.8
5.2
9.7
1.9
14.7
8.3
8.4
Yes MC
6.2
5.2
1.5
3
10.3
10.6
10.4
10
SHB
Male
No MC
5
8
12
15
Female
No MC
Yes MC
4.1
4.7
3.6
2
7.8
9.5
4.7
4.3
Yes MC
6.5
6.6
4.5
3.7
4.8
7.3
3.8
5
WHB
Male
No MC
5
8
12
15
1.3
3.6
4.3
1.1
Male
No MC
5
8
12
15
Female
No MC
Yes MC
4.6
3
13.3
2.8
TOTAL ROI
Female
No MC
Yes MC
3.7
6.4
5.4
4
Yes MC
3.7
5.3
4.2
10.1
4.4
9.8
8.7
6
1.9
4.8
4.3
3.6
Yes MC
6
7.7
5.5
5.2
7.2
6.7
8.1
6.5
Appendix 9 a: Percentage of children overweight and obese using UK90 91st and 98th centile cut-offs; US (CDC) 85th and
95th centile cut-offs and the IOFT cut off by age and gender, ROI
ROI
MALES
UK 1990
N
AGE (Yrs)
4
US (CDC)*
%
overweight
(incl. obese)
%
obese
IOFT
%
overweight
(incl. obese)
%
obese
FEMALES
US (CDC)*
UK 1990
%
overweight
(incl. obese)
%
obese
N
%
overweight
(incl. obese)
%
obese
IOFT
%
overweight
(incl. obese)
%
obese
%
overweight
(incl. obese)
obese
630
26
8
39
17
26
7
722
19
6
40
14
29
7
5
2,474
21
8
34
13
22
5
2,278
18
6
35
11
29
7
6
224
19
7
32
8
18
5
152
16
7
32
10
29
7
7
338
21
9
26
10
20
7
451
22
12
31
14
30
11
8
1,372
26
12
30
13
24
7
1,327
25
9
30
11
30
8
9
152
26
13
27
13
22
9
85
27
12
31
14
31
9
11
327
30
13
30
12
27
6
438
25
11
29
11
29
8
12
1,325
27
13
26
11
25
6
1,381
23
9
25
9
25
6
13
206
22
8
21
8
20
4
154
31
10
32
9
32
5
14
608
23
10
21
9
22
6
708
25
10
27
8
27
7
15
1,051
22
9
20
8
22
5
935
19
8
21
7
22
5
16
88
20
10
20
9
20
5
73
21
11
21
5
21
5
8,795
24
10
29
12
23
6
8,704
22
8
30
11
28
7
ROI
Appendix 9b: Percentage of children overweight and obese using UK90 91st and 98th centile cut-offs; US (CDC) 85th and
95th centile cut-offs and the IOFT cut off by age and gender, NI
NI
MALES
UK 1990
N
AGE (Yrs)
4
US (CDC)*
%
overweight
(incl. obese)
%
obese
IOFT
%
overweight
(incl. obese)
%
obese
FEMALES
US (CDC)*
UK 1990
%
overweight
(incl. obese)
%
obese
N
IOFT
%
overweight
(incl. obese)
%
obese
7
22
0
%
overweight
(incl. obese)
%
obese
0
28
%
overweight
(incl. obese)
%
obese
50
26
8
38
22
28
4
54
9
5
356
22
8
33
14
22
5
365
18
7
35
13
28
7
8
131
19
6
22
7
18
1
119
20
14
24
14
23
13
11
47
28
6
26
6
23
4
57
28
16
33
14
33
9
12
115
26
10
25
9
23
6
122
25
10
27
8
27
7
14
108
28
15
25
12
26
7
86
12
6
13
5
14
1
198
26
9
23
8
25
6
231
21
10
23
8
23
6
1,005
24
9
28
11
23
5
1,034
19
9
28
10
25
7
15
NI
*Note: US terminology uses "At risk of overweight" and "Overweight" for 85th and 95th Centiles, respectively.
