Background Routine monitoring of Body Mass Index (BMI) in general practice, and via national surveillance programmes, is essential for the identification, prevention, and management of low or excess childhood weight. We examined and compared the presence and representativeness of children and young people’s (CYPs) BMI recorded in two routinely collected administrative datasets: general practice electronic health records (GP-BMI) and the Child Measurement Programme for Wales (CMP-BMI), which measures height and weight in 4–5-year-old school children. We also assessed the feasibility of combining GP-BMI and CMP-BMI data for longitudinal analyses.

Methods We accessed de-identified population-level GP-BMI data for the calendar years 2011 to 2019 for 246,817 CYP, and CMP-BMI measures for 222,772 children, held within the Secure Anonymised Information Linkage Databank. We examined the proportion of CYP in Wales with at least one GP-BMI record, its distribution by child demographic and socio-economic characteristics, and trends over time. We compared the GP-BMI distributions with those similarly derived from the CMP. We quantified the proportion of children with a CMP-BMI measure and a follow-up GP-BMI recorded at an older age and explored the representativeness of these measures.

Results We identified a GP-BMI record in 246,817 (41%) CYP, present in a higher proportion of females (54.2%), infants (20.7%) or older adolescents. There was no difference in the deprivation profile of those with a GP-BMI measurement. Overall, 15.2% of CYP with a CMP-BMI had at least one follow-up GP-BMI. However, CYP with a CMP-BMI considered underweight or very overweight were 87% and 70% more likely to have at least one follow-up GP-BMI record respectively compared to those with a healthy weight, as were males and those living in the most deprived areas.

Discussion Records of childhood weight status extracted from general practice records are not representative of the population and are biased with respect to weight status. Linkage of information from the national programme to GP records has the potential to enhance discussions around healthy weight at the point of care but does not provide a representative estimate of population level weight trajectories, essential to provide insights into factors determining a healthy weight gain across the early life course. A second CMP measurement is required in Wales so that changes in the weight status of children between the first and final years of primary school can be assessed.