Mathematical methods in the assessment of human growth

Lead Research Organisation: University College London
Department Name: Institute of Child Health

Abstract

Nearly all children grow, and healthy children grow well. This important principle distinguishes paediatrics from adult medicine, so that a simple and effective way to measure the health of children is to assess their size and growth over time. Growth charts are used throughout the world for this purpose by midwives, nurses, doctors and paediatricians, either at home, or the welfare clinic, doctor?s surgery or in hospital. Growth is important in many areas of paediatrics and child health.

But growth assessment raises quite complex statistical questions about how the charts should be constructed and used. The grant aims to develop the science of growth assessment by building on previous work: improving statistical methods for their construction, devising new forms of chart to sharpen the assessment, and addressing underlying questions such as ?What exactly is good growth??, or ?Why are people taller now than last century?? or ?How tall will my baby be?? A clue to the first question comes from babies followed up into later life, where their growth rate in infancy relates to their later health. There is increasing evidence that growing too fast too early leads to greater illness later, for reasons which are not well understood but which may relate to obesity. So this suggests that ?good? growth is not necessarily ?rapid? growth, and growth charts for babies should be able to test for this. Yet despite their name, growth charts are not good at measuring growth over time, instead they measure a child?s size. This is just one area where the charts need to be improved.

Another area is child obesity, which has become a serious public health problem in recent years. Methods for measuring fatness, and for identifying overweight or obesity, involve similar statistical questions to those for growth, and are best answered by approaching them in the same way. For example recent work on the grant has led to a new definition of child obesity which is being used worldwide.

Technical Summary

The assessment of child growth is important for clinical practice, public health and policy. In general, healthy children grow well while ill children often grow poorly, so that child growth is a powerful proxy for child health and disease. Child obesity , a matter of great public health concern, is a form of overgrowth in that obese children have a history of relatively rapid growth. Current trends in child obesity have important policy implications in terms of diet, activity, lifestyle and the built environment. The assessment of growth and obesity raises substantive statistical issues about the construction and use of growth references, the transition from child to adult in terms both of body size and its related risk, the appropriate handling of longitudinal growth data, and the design of growth studies, all of which benefit from the use of a consistent statistical approach. The proposed research, which is a continuation of previous MRC-funded work, involves extending the LMS method, a widely used technique for growth chart construction (e.g. as used for the new WHO standard), and reanalysing existing growth data, in each case building on the techniques and experience previously accumulated. Particular aims are to see how to adjust measurements in children and adults for body size, over and above the conventional age adjustment, using an extended form of the LMS method. Examples are lung spirometry, basal metabolic rate (BMR) and blood pressure, where the adustment will quantify the important but currently unknown transition from child to adult. It will also help to clarify the life course of early growth in lung function related to later outcome, where poor lung function is known to be a powerful mortality risk. Other analyses will involve developing charts to assess growth velocity in infants, both preterm and term, and charts relating mortality in very preterm infants to gestation and birth weight z-score. Fitting longitudinal growth curve models during puberty should clarify the role of early body composition and sex steroids in determining pubertal growth patterns, using the ALSPAC data. Throughout the emphasis is on developing basic statistical methodology that translates into clinical practice.

Publications

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Chitty LS (2011) New aids for the non-invasive prenatal diagnosis of achondroplasia: dysmorphic features, charts of fetal size and molecular confirmation using cell-free fetal DNA in maternal plasma. in Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology

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Cole T (2012) Designing the new UK-WHO growth charts to enhance assessment of growth around birth in Archives of Disease in Childhood - Fetal and Neonatal Edition

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Cole TJ (2011) A chart to predict adult height from a child's current height. in Annals of human biology

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Cole TJ (2009) Growth and organ development. in Advances in experimental medicine and biology

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Cole TJ (2012) The development of growth references and growth charts. in Annals of human biology

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Cole TJ (2009) Mexican anthropometry percentiles and the LMS method. in European journal of clinical nutrition

