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Childhood obesity

Shared care does not reduce BMI in children

Shared care model of primary and tertiary care management did not lead to better body mass index or other outcomes

The 12 month outcomes from the 12 month outcomes of HopSCOTCH randomised clinical trial have reported that a shared approach to managing childhood obesity did not result in a better BMI or other outcomes for the intervention group compared with the control group.

The study assessed BMI reduction in children who either saw a specialist and dietician at a weight management clinic and were given an agreed care plan that included dietary, physical activity and family lifestyle changes (intervention group) or usual care (control group). The study results were published online in the BMJ.

“Although feasible, not harmful, and highly rated by both families and general practitioners, the shared care model of primary and tertiary care management did not lead to better body mass index or other outcomes for the intervention group compared with the control group,” the researchers concluded.

The trial, conducted by the Murdoch Childrens Research Institute, was designed to determine whether general practice surveillance for childhood obesity, followed by obesity management across primary and tertiary care settings using a shared care model, improved BMI and related outcomes in obese children aged 3-10 years.

Children’s BMI (primary outcome), body fat percentage, waist circumference, physical activity, quality of diet, health related quality of life, self-esteem, and body dissatisfaction and parents’ body mass index (all 15 months post-enrolment) were calculated.

From the 118 (60 intervention, 56 control) children recruited, 107 (91%) were retained and analysed (56 intervention, 51 control) after 12 months. All retained intervention children attended the tertiary appointment and their general practitioner for at least one (mean 3.5 (SD 2.5, range 1-11)) weight management consultation.

At outcome, children in the two trial arms had similar body mass index (adjusted mean difference −0.1 (95% confidence interval −0.7 to 0.5; p=0.7)) and body mass index z score (−0.05 (−0.14 to 0.03); p=0.2). There was no evidence was found of benefit or harm on any secondary outcome. Outcomes varied widely in the combined cohort (mean change in body mass index z score −0.20 (SD 0.25, range −0.97-0.47); 26% of children resolved from obese to overweight and 2% to normal weight.

“More intense shared-care approaches to managing childhood obesity might be effective, but increasing the intensity of the program would need significant IT and healthcare investment – that might prevent this approach from widespread dissemination,” said lead researcher Professor Melissa Wake. “We’re optimistic that childhood obesity can be overcome, just as smoking and traffic deaths have been steadily reduced over the last 30 years. But we have to keep looking for new solutions. Next we want to focus very hard on the 20% who lose a substantial amount of weight anyway. We don’t think this is purely from being observed in a trial.”

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