A school-based lifestyle intervention didn’t help children avoid unhealthy weight gain

Wyatt K, Lloyd J, Creanor S, et al. Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children. Public Health Res. 2018;6(1).

The Healthy Lifestyle Programme delivered to 9-10-year-old school children did not reduce their weight over the course of two years. Around a third remained overweight or obese, the same as iBiken schools that followed the standard syllabus.

This trial, funded by the NIHR, assigned schools across Devon to follow a lifestyle programme in Year five. The comprehensive curriculum included drama and activity workshops, personal goal setting and parental involvement.

Children made better food choices, but this did not affect weight outcomes. It was almost certain the programme wouldn’t give value for money.

Programmes addressing the wider school environment or delivered at the community or population level may have greater scope for preventing obesity.

Takeaways linked to increased cardiovascular risk factors and obesity in children

Donin AS, Nightingale CM, Owen CG, et al. Takeaway meal consumption and risk markers for coronary heart disease, type 2 diabetes and obesity in children aged 9-10 years: a cross-sectional study. Arch Dis Child. 2017

Children who eat takeaways once or more each week have more body fat and higher low-density lipoprotein (LDL) “bad” cholesterol levels than those who never or hardly evefish-and-chipsr eat them. Their diets were also higher in fat and lower in protein and calcium.

This cross-sectional study looked in depth at eating habits and risk markers for coronary heart disease, obesity and diabetes in 2,529 children in England. Though this type of study can only show an association between takeaways and risk markers, it is one of the first of its type, and the results do give cause for concern.

Increasing numbers of people are eating takeaways in the UK. Local authorities and healthcare professionals are well placed to encourage parents and children to choose healthier foods, in line with current national guidance.

Intensive lifestyle interventions can help obese young people lose weight

O’Connor EA, Evans CV, Burda BU, et al. Screening for Obesity and Intervention for Weight Management in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017;317(23):2427-44.

BikeObese children and adolescents can lose up to seven pounds over six to 12 months when they engage in at least 52 hours of behaviour-based lifestyle interventions. Minimal benefit was seen with shorter contact time, with less than 25 hours ineffective. The control group gained weight.

Rising obesity in the young is a global concern, which may lead to high rates of obesity-related diseases in adulthood. This review identified trials covering various weight management strategies. Lifestyle-based-interventions with sufficient contact time – as recommended by UK guidelines – showed clear benefits with no evidence of harms.

Investing in effective strategies to manage child obesity will ultimately save healthcare costs. Behaviour-based support should now be assessed for long-term weight loss and maintenance.

The evidence is still lacking whether universal child screening for obesity should be performed in the UK.

Burden of child and adolescent obesity on health services in England

Viner RM, Kinra S, Nicholls D, et al. Burden of child and adolescent obesity on health services in England. Archives of Disease in Childhood Published Online First: 01 August 2017. doi: 10.1136/archdischild-2017-313009

Abstract

Objective To assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England.

Design Pathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data.

Setting Data on CYP aged 2–18 years from the Health Survey for England 2006 to 2013.

Main outcome measures Clinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI ≥99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function).

Results 11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13–18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management.

Conclusions There is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden

National child measurement programme operational guidance

Guidance for local commissioners, providers and schools on running the national child measurement programme (NCMP) as part of the government’s commitment to tackling the public health challenge of excess weight.

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The publication of the Childhood Obesity Plan: A Plan for Action, in August 2016 shows that tackling child obesity is a priority for the Government. The plan aims to significantly reduce England’s rate of childhood obesity within the next ten years. Most local authorities have also identified addressing childhood obesity as a key issue in their health and wellbeing strategies, and reducing obesity is prioritised in many Sustainability and Transformation Plans.

The NCMP is key to monitoring the progress of the Government’s Childhood Obesity Plan. It provides the data for the Public Health Outcomes Framework indicators on “excess weight in children aged four to five years and ten to 11 years.” Because the data is valid at local level, it can also be used to inform the development and monitoring of local childhood obesity strategies.

 

National child measurement programme operational guidance

National child measurement programme: information for schools

Cochrane reviews show impact of lifestyle changes on obesity

Two Cochrane reviews, published today, show that a combination of diet, physical activity and behavioural change interventions may reduce weight in children and adolescents | OnMedica

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The two reviews look at the effects of diet, physical activity and behavioural interventions in treating children with overweight or obesity from six years old to early adulthood. They summarise the results of 114 studies which involved over 13,000 children and young people.

Labor or Cesarean for Superobese Women?

Rates of severe maternal and neonatal morbidity were similar among superobese women undergoing primary cesarean delivery versus a trial of labor, most often ending in vaginal delivery | Clinical Anesthesiology

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Researchers say a prospective clinical trial is needed to determine whether one method of birth is superior to the other in mothers who are superobese.

According to Alexander Butwick, MBBS, FRCA, MS, among women who are superobese, rates of cesarean delivery are particularly high (≥50%), but little has been known about how delivery mode affects perinatal and neonatal outcomes. Dr. Butwick, who presented the findings at the 2016 annual meeting of the Society for Obstetric Anesthesia and Perinatology (abstract 01-02), is associate professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, in California.

Over the years, clinicians have observed that obesity is associated with an increased risk for obstetric, perinatal and anesthetic morbidities. Obese pregnant women are at an increased risk for gestational diabetes, preeclampsia, operative delivery, postpartum infection and venous thromboembolism.

Read the full article here