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Shared care obesity management in 3-10 year old children: 12 month outcomes of HopSCOTCH randomised trial
Melissa Wake1, Kate Lycett, Susan A Clifford
1Royal Children's Hospital, Parkville VIC 3052, Australia. melissa.wake@rch.org.au
Insights
A shared care model for childhood obesity management in primary and tertiary settings was feasible and well-received but did not improve body mass index (BMI) or related outcomes compared to usual care. Improvements in BMI were observed in both groups, underscoring the importance of control groups in research.
Area of Science:
- Pediatrics
- Public Health
- Clinical Trials
Background:
- Childhood obesity is a significant public health concern requiring effective management strategies.
- Integrated care models involving primary and tertiary settings are being explored to address this issue.
- A shared care approach aims to leverage the strengths of both general practice and specialist weight management services.
Purpose of the Study:
- To evaluate the effectiveness of a shared care model for managing obesity in children aged 3-10 years.
- To determine if this model improves body mass index (BMI) and related health outcomes compared to usual care.
- To assess the feasibility and acceptability of the shared care model for families and healthcare providers.
Main Methods:
- A randomized controlled trial was conducted involving 22 family practices and a tertiary weight management service in Melbourne, Australia.
- Children aged 3-10 years with obesity were randomly assigned to either the shared care intervention or usual care.
- The intervention group received one tertiary appointment followed by general practice consultations over one year, supported by web-based software.
Main Results:
- 107 children were analyzed (56 intervention, 51 control).
- No significant difference in body mass index (BMI) z-score was found between the intervention and control groups at 15 months post-enrolment (adjusted mean difference -0.05; P=0.2).
- No evidence of benefit or harm was observed for any secondary outcomes, including body fat percentage and quality of life.
Conclusions:
- The shared care model, while feasible and highly rated, did not lead to improved BMI or other outcomes compared to usual care.
- The study highlights the value of untreated control groups in accurately determining the efficacy of interventions.
- Further research may be needed to optimize integrated care models for childhood obesity.
Objective:
To determine whether general practice surveillance for childhood obesity, followed by obesity management across primary and tertiary care settings using a shared care model, improves body mass index and related outcomes in obese children aged 3-10 years.
Design:
Randomised controlled trial.
Setting:
22 family practices (35 participating general practitioners) and a tertiary weight management service (three paediatricians, two dietitians) in Melbourne, Australia.
Participants:
Children aged 3-10 years with body mass index above the 95th centile recruited through their general practice between July 2009 and April 2010.
Intervention:
Children were randomly allocated to one tertiary appointment followed by up to 11 general practice consultations over one year, supported by shared care, web based software (intervention) or "usual care" (control). Researchers collecting outcome measurements, but not participants, were blinded to group assignment.
Main Outcome Measures:
Children's body mass index z score (primary outcome), body fat percentage, waist circumference, physical activity, quality of diet, health related quality of life, self esteem, and body dissatisfaction and parents' body mass index (all 15 months post-enrolment).
Results:
118 (60 intervention, 56 control) children were recruited and 107 (91%) were retained and analysed (56 intervention, 51 control). All retained intervention children attended the tertiary appointment and their general practitioner for at least one (mean 3.5 (SD 2.5, range 1-11)) weight management consultation. At outcome, children in the two trial arms had similar body mass index (adjusted mean difference -0.1 (95% confidence interval -0.7 to 0.5; P=0.7)) and body mass index z score (-0.05 (-0.14 to 0.03); P=0.2). Similarly, no evidence was found of benefit or harm on any secondary outcome. Outcomes varied widely in the combined cohort (mean change in body mass index z score -0.20 (SD 0.25, range -0.97-0.47); 26% of children resolved from obese to overweight and 2% to normal weight.
Conclusions:
Although feasible, not harmful, and highly rated by both families and general practitioners, the shared care model of primary and tertiary care management did not lead to better body mass index or other outcomes for the intervention group compared with the control group. Improvements in body mass index in both groups highlight the value of untreated controls when determining efficacy.
Trial Registration:
Australian New Zealand Clinical Trials Registry ACTRN12608000055303.
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