Log in
High global and national prevalence levels of child obesity and physical inactivity carry a substantially increased health risk. Exposure to this risk is exacerbated in north-west England where health inequalities are large. Consequently, the prevention of physical inactivity and associated conditions such as obesity are vital at the local level. This case study summarises the impact of research within the Research Institute for Sports and Exercise Sciences (RISES) that has focused on children's physical activity and health promotion in educational settings in the North West of England. This research has been utilised by the Local Authorities that have partnered with RISES to develop and deliver; health and physical activity monitoring (SportsLinx); evidenced-based programmes of physical activity for schoolchildren (school-based interventions); and educational practice development (teacher training) that have demonstrably enhanced children's physical activity and health.
Research in the area of childhood obesity has focussed on the development, implementation and evaluation of interventions. The APPLES Study (1996-99), the first UK school-based RCT was key in contributing to the evidence-base through wide dissemination including 3 BMJ (2001) publications, cited in NICE (2006) and WHO guidance (2004). Collaborations with academics, practitioners and the RCPCH led to the development of further community-based obesity treatment and prevention interventions including WATCH IT; early programmes e.g. EMPOWER, HELP and HAPPY and more recently innovative school-based initiatives involving school gardening. There is evidence of results being disseminated and influencing research, practice and policy.
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.
Clinical research conducted at the UCL Institute of Child Health between 1998 and 2011 under the direction of Professors Alan Lucas and Atul Singhal showed that a slower rate of infant weight gain had long-term benefits to reduce the risk of obesity and cardiovascular disease. This contradicted the accepted view, which favoured the promotion of rapid weight gain in infancy. This work has had a significant influence on public health policies and initiatives in the UK and elsewhere. It has changed the way infant formulas are made and used. Two new interventions for overweight children have been developed and are helping families around the world.
Childhood obesity is an increasing problem in the UK with roughly one in seven school aged children in Scotland and England being classified as obese. The picture is similar in Wales where the prevalence is one in eight. The direct cost of obesity to the NHS is estimated to be £4.2bn a year, with this set to rise if the causes of childhood obesity are not addressed. The contribution of the research described below to tackling this issue is manifold: it has enabled the development and improvement of child health interventions/programmes; it has allowed commissioners and programme leads to make more informed decisions about investment in these interventions/programmes; and it has contributed to the development of regional healthy weight strategies and national guidelines on weight management.
The further development of the UK Physical Activity guidelines in 2010 highlighted the need to consider the emerging research in the area of sedentary behaviour. Prof S. Biddle at Loughborough University, based upon his and the Unit's leading research in this area, was invited to Chair a working group to review and make recommendations regarding the incorporation of guidance on sedentary behaviour into these new national policies. This group, drawing on the original work of Biddle and co-workers, set out clear recommendations for the incorporation of sedentary behaviour into the UK national Physical Activity Guidelines through the `Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence' report (2010).
Physical Activity guidelines in the UK had never included recommendations for sedentary behaviour, until the publication of `Start Active, Stay Active' (2011), as a direct result of the Unit's research.
Obesity in the UK is a growing problem for individuals and for NHS resources.a,f There is evidence to suggest that the Government's healthy living messages are failing to get through, as figures show obesity levels have almost doubled in 14 years.a,f More than half the adult population are now overweight or obese.b The report led by Waumsley that reviews the evidence base for psychological approaches to obesity and provides guidelines for practitioners forms the basis for this impact case. This influential research on secondary data was commissioned by the British Psychological Society (BPS) and remains their position statement on obesity, and features in advice to the general public on obesity in adults. As lead, Waumsley participated in a House of Lords cross-party seminar on behaviour change and obesity, has been an expert discussant on obesity at the BPS Annual Conference, and will lead the BPS's response to the National Institute for Health and Care Excellence (NICE) consultation on Overweight and obese adults: lifestyle weight management.
With childhood obesity now of global public health and clinical importance, attention had to be directed toward how best to identify the condition and more importantly those who are at further risk of serious obesity-related conditions. This case study illustrates how assessment has moved beyond the simple crude measure, challenging the accepted approach and developed more sensitive and specific assessment tools. Described is a new range of clinical assessment charts which allow practitioners and epidemiologists to evaluate a range of body characteristics known to be linked to morbidity, make a fuller assessment of individual risk and target better and specific intervention.
The Counterweight Programme (CW) is a structured model for obesity management in primary care settings. CW has made substantial changes to clinical and public health guidelines and to practice nationally and internationally: the Programme has since been adopted in Primary Care Galway, Ireland and for a government funded trial in Ontario, Canada. The creation of a spin out company, Counterweight Ltd, in 2011 resulted in concomitant job creation and significant commercial activity, with CW now being used in private healthcare, pharmacies, fitness clubs, and by freelance healthcare professionals. Moreover, the programme has significantly benefited the health and welfare of obese patients and improved care practice by increasing quality, accessibility and cost effectiveness of weight management services in the UK.
Professors O'Rahilly and Farooqi were the first to identify monogenic causes of severe childhood obesity, leading the way for identification of additional genetic causes by their group and others. Their research led to the development of diagnostic tests for these conditions, which are now an accepted element of clinical guidelines around the world. This work led to the understanding that inherited disorders of appetitive drive can underlie human obesity which has altered attitudes to obesity and had an impact on the management of families with these conditions. Their research also led directly to a highly effective therapy for congenital leptin deficiency which reverses the severe obesity associated with this condition and associated endocrine and immunological deficiencies. This treatment is now available throughout the UK and in specialist centres worldwide.