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Background. High numbers of young people are living with obesity in England, with associated negative impacts on their mental and physical health. Social prescribing involves professionals referring individuals to community‐based services to provide additional health and well‐being support. Social prescribing may be a helpful way to provide holistic support to young people living with obesity alongside weight management services. However, there is a need to better understand the availability of community‐based services that could provide this support. Aims. This study aimed to explore the process for mapping community‐based services to be part of a social prescribing offer within children's specialist weight management services in one region of England and to provide an understanding of the availability of community‐based services in this region that are accessible for this population. Method. Community‐based services providing physical activity opportunities to young people in an area local to a specialist weight management service (South Yorkshire) were mapped using a mixed methods approach, including scoping of online resources and meetings with relevant contacts. Services were identified and reviewed against criteria developed through stakeholder engagement to assess suitability for young people living with obesity. Results. A total of 933 community‐based services were identified across South Yorkshire between January and June 2023. Scoping and suitability assessment of these services took 6 months. There was often limited information provided about services, particularly relating to costs. Nineteen services met all suitability criteria. Conclusion. It requires time and capacity to identify relevant community‐based services as part of a social prescribing offering. Although a high number of services were identified, few of these were suitable for young people living with obesity. Consideration should be given to how young people can be supported to access services, as well as how services can be supported to meet the needs of young people living with severe obesity. [ABSTRACT FROM AUTHOR]

Central obesity has been shown to better indicate health risks compared to general obesity. Measures of central obesity include waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and waist circumference (WC). The National Institute of Health and Care Excellence (NICE) recently recommended the use of WHtR alongside body mass index (BMI) to identify risks in adults and children, whilst recognising the need for more evidence relating to WHtR in children. This study explores risk thresholds for central obesity measures throughout adolescence. It compares these with those currently recommended in England and discusses whether these thresholds are age- and sex-specific. Data on adolescents aged 11 to 18 years from the Health Survey for England (HSE) during 2005 to 2014 was used to calculate WHtR, WHR and WC percentiles. Next, smoothed lambda-mu-sigma (LMS) curves were created and the percentiles which align with the adult thresholds at age 18 years identified. This allows the most appropriate risk related thresholds for each measure during adolescence to be determined. WHtR LMS curves are stable and flat throughout adolescence. WHR decreases in girls and WC increases in both boys and girls, during adolescence. Across all measures, there is slightly more fluctuation in higher percentiles, and in girls' WHR. In practice, WHtR thresholds are simple to use to identify central obesity related risks. In particular, they are recommended because the same thresholds can be used for males and females and for adolescents and adults. The results support NICE guidance to use WHtR thresholds alongside BMI thresholds to identify individual risk. This study uses central obesity measures, including waist-to-height and waist-to-hip ratios, to investigate risk-related thresholds for adolescents. It is the first to do so using English data. It provides support for current NICE recommendations to use adult waist-to-height thresholds in adults and children, alongside BMI measures in clinical and non-clinical settings. [ABSTRACT FROM AUTHOR]

Aim: Obesity has a significant impact on all‐cause mortality rate and overall health care resource use (HCRU). These outcomes are also strongly linked to age, sex and local deprivation of the population. We aimed to establish the lifetime costs of obesity by demographic group/geographic area using published mortality rates and HCRU use for integrated care boards (ICB) in England in the context of costs of therapeutic intervention. Methods: Population and expected mortality rates by age, sex and deprivation were obtained from national data. Obesity class prevalence was taken from the health of the nation study. The published impact of obesity by age, group, sex and deprivation on mortality and HCRU were applied to estimate life years lost and lifetime HCRU [by sex, age band and body mass index (BMI) class for each ICB]. The year 2019 was chosen as the study basis data to avoid influences of COVID‐19 pandemic on obesity rates with application of 2022/23 HCRU values. Outcomes including prevalence, deaths, life years lost, HCRU and lifetime HCRU were compared by age and sex groups across four BMI classes normal/underweight (BMI <25 kg/m2), overweight (25‐29.9 kg/m2), obese class I and II (30‐39.9 kg/m2), and obese class III (≥40), with benchmarking being set against all population being BMI <25 kg/m2 overall and by each of the 42 ICBs. We also associated future life with deaths to provide an estimate of 'future life years lost' occurring each year. Results: Total population aged >16 years was 45.4 million (51% female). Prevalence: 13.7 million (28% of the total adult population) had a BMI ≥30 mg/m2 and BMI ≥40 kg/m2 were 1.50 million (12%) of these 1.0 million (68%) were female and of these 0.6 million 40% were women aged 16‐49 years. In addition, 35% of those with a BMI ≥40 kg/m2 were in the top deprivation quintile (i.e. overall 20%). Mortality was based on expected deaths of 518K/year, and modelling suggested that if a BMI <25 kg/m2 was achieved in all individuals, the death rate would fall by 63K to 455K/year for the English population (12% reduction). For those with a BMI ≥40 kg/m2 the predicted reduction was 12K deaths (54% lower); while in those aged 16‐49 years with a BMI ≥40 kg/m2 72% of deaths were linked to obesity. For future life years lost, we estimated 2.5 years were lost in people with BMI 30‐39.9 kg/m2 6.7 years when BMI ≥40 kg/m2. However, for those aged 16‐49 years with a BMI ≥40 kg/m2, 8.3 years were lost. HCRU, for weight reduction, the annual HCRU decrease from BMI ≥40 kg/m2 to BMI 30‐39.9 kg/m2 was £342 per person and from BMI 30‐39.9 to 25‐29.9 kg/m2 the reduction was £316/person. However, lifetime costs were similar because of reduced life expectancy for obese individuals. In quality adjusted life years (QALY), overall, 791 689 future life years were lost (13.1% of all) in people with BMI ≥25 kg/m2 and were related to excess weight. When the NICE £30 000 per QALY value was applied to the estimated total 791 689 future life years lost then the potential QALY value reduction lost was equivalent to £24 billion/year or £522/person in the obese population. For morbidly obese men and women the potential QALY value lost was £2864/person/year. Regarding geography, across the 42 ICBs, we observed significant variation in the prevalence of BMI ≥40 (1.8%‐4.3%), excess mortality (11.6%‐15.4%) and HCRU linked to higher BMI (7.2%‐8.8%). The areas with the greatest impact on HCRU were in the north‐west, north‐east and Midlands of England, while the south shows less impact. Conclusion: The expected increases in annual HCRU because of obesity, when considered over a lifetime, are being mitigated by the increased mortality of obese individuals. Our data suggest that simple short‐term HCRU reduction brought about through BMI reduction will be insufficient to fund additional specialist weight reduction interventions. The HRCUs associated with BMI are not in most cases related to short‐term health conditions. They are a cumulative result over a number of years, so for age 16‐49 years reducing BMI from ≥40 to 30‐39.9 kg/m2 might show an annual decrease in HCRU/person by £325/year for women and £80/year for men but this might not have immediately occurred within that year. For those aged >70 years reducing BMI from ≥40 to 30‐39.9 kg/m2 might show an annual decrease in HCRU/person by £777/year for women and £796/year for men but also may not be manifest within that year. However, for the morbidly obese men and women, the potential QALY value lost was £2864 per person per year with the potential for these funds to be applied to intensive weight management programmes, including pharmacotherapy. [ABSTRACT FROM AUTHOR]

Women with obesity during pregnancy are at increased risk of excessive gestational weight gain (GWG) and other maternal and infant adverse outcomes, which all potentially increase childhood obesity. This study explored infant weight outcomes for women with a body mass index (BMI) ≥ 35 kg/m² who were offered an antenatal healthy lifestyle service. A retrospective cohort study, including linking data from two separate health care Trusts, was undertaken. Data were collected from maternity records for women with a BMI ≥ 35 kg/m2 referred to an antenatal healthy lifestyle service from 2009 to 2015. The respective child's weight outcome data was additionally collected from health and National Child Measurement Programme records. Univariate logistic regression determined the odds of childhood overweight, obesity and severe obesity according to attendance at the antenatal healthy lifestyle service, GWG and sociodemographic characteristics. Factors significant (p < 0.05) within the univariate analysis were entered into multiple logistic regression models. Among women with a BMI ≥ 35 kg/m², 30.4% of their children were obese at school entry and 13.3% severely obese. Healthy lifestyle service attendance was not associated with childhood overweight or obesity at any point within the univariate analysis. At school age multiple regression analysis showed the odds of overweight and obesity increased with excessive GWG and the odds of obesity decreased with a parent in a professional occupation, additionally having a mother who smoked in pregnancy increased severe obesity. Women should be supported to optimise their BMI before pregnancy. Additionally, rather than exclusively focusing on changing an individual's behaviour, future interventions should consider external influences such as the woman's family, friends and sociodemographic background. Key messages: Among children born to women with a body mass index (BMI) ≥ 35 kg/m2 almost 50% were classified as overweight or obese at age 5. Of these, only 15.6% had been born large for gestational age.This brief antenatal healthy lifestyle intervention provided to mothers with obesity did not significantly reduce child's overweight or obesity.Demographic factors such as household occupation and maternal smoking during pregnancy were associated with long‐term childhood obesity.More emphasis is required on interventions that support women to optimise their BMI before pregnancy.Future interventions should consider external influences on the woman for example through a socioecological framework. [ABSTRACT FROM AUTHOR]

Background: Local authorities in England have an important role in shaping healthy local environments contributing to childhood obesity. This study examined changes in diet and physical activity in primary school children following a three-year, complex, community-based intervention in Golborne ward, the second most deprived ward in London. Methods: The Go-Golborne intervention aimed to shape the local environment across multiple settings with the engagement of a large number of local government and community stakeholders in a joint approach. Activities focused on six co-created themes to make changes to local environments and reduce sugary snacks and beverage consumption, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually between 2016 and 2019, from 1,650 children aged 6–11 years through six local schools, who all received the intervention. We used multilevel, linear and logistic random-slope regression models adjusted for time on study, baseline age, gender, ethnicity, deprivation quintile, school, and baseline weight status. Results: After three years of follow-up, there were reductions in sugar-sweetened beverage consumption (adjusted beta -0·43 occasions/day, 95% CI -0·55 to -0·32), fruit and vegetable consumption (adjusted beta -0.22 portions, 95% CI -0.44 to 0.001) and car travel to and from school (adjusted OR 0·19, 95% CI 0·06 to 0·66), while screen time increased (high versus moderate/low: OR 2·30, 95% CI 1·36 to 3·90). For other behavioural outcomes, there was no statistically significant evidence of changes. Conclusion: Local authorities have substantial powers to make positive changes to the obesogenic environment but programmes remain under-evaluated. Results from the ambitious Go-Golborne intervention demonstrated mixed results in health behaviours following programme implementation. These results underline the importance of a coordinated and comprehensive policy response to support changes in wider environmental and social conditions as well as appropriate and holistic evaluations of initiatives to inform local actions on obesogenic environments. [ABSTRACT FROM AUTHOR]

Introduction: There continues to be an imbalance of research into weight loss and weight loss maintenance (WLM), with a particular lack of research into WLM in young people under 18 years. Failure to coherently understand WLM in young people may be a potential contributor to the underdeveloped guidance surrounding long‐term support. Furthermore, no research has investigated young people's preferences around WLM support following the attendance of a residential intensive weight loss intervention from a qualitative perspective. This study explored the influences of WLM in young people following a residential intensive weight loss intervention, considered how interventions could be improved and sought to develop recommendations for stakeholders responsible for designing WLM interventions. Methods: The context in which this research is framed was taken from a residential Intensive Weight Loss Intervention for young people aged 8–17 years in England. Six semi‐structured interviews were carried out to understand the lived experience of WLM, including barriers and enablers influencing WLM, adopting an interpretative phenomenological analysis design. Findings: Three superordinate themes were developed to explain the barriers and enablers to WLM; (1) Behavioural control and the psychosocial skills to self‐regulate WLM; (2) Delivering effective social support; and (3) Conflicting priorities and environmental triggers. Conclusion: The findings of this research mirror that of other studies of WLM in young people, with the majority of young people struggling to maintain weight loss. However, by exploring the experience of WLM in young people through qualitative means, it was possible to understand the specific motivators and barriers influencing WLM behaviours in this context, providing recommendations to support WLM. Patient or Public Contribution: The interview guide was developed in consultation with a young person from the intervention, and through discussions with the intervention stakeholders (delivery staff and management staff). The interview guide included topics such as knowledge and skills; experience of weight loss; reflections on weight maintenance, and experiences of daily life postintervention. We piloted the interview schedule with one young person who had consented to take part in the research. This first interview was used to check for understanding of questions and to assess the flow of the interview. [ABSTRACT FROM AUTHOR]

The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. This study of a Barts Health NHS Trust cohort from 2008 to 2022 aims to elucidate the incidence, clinical outcomes, and complications associated with paediatric T2D. A retrospective analysis utilising electronic and paper records identified 40 patients with T2D. The incidence doubled from 2.6/year in 2008–2013 to 5.4/year in 2014–2018. Sixty-eight percent exhibited co-morbidities, notably learning disabilities. At diagnosis, the mean BMI was 32.4 ± 6.71 kg/m2, with no gender-based disparity and no significant change over a two-year follow-up. The initial HbA1c was 75.2 ± 21.0 mmol/mol, decreasing to 55.0 ± 17.4 mmol/mol after three months (p = 0.001) and then rising to 63.0 ± 25.5 mmol/mol at one year (p = 0.07). While 22/37 patients achieved HbA1c < 48 mmol/mol, only 9 maintained this for a year. Several metabolic and cardiovascular complications were observed at diagnosis and follow-up, with no significant change in frequency. In 2022, 15 patients transitioned to adult services. HbA1c at transition was 74.7 ± 27.6 mmol/mol, showing no change one year post-transition (71.9 ± 26.9 mmol/mol, p = 0.34). This study highlights substantial therapeutic failure, with current management falling short in achieving a sustained reduction in BMI or HbA1c. Novel treatment approaches are needed to improve clinical outcomes and address the high burden of co-morbidities and complications. [ABSTRACT FROM AUTHOR]

Background: The prevalence of overweight and obesity in young children rose sharply during the COVID-19 pandemic. Here we estimate the potential future health and economic effects of these trends in England. Methods: Using publicly available annual Body Mass Index (BMI) data from 2006–2022, we calculated the increase in overweight/obesity prevalence (BMI ≥85th reference percentile) during the COVID-19 pandemic among children aged 4–5 and 10–11, and variation by deprivation and ethnicity. We projected the impact of child BMI trends on adult health measures to estimate added lifelong medical and social costs. Results: During 2020–2021 there were steep increases in overweight and obesity prevalence in children. By 2022, overweight and obesity prevalence in children aged 4–5 returned to expected levels based on pre-pandemic trends. However, overweight and obesity prevalence in children aged 10–11 persisted and was 4 percentage points (p<0.001) higher than expected, representing almost 56,000 additional children. The increase was twice as high in the most compared with the least deprived areas. The additional lifelong healthcare cost in this cohort will amount to £800 million with a cost to society of £8.7 billion. We did not find an increase in maternal obesity associated with the COVID-19 pandemic, however, prevalence grew faster in the post pandemic period. Discussion: The return of overweight and obesity prevalence to pre-pandemic trends in children aged 4–5 provides a clear policy target for effective intervention to tackle this growing and serious population health concern. [ABSTRACT FROM AUTHOR]

The article focuses on the allocation of funds by the British government to local authorities in England for enhancing drug and alcohol treatment and recovery services, with priorities including recruiting specialized staff, supporting prison leavers, and reducing crime through improved treatment quality. It mentions that the funding aims to address drug-related issues, prevent deaths, and combat criminal activities associated with substance misuse.

Background Understand factors that influence food choice and explore public perceptions of the need for government policies to improve diets in the UK, particularly food pricing interventions. Methods A qualitative study design was used with semi-structured interviews. The study was carried out in Greater Manchester, England. In all, 15 participants from a diverse range of backgrounds were recruited. Results Food price, lack of time, availability, and food knowledge and culture were key factors that led some study participants towards unhealthy food choices. The UK's individual, willpower-focused approach to tackling obesity was deemed ineffective and many participants supported further government intervention. Product reformulation was supported as a less intrusive and less regressive way of improving diets than taxation. There was also support for increasing cooking classes within schools. Conclusions Whilst the government ambition to half childhood obesity by 2030 is welcome, population level interventions that enable healthier food choices are needed to achieve this goal. Rising global food prices may make reformulation a more practical policy option than further pricing interventions. Mandatory reformulation of convenience meal and snack products and strengthening education in schools may represent a publicly acceptable and effective package of interventions within a comprehensive strategy to tackle obesity. [ABSTRACT FROM AUTHOR]

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The English National Child Measurement Programme (NCMP) is a nationally mandated public health programme. It provides data for child excess weight indicators in the Public Health Outcomes Framework, part of the government's approach to reducing childhood obesity. Drawing on a meta-ethnographic synthesis of household members' experiences of the programme, we conceptualise the NCMP as a 'technique of futuring' to generate new insights into how it (re)shapes and (re)imagines past, present, and future responsibilities and practices for overweight children, parents, and carers, in potentially harmful ways. For children categorised by the NCMP as overweight, the NCMP is an emotionally significant event, driving new bodily practices, new food practices and changed relationships with peers. This paper outlines how parents come to resist and reframe the programme and its results, to protect their children from a weight-focused future. They consider the potential risks of bullying, dysfunctional eating, and mental health consequences more important than future risks of overweight. We show how parents of children categorised as overweight preserve their claim to 'responsible' and 'good' parenting amongst peers, whilst shifting the blame for childhood obesity to other, 'irresponsible' parents, thus reproducing moralising and responsibilising discourses inherent within the 'behaviour change' messaging of the NCMP and associated research. Finally, we consider a central paradox of this programme and the use of NCMP population level monitoring data to (re)shape lives at the individual and social level – the children it sets out to help are the most likely to experience harm as a result of it. [ABSTRACT FROM AUTHOR]

Objective: Physical access to food may affect diet and thus obesity rates. We build upon existing work to better understand how socio-economic characteristics of locations are associated with childhood overweight. Design: Using cross-sectional design and publicly available data, the study specifically compares rural and urban areas, including interactions of distance from supermarkets with income and population density. Setting: We examine cross-sectional associations with obesity prevalence both in the national scale and across urban and rural areas differing in household wealth. Participants: Children in reception class (aged 4–5) from all state-maintained schools in England taking part in the National Child Measurement Programme (n 6772). Results: Income was the main predictor of childhood obesity (adj. R-sq=.316, p<.001), whereas distance played only a marginal role (adj. R-sq=.01, p<.001). In urban areas, distance and density correlate with obesity directly and conditionally. Urban children were slightly more obese, but the opposite was true for children in affluent areas. Association between income poverty and obesity rates was stronger in urban areas (7·59 %) than rural areas (4·95 %), the former which also showed stronger association between distance and obesity. Conclusions: Obesogenic environments present heightened risks in deprived urban and affluent rural areas. The results have potential value for policy making as for planning and targeting of services for vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: Sugar-sweetened beverages (SSBs) are the primary source of dietary added sugars in children, with high consumption commonly observed in more deprived areas where obesity prevalence is also highest. Associations between SSB consumption and obesity in children have been widely reported. In March 2016, a two-tier soft drinks industry levy (SDIL) on drinks manufacturers to encourage reformulation of SSBs in the United Kingdom was announced and then implemented in April 2018. We examined trajectories in the prevalence of obesity at ages 4 to 5 years and 10 to 11 years, 19 months after the implementation of SDIL, overall and by sex and deprivation. Methods and findings: Data were from the National Child Measurement Programme and included annual repeat cross-sectional measurement of over 1 million children in reception (4 to 5 years old) and year 6 (10 to 11 years old) in state-maintained English primary schools. Interrupted time series (ITS) analysis of monthly obesity prevalence data from September 2013 to November 2019 was used to estimate absolute and relative changes in obesity prevalence compared to a counterfactual (adjusted for temporal variations in obesity prevalence) estimated from the trend prior to SDIL announcement. Differences between observed and counterfactual estimates were examined in November 2019 by age (reception or year 6) and additionally by sex and deprivation quintile. In year 6 girls, there was an overall absolute reduction in obesity prevalence (defined as >95th centile on the UK90 growth charts) of 1.6 percentage points (PPs) (95% confidence interval (CI): 1.1, 2.1), with greatest reductions in the two most deprived quintiles (e.g., there was an absolute reduction of 2.4 PP (95% CI: 1.6, 3.2) in prevalence of obesity in the most deprived quintile). In year 6 boys, there was no change in obesity prevalence, except in the least deprived quintile where there was a 1.6-PP (95% CI: 0.7, 2.5) absolute increase. In reception children, relative to the counterfactual, there were no overall changes in obesity prevalence in boys (0.5 PP (95% CI: 1.0, −0.1)) or girls (0.2 PP (95% CI: 0.8, −0.3)). This study is limited by use of index of multiple deprivation of the school attended to assess individual socioeconomic disadvantage. ITS analyses are vulnerable to unidentified cointerventions and time-varying confounding, neither of which we can rule out. Conclusions: Our results suggest that the SDIL was associated with decreased prevalence of obesity in year 6 girls, with the greatest differences in those living in the most deprived areas. Additional strategies beyond SSB taxation will be needed to reduce obesity prevalence overall, and particularly in older boys and younger children. Trial registration: ISRCTN18042742. Nina T Rogers and colleagues investigate changes in the levels of obesity in children aged 4-5 years and 10-11 years, 19 months after the implementation of UK soft drinks industry levy. Author summary: Why was this study done?: In England, childhood obesity rates are high with around 10% of reception age children (4/5 years) and 20% of children in year 6 (10/11 years) recorded as living with obesity in 2020. Children who are obese are more likely to suffer from serious health problems including high blood pressure, type 2 diabetes, and depression in childhood and in later life. In March 2016, to tackle childhood obesity, the UK government announced there would be a soft drinks industry levy (SDIL) on manufacturers of soft drinks to incentivize them to reduce the sugar content of drinks. What did the researchers do and find?: We tracked changes in the levels of obesity in children in England from reception (ages 4/5 years) and year 6 (ages 10/11 years) over time between 2014 and 2020. This analysis involved comparing obesity levels 19 months following the SDIL with predicted obesity levels had the SDIL not happened according to gender of the child and school's area level of deprivation. The UK SDIL was associated with an 8% relative reduction in obesity levels in girls aged 10/11 years, equivalent to prevention of 5,234 cases of obesity per year in girls aged 10/11 years, alone. Reductions were greatest in girls whose school was in the 40% most deprived areas. No associations were found between the SDIL and changes in obesity levels in boys aged 10/11 years or younger children aged 4/5. What do these findings mean?: Our findings suggest that the UK SDIL led to positive health impacts in the form of reduced obesity levels in girls aged 10/11 years. Further strategies are needed to reduce obesity prevalence in primary school children overall, and particularly in older boys and younger children. [ABSTRACT FROM AUTHOR]

