Background

Both internationally and in the UK, there is widespread concern about rising rates of overweight and obesity and the consequences of this for individuals, for population health and for the wider society. This concern is not yet matched by either a clear map of interventions provided for children and young people or a robust evidence base on the effectiveness of interventions. The potential range of such interventions is very wide, with sound evaluation facing both methodological and practical challenges.

The chronology which follows demonstrates the policy interest in childhood overweight and obesity in the UK over the last few years.

In 2004, the UK government identified obesity as a policy priority and set targets to halt the year-on-year rise in childhood obesity by 2010 (HM Treasury 2004).

In 2006 the National Institute for Health and Clinical Excellence (NICE) published guidelines on the prevention, identification, assessment and management of overweight and obesity in adults and children. These guidelines contain recommendations for the public, the NHS, local authorities (LAs) and partners in the community, which can be put into practice in early-years settings, schools and workplaces, and in self-help, commercial and community programmes. Some of the recommendations are at a strategic level, while others are at delivery level. The types of factors and interventions covered range from individual to environmental and structural levels (NICE Public Health Collaborating Centre 2006).

In 2008, the government established the Cross-Government Obesity Unit, jointly led by the Department of Health (DH) and the Department for Children, Schools and Families (DCSF), and published guidance for local areas on tackling obesity and achieving healthy weight in the population (Cross-Government Obesity Unit et al. 2008). The guidance is aimed at Primary Care Trust (PCT) and local authority (LA) managers, and frontline staff including health visitors, planners, teachers and GPs. It suggests ways in which local partners can develop plans, set local goals and choose interventions. The guidance highlights other public policy priorities that may share goals with healthy weight policies, and encourages a multi-agency approach between PCTs, LAs and partners in the private and third sectors. Agencies are encouraged to focus on the whole family, adopt an early identification and intervention approach to children at high risk of unhealthy weight, and use a broad range of targeted, population-level and structural interventions for healthy eating and physical activity to address the issue.

A number of reviews on obesity and overweight were conducted between 2003 and 2006. NICE published an evidence briefing for its guidelines on obesity and overweight using review-level evidence, and Summerbell and colleagues published two Cochrane reviews investigating the prevention and treatment of obesity and overweight in children using primary evidence (NICE Public Health Collaborating Centre 2003, Summerbell et al. 2003, Summerbell et al. 2005). All three reviews focus on lifestyle and behavioural interventions to prevent and treat obesity and overweight.

In addition to these, the UK Government’s Foresight team recently published a report based on a series of evidence reviews which investigated the obesogenic environment, lifestyle changes and international comparisons of obesity trends and determinants (Butland et al. 2007).

Once a social or health phenomenon has been identified as a problem and is targeted for intervention, it is common for a great deal of activity to be initiated and for projects to proliferate on the ground. Policy and funding drivers have led to a growth in the number of local schemes set up to address overweight and obesity.

This is the background against which we were asked by the Department of Health to start to map interventions.  This report and associated database provide a summary of ongoing and recent activity. Ethics approval was provided through the Institute of Education, University of London.

 Summary

• The government has identified obesity as a priority, and there is considerable policy interest in the UK and internationally in tackling the problem of overweight and obesity in children and young people. However, assembling a picture of activity in this area has been problematic.
• This report and the associated searchable database summarise those schemes in England for which we were able to obtain data. In order to be included in the database, schemes needed a primary focus on tackling overweight or obesity in school-age children (4-18 years) who were already overweight or obese, through dietary, exercise or other means. Included interventions had to be structured and sustained over a period of time.
• Priority questions were identified with officials from the Cross-Government Obesity Unit and information about schemes meeting our inclusion criteria was collected. This included data on the content and running of the scheme, as well as what monitoring or evaluation had taken place. Evaluation reports were requested, where applicable.
• Data were collected using web searches and an online survey was posted on relevant JISCmail mailing lists. Contact was made with obesity leads and those running schemes via email, telephone, and face to face.
• Some of the schemes aimed at tackling childhood obesity are small, local ones but others run at a number of sites across the country. Our best estimate on the basis of data retrieved is that at any one time, between 314 and 375 schemes meeting our criteria are running in England.
• This report is one of the first outputs from a review series on childhood obesity currently being undertaken by the EPPI Centre as part of a larger programme of work on health promotion and public health reviews funded by the Department of Health, England. The map of schemes described in this report was undertaken alongside a map of review-level evidence on the effectiveness of social and environmental interventions for childhood obesity (Woodman et al. 2008). The next report, due for publication in 2009, will describe a systematic review of research on children’s views relating to obesity (see Rees et al. 2008 for the protocol). 

The EPPI Centre reference number for this report is 1607.

This report should be cited as: Aicken C, Arai L, Roberts H (2008) Schemes to promote healthy weight among obese and overweight children in England. Report. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London.