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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.
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.
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.
This research provided the first evidence that long-chain polyunsaturated fatty acids (LCPUFAs) added to infant formula improve the development of specific cognitive abilities. Manufacturers of infant formula have included the research in their submissions to regulatory authorities to justify inclusion of LCPUFAs in infant formula. The research is also included in information and advice on infant feeding provided by manufacturers for the general public. Between 2008 and 2013, the research has been cited by national and international organisations in connection with recommendations for dietary intakes of LCPUFAs and policy on infant nutrition. Formulas enriched with LCPUFA are now available in most countries, and the formula-fed infants worldwide receive the benefits of LCPUFAs.
The University of Southampton's lifecourse cohort studies have led to a paradigm shift in the medical approach to obesity and non-communicable diseases. Research linking maternal pre-conception and early years nutrition with health outcomes for later life has directly influenced public healthcare policy at international (United Nations), national (Scientific Advisory Committee on Nutrition) and local (Southampton City) levels. Dissemination through medical practice and Southampton-designed public education programmes such as LifeLab means this research has already led to health benefits for tens of thousands of people, providing them with the information and tools to help prevent themselves and their children from succumbing to a non-communicable disease.
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.
Our impact has been to protect the public by informing and influencing both the international policy debate on health claims associated with soy consumption, and the relevant regulatory risk assessment authorities.
Our research formed a key component of dossiers that resulted in the rejection of health claims by the European Food Safety Authority (EFSA, the EU agency responsible for the scientific substantiation of health claims) relating to soy isoflavones and a number of health endpoints including bone health, heart health and menopausal symptoms. Earlier work had underpinned decisions on comparable health claims in the US and UK.
Our soy isoflavone research also provided key scientific data on the absorption of isoflavones by the body (and dependence on age and food source) to the UK Government Committee on Toxicity (COT) policy review on the toxicity of chemicals with a specific focus on soy infant formula. This expands on COT advice in 2003, which used earlier Cassidy research and helped to inform the UK government's (Food Standards Agency) research programme on phytoestrogens /isoflavones.
Research at the University of Nottingham (UoN) has had influence on development of health policy in the UK and internationally. It is recognised that the risk of diseases related to obesity and insulin resistance, is partly determined by the nutritional environment experienced during early life. Against a background of scepticism researchers at the UoN have generated data that has been critical in demonstrating the biological plausibility of such associations. This has influenced expert panels and non-governmental organisations in framing their current recommendations for nutrition in pregnancy and infancy, which benefit women and children worldwide.
UCL research, from the Department of Epidemiology & Public Health, has underpinned the Health Survey for England's (HSE) role in informing obesity policy in England. HSE data quantified the extent and escalation of obesity within the population as a whole as well as specific sub-groups, resulting in this issue being given significant attention in government. HSE data has underpinned strategy development, the modelling of future scenarios, the identification of inequalities, and the creation of clinical guidance. HSE data has showed early indications that the focus on childhood obesity is paying off, with wider evaluation shifting further strategy work to adults. HSE data has also played a role in this area, defining the adult target group for the Change4Life programme. Furthermore, HSE data are underpinning new agreements with the food industry through the Responsibility Deal.
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.