Childhood obesity in England could be curbed with systematic interventions, study suggests

In a recent article published in The Lancet Public Health, researchers examined the potential effects of systematically delivering obesity management interventions on the prevalence of childhood obesity in England.

Study: Estimating the effects of preventive and weight-management interventions on the prevalence of childhood obesity in England: a modelling study. Image Credit: Eviart/Shutterstock.com

Background

Childhood obesity has become highly prevalent worldwide, including in the United Kingdom (UK). Stigmatization due to obesity hampers the well-being of young children, while its establishment in adulthood increases susceptibility to cardiovascular diseases and psychosocial comorbidities. 

Unfortunately, even clinical treatments for obesity are considered inappropriate or ineffective for young children. Thus, preventing and treating childhood obesity through weight management interventions remains a public health priority.

In England, there is a multi-tiered approach to obesity management, where

tier-1 (primary care), tier-2 (lifestyle), tier-3 (pharmaceutical), and tier-4 (surgical) typically encompass universal weight management services, lifestyle interventions, specialist services, and bariatric surgery, respectively.

Significant overlaps exist between intervention components; however, the targeting and eligibility criteria for each are distinct. 

About the study

Researchers thoroughly searched PubMed and Google Scholar from inception to June 6, 2022, to identify all studies published in English that explored the potential effects of systematically delivering preventive and weight-management interventions for all eligible children and young people aged 0–18.

They examined the effects of weight management interventions individually or in combination at a population level.

They found meta-analyses of trials evidencing that preventive and treatment interventions provided to individual children effectively reduced body weight. However, none of the studies from any country estimated the effects of systematically providing these interventions to all eligible children with childhood obesity.

Study design

For the current study, researchers used data from the Health Survey of England (HSE) to develop a cross-sectional simulation model nationally representative of the children and young adult population aged 2-18 in England. 

They merged data from each year of HSE, from January 1, 2010, to December 31, 2019, to create a model dataset that helped estimate who among these children and young adults were eligible for different tiers of intervention based on the UK National Institute of Health and Care Excellence (NICE) guidance.

Since HSE collects health-related data, the study dataset included body mass index (BMI), indices of multiple deprivation (IMD), and ethnicity data for all participating children and young adults. 

Modeling scenarios and outcomes

The study modeled six scenarios, of which four were single-tier, while two were systematic approaches of the tiers. In this way, the team estimated the effects of each tier of obesity management individually and then combined, either in a staged- or stepped-care approach.

The outcomes were the prevalence of clinical obesity defined as a BMI greater than or equal to the 98th centile on the UK90 growth chart and the difference in its prevalence compared to the baseline estimate for BMI Z score.

In the staged care approach, all children received the most intensive treatment they were eligible for. In contrast, in the stepped care approach, each tier was applied additively in sequence, from the lowest- to the highest cost and least- to more intensive treatments. The follow-up continued up to 12 months after the end of the intervention.

Statistical approaches

In this study, the researchers used Multiple Imputation by Chained Equations (MICE) to generate 100 datasets of all children and young people with data on age, zBMI, IMD quintiles, ethnicity, and the weighting variable and established effect estimates accounting for the uncertainty introduced due to missing data.

Likewise, simulated interventions helped estimate the change in population prevalence of obesity, including absolute and relative differences; however, these were applied randomly among eligible children and young people. They also computed uptake and completion rates.

In the two sensitivity analyses, the first varied uptake of interventions by socioeconomic status, and the second reduced uptake and completion rates by one-third from rates in randomized controlled trials.

Results

The analytical sample of this modeling study included 18,080 children and young people.

Clinical obesity (eligible for tiers one and two interventions) developed strongly in early childhood and was estimated to be 11·2% in all children and young people aged 2–18 years.

Along with obesity with comorbidity and severe obesity (eligible for tier three and tier four, respectively), clinical obesity was found to be more prevalent among males, older, and more socioeconomically deprived children, and young people who hailed from the northeastern and western regions of England.

The stepped-care approach resulted in an absolute reduction of 2.4% in obesity prevalence and a 21·4% relative reduction in obesity. Universal, community, and lifestyle interventions had the highest potential effect and reduced obesity prevalence by 0·9% and 1·0%, respectively.

Among the single-tier interventions, preventive interventions led to the greatest reductions in the prevalence of obesity for children and young people aged 10–13 years.

On the other hand, community and lifestyle interventions brought the highest absolute reductions in obesity prevalence among people aged 17–18 years and the highest relative reductions in children aged 2–5 years.

Furthermore, surgical interventions brought the greatest reductions in young people aged 17–18. Both stepped and staged approaches were most effective for adolescents aged 14–16.

In the first sensitivity analysis, inequalities in obesity prevalence marginally increased despite declines across all IMD quintiles.

In the second sensitivity analysis, the changes in most obesity compared with the original models were most prominent for systematic approaches, specifically, 0·8% for staged and 2% for stepped care.

Conclusions

Overall, the study data suggested that if obesity management interventions are delivered systematically, they could narrow the widening gap in obesity prevalence among the most and least deprived children and young adults if their uptake of these intervention is equal to children from other socioeconomic strata.

Conversely, even a 20% lower uptake by people from more deprived groups might widen inequities in obesity prevalence. 

Thus, investment in a scale-up approach to weight management is as critical as targeting systematic and structural drivers of obesity to potentially decrease the prevalence of obesity and inequities in children and young people.

Moreover, future work should consider incorporating digital weight-management programs, which are easier to scale and economical to deliver than conventional in-person programs.