4 Recommendations for research

The Programme Development Group (PDG) recommends that the following research questions should be addressed. It notes that 'effectiveness' in this context relates not only to the size of the effect, but also to cost effectiveness and duration of effect. It also takes into account any harmful/negative side effects.

Recommendation 1 Research studies and trials

Who should take action?

Research councils, commissioners and funders.

What action should they take?

Research studies and trials of lifestyle weight management programmes for children and young people who are obese or overweight should:

  • Standardise outcome measures to assess effectiveness. Outcomes should be reported on an 'intention to treat' basis (as opposed to reporting outcomes for programme completers only). They should include:

    • changes in BMI z score, as the primary outcome measure

    • factors that affect weight (matching these to the intervention objectives) for example, measures of self-efficacy, changes in diet, physical activity and time spent being sedentary and measures of wellbeing.

  • Standardise the time points at which outcome measures are reported and followed up. They should include, as a minimum: at baseline, completion of the intervention and at 6 months and at 1 year after completing the intervention.

  • Report in detail the components of the intervention. This should include: what is done, to whom, by whom, in which setting, and when and how?

  • Include an appropriate comparator group and report the components above. If a randomised controlled trial is not possible, alternative research designs should be considered.

  • Report attrition (drop-out) rates, follow up non-completers and investigate the causes of attrition. Also should investigate the causes of low uptake and how these might be addressed.

  • Be sufficiently powered to detect effects.

  • If possible use only standardised validated tools (appropriate for the study sample) to collect data, for example, a validated food frequency questionnaire to investigate dietary intake. If validated tools for secondary measures do not exist, a tool to measure the outcome (for example, physical activity) should be developed as part of the study.

  • Include the collection and analysis of qualitative data to allow a process evaluation of the intervention. These data should include the referral process and experiences of both programme staff and participants.

  • Include the collection of cost data to allow cost effectiveness to be evaluated.

  • Report any unexpected effects or outcomes.

Recommendation 2 Longer-term programme evaluation

Who should take action?

Research councils, commissioners and funders.

What action should they take?

Consider funding longer term research studies and trials of lifestyle weight management programmes for children and young people who are obese or overweight. Ideally studies should last between 5 and 10 years.

Recommendation 3 Barriers and facilitators

Who should take action?

  • Research councils, commissioners and funders.

  • Researchers and investigators.

What action should they take?

  • Determine any variation in the barriers to, and facilitators for, participating in lifestyle weight management programmes for overweight and obese children and young people and their families (including beliefs about obesity). Include:

    • ethnicity and cultural aspects

    • socioeconomic group

    • gender (boys in particular)

    • age.

  • Ask parents, carers and families of children younger than 6 what factors encourage or discourage overweight and obese children to participate (or not) in lifestyle weight management programmes. Determine how these might be addressed.

  • Investigate the barriers to, and facilitators for, implementing lifestyle weight management services for overweight and obese children and young people with special needs. Determine how these might be addressed.

Recommendation 4 Weight management programmes

Who should take action?

  • Research councils, commissioners and funders.

  • Researchers and investigators.

What action should they take?

  • Consider which components of multi-component interventions determine effectiveness and cost effectiveness.

  • Investigate effective and cost effective approaches to lifestyle weight management for children younger than 6 years.

  • Investigate effective and cost effective approaches to lifestyle weight management for children and young people with special needs. How can their needs, and the needs of their families, best be met? What training would staff need to deliver such interventions?

  • Determine the long-term effectiveness of programmes. Do children and young people who have lost or maintained their weight in a lifestyle weight management programme maintain this in the long term and, if so, for how long? What programme characteristics facilitate longer term effectiveness?

  • Examine how best to communicate the individual measures of the National Child Measurement Programme to parents and carers to ensure they take action, as needed, without causing distress.

  • Investigate how to encourage parents and carers to take responsibility for their child's weight management. This includes how best to help parents, carers and families recognise when children and young people are overweight or obese. It also includes how to encourage parents and carers to participate in programmes.

  • Investigate what impact parents and carers have on the outcomes of programmes.

  • Examine who is best placed to deliver lifestyle weight management programmes (including lay people) for children and young people and what their training needs are.

  • Investigate effective and appropriate ways of getting children and young people involved in lifestyle weight management programmes. This might include use of new technology such as texting or phone apps.

  • Investigate and develop a comorbidity assessment tool for use by lifestyle weight management services, to ensure that, if necessary, children and young people are referred for specialist support.

More detail identified during development of this guidance is provided in Gaps in the evidence.

  • National Institute for Health and Care Excellence (NICE)