Evaluating the transferability of a hospital-based childhood obesity clinic to primary care: a randomised controlled trial

Abstract

Research Abstract BackgroundThe Care Of Childhood Obesity (COCO) clinic at the Bristol Royal Hospital for Children (BRHC) uses a multidisciplinary approach comprising a consultant, dietitian, and exercise specialist. The clinic has demonstrated efficacy in managing children's weight but similar clinics are scarce in the UK. AimThis pilot randomised controlled trial (RCT) aimed to examine the feasibility of undertaking a fully powered RCT and to gauge whether the COCO model could be effective as a nurse-led clinic in primary care settings. Design and settingPatients were randomised to a hospital-based childhood obesity clinic or a nurse-led clinic in a primary care setting in south-west England. MethodChildren aged 5-16 years with a body mass index (BMI) ≥98th centile were referred by GPs to the consultant in charge of the COCO clinic at BRHC. Referred children were clinically screened for suitability and invited into the study. Consenting families were randomised to BRHC or a primary care clinic (PCC) and offered five appointments over 12 months. Clinical effectiveness was measured by change in body mass index standard deviation score (BMI SDS) at 12 months. Other measures included: treatment adherence, quality of life (QOL), and satisfaction. Feasibility was examined by assessing referral, screening, and recruitment data. ResultsA total 152 patients were referred by GPs: 31 (20%) were screened out; 45 (30%) declined to participate. Seventy-six (50%) patients were randomised and 68 provided baseline data (PCC = 42; BRHC = 26); 52 provided outcome data (PCC = 29; BRHC = 23). Mean change in BMI SDS was PCC -0.17 (95% confidence interval [CI] = -0.27 to -0.07); BRHC -0.15 (95% CI = -0.26 to -0.05). QOL, adherence, and satisfaction data indicated similar positive patterns in both trial arms. ConclusionScreening and recruitment data indicate that primary care is a clinically appropriate setting and acceptable to families. The primary clinical outcome measure (reduction in BMI SDS), along with secondary outcome measures, indicate that primary care has the potential to be effective in providing weight management for children, using the COCO model.

An Intensive Family Intervention Clinic for Reducing Childhood Obesity

“…6 The primary care setting provides the opportunity for interventions to reduce childhood obesity, such as those successfully reported in the United Kingdom, the United States, and Singapore. [7][8][9][10] There is moderate-to high-strength evidence that diet and/or physical activity interventions implemented in school settings help prevent weight gain or reduce the prevalence of overweight and obesity, as noted in a 2013 report from the American Agency for Health Research and Quality. 11 The generalizability of evidence of the effectiveness of interventions primarily implemented in other settings is largely unknown.…”

Obesity and chronic disease in younger people: an unfolding crisis

“…8 They report a proof of concept pilot study investigating whether a pragmatic evidence-based nurse-led childhood obesity clinic can be implemented in a primary care setting and achieve results that are consistent with those achieved in an established consultant-led pathway in secondary care. 8 Their study demonstrates that primary care can be used to engage effectively with, and manage, childhood obesity, which is important given that specialist secondary care centres are an unsustainable and inappropriate method of dealing with a mass disease.…”

“…8 They report a proof of concept pilot study investigating whether a pragmatic evidence-based nurse-led childhood obesity clinic can be implemented in a primary care setting and achieve results that are consistent with those achieved in an established consultant-led pathway in secondary care. 8 Their study demonstrates that primary care can be used to engage effectively with, and manage, childhood obesity, which is important given that specialist secondary care centres are an unsustainable and inappropriate method of dealing with a mass disease. However, as highlighted by Philips et al in this issue of BJGP, we also need to be aware that there is currently a lack of consistency, clarity, and message specificity when conducting dietary counselling in primary care; 9 a trend that is likely to be more pronounced in younger age groups given the increased complexity of the issues involved.…”

Confronting child obesity in primary care

“…Just under half (47%) of those who were sent invitation letters went on to consult their GP and only 15% of the total discussed issues of weight at the resulting consultation. 7 There is little systematic weight assessment of children in primary care, so such recognition by GPs relies on opportunistic efforts during health contacts initiated by parents for other conditions. But doctors regularly miss opportunities to discuss weight problems in around 40% of overweight patients.…”

“…Behind this lack of awareness were a number of factors, from the familiar lack of time and competing demands, to a lack of faith in primary care as an appropriate setting. 7 Other issues such as a concern for promoting a medical model of disease for an issue which is argued by many to be a social problem rather than the responsibility of the medical establishment were also raised.…”