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Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial

Wake, Melissa, Baur, Louise A, Gerner, Bibi, Gibbons, Kay, Gold, Lisa, Gunn, Jane, Levickis, Penny, McCallum, Zoe, Naughton, Geraldine, Sanci, Lena and Ukoumunne, Obioha C 2009, Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial, BMJ, vol. 339, no. 32, pp. 1-8.

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Title Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial
Author(s) Wake, Melissa
Baur, Louise A
Gerner, Bibi
Gibbons, Kay
Gold, Lisa
Gunn, Jane
Levickis, Penny
McCallum, Zoe
Naughton, Geraldine
Sanci, Lena
Ukoumunne, Obioha C
Journal name BMJ
Volume number 339
Issue number 32
Start page 1
End page 8
Publisher B M J Group
Place of publication London, England
Publication date 2009-09-03
ISSN 0959-535X
1468-5833
Summary Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children.

Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment.

Setting 45 family practices (66 general practitioners) in Melbourne, Australia.

Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score 3.0) were excluded.

Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials.

Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI.

Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention – control) at 6 and 12 months were, for BMI, –0.12 (95% CI –0.40 to 0.15, P=0.4) and –0.11 (–0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (–4 to 52, P=0.09) and 11 (–26 to 49, P=0.6); and, for nutrition score, 0.2 (–0.03 to 0.4, P=0.1) and 0.1 (–0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm.

Conclusions Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia.
Notes This article has been published in the BMJ : Wake, Melissa, Baur, Louise A, Gerner, Bibi, Gibbons, Kay, Gold, Lisa, Gunn, Jane, Levickis, Penny, McCallum, Zoe, Naughton, Geraldine, Sanci, Lena and Ukoumunne, Obioha C 2009-09-03, Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial, BMJ, vol. 339, no. 32, pp. 1-8, and can also be viewed on the journal’s website at www.bmj.com
Language eng
Field of Research 111704 Community Child Health
Socio Economic Objective 920501 Child Health
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
HERDC collection year 2009
Copyright notice ©2009, BMJ Group
Persistent URL http://hdl.handle.net/10536/DRO/DU:30019513

Document type: Journal Article
Collections: School of Health and Social Development
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.