Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT-Reference-Cited by-同舟云学术

Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT

Published:2020-03 Issue:3 Volume:8 Page:1-264
ISSN:2050-4322
Container-title:Programme Grants for Applied Research
language:en
Short-container-title:Programme Grants Appl Res

Author:

Viner Russell M¹^ORCID,Kinra Sanjay²^ORCID,Christie Deborah³^ORCID,Cole Tim J⁴^ORCID,Costa Silvia¹^ORCID,Croker Helen⁵^ORCID,Fry Tam⁶,Hsia Yingfen⁷^ORCID,Hudson Lee⁸^ORCID,Kessel Anthony S⁹,Morris Steve¹⁰^ORCID,Nazareth Irwin¹¹^ORCID,Nicholls Dasha⁸^ORCID,Park Min Hae¹²^ORCID,Saxena Sonia¹³^ORCID,Taylor Barry¹⁴^ORCID,White Billy¹⁵^ORCID,Wong Ian C¹⁶^ORCID

Affiliation:

1. Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK

2. Department of Genetics and Adolescent Paediatrics, London School of Hygiene & Tropical Medicine, London, UK

3. Department of Behavioural Science and Health, University College London Hospitals NHS Foundation Trust, London, UK

4. Department of Infection, Immunology and Inflamation, Institute of Child Health, University College London, London, UK

5. The Obesity and Policy Research Unit, Institute of Child Health, University College London, London, UK

6. Child Growth Foundation, Edgware, UK

7. Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK

8. Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

9. Director of Global Public Health, Public Health England, London, UK

10. Centre of Applied Health Research, University College London, London, UK

11. Research Department of Primary Care and Population Science, University College London, London, UK

12. Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK

13. Faculty of Medicine, Imperial College London, London, UK

14. Paediatrics and Child Health, The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

15. Department for Children’s and Young People’s Diabetes, University College London Hospitals NHS Foundation Trust, London, UK

16. Research Department of Practice and Policy, University College London School of Pharmacy, University College London, London, UK

Abstract

BackgroundFive 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).MethodsFive 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.ResultsStudy 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 limitationsWork 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 registrationCurrent Controlled Trials ISRCTN99840111.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.

Funder

National Institute for Health Research

Publisher

National Institute for Health Research

Subject

Automotive Engineering

Reference355 articles.

1. Department of Health and Social Care. Healthy Lives, Brighter Futures – The Strategy for Children and Young People’s Health. London: Department of Children, Schools and Families; 2009.

2. Cross-Government Obesity Unit, Department of Health and Social Care, Department of Children, Schools and Families. Healthy Weight, Healthy Lives: A Cross-Government Strategy for England. London: Department of Health and Social Care, Department of Children, Schools and Families; 2008.

3. Chief Medical Officer. Annual Report of the Chief Medical Officer 2012. Our Children Deserve Better: Prevention Pays. London: Department of Health and Social Care; 2013.

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