Title: Can embedding the MapMe intervention, a tool to improve parental acknowledgement and understanding of childhood overweight and obesity, in the National Child Measurement Programme lead to improved child weight outcomes at one year?
Funder: Department of Health and Social Care

Abstract: Aims: To understand whether the MapMe intervention can reduce child overweight, and if so how and at what cost. _x000D_ _x000D_ Background: Child overweight can lead to serious short and long term health problems, resulting in high costs to the NHS and other services. Overweight affects 1 in 4 children starting school and 1 in 3 leaving primary school. Urgent action is needed to address this. Parents play a key role managing their children’s weight but tend not to know when their child is overweight, and so are less likely to take action. All 4-5 and 10-11 year olds in England are weighed and measured as part of the National Child Measurement Programme (NCMP), and parents receive the results by letter. MapMe supports parents to act upon the NCMP result by providing: 1) ‘body image scales’ (images of children ranging from underweight to very overweight) to help parents to understand if their child is overweight; 2) information on the consequences of child overweight, healthy eating, physical activity and sources of support. MapMe was tested in about 300 overweight children who achieved a healthier weight 1 year later, when compared to overweight children whose parents did not receive MapMe. We now need to confirm these findings in a better study with more children, to understand how MapMe works, and if it offers value for money. _x000D_ _x000D_ Design & Method: We will first talk to parents and health professionals to ask them: 1) how we can improve MapMe, and 2) what information we should collect to find out how MapMe is delivered and used. _x000D_ _x000D_ About 56 000 families who agree to take part in the NCMP across 9 Local Authorities will then be allocated by chance to one of 3 groups. Parents in each group will receive their child’s NCMP results as usual, plus:_x000D_ • Group 1 gets a letter with the paper-based MapMe body image scales and a link to the MapMe online materials after the NCMP measurement._x000D_ • Group 2 gets the same as Group 2 but also a booster letter 6 months later with a link to the MapMe online materials._x000D_ • Group 3 gets the standard NCMP measurement letters only._x000D_ _x000D_ Groups 1 and 2 will be compared to group 3. All children will be weighed and measured again after 1 year. A selection of families will be invited to provide more information on child food intake and activity, and what help parents accessed, to help us understand how MapMe worked and if it is value for money. We will also ask some parents, and professionals who delivered MapMe, to tell us what they thought about it, and how it could be further improved._x000D_ _x000D_ PPI: A Parent Involvement Panel will be created to ensure parents are involved across different stages of the research. To date members of a public involvement panel have played an important role in highlighting child overweight as a research priority and parents of primary school children have helped to shape the project and future public involvement._x000D_ _x000D_ Dissemination: The Parent Involvement Panel will help us to develop creative ways of sharing the study results to inform as many people as possible. Results will also be published in journals and presented at conferences. The NCMP and Local Authority team members will share results with their colleagues across the country. If MapMe is found to have a positive impact on child weight outcomes, then the materials will become part of the standard NCMP process and available on www.nhs.uk

Lay abstract: Research Question: Can embedding the MapMe intervention in the National Child Measurement Programme (NCMP) lead to improved child weight outcomes?_x000D_ _x000D_ Background: Childhood overweight and obesity (OW/OB) is a Public Health England (PHE) priority. Parents are key to managing children’s weight, but tend to struggle to recognise OW/OB, and so do not take action. In England, the NCMP measures the weight status of 4-5 and 10-11 year-olds and reports results to parents via letter. Parents are often surprised by, and mistrust the result. More support is required to help parents understand and act upon the letter. The ‘Map Me’ intervention includes Body Image Scales (BIS) (images of underweight to very OW children of NCMP age, to help parents recognise child weight status), and information on healthy eating, physical activity, consequences of child OW and further support. MapMe was tested in ~300 OW/OB children who showed improved Body Mass Index (BMI) Z scores after 1 year. These findings now need to be confirmed in a larger study and, if confirmed, we need to establish how the intervention works, and if it cost effective. _x000D_ _x000D_ Objectives:_x000D_ 1. Update MapMe_x000D_ 2. Assess the impact of enhanced NCMP letters including MapMe (delivered using 2 different approaches) on child BMI Z score at 1 year_x000D_ 3. Examine mechanisms of impact of MapMe_x000D_ 4. Examine the cost/benefit of MapMe _x000D_ 5. Assess the impact of MapMe enhanced NCMP letter on health inequalities and psychological outcomes_x000D_ 6. Explore the implementation and acceptability of the MapMe enhanced NCMP letters and potential for national adoption_x000D_ _x000D_ Methods: Parents and key stakeholders will be consulted on how MapMe can be improved. The improved MapMe will then be examined by a Randomised Controlled Trial across 9 Local Authorities (LAs). Schools within each LA, will be randomised to 1 of 3 groups: 1) MapMe BIS and link to web-based MapMe added to the NCMP post-measurement letter; 2) as group 1, plus an additional ‘booster’ letter with the link to web-based MapMe sent 6 months later; 3) standard NCMP letters (control). Child BMI Z score changes will be assessed at 1 year. A sub-group will be recruited for a process evaluation examining: parents’ perceptions of child weight status; changes in child food intake, activity, and parental help seeking. Child quality of life, use of NHS/LA services will inform an economic evaluation. Data on self-esteem, eating disorder risk, deprivation and ethnicity will be used to evaluate psychological impact and health inequalities. Views from NCMP teams and parents will explore experiences and implementation of MapMe._x000D_ Timelines for delivery: Total study duration is 36 months. MapMe update (months 1-6); Health-related and cost impacts of MapMe, and process and acceptability evaluations (months 7-29); Analysis and dissemination (months 30-36). _x000D_ _x000D_ Anticipated impact: If found to be effective MapMe will be incorporated into routine NCMP delivery and hosted by NHS Choices: providing a minimal cost, national scale intervention capable of improving the weight status of children with OW/OB._x000D_ _x000D_ Dissemination: A Public Health England co-hosted workshop for NCMP commissioning and delivery teams; feedback to participating families, school nursing, NCMP teams, health practitioners, local and national policy makers (informed by the public involvement panel); dissemination at conferences and in open-access academic journals.

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