 
Description IOTF BMI cutoffs systematic review citations
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in systematic reviews
Impact My paper (Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity: international survey. BMJ 2000;320:1240-3) gave a set of BMI cut-offs by age and sex to define overweight and obesity in children internationally. It has since been cited >3500 times, and Web of Science classifies 102 of these citations since 2006 as 'reviews'. A few highly cited examples of these reviews are (in November 2011): Title: Interventions for treating obesity in children Author(s): Luttikhuis HO, Baur L, Jansen H, et al. Source: COCHRANE DATABASE OF SYSTEMATIC REVIEWS Issue: 1 Article Number: CD001872 Published: 2009 Times Cited: 74 Title: Epidemiology of Obesity in the Western Hemisphere Author(s): Ford ES, Mokdad AH Source: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Volume: 93 Issue: 11 Pages: S1-S8 Supplement: Suppl. 1 Published: NOV 2008 Times Cited: 58 Title: Socioeconomic status and adiposity in childhood: A systematic review of cross-sectional studies 1990-2005 Author(s): Shrewsbury V, Wardle J Source: OBESITY Volume: 16 Issue: 2 Pages: 275-284 Published: FEB 2008 Times Cited: 95 Title: Assessment of child and adolescent overweight and obesity Author(s): Krebs NF, Himes JH, Jacobson D, et al. Source: PEDIATRICS Volume: 120 Pages: S193-S228 Supplement: Suppl. S Published: DEC 2007 Times Cited: 127 Title: Body mass index in children and adolescents: considerations for population-based applications Author(s): Must A, Anderson SE Source: INTERNATIONAL JOURNAL OF OBESITY Volume: 30 Issue: 4 Pages: 590-594 Published: APR 2006 Times Cited: 28
 
Description Irish growth charts
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact discussion about changing the Irish national growth charts to include WHO, following the UK model.
 
Description LMS method applications
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact My LMS method (Cole TJ, Green PJ. 1992. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11:1305-1319) has been cited 472 times to date, 278 times since 2006. It allows researchers to derive age-related reference ranges for measurements in children, such as height and weight growth charts, blood pressure centiles etc. The 278 citations show that the method has been applied, often using my software LMSchartmaker (licensed via MRC), in many countries and organisations e.g. USA, WHO, Germany, Italy, Netherlands, Norway, Denmark, Saudi Arabia, Kuwait, Bulgaria, Turkey, Greece, Poland, India and Argentina. Growth charts for the last three countries have been published in 2009/10 with Cole or Pan as co-authors. The measurements to which the method has been applied include anthropometry (weight, height, arm circumference, % body fat etc), blood pressure, heart rate, lung function, aerobic fitness, etc, for children at all ages from fetus through neonatal, infant, preschool and school age to adolescent.
 
Description SACN BMI cutoffs
Geographic Reach National 
Policy Influence Type Participation in advisory committee
Impact The Department of Health uses BMI cutoffs for classifying overweight and obesity in children. The Standing Advisory Committee on Nutrition met to discuss changing the cutoffs. Another meeting has been called to finalise the decision, which will affect all national reporting of child obesity.
 
Description SACN growth charts
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact SACN published its report recommending that WHO charts be introduced to the UK. The new charts have since been designed, produced and launched nationally (May 2009).
 
Description UK-WHO growth charts
Geographic Reach National 
Policy Influence Type Membership of a guidance committee
Impact I am a member of the Royal College of Paediatrics and Child Health expert group funded by the English Department of Health to design the new UK-WHO growth charts, which were launched nationally in May 2009. Some hundreds of thousands of printed growth charts are used in primary care, secondary care and by parents of young children. The expert group has continued to meet in 2011/12 to develop growth charts for the age group 4-18 years. This activity also appears under collaborations.
 
Description UK90 BMI centiles
Geographic Reach National 
Policy Influence Type Citation in systematic reviews
Impact My paper (Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990. Arch Dis Child 1995;73:25-9) published BMI centiles for the UK and has been used since 1995 for national BMI assessment and screening. It has been cited 690 times to date, and Web of Science categorises 27 of these citations since 2006 as 'reviews'. Some highly cited examples of such review citations are as follows: Title: Body mass index in children and adolescents: considerations for population-based applications Author(s): Must A, Anderson SE Source: INTERNATIONAL JOURNAL OF OBESITY Volume: 30 Issue: 4 Pages: 590-594 Published: APR 2006 Times Cited: 24 Title: The evolution of human fatness and susceptibility to obesity: an ethological approach Author(s): Wells JCK Source: BIOLOGICAL REVIEWS Volume: 81 Issue: 2 Pages: 183-205 Published: MAY 2006 Times Cited: 30 Title: Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome Author(s): Brambilla P, Lissau I, Flodmark CE, et al. Source: INTERNATIONAL JOURNAL OF OBESITY Volume: 31 Issue: 4 Pages: 591-600 Published: APR 2007 Times Cited: 23 Title: Tracking of childhood overweight into adulthood: a systematic review of the literature Author(s): Singh AS, Mulder C, Twisk JWR, et al. Source: OBESITY REVIEWS Volume: 9 Issue: 5 Pages: 474-488 Published: SEP 2008 Times Cited: 41
 
Description WHO growth velocity
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a national consultation
 
Description MRC Project Grant
Amount £355,343 (GBP)
Funding ID G0700961 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 10/2008 
End 11/2011
 
Description MRC Project Grant
Amount £79,272 (GBP)
Funding ID MR/J004839/1 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 03/2012 
End 02/2015
 
Description GOSH 
Organisation Great Ormond Street Hospital (GOSH)
Country United Kingdom 
Sector Hospitals 
PI Contribution advice on aspects of growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publications: 19875994 16552412 19183310 18043501 16986993 16936560
 
Description Hey 
Organisation Sunderland Royal Hospital
Country United Kingdom 
Sector Hospitals 
PI Contribution advice on growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publication: 19700396
 
Description Khadilkar 
Organisation Jehangir Hospital
Country India 
Sector Hospitals 
PI Contribution advice on growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publication: 19556658 21158695
Start Year 2007
 
Description Kulaga 
Organisation Children's Memorial Health Institute
Country Poland 
Sector Hospitals 
PI Contribution providing statistical expertise in deriving reference centiles for weight, height, BMI and blood pressure in Polish children.
Collaborator Contribution providing the data
Impact Two papers: PMIDs 20972688 and 20199693
Start Year 2007
 
Description LSHTM 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Department Faculty of Epidemiology and Population Health
Country United Kingdom 
Sector Academic/University 
PI Contribution advice on growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publications: 16306313 17200989 19564879 16570089
 
Description Lejarraga 
Organisation Hospital Nacional de Pediatria
Country Mexico 
Sector Hospitals 
PI Contribution advice on growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publication: 19452084
Start Year 2007
 
Description MRC Centre of Epidemiology for Child Health 
Organisation University College London
Department MRC Centre for Epidemiology for Child Health
Country United Kingdom 
Sector Academic/University 
PI Contribution Lead on the statistical methodology theme of the Centre. Joint publication with other members of the Centre. Participation in Centre scientific and academic seminars, workshops, symposia and masterclasses and multi-disciplinary team working.
Collaborator Contribution Statistical, epidemiological and IT expertise from other members of the Centre.• Access to a critical mass of epidemiological and statistical expertise applied to children's health creating a positive working environment that contributes to researcher capacity, scientific excellence, methodological expertise and impact in this field. The mission of the MRC Centre of Epidemiology for Child Health is to improve the health and well being of children by conducting, and contributing to the application of, high quality interdisciplinary research. The MRC Centre adds value by: exploiting opportunities for electronic health record linkage; developing and applying advanced statistical methods; capacity building in genetic epidemiology; and developing approaches to policy research in child health. • Provision of Epilab: The epiLab is an advanced computing environment and data management service that has been developed at the MRC Centre to support researchers through all aspects of the research data management life-cycle. The service provides core data storage and backup provision in conjunction with a virtualised desktop and backend-server infrastructure, designed to provide high levels of resilience and information security. Additional services provide users with tools, training and assistance with data transfer, metadata management, data collection, archival and destruction and pseudonymisation.
Impact Publications, other collaborations and partnerships, influence on policy and practice, networking opportunities. Joint papers are listed under Other-MRC in the Contribution section.
Start Year 2007
 
Description MRC HNR 
Organisation Medical Research Council (MRC)
Department MRC Human Nutrition Research Group
Country United Kingdom 
Sector Public 
PI Contribution advice on growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publications: 19594476 18541591 16522914 22990031
 
Description MRC Nutrition ICH 
Organisation University College London
Department Institute of Child Health
Country United Kingdom 
Sector Academic/University 
PI Contribution advice on aspects of growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publications: 17429924 17667912 18239656 16770333 16894361 17179023 17209191 23076617 22580078 27604768
 
Description Modi 
Organisation Imperial College London
Department Faculty of Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution advice on growth modelling
Collaborator Contribution contribution of data and shared authorship
Impact 23934365
Start Year 2009
 
Description Portex 
Organisation University College London
Department Institute of Child Health
Country United Kingdom 
Sector Academic/University 
PI Contribution advice on growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publications: 19574442 19065626 17197485 18006882 20351026 20817707 23045209 22743675 22474159 22183491 25254426 25700391 25837028 26493801 27831907
 
