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Headline
This research programme included five linked studies relating to childhood obesity, one of which found that the Healthy Eating and Lifestyles Programme for obese adolescents did not reduce BMI after 6 months.
Abstract
Background:
Five linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway.
Objectives:
(1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E).
Methods:
Five substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre.
Results:
Study A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primary outcome) when compared with enhanced usual care. Study D – anti-obesity drugs appear efficacious in meta-analysis, and their use has expanded rapidly in the last decade. However, the majority of prescriptions are rapidly discontinued after 1–3 months of treatment. Few young people described positive experiences of anti-obesity drugs. Prescribing was rarely compliant with the National Institute for Health and Care Excellence guidance. Study E – bariatric surgery appears safe, effective and highly cost-effective in adolescents in the NHS.
Future work and limitations:
Work is needed to evaluate behaviour and body mass index change in the National Childhood Measurement Programme more accurately and improve primary care professionals’ understanding of the National Childhood Measurement Programme feedback, update and further evaluate the Computer-Assisted Treatment of CHildren (CATCH) tool, investigate delivery of weight management interventions to young people from deprived backgrounds and those with significant psychological distress and obtain longer-term data on anti-obesity drug use and bariatric surgery outcomes in adolescence.
Trial registration:
Current Controlled Trials ISRCTN99840111.
Funding:
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
Contents
- Plain English summary
- Scientific summary
- Chapter 1. Introduction
- Chapter 2. Study A: scoping the impact of the National Child Measurement Programme on the Childhood Obesity Pathway
- Chapter 3. Study B: developing a new electronic tool to improve childhood obesity management in primary care
- Chapter 4. Study C: the Healthy Eating and Lifestyle Programme randomised clinical trial
- Chapter 5. Study D: evaluation of anti-obesity drug treatment in children and adolescents
- Abstract
- Key findings across study D
- Background
- Substudy 5.1: systematic review and meta-analysis to evaluate the efficacy and safety of anti-obesity drugs
- Aim
- Methods
- Results
- Discussion
- Conclusion
- Substudy 5.2: current practice in the prescription of anti-obesity drugs
- Background
- Aims
- Methods
- Results
- Discussion
- Anti-obesity drug prescribing for obese children and young people in the UK
- Introduction
- Methods
- Results
- Discussion
- Limitations
- Conclusion
- Subsudy 5.3: understanding young people’s experiences of anti-obesity drugs
- Background
- Aims
- Methods
- Results
- Discussion
- Conclusion
- Chapter 6. Study E: evaluation of acceptability and early outcomes of adolescent bariatric surgery in the UK
- Key findings across study E
- Background
- Substudy 6.1: characteristics and outcomes of the first 50 patients entering an adolescent bariatric surgery programme at University College Hospital
- Discussion
- Conclusions
- Substudy 6.2: clinicians’ decision-making for adolescent bariatric surgery
- Substudy 6.3: how adolescents decide on bariatric surgery
- Substudy 6.4: systematic review of psychological and social outcomes of adolescents undergoing bariatric surgery, and predictors of success
- Abstract
- Introduction
- Methods
- Results
- Discussion
- Limitations
- Conclusions
- Substudy 6.5: cost-effectiveness of bariatric surgery in severely obese adolescents in the UK
- Background
- Methods
- Results
- Discussion
- Substudy 6.6: formation of a national network for adolescent bariatric surgery
- Chapter 7. Impact and dissemination
- Chapter 8. Modelling the burden of child and adolescent obesity on the health services in England
- Chapter 9. Future research recommendations
- Study A: scoping the impact of the National Child Measurement Programme on the childhood obesity pathway
- Study B: developing a new electronic tool to improve childhood obesity management in primary care
- Study C: the Healthy Eating and Lifestyle Programme randomised clinical trial
- Study D: evaluation of anti-obesity drug treatment in children and adolescents
- Study E: evaluation of acceptability and early outcomes of adolescent bariatric surgery in the UK
- Acknowledgements
- References
- Appendix 1. Wording from specimen National Child Measurement Programme result letters to parents and carers, by child’s weight category (study A)
- Appendix 2. Interview schedule for parents (study A)
- Appendix 3. Interview topic guides (study B)
- Appendix 4. Clinician interview guide for study D, substudy 6.2
- Appendix 5. Adolescent interview guide for study E, substudy 6.3
- Appendix 6. Presentations at meetings and congresses
- Appendix 7. Dissemination events organised
- Appendix 8. Young people’s responses in the PROMISE focus group
- Appendix 9. Responses to the online survey questions
- Appendix 10. Social media messages by the Association for Young People’s Health
- Glossary
- List of abbreviations
- List of supplementary material
About the Series
Article history
The research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0608-10035. The contractual start date was in January 2010. The final report began editorial review in January 2017 and was accepted for publication in March 2018. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.
Declared competing interests of authors
Stephen Morris is a member of the National Institute for Health Research (NIHR) Health Services and Delivery Research Board. Irwin Nazareth is a member of the NIHR Health Technology Assessment Commissioning Board. Sonia Saxena was funded by a NIHR Career Development fellowship (NIHR CDF-2011-04-048). Min Hae Park received grants from NIHR during the conduct of the study and received personal fees from Research Consultancy for Marie Stopes International (London, UK). Anthony S Kessel is the director of International Public Health at Public Health England.
Last reviewed: January 2017; Accepted: March 2018.
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