Background: The WATCH IT programme was developed to address the needs of obese children from disadvantaged communities in Leeds and has been running since January 2004. Results of the pilot phase, prior to a randomised controlled trial, are presented. Methods: A process evaluation to assess success of implementation was conducted in December 2004. User views (parent and child) were obtained by semi-structured interviews and focus groups. Change in BMI SD score was calculated for children attending between January 2004 and November 2005. Results: A total of 94 children (49 girls, 45 boys), mean age (SD) 12.2 (2.0) years attended. They were moderately to severely obese (mean BMI SDS 3.09 (0.45), with low quality of life and self-image scores. There was a significant reduction in overweight at 6 months (DBMI SD 20.07), especially for teenagers (DBMI SD 20.13) and girls (DBMI SD 20.07). The programme was successfully implemented. By December 2004 mean attendance was 2.1 (0.7) clinics per month, and sports sessions 3.3 (1.7) sessions per month. Fourteen children dropped out and non-attendance was low (only 7.5% sessions missed in 12 months). Qualitative research indicated significant appreciation of the service, with reported increase in self-confidence and friendships, and reduction in self-harm. Conclusion: WATCH IT offers a model for a community based service for obese children. The programme suggests that effective care can be delivered by health trainers supervised by health professionals, and so potentially provides a cost effective programme within children's communities. These findings are encouraging, and need to be substantiated by extension to other locations and evaluation by randomised controlled trial.

Waist circumference is a measure of potential value in paediatrics, given its relation to cardiovascular risk in adults. However, three different methods of measurement are currently in use, giving potential for confusion. This study was undertaken to assess consistency across the measures in a population of overweight and normal weight children. We found that when expressed as standard deviation score (SDS) on the British 1990 reference, all three methods correlated highly with body mass index standard deviation score (BMI SDS); however, there was bias and variability between the measures. Based on ease of measurement, the site 4 cm above the umbilicus was the most convenient. This method was also endorsed by children's views. We therefore recommend that 4 cm above the umbilicus is adopted for clinical use until such time as the methods are verified against the gold standard of visceral fat, as measured by magnetic resonance imaging scan.

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SummaryThe risk of accidental over-dosing of obese children poses challenges to anaesthetists during dose calculations for drugs with serious side-effects, such as analgesics. For many drugs, dosing scalars such as ideal body weight and lean body mass are recommended instead of total body weight during weight-based dose calculations. However, the complex current methods of obtaining these dosing scalars are impractical in the peri-operative setting. Arbitrary dose adjustments and guesswork are, unfortunately, tempting solutions for the time-pressured anaesthetist. The study's aim was to develop and validate an accurate, convenient alternative. A nomogram was created and its performance compared with the standard calculation method by volunteers using measurements from 108 obese children. The nomogram was as accurate (bias 0.12 kg vs À0.41 kg, respectively, p = 0.4), faster (mean (SD) time taken 2.8 (1.0) min (vs 3.3 (0.9) min respectively, p = 0.003) and less likely to result in mistakes (significant errors 3% vs 19%, respectively, p = 0.001). We present a system that simplifies estimation of ideal body weight and lean body mass in obese children, providing foundations for safer drug dose calculation.

Novice anaesthetists should be given explicit instructions on correct trolley height and should be taught to intubate with a straight back.

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Novice anaesthetists should be given explicit instructions on correct trolley height and should be taught to intubate with a straight back.

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