title: Shared care obesity management in 3-10 year old children: 12 month outcomes of HopSCOTCH randomised trial.
abstract: OBJECTIVE
  To determine whether general practice surveillance for childhood obesity, followed by obesity management across primary and tertiary care settings using a shared care model, improves body mass index and related outcomes in obese children aged 3-10 years.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  22 family practices (35 participating general practitioners) and a tertiary weight management service (three paediatricians, two dietitians) in Melbourne, Australia.
  
  
  METHODS
  Children aged 3-10 years with body mass index above the 95th centile recruited through their general practice between July 2009 and April 2010.
  
  
  METHODS
  Children were randomly allocated to one tertiary appointment followed by up to 11 general practice consultations over one year, supported by shared care, web based software (intervention) or "usual care" (control). Researchers collecting outcome measurements, but not participants, were blinded to group assignment.
  
  
  METHODS
  Children's body mass index z score (primary outcome), body fat percentage, waist circumference, physical activity, quality of diet, health related quality of life, self esteem, and body dissatisfaction and parents' body mass index (all 15 months post-enrolment).
  
  
  RESULTS
  118 (60 intervention, 56 control) children were recruited and 107 (91%) were retained and analysed (56 intervention, 51 control). All retained intervention children attended the tertiary appointment and their general practitioner for at least one (mean 3.5 (SD 2.5, range 1-11)) weight management consultation. At outcome, children in the two trial arms had similar body mass index (adjusted mean difference -0.1 (95% confidence interval -0.7 to 0.5; P=0.7)) and body mass index z score (-0.05 (-0.14 to 0.03); P=0.2). Similarly, no evidence was found of benefit or harm on any secondary outcome. Outcomes varied widely in the combined cohort (mean change in body mass index z score -0.20 (SD 0.25, range -0.97-0.47); 26% of children resolved from obese to overweight and 2% to normal weight.
  
  
  CONCLUSIONS
  Although feasible, not harmful, and highly rated by both families and general practitioners, the shared care model of primary and tertiary care management did not lead to better body mass index or other outcomes for the intervention group compared with the control group. Improvements in body mass index in both groups highlight the value of untreated controls when determining efficacy.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12608000055303.
authors.affiliation: Royal Children's Hospital, Parkville VIC 3052, Australia. melissa.wake@rch.org.au
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
authors.forename: Kate
authors.initials: K
authors.lastname: Lycett
authors.forename: Susan A
authors.initials: SA
authors.lastname: Clifford
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Sabin
authors.forename: Jane
authors.initials: J
authors.lastname: Gunn
authors.forename: Kay
authors.initials: K
authors.lastname: Gibbons
authors.forename: Cathy
authors.initials: C
authors.lastname: Hutton
authors.forename: Zoë
authors.initials: Z
authors.lastname: McCallum
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Arnup
authors.forename: Gary
authors.initials: G
authors.lastname: Wittert
mesh_terms: D001315:Australia; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005194:Family Practice / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D009043:Motor Activity; D009096:Multi-Institutional Systems / Q000458:organization & administration / Q000706:statistics & numerical data; D015596:Nutrition Assessment; D009765:Obesity / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011788:Quality of Life; D012649:Self Concept; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055105:Waist Circumference; D061217:Weight Reduction Programs / Q000379:methods / Q000706:statistics & numerical data