A lack of fundamental motor skills (FMS) in the early years can lead to lower engagement with physical activity (PA), and track into adulthood. This study aimed to test the feasibility of an existing intervention for Early Years Educators ("Educators") designed to increase knowledge, confidence and the ability to increase PA and FMS of children in a deprived area of England. Non-randomised design with wait-list control. Sixty-seven settings in Middlesbrough, North East England were invited. Recruitment target: 10 settings, 2 Educators per setting, four children per Educator. Intervention: one-day training course "Physical Literacy in the Early Years", an age-appropriate theoretical and practical training course to support the development of physical literacy. Primary outcomes: recruitment, retention, acceptability of intervention and outcome measures. Secondary outcomes: change in Educators' knowledge, intentions and behaviour, and change in children's BMI z-score, PA and FMS. Eight settings were recruited; all Intervention Educators completed the training. Six settings participated at follow-up (four Intervention, two Control). The target for Educator recruitment was met (two per setting, total n = 16). Questionnaires were completed by 80% of Intervention Educators at baseline, 20% at follow-up. Control Educators completed zero questionnaires. No Educators took part in a process evaluation interview. Forty-eight children participated at baseline, 28 at follow-up. The intervention was deemed acceptable. The recruitment, retention and acceptability of measurements were insufficient to recommend proceeding. Additional qualitative work is needed to understand and surmount the challenges posed by the implementation of the trial. [ABSTRACT FROM AUTHOR]

Research has highlighted damaging contradictions in the responsibilisation of mothers over children's health, at once held responsible for tackling "childhood obesity" while being cautious not to encourage children to become obsessive with their bodies. While research has highlighted discourses of blame and elucidated mothers' experiences, less is known about how mothers negotiate discourse in their voiced accounts. Utilising Feminist Relational Discourse Analysis, this study analysed interviews with 12 mothers in England to explore their experiences of a nationally mandated BMI screening programme in schools and how discourses shape their voices and experiences. In negotiating complex and contradictory discourses of motherhood and fatness, participants expressed a "duty to protect" their children from both fatness and fatphobia. Negotiating these responsibilities left mothers feeling guilt at their personal "failure" to protect their children from one or both harms. Mothers did not take up these discourses unproblematically; they resisted them, yet felt constrained by "expert knowledges" of fatness and motherhood that had clear consequences in responsibilising mothers for the "harm" of fatness. This analysis calls attention to how dominant discourses function personally and politically to responsibilise mothers for the harm caused by state-sanctioned fatphobia. [ABSTRACT FROM AUTHOR]

Background: The UK government released Chapter 1 of the 'Childhood Obesity: a plan for action' (2016), followed by Chapter 2 (2018) and preliminary Chapter 3 was published for consultation in 2019 (hereon collectively 'The Policy'). The stated policy aims were to reduce the prevalence of childhood obesity in England, addressing disparities in health by reducing the gap (approximately two-fold) in childhood obesity between those from the most and least deprived areas.Methods: Combining a realist approach with an analysis of policy discourses, we analysed the policies using a social determinants of health (SDH) perspective (focusing on socio-economic inequalities). This novel approach reveals how the framing of policy 'problems' leads to particular approaches and interventions.Results: While recognising a social gradient in relation to obesity measures, we critique obesity problem narratives. The Policy included some upstream, structural approaches (e.g. restrictions in food advertising and the soft-drinks industry levy). However, the focus on downstream individual-level behavioural approaches to reduce calorie intake and increase physical activity does not account for the SDH and the complexity and contestedness of 'obesity' and pays insufficient attention to how proposals will help to reduce inequalities. Our findings illustrate that individualising of responsibility to respond to what wider evidence shows is structural inequalities, can perpetuate damaging narratives and lead to ineffective interventions, providing caution to academics, practitioners and policy makers (local and national), of the power of problem representation. Our findings also show that the problem framing in The Policy risks reducing important public health aims to encourage healthy diets and increase opportunities for physical activity (and the physical and mental health benefits of both) for children to weight management with a focus on particular children.Conclusions: We propose an alternative conceptualisation of the policy 'problem', that obesity rates are illustrative of inequality, arguing there needs to be policy focus on the structural and factors that maintain health inequalities, including poverty and food insecurity. We hope that our findings can be used to challenge and strengthen future policy development, leading to more effective action against health inequalities and intervention-generated inequalities in health. [ABSTRACT FROM AUTHOR]

Background The study aimed to evaluate the validity and spatial accuracy of the Food Standards Agency Food Hygiene Rating online data through a field audit. Methods A field audit was conducted in five Lower Layer Super Output Areas (LSOAs) in the North East of England. LSOAs were purposively selected from the top and bottom quintiles of the Index of Multiple Deprivation and from urban and rural areas. The FHRS data validity against the field data was measured as Positive Predictive Values (PPV) and sensitivity. Spatial accuracy was evaluated via mean difference in straight line distances between the FHRS coordinates and the field coordinates. Results In all, 182 premises were present in the field, of which 162 were in the FHRS data giving a sensitivity of 89%. Eight outlets recorded in the FHRS data were absent in the field, giving a PPV of 95%.The mean difference in the geographical coordinates of the field audit compared to the FHRS was 110 m, and <100 m for 77% of outlets. Conclusions After an evaluation of the validity and spatial accuracy of the FHRS data, the results suggest that it is a useful dataset for surveillance of the food environment and for intervention evaluation. [ABSTRACT FROM AUTHOR]

The article focuses on dealing with children with diabetes in the United Kingdom. Topics discussed include findings of the National Paediatric Diabetes Audit annual report 2020-2021, warning from Diabetes UK on the growing rates of obesity, and statement from registered dietitian Aisling Pigott, based in Cardiff, Wales.

Background Secondary schools are an important setting for preventing obesity in adolescence. Headteachers and chairs of governors are identified in national guidance as crucial stakeholders for school-based preventative action. Despite this, their views remain unexplored and unrepresented. Methods A sequential mixed method study was conducted. Semi-structured interviews were undertaken with a purposive sample of 22 secondary school headteachers and chairs of governors in England. Data were thematically analysed and informed the development of a descriptive cross-sectional survey, completed by 127 participants from the same population. Results Unhealthy dietary and sedentary behaviours were viewed as a more significant problem than adolescent obesity. Obesity was perceived as complex and multi-causal, and a range of stakeholders were deemed to have responsibility for its prevention, most notably parents. Support was identified for the role of secondary schools, although this was not an explicit priority and extensive internal and external barriers exist, which hinder preventative action. Conclusions Whilst secondary school settings in England remain an important setting for the prevention of adolescent obesity, it is crucial for policy makers and public health professionals to recognize the factors affecting school leaders' ability and willingness to contribute to this agenda. [ABSTRACT FROM AUTHOR]

Applying the Behavior Change Technique Taxonomy has the potential to facilitate identification of effective childhood obesity intervention components. This article evaluates the feasibility of coding Childhood Obesity Prevention and Treatment Consortium interventions and compares reliability between external taxonomy-familiar coders and internal intervention-familiar coders. After training, coder pairs independently coded prespecified portions of intervention materials. An adjudication process was used to explore coding discrepancies. Reliability between internal and external coders was moderate (prevalence and bias-adjusted kappa.38 to.55). Reliability for specific target behaviors varied with substantial agreement for physical activity (.63 to.76) and moderate for dietary intake (.44 to.63). Applying the taxonomy to these interventions was feasible, but agreement was modest. Coding discrepancies highlight the importance of refining coding to capture the complexities of childhood obesity interventions, which often engage multiple recipients (e.g., parents and/or children) and address multiple behaviors (e.g., diet, physical activity, screen time). [ABSTRACT FROM AUTHOR]

Objective: The National Child Measurement Programme (NCMP) is a mandatory initiative delivered in England to children in Reception and Year 6. To date, no research has explored the methods used to deliver the NCMP by Local Government Authorities (LGA) across England.Design: An online survey was administered between February 2018 and May 2018 to explore the delivery of the NCMP across the 152 LGA in England and disseminated using non-probability convenience sampling.Setting: LGA received an anonymous link to the survey.Participants: A total of 92 LGA participated in the survey.Results: Most LGA who responded provide result feedback (86 %), a proactive follow-up (71 %) and referrals to services (80 %). Additionally, 65 % of the authorities tailor Public Health England specimen result letters to suit their needs, and 84 % provide attachments alongside. Out of 71 % of LGA who provide proactive follow-up, 19 (29 %) provide the proactive follow-up only to upper weight categories and only 4 (6 %) include Healthy Weight category with other categories in proactive follow-up. Regarding the service availability for children, out of 80 % of LGA who indicated that services are available, 32 (43 %) targeted solely upper weight categories, while the other 42 (57 %) offered services across all weight categories. Finally, most LGA (88 %) commission providers to manage various parts of the NCMP.Conclusions: The results show that LGA in England localise the NCMP. Further guidance regarding standards of best practice would help LGA to find the most suitable localisation out of various options that exist across other LGA. [ABSTRACT FROM AUTHOR]

