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Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study)

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k211 (Published 07 February 2018) Cite this as: BMJ 2018;360:k211

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Re: Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study)

The WAVES trial results are disappointing but sadly not surprising, to us. We have also just reported a large (1250 children) school-based trial aimed at preventing excess weight gain in 9-10 year olds which reported no change in anthropometric or physical activity behaviours at two year follow up (1). However, unlike Zwolinsky et al, we are less optimistic about the potential of school-based interventions to affect weight status; Similar to WAVES, the Healthy Lifestyles Programme was a theoretically informed programme, based on the best available evidence and also had considerable input from teachers, children and families to ensure it was feasible and acceptable across the socioeconomic spectrum. Both Programmes sought to affect both the school and the family environment, although for HeLP all of the parental activities were conducted through the school, with no activities linked to the wider community. The process evaluation of HeLP showed that the programme was delivered with very high fidelity both in terms of content and quality of delivery with 100% of the activities being delivered in all intervention schools and 93% of children receiving the Programme; this, and our 94% follow up at 24 months, allows us to be confident that the Healthy Lifestyles Programme did not affect overweight or obesity. Qualitative data from schools, children and their families showed that the Programme was valued by teachers and head-teachers and children and their families engaged with the Programme across the socioeconomic spectrum (2).

We believe that there is now considerable evidence from three, well-conducted school-based obesity prevention trials (1,3,4) in England, none of which were able to affect weight status or obesity related behaviours, to suggest that different approaches are needed to change children’s behaviours. Whilst schools are attractive locations for obesity prevention programmes, this is not their core business and therefore intensive involvement of the family and community within a school-based programme is unlikely to be feasible. Even if it were possible for such an intensive programme to be delivered in schools, we agree with the conclusion from Adab et al (3) that without affecting the wider environment which drives choices and behaviours, preventing childhood overweight and obesity will remain a major challenge for researchers and commissioners.

1. Lloyd J, Creanor S, Logan S, Green C, Dean SG, Hillsdon M, et al. Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial. Lancet Child Adolesc Health. 2018;2(1):35-45.
2. Lloyd J, Dean S, Creanor S, Abraham C, Hillsdon M, Ryan E, et al. Intervention fidelity in the definitive cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP) trial: findings from the process evaluation. Int J Behav Nutr Phys Act. 2017;14(1):163.
3. Adab P, Pallan MJ, Lancashire ER, Hemming K, Frew E, Barrett T, et al. Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). BMJ. 2018;360.
4. Kipping RR, Howe LD, Jago R, Campbell R, Wells S, Chittleborough CR, et al. Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: active for Life Year 5 (AFLY5) school based cluster randomised controlled trial. BMJ. 2014;348:g3256.

Competing interests: No competing interests

21 February 2018
Jenny J Lloyd
Senior Research Fellow in Health Complexity and Child Health
Professor Katrina Wyatt
University of Exeter Medical School
St Luke's Campus, Exeter