Evaluation, Trials and Studies Coordinating Centre Challenges and opportunities for obesity research – what are the challenges faced by the NHS and where can research help ? MRC Epidemiology Unit and CEDAR, University of Cambridge Formerly Deputy Chair, NIHR Public Health Research Programme Funding Board Nick Wareham

Evaluate the effectiveness of new, promising or existing interventions Support the translation of effective interventions into practice Improve adherence to individual, family or group health behaviour interventions or treatments Investigate the durability of effect, or undertake longer term follow up of pre-existing research for existing interventions The NIHR obesity themed call

EME – may test novel interventions used in the prevention, diagnosis or treatment of obesity HS&DR – focus on quality, accessibility and organisation of weight management services HTA – management of obesity/overweight in people with T2DM I4i – innovative non-invasive technologies for prevention, early intervention and diagnosis, rapid decision making and active monitoring PGfAR – programmes that are likely to benefit patients in 3-5 years PHR – interventions to prevent or reduce overweight/obesity and to prevent T2DM RfPB – programmes arising from daily practice that demonstrate a trajectory to patient benefit NIHR Research Training Programmes The NIHR obesity themed call

Trend in obesity prevalence among adults Health Survey for England (3-year average) 4Patterns and trends in adult obesity Adult (aged 16+) obesity: BMI ≥ 30kg/m 2

Change in the adult BMI distribution Health Survey for England and Patterns and trends in adult obesity Adults aged 18+ years (population weighted)

Trend in adult obesity prevalence by social class Health Survey for England (5 year moving average*) 6Patterns and trends in adult obesity Adult (aged 16+) obesity: BMI ≥ 30kg/m 2 MenWomen *No data on social class were collected in 2010 and Therefore data presented as are based on a 4 year average. Data presented for 07-11, 08-12, and are based on a 3 year average.

Trend in the prevalence of obesity Children aged 2-10 and years; Health Survey for England Patterns and trends in child obesity Child obesity: BMI ≥ 95 th centile of the UK90 growth reference. 95% confidence intervals are displayed on the chart

BMI distribution: Reception children National Child Measurement Programme 2013/14 8Patterns and trends in child obesity

BMI distribution: Year 6 children National Child Measurement Programme 2013/14 9Patterns and trends in child obesity

Obesity prevalence and deprivation National Child Measurement Programme 2013/14 – Year 6 children 10Patterns and trends in child obesity Child obesity: BMI ≥ 95 th centile of the UK90 growth reference Local authorities in England

Total prevalence of diabetes in the UK

Global prevalence of diabetes

EME – may test novel interventions used in the prevention, diagnosis or treatment of obesity HS&DR – focus on quality, accessibility and organisation of weight management services HTA – management of obesity/overweight in people with T2DM I4i – innovative non-invasive technologies for prevention, early intervention and diagnosis, rapid decision making and active monitoring PGfAR – programmes that are likely to benefit patients in 3-5 years PHR – interventions to prevent or reduce overweight/obesity and to prevent T2DM RfPB – programmes arising from daily practice that demonstrate a trajectory to patient benefit NIHR Research Training Programmes

What exactly is the research question ? The research question

What exactly is the research question ? Has it already been answered ? The research question

By primary studies ?

Source: Gillies et al, BMJ 2007 By secondary research ?

By NICE guidelines / guidance ?

What exactly is the research question ? Has it already been answered ? Can it be answered using secondary research methods ? Can it be answered using a re-analysis of existing data ? What studies are already underway that might address the issue ? The research question

Are relevant studies already underway ?

Can the research question be answered ? Can the study design proposed answer the question ? The research question

Seek advice on research design and methods

Can the research question be answered ? Can the study design proposed answer the question ? Can the research question be answered in a timely manner ? Will the question still be relevant when you get the answer ? The research question

HRR 0.96( ) HRR 0.29( ) Women Men follow up year cumulative incidence(%) IGT-contro l IGT-interventio n follow up year cumulative incidence(%) IGT-control IGT-intervention Source: Li et al, Lancet Diabetes and Endocrinology 2014 Some answerable and relevant questions may simply take too long to answer

Whose research question is it ? Who is interested in the answer to the research question ? The research question

Programme advisory board Perspectives on the research question

Awareness of issues in current policy realm

Source: Wareham, Lancet Diabetes and Endocrinology 2015 From efficacy to effectiveness

VA MOVE! programme Hazard ratio Any participation vs none0·80 (95% CI 0·77–0·83) Intense & sustained participation 0·67 (95% CI 0·61–0·74) Source: Jackson et al, Lancet Diabetes and Endocrinology 2015

VA MOVE! programme Number of people All those eligible 1.8 million Any participation vs none 238,540 (13%) Intense & sustained participation 19,327 (1%) Source: Jackson et al, Lancet Diabetes and Endocrinology 2015

Whose research question is it ? Who is interested in the answer to the research question ? Who should be interested in the answer to the research question ? The research question

Whose research question is it ? Who is interested in the answer to the research question ? Who should be interested in the answer to the research question ? What will you do with the answer to the question ? The research question

Pathways to impact

Whose research question is it ? Who is interested in the answer to the research question ? Who should be interested in the answer to the research question ? What will you do with the answer to the question ? What will others do with the answer to the question ? The research question

Conclusion What exactly is the research question ? Has it already been answered ? Can it be answered using secondary research methods ? Can it be answered using a re-analysis of existing data ? What studies are already underway that might address the issue ? Can the research question be answered ? Can the study design proposed answer the question ? Can the research question be answered in a timely manner ? Will the question still be relevant when you get the answer ? Whose research question is it ? Who is interested in the answer to the research question ? Who should be interested in the answer to the research question ? What will you do with the answer to the question ? What will others do with the answer to the question ?