Childhood Obesity Clinical Trial
Official title:
A Feasibility Study of an Interactive, Educational Programme to Facilitate Proactive Assessment of Overweight Risk During Infancy
Children who are above healthy weight are more likely to be ill and to miss time off school.
Being overweight in childhood can also sow the seeds for health problems in later life such
as heart disease and diabetes. Most overweight children become overweight adults. One
solution is to try to prevent children becoming overweight by intervening very early in
life. The risk factors for childhood overweight are known and this project aims to
facilitate parents' (and other carers') understanding about this for their infant and to
enable them to access intervention. UK health visitors (public health nurses) will use an
interactive, multimedia programme (Proactive Assessment of Overweight Risk during infancy
(ProAsk)), with parents to calculate their infant's risk and to discuss strategies for risk
reduction as appropriate. Health visitors will be trained to communicate obesity risk and in
Motivational Interviewing techniques to enable them to offer intervention to parents of
infants identified as at risk.
A feasibility study of ProAsk will take place in two health provider organisations in the
UK. The purpose of this is to a) determine the acceptability and utility of the ProAsk
intervention with health visitors and parents and b) gather information to inform the trial
design and data collection procedures for a future Randomised Controlled Trial (RCT).
Globally, overweight and obesity is a significant public health issue affecting more than 40
million children under the age of five in 2011. There is broad agreement around the
aetiology of childhood overweight and obesity and risk factors have been identified
prenatally, during pregnancy and early infancy. Clearly, from the point of view of the
infant, risk factors that are present prenatally or during pregnancy are non-modifiable but
those identified during infancy are potentially modifiable. Between 25%-33% of infants gain
weight more rapidly than desirable during the first 6 months of life and this is the
strongest risk factor for childhood overweight at 3 years. Rapid weight gain is potentially
modifiable with interventions to facilitate better infant diet, feeding practices and
exposure to physical activity. To facilitate identification of infants that might be at
greater risk of developing childhood overweight and obesity a number of models have been
developed. The Infant Risk of Obesity Checklist (IROC) was developed by the research team
using data from the Millennium Cohort Study (MCS) and Avon Longitudinal Study of Parents and
Children (ALSPAC) to potentially screen infants at 4 months of age for risk factors for
childhood overweight and obesity at 3 years. However, it has not yet been tested in clinical
practice.
Concerns have been expressed about using tools developed from the epidemiological literature
to identify overweight and obesity risk where there are few effective evidence-based
interventions for those affected. There is evidence that complex interventions targeting
diet and feeding delivered to parents of infants <2 years old show some positive
intervention effects on feeding practices and physical activity, although many of these
interventions do not tackle the psycho-emotional aspects of feeding and are not underpinned
by behavioural change theory. The impact on weight outcomes is less certain, and in some
cases this may be due to intervention components and behaviour change techniques targeted at
the parent rather than infant level. Universal eligibility for overweight and obesity
prevention is costly and may be unnecessary for those with a low baseline risk. However,
targeting of certain groups where overweight and obesity is more prevalent (for example,
lower socio-economic status, minority ethnic groups) has raised concerns around
stigmatisation. Preliminary work with parents/legal guardians/carers suggests that targeting
may be appropriate provided the person conveying the information has appropriate knowledge
and sensitivity. his suggests a novel approach to such discussions is needed. Digital
technologies are being used to provide information to patients about health care related
areas. The findings of a recent review suggest that interactive multimedia programmes have
the capacity to facilitate communication between health professionals and patients, but
further research in this field is needed.
A pragmatic research design is planned with three linked phases. The first involved the
development of an interactive multimedia programme, namely ProActive Assessment of
Overweight Risk during Infancy (ProAsk) which includes the IROC and a therapeutic wheel, to
facilitate health professionals' discussions with parents/legal guardians/carers about
overweight risk and prevention during infancy. This phase is a feasibility study of the
ProAsk intervention with parents/legal guardians/carers and health professionals. The study
will gather information to inform the trial design and data collection procedures for a
Randomised Controlled Trial (RCT) of overweight risk identification and intervention during
infancy by UK health visiting teams.
The third phase will be conducted at the end of the feasibility trial .Qualitative work will
be undertaken to determine the acceptability and utility of ProAsk with the health
professionals working in a health visiting team and parents/legal guardians/carers.
;
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