From trial to population: a study of a family-based community intervention for childhood overweight implemented at scale

• Published in: International Journal of Obesity Vol. 38; no. 10; pp. 1343 - 1349
• Main Authors: Fagg, J, Chadwick, P, Cole, T J, Cummins, S, Goldstein, H, Lewis, H, Morris, S, Radley, D, Sacher, P, Law, C
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-10-2014; Nature Publishing Group
• Subjects: 692/699/1702/393; 692/700/1720; 692/700/2817; 692/700/478; Adolescent; Adult; Biological and medical sciences; Body Mass Index; Care and treatment; Child; Child Nutritional Physiological Phenomena; Community Participation; Diet; Domestic relations; Education; Epidemiology; Evidence-Based Medicine; Exercise; Family - psychology; Female; General aspects; Health aspects; Health promotion; Health Promotion and Disease Prevention; Humans; Internal Medicine; Intervention; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Nutrition research; Obesity; Obesity in children; Outcome Assessment, Health Care; Pediatric Obesity - epidemiology; Pediatric Obesity - prevention & control; Pediatric Obesity - psychology; Pediatric Original; pediatric-original-article; Program Evaluation; Prospective Studies; Public Health; Public health administration; Randomized Controlled Trials as Topic; Self Concept; Self esteem; Socioeconomic factors; Surveys and Questionnaires; Training; United Kingdom - epidemiology; Weight Loss; Weight Reduction Programs; United Kingdom; United Kingdom > UK; England; Human; Obesity; Nutrition; Family study; Body weight; Nutrition disorder; Metabolic diseases; Corporal biometry; Overweight; At home; Family environment; Clinical trial; Population; Child; Nutritional status
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/ijo.2014.103

Objectives:
To assess how outcomes associated with participation in a family-based weight management intervention (MEND 7–13, Mind, Exercise, Nutrition..Do it!) for childhood overweight or obesity implemented at scale in the community vary by child, family, neighbourhood and MEND programme characteristics.
Methods/Subjects:
Intervention evaluation using prospective service level data. Families (
N
=21 132) with overweight children are referred, or self-refer, to MEND. Families (participating child and one parent/carer) attend two sessions/week for 10 weeks (
N
=13 998;
N
=9563 with complete data from 1788 programmes across England). Sessions address diet and physical activity through education, skills training and motivational enhancement. MEND was shown to be effective in obese children in a randomised controlled trial (RCT). Outcomes were mean change in body mass index (BMI), age- and sex-standardised BMI (
z
BMI), self-esteem (Rosenberg scale) and psychological distress (Strengths and Difficulties Questionnaire) after the 10-week programme. Relationships between the outcome and covariates were tested in multilevel models adjusted for the outcome at baseline.
Results:
After adjustment for covariates, BMI reduced by mean 0.76 kg m
−2
(s.e.=0.021,
P
<0.0001),
z
BMI reduced by mean 0.18 (s.e.=0.0038,
P
<0.0001), self-esteem score increased by 3.53 U (s.e.=0.13,
P
<0.0001) and psychological distress score decreased by 2.65 U (s.e.=0.31,
P
<0.0001). Change in outcomes varied by participant, family, neighbourhood and programme factors. Generally, outcomes improved less among children from less advantaged backgrounds and in Asian compared with white children. BMI reduction under service conditions was slightly but not statistically significantly less than in the earlier RCT.
Conclusions:
The MEND intervention, when delivered at scale, is associated with improved BMI and psychosocial outcomes on average, but may work less well for some groups of children, and so has the potential to widen inequalities in these outcomes. Such public health interventions should be implemented to achieve sustained impact for all groups.