Background

The effects of the systematic delivery of treatments for obesity are unknown. We aimed to estimate the potential effects on the prevalence of childhood obesity of systematically offering preventive and treatment interventions to eligible children in England, based on weight or health status.

Methods

For this modelling study, we developed a cross-sectional simulation model of the child and young adult population in England using data from multiple years of the Health Survey of England conducted between Jan 1, 2010, and Dec 31, 2019. Individuals were assessed for eligibility via age, BMI, and medical complications. Weight status was defined based on clinical criteria used by the UK National Institute of Health and Care Excellence. Published systematic reviews were used to estimate effect sizes for treatments, uptake, and completion for each weight-management tier. We used all available evidence, including evidence from studies that showed an unfavourable effect. We estimated the effects of two systematic approaches: a staged approach, in which children and young people were simultaneously given the most intensive treatment for which they were eligible, and a stepped approach, in which each management tier was applied sequentially, with additive effects. The primary outcomes were estimated prevalence of clinical obesity, defined as a BMI ≥98th centile on the UK90 growth chart, and difference in comparison with the estimated baseline prevalence.

Findings

18 080 children and young people were included in the analytical sample. Baseline prevalence of clinical obesity was estimated to be 11·2% (95% CI 10·5 to 11·8) for children and young people aged 2–18 years. In modelling, we estimated absolute decreases in the prevalence of obesity of 0·9% (95% CI 0·1 to 1·8) for universal, preventive interventions; 0·2% (0·1 to 0·4) for interventions within a primary-care setting; 1·0% (0·1 to 2·1) for community and lifestyle interventions; 0·2% (0·0 to 0·4) for pharmaceutical interventions; and 0·4% (0·1 to 0·7) for surgical interventions. Staged care was estimated to result in an absolute decrease in the prevalence of obesity of 1·3% (–0·3 to 2·4) and stepped care was estimated to lead to an absolute decrease of 2·4% (0·1 to 4·8).

Interpretation

Although individual effect sizes for prevention and treatment interventions were small, when delivered at scale across England, these interventions have the potential to meaningfully contribute to reducing the prevalence of childhood obesity.

Funding

UK National Institute for Health and Care Research.

中文翻译：

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估计预防和体重管理干预措施对英格兰儿童肥胖患病率的影响：一项模型研究

背景

系统性肥胖治疗的效果尚不清楚。我们的目的是评估根据体重或健康状况向英格兰符合条件的儿童系统地提供预防和治疗干预措施对儿童肥胖患病率的潜在影响。

方法

在这项建模研究中，我们利用 2010 年 1 月 1 日至 2019 年 12 月 31 日期间进行的英格兰健康调查多年的数据，开发了英格兰儿童和年轻人口的横断面模拟模型。通过年龄、体重指数和医疗并发症来确定资格。体重状况是根据英国国家健康与护理卓越研究所使用的临床标准定义的。已发表的系统评价用于估计每个体重管理层级的治疗、摄取和完成的效果大小。我们使用了所有可用的证据，包括来自显示不利影响的研究的证据。我们评估了两种系统方法的效果：一种是分阶段方法，其中儿童和青少年同时接受他们符合资格的最强化治疗；另一种是阶梯方法，其中每个管理层依次应用，具有累加效应。主要结局是临床肥胖的估计患病率（定义为 UK90 生长图表上 BMI ≥ 98%），以及与估计基线患病率相比的差异。

发现

分析样本包括 18 080 名儿童和青少年。2-18 岁儿童和青少年的临床肥胖基线患病率估计为 11·2%（95% CI 10·5 至 11·8）。在建模中，我们估计，通过普遍的预防性干预措施，肥胖患病率绝对下降了 0·9%（95% CI 0·1 至 1·8）；初级保健机构内的干预措施为 0·2%（0·1 至 0·4）；1·0%（0·1 至 2·1）用于社区和生活方式干预；0·2%（0·0 至 0·4）用于药物干预；手术干预为 0·4%（0·1 至 0·7）。据估计，分阶段护理可导致肥胖患病率绝对下降 1·3%（–0·3 至 2·4），而分阶段护理估计可导致肥胖患病率绝对下降 2·4%（0·1至 4·8)。

解释

尽管预防和治疗干预措施的个体效应较小，但在英格兰范围内大规模实施时，这些干预措施有可能为降低儿童肥胖症的患病率做出有意义的贡献。

资金

英国国家健康与护理研究所。