Appendix 10a: Weighted Mean BMI by Sweet Snacks or Drinks in second class (ROI)
Health Board Area
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
Total ROI
Never
Mean Std
15
15
16.1
2.7
16.9
14.3
20.4
4.2
17.3
3.3
Never
Mean Std
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
Total ROI
18.2
0.2
18.2
20.9
9
16.6
0.5
17.8
15
19.9
17.9
2.7
0
4.1
3.7
<1/day
Mean Std
17.5
19
17.3
17.9
18.6
18.2
17.2
16.6
17
17.6
17.5
17.7
2.4
3.8
1.8
2.3
4.1
2.5
2.1
2.5
2.5
2.7
2.3
2.7
<1/day
Mean Std
16.5
19.5
17
17.8
17.7
17.7
17.3
18.2
18
18
18.4
17.9
2.1
4.7
2.4
3.1
2.7
2.9
2.5
4.6
3.1
2.4
2.6
2.9
1/day
Mean Std
16.7
17.3
18
17.5
17.9
17.4
18.4
17.4
17.5
17.3
17.7
17.6
1.8
2.6
2.4
2.8
3.3
2.2
4
1.9
2.7
2.4
2.5
2.7
1/day
Mean Std
18.1
17.6
17.5
17.6
17.4
18
17.6
18.6
17.9
18
17.8
17.8
4.1
2.7
2.2
3.1
2.3
4
2
3.2
3.5
3
3
3.1
2/day
Mean Std
17.5
17.6
16.9
17.3
17.3
17.2
16.9
17.7
17.7
17.5
17.9
17.4
4
2.6
1.8
3.5
3.1
2
2
2.6
2.9
2.3
3.2
2.7
2/day
Mean Std
17.5
17.1
18
17.6
17.5
17.8
18.6
17.4
17.9
17.6
16.9
17.6
2.3
2.3
2.3
2.3
2.1
3.5
3.3
3
2.3
2.4
2.2
2.6
Male
3/day
Mean Std
17.6 4.9
17.9 2.9
18.8 3.7
18.2 2.5
17.5 2.4
18.1 3.1
16.7 1.6
17.1 1.3
18.8 4.1
18.1 2.8
16.8 1.3
17.9
3
Female
3/day
Mean Std
18.1
17.8
17.7
17.8
17.9
18.3
16.8
17.1
17.6
19.3
17.7
17.9
2.8
3.8
2.6
3.4
2.5
3.1
2.2
2.1
3
3.8
1.4
3.1
4/day
Mean Std
16.3
18.1
16.5
17
16.7
17.4
17
17.5
19.1
17.8
17.9
17.5
2.5
3
1.4
1.7
0.9
3.3
1.6
4.8
4.4
4.5
2.2
3.1
4/day
Mean Std
16.8
17.6
20.7
18.9
17.5
17.7
19.5
18.1
18.5
17.4
16.9
18.3
5/day
Mean Std
17.4
16.6
20.4
17.4
18.1
16.8
17
17.2
16.1
18.1
16.3
17.1
0.8
1.6
0.7
0.7
2.9
0.9
3.7
0.6
1.8
5/day
Mean Std
1.8
2
4.5
3.5
17.2
18.3
18.1
18
2.4
2
1.7
1.7
2.5
2
2.6
15.5
15.7
16
15.6
15.7
17
16.8
0.7
2.3
1.6
1.1
1
0.7
0
2
1.6
6+/day
Mean Std
Don't know
Mean Std
15.7
18.4
18.5
18.1
18.4
16.1
15.2
17.3
18.4
17.9
0.9
2.3
3.1
19
16.8
16.5
18.1
18
4.2
3.6
1
3.9
2.1
17.6
19.3
3.1
4.4
17.9
2.7
18.1
3
6+/day
Mean Std
18.1
18.1
3.2
3.2
21.5
16.9
17.2
18.1
2.1
18.3
2.3
3.1
4
0.2
3.9
Don't know
Mean Std
19.5
16.5
17.5
1.3
1.9
17.9
5.2
18.7
20.6
20.7
18.3
6.2
4.9
5.8
4
Appendix 10b: Weighted Mean BMI by Sweet Snacks or Drinks in junior cert classes (ROI)
Health Board
Region
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
Total ROI
Health Board
Region
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
Total ROI
Never
Mean
Std
23.1
23.1
24.1
23.8
18.4
19.9
2.1
2.1
0.2
1
22.8
4
22.5
3.2
Never
Mean
Std
18.2
28.3
24.6
19.8
11.7
10
0.2
26.8
24.1
20.6
32
24
3.1
5.5
<1/day
Mean Std
23.5 5.2
23.2
4
19.8 3.3
21.8 4.3
21.5 1.9
19.9 1.5
21.8 2.3
23.2 3.6
22.4 3.4
22.4 5.9
20.8 3.8
21.8
4
1/day
Mean Std
22 5.4
21 3.4
22.1 3.1
21.7 3.9
21.7 3.2
22.1 3.6
21.6 4.2
20.5 2.9
21.4 3.3
22.2 3.5
21 3.5
21.6 3.6
2/day
Mean Std
22.2 3.4
22.3
3
20.8 2.6
21.6
3
22.7 3.4
22.6 4.6
21.3 2.9
20.6 2.4
22.4
4
21 3.9
20.8
4
21.6 3.6
<1/day
Mean Std
19.8 3.3
23.3 2.8
21.9 3.6
21.9 3.5
23.6
5
23.1 3.3
21.7 2.9
21.8 3.5
20.9 1.9
22.3 2.5
20.5 1.8
21.9 3.2
1/day
Mean Std
23
4
21.6 2.7
22.3 3.9
22.2 3.5
22.3 3.7
22.5 3.8
23.3
5
21.5 2.5
22.4 3.9
22.9 3.9
22.8
4
22.5 3.8
2/day
Mean Std
20.7 3.9
23 4.5
20.9 2.4
21.6 3.7
22.8 3.7
22.4 4.4
22.7 3.4
22.8 4.2
22.1 4.9
22.3 4.5
22.4 3.3
22.2 4.1
Male
3/day
Mean Std
20.5 3.4
20.9 3.5
21.9 4.1
21.3 3.7
21.1 3.9
20.3 2.4
21 3.1
22 3.5
21.3 2.8
20.7 2.7
22.1 3.1
21.2 3.2
Female
3/day
Mean Std
21.2 2.9
21.2 3.3
21.2 3.7
21.2 3.2
22.8 4.1
21.5 3.4
21.2
3
21.6 2.3
22.7 3.8
22.9 3.3
20.9
3
21.7 3.3
4/day
Mean Std
19.9 2.1
19.8 2.2
22 3.9
20.7
3
21.5 2.1
21.1 5.9
22.7 3.3
20.3 2.6
23.3 5.4
21 2.5
20.2
2
21.3 3.9
5/day
Mean Std
18.7 1.4
19.3 1.2
20.2 1.1
19.3 1.2
17.3 0.7
19 0.3
24.9 3.4
18.4
23.2 4.6
22.3 3.8
17
20.5 3.3
6+/day
Mean Std
19.3 2.8
21.4 4.1
22.2
5
21.2 4.2
20.8
21.5 3.2
21.2 1.8
19.5 1.2
21.6 2.5
19.4 1.5
22.1
2
21 3.1
Don't know
Mean Std
22.1 3.4
21.1 3.5
21.7 2.8
21.6 3.3
21.3 3.7
19.4 3.9
20.8 2.4
22.4 4.5
21.9 3.6
21.3 2.6
22.8 6.3
21.5 3.6
4/day
Mean Std
24.5 3.8
20.4 2.1
22.1 5.1
22.2 4.2
21.8 2.8
22 3.5
23.5 4.5
19.7 1.8
21.3 5.4
22 2.9
21.7 1.7
21.9 3.6
5/day
Mean Std
20.8 0.1
22.9
1
19.5 1.5
21
2
17.2 2.4
21.5 4.2
20.8 1.4
22 5.6
20 4.3
18 1.2
19.3
20.5 3.2
6+/day
Mean Std
20.6 3.7
19.5 2.8
19.3 2.6
19.7 2.6
23.4
18.1
22.3 3.1
16.6
19.7 2.5
22.5 2.2
27.2
20.9 2.9
Don't know
Mean Std
22.3 3.5
20.8 2.7
23.3
5
22.2 3.8
21.8 2.8
21.8
4
23.3 4.1
22.9 3.4
23.3
4
22 4.1
23.9
7
22.6 4.2
Appendix 11: ROI: Weighted Mean BMI by Gender, Daily Soft Drink or Juice, and
Health Board Region
Male
No
Mean
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
Total ROI
20.7
25.2
20.5
22.5
21.5
22.4
22.2
20.6
21.5
22.4
20.9
22
Std
1.9
4.6
2.7
3.7
3.4
4.9
3.4
2.3
3.4
3.2
5.6
3.8
Female
Yes
Mean
21.7
21.2
21.5
21.5
21.7
21.6
21.2
21.2
22
21.4
21.4
21.5
Std
3.9
3.2
3.3
3.4
3.3
3.8
3.1
3.2
3.7
3.7
3.6
3.5
No
Mean
21.6
21.3
20.7
21.1
21.1
23.1
21.7
22.3
21.5
23.4
22.1
21.9
Std
2.4
2.9
3.2
2.8
2.9
3.2
2.8
2.9
3.7
3.9
4.7
3.4
Yes
Mean
21.6
22
21.8
21.8
22.8
22.1
22.7
21.7
22.2
22.4
22.4
22.2
Std
3.7
3.4
3.9
3.7
3.7
3.9
3.9
3.4
4.2
3.7
3.9
3.8
Appendix 12: ROI: Weighted Mean BMI by Gender, hours in front of a
screen, and Health Board Region
Health Board Region
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
Total ROI
Health Board Region
ERHA-ECAHB
ERHA-NAHB
ERHA-SWAHB
ERHA TOTAL
MHB
MWHB
NEHB
NWHB
SEHB
SHB
WHB
Total ROI
<1hr
Mean Std
16.1 2.49
17.3 2.72
18.9 2.97
17.8 2.74
18.5 1.98
17
18.8
16.2
16.7
16.8
17.3
1.19
0.86
1.91
1.81
2.19
<1hr
Mean Std
17.5 1.89
17.1
1.7
18.6 1.51
17.8 1.79
16.8
17.8
15.4
17.2
17.9
19
17.7
3.09
1.8
3.6
2.58
1-2hrs
Mean Std
18.2 3.21
18.1 3.01
17 2.05
17.7 2.78
17.2 3.05
17.5 2.48
17 2.04
16.8 2.24
17.5 2.81
17.5
2.6
17 2.43
17.4 2.62
1-2hrs
Mean Std
17.8 2.39
17.6 2.51
17.5 2.33
17.6 2.41
17.2 2.48
18.1 3.54
17.6 2.56
18.3 2.94
17.7 2.61
18.5 2.68
17.4 2.74
17.8 2.71
Male
3-4 hrs
Mean Std
17.2 3.47
16.9 1.91
17.3 1.65
17.1 2.34
16.7 2.79
17.2 2.36
18.1 2.87
16.7 1.76
17.2 3.24
17.8 2.68
17 1.77
17.3 2.53
Female
3-4 hrs
Mean Std
17.9 5.78
17.7 3.55
17.1 2.41
17.5 3.73
19.3 2.71
16.7 3.38
19 2.69
17.1 2.56
17.7 3.02
18.1 3.52
16.9 1.93
17.7
3.2
5hrs
Mean
Std
18.4
18.8
3.12
16.6
2.55
17.8
2.68
22 10.14
19.3
4.82
16
1.03
15.4
0.91
18.1
1.67
18.3
1.81
20.4
7.93
18
3.6
6+hrs
Mean Std
16.2 1.82
17.2 2.36
19.2 5.34
17.7 3.91
18.7 2.84
15.7 1.05
17.5
1.7
16 1.08
20.4
