Title: Improving the assessment and management of obesity in UK children and adolescents
Funder: Department of Health (England)

Abstract: Programme aims: 1. To improve the assessment and treatment of childhood obesity through research addressing key gaps in the evidence base supporting the NICE childhood obesity treatment pathway 2. Build a coherent programme of clinical and public health research within a patient pathway perspective that significantly contributes towards improving the treatment of childhood obesity in the NHS Background & Research Plan The childhood obesity epidemic is one of the foremost health priorities in the UK. While a sustainable solution ultimately lies with managing our obesogenic environment, the NHS still has responsibility for treatment of the 7-10% of children and young people already obese. NICE guidance in 2006 outlined a childhood obesity pathway (COP) covering best practice management in primary and secondary care. NICE also highlighted key gaps in evidence. We examined the COP and particularly identified areas where additional knowledge or application of existing knowledge could support NHS staff to provide the best care to the overweight children, and developed a programme of research around this. This programme integrates public health and clinical perspectives and will build a unique research grouping. It comprises of five linked studies (A to E) together with a 6th integrative work package related to the implementation of finding from each of the studies. It will have impacts at all levels of the COP to improve outcomes and experiences of care and streamline patient flow. Key area: The National Child Measurement Programme (NCMP) assesses the BMI of all school children in Reception and Year 6. From summer 2009, parents of all obese children will receive feedback from PCTs advising them to seek help from primary care professionals. However the impact of the NCMP on (1) behaviour change by parents and (2) primary care burden, is unknown. Response: Study A will carry out quantitative and qualitative surveys of overweight children and their families identified and given feedback through the NCMP programme. Key area: NCMP feedback is likely to increase numbers of overweight children presenting at GP practices. Staff time and skills are limited. Electronic management tools for front line staff may be a cost effective way of improving management and referral of large numbers of obese children. Response: Study B involves the development and evaluation of a brief electronic management-cum-referral tool for use by practice nurses in assessment /management of overweight children Key area: The most effective obesity management for children and young people is lifestyle modification; while programmes for children exist, those for adolescents particularly >15 years are lacking. Response: Study C is an efficacy RCT of the HELP intervention compared with enhanced standard care for obese adolescents in the community. Key area: Anti-obesity drugs (AOD) are increasingly being prescribed for obese children with significant comorbities. Data on effectiveness and acceptability in practice are lacking. Response: Study D will carry out analyses of national prescribing data and a survey of practitioners to establish these, and develop a practical support tool for GPs using AOD. Key area: Bariatric surgery is recommended by NICE as appropriate for morbidly obese adolescents with significant comorbidities. There are no UK data on outcomes and safety in adolescents. Response: Study E will collect data on BMI, quality of life, surgical and safety outcomes from one large centre. To ensure that the findings from this programme are implemented in practice, an implementation work package will occupy the final 12 months of this programme. Research Team We have assembled a unique multi-disciplinary group of researchers from public health, general practice and secondary care to work together on this programme. Programme Management: Clear management and governance procedures will be maintained by the CI, the Programme Steering Committee and a dedicated programme manager. Research Environment: The programme is being undertaken within UCL Partners, an Academic Health Sciences Centre with international quality research and clinical services and strong support for translational research. Outputs: The programme will have impacts at all levels of the COP to improve outcomes and experiences of care and reduce burden on the NHS. Outputs include 3 new management tools and data to improve health services and planning, and will have patient benefit within 3-5 years of the end of the studies. Patient/public involvement: Consultancy from 3 obesity charities, with one representative on the Programme Steering Committee. A young patients advisory group will also advise. Ethics: Research ethics permissions will be obtained for all studies. Support: The programme will support 6 workstreams at a cost of £2m. The programme has been structured to allow for sharing of resources between studies to provide economies of scale.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;7.3 MANAGEMENT AND DECISION MAKING
Health categories: STROKE;CANCER AND NEOPLASMS;METABOLIC AND ENDOCRINE;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL