title: From trial to population: a study of a family-based community intervention for childhood overweight implemented at scale.
abstract: OBJECTIVE
  To assess how outcomes associated with participation in a family-based weight management intervention (MEND 7-13, Mind, Exercise, Nutrition..Do it!) for childhood overweight or obesity implemented at scale in the community vary by child, family, neighbourhood and MEND programme characteristics.
  
  
  METHODS
  Intervention evaluation using prospective service level data. Families (N=21,132) with overweight children are referred, or self-refer, to MEND. Families (participating child and one parent/carer) attend two sessions/week for 10 weeks (N=13,998; N=9563 with complete data from 1788 programmes across England). Sessions address diet and physical activity through education, skills training and motivational enhancement. MEND was shown to be effective in obese children in a randomised controlled trial (RCT). Outcomes were mean change in body mass index (BMI), age- and sex-standardised BMI (zBMI), self-esteem (Rosenberg scale) and psychological distress (Strengths and Difficulties Questionnaire) after the 10-week programme. Relationships between the outcome and covariates were tested in multilevel models adjusted for the outcome at baseline.
  
  
  RESULTS
  After adjustment for covariates, BMI reduced by mean 0.76 kg m(-2) (s.e.=0.021, P<0.0001), zBMI reduced by mean 0.18 (s.e.=0.0038, P<0.0001), self-esteem score increased by 3.53 U  (s.e.=0.13, P<0.0001) and psychological distress score decreased by 2.65 U (s.e.=0.31, P<0.0001). Change in outcomes varied by participant, family, neighbourhood and programme factors. Generally, outcomes improved less among children from less advantaged backgrounds and in Asian compared with white children. BMI reduction under service conditions was slightly but not statistically significantly less than in the earlier RCT.
  
  
  CONCLUSIONS
  The MEND intervention, when delivered at scale, is associated with improved BMI and psychosocial outcomes on average, but may work less well for some groups of children, and so has the potential to widen inequalities in these outcomes. Such public health interventions should be implemented to achieve sustained impact for all groups.
authors.affiliation: Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Fagg
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Chadwick
authors.affiliation: Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK.
authors.forename: T J
authors.identifier: 0000000157118200
authors.initials: TJ
authors.lastname: Cole
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Cummins
authors.affiliation: 1] Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK [2] Centre for Multilevel Modelling, University of Bristol, Bristol, UK.
authors.forename: H
authors.initials: H
authors.lastname: Goldstein
authors.affiliation: Psychosocial and Family Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Lewis
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Morris
authors.affiliation: Carnegie Faculty, Leeds Metropolitan University, Leeds, UK.
authors.forename: D
authors.initials: D
authors.lastname: Radley
authors.affiliation: Childhood Nutrition Research Centre, Institute of Child Health, University College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Sacher
authors.affiliation: Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Law
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003256:Community Participation; D004032:Diet; D019317:Evidence-Based Medicine; D015444:Exercise; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D015397:Program Evaluation; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012649:Self Concept; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D015431:Weight Loss; D061217:Weight Reduction Programs