National consensus to develop core outcomes for the evaluation of complications from excess weight (CEW) clinics: results of a national Delphi process.

OBJECTIVE: In 2021, centres across all seven NHS-England regions were selected to develop pilot clinics with the aim of treating children and young people (CYP) living with complications relating to excess weight (CEW). We led a process to develop core outcomes to enable the evaluation of these clinics. METHODS: A two-round Delphi process, virtual steering group meetings and two patient representation workshops were used to agree the most important outcomes for both clinicians/allied professionals and representative prospective service users. RESULTS: A total of 119 clinicians/allied professionals were invited to contribute to the Delphi process: 62 (52%) agreed and completed round 1 and 47 of these (76%) went on to complete round 2. Six young people (age range 13-17 years) and six parents were involved in two patient representation workshops and their experiences fed into virtual steering group meetings, via a representative.There were 44 outcomes assessed in round 1 and 21 outcomes assessed in round 2. There were 16 core outcomes selected: anthropometric, glucose tolerance/insulin resistance/type 2 diabetes, blood pressure, lipid profile, breathing problems, identification of aetiology, non-alcoholic fatty liver disease, idiopathic intracranial hypertension, anxiety, depression, self-esteem, quality of life, school attendance, dietary habits including disordered eating, exercise and activity habits. CONCLUSIONS: Use of an online Delphi process, patient representation workshops and virtual steering group meetings has enabled the development of core outcomes for clinical obesity services with eight physical health, five mental health and three self-management outcomes. Further work is needed to develop outcome measures to complete a core outcome set. These will be used to guide the evaluation of novel regional clinics for the treatment of complications of excess weight.

Successful outcomes in childrens specialist weight management: Impact assessment of a novel early years weight management programme.

BACKGROUND: In the UK, more than one in five children are overweight on starting school. An elevated body mass index (BMI) in childhood increases the likelihood of developing many health and social issues. The Lifestyles, Eating and Activity for Families (LEAF) programme is a weight management service for clinically obese children under the age of 7 years and their families. This study evaluates the effectiveness of the LEAF programme by measuring BMI z-score change, the reduction in calorific beverage consumption and user satisfaction. METHODS: Data were collected over 6 years from 2012 and children who met the local weight management pathway criteria were recruited. Contact time was typically 20 h over 12 months and included home and clinic-based assessment by the multidisciplinary team and community-based intervention through six group sessions. This study compared baseline and post-intervention BMI z-scores (zBMI) for 65 children, as well as daily total calorific intakes from beverages for 41 children, and, in addition, 20 parents completed user satisfaction questionnaires. RESULTS: There was a highly significant reduction in both mean zBMI (0.5; p < 0.001) and mean total calories from beverages (199; p < 0.001) across the intervention period. There was no significant correlation between zBMI and beverage calorific trends. Families who completed user satisfaction questionnaires reported that they had changed their dietary habits and 90% would recommend the programme to others. CONCLUSIONS: This initial evaluation indicates that the LEAF programme was effective in reducing the zBMI of a group of clinically obese young children. Keywords obesity epidemic, young children, intervention, multidisciplinary.