Objectives: For the effective treatment of childhood obesity, intervention attendance and behaviour change at home are both important. The purpose of this study was to qualitatively explore influences on attendance and behaviour change during a family‐based intervention to treat childhood obesity in the North West of England (Getting Our Active Lifestyles Started (GOALS)). Design: Focus groups with children and parents/carers as part of a broader mixed‐methods evaluation. Methods: Eighteen focus groups were conducted with children (n = 39, 19 boys) and parents/carers (n = 34, 5 male) to explore their experiences of GOALS after 6 weeks of attendance (/18 weeks). Data were analysed thematically to identify influences on attendance and behaviour change. Results: Initial attendance came about through targeted referral (from health care professionals and letters in school) and was influenced by motivations for a brighter future. Once at GOALS, it was the fun, non‐judgemental healthy lifestyle approach that encouraged continued attendance. Factors that facilitated behaviour change included participatory learning as a family, being accountable and gradual realistic goal setting, whilst challenges focussed on fears about the intervention ending and a lack of support from non‐attending significant others. Conclusions: Factors that influence attendance and behaviour change are distinct and may be important at different stages of the family's change process. Practitioners are encouraged to tailor strategies to support both attendance and behaviour change, with a focus on whole family participation within and outside the intervention. [ABSTRACT FROM AUTHOR]

Background: Over the last 10 years HENRY has been working to reduce and prevent child obesity by training health and early years professionals to deliver its evidence-based programme to parents. The aim and unique contribution of this study was to evaluate whether training volunteers to deliver this programme on a one-to-one basis was feasible.Methods: Mixed-methods service evaluation with parent-reported pre- and post-programme outcomes and focus groups conducted with parents and volunteer facilitators. The programme consisted of 8 one-to-one sessions delivered weekly by volunteers (n = 18) to build food and activity-related knowledge, skills, and understanding, and improve parenting efficacy, and parent and child eating and physical activity. Programmes took place at parent's (n = 69) home or local community venues in four London boroughs, United Kingdom. Parent-reported parenting efficacy, emotional wellbeing, eating, and physical activity data were captured, alongside parent ratings of the programme and volunteer ratings of the training. Parent and volunteer focus groups explored involvement, expectations, and experiences of the programme, training and delivery, feedback, and impact.Results: Parents were mostly female, had varied ethnic backgrounds, and were often not working but well educated. There were statistically significant improvements of a medium-to-large size in parent and child emotional wellbeing, parenting efficacy, fruit and vegetable consumption, family eating and food purchasing behaviours. Parent ratings of the programme were positive and qualitative data highlighted the holistic nature of the programme, which focused on more than just food, and the relationships with volunteers as key facets. Volunteers were also mostly female, had varied ethnic backgrounds, and were often well educated, but more likely to be employed than parents. Volunteers rated the training and delivery as useful in enabling them to deliver the programme confidently and for their own wellbeing. Despite finding some sessions challenging emotionally, volunteers reported positive family lifestyle improvements by parents and children and that the experience would be useful for future employment.Conclusions: It is feasible to recruit and train volunteers to deliver a structured preschool obesity prevention programme, which parents considered acceptable and enjoyable, with preliminary reports of parent and child benefits. [ABSTRACT FROM AUTHOR]

Early childhood is a critical time for growth and development, but diets of young children in England are not fully in line with dietary recommendations, and childhood obesity is a national and international concern. The importance of early years' settings in promoting healthy food choices and helping to prevent obesity has been highlighted, and the extension in entitlement to funded early education and childcare in England over recent years provides an opportunity to encourage more children to develop good eating habits. Food provision in early years' settings is required to be 'healthy, balanced and nutritious', and voluntary food and drink guidelines were published in 2012 to support settings in England to meet this requirement. However, since these guidelines were developed, revised Dietary Reference Values for energy, sugars and dietary fibre have been published. As part of the government's Childhood obesity: A plan for action, Public Health England commissioned the Children's Food Trust to produce example menus for early years' settings, to support provision of meals and snacks meeting current dietary recommendations. A multi‐sectoral external reference group was convened and advised on the protocol for developing two seasonal example menus, including revising the underpinning nutrient framework for 1‐4 year‐olds, and developing an appropriate framework for infants aged 6–12 months, as previous menus did not cater for this age group. This article describes the process of developing the example menus and associated guidance, which have since been published by HM Government, and offers recommendations for effective implementation. [ABSTRACT FROM AUTHOR]

Background: Evidence indicates that early life is critical for determining future obesity risk. A sharper policy focus on pregnancy and early childhood could help improve obesity prevention efforts. This study aimed to systematically identify and categorise policy levers used in England with potential to influence early life course (pregnancy, 0–5 years) and identify how these interface with energy balance behaviours. The objective is to identify gaps and where further policy actions could most effectively focus. Methods: A behavioural science approach was taken using the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW) framework. The key determinants of energy balance in the early years were identified from the Foresight Systems Map. Policy actions were scoped systematically from available literature, including any health or non-health policies which could impact on energy balance behaviours. Foresight variables and policy actions were considered in terms of COM-B and the BCW to determine approaches likely to be effective for obesity prevention and treatment. Existing policies were overlaid across the map of key risk factors to identify gaps in obesity prevention and treatment provision. Results: A wide range of policy actions were identified (n = 115) to address obesity-relevant risk factors. These were most commonly educational or guidelines relating to environmental restructuring (i.e. changing the physical or social context). Scope for strengthening policies relating to the food system (e.g. the market price of food) and psychological factors contributing to obesity were identified. Policies acted via all aspects of the COM-B model, but there was scope for improving policies to increase capability through skills acquisition and both reflective and automatic motivation. Conclusions: There is substantial policy activity to address early years obesity but much is focused on education. Scope exists to strengthen actions relating to upstream policies which act on food systems and those targeting psychological factors contributing to obesity risk. [ABSTRACT FROM AUTHOR]

Background: Geographical inequalities in overweight and obesity prevalence among children are well established in cross-sectional research. We aimed to examine how environmental area characteristics at birth are related to these outcomes in childhood.Methods: Anonymised antenatal and birth data recorded by University Hospital Southampton linked to school-measured weight and height data for children within Southampton, UK, were utilised (14,084 children at ages 4-5 and 5637 at ages 10-11). Children's home address at birth was analysed at the Lower and Middle layer Super Output Area (LSOA/MSOA) levels (areas with average populations of 1500 and 7000, respectively). Area-level indices (walkability, relative density of unhealthy food outlets, spaces for social interaction), natural greenspace coverage, supermarket density and measures of air pollution (PM2.5, PM10 and NOx) were constructed using ArcGIS Network Analyst. Overweight/obesity was defined as a body mass index (BMI; kg/m2) greater than the 85th centile for sex and age. Population-average generalised estimating equations estimated the risk of being overweight/obese for children at both time points. Confounders included maternal BMI and smoking in early pregnancy, education, ethnicity and parity. We also examined associations for a subgroup of children who moved residence between birth and outcome measurement.Results: There were mixed results between area characteristics at birth and overweight/obesity at later ages. MSOA relative density of unhealthy food outlets and PM10 were positively associated with overweight/obesity, but not among children who moved. LSOA greenspace coverage was negatively associated with the risk of being overweight/obese at ages 10-11 in all children (relative risk ratio 0.997, 95% confidence interval 0.995-0.999, p = 0.02) and among children who moved.Conclusions: Local access to natural greenspaces at the time of birth was inversely associated with becoming overweight or obese by age 10-11, regardless of migration. Increased access/protection of greenspace may have a role in the early prevention of childhood obesity. [ABSTRACT FROM AUTHOR]

