Barriers and facilitators of a community-based childhood weight management programme

To explore the barriers and facilitators experienced by those implementing a government-funded, community-based childhood weight management programme | BMJ Open

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Image source: Jixuan Zhou – Flickr // CC BY-NC-SA 2.0

Results: Most barriers occurred at the level of the organisational context. For all stakeholders, barriers arose due to the multidisciplinary nature of the programme, including the lack of role clarity and added complexity of working in different locations. Health professionals’ low-perceived self-efficacy in approaching the subject of weight with parents and parental resistance to hearing about their child’s weight status were barriers to programme implementation at the individual professional and patient levels, respectively. The main facilitators of implementation, occurring at the level of the health professional, included stakeholders’ recognition of the need for a weight management programme and personal interest in the area of childhood obesity. Having a local lead and supportive colleagues were further implementation drivers.

Conclusions: This study highlights the complexities associated with implementing a multidisciplinary childhood weight management programme, particularly translating such a programme to a community setting. Our results suggest the assignment of clear roles and responsibilities, the provision of sufficient practical training and resources, and organisational support play pivotal roles in overcoming barriers to change. This evidence can be used to develop an implementation plan to support the translation of interventions into real-world settings.

Full reference: Kelleher, E. et al (2017) Barriers and facilitators to the implementation of a community-based, multidisciplinary, family-focused childhood weight management programme in Ireland: a qualitative study. BMJ Open. 7:e016459.

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Weight management services – why are they important?

Obesity is caused by a complex set of personal, social and environmental factors. It can come with a number of associated health consequences, all of which can have a huge impact on the individual, as well as the people around them | Public Health Matters Blog

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But what impact does obesity have on our local population as a whole, and what part can local services play in addressing this issue?

PHE’s ‘Guide to Delivering and Commissioning Tier 2 Adult Weight Management Services’ supports local authorities, clinical commissioning groups and providers to develop and deliver weight management services that can help individuals achieve a healthier weight, while potentially contributing towards healthier communities.

Our guide, co-badged by NICE, LGA, ADPH and RCP, helps make the case for evidence-based services that are effective and accessible for users.

Some healthcare professionals are not comfortable discussing weight with patients, while others may doubt the efficacy of such services, meaning some patients might be missing out.

Our guide will help professionals engage with people across the obesity pathway, to ensure those referring into the service and those eligible to access services get all the support and information they need.

Read the full blog post here

National child measurement programme operational guidance

Guidance for local commissioners, providers and schools on running the national child measurement programme (NCMP) as part of the government’s commitment to tackling the public health challenge of excess weight.

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The publication of the Childhood Obesity Plan: A Plan for Action, in August 2016 shows that tackling child obesity is a priority for the Government. The plan aims to significantly reduce England’s rate of childhood obesity within the next ten years. Most local authorities have also identified addressing childhood obesity as a key issue in their health and wellbeing strategies, and reducing obesity is prioritised in many Sustainability and Transformation Plans.

The NCMP is key to monitoring the progress of the Government’s Childhood Obesity Plan. It provides the data for the Public Health Outcomes Framework indicators on “excess weight in children aged four to five years and ten to 11 years.” Because the data is valid at local level, it can also be used to inform the development and monitoring of local childhood obesity strategies.

National child measurement programme operational guidance

National child measurement programme: information for schools

Adult weight management

Public Health England has published guidance to support the commissioning and delivery of tier 2 adult weight management services.

This guidance supports commissioners and providers of tier 2 adult weight management services, including:

  • local authorities (LAs)
  • clinical commissioning groups (CCGs)
  • NHS institutions

The guidance is published under the following categories: following categories:

Commission and provide

Adult weight management services: commission and provide

Weight management services: insights into user experiences

Interventions

Data collection

Supported web-based programme helps people lose weight in the short term

A web-based programme (POWeR) with nurse support helped about 30% of people lose at least 5% of their body weight, maintained for at least 12 months. By comparison, twenty percent of people achieved this with an online information sheet only.  | National Institute for Health Research (NIHR)

weights-1501439_1920POWer+ helped more people achieve short-term weight loss but the average weight loss of about 3-4 kg after 12 months was statistically similar for those given information only. The healthy eating online materials tested had previously been shown to help people to control their weight, without expert advice.

This NIHR research showed that the web programme, with phone or email support from nurses, had a modest benefit and was probably cost-effective.  It represents one option that could be offered to patients.

Full reference: Little P, Stuart B, Hobbs FR, et al. Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (PositiveOnline Weight Reduction). Health Technol Assess. 2017;21(4):1-62.

Community weight loss programmes should be more widely available

Community weight loss programmes, such as Weight Watchers, are effective at helping people to lose weight, according to research published in The Lancet.

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A study published in this weeks issue of The Lancet  found that a three-month weight loss programme helps people lose weight, but a one-year programme helps people lose more weight for longer and reduces their risk of developing type 2 diabetes. The paper suggests that wider availability of these programmes could help people avoid metabolic diseases, such as diabetes, and may save the NHS money in the long run.

In the study the authors compared the effectiveness and cost-effectiveness of three treatment options: referral to Weight Watchers for three months, referral to Weight Watchers for one year, and a brief intervention (one-off advice together with a self-help booklet).

1,267 overweight or obese adults from 23 GP clinics across the UK were recruited and randomly allocated to one of the three interventions. Over a two-year follow-up, those who were referred to Weight Watchers lost more weight than those who were in the self-help group. And those in the one-year programme lost more weight than those in the three-month programme.

At two years, all groups had regained some of the weight, but those given a year-long programme were still lighter than the other groups.

Full reference: Ahern, A.L. et al. Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial. The Lancet. Published online 03 May 2017

Health matters: obesity and the food environment

This resource outlines how councils and partners can help small food outlets and schools offer healthier food to reduce obesity levels | Public Health England

Nearly two-thirds of adults (63%) in England were classed as being overweight or obese in 2015.  In England, the proportion who were categorised as obese increased from 13.2% of men in 1993 to 26.9% in 2015 and from 16.4% of women in 1993 to 26.8% in 2015. The rate of increase has slowed down since 2001, although the trend is still upwards.

In 2015 to 2016, 19.8% of children aged 10 to 11 were obese and a further 14.3% were overweight. Of children aged 4 to 5, 9.3% were obese and another 12.8% were overweight. This means a third of 10 to 11 year olds and over a fifth of 4 to 5 year olds were overweight or obese.  In summary, nearly a third of children aged 2 to 15 are overweight or obese and younger generations are becoming obese at earlier ages and staying obese for longer.

Health matters: obesity and the food environment covers the following:

Scale of the obesity problem

Factors behind the rise in obesity levels

Improving everyone’s access to healthier food choices

How local authorities can help businesses offer healthier food and drink

National policies to tackle obesity

Call to action

5 Local food

Image source: http://www.gov.uk