title: Evaluating the transferability of a hospital-based childhood obesity clinic to primary care: a randomised controlled trial.
abstract: BACKGROUND
  The Care Of Childhood Obesity (COCO) clinic at the Bristol Royal Hospital for Children (BRHC) uses a multidisciplinary approach comprising a consultant, dietitian, and exercise specialist. The clinic has demonstrated efficacy in managing children's weight but similar clinics are scarce in the UK.
  
  
  OBJECTIVE
  This pilot randomised controlled trial (RCT) aimed to examine the feasibility of undertaking a fully powered RCT and to gauge whether the COCO model could be effective as a nurse-led clinic in primary care settings.
  
  
  METHODS
  Patients were randomised to a hospital-based childhood obesity clinic or a nurse-led clinic in a primary care setting in south-west England.
  
  
  METHODS
  Children aged 5-16 years with a body mass index (BMI) ≥98th centile were referred by GPs to the consultant in charge of the COCO clinic at BRHC. Referred children were clinically screened for suitability and invited into the study. Consenting families were randomised to BRHC or a primary care clinic (PCC) and offered five appointments over 12 months. Clinical effectiveness was measured by change in body mass index standard deviation score (BMI SDS) at 12 months. Other measures included: treatment adherence, quality of life (QOL), and satisfaction. Feasibility was examined by assessing referral, screening, and recruitment data.
  
  
  RESULTS
  A total 152 patients were referred by GPs: 31 (20%) were screened out; 45 (30%) declined to participate. Seventy-six (50%) patients were randomised and 68 provided baseline data (PCC = 42; BRHC = 26); 52 provided outcome data (PCC = 29; BRHC = 23). Mean change in BMI SDS was PCC -0.17 (95% confidence interval [CI] = -0.27 to -0.07); BRHC -0.15 (95% CI = -0.26 to -0.05). QOL, adherence, and satisfaction data indicated similar positive patterns in both trial arms.
  
  
  CONCLUSIONS
  Screening and recruitment data indicate that primary care is a clinically appropriate setting and acceptable to families. The primary clinical outcome measure (reduction in BMI SDS), along with secondary outcome measures, indicate that primary care has the potential to be effective in providing weight management for children, using the COCO model.
authors.affiliation: Academic Unit of Primary Health Care, School of Social and Community Medicine, University of Bristol, Bristol.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Banks
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Sharp
authors.forename: Linda P
authors.initials: LP
authors.lastname: Hunt
authors.forename: Julian P H
authors.initials: JP
authors.lastname: Shield
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004032:Diet; D004739:England; D005081:Exercise Therapy; D005240:Feasibility Studies; D058006:General Practice / Q000458:organization & administration / Q000592:standards*; D006266:Health Education; D006760:Hospitalization; D006801:Humans; D009765:Obesity / Q000451:nursing / Q000628:therapy*; D010349:Patient Compliance; D017060:Patient Satisfaction; D010360:Patient Transfer / Q000592:standards*; D011788:Quality of Life; D016896:Treatment Outcome