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World Obesity Day and spotlight on childhood obesity

Today is World Obesity Day (11th October) – an annual campaign seeking to stimulate and support practical actions that will help people achieve and maintain a healthy weight and reverse the global obesity crisis. The campaign was first launched in 2015 by the World Obesity Federation, the federation representing organisations dedicated to solving the issue of obesity.

The CHErIsH study is an example of a multi-component intervention that seeks to support and promote healthy infant feeding practices among parents and primary caregivers. Research on the feasibility of CHErIsH is continuing at the Mallow Primary Healthcare Centre in Co. Cork and the findings from this research should be available early next year. A key focus of and the primary impetus for CHErIsH is to help reduce the risk of childhood overweight and obesity.

The issue of childhood obesity has received particular attention in recent days and weeks with the publication of two key reports to coincide with World Obesity Day. The first is the Atlas of Childhood Obesity, published by the World Obesity Federation earlier this month. The global atlas presents data for 191 countries (including Ireland) based on their current and predicted levels of obesity in children, the risk factors and the presence of government policies to tackle obesity. The report highlights the need for greater progress and government action in this area, indicating that no country has a better than 50 percent chance of meeting their target for tackling childhood obesity.

The second publication is an independent report by former UK Chief Medical Officer, Professor Sally Davies – entitled Time to Solve Childhood Obesity. Published this week, the hard-hitting report once again highlights the lack of government action in tackling the issue of childhood obesity. The report outlines key principles that should underpin further action in this area, with a particular focus on primary prevention – including shaping environments to ensure that children eat healthier and are more active. A BMJ opinion piece published on the same day offers further commentary on this report, conceding that a radical increase in both the breadth and intensity of actions to tackle childhood obesity is required if we are to halve its prevalence by 2030.

These reports underline the seriousness of the childhood obesity issue, which is estimated to increase by 100 million worldwide by 2030 among school-age children and adolescents, unless substantial interventions are implemented to prevent and treat childhood obesity.  

CHErIsH is a novel intervention that seeks to promote healthy infant feeding, viewing early feeding as a critical window in which parents or caregivers can reduce the risk of childhood obesity and overweight. The CHErIsH team is committed to helping to stem the rise of childhood overweight and obesity, as part of the global and multi-faceted efforts to address this critical issue. On World Obesity Day, CHErIsH would like to thank all its stakeholders, including its primary care partner, for their commitment and efforts in helping to design and implement this multi-component intervention, and the team looks forward to sharing the findings of its latest research.

Note: The World Obesity Federation has announced that, from next year, World Obesity Day will move to 4th March. It states that the new World Obesity Day 2020 will focus on changing the narratives around obesity globally in coordination with national and regional efforts.

CHErIsH feasibility study protocol now published

The CHErIsH team is happy to announce that the protocol for its feasibility study has now been published on BMJ Open and is available to view online.

The protocol provides a description of the non-randomised feasibility study for this infant feeding intervention and the accompanying implementation strategy. This feasibility study is currently underway at the Mallow Primary Healthcare Centre.

Well done to the CHErIsH team on this latest publication. The protocol is available to view at: https://bmjopen.bmj.com/content/bmjopen/9/8/e029607.full.pdf

European Obesity Day takes place this week

This week marks European Obesity Day (18th May), an annual awareness day which seeks to highlight Europe’s growing obesity problem and the need for better prevention and treatment in this area.

The campaign, which is an initiative of the European Association for the Study of Obesity (EASO), was first held in 2010 and continues to generate awareness and support across 32 European countries. To mark the campaign, a wide range of events are being held throughout Europe this week, including free health check-ups and healthy eating advice, walks and runs to encourage exercise, open days at hospitals and treatment centres, and training and information for healthcare providers.

Maintaining the focus on the need to address obesity is crucial given the extent and impact of this global problem. The World Health Organization (WHO) cites obesity as one of the greatest public health challenges of the 21st century, with its prevalence almost tripling since the mid-1970s. Regarding childhood overweight/obesity, an estimated 41 million children under the age of 5 years were living with overweight/obesity in 2016. In Ireland, as many as one in four Irish children is now considered to be affected by overweight/obesity, and evidence suggests that these children are more likely to remain overweight/obese into adulthood.

The CHErIsH project is committed to addressing childhood overweight/obesity through its ongoing research and interventions in the area of early infant feeding. Early infant feeding practices are known to play a role in the risk of overweight/obesity in later childhood and adult life.

A feasibility study examining the implementation of a multi-component intervention seeking to improve early infant (aged 0–2 years) feeding practