How can GPs help prevent and manage obesity in children?

Paediatric Research in Obesity Multi-modal Intervention and Service Evaluation Programme (PROMISE)

4th March 2015, 6.00pm-8.00pm followed by a drinks reception

Royal College of General Practitioners,

30 Euston Square, London NW1 2FB

Funder: National Institute for Health Research (NIHR)

The purpose of this event is to raise awareness among GPs of our research that has examined what we can do to play a greater role in prevention and management of obesity in children. We will present our results of our evaluation of the National Child Measurement Programme, what parents are saying about the feedback and difficulties in raising concerns about children’s weight with parents and demonstrate tools that are is available to guide discussion and engage families. We will then discuss in an open forum how we can achieve this together.

Dr Sonia Saxena FRCGP, Clinical Reader Imperial College London and Putney GPwho is one of the investigators on the programme willhost this event and drinks reception afterwards

17.45 / Registration
18.00 / James Cracknell
Senior research fellow, Health Policy Exchange and Double Olympic gold medallist. / Engendering a culture of physical activity and healthy lifestyle especially for in children and the UK population
18.10 / Dr Rachel Pryke, Clinical Champion for Nutrition for Health, RCGP / The role of GPs in weight management
18:20 / Dr Sanjay Kinra, Senior Lecturer
London School of Hygiene Tropical Medicine / Electronic tools to guide a brief intervention in primary care
18:40 / Professor Ian WongProfessor of Pharmaco-epidemiology
University of Hong Kong / Use of anti-obesity drugs in children in primary care
19:00 / Dr Sonia SaxenaGP/ Clinical Reader
Imperial College London / Implications for primary care
19:20 / Panel discussion / How can GPs help prevent and manage obesity in children?
20.00 / Drinks reception

For Registration: Click hereor send an email to

Please note that places will be allocated on a first come, first served basis.
Any questions please contact: , 0207 905 2772

Getting there

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Royal College of General Practitioners
30 Euston Square
London
NW1 2FB

We are located on the corner of Euston Road and Melton Street, adjacent to Euston Square Gardens.

Tel:020 3188 7400

Fax:020 3188 7401

Nearest underground and rail connections:

Euston: Northern line and Victoria line, and mainline rail services

2 minute walk from Euston Square: Circle line, Hammersmith and City line and Metropolitan line

5minute walkfrom Kings Cross St. Pancras: Circle line, Hammersmith and City line, Metropolitan line, Northern line, Piccadilly line and mainline rail services.

Speakers biographies

/ Dr Sonia Saxena (Host), Clinical Reader School of Public Health Imperial College London is a GP academic leading research to improve prevention, detection and treatment of childhood illness in primary care. She has led studies examining medical problems in obese British children and developed guidance and research tools for GPs to assess and advise families with overweight children. She has led initiatives to raise awareness of childhood obesity and contributed to the UK government’s policyon food and nutrition in British schools.
/ James Cracknell,Senior research fellow Health Policy ExchangeOlympic gold medallists one of Britain’s most successful athletes winning two Olympic Gold medals and six World Championships.James was motivated to enter politics by the 2007 Foresight Report – Tackling obesities: future choices, and continues to champion health improvement and physical activity in Britain.
/ Dr Rachel Pryke,Clinical Champion for Nutrition for Health, RCGP is a part-time GP in Redditch, Worcestershire, with particular interests in child obesity and women's health.She established the RCGP Nutrition Group in 2013has contributed to obesity steering groups and reports for the Royal College of GPs and Academy of Medical Royal Colleges. She has written two books about weight for children and young people
/ Dr Sanjay Kinra,Reader, London School of Hygiene Tropical Medicineis a Clinical Epidemiologist trained in Paediatrics with research programmes in India and the UK. He practices in the weight management clinic at University College London Hospitals Trust and leads a public health research programto improve the assessment, referral and management of overweight childrenin primary and secondarycare acrossLondonand more widely.
/ Professor Ian WongProfessor of Pharmaco-epidemiologyin Hong Kong University. He is the founding director of the Centre for Paediatric Pharmacy Research, at The School of Pharmacy, UCL Institute of Child Health, University of London and Great Ormond Street Hospital for Children and has published extensive research on the impact of medication use in children.

Evaluation of the National Child Measurement Programme (NCMP) Feedback

PROMISE Research Programme Briefing Paper 1

Funded by the NIHR Programme Grants for Applied Research (RP-PG-0608-10035)

Summary

After children are measured as part of the National Child Measurement Programme (NCMP), parents are provided with feedback letters about their child’s weight status (underweight, healthy weight, overweight, very overweight).

We worked with the NCMP to assess the impact of the feedback on parental perceptions of their child’s weight and health, and health-related behaviours. We conducted a longitudinal study of 1,844 parents of children in Reception (age 4-5) and Year 6 (age 10-11) who were measured as part of the 2010-2011 NCMP in five Primary Care Trusts. Parents were surveyed before they received NCMP feedback (response rate: 18.9%), and 1 and 6 months after the feedback (response rate: 54.3%). Qualitative interviews were conducted with 52 parents with overweight children.

Key Findings

Baseline

  • Three-quarters of parents of overweight and obese children do not recognise their child to be overweight: Before they received NCMP feedback, only 14% of parents with overweight children and 35% of parents with obese children perceived their child to be overweight. Parents were only likely to classify their children as overweight if BMI was above the 99.7th centile (much higher than the standard 95th centile used by the NCMP).
  • Many parents do not consider their child’s overweight status to be a health risk: 41% of parents that acknowledged their child to be overweight did not perceive this to be a health risk. Interviews with parents suggested that parental definitions of health frequently did not include weight; some parents did not consider the NCMP result to be credible because it didn’t take into account their child’s background or lifestyle.
  • Cultural factors as well as deprivation may explain high levels of obesity among black and South Asian children in England: After accounting for deprivation and other sociodemographic characteristics, black and South Asian children were three times more likely to have an obesogenic lifestyle than white children. Qualitative work indicated that being overweight was not viewed negatively by some non-white parents.

After NCMP feedback

  • The majority of parents found NCMP feedback to be helpful: 87% of parents found NCMP feedback helpful. More than one-fifth of parents of overweight children reported feeling upset, but only 1.8% of parents stated that they would withdraw their child from the NCMP in the future.
  • A quarter of parents of overweight children and half of parents of obese children sought further information regarding their child’s weight: The most frequently reported sources of information were friends and family (reported by 14.4% of parents), the internet (9.9%), the GP (8.9%) and school nurse (8.4%).
  • NCMP feedback has positive effects on parental knowledge, perceptions and intentions: After receiving NCMP feedback, parents’ general knowledge about the health risks associated with child overweight improved, particularly among non-white parents. The proportion of parents that recognised their child to be overweight nearly doubled after feedback, but remained low at 38%. Nearly three-quarters of parents reported an intention to change lifestyle behaviours following NCMP feedback.
  • But NCMP feedback has little impact on actual lifestyle behaviours: After feedback, there were no changes in reported dietary behaviours or screen time. There was a slight increase in the proportion of obese children meeting recommended levels of physical activity, but physical activity levels did not change in other groups.
  • ‘Proactive’ feedback may be more effective than letters alone: In areas where ‘proactive’ NCMP feedback (telephone call or face-to-face meeting) was given to parents of obese children in addition to the letter, there was a greater improvement in parental recognition of child overweight and health risks. However, telephonic feedback required additional resources (£9.50 versus £1.24 per child) and most parents reported a preference for feedback by letter.

Implications

  • NCMP feedback has a positive effect on parental perceptions and intentions to make lifestyle changes, and is acceptable to most parents. However, intentions do not necessarily translate into behaviour change. There is a need to ensure that local services and networks are in place to support parents in making and maintaining lifestyle changes following NCMP feedback.
  • Parents seek advice about their child’s weight from the GP and school nurse, as well as informal sources such as friends and the internet. Parents must be directed towards accurate, reliable information, while primary care professionals must be trained and equipped with the resources to treat childhood overweight.
  • Parental perceptions of child overweight and health risk are not aligned with those of health professionals, even after NCMP feedback. There is a need to understand how these parental perceptions are formed, and to identify more effective ways of communicating messages about healthy weight and health risk to parents.
  • The impact of NCMP feedback may be greater among the parents of non-white children than white children, and therefore may help in reducing health inequalities. Culturally appropriate feedback could be considered to enhance this.
  • Proactive forms of feedback may be more effective in changing parental perceptions than feedback letters, but are more resource-intensive and most parents report a preference for written feedback. The cost-effectiveness and acceptability of alternative forms of feedback needs to be further evaluated.

Bibliography

  1. Falconer C L, Park M H, Skow A, Black J, Sovio U, Saxena S, Kessel A, Croker H, Morris S, Viner R M and Kinra S. Scoping the impact of the National Child Measurement Programme feedback on the child obesity pathway: study protocol. BMC Public Health 2012; 12(1):783
  2. Park M H, Falconer C L, Saxena S, Kessel A S, Croker H, Skow A, Viner R M and Kinra S. Perceptions of health risk among parents of overweight children: A cross-sectional study within a cohort. Preventive Medicine 2013;57(1):55-59. doi: 10.1016/j.ypmed.2013.04.002
  3. Falconer C L, Park M H, Croker H, Kessel A S, Saxena S, Viner R M and Kinra S. Can the relationship between ethnicity and obesity-related behaviours among school-aged children be explained by deprivation? A cross-sectional study. BMJ Open 2014;4:e003949
  4. Park M H, Falconer C L, Croker H, Saxena S, Kessel A S, Viner R M and Kinra S. Predictors of health-related behaviour change in parents of overweight children in England. Preventive Medicine 2014;62:20-24
  5. Syrad H, Falconer C, Cooke L, Saxena S, Kessel A S, Viner R, Kinra S, Wardle J and Croker H. “Health and happiness is more important than weight”: a qualitative investigation of the views of parents receiving written feedback on their child’s weight as part of the National Child Measurement Programme. J Human Nutrition and Dietetics 2014;doi:10.1111/jhn.12217
  6. Falconer C L, Park M H, Croker H, Skow A, Black J, Saxena S, Kessel A S, Karlsen S, Morris S, Viner R M and Kinra S. The benefits and harms of providing parents with weight feedback as part of the National Child Measurement Programme. BMC Public Health 2014;14:549
  7. Black J A, Park M H, Gregson J, Falconer C L, White B, Kessel A S, Saxena S, Viner R M and Kinra S. What would parent derived child obesity cut-offs look like? (in press)

CATCH: an electronic tool to improve childhood obesity management in primary care

PROMISE Research Programme Briefing Paper

Funded by the NIHR Programme Grants for Applied Research (RP-PG-0608-10035)

Summary

We developed an online tool (Computer-Assisted Treatment of CHildren, CATCH) to aid primary care practitioners in assessing and treating childhood obesity. The tool incorporates risk estimation models to identify children at risk of obesity-related comorbidities who may need referral to secondary care, and provides families with tailored, printable lifestyle advice.

An uncontrolled pilot study with integral process evaluation was conducted at three GP clinics in northwest London, to evaluate the acceptability to families and practitioners of using CATCH in primary care. Families with concerns about excess weight in a child aged 5-18 years (n=14 children) had a consultation with a GP or practice nurse using CATCH. Families and practitioners completed questionnaires to assess the acceptability and usefulness of the consultation, and participated in semi-structured interviews which explored user experiences.

Key findings

  • A consultation using an online tool is acceptable to families presenting at a GP clinic with concerns about excess weight in a child: the majority of families (n=12, 86%) were satisfied with the CATCH-assisted consultations, and all respondents found the personalised lifestyle advice useful or somewhat useful.
  • In interviews, parents described the consultation as informative, and several referred to theconsultation as a ‘wake-up call’ that alerted them to the severity of their child’s weight problem.
  • Parents felt that the use of visual aids such as the BMI chart to show the child’s weight status and printed lifestyle advice reinforced the practitioner’s message.Similarly, practitioners felt that the tool could enhance the impact of their advice. It was suggested that the tool could be used as positive reinforcement for patients with BMI in the healthy range and healthy lifestyle.
  • Practitioners (n=4) were satisfied with the tool-assisted consultationand reported that the tool was easy to use.
  • All practitioners were in agreement that the tool (or a version of it) would be something they would continue to use in the future and would like to see integrated into their clinical software system.
  • Families and practitioners identified a need for practical, structured support for weight management following the consultation: several parents suggested that follow-up appointments for monitoring and guidance on weight management would be beneficial.

Bibliography

  1. Sovio U, Skow A, Falconer C, Park M H, Viner R M and Kinra S. Improving prediction algorithms for cardiometabolic risk in children and adolescents. Journal of Obesity 2013 doi:10.1155/2013/684782
  2. Park M H, Skow A, Puradiredja D I, Lucas A, Syrad H, Sovio U, White B, Kessel A S, Taylor B, Saxena S, Viner R M and Kinra S.. Development and evaluation of an online tool for management of overweight children in primary care: a pilot study (submitted)