Proactve Assessment of Overweight Risk During Infancy
Condition: Childhood Obesity
MeSH terms: Overweight; Pediatric Obesity
Study type: Observational

Summary: 
      Children who are above healthy weight are more likely to be ill and to miss time off school.
      Being overweight in childhood can also sow the seeds for health problems in later life such
      as heart disease and diabetes. Most overweight children become overweight adults. One
      solution is to try to prevent children becoming overweight by intervening very early in life.
      The risk factors for childhood overweight are known and this project aims to facilitate
      parents' (and other carers') understanding about this for their infant and to enable them to
      access intervention. UK health visitors (public health nurses) will use an interactive,
      multimedia programme (Proactive Assessment of Overweight Risk during infancy (ProAsk)), with
      parents to calculate their infant's risk and to discuss strategies for risk reduction as
      appropriate. Health visitors will be trained to communicate obesity risk and in Motivational
      Interviewing techniques to enable them to offer intervention to parents of infants identified
      as at risk.

      A feasibility study of ProAsk will take place in two health provider organisations in the UK.
      The purpose of this is to a) determine the acceptability and utility of the ProAsk
      intervention with health visitors and parents and b) gather information to inform the trial
      design and data collection procedures for a future Randomised Controlled Trial (RCT).
    

Detailed description: 
      Globally, overweight and obesity is a significant public health issue affecting more than 40
      million children under the age of five in 2011. There is broad agreement around the aetiology
      of childhood overweight and obesity and risk factors have been identified prenatally, during
      pregnancy and early infancy. Clearly, from the point of view of the infant, risk factors that
      are present prenatally or during pregnancy are non-modifiable but those identified during
      infancy are potentially modifiable. Between 25%-33% of infants gain weight more rapidly than
      desirable during the first 6 months of life and this is the strongest risk factor for
      childhood overweight at 3 years. Rapid weight gain is potentially modifiable with
      interventions to facilitate better infant diet, feeding practices and exposure to physical
      activity. To facilitate identification of infants that might be at greater risk of developing
      childhood overweight and obesity a number of models have been developed. The Infant Risk of
      Obesity Checklist (IROC) was developed by the research team using data from the Millennium
      Cohort Study (MCS) and Avon Longitudinal Study of Parents and Children (ALSPAC) to
      potentially screen infants at 4 months of age for risk factors for childhood overweight and
      obesity at 3 years. However, it has not yet been tested in clinical practice.

      Concerns have been expressed about using tools developed from the epidemiological literature
      to identify overweight and obesity risk where there are few effective evidence-based
      interventions for those affected. There is evidence that complex interventions targeting diet
      and feeding delivered to parents of infants <2 years old show some positive intervention
      effects on feeding practices and physical activity, although many of these interventions do
      not tackle the psycho-emotional aspects of feeding and are not underpinned by behavioural
      change theory. The impact on weight outcomes is less certain, and in some cases this may be
      due to intervention components and behaviour change techniques targeted at the parent rather
      than infant level. Universal eligibility for overweight and obesity prevention is costly and
      may be unnecessary for those with a low baseline risk. However, targeting of certain groups
      where overweight and obesity is more prevalent (for example, lower socio-economic status,
      minority ethnic groups) has raised concerns around stigmatisation. Preliminary work with
      parents/legal guardians/carers suggests that targeting may be appropriate provided the person
      conveying the information has appropriate knowledge and sensitivity. his suggests a novel
      approach to such discussions is needed. Digital technologies are being used to provide
      information to patients about health care related areas. The findings of a recent review
      suggest that interactive multimedia programmes have the capacity to facilitate communication
      between health professionals and patients, but further research in this field is needed.

      A pragmatic research design is planned with three linked phases. The first involved the
      development of an interactive multimedia programme, namely ProActive Assessment of Overweight
      Risk during Infancy (ProAsk) which includes the IROC and a therapeutic wheel, to facilitate
      health professionals' discussions with parents/legal guardians/carers about overweight risk
      and prevention during infancy. This phase is a feasibility study of the ProAsk intervention
      with parents/legal guardians/carers and health professionals. The study will gather
      information to inform the trial design and data collection procedures for a Randomised
      Controlled Trial (RCT) of overweight risk identification and intervention during infancy by
      UK health visiting teams.

      The third phase will be conducted at the end of the feasibility trial .Qualitative work will
      be undertaken to determine the acceptability and utility of ProAsk with the health
      professionals working in a health visiting team and parents/legal guardians/carers.
    

Intervention name(s): ProAsk
Intervention type(s): Behavioral
Intervention description(s): The intervention is a computer programme ProActive Assessment of Overweight Risk to identify infants at risk of developing childhood overweight and obesity. Parents of infants identified as at risk will be offered strategies for prevention by UK health visitors (public health nurses)
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Infants 6-8 weeks old living in the study areas (Cambridshire and Nottingham City)