4.3
17.7
2.5
20.4 3.85
18.3 3.43
5hrs
Mean
Std
6+hrs
Mean Std
17.4 3.94
18.3 4.35
18.8
18.2 3.56
18.9 2.21
17.9 3.67
18.8 3.81
20
4.2
20.2 3.96
17.8 2.52
17 2.72
18.5 3.31
18.1
18.8
18.3
21.6
17.3
19
19.9
22.4
17.7
15
18.8
4.65
4.31
2.22
3.57
2.37
9.28
1.16
3.7
4.54
Appendix 13: Funding, support, ethical approval and data protection
The survey reported here was carried out opportunistically as part of a North South
Survey of Oral Health in Ireland. The analysis and reporting of these data were funded by
the Health Promotion Unit in the Department of Health and Children, Dublin and by the
Health Promotion Agency in Northern Ireland. The fieldwork was supported and funded
for the Republic of Ireland, by the Department of Health and Children and the Health
Boards. The Oral Health Survey was part of a larger contract for epidemiological services
which was won by The Oral Health Services Research Centre (OHSRC) in University
College Cork through a competitive tender process. The main contract required the
OHSRC to advise and assist the Health Boards in the design and conduct of five National
Oral Health Surveys and conduct other specified health services research projects. The
extension of the fieldwork to Northern Ireland resulted from discussions with the Chief
Dental Officer, and managers of the Community Dental Service in NI who provided
support for the extension of the survey. The standardised equipment for the
measurement of height and weight were purchased by the Health Boards in the Republic
of Ireland and by the Health Promotion Agency in Northern Ireland.
The protocol for the survey was developed by the project team in the Oral Health
Services Research Centre (Appendix 1) following consultation with the. Assistant Chief
Executive Officers of the health boards, Principal Dental Surgeons, Dental Examiners for
the Survey, Irish Dental Council, Council Members of the Irish Dental Association, Dublin
Dental Hospital, Irish Dental Health Foundation and the National Adult Literacy Agency.
The procedures for measuring height and weight were agreed in consultation with the
Department of Epidemiology and Public Health in UCC.
The staff of the Department of Health and Children and health boards had an important
role in the planning and management of the survey. A ‘User Group’ (Appendix 13) was
established to represent the health boards in the planning, implementation and
monitoring of the surveys.
This group provided the link between the dental service
managers and the survey headquarters team. Regular meetings ensured clear
communication between the two. The Northern Ireland component of the survey was
facilitated by members of the Community Dental Service and the Department of Health
and Personal Social Services (Appendix 13).
83
Ethical approval and data protection
The Ethics Committee of the Cork Teaching Hospitals reviewed the protocols for training
and calibration of the examiners and for the main study. The committee approved the
study on 2nd October 2001. Ethical Approval was also obtained from the Research Ethics
Committee of Queen’s University, Belfast for the Northern part of the study.
