Objective To assess if a school based intervention was effective in reducing risk factors for obesity. Design Group randomised controlled trial. Setting 10 primary schools in Leeds. Participants 634 children aged 7-11 years. Intervention Teacher training, modification of school meals, and the development of school action plans targeting the curriculum, physical education, tuck shops, and playground activities. Main outcome measures Body mass index, diet, physical activity, and psychological state. Results Vegetable consumption by 24 hour recall was higher in children in the intervention group than the control group (weighted mean difference 0.3 portions/day, 95% confidence interval 0.2 to 0.4), representing a difference equivalent to 50% of baseline consumption. Fruit consumption was lower in obese children in the intervention group ( − 1.0, − 1.8 to − 0.2) than those in the control group. The three day diary showed higher consumption of high sugar foods (0.8, 0.1 to 1.6)) among overweight children in the intervention group than the control group. Sedentary behaviour was higher in overweight children in the intervention group (0.3, 0.0 to 0.7). Global self worth was higher in obese children in the intervention group (0.3, 0.3 to 0.6). There was no difference in body mass index, other psychological measures, or dieting behaviour between the groups. Focus groups indicated higher levels of self reported behaviour change, understanding, and knowledge among children who had received the intervention. Conclusion Although it was successful in producing changes at school level, the programme had little effect on children's behaviour other than a modest increase in consumption of vegetables.

In March 2004 a group of 65 physicians and other health professionals representing nine countries on four continents convened in Israel to discuss the widespread public health crisis in childhood obesity. Their aim was to explore the available evidence and develop a consensus on the way forward. The process was rigorous, although time and resources did not permit the development of formal evidence-based guidelines. In the months before meeting, participants were allocated to seven groups covering prevalence, causes, risks, prevention, diagnosis, treatment, and psychology. Through electronic communication each group selected the key issues for their area, searched the literature, and developed a draft document. Over the 3-d meeting, these papers were debated and finalized by each group before presenting to the full group for further discussion and agreement. In developing a consensus statement, this international group has presented the evidence, developed recommendations, and provided a platform aimed toward future corrective action and ongoing debate in the international community.

Background: The alarming increase in the worldwide prevalence of childhood obesity is now recognised as a major public health concern. Failure to isolate and understand the external and internal factors contributing to successful weight loss may well be contributing to the ineffectiveness of current treatment interventions. Aim: To identify the physical and psychological levers and barriers to weight loss experienced by obese children using qualitative techniques. Methods: 20 participants were randomly selected from a population of clinically obese children (7-15 years old) attending a weight-loss clinic for .3 months. The children expressed their opinions in a series of interviews and focus group sessions. Data were recorded, semitranscribed and analysed using the thematic framework analysis technique and behavioural-change models. Results: Children described the humiliation of social torment and exclusion as the main reasons for wanting to lose weight, although initiation of behavioural change required the active intervention of a role model. The continuation of action was deemed improbable without continual emotional support offered at an individual level. Behavioural sacrifice, delayed parental recognition and previous negative experiences of weight loss were recognised as barriers to action. Participants identified shortcomings in their own physical abilities, the extended time period required to lose weight and external restrictions beyond their control as barriers to maintaining behavioural change. Discussion: This study identifies the important levers and barriers experienced by obese children in their attempt to lose weight. Dealing with these levers and barriers while acknowledging the complex interplay of social and emotional factors unique to the individual may well promote successful weight control.

