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Résumé (anglais)

Abstract:The prevalence of childhood obesity has increased dramatically over the last three decades in Canada with substantial consequences for the physical, mental, and economic wellbeing of the population. The overarching objective of this thesis was to examine the various aspects of childhood obesity in Canada, from prevalence trends and risk factors to economic and medical consequences. A systematic review (Objective 1) showed that the prevalence of childhood obesity in Canada has tripled since 1980. Using a prediction model (Objective 2), I demonstrated that the prevalence of overweight and obesity will further increase by 10% over the next 15 years if current trends continue unabated. An analysis of a population-based survey data among Grade 5 students in Nova Scotia linked with a perinatal database (Objective 3) showed that perinatal factors (large-for-gestational age, maternal pre-pregnancy weight) play an important role in the development of childhood overweight. Calculating the population attributable risk fractions for these risk factors (Objective 4), I was able to show that excess screen time and maternal pre-pregnancy weight offer the largest potential for prevention. My analysis of the health care costs associated with childhood obesity (Objective 5) found that the obese children incurred 21% higher costs than normal weight children. Using data from the Canadian Health Measures Survey (Objective 6) I showed that the higher health care use is paralleled by a more frequent use of prescription medications in obese compared to normal weight children. An analysis of the medical reasons for this cost differential (Objective 7) found that obese children had higher health care utilization for internalizing disorders, asthma, other respiratory disorders, obesity, and chronic adenoid/tonsil disorder. I was further able to show, for the first time, that childhood obesity is strongly associated with otitis media (Objective 8), one of the most frequent childhood disorders. In my analysis of the diagnostic properties of an ICD code for obesity for the detection of measured obesity (Objective 9), the sensitivity was 10%. Children correctly identified as obese by an ICD code had a higher BMI and higher health care utilization.