The Office of the Data Protection Commissioner was consulted regarding the direct entry
of data to computers. The Data Protection Licenses of the health boards and of University
College Cork were extended to include the survey data. The study complied with the
requirements of the Data Protection Act 1988, Data Protection (Access Modification)
(Health) Regulations, 1989, (S.I. No.82 of 1989), Data Protection (Access Modification)
(Social Work) Regulations, 1989, (S.I. No.83 of 1989), Council Directive on the Protection
of Individuals with Regard to Processing of Personal Data (Directive 95/46/EC) (W)
84
Appendix 14: Contributors to the survey
Project group – Oral Health Survey - University College Cork
Dr. Helen Whelton Principal Investigator
Dr. Evelyn Crowley Senior Research Fellow
Prof. Denis O’ Mullane Consultant
Ms. Theresa O’ Mahony Research Assistant
Ms Edel Flannery Statistician
Mr. Michael Cronin Statistician
Ms. Virginia Kelleher Data Analyst
Ms Helena Guiney Data Analyst
Ms Collette Spicer Proof Reader
Ms. Maria Tobin Projects Manager
Dr. Paul Beirne HRB/HSR Research Fellow
Dr. Rose Kingston Research Fellow
Mr. Denis Field Dept. of Oral Health and Development
Mr. Tim Holland Dept. of Oral Health and Development
Dr. Francis Burke Dept. of Restorative Dentistry
Dr Mairead Harding Researcher
Ms Liz Flynn, Senior Executive Assistant
Ms Anna Couch, Executive Assistant
Ms. Elspeth Cameron Senior Executive Assistant
Ms. Ann Daly Executive Assistant
Ms. Niamh Cronin Executive Assistant
Ms. Maura Gallagher Research Assistant
Ms. Eileen MacSweeney Research Assistant
Ms. Ita Rattray Executive Assistant
Ms. Catherine Mills Research Assistant
Dr. Judith Cochran Senior Research Fellow
Dr. Stephen Phillips Statistician
Prof. Ivan Perry Dept. of Epidemiology and Public Health
Ms. Rita Hinchion Dept. of Epidemiology and Public Health
Dr Janas Harrington Dept. of Epidemiology and Public Health.
44
Survey Teams, Republic and Northern Ireland
Health Board/Health Authority
Dental Examiner
Dental Recorder
East Coast Area Health Board
Dr. Aideen Hayes
Ms. Mary Richardson
Dr. Anne-Marie
Ms. Eileen Bentley
Brady
Northern Area Health Board Dr. Joe Glackin
Ms. Deirdre O'Neill
Dr. Siobhan Bell
Ms. Naomi Bergin
Dr. Sarah McKeon
Ms. Cora Carty
South West Area Health Board
Dr. Mia Delaney
Ms. Caroline Bailey
Dr. Aisling Holland
Ms. Valerie Belton
Dr. Iryna Dootson
Ms. Carmel Dowling
Midland Health Board
Dr. Joe Hynes
Ms. Denise Todd
Dr. Orla O'Connor
Ms. Caroline Gallagher
Hogan
Mid-Western Health Board
Dr. Matt O'Brien
Ms. Geraldine O'Connor
Dr. Cora McCarthy Ms. Deirdre Mc Namara
Dr. Adrian O'Neill
Ms. Agnes Franklin
85
North Eastern Health Board
North Western Health Board
South Eastern Health Board
Southern Health Board
Western Health Board
Northern Ireland
Dr. Imelda Counihan
Dr. Margie Houlihan
Dr. Evelyn Connolly
Dr. Bernie Tiernan
Dr. Mary O'Farrell
Ms. Geraldine Darcy
Ms. Michelle Geraghty
Ms. Joanne Lane
Ms. Rosemary Cunningham
Ms. Liz O'Reilly
Ms. Mairead Clinton
Dr. Rose Kingston
Dr. Kevin Kennedy Ms. Anne Harkin
Dr. Ciaran Rattigan Ms. Barbara Lowry
Dr. Louise Lowry
Ms. Clair Mahony
Dr. Pamela Gartland Ms. Helen Geoghegan
Dr. Maeve Keller
Ms. Liz Joyce
Dr. Margueretta Kelly Ms. Geraldine O'KeeffeMackey
Dr. John Jones
Ms. Joanne McGrath
Dr. Mary Ita Creedon Ms. Anne Sheahan
Dr. Ger Breen
Ms. Johann Oregan-Moran
Dr. Gerry Buckley
Ms. Siobhan Sheehy
Ms. Mary Murphy
Dr. Orla Harding
Ms. Mary O'Driscoll
Smith
Dr. Bob McNulty
Ms. Winnie O'Flaherty
Dr. Antonia Hewson Ms. Breege Barrett
Dr. Matt Walsh
Ms. Celia Naughton
Dr. Seamus O’Donnadhcha
Dr. Doreen Jenkinson Ms. Lorna Ritchie
Dr. Anne-Marie
Ms. Leona Hill
McKenna
Dr. Martin Smith
Ms. Phillipa Heron
Dr. Anne Stevens
Ms. Margaret Boyd
Dr. Colette McCaul Ms. Christina Quinn
Ms. Aine McGuigan
User Group Members RoI – Children’s Survey
Dr. Gerard Gavin, Chief Dental Officer, Department of Health and Children
Dr. Padraig Creedon, Principal Dental Surgeon, SEHB
Dr. Marie Tuohy, Principal Dental Surgeon, SEHB
Dr. Maurice Delaney, Principal Dental Surgeon, MWHB