Design -Programme development, pilot study and evaluation using intention-to-treat analysis. Setting -Coventry, EnglandParticipants -27 overweight or obese children aged 7-13 years (18 girls, 9 boys) and their parents, from 21 families.Intervention -'Families for Health' is a 12 week programme with parallel groups for parents and children, addressing parenting, lifestyle change and social & emotional development.Main Outcome Measures -Primary: change in baseline BMI z-score at end of programme (3 months) and 9 month follow-up. Attendance, drop-out, parents' perception of programme, child's quality of life and self esteem, parental mental health, parent-child relationships and lifestyle changes were also measured.Results: Attendance rate was 62%, with 18 of the 27 (67%) children completing the programme. For the 22 children with follow-up data (including 4 drop-outs), BMI z-score was reduced by -0.18 (95%CI -0.30 to -0.05) at end of programme and by -0.21 (-0.35 to -0.07) at 9 months. Statistically significant improvements were observed in children's quality of life and lifestyle (reduced sedentary behaviour, increased steps and reduced exposure to unhealthy foods), child-parent relationships and parents' mental health. Fruit and vegetable consumption, participation in moderate/vigorous exercise and children's self-esteem did not change significantly. Topics on parenting skills, activity and food were rated as helpful and were used with confidence by the majority of parents. ConclusionsFamilies for Health is a promising new childhood obesity intervention. Definitive evaluation of its clinical effectiveness by randomised controlled trial is now required. A current challenge is how best to manage children who are already obese or overweight. Systematic reviews have reported an inadequate evidence base with no studies from the UK.[5] They have highlighted the importance of family involvement.[6] The UK National Institute for Health and Clinical Excellence concluded that programmes incorporating behavioural treatment alongside physical activity and diet were effective, particularly if parents were given the responsibility for behaviour change. [7] Primary research contributing to this field include Epstein's group from New York who showed that 'family based behavioural treatment' (FBBT) targeted at parent and child together was more effective in long term weight management than targeting the child alone.[8] Golan from Israel compared parents with children as the exclusive agents of change, finding a greater reduction in overweight for the parent group.[9] A further RCT by Israel et al demonstrated that a behavioural programme was more effective when run with a parent training course, [10] indicating that parenting skills help to sustain improvement.These trials, though suggesting that family interventions are effective, were all carried out in clinical settings. There is a lack of evidence on community-based interventions. Recent UK research on community interventions to manage childhood obesity include pilot studies...

Objectives To implement a school based health promotion programme aimed at reducing risk factors for obesity and to evaluate the implementation process and its effect on the school. Design Data from 10 schools participating in a group randomised controlled crossover trial were pooled and analysed. Setting 10 primary schools in Leeds. Participants 634 children (350 boys and 284 girls) aged 7-11 years. Main outcome measures Response rates to questionnaires, teachers' evaluation of training and input, success of school action plans, content of school meals, and children's knowledge of healthy living and self reported behaviour. Results All 10 schools participated throughout the study. 76 (89%) of the action points determined by schools in their school action plans were achieved, along with positive changes in school meals. A high level of support for nutrition education and promotion of physical activity was expressed by both teachers and parents. 410 (64%) parents responded to the questionnaire concerning changes they would like to see implemented in school. 19 out of 20 teachers attended the training, and all reported satisfaction with the training, resources, and support. Intervention children showed a higher score for knowledge, attitudes, and self reported behaviour for healthy eating and physical activity. Conclusion This programme was successfully implemented and produced changes at school level that tackled risk factors for obesity.

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.

Aims: To ascertain the long term outcomes in children diagnosed as having failure to thrive (FTT). Methods: Systematic review of cohort studies. Medline, Psychinfo, Embase, Cinahl, Web of Science, Cochrane, and DARE databases were searched for potentially relevant studies. Inclusion criteria: cohort studies or randomised controlled trials in children ,2 years old with failure to thrive defined as weight ,10th centile or lower centile and/or weight velocity ,10th centile, with growth, development, or behaviour measured at 3 years of age or older. Results: Thirteen studies met the inclusion criteria; eight included a comparison group, of which five included children identified in community settings. Two were randomised controlled trials. Attrition rates were 10-30%. Data from population based studies with comparison groups and which reported comparable outcomes in an appropriate form were pooled in a random effects meta-analysis. Four studies report IQ scores at follow up and the pooled standardised mean difference was 20.22 (95% CI 20.41 to 20.03). Two studies reported growth data as standard deviation scores. Their pooled weighted mean difference for weight was 21.24 SDS (95% CI 22.00 to 20.48), and for height 20.87 SDS (95% CI 21.47 to 20.28). No studies corrected for parental height, but two reported that parents of index children were shorter. Conclusions: The IQ difference (equivalent to ,3 IQ points) is of questionable clinical significance. The height and weight differences are larger, but few children were below the 3rd centile at follow up. It is unclear to what extent observed differences reflect causal relations or confounding due to other variables. In the light of these results the aggressive approach to identification and management of failure to thrive needs reassessing. M ost child health surveillance programmes both in the West and in poor countries include the regular weighing of infants and young children, with the aim of identifying those children who are growing inappropriately slowly. A variety of cut-off points for action are used, including weight below a particular centile (which ranges from ,10th to ,0.4th centile) or crossing more than a certain number of centiles. Recently it has been argued that clinicians should use the new charts which identify the slowest growing children while correcting for regression to the mean.

Background: One quarter of children in England are overweight/obese at school entry. We