The obesity challenge

27 April 2007

Dr Pinki Sahota, Leeds Metropolitan University, shares the research behind the current treatment programmes tackling childhood obesity.

Childhood obesity has trebled in the last 20 years and current prevalence rates indicate that 16% of children aged between two and 15 years are obese and 30% are overweight. Current trends suggest that the Public Service Agreement target to halt the rise of obesity in children under 11 years by 2010 will not be attained. Tackling obesity is therefore a national priority.

Research evidence indicates that childhood obesity tracks into adulthood, and that adolescent obesity is related to subsequent morbidity and mortality more than 50 years later, irrespective of adult weight. Moreover, the impact of obesity on both physical and psychological health in childhood, through bullying and victimisation, may result in serious consequences for the child. In addition to the personal cost of increased morbidity and mortality in both childhood and later in life, the economic costs of obesity and related co-morbidities have been estimated in England at £3.3-3.7bn in 2002, or 2.6% of the national healthcare budget. The time-lag between the onset of obesity and increases in related chronic diseases suggests that further increases in health problems and economic costs are already 'locked in' and will increase. The rise in childhood obesity is likely to multiply such effects as exposure to risk occurs over a longer period. Therefore, effective interventions for obese children are urgently required to reduce the impact on physical and psychological wellbeing during childhood, subsequent morbidity and mortality in adulthood, and the economic costs associated with treating obesity related diseases. A two-pronged approach is necessary, aimed at obesity prevention and treatment of those children already obese, if the current epidemic is to be stemmed.

It is acknowledged that diet, physical activity and behavioural approaches are the components of successful interventions, but it remains unclear how these approaches are best implemented and potentially combined. Researchers at Leeds Metropolitan University have made a valuable contribution to both policy and practice through contributing to the sparse evidence base in the childhood obesity area. The Childhood Obesity Group at Leeds Metropolitan University, led by Dr Sahota, involves interdisciplinary academics and practitioners from Leeds Met, Leeds University, Leeds Teaching Hospitals Trust and Leeds Primary Care Trust.

The Group was one of the first to be established with a research focus on this challenging area and it has undertaken a number of studies that aim to develop, implement and rigorously evaluate interventions aimed at both obesity prevention and treatment in children. The Carnegie Camp at Leeds Met has been at the forefront in developing residential programmes and evaluating the impact on obese children and their families since the early 1990s.

The APPLES study was the first UK-based RCT and has been cited in numerous systematic reviews, meta-analyses and review papers, including the WHO report on childhood obesity and the recent NICE guidelines on obesity. Three BMJ articles and numerous media reports resulted from this study and contributed significantly to raising the awareness of childhood obesity as a public health issue. This research and the knowledge and understanding related to promoting behaviour change in children have informed further studies and initiatives targeting schoolchildren, eg. DH Food in Schools dining room pilot study and Sustain's national Grab 5 project. The APPLES study was one of the first studies to highlight the increasing prevalence of childhood obesity within the UK. Phase 2 of APPLES confirmed the continuing rise in childhood obesity and informed the development of co-ordinated government policy. The House of Commons Health Select Committee visited Leeds to establish current evidence related to childhood obesity in September 2003 and made recommendations to Government.

Currently, the Group is involved in conducting a feasibility trial for 'WATCH IT', a community-based obesity treatment programme, in collaboration with Leeds University and funded by the Wellcome Trust. The aim is to undertake a RCT to establish effectiveness of the programme. This innovative community-based intervention was developed with input from users and employs health trainers supported by health professionals to deliver the family-based intervention. There has been national and international interest in this approach and, in April 2005, representatives from DH visited Leeds to discuss Best Practice in obesity treatment programmes. Whilst evidence on the effectiveness of interventions is slowly emerging, limited information is available about the costs of behavioural interventions targeted at weight loss. To date, the contribution of economics has largely been to highlight the economic burden of obesity to health services and society. However, formal economic evaluation of interventions can provide guidance on the allocation of scarce resources to different strategies designed to prevent and treat obesity. In collaboration with a health economist from Leeds Met University, the direct costs to healthcare and other public sector agencies of the WATCH IT Programme are being assessed.

In the light of current evidence indicating that early weight gain is a predictor of later childhood obesity, research is being undertaken in collaboration with the Royal College of Paediatrics and Child Health and Warwick University, and involves evaluation of a health visitor-led intervention aimed at parents of newborns at risk of obesity. A training manual has been developed to facilitate health visitors in working with families of children at risk of developing obesity, and the health visitors will receive specialist training on employing the Family Partnership Model led by a psychologist. In order to generalise the training to health visitors beyond the research study, the Child Growth Foundation is currently offering training to all health visitors based on the manual, as health visitors have expressed a training need in this area.

Other current research targeted at the early years age group involves researchers working with local authority staff who run the Children Centres to explore whether the Centres provide an appropriate setting to address childhood obesity risk factors, and how best to support parents in promoting healthy behaviours in their children. The aim is to develop, implement and evaluate an intervention based on the specific needs of parents and the Children Centre staff.

Strong links exist locally between the researchers, Leeds PCT and the local authority, with the focus on improving nutrition in children and reducing health inequalities. The Group has informed the development of policy and practice through, for example, informing the development of Leeds Children and Young People's Obesity Strategy and will maintain its contribution through advising on implementation, monitoring and evaluation of the strategy. It is acknowledged that childhood obesity rates are higher amongst disadvantaged children and Leeds data reflects the national situation of poor uptake of free school meals. The Group is currently investigating the reasons for this with parents, children and school staff and aims to work with the local authority and partners such as the Benefit Agency to increase uptake.

Despite the generation of evidence on effectiveness of interventions aimed at tackling childhood obesity, it is apparent that further work is required if the increase in prevalence is to be stemmed. Researchers at Leeds Met University have contributed to practice and policy, both nationally and internationally, and the applied research undertaken places the University at the cutting edge in this area. In July 2006, the first conference for researchers involved in childhood obesity treatment trials took place at the University with all groups within the UK being represented. A consensus to establish a network was reached so that the group could share experiences but also offer expertise to policy-makers and researchers in the area of childhood obesity.