24/59 Behavioural overweight and obesity management interventions that include long term support in achieving and maintaining weight loss in children and young people

NICE are expected to update guidance and recommendations for further research on ‘Weight management: lifestyle services for overweight or obese children and young people’ [PH47], later this year.

The following recommendation is of particular interest to the Public Health Research (PHR) Programme research question:

• What is the effectiveness and cost effectiveness of behavioural overweight and obesity management interventions that include long term support in achieving and maintaining weight loss in children and young people?

Tackling obesity is one of the greatest long-term challenges currently faced in the United Kingdom. Children living with obesity are more likely to become adults living with obesity and thus increase the risk of obesity for their own children later in life. Causes of obesity are complex and childhood obesity is also associated with psychological problems such as anxiety and depression, low self-esteem and lower self-reported quality of life and social problems such as bullying and stigma.

Obesity prevalence is highest among the most deprived groups in society. Children in the most deprived areas of England are more than twice as likely to be living with obesity compared with those living in the least deprived areas. By the time children in the most deprived areas reach year 6 (age 10-11) 30.2% are obese, compared to 13.1% of children in the least deprived areas. Disparities in obesity in childhood is likely to worsen health outcomes and health inequalities in children from more deprived areas.

Obesity is a chronic condition so there is an expectation that people will need ongoing support over the long term, however the majority of Randomised Control Trials (RCTs) used fixed term interventions with very little support in the post intervention period. It is important to measure the effect of adding longer term support to weight management interventions to investigate whether health improvements can be maintained and changes to BMI sustained over a longer period.

For the purpose of this research, longer term interventions are those with a duration greater than six months, with follow up support lasting more than six months. Longer term support may include support from a registered dietitian or registered nutritionist, youth worker, school nurse, family support worker, local support group, online groups or networks, friends and family, free healthcare-endorsed apps, national programmes, charities, helplines, and community groups (such as local leisure services or sports clubs).

The Public Health Research (PHR) Programme wishes to commission research evaluating existing population level interventions delivered in non-NHS settings aimed at achieving and maintaining weight loss in children. We would encourage applicants to also review the remit of other NIHR programmes such as the NIHR Health Technology Assessment Programme and the Health and Social Care Delivery Research Programme to determine the best fit for their application.

The Programme is predominantly interested in the evaluation of interventions operating at a population rather than an individual level, and their impact on health inequalities and the wider determinants of health. We recognise that interventions are likely to impact different (sub)populations in different ways. Applicants should explain and justify their choice of (sub)population.  

Of particular importance to the PHR Programme is an understanding of inequalities in the impact of interventions on people from ethnic minority backgrounds and other vulnerable risk groups in the UK. Evaluations of interventions seeking to reduce health inequalities experienced by people from ethnic minority backgrounds are also of specific interest to the PHR Programme.

Suggested research areas of interest could include (but are not limited to) an evaluation of:

• the longer-term effectiveness (5 to 10 years) of behavioural overweight and obesity management programmes for children and young people
• interventions aimed at male children and young men
• effective behavioural overweight and obesity management programmes for children and young people with disabilities, learning difficulties or other special needs
• effective and cost-effective approaches to overweight and obesity management for children younger than six years, including the views of their parents and families
• how the barriers to, and facilitators for, participating in behavioural overweight and obesity management programmes vary according to socioeconomic group, ethnicity, gender and age
• evidence on the lifetime effects of overweight and obesity management programmes

A range of study designs and outcome measures can be used. Researchers will need to clearly justify the choice of and describe the population group targeted, as well as justify the most suitable methodological approach. Primary outcomes must be health related. Researchers are encouraged to consider other outcome measures that may be influential on policy makers as secondary outcome measures. All key outcome measures should be justified, and researchers need to specify how the outcomes will be measured in the medium and long term. It is recognised that the health outcome of interest may only be achieved later in the children’s lifecourse, and researchers will need to specify and justify any proxy health measures used. Cost-effectiveness and policy implications are always of interest to policy makers and the PHR Programme encourages researchers to consider including economic and policy considerations in their application.

Researchers are strongly encouraged to ensure that service users, including children with lived experience from the target population and their carers, if appropriate, are meaningfully involved in the design and planning of the intervention and/or as potential, suitably rewarded, members of the research team. Researchers should demonstrate the relevance of their proposed research to decision-makers and people with lived experiences and they might do this through involving them as costed/rewarded members of the research team. Researchers are encouraged to explain how they will share their findings with policy makers, public health officers, special interest groups, charities, community audiences and other relevant stakeholders. Researchers are expected to be aware of other studies in this area, development in practice and ensure their proposed research is complementary.

For further information on submitting an application to the PHR Programme, please refer to the supporting information for applicants submitting stage 1 and stage 2 applications. These can be found by clicking on the relevant commissioned call on the main funding opportunities page. This also includes closing dates and details about how to apply.