Changes in referral patterns for weight in association with the preschool Raising Healthy Kids target

Abstract

Introduction The ‘Raising Healthy Kids (RHK) health target’ recommended that children identified as having obesity [body mass index (BMI) ≥98th centile] through growth screening at the B4 School Check (B4SC) be offered referral for subsequent assessment and intervention. Aim To determine the impact of the ‘RHK health target’ on referral rates for obesity in Aotearoa New Zealand (NZ). Methods A retrospective audit was undertaken of 4-year-olds identified to have obesity in the B4SC programme in Taranaki and nationally in 2015–19. Key outcomes were: ‘RHK health target’ rate [proportion of children with obesity for whom District Health Boards (DHBs) applied the appropriate referral process]; Acknowledged referral rate (proportion of children with a referral for obesity whose referral was acknowledged by DHBs); and Declined referral rate (proportion of children offered a referral for obesity who declined their referral). Results Data were audited on 266 448 children, including 7464 in Taranaki. ‘RHK health target’ rates increased markedly between 2015–16 and 2016–17 following the health target implementation (NZ: 34–87%; P < 0.0001, Taranaki: 21–68%; P < 0.0001). Acknowledged referral rates also increased post-target nationally (56–90%; P < 0.0001), and remained high in Taranaki over the 4-year period (ranging from 89 to 99%). However, there were notably high Declined referral rates across NZ (26–31%) and in Taranaki (although variable: 38–69%). Discussions The ‘RHK health target’s’ focus on referral rather than intervention uptake limited the policy’s impact on improving preschool obesity. Future policy should focus on ensuring access to multidisciplinary intervention programmes across NZ to support healthy lifestyle change.