Great Ormond Street Institute of Child Health, University College London, London, UK.
Great Ormond Street Institute of Child Health, University College London, London, UK.
Lancet Public Health. 2023 Nov;8(11):e878-e888. doi: 10.1016/S2468-2667(23)00216-5.
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.
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.
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).
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.
UK National Institute for Health and Care Research.
系统提供肥胖治疗对肥胖的影响尚不清楚。我们旨在根据英格兰儿童和年轻人的体重或健康状况，评估系统地为合格儿童提供预防和治疗干预措施对儿童肥胖患病率的潜在影响。
为了进行这项建模研究，我们利用英格兰健康调查中多年的数据（该调查于 2010 年 1 月 1 日至 2019 年 12 月 31 日进行），建立了英格兰儿童和年轻人的横断面模拟模型。通过年龄、BMI 和医疗并发症来评估个体的合格性。体重状况是根据英国国家卫生与保健卓越研究所使用的临床标准来定义的。使用发表的系统评价来估计每个体重管理层次的治疗、参与和完成的效果大小。我们使用了所有可用的证据，包括显示不利影响的研究证据。我们估计了两种系统方法的效果：一种是分阶段的方法，即同时为符合条件的儿童和年轻人提供最有效的治疗方法；另一种是逐步的方法，即依次应用每个管理层次，并具有附加效果。主要结果是估计临床肥胖的流行率，定义为 UK90 生长图表上的 BMI≥98 百分位，与估计的基线流行率相比的差异。
在分析样本中纳入了 18080 名儿童和年轻人。估计 2-18 岁儿童和年轻人的临床肥胖症患病率基线为 11.2%（95%CI 10.5 至 11.8）。在建模中，我们估计普遍的预防干预措施可使肥胖症的患病率绝对降低 0.9%（95%CI 0.1 至 1.8）；初级保健环境中的干预措施可使肥胖症的患病率绝对降低 0.2%（0.1 至 0.4）；社区和生活方式干预措施可使肥胖症的患病率绝对降低 1.0%（0.1 至 2.1）；药物干预措施可使肥胖症的患病率绝对降低 0.2%（0.0 至 0.4）；手术干预措施可使肥胖症的患病率绝对降低 0.4%（0.1 至 0.7）。分阶段护理估计会使肥胖症的患病率绝对降低 1.3%（-0.3 至 2.4），而逐步护理估计会使肥胖症的患病率绝对降低 2.4%（0.1 至 4.8）。
尽管预防和治疗干预措施的个别效果大小较小，但在英格兰大规模实施时，这些干预措施有可能显著有助于降低儿童肥胖症的患病率。
英国国家卫生与保健卓越研究所。