Description RCPCH growth chart expert group 
Organisation Royal College of Paediatrics and Child Health (RCPCH)
Country United Kingdom 
Sector Multiple 
PI Contribution I as a member of the expert group have attended meetings discussing the design of the charts, and been involved in publications, presentations and training about the new materials.
Collaborator Contribution There have been several presentations to the RCPCH conference and subsequent publications arising from the work of the group, about the design of new growth charts for the UK. In addition the group has developed and had published the UK-WHO growth charts, now universally used in the UK. I have continued collaborating with Prof Charlotte Wright, chair of the expert group, and have set up a separate entry for her.
Impact The main outcome has been the new UK-WHO age 0-4 year charts. A copy is given to all new parents, totalling some 600k copies per year. Further outcomes have been RCPCH presentations and peer-reviewed publications: 20231247, 21175302, 21398325, 21767107.
Start Year 2008
 
Description Rudolf 
Organisation University of Leeds
Department Faculty of Medicine and Health
Country United Kingdom 
Sector Academic/University 
PI Contribution advice on growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publication: 17763011 22529106
 
Description Soc Med Bristol 
Organisation University of Bristol
Department School of Social and Community Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution advice on growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publications: 16344844 16720666
 
Description UCL Epidemiology 
Organisation University College London
Department Institute of Epidemiology and Health Care
Country United Kingdom 
Sector Academic/University 
PI Contribution advice on growth and statistical analysis
Collaborator Contribution provision of data and joint authorship
Impact publications: 19884892 16679329
 
Title Growth chart aids 
Description Two new forms of growth charts incorporated into the UK-WHO growth charts. The first predicts a child's adult height, from as young as 2 years, and the second uses a lookup to provide a child's BMI centile without having to calculate BMI or use BMI charts. Both are incorporated in the new UK-WHO charts. 
Type Diagnostic Tool - Non-Imaging
Current Stage Of Development Market authorisation
Year Development Stage Completed 2009
Development Status Closed
Impact For the first time children and their parents will have a good idea how tall the child will be. Also the assessment of overweight is greatly simplified with the BMI look-up. The work has been published as 21767107, and the BMJ has published an editorial commenting on the paper. 
 
Title International BMI cut-offs 
Description A set of cut-off values for children's BMI by age and sex, identifying obesity, overweight, and thinness. They were described in BMJ articles in 2000 and 2007. 
Type Diagnostic Tool - Non-Imaging
Current Stage Of Development Market authorisation
Year Development Stage Completed 2007
Development Status Closed
Impact The international cut-offs have been widely cited (5000+ Web of Science citations, Oct 2014) and are regularly mentioned in systematic reviews of child obesity prevention and treatment. 
 
Title LMSchartmaker software 
Description The LMS method summarises the distribution of the measurement (e.g. weight) as it changes with age, in terms of the median, coefficient of variation and skewness (based on a Box-Cox power). The three quantities are modelled as cubic spline curves in age, and so summarise the whole distribution as it changes with age. The LMSchartmaker software makes this statistical analysis accessible to non-statisticians to construct growth centile charts. It is available on the web as a Windows program in two forms, Light (free) and Pro (paid for). The software has been continually developed since before 2006, but there have been notable improvements since then. 
Type Of Technology Software 
Impact The LMSchartmaker software is widely used for growth chart construction. The underlying statistical theory paper (Cole & Green, 1992) has been cited some 400 times, and the method has been used for national growth references in many countries including the UK, US, Netherlands and World Health Organization. Downloads of the Light version are not recorded, but the Pro version pays a royalty to the MRC under an agreement with Harlow Printing Ltd, who host the download site. 
 
Title LMSgrowth Excel add-in 
Description The LMSgrowth add-in allows users to manipulate growth references and growth charts fitted by the LMS method (e.g. using my LMSchartmaker software), allowing children's heights and weights etc to be converted to centiles and z-scores. 
Type Of Technology Software 
Impact The software is a free download from a website hosted by Harlow Printing, a company that sells growth charts. It is used by paediatric health professionals very widely in the UK, as a way to handle growth data as collected either in general practice, growth clinics or in research. 
 
Description ABC LateLine appearance 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact I was interviewed for the Australian TV programme ABC LateLine about a court case involving an Indonesian fisherman charged with people smuggling, where I had given expert witness evidence contradicting a prosecution expert witness who argued that he was over 18 years old. I argued that the use of hand-wrist x-rays to estimate someone's age is too imprecise to be of any value. The case was subsequently dismissed, and the programme showed the fisherman being repatriated to Indonesia.

