Evaluation of activ8: the effectiveness of a joint dietetic and physiotherapy weight management group intervention in children and adolescents

Background:  With the prevalence of overweight and obesity in the under 18 s on the rise, there are increasing numbers of weight management programmes offering treatment within and outside of the NHS, however only a few are formally evaluated (Aicken et al., 2008). Activ8 is a 6-week community based group intervention targeting overweight and obese children aged between 5 and 18 years. The course consists of weekly 1-h sessions that combine game based physical activities and nutritional education sessions. The aim of this study was to evaluate the effect of the Activ8 intervention on anthropometry and body composition. Methods:  Routinely collected data was pooled from all children attending Activ8 during 2009. Information recorded included gender, date of birth and measurements for weight, height and body fat percentage (%BF), measured using bioelectrical impedance analysis. Patients with only a single measurement, missing birth date and attending siblings under the 91st percentile for BMI for age were excluded. The prevalence of co-morbidities such as type 2 diabetes and sleep apnoea were not assessed. Statistical analysis was carried out using SPSS comparing anthropometric and body compositional variables before and after attendance and examining the effect of age and gender on outcomes. Ethical approval was received from the Research Ethics Review Panel of the London Metropolitan University prior to the commencement of data collection. Results:  In 2009, 15 courses were organised. Of the 133 children starting, 70 completed the course. All but two of the participants were clinically obese at the start of the course (mean BMI centile = 99.69 (0.60). Mean age was 10.62 (2.97) years. Girls represented 52.9% of the sample, whilst 86.7% were from ethnic minority backgrounds. The results indicated that at the end of the intervention average absolute BMI decreased by −0.29 kg m−2 (SD = 0.49, P = 0.000, CI = 95%), which remained significant when converted to z-scores and percentiles. Whilst %BF decreased on average by −0.79%, this did not reach statistical significance (SD = 2.43, P = 0.080, CI = 95%). Reduction in z-BMI, but not absolute BMI or BMI centile, was significantly greater (P = 0.046) in boys compared with girls. Some differences in outcomes stratified by age were also observed with the younger age groups achieving significantly greater reductions in absolute BMI (P = 0.003), z-BMI (P = 0.000) and BMI centile (P = 0.009). No significant differences were observed according to age group or gender in the reduction of %BF. Discussion:  The results are in line with the findings of other, similar interventions (Oude Luttikhuis et al., 2009). In line with NICE guidelines, the results indicate that Activ8 appears to be successful in achieving a decrease in adiposity as indicated by BMI, at least in the short term. Whether these results are sustained should be examined in a longer-term follow up study. It is recommended that the reasons behind the relatively high drop out and low uptake rates should be investigated through the adoption of a robust evaluation process. Conclusion:  This audit of Activ8 has shown that it compares favourably to similar interventions, however further studies are required to evaluate long term efficacy, to eliminate the possible confounding effect of factors such as ethnicity and co morbidities and to strengthen the quality of the evidence by the use of randomisation and a control group. References:  Aicken, C., Arai, L. & Roberts, H. (2008) Schemes to Promote Healthy Weight Amongst Obese and Overweight Children in England. London: Evidence for Policy and Practice Information Centre, Social Science Research Unit, Institute of Education, University of London. Luttikhuis, H.O. et al. (2009) Interventions for Treating Obesity in Children. Cochrane Database Syst. Rev.3, 1–57.