What do we want to know?
In the UK in 2015/16 one in five children aged 4 to 5-years, and one in three children aged 10 to 11-years, were found to be obese or overweight. Many systematic reviews have shown that lifestyle weight management programmes (LWMPs) which address diet, physical activity and behaviour change can be effective in helping children to become less overweight. However, there is a lack of more fine-grained information about the critical features of successful programmes. More information is also needed about the nature of current provision within local authorities in the UK.
Who wants to know?
This systematic review was commissioned by Public Health England. The aim was to help decision-makers, such as service commissioners and providers in Local Authorities in the UK, determine which kinds of LWMPs for children aged 0-11 years they should be providing. The novel systematic review methods used will be of interest to researchers examining complex interventions.
What did we find?
Research on the views of children, parents and programme providers from the UK revealed that three key LWMP features were felt to be vital for successful weight management. These three features were described as helping families develop the skills, confidence and resilience perceived as critical for successful weight management. The three features were:
- Practical experiences, which were exemplified by showing participants how to change, rather than just telling them what to change.
- Family involvement, which was exemplified by creating a shared understanding across different family members and a healthy home environment; and
- Social support, which was exemplified by creating a safe space in which to gain confidence and skills.
Examination of 20 rigorous service evaluations revealed that the features identified as important by children, parents and providers were present in the most effective LWMPs (i.e. those achieving clinically significant improvements in children’s weight) and absent in the least effective LWMPs.
Case studies with local authority LWMP commissioners and providers revealed that their experiences resonated with the findings on two key mechanisms (showing families how to change, and getting all family members ‘on board’) but discussion with one authority revealed how delivery of group programmes may be a challenge for authorities in rural areas, such that creative approaches to enable social support may be needed.
Public Health England have published the full report of the findings here: https://www.gov.uk/government/publications/child-weight-management-services-systematic-review
What are the conclusions?
The three key mechanisms perceived by children, parents and providers to support health behaviour change were shown to be associated with the most successful interventions that we examined and not with the least successful interventions. Thus we conclude that future service provision should aim to ensure that families are not just told what to change but shown how to change, that the whole family is on board with the programme, and that there are opportunities for parents and children to receive social support.
How did we get these results?
This systematic review involved a comprehensive review of the literature to identify the critical features of weight management programmes (LWMPs) for children.
The review comprised of three stages:
- Analysis of children’s, parents’ and service providers’ views: In the first stage, we sought to understand which weight management programme features are perceived as key to successful weight loss and the mechanisms through which these features are perceived to lead to successful weight loss according to those with direct experience of services. We examined studies reporting the views of families and providers in the UK who had used or delivered weight management programmes.
- Analysis of service evaluations: In the second stage, we sought to test whether features perceived to be important are actually associated with improved weight in children; we examined the presence or absence of identified features in LWMPs for children evaluated in randomised controlled trials (RCTs). We identified 20 rigorously evaluated interventions and compared the features of the most effective LWMPs (i.e. those achieving clinically significant improvements in weight n=5) with the least effective ones (i.e. those with minimal or no improvements in weight n=15).
- Case studies with local authorities: In the third stage of the review we aimed to ensure that the findings of the review could be put to best use by local authorities; thus we engaged with service commissioners and providers in two local authorities to explore the nature of current weight management provision and to consider the implications of the review findings for future provision.
This report should be cited as:
Sutcliffe K, Burchett H, Rees R, Stansfield C, Thomas J (2016), What are the critical features of successful Tier 2 lifestyle weight management programmes for children aged 0-11 years? A systematic review to identify the programme characteristics, and combinations of characteristics, that are associated with successful outcomes. London: EPPI Centre, Social Science Research Unit, Institute of Education, University College London.