Cluster Randomised Controlled Feasibility Study of HENRY; a Community Based Intervention Aimed at Reducing School Entry Obesity Rates

Background:

Childhood obesity impacts physiological and psychological health that tracks into adulthood; increasing risk of morbidity and mortality [1, 2]. It incurs significant costs on the UK economy, with an expected 7-fold increase in related NHS costs by 2020, and forecasted £2 billion annual spend by 2030[3]. Tackling obesity is a key NHS public health priority, with government strategies aimed at reversing the trend of rising childhood obesity levels to return to those of 2000. Whilst treating obesity remains a priority, there are compelling arguments to prevent its onset. Establishing healthy behaviours in early childhood is critical for optimum growth and development [4]. Further, poor eating patterns developed early can persist and are associated with chronic diseases in adulthood (e.g. cardiovascular disease, type-2-diabetes [5]). Once established, obesity is difficult to reverse[6]; strengthening the case for primary prevention[7]. Early preventive interventions are therefore essential to impact the health of our children now and in the future [8].

Interventions aimed at treating obesity report inconsistent results [9-11, 6, 12, 13], though there is agreement that multi-component interventions, especially those engaging parents have a greater impact [14, 6]. Proposed research involves an independent evaluation of an existing preschool obesity prevention intervention. The HENRY programme was developed in 2007 with Department of Health and Department for Education support and is currently delivered across the UK by approximately 35 Local Authorities providing ~190 courses/year. Over 10,000 families have already participated. It is delivered in the community, predominantly by Children's Centre staff [15]. HENRY uses a responsive approach to provide practical guidance and improve parenting skills, aimed at enhancing family homes and Children's Centre environments. These are intervention targets that are consistent with recent literature in childhood obesity. Preliminary data indicates that HENRY may be effective at reducing childhood obesity and improving family health [15] although evidence to date has not compared findings with parents who have not attended HENRY; thus, further robust evaluation using a RCT design is needed to confirm its effectiveness. A good deal of public money has already been used to develop and commission HENRY and it is essential to demonstrate clear benefits of the programme before further funding. Given the uncertainties associated with recruiting local authorities, service providers and Children's Centres, it is necessary to conduct research in advance of a definitive multi-site trial. The models of commissioning and delivering HENRY are complex and vary by location. In some instance, HENRY is commissioned by local authorities and delivered by existing Centre staff. In others, Children's Centres are tendered to external service providers (e.g. Barnardo's) who are responsible for commissioning programmes such as HENRY. This study will assess feasibility of the planned recruitment rate at the authority, Centre and parent level and ensure competence of programme delivery; in addition to providing vital information for calculation of the sample size for the future trial. A future trial will be used to offer commissioners an evidence based intervention, tested in Children's Centres in the UK and to provide much needed evidence on the effectiveness of early obesity prevention in primary care settings.

Aim:

The feasibility study aims to determine the feasibility of undertaking a full trial to evaluate the clinical effectiveness of the HENRY programme in preventing childhood obesity.