Dr. Maria Kenny, Principal Dental Surgeon, MHB
Dr. Daniel O’Meara, Principal Dental Surgeon, MHB
Dr. Anne O’Neil, Principal Dental Surgeon, NAHB
Dr. David Clarke, Principal Dental Surgeon, ECAHB
Dr. Matt Walshe, Principal Dental Surgeon, WHB
Dr. Joe Mullen, Principal Dental Surgeon, NWHB
Dr. John Kelly, Principal Dental Surgeon, NEHB
Dr. Mary O’Farrell, Principal Dental Surgeon, NEHB
Dr. Mary O’Connor, Principal Dental Surgeon, SHB
Dr. John Jones, Principal Dental Surgeon, SHB
Dr. Michael Thornton, Principal Dental Surgeon, SHB
Department of Health and Children
Mr Christopher Fitzgerald, Principal Officer
Mr David Moloney. Former Principal Officer
86
Mr Gregory Canning Assistant Principal Officer
Dr Margaret Shannon, Dental Advisor
Dr. Gerard Gavin, Former Chief Dental Officer
Ms Elizabeth Barrett
Members of the Department of Health, Social Services and Public Safety and the
Community Dental Service in Northern Ireland
Dr. Doreen Wilson, Chief Dental Officer, DHSSPS
Dr. Michael Donaldson, SpR Dental Public Health, Fieldwork Co-ordinator NI
Dental Directors
Dr. Judi McGaffin
Dr. Will Maxwell
Dr. Adrian Millen
Dr. Heather Clarke
Clinical Directors Community Dental Services NI
Dr. Aideen Sweeney
Dr. Borghild Breistein
Dr. Patricia Stewart
Dr. Solveig Noble
Dr. John Finnerty
Dr. Julia Kirk
Dr. Ray Parfitt
Dr. Grainne Lynn
Dr. John Hardy
Dr. Pauline Carson
Principal Trainer and Assistant Trainers
Principal Trainer
Dr. Helen Whelton, Principal Investigator, Director, Oral Health Services Research Centre
and
Senior Lecturer in Dental Public Health and Preventive Dentistry, University College Cork
Assistant Trainers
Dr. Evelyn Crowley, Senior Research Fellow, University College Cork
Dr. Margie Houlihan, Senior Dental Surgeon - Admin, Mid Western Health Board
Dr. Cora McCarthy, Senior Dental Surgeon – Admin, Mid Western Health Board
Dr. Imelda Counihan, Senior Dental Surgeon – Admin, Mid Western Health Board
Dental Nurses assisting trainers
Ms. Theresa O’Mahony, University College Cork
Ms. Michelle Geraghty, Mid-Western Health Board
Ms. Geraldine Darcy, Mid-Western Health Board
Ms. Deirdre McNamara, Mid-Western Health Board
Photographers and Time Keepers
Health Board/Health Authority
Photographer
Time Keeper
East Coast Area Health Board
Ms. June Murray
Dr. Catriona Roe
87
Mid-Western Health Board
North Western Health Board
Southern Health Board
Northern Ireland
Trainers
Dr. Anne-Marie Brady Ms. Eileen Bentley
Dr. Cora McCarthy Ms. Deirdre Mc Namara
Dr. Adrian O'Neill
Ms. Agnes Franklin
Dr. Imelda Counihan Ms. Geraldine Darcy
Dr. Margie Houlihan Ms. Michelle Geraghty
Ms. Anne Harkin
Dr. Kevin Kennedy
Dr. Ciaran Rattigan Ms. Barbara Lowry
Dr. John Jones
Ms. Joanne McGrath
Ms. Susan
Ms. Geraldine Walshe
O’Donovan
Dr. Ger Breen
Ms. Johann Oregan-Moran
Dr. Gerry Buckley
Ms. Siobhan Sheehy
Dr. Orla Harding
Ms. Mary O'Driscoll
Smith
Dr. Doreen
Ms. Lorna Ritchie
Jenkinson
Dr. Martin Smith
Ms. Phillipa Heron
Dr. Anne Stevens
Ms. Margaret Boyd
Dr. Colette McCaul Ms. Christina Quinn
Ms. Aine McGuigan
Dr. Judith Cochran
Ms. Eileen MacSweeney
Dr. Evelyn Crowley
Mr. John Roche
47
Direct Data Entry Software
Developer: JacSoftware Ltd, The Old Barracks, Watergrasshill, Co. Cork
Manual compiled and training provided by Dr. Evelyn Crowley, University College Cork
Random Number Generator Software
Developer: Stephen Spelman Engineering Ltd., Bohillane, Ladysbridge, Co. Cork
Manual compiled and training provided by Dr. Evelyn Crowley, University College Cork
88
TECHNICAL NOTES
89
Technical Note 1: Comparison of the UK 1990, US and the IOFT criteria
for defining BMI
The UK 1990 standards are based on percentiles of UK reference curves
(85th percentile for overweight, 95th percentile for obesity). The 1990 UK
reference charts are the most recent cross sectional growth standards for
British children and were published in 1995 [46, 47]. These growth standards
have been compiled from data collated from seven separate growth studies,
conducted in different areas of the United Kingdom between 1978 and 1990.