Background Childhood psychotic symptoms have been associated with various psychiatric disorders in adulthood but their role as early markers of poor outcomes during the crucial transition to adulthood is largely unknown. Therefore, we investigated associations between age-12 psychotic symptoms and a range of mental health problems and functional outcomes at age 18. Methods Data were used from the Environmental Risk Longitudinal Twin Study, a nationally representative birth cohort of 2232 twins born in 1994–1995 in England and Wales, followed to age 18 with 93% retention. Childhood psychotic symptoms were assessed in structured interviews at age 12. At age 18, study members' mental health problems, functional outcomes, risky behaviors, and offending were measured using self-reports and official records. Results Children with psychotic symptoms (N = 125, 5.9%) were more likely to experience a range of mental health problems in young adulthood than children without such symptoms. They were also more likely to be obese, smoke cigarettes, be lonely, be parents, and report a lower quality of life, but not more likely to commit crimes. Childhood psychotic symptoms predicted these poor outcomes over and above other emotional and behavioral problems during childhood. Nevertheless, twin analyses indicated that these associations were largely accounted for by shared family factors. Conclusions Psychotic symptoms in childhood signal risk for pervasive mental health and functional difficulties in young adulthood and thus may provide a useful screen for an array of later problems. However, early psychotic symptoms and poor outcomes may be manifestations of shared environmental and genetic risks. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the feasibility and acceptability of the PhunkyFoods Programme, a primary school-based intervention to promote healthy nutrition and physical activity knowledge and behaviours to assess outcomes to inform a phase 3 trial. Methods: The cluster randomised feasibility trial recruited eight primary schools from the North of England. Elibility criteria included all primary schools in one town, excluding independent and special schools and schools that comprised of only key stage 2 pupils (years 3–6). Eight schools agreed to participate. Randomisation to intervention or control arms was in a 1:1 ratio. Intervention schools received PhunkyFoods over 17 months. Control schools continued with usual curriculum. Assessors were blinded to group assignment. Measures comprised of a Healthy Lifestyle Knowledge Questionnaire and Synchronised Nutrition and Activity Program to assess diet and physical activity, height, weight, and psychological wellbeing. Feasibility outcomes were recruitment, attrition rates, interviews with teaching staff, focus groups with pupils to explore the acceptability of outcome measures, implementation, intervention content, and programme fidelity. Results: Three hundred fifty-eight pupils, aged 6–9 years from eight schools were recruited at baseline (control n = 170, intervention n = 188); 337 (94.1%) at 6 months (control n = 163, intervention n = 181); and 331 (92.5%) at 18 months (control n = 152, intervention n = 179), and 6 pupils opted out. Trends in increased knowledge of healthy lifestyle behaviours, healthier eating, and liking of fruit and vegetables were reported in the intervention compared to the control group. Year 4 intervention pupils had significantly higher healthy balanced diet knowledge scores compared to control pupils, mean difference 5.1 (95% CI 0.1 to 10.1, p=0.05). At 18 months, the mean percentage of vegetables liked was higher (intervention 53.9% vs. 43.0% control). Similarly, percentage of fruits liked was also higher (intervention 76.9% vs. 67.2% control). Qualitative data showed that delivery of the intervention was feasible and acceptable to teachers and pupils. Lessons were learned to inform the phase 3 trial around the dietary assessment measure and timing of recruitment. Conclusions: Whilst the study was not powered to detect a definitive effect, results suggest a potential to increase knowledge of healthy lifestyle behaviours and dietary behaviours, suggesting that with minor changes, a phase 3 trial is likely to be deliverable. Trial registration: ISRCTN, ISRCTN15641330. Registered 8 May 2015—retrospectively registered, 10.1186/ISRCTN15641330 [ABSTRACT FROM AUTHOR]

Background We investigated differing trajectories of childhood obesity prevalence amongst English local authorities (LAs). Methods Data on prevalence of childhood obesity (BMI ≥ 95th centile) for Reception year and Year 6 for 150 LAs in England from 2006/07 to 2015/16 were obtained from the National Child Measurement Programme (NCMP). Latent class mixture modelling (LCCM) was used to identify classes of change in obesity prevalence. Results In Reception, most LAs showed little change across the period (Class 1; stable, moderate obesity prevalence;84%), with a smaller group with a high prevalence that fell thereafter (Class 2; high but falling obesity prevalence; 16%). In Year 6 we identified three classes: moderate obesity prevalence (Class 3; 43%); high and rising obesity prevalence (Class 2; 36%); and stable low obesity prevalence (Class 1; 21%). Greater LA deprivation and higher LA proportion of non-white ethnicity increased risk of being in Class 2 (Reception) or Class 2 or 3 (Year 6) compared with Class 1. Conclusions The prevalence of childhood obesity in LAs in England follow a small number of differing trajectories that are influenced by LA deprivation and ethnic composition. LAs following a stable low obesity trajectory for Year 6 are targets for further investigation. [ABSTRACT FROM AUTHOR]

School food provision is an important lever to shape the eating behaviours and dietary intake of school‐aged children and young people, and may help to address issues of childhood obesity, inadequate nutrient intakes and the widening gap of health inequalities. The regulation of school food has been an issue since the 1940s, with the challenges of developing a school food policy that supports health and wellbeing and that can be effectively translated in practice remaining to the present day. This paper examines changes to school food provision in England since the 1940s, with regard to the political structure and decisions made by each respective government. It considers the lessons learned from the development of school food policies over this period and possible ways to improve the standards of school food in the future. [ABSTRACT FROM AUTHOR]

Obesogenic environments and obesity: a comment on 'Are environmental area characteristics at birth associated with overweight and obesity in school-aged children? Keywords: Health geography; Obesity; Environment; Greenspace; Cohort study It is particularly important to consider these age groups of children given recent evidence from the English 2018/19 National Childhood Measurement Programme, which showed 9.7% of reception class children (aged 4-5 years) were obese, while the prevalence of obesity in year 6 children (aged 10-11 years) was 20.2% [[9]]. There continues to be growing interest in the environmental determinants of health outcomes and health behaviours. [Extracted from the article]

Objective: To test the impact of obesity on health and health care use in children, by the use of various methods to account for reverse causality and omitted variables.Data Sources/study Setting: Fifteen rounds of the Health Survey for England (1998-2013), which is representative of children and adolescents in England.Study Design: We use three methods to account for reverse causality and omitted variables in the relationship between BMI and health/health service use: regression with individual, parent, and household control variables; sibling fixed effects; and instrumental variables based on genetic variation in weight.Data Collection/extraction Methods: We include all children and adolescents aged 4-18 years old.Principal Findings: We find that obesity has a statistically significant and negative impact on self-rated health and a positive impact on health service use in girls, boys, younger children (aged 4-12), and adolescents (aged 13-18). The findings are comparable in each model in both boys and girls.Conclusions: Using econometric methods, we have mitigated several confounding factors affecting the impact of obesity in childhood on health and health service use. Our findings suggest that obesity has severe consequences for health and health service use even among children. [ABSTRACT FROM AUTHOR]

Background Childhood obesity is a serious public health issue. Understanding environmental factors and their contribution to weight gain is important if interventions are to be effective. Aims The purpose of this research was to assess the relationship between weight gain in children and accessibility of fast-food outlets. Methods A longitudinal sample of 1577 children was created using two time points from the National Child Measurement Programme in South Gloucestershire (2006/7 and 2012/13). A spatial analysis was conducted using a weighted accessibility score on the number of fast-food outlets within a 1-km network radius of each child’s residence to quantify access to fast food. Results The mean accessibility score for all children was 0.73 (standard deviation: 1.14). Fast-food outlets were more prevalent in areas of deprivation. A moderate association was found between deprivation score and accessibilty score (r = 0.4, P < 0.01). Children who had greater access to fast-food outlets were more likely (odds ratio = 1.89, P = 0.04) to gain significant weight (>50 percentile points) compared to children who had no access to fast-food outlets. Conclusions This paper supports previous research that fast-food outlets are more prevalent in areas of deprivation and presents new evidence on fast-food outlets as a potential contributor towards weight gain in mid-childhood. [ABSTRACT FROM AUTHOR]

Objective To undertake an analysis of National Child Measurement Programme (NCMP) data to quantify the obesity prevalence gap over time between children in primary schools in the most and least deprived areas of Doncaster. Study design The research design for this study was retrospective quantitative analysis of secondary data. Methods The study undertook secondary analysis of NCMP data on obesity prevalence in children in Reception Year and Year 6 in primary schools in Doncaster for the period 2006-2007 to 2014-2015. Data were combined into three 3-year periods (2006-2007 to 2008-2009; 2009-2010 to 2011-2012; and 2012-2013 to 2014-2015), and schools were grouped by deprivation based on the national Indices of Multiple Deprivation 2015. Analysis was undertaken to assess whether there is a difference in obesity prevalence for Reception Year and Year 6 children in schools in the most deprived areas compared with the least deprived (prevalence gap), over time. Results The difference in obesity prevalence between children attending schools in the most and least deprived areas has increased over time. For Reception Year children, the prevalence gap has widened from a difference of 1.01% higher in the most deprived schools in 2006-2007 to 2008-2009 to 3.64% higher in 2012-2013 to 2014-2015. In the same time periods, for Year 6 children, the obesity prevalence gap has also increased over time from 2.82% to 5.08%. Conclusions There is inequality in relation to obesity in primary school children in Doncaster with those in schools in the most deprived areas carrying the greatest burden. Research is needed to understand why the plateau seen nationally is not reaching the most deprived children. [ABSTRACT FROM AUTHOR]

Objectives: To describe the epidemiology of slipped capital femoral epiphysis (SCFE), to examine associations with childhood obesity and socioeconomic deprivation, and to explore factors associated with diagnostic delays.Design: Historic cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink and Hospital Episode Statistics.Setting: All contacts with healthcare services, including emergency presentations, outpatient appointments, inpatient admissions and primary care visits, within the UK National Health Service.Patients: All individuals <16 years old with a diagnosis of SCFE and whose electronic medical record was held by one of 650 primary care practices in the UK between 1990 and 2013.Main Outcome Measures: Annual incidence, missed opportunities for diagnosis and diagnostic delay.Results: Over the 23-year period the incidence remained constant at 4.8 (95% CI 4.4 to 5.2) cases per 100,000 0-16-year-olds. There was a strong association with socioeconomic deprivation. Predisease obesity was also strongly associated with SCFE; mean predisease z-score of body mass index was 1.43 (95% CI 1.20 to 1.68) compared with the UK reference mean. Diagnostic delays were common, with most children (75.4%) having multiple primary care contacts with relevant symptomatology, and those who presented with knee pain having significantly longer diagnostic delay (median 161 (IQR 27-278) days) than those with hip pain (20 (5-126)) or gait abnormalities (21 (7-72)).Conclusions: SCFE has a strong association with both area-level socioeconomic deprivation and predisease obesity. The majority of patients with SCFE are initially misdiagnosed and those presenting with knee pain are particularly at risk. [ABSTRACT FROM AUTHOR]

This study examined differences in children’s body mass index (BMI) and body fatness (BF%) as a function of gender and fundamental movement skill (FMS) proficiency. Following ethics approval and parental consent, 248, 6–11 year-old children (112 boys, 136 girls) underwent assessment of 7 FMS: sprint run, side gallop, hop, kick, catch, throw and vertical jump. FMS tertiles (“high”, “medium” or “low” FMS) were created based on the summed components of the FMS. Skinfold measures were used to calculate BF%. Physical activity (PA) was assessed using pedometry and maturation predicted using anthropometry. Data were analysed using a 2 (Gender) × 3 (FMS tertile) ways analysis of covariance (ANCOVA), controlling for age, maturation and PA. Age (P = .001) and maturation (P = .006) were associated with BMI. Girls classified as high FMS proficiency had significantly lower BMI compared to girls with low and medium FMS proficiency. Age (P = .0001) and maturation (P = .007) were associated with BF%. BF% was also higher for girls with low FMS compared to those with medium and high FMS. BF% and BMI were not different across FMS tertile in boys. Such findings suggest focusing on FMS may be especially important for healthy weight, particularly in girls. [ABSTRACT FROM PUBLISHER]

There is initial evidence that beliefs about the eating behaviour of others (perceived eating norms) can influence children's vegetable consumption, but little research has examined the mechanisms explaining this effect. In two studies we aimed to replicate the effect that perceived eating norms have on children's vegetable consumption, and to explore mechanisms which may underlie the influence of perceived eating norms on children's vegetable consumption. Study 1 investigated whether children follow perceived eating norms due to a desire to maintain personal feelings of social acceptance. Study 2 investigated whether perceived eating norms influence eating behaviour because eating norms provide information which can remove uncertainty about how to behave. Across both studies children were exposed to vegetable consumption information of other children and their vegetable consumption was examined. In both studies children were influenced by perceived eating norms, eating more when led to believe others had eaten a large amount compared to when led to believe others had eaten no vegetables. In Study 1, children were influenced by a perceived eating norm regardless of whether they felt sure or unsure that other children accepted them. In Study 2, children were most influenced by a perceived eating norm if they were eating in a novel context in which it may have been uncertain how to behave, as opposed to an eating context that children had already encountered. Perceived eating norms may influence children's eating behaviour by removing uncertainty about how to behave, otherwise known as informational social influence. [ABSTRACT FROM AUTHOR]

Schools are seen as important contributors to obesity prevention, yet face barriers in fulfilling this function. This qualitative study investigates headteacher views on the primary school role in preventing obesity. Semi-structured interviews were held with 22 headteachers from ethnically and socio-economically diverse schools in the West Midlands, UK. Data analysis was conducted using the framework approach. Two over-arching categories were identified: 'School roles and responsibilities' and 'Influencing factors'. Participants agreed that although schools contribute towards obesity prevention in many ways, a moral responsibility to support children's holistic development was the principal motivator, rather than preventing obesity per se. The perceived impact on learning was a key driver for promoting health. Parents were believed to have the main responsibility for preventing obesity, but barriers were identified. Whilst headteachers recognized the advantageous position of schools in offering support to parents, opinion varied on the degree to which schools could and should take on this role. Headteachers serving more deprived areas reported adopting certain responsibilities that elsewhere were fulfilled by parents, and were more likely to view working with families on healthy lifestyles as an important school function. Several factors were perceived as barriers to schools doing more to prevent obesity, including academic pressure, access to expert support and space. In conclusion, school leaders need more support, through resources and government policy, to enable them to maximize their role in obesity prevention. Additionally, school-based obesity prevention should be an integral part of the education agenda rather than bolt-on initiatives. [ABSTRACT FROM AUTHOR]

Background: Movement behaviours performed over a finite period such as a 24 h day are compositional data. Compositional data exist in a constrained simplex geometry that is incongruent with traditional multivariate analytical techniques. However, the expression of compositional data as log-ratio co-ordinate systems transfers them to the unconstrained real space, where standard multivariate statistics can be used. This study aimed to use a compositional data analysis approach to examine the adiposity and cardiorespiratory fitness predictions of time reallocations between children's daily movement behaviours. Methods: This study used cross-sectional data from the Active Schools: Skelmersdale study, which involved Year 5 children from a low-income community in northwest England (n = 169). Measures included accelerometer-derived 24 h activity (sedentary time [ST], light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and sleep), cardiorespiratory fitness determined by the 20 m shuttle run test, objectively measured height, weight and waist circumference (from which zBMI and percent waist circumference-to-height ratio (%WHtR) were derived) and sociodemographic covariates. Log-ratio multiple linear regression models were used to predict adiposity and fitness for the mean movement behaviour composition, and for new compositions where fixed durations of time had been reallocated from one behaviour to another, while the remaining behaviours were unchanged. Predictions were also made for reallocations of fixed durations of time using the mean composition of three different weight status categories (underweight, normal-weight, and overweight/obese) as the starting point. Results: Replacing MVPA with any other movement behaviour around the mean movement composition predicted higher adiposity and lower CRF. The log-ratio model predictions were asymmetrical: when time was reallocated to MVPA from sleep, ST, or LPA, the estimated detriments to fitness and adiposity were larger in magnitude than the estimated benefits of time reallocation from MVPA to sleep, ST or LPA. The greatest differences in fitness and fatness for reallocation of fixed duration of MVPA were predicted at the mean composition of overweight/obese children. Conclusions: Findings reinforce the key role of MVPA for children's health. Reallocating time from ST and LPA to MVPA in children is advocated in school, home, and community settings. [ABSTRACT FROM AUTHOR]

Background: This study investigated the association of travel mode to school and non-school destinations with objectively assessed health markers and physical activity in an ethnically diverse sample of inner-city UK schoolchildren.Methods: We used data from the Camden Active Spaces project (n = 450 children aged 9.1 yrs) to examine associations of school travel mode and frequency of active travel to non-school destinations with daily and out-of-school physical activity, sedentary time and health markers; whilst controlling for appropriate covariates including objectively measured route length.Results: High frequency of active travel to non-school destinations was associated with more time in moderate-to-vigorous physical activity during out-of-school periods (3.8, 0.8-6.9 min/d) and greater out-of-school (738, 197.4-1278.6 steps/d) and daily step counts (588.1, 51.6-1124.6 steps/d). No associations were observed between school travel mode, health outcomes and activity levels.Conclusion: High frequency of active travel to non-school destinations is associated with higher levels of physical activity. These findings highlight the contribution of travel to non-school destinations to overall physical activity levels in schoolchildren. [ABSTRACT FROM AUTHOR]

Almost 20% of children in England are living with obesity by the end of primary school, with marked and growing inequalities driven by increasing prevalence in more deprived areas. Neighbourhood environments are upstream determinants of childhood weight status. Cultural, Environmental and Planning (CEP) services delivered by local authorities (LAs) in England include various services that contribute to these local environments, e.g. leisure centres, parks, playgrounds, libraries, community safety and environmental protection. Children in deprived areas potentially benefit most from the provision of these universal services. Spending on CEP services has been cut dramatically over the past decade, especially in more deprived areas. Given the potential link between these services and childhood obesity, we examined whether recent cuts in LA spending on CEP services are associated with trends and inequalities in obesity. We compiled annual data (2009–2017) on CEP spending in 324 LAs in England, from Ministry of Housing, Communities and Local Government reports. Obesity prevalence data for Year 6 children were obtained from the National Child Measurement Programme, for LAs and Middle-layer Super Output Areas (MSOAs). Following descriptive and pooled OLS analyses, we used fixed effects panel regression to estimate associations between CEP spending and obesity prevalence, within LAs over time, adjusting for potential confounding by local economic conditions and spending on other public services. Final models included an interaction term between area deprivation (2015 IMD) and year to account for differential background trends in obesity across deprivation levels. We tested for effect modification by deprivation and, using MSOA-level obesity data, explored associations between spending and within-LA obesity inequalities. In unadjusted pooled OLS analyses, areas with higher CEP spending had higher prevalence of obesity, reflecting the strong social gradient in childhood obesity and the higher levels of central government funding allocated to more deprived areas. Deprivation, other spend, and local economic conditions explained this relationship. In the fixed effects analysis, designed to isolate average within-area change in obesity associated with changing spend, we observed a 0.10 percentage point increase in obesity prevalence for each 10% reduction in spend (95%CI: 0.04,0.15; p < 0.001), but this disappeared after accounting for differential background trends in obesity across deprivation levels (−0.02; 95%CI: 0.07,0.03; p = 0.39). Similar results were observed for obesity inequalities, although sensitivity analyses suggest spending on Environmental Services in particular may affect inequalities in urban local authorities. CEP spending levels may influence local childhood obesity risk, but the increasing prevalence and widening inequalities in obesity of the past decade seem to have been driven mainly by factors other than CEP spending cuts, that are also unevenly distributed across deprivation levels. The influence of specific services might be obscured by grouping CEP services for analysis. • Spending on Cultural, Environmental and Planning services in England has been cut. • This may be linked to rising childhood obesity and widening inequalities. • Longitudinal ecological analysis of 324 local authorities to examine relationship. • Cuts to CEP services not a dominant driver of recent trends in child obesity. • True influence of some specific services may be obscured by data limitations. [ABSTRACT FROM AUTHOR]

Background: Lean mass is positively associated with bone mineral density (BMD). However, the relationship between adiposity and BMD is more controversial. In particular, it is unclear if the observational association between the two reflects a causal effect of fat mass on BMD. Previous Mendelian randomization (MR) studies using variants in the FTO and MC4R genes as genetic instruments for adiposity have suggested that fat mass does indeed causally influence BMD. However, it is possible that these genetic variants pleiotropically influence lean mass and affect BMD through pathways independent of adiposity, invalidating one of the core assumptions of MR and complicating interpretation of the analysis.Methods: To investigate whether adiposity causally affects BMD, we investigated the relationship between fat mass and BMD at the skull (SK), upper limbs (UL) and lower limbs (LL), spine (SP) and pelvis (PE), using 32 body mass index (BMI)-associated SNPs, including a variant near ADCY3 that was strongly associated with fat but not lean mass in our sample. Dual-energy X-ray absorptiometry (DXA) scans and genetic data were available for 5221 subjects (mean age 9.9 years) from the Avon Longitudinal Study of Parents and Children. We performed a series of MR analyses involving single BMI-associated SNPs and allelic scores of these SNPs. We used new extensions of the MR method including MR Egger regression and multivariable MR, which are more robust to possible confounding effects due to horizontal pleiotropy and, in the case of multivariable MR, specifically account for the effect of lean mass in the analysis. Bidirectional Mendelian randomization analysis was also performed to examine whether BMD causally affected BMI and adiposity.Results: Observationally, fat mass was strongly positively related to BMD at all sites, but more weakly at the skull. Instrumental variables (IV) analyses using an allelic score of BMI SNPs suggested that fat mass was causally related to LL-BMD, UL-BMD, SP-BMD and PE-BMD but not SK-BMD. Multivariable MR, Egger regression and IV analyses involving the ADCY3 variant suggested a positive causal effect of adiposity on all sites except the skull, and that an effect was present even after taking lean mass into account. Finally, IV analyses using BMD allelic scores showed no evidence of reverse causality between BMD and fat mass.Conclusions: Our results suggest that adiposity is causally related to increased BMD at all sites except the skull, perhaps reflecting positive effects of loading on bone formation at weighted but not unweighted sites. In contrast, we found no evidence for BMD causally affecting BMI or measures of adiposity. Our results illustrate how MR can be used profitably to investigate clinical questions relevant to osteoporosis. [ABSTRACT FROM AUTHOR]

Background A growing body of evidence suggests that childhood overweight may have its roots in early life. This study aimed to explore patterns of weight in children from birth to 40 months, born between 1994 and 2006, in Halton, Northwest England. Methods Halton infants were compared with the UK-90 reference population at four time points (birth, 2 months, 8 months and 40 months) by converting heights and weights into age--sex adjusted SD scores. The mean and SD of Halton SD scores were calculated for each time point and sex. Cohort trends and gender differences in rates of children above the 85th and 95th centiles at each time point were tested for using Poisson regression modelling. Results A total of 16 381 births were analysed. At birth, 8 months and 40 months, proportions of Halton children above the 85th and 95th centiles were consistently higher than reference data. Proportions above the 85th and 95th centiles at birth did not change significantly year on year, but for all other time points the proportions increased with subsequent cohorts. Conclusions This study may provide evidence that the development of overweight and obesity has its roots in very early life and has highlighted patterns of infant overweight and obesity not previously reported. [ABSTRACT FROM AUTHOR]