Guideline for UK midwives/health visitors to use with parents of infants at risk of developing childhood overweight/obesity

A guideline for members of the health visiting team to use with parents of infants at risk of overweight/obesity has been developed. The guideline contains recommendations about identification of infants at risk as well as a number of strategies that could be used for prevention of overweight/obesity. The guideline needs to be applied alongside health visitors’ professional judgement. It is not intended to replace normal UK clinical practice which is guided by the Healthy Child Programme and complements existing guidance such as the Framework for Action for tackling obesity

Development of an evidence-based practice guideline for UK public health nurses (health visitors) to use with parents of infants at risk of obesity

Introduction: Evidence about effective interventions that reduce obesity risk during infancy is needed. This project aimed to systematically review published Randomised Controlled Trials (RCTs) of behavioural and non-behavioural interventions which address potential risk factors for obesity to inform a guideline for UK health visitors. Methods: A multiprofessional Guideline Development Group (GDG) was convened to undertake a systematic review, based on the National Institute for Health and Clinical Excellence (NICE) guidelines. Findings from the review were used to develop a guideline which was subsequently externally reviewed by national experts and practitioners. Results: We identified 28 RCTs reporting behavioural and non-behavioural interventions delivered during infancy with breastfeeding and/or weight outcomes measured during the first two years of life. A number of on-going studies were also identified. Inclusion criteria for intervention studies included parental breastfeeding intentions and first time parents. Good evidence exists for breastfeeding promotion and support interventions. Evidence exists for parental education around responsive feeding, aspects of infant diet and soothing/sleep expectations. These behavioural components informed the guideline. Despite good evidence that infants fed lower protein formula milk gained less weight compared to milk with higher protein levels, it was not possible to incorporate the evidence from the non-behavioural studies into the guideline. Conclusion: Further research is needed to establish clinically effective interventions for obesity prevention during infancy. Continuous dialogue between commissioners, policy makers, health visitors and parents is essential to ensure existing UK policies are not a barrier to implementing obesity prevention strategies in the first year of life

Validation, optimal threshold determination, and clinical utility of the Infant Risk of Overweight Checklist (IROC) for early prevention of child overweight

Background: Previous research has demonstrated the predictive validity of the Infant Risk of Overweight Checklist (IROC). This study further establishes the predictive accuracy of the IROC using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and examines the optimal threshold for determining high risk of childhood overweight. Methods: Using the IROC algorithm, we calculated the risk of being overweight, based on International Obesity Task Force (IOTF) criteria, in the first year of life for 980 children in the ALSPAC cohort at 5 years. Discrimination was assessed by the area under the receiver operating curve (AUC c¬¬-statistic). Net reclassification index (NRI) was calculated for risk thresholds ranging from 2.5% to 30% which determine cut-offs for identifying infants at risk of becoming overweight. Results: At five years of age, 12.3% of boys and 19.6% of girls were categorised overweight. Discrimination (AUC c-statistic) ranged from 0.67 (95% CI 0.62 – 0.72) when risk scores were calculated directly to 0.93 (95% CI 0.88 – 0.98) when the algorithm was recalibrated and missing values of the risk factor algorithm were imputed. The NRI showed there were positive gains in reclassification using risk thresholds from 5% to 20%, with the maximum NRI being at 10%. Conclusions: This study confirms the IROC has moderately good validity for assessing overweight risk in infants and offers an optimal threshold for determining high risk. The IROC algorithm has been imbedded into a computer programme for Proactive Assessment of Obesity Risk during Infancy (ProAsk) which facilitates early overweight prevention through communication of risk to parents. http://online.liebertpub.com/doi/full/10.1089/chi.2015.024

Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non-behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non-behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self-reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research

Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non-behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non-behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self-reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research

Early years' prevention of childhood obesity: the challenges facing UK health visitors

Objectives A number of modifiable risk factors are associated with the development of childhood obesity. These are lower breast feeding duration, early weaning onto solid foods, parental response to infant temperament and parental control over food intake. This study explored parents’ beliefs concerning their infant’s size and growth and their receptiveness to intervention aimed at reducing the risk of childhood obesity. Method Six focus groups were undertaken in a range of different demographic areas, with parents of infants less than one year old. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis using an interpretative, inductive approach. Results 38 parents (n=36 female, n=2 male), age range 19-45 years (mean 30.1 years, SD 6.28) participated in the focus groups. Half the sample were overweight (n=12) or obese (n=8). Five main themes were identified. These were a) rationalisation for infant’s larger size, b) parents’ understanding of breastfed infants’ growth and age-related behaviour; c) parents’ understanding of infant growth, developmental norms and feeding practices, d) belief that nothing can be done about overweight/obese infants and e) intentions and behaviour in relation to a healthy diet. Conclusions Some risk factors for childhood obesity are potentially modifiable. Parents are receptive to prevention prior to weaning and need better support with best practice in infant feeding. This should focus on helping them understand the physiology of breast feeding, the rationale around weaning at 6 months and how to recognise that hunger is only one explanation for infant distress and behaviour change

Evaluating the effectiveness of a schools-based programme to promote exercise self-efficacy in children and young people with risk factors for obesity: Steps to active kids (STAK)

