Title: Evaluation of a sustainable obesity prevention programme delivered at scale ‘HENRY’: Effectiveness, cost-effectiveness and its role in obesity prevention within the wider complex system
Funder: Department of Health and Social Care

Abstract: Background: One in five children in the UK start school overweight or with obesity. This is more common in children living in deprived areas. ‘HENRY’ is an intervention to help families be more healthy to prevent children from becoming overweight. Around 24,500 families have attended HENRY since 2008. HENRY is delivered in children’s centres across the UK. In centres where HENRY is delivered, staff are trained on the HENRY approach and encouraged to provide a healthy environment. Some staff are then trained to deliver HENRY. Research that has already been done suggests that obesity levels are lower in areas that deliver HENRY. This has not yet been proved because it is difficult to find out exactly what makes obesity rates go up and down. Obesity can be influenced by things such as; the environment, our culture and the way our bodies are made. Other interventions besides HENRY might also help us to be healthy, so it can be hard to understand exactly what role HENRY might play._x000D_ _x000D_ Aim: The aim of this study is to find out whether children whose parents attend HENRY are less likely to become overweight or develop obesity than those that do not. We also want to find out whether HENRY gives value for money, improves the health of parents and carers that attend, benefits the staff that work in children’s centres, and has benefits to the wider community. We have already carried out some research to test whether these questions can be answered by our study (e.g. if our methods will work), and our results showed that they can._x000D_ _x000D_ Methods: We will carry out a randomised controlled trial. Children’s centres that do not deliver HENRY will be randomly selected to either; be trained to deliver HENRY alongside standard sessions (like ‘stay and play’), or continue to offer standard sessions only. We will recruit 14 local authorities and ask each to choose around 6 of their centres to take part (82 centres total). We will then collect information from 984 families, and children centre staff from both types of centre. The data we will collect include: height, weight, waist circumference, food intake, physical activity and quality of life. We will then collect the same information 12 months later to see if there are any differences between participants from centres delivering HENRY and those that did not._x000D_ _x000D_ Long-term impact: To find out whether HENRY has any long term influence on childhood obesity, we will collect data that are already routinely collected from children by health visitors and schools after 3 years. We will then compare obesity rates in those who took part in the trial to the rest of the local population._x000D_ _x000D_ Wider impact: We will explore the wider influence of HENRY on obesity within local government areas and across the country. To do this, we will speak to around 60 people (including parents, health visitors, local council representatives), hold a workshop, and review documents (e.g. council strategies, planning rules)._x000D_ _x000D_ Public involvement in the research: A group of parents with young children have already helped design our study (e.g., when and how to recruit parents). We will continue to meet with this group 2-3 times a year. One of the parents has also joined our co-applicant team. _x000D_ _x000D_ Impact of the research: Our results will be shared with a wide range of people, including local authorities, parents, health visitors. Different delivery approaches will be planned for each group in partnership with our parent advisory group.

Lay abstract: Background: Childhood obesity disproportionately impacts those living in the highest levels of deprivation. COVID has had a profound effect on rates, where almost a third of children start school with overweight/obesity (~25% pre-COVID). The most widely funded community obesity prevention intervention, HENRY, has been delivered at scale in areas of high deprivation since 2008._x000D_ _x000D_ Aim: Following a successful feasibility study, we aim to establish the effectiveness and cost-effectiveness of an obesity prevention programme delivered at scale, including its potential role from a wider systems perspective._x000D_ _x000D_ Research questions:? What is the effectiveness and cost-effectiveness of HENRY in terms of reducing the risk of obesity in children??Does HENRY influence obesity rates in parents, siblings and centre staff??What does the obesity system in which HENRY is positioned look like? What role does HENRY play in childhood obesity prevention within the wider system?_x000D_ _x000D_ Methods: Design: Multi-centre, open-labelled, two group, prospective, cluster RCT, with cost-effectiveness analysis, systems based process evaluation and internal pilot._x000D_ _x000D_ Randomisation: Centres within local authorities will be randomised to receive HENRY or continue with standard practice (1:1) stratified by centre size, area level ethnicity and area level deprivation._x000D_ _x000D_ Setting: Local authority children’s centres/other community venues._x000D_ _x000D_ Intervention: Centre practitioners receive core HENRY training to influence centre environment (culture, policy, practice) to promote positive behaviours among workforce and families. A proportion of these are trained to deliver an 8-week HENRY programme to parents attending centres. Parents gain skills and knowledge to provide a healthy start for their child. Comparator: Staff within control centres will not receive HENRY training and will continue to deliver usual programmes (e.g. stay and play)._x000D_ _x000D_ Outcomes: 12 months: Primary=child BMI z-score; Secondary= parent and staff BMI and waist circumference, parenting self-efficacy, feeding, eating habits, quality of life, resource use, centre environment. Long-term (~3 years post registration): Child BMI z-score (NCMP/Health visiting data). Economic: cost per unit change in child BMI z-score, cost per unit change in weight after controlling for height, and the cost per change in obesity cases._x000D_ _x000D_ Qualitative systems process evaluations: including the development of systems map and evaluation of system response to HENRY with quantitative systems modelling to inform how HENRY can influence population obesity._x000D_ _x000D_ Analysis: ITT analysis will compare primary and secondary outcomes between arms using mixed effects linear regression as appropriate. Economic evaluation=1-year within-trial calculation of cost-per unit change in BMI z-score; long-term area under the curve and spillover impact; and longer-term trajectories to determine lifelong cost savings. Systems analysis=Qualitative thematic analysis and Morphological Analysis/Fuzzy Cognitive Mapping._x000D_ PPI: An established parent advisory group will support design, delivery, interpretation and dissemination of the research._x000D_ _x000D_ Timeline:73 months. Main study=60 months (primary reporting); 6 month dormant period; followed by 7 month long term follow-up._x000D_ _x000D_ Impact and dissemination: Dissemination and impact strategy will ensure clear pathways to impact, including; policy reports, dissemination events, community resources, social media and academic output.

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