Nothing obvious here in the UK, but it probably has added to the widespread discussion on people smuggling in Australia. The Australian Government subsequently stated that it would no longer use bone age for age assessment hearings.
Year(s) Of Engagement Activity 2011
 
Description BBC Radio 4 More or Less 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact In 2011 I spoke on the BBC Radio 4 programme More or Less, two successive weeks, about predicting a child's adult height from their current height.

In 2013 I discussed a new index that had been proposed by Professor Trefethen to improve on the body mass index.

In 2015 I was asked the question "Are tall people more likely to get cancer?" (URL below)

Several friends and colleagues remarked that they'd heard the programme.
Year(s) Of Engagement Activity 2011,2013,2015
URL http://www.bbc.co.uk/programmes/p0343hhk
 
Description BSPED Reading 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact 100+ endocrinologists attended a talk describing patterns of growth in puberty, showing that this pubertal pattern predicts the level of hormonal activity 50 years later.

nothing obvious
Year(s) Of Engagement Activity 2009
 
Description Bridge Street doctors 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact I presented the new UK-WHO charts to all 8 Principals in my own GP surgery.

a lot of interest, and recognition that they would not usually be able to learn about new charts in this way.
Year(s) Of Engagement Activity 2009
 
Description Community Paediatricians 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact 60+ attended a talk on the new UK-WHO growth charts and their implications for community paediatricians

?
Year(s) Of Engagement Activity 2009
 
Description Expert witness in age assessment hearings 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact I gave evidence as an expert witness about forensic age assessment, to the Court of Session in Edinburgh, via videolink to the District Court in Perth Australia, and by phone to the Magistrates Court in Melbourne Australia. I also provided expert witness reports to these cases plus a further nine in other Australian courts in Brisbane, Perth and Sydney.

All eleven Australian cases involved Indonesian fishermen accused of people smuggling, where if found guilty and aged over 18 the mandatory sentence is 5 years in jail. But if under 18 they are repatriated. In my evidence I argued that the wrist x-ray technique used for assessing their age is not fit for purpose.

My evidence caused nine of the eleven Australian cases to be dropped, with the accused being repatriated and a longstanding prosecution witness being discredited.

The URL above covers the Australian Human Rights Commission's "Inquiry into the treatment of individuals suspected of people smuggling offences who say that they are children", to which I gave evidence that is reported extensively in Chapter 2 of the AHRC report "An Age of Uncertainty". The report was undoubtedly a key factor in the Australian government's subsequent decision to no longer use bone age based on hand-wrist x-rays to assess chronological age.

I also wrote an article describing one of the court cases -
doi 10.1111/j.1740-9713.2012.00568.x
Year(s) Of Engagement Activity 2011
URL http://www.humanrights.gov.au/age-assessment-people-smuggling-cases-inquiry-treatment-individuals-su...
 
Description RCPCH 2009, 2011 and 2012 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Health professionals
Results and Impact In 2009 a plenary talk to 200+ paediatricians at their annual meeting about a novel adult height prediction tool included with the UK-WHO growth charts. In 2011 a contributed talk in a plenary session about the assessment of growth in very preterm infants. In 2012 a poster and a contributed talk about growth chart development.

In 2009 a lot of interest, though no obvious impacts to date.
In 2011 feedback that my talk was one of the best in the whole conference. In 2012 obtained feedback on charts being developed by the UK-WHO chart expert group.
Year(s) Of Engagement Activity 2009,2011,2012
 
Description RCPCH training trainers 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact part of a training day for ~30 paediatricians from the regions to learn about the new UK-WHO growth charts, with the aim of them going on to train their local colleagues

?
Year(s) Of Engagement Activity 2009
 
Description Sawston Health Centre 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact invited to talk to the whole health visitor team in Sawston Health Centre about the new UK-WHO charts.

a lot of interest, and grateful to learn of the new charts in advance
Year(s) Of Engagement Activity 2008
 
Description Young Fabians 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact 9 people attended a policy meeting of the Young Fabians, held in the Houses of Parliament, to provide advice to the Labour Party for its 2015 election manifesto. The topic was child obesity, where I was one of three invited experts who introduced the discussion.

None yet, though it may in due course affect the Labour manifesto.
Year(s) Of Engagement Activity 2013