Shared care obesity management in 3-10 year old children: 12 month outcomes of HopSCOTCH randomised trial
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3092 (Published 10 June 2013) Cite this as: BMJ 2013;346:f3092
- Melissa Wake, paediatrician123,
- Kate Lycett, research assistant23,
- Susan A Clifford, research officer2,
- Matthew A Sabin, paediatric endocrinologist123,
- Jane Gunn, professor4,
- Kay Gibbons, dietitian12,
- Cathy Hutton, general practitioner4,
- Zoë McCallum, paediatrician13,
- Sarah J Arnup, biostatistician2,
- Gary Wittert, professor5
- 1Royal Children’s Hospital, Parkville VIC 3052, Australia
- 2Murdoch Childrens Research Institute, Parkville VIC 3052, Australia
- 3University of Melbourne, Parkville VIC 3052, Australia
- 4Department of General Practice, University of Melbourne, Parkville VIC 3052, Australia
- 5Discipline of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
- Correspondence to: M Wake, Centre for Community Child Health, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Australia melissa.wake{at}rch.org.au
- Accepted 8 May 2013
Abstract
Objective To determine whether general practice surveillance for childhood obesity, followed by obesity management across primary and tertiary care settings using a shared care model, improves body mass index and related outcomes in obese children aged 3-10 years.
Design Randomised controlled trial.
Setting 22 family practices (35 participating general practitioners) and a tertiary weight management service (three paediatricians, two dietitians) in Melbourne, Australia.
Participants Children aged 3-10 years with body mass index above the 95th centile recruited through their general practice between July 2009 and April 2010.
Intervention Children were randomly allocated to one tertiary appointment followed by up to 11 general practice consultations over one year, supported by shared care, web based software (intervention) or “usual care” (control). Researchers collecting outcome measurements, but not participants, were blinded to group assignment.
Main outcome measures Children’s body mass index z score (primary outcome), body fat percentage, waist circumference, physical activity, quality of diet, health related quality of life, self esteem, and body dissatisfaction and parents’ body mass index (all 15 months post-enrolment).
Results 118 (60 intervention, 56 control) children were recruited and 107 (91%) were retained and analysed (56 intervention, 51 control). All retained intervention children attended the tertiary appointment and their general practitioner for at least one (mean 3.5 (SD 2.5, range 1-11)) weight management consultation. At outcome, children in the two trial arms had similar body mass index (adjusted mean difference −0.1 (95% confidence interval −0.7 to 0.5; P=0.7)) and body mass index z score (−0.05 (−0.14 to 0.03); P=0.2). Similarly, no evidence was found of benefit or harm on any secondary outcome. Outcomes varied widely in the combined cohort (mean change in body mass index z score −0.20 (SD 0.25, range −0.97-0.47); 26% of children resolved from obese to overweight and 2% to normal weight.
Conclusions Although feasible, not harmful, and highly rated by both families and general practitioners, the shared care model of primary and tertiary care management did not lead to better body mass index or other outcomes for the intervention group compared with the control group. Improvements in body mass index in both groups highlight the value of untreated controls when determining efficacy.
Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000055303.
Footnotes
We thank all the children and parents; paediatrician Michele Campbell and dietitian Elisha Matthews who, along with MAS, KG, and ZM, provided the specialist weight management service; general practitioners and practice staff; and research assistants Louise Canterford, Megan Mathers, Caroline Bambrick, Natalie de Bono, Melissa Bourchier, Fari Koeman, and Elissa York. We also gratefully acknowledge the input and support of Pen Computer Systems and Michael Stringer of Knowsys in developing, deploying, and managing the shared care software.
Contributors: MW, JG, KG, GW, and MAS conceived HopSCOTCH, obtained funding, and directed the study. SC carried out the analyses with SA. MW, SC, and KL wrote the paper, with critical input from the other authors. MW is the guarantor.
Funding: HopSCOTCH was funded by the Australian National Health and Medical Research Council (NHMRC Priority Driven Research Grant 491212). MW was part funded by NHMRC Population Health Career Development Grants 284556 and 546405 and MAS by NHMRC Professional Training Fellowship 1012201. Murdoch Childrens Research Institute is supported by the Victorian Government’s Operational Infrastructure Support Program.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: MW, KL, MAS, JG, KG, CH, ZM, SC, and GW have support from the Australian National Health and Medical Research Council (NHMRC) for the submitted work; no relationships with any companies that might have an interest in the submitted work in the previous three years; no non-financial interests that may be relevant to the submitted work.
Ethical approval: The project was approved by the Royal Children’s Hospital Ethics in Human Research Committee (HREC 280178) and the University of Melbourne Human Research Ethics Committee (0827435).
Data sharing: No additional data available.
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