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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.
Long-standing research led by Prof. O'Rahilly (Department of Clinical Biochemistry) into the genetic and biochemical basis of severe insulin resistance syndromes, has led to improvements in diagnosis and care of patients internationally. These advances have facilitated revision of existing clinical classifications and implementation of novel diagnostic and management algorithms for these conditions. The clinical applicability of this research was recognised in 2011 by the Department of Health-England who have commissioned a national severe insulin resistance service in Cambridge, with support totalling ~£450,000 per annum.
Obesity is a global epidemic. Currently, more than half a billion adults worldwide are estimated to be overweight or obese yet this problem is entirely preventable. Excess weight costs the NHS over £5 billion each year and is associated with an increased risk of obesity-related disease (e.g. type 2 diabetes and heart disease). University of Glasgow researchers defined two `Action Levels' for waist circumference to indicate the point when an individual needs to initiate weight loss to reduce their risk of disease. These Action Levels have been incorporated into national and international clinical guidelines for the diagnoses and management of obesity-related disease, and have provided the foundation for public-health campaigns and policies worldwide, designed to reduce the burdens of chronic ill-health that follow obesity.
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.
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.
Our sustained impact in obesity treatment began in 1999 with Europe's first residential camp programme for overweight and obese children. Our impact on treatment grew sufficiently to warrant the formation of a dedicated spin out company, MoreLife. Underpinned by our research, MoreLife is an award winning, Department of Health accredited provider, delivering specialist weight management services, both nationally and internationally. Through NHS and other contracts we are delivering high quality, evidence based services to over 3,500 adults and 3000 young people per year. Our impact on the policy and practice of obesity treatment and public understanding continues in the UK and has been extended internationally.
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.
Diabetes research at University of Ulster (Ulster) addresses the unmet need of industry for new and more effective commercially applicable approaches for diabetes therapy. We have generated a new class of innovative peptide therapeutics resulting in a strong portfolio of intellectual property, significant international recognition, financial investment and job creation, with commercialisation through Ulster's technology transfer company, Innovation Ulster (IUL), and the Ulster start-up company, Diabetica Ltd. Our substantial interactions with industry have resulted in the licensing and further development of our international patents on stable incretin peptides for diabetes and, through our discovery of their positive effects on cognition, for treatment of Alzheimer's disease. This work has provided industry with new and commercially viable approaches to significantly improve the lives of people with diabetes and related neurodegenerative disease.
Research led by Dr. Peter Richardson in the Department of Pharmacology led to the development of an A2A adenosine receptor antagonist (istradefylline) for the treatment of Parkinson's disease. In 2001, Dr Richardson founded the spin-out company Cambridge Biotechnology (CBT) to develop these drugs. A pH-sensitive adenosine A2A receptor agonist is now being developed for the treatment of neuropathic pain, with one product licensed for use in Japan in 2013 (Nouriast). Small-molecule leptin mimetics as potential anti-obesity drugs were also developed, initially by CBT and since 2009 by Astra Zeneca following acquisition of the research programme. CBT has undergone a number of high-value acquisitions, by Biovitrium, Proximagen, and most recently Upsher-Smith. It continues to operate as a wholly-owned subsidiary, employing 30-35 people from 2001 to the present.
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.