1. Scoping the impact of NCMP feedback on the child obesity pathway – Study results Falconer, C; Park, MH; Croker, H; Skow, A; Black, J; Saxena, S; Kessel, A; Morris, S; Karlsen, S; Viner, R; and Kinra, S. Improving health worldwidewww.lshtm.ac.uk

2. 1. To increase public understanding of child weight issues; 2. To engage families with the issue of healthy weight in children; 3. To offer information, advice and services which provide an opportunity for families to make healthy lifestyle choices. Aims of NCMP feedback

3. Study Aims 1.To estimate the impact of NCMP feedback on parental risk perceptions, parental acceptance of the feedback and associated behaviour change and health service use; 2.To identify barriers and levers to behaviour change and health service use, particularly among deprived/ethnic minority groups; 3.To determine which feedback approach (letter versus pro-active) has the greatest positive impact.

4. Methods

5. Parents of children enrolled in the NCMP in 5 PCTS (N=18,000): – Redbridge – Islington, – West Essex, – Bath and North East Somerset (BANES) – Sandwell PCT Questionnaire surveys at three time points – Baseline – One month, 6 months and 1 year post feedback Interviews with parents of 52 overweight and very overweight children Time-line

6. Results

7. 1,844 parents completed a questionnaire at baseline and follow-up Weight status: – 9.7% overweight – 5.7% very overweight Ethnicity: – 66% white – 15.7% Asian – 5.5% Black – 12.8% mixed/other Comparable to NCMP population Participants

8. Parental knowledge was high? – Baseline 72.5% – Follow-up 79.7% Assessed parents knowledge of future health risks associated with child overweight Aim 1: Public awareness of child overweight

9. Parental acceptance of childs overweight category – Baseline 22% – Follow-up 38% Parental perception of their childs weight as a health risk – Baseline 21% – Follow-up 27% BUT these changes were not as big as you would expect Aim 2: Engage families with overweight children

10. Disagreement with feedback I look at him and I see puppy fat. I dont see overweight fat. I think theyre two different things Parents view their child in terms of their physical and emotional functioning and not their weight If shes not active I would be worried. Yes but shes active, she runs she do all of them things so Im not worried about her health Comparisons to other children He honestly doesnt look overweight to me so you see children in the street and theyre little round puddings. Hes not one of them Rationalising – failed attempts before? Why?

11. 36.6% parents sought further help or information following NCMP feedback Aim 2: Engage families with overweight children

12. Lack of knowledge I dont think I need to go to the GP unless shes ill or something. I dont know. What would you suggest? Mis-information He said Looking at her she looks perfectly healthy so I wouldnt be too concerned about that side of things. It gave me reassurance Sometimes I used to check with the doctor, GP, whether his height and weight is normal. The doctor when he sees him, I think hes normal, and they didnt find him as overweight Aim 2: Engage families with overweight children

13. After NCMP feedback: – Dietary behaviour was unchanged – Physical activity was unchanged (increased in very overweight only) – Screen-time increased Aim 3: Encourage behaviour change

14. Lack of knowledge I do give fish fingers and I dont know whether its healthy or not…If I can get proper guidance of what I should give her Availability/access to services At the local sports centre they have things going on but things are so expensive to pay for that is a lot…I always keep thinking, oh I want him to do another thing, but we just dont have the funds to do that Perceived healthy lifestyle Then actually I threw the letter away because I thought Im not going to alter her diet. She eats, as far as Im concerned a healthy diet. She does sport Why?

15. After NCMP feedback – Frequency of weight-related teasing remained unchanged 10% overweight children 2% healthy weight children – Frequency of bouts of low self-esteem remained unchanged 4% overweight children 1% healthy weight children Does it cause any harm?

16. Emotions reported after NCMP feedback in parents of overweight children: – 22.8% upset – 15.4% guilty – 14.8% angry BUT: 87.2% of parents found the feedback to be somewhat or very helpful 70% would encourage future participation in the NCMP Only 1.8% would withdraw their child in the future Parental experience of NCMP feedback

17. Parents of non-white children: – Lower knowledge of the health risks of child overweight – Greater change in recognition of the health risks following weight feedback – More likely to seek help Parents of older children – More recognised overweight and associated health risks Effect of population characteristics on the impact of NCMP feedback

18. Pro-active feedback: – More accepted the feedback result 10% change with letter 32% change with pro-active – No additional impact on behaviour But – Additional cost Letter: £1.24/child Pro-active: £9.50/child for phone call and £41/child for appointment Parents prefer the letter Effect of feedback type on the impact of NCMP feedback

19. Recommendations

20. Feedback letter is moderately effective and well received by parents Suggested actions: – Continue to provide routine letter feedback to all parents of children participating in the NCMP Proactive feedback offered some additional benefit but comes at an additional cost and is less preferred by parents Suggested actions: – Re-think the best use of the additional costs. Consider investing these resources in: – Providing additional contacts to parents – Increasing the capacity of local services – Improving the capability of staff delivering interventions Feedback

21. Parents are willing to seek help, but may not be finding the best information Suggested actions: – Make it easier for parents to access the right information Make high quality information more accessible NCMP champions at schools – Ensure that the capacity of local services is sufficient to deal with any increased help-seeking – Engage with GPs Provision of information and help-seeking

22. Thanks for listening Catherine.falconer@lshtm.ac.uk PROMISE Research – http://www.promiseresearch.org.uk http://www.promiseresearch.org.uk HELP trial – http://helptrial.org.uk http://helptrial.org.uk

23. Help seeking by ethnicity

24. Help seeking by SES