Addressing the Childhood Obesity Problem in the West Midlands: enhancing child weight management programmes
Submitting InstitutionUniversity of Worcester
Unit of AssessmentSport and Exercise Sciences, Leisure and Tourism
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Clinical Sciences, Public Health and Health Services
Summary of the impact
Childhood obesity is a national problem but it is a problem even more
keenly felt in the West Midlands where statistics show the percentage of
children classified as obese is higher than the national average. Research
demonstrating that simple measures such as waist circumference and body
mass index (BMI) are every bit as effective as complex and expensive
measuring processes such as magnetic resonance imaging (MRI) scans in
identifying high risk obese children has fed into the evaluation and
subsequent improvement of child weight management programmes in the region
and more widely in the UK. It also informed the development of an obesity
strategy and action plan for Worcestershire for the period 2008-11.
Professor Derek Peters (2001-present) has an established track record in
research into childhood obesity, particularly focusing on adipose tissue
patterning and implications for health in children and adolescents. A key
strand of this work has examined the efficacy of using simple
anthropometrical measures — such as waist circumference or Body Mass Index
(BMI) — as an indicator of obesity compared to criterion adipose tissue
values measured by expensive and time consuming MRI scans. The ability to
identify high risk obese children using simple and affordable surrogates
of central fat distribution is critical to healthcare providers tackling
the increasing prevalence of obesity in children and adolescents.
An international study pooled data from existing world studies (Peters
contributing approximately 20% of this data) where MRI assessment of
visceral adipose tissue and anthropometrical measures had been taken (Reference
1). Analysis indicated that waist circumference was the single best
predictor of visceral adipose tissue and BMI was the single best predictor
of subcutaneous adipose tissue. It was thus proposed that simple
anthropometrical assessments could be used as surrogate measures for the
identification of high risk obese children. Peters undertook further work
in collaboration with the University of Bristol to validate the use of
waist circumference across the full range of BMI. 179 12-13 year old
children underwent MRIs and anthropometric assessments confirming the
findings of the earlier international study (Reference 2). Further
research sought to determine the accuracy of dual-energy x-ray
absorptiometry (DXA) for the assessment of abdominal adipose tissue in
children (Reference 3). The study indicated a lack of precision at
the individual level for estimating abdominal fat levels and concluded
that in some situations, particularly at group monitoring level,
anthropometric measures would be the preferred assessment choice.
Peters brought this expertise to an evaluation study of child weight
management programmes funded by the Department of Health West Midlands (Grant
a) and undertaken with colleagues from Worcester's Psychological
Sciences Unit (Professor Dominic Upton 2006-present and Dr Penney Upton
2007-present) in 2009. At the time of the evaluation, seven family based
intervention programmes were in service across the West Midlands and four
of these had no published evidence of their effectiveness. The research
reported that none of the seven programmes routinely assessed all of the
essential evaluation measures highlighted by the National Obesity
Observatory's Standard Evaluation Framework. Analysis of waist
circumference and BMI indicated variable outcomes across the programmes
for short term effectiveness, and very few reported long term (> 6
months) effectiveness (Reference 4).
Further research reflected upon the impact of the timing of measurement
within the school day on National Child Measurement Programme statistics (Reference
5). The study showed a systematic increase in BMI across the
school-day for 81% of its sample due to variations in weight and height.
Consequently when a child was measured would affect which BMI category a
child was placed in, and thus the `follow-up' process initiated
potentially resultant from lack of measurement time standardisation.
References to the research
1. Brambilla, P., Bedogni, G., Moreno, L.A., Goran, M.I., Gutin, B., Fox,
K.R., Peters, D. M., Barbeau, P., De Simone, M. & Pietrobelli, A.
(2006) Cross validation of anthropometry against magnetic resonance
imaging for the assessment of visceral and subcutaneous adipose tissue in
children. International Journal of Obesity, 30, 23-30.
2. Benfield, L.L., Fox, K.R., Peters, D.M., Blake, H., Rogers, I., Grant,
C. & Ness, A. (2008) Magnetic resonance imaging of abdominal adiposity
in a large cohort of British children. International Journal of
Obesity, 32, 91-9.
3. Benfield, L.L., Peters, D.M., Fox, K.R., Blake, H., Wenyika, R. &
Ness, A.R. (2009) Dual energy x-ray absorptiometry (DXA) estimation of
children's abdominal adiposity measure by magnetic resonance imaging
(MRI). International Journal of Body Composition Research, 7 (4),
4. Upton, P., Taylor, C.E., Peters, D.M., Errol, R. & Upton, D.
(2013) The effectiveness of local child weight management programmes: an
audit study. Child: Care, Health and Development, 39 (1), 125-133.