BackgroundLow levels of physical activity in children have been linked to an increased risk of obesity, but many children lack confidence in relation to exercise (exercise self-efficacy). Factors which can impact on confidence include a chronic health condition such as asthma, poor motor skills and being overweight. Increasing levels of physical activity have obvious benefits for children with asthma and children who are overweight, but few activity interventions with children specifically target children with low exercise self-efficacy (ESE). This study aims to evaluate the efficacy and feasibility of a schools-based activity programme suitable for children with risk factors for adult obesity, including asthma, overweight and low exercise self-efficacy. Methods/DesignA clustered (at the level of school) RCT will be used to compare a targeted, 10 week, stepped activity programme (activity diary, dance DVD, circuit-training and motivational interviewing) designed to promote ESE. We will recruit 20 primary schools to participate in the intervention and 9-11 year old children will be screened for low levels of ESE, asthma and overweight. In order to provide sufficient power to detect a difference in primary outcomes (Body Mass Index-BMI & ESE at 12 month follow-up) between children in the intervention schools and control schools, the target sample size is 396. Assessments of BMI, ESE, waist circumference, peak flow, activity levels and emotional and behavioural difficulties will be made at baseline, 4 months and 12 month follow-up. DiscussionWe aim to increase ESE and levels of physical activity in children with risk factors for adult obesity. The outcomes of this study will inform policy makers about the feasibility, acceptability and effectiveness of delivering targeted health interventions within a school setting. © 2011 Glazebrook et al; licensee BioMed Central Ltd

Evaluating the effectiveness of a schools-based programme to promote exercise self-efficacy in children and young people with risk factors for obesity: Steps to active kids (STAK)

BackgroundLow levels of physical activity in children have been linked to an increased risk of obesity, but many children lack confidence in relation to exercise (exercise self-efficacy). Factors which can impact on confidence include a chronic health condition such as asthma, poor motor skills and being overweight. Increasing levels of physical activity have obvious benefits for children with asthma and children who are overweight, but few activity interventions with children specifically target children with low exercise self-efficacy (ESE). This study aims to evaluate the efficacy and feasibility of a schools-based activity programme suitable for children with risk factors for adult obesity, including asthma, overweight and low exercise self-efficacy. Methods/DesignA clustered (at the level of school) RCT will be used to compare a targeted, 10 week, stepped activity programme (activity diary, dance DVD, circuit-training and motivational interviewing) designed to promote ESE. We will recruit 20 primary schools to participate in the intervention and 9-11 year old children will be screened for low levels of ESE, asthma and overweight. In order to provide sufficient power to detect a difference in primary outcomes (Body Mass Index-BMI & ESE at 12 month follow-up) between children in the intervention schools and control schools, the target sample size is 396. Assessments of BMI, ESE, waist circumference, peak flow, activity levels and emotional and behavioural difficulties will be made at baseline, 4 months and 12 month follow-up. DiscussionWe aim to increase ESE and levels of physical activity in children with risk factors for adult obesity. The outcomes of this study will inform policy makers about the feasibility, acceptability and effectiveness of delivering targeted health interventions within a school setting. © 2011 Glazebrook et al; licensee BioMed Central Ltd

Using interactive digital technology to predict and prevent childhood overweight

Special Issue: 27th congress of the European Childhood Obesity Group, ECOG abstracts in 2017, 15–17 November 2017, Rome, Ital

Evaluating the effectiveness of a schools-based programme to promote exercise self-efficacy in children and young people with risk factors for obesity: Steps to active kids (STAK)

<p>Abstract</p> <p>Background</p> <p>Low levels of physical activity in children have been linked to an increased risk of obesity, but many children lack confidence in relation to exercise (exercise self-efficacy). Factors which can impact on confidence include a chronic health condition such as asthma, poor motor skills and being overweight. Increasing levels of physical activity have obvious benefits for children with asthma and children who are overweight, but few activity interventions with children specifically target children with low exercise self-efficacy (ESE). This study aims to evaluate the efficacy and feasibility of a schools-based activity programme suitable for children with risk factors for adult obesity, including asthma, overweight and low exercise self-efficacy.</p> <p>Methods/Design</p> <p>A clustered (at the level of school) RCT will be used to compare a targeted, 10 week, stepped activity programme (activity diary, dance DVD, circuit-training and motivational interviewing) designed to promote ESE. We will recruit 20 primary schools to participate in the intervention and 9-11 year old children will be screened for low levels of ESE, asthma and overweight. In order to provide sufficient power to detect a difference in primary outcomes (Body Mass Index-BMI & ESE at 12 month follow-up) between children in the intervention schools and control schools, the target sample size is 396. Assessments of BMI, ESE, waist circumference, peak flow, activity levels and emotional and behavioural difficulties will be made at baseline, 4 months and 12 month follow-up.</p> <p>Discussion</p> <p>We aim to increase ESE and levels of physical activity in children with risk factors for adult obesity. The outcomes of this study will inform policy makers about the feasibility, acceptability and effectiveness of delivering targeted health interventions within a school setting.</p> <p>Trial Registration</p> <p>ISRCTN Register no. <a href="http://www.controlled-trials.com/ISRCTN12650001">ISRCTN12650001</a></p