Over 25,000 children, mostly of white origin, were randomly selected and
measured. Data from the non-white children were not used in the preparation
of the charts. The following cut offs were applied to United Kingdom reference
data: a standard deviation score >1.04 for body mass index (above the 85th
centile) was defined as overweight, and a standard deviation score >1.64
(above the 95th centile) was defined as obese [48]. Thus 15% of children are
expected to be overweight and 5% obese, if there has been no change in the
prevalence
of
overweight
and
obesity
amongst
children
since
the
establishment of the United Kingdom 1990 reference data.
The third set of standards available for comparison is the US standard. The
US reference charts, published in May 2000 by the Centers for Disease
Control and Prevention (CDC), consist of revised versions of the 1977 NCHS
growth charts with the addition of new BMI-for-age charts. These charts derive
from data periodically collected by the National Health and Nutrition
Examination Survey (NHANES) on the general population since the early
1960s. As in the UK, the US standard sets the 85th and 95th centiles on their
BMI-for-age reference charts as cut-offs: A BMI falling above the 85th centile
was defined as ‘at risk of overweight’ (which compares with the UK
‘overweight’), and a BMI falling above the 95th centile as ‘overweight’ (which
compares with the UK ‘obese’). (www.cdc.gov)
Chart 1 below plots the cut-off points for overweight and obese from the IOTF,
UK and US reference BMI-for-age curves against the mean age of Irish male
and female children for each age year. It is obvious that a lower cut-off will
generate a higher prevalence rate for a given age and vice versa. The IOTF
90
cut-offs for obesity are consistently higher than both the UK and US 95th
centile cut-offs for male and female children, and will result in a lower overall
prevalence of obesity.
The IOTF cut-off points for overweight in male children are higher than the UK
and US 85th centile cut-offs up to the age of 12, and drops below the US cutoffs from the age of 13. The cut-off points for overweight in female children
show the least difference among the three standards. The choice of reference
BMI-for-age curves will impact on the resulting overall prevalence rates of
overweight and obesity, with the UK 90 growth curves giving higher
prevalence rates and the US and IOTF reference cut-off giving lower
prevalence rates.
While the IOTF criteria may underestimate actual levels of obesity [49] they
permit valid comparisons over time and across countries. Thus, the IOTF
standards are used as the basis for estimating the prevalence of overweight
and obesity in the body of this report as it facilitates international comparison
BMI Cut-Off Points for Overweight in Male Children, ROI
30
27
BMI
24
21
18
UK 1990 Growth Charts 85th Centile
US CDC 2000 Growth Charts 85th Centile
International Cut-off Points BMI 25 kg/m2
15
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Age in Years
91
BMI Cut-Off Points for Obesity in Female Children, ROI
30
27
BMI
24
21
18
UK 1990 Growth Charts 95th Centile
US CDC 2000 Growth Charts 95th Centile
International Cut-off Points BMI 30 kg/m2
15
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Age in Years
BMI Cut-Off Points for Overweight in Female Children, ROI
30
27
BMI
24
21
18
UK 1990 Growth Charts 85th Centile
US CDC 2000 Growth Charts 85th Centile
International Cut-off Points BMI 25 kg/m2
15
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Age in Years
92
Technical Note 2
The occupations were collapsed into 5 groups to look at the prevalence of
overweight and obesity according to occupational classification. The
distribution of children and adolescents according to parent’s occupational
classification is shown in Figure A1. The balance of parents’ occupation
across the groups was reasonably even except for the higher numbers in the
unemployed category in NI (11-20% in NI as opposed to 8% in RoI. The
proportion of the groups in the Managerial / Professional category ranged
from 27 – 30% in RoI and 26 – 37% in NI. In the Technical / Clerical / Craft
category the range was 44 – 46% in RoI and 37 – 40% in NI.
Looking at the numbers in the different occupational classifications, the
numbers in RoI were sufficient to allow estimation of the prevalence of
overweight and obesity across the occupational classes. However, the
numbers in NI where a smaller sample was drawn, were insufficient to give
reliable estimates.
Figure
A1
Percentage
distribution of children and adolescents
according to jurisdiction, year in school, gender, and highest
occupational class of parents.
100%
80%
8
8
8
8
6
7
8
7
11
16
18
20
5
4
12
12
12
13
2
5
10
13
12
10
60%
37
45
44
46
44
40
39
27
26
27
M
F
38
40%
20%
Unemployed
Other
Service / Sales / Operatives
Technical / Clerical / Craft
Managerial / Professional
37
29
30
27
M
F
30
0%
F
2nd Class
Junior Cert
RoI
M
F
Primary 4
M
Year 4
NI
93
Table A1. Number of children and adolescents according to jurisdiction, year
in school, gender, and highest occupational class of parents.
RoI
2nd Class
Female Male
Managerial /
Professional
Technical /
Clerical / Craft
Service / Sales /
Operatives
Other
Unemployed
All
NI
Junior Cert
Female Male
Primary 4
Female Male
Year 4
Female Male
520
524
462
451
36
40
91
109
792
767
745
776
54
58
115
109
212
209
211
207
16
15
38
30
110
120
135
122
3
8
11
14
136
143
133
134
27
27
48
34
1770
1763
1686
1690
136
148
303
296
Figure A2a Prevalence of overweight according to parents occupational
classification, 2nd class RoI
Prevalence of overweight among children in 2nd class in RoI
50
45
40
33.8
33.6
35
31.1
Percent
30
25
27.7
26.9
23.9
25.8
24.5
23.9
Female
Male
20
15
13.3
10
5
0
Managerial / Professional
Technical / Clerical / Craft
Service / Sales /
Operatives
Other
Unemployed
Occupational Class
94
Figure A2b Prevalence of obesity (IOTF) according to parents
occupational classification, 2nd class RoI
Prevalence of obesity among children in 2nd class in RoI
50
45
40
35
Percent
30
Female
Male
25
20
15
11.8
10
11
9.6
9.2
8.7
6.9
7.5
6.4
8.4
4.5
5
0
Managerial / Professional
Technical / Clerical / Craft
Service / Sales /
Operatives
Other
Unemployed
Occupational Class
Figure A2c Prevalence of overweight (IOTF) according to parents
occupational classification, Junior Cert RoI
Prevalence of overweight among children in Junior Certificate in RoI
50
45
40
35
33.3
Percent
30
27.1
25.4
24.6
25
21
21.3
Female
Male
22.7
21.1
21.1
20.9
20
15
10
5
0
Managerial / Professional
Technical / Clerical / Craft
Service / Sales /
Operatives
Other
Unemployed
Occupational Class
95
Figure A2d Prevalence of obesity (IOTF) according to parents
occupational classification, Junior Cert RoI
Prevalence of obesity among children in Junior Certificate in RoI
50
45
40
35
Percent
30
Female
Male
25
20
15
10.4
10
8.3
5.6
5
4.7
5
5.2
6.6
6.8
6.6
7.5
0
Managerial / Professional
Technical / Clerical / Craft
Service / Sales /
Operatives
Other
Unemployed
Occupational Class
The prevalence of overweight and obesity according to the parents’
occupational classification is presented for RoI in Table A2. The prevalence of
obesity among children and adolescents in RoI is lower among children of
those in Managerial and Professional Classes than those of the Unemployed
among both Second Class children and Junior Cert adolescents.
96
Table A2 Prevalence of overweight and obesity according to the parents’
occupational classification
2nd Class RoI
Female %
Overweight Obese
Male %
Overweight Obese
Managerial /
Professional
27.7
8.7
23.9
6.9
Technical /
Clerical / Craft
31.1
9.2
23.9
6.4
Service / Sales /
Operatives
26.9
11.8
25.8
11
Other
33.6
4.5
13.3
7.5
Unemployed
33.8
9.6
24.5
8.4
All
29.9
9.1
23.4
7.3
Junior Cert RoI
Female %
Overweight Obese
Male %
Overweight Obese
Managerial /
Professional
21
5.6
21.3
4.7
Technical /
Clerical / Craft
25.4
5
21.1
5.2
Service / Sales /
Operatives
22.7
6.6
27.1
6.8
Other
33.3
10.4
24.6
6.6
Unemployed
21.1
8.3
20.9
7.5
All
24.1
6
22.1
5.5
97
Technical Note 3a: Questionnaire Second /Primary Four Classes
98
Technical Note 3b: Questionnaire Junior Certificate/Form Four Classes
99
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