5. Routen, A.C., Edwards, M.G., Upton, D. & Peters, D.M. (2011) The
impact of school-day variation in weight and height on National Child
Measurement Programme body mass index-determined weight category in Year
6 children. Child: Care, Health and Development, 37 (3), 360-7.
a. Upton, D., Upton, P., Bold, J. & Peters, D. Regional
Evaluation of Weight Management Programmes for Children and Families,
Department of Health West Midlands, March-December 2009, £80,000.
The University is confident the underpinning research meets the
excellence threshold. References 2 and 3 are returned to UoA26 in REF 2014
with Output ID "Peters4" and "Peters1" respectively. Reference 1 has been
cited 286 times, a measure of its significance within the field. Reference
4 resulted from a funded project (Grant a) won through competitive tender
and it is argued that this is indicative of its 2* quality. Reference 5
resulted from a University of Worcester funded studentship undertaken in
collaboration with the University of Birmingham.
Details of the impact
The West Midlands has consistently reported above the national UK average
for overweight and obese children based on National Child Measurement
Programme (NCMP) data with, for example, 21.2% of year 6 pupils measured
being recorded as obese for the year 2011/12 (against a national average
of 19.2%).i Weight management programmes are a key part of the
strategy adopted by West Midlands Primary Care Trusts (PCTs) to combat
this problem. A significant contribution of the research has been to
improve the delivery of child weight management programmes by PCTs
across the West Midlands. In addition, it has led to changes in practice
relating to the NCMP and it influenced the development of the
Worcestershire Childhood Obesity Strategy and Action Plan 2008-11.
The evaluation study was central to the first of these impacts (though it
must be stressed that this study itself was underpinned by Peters'
previous work on the value of anthropometrical measures). Key outcomes of
the evaluation were a set of recommendations for commissioners of weight
management programmes (Source A) and a toolkit of validated
measures for use by programme leads (Source B). In February 2010,
the research team presented the findings from the evaluation at a workshop
held by the Department of Health West Midlands (DoHWM) which was attended
by 65 weight management programme leads, commissioners, health improvement
specialists and others involved in developing, running and evaluating
public health interventions from across the region (Source C).
DoHWM published a document in March 2011 setting out the legacy of its
Healthy Weight programme which describes in detail the impact of the
evaluation (Source D). At a general level, it is stated that the
evaluation enabled Primary Care Trusts (PCTs) to improve measurement, data
collection and evaluation within their programmes (with concomitant
benefits for those children and families engaged in the programmes);
reassured PCTs that they were commissioning effective programmes; led to
PCTs adopting the National Obesity Observatory's Standard Evaluation
Framework (SEF) when making commissioning decisions. More specifically,
one PCT specified that the SEF and the University of Worcester's
evaluation tools and findings must be used by service providers.
The same PCT also used the evaluation and associated tools for their
revised NCMP service. Another PCT decided to pilot their own in-house
child weight management programme, incorporating best practice identified
through the evaluation; while another decided not to continue funding
their current programme which had been evaluated as part of this. Perhaps
the key overarching impact is that all West Midlands' PCTs accepted the
recommendation that they should continue to invest in child weight
The research relating to school-day variation in weight and height has
been fed into the practice of PCTs in data collection for the NCMP. Peters
contacted PCTs directly with the outcomes of the research and a number
responded to state that they would in future be recording whether
measurements were taken in the morning or the afternoon such that
school-day variation could be built into the outcome statistics (Source
More generally, Peters' expertise led to him being invited to sit on the
Worcestershire Childhood Obesity Strategy Group in 2008-9 (Source F).
Within this Group, Peters held particular responsibilities for research,
specifically relating to childhood obesity intervention programmes which
are set out in the final version of the strategy and associated action
plan (Source G).
Sources to corroborate the impact
A. Recommendations for commissioners of weight management programmes:
B. Toolkit of validated measures for use by weight management programme
C. List of delegates at workshop to report findings of the evaluation of
child weight management programmes: http://www.obesitywm.org.uk/resources/CWM_Attendees.xls.
D. Saunders, K., Baker, J. & Davis, J. (2011) The Healthy Weight
Programme in the West Midlands Legacy Document. Department of Health
E. Emails from Primary Care Trusts.
F. Minutes of meetings of the Worcestershire Childhood Obesity Strategy
Group 16/10/2008, 29/1/2009, 24/4/2009
G. Childhood Obesity Strategy Worcestershire PCT 2008 and Worcestershire
Childhood Obesity Action Plan 2008 - 2011: http://www.worcestershire.gov.uk/cms/pdf/pct_2008-05-30_childhood_obesity_strategy2.pdf.
Department of Health (2012) National Child Measurement
Programme: England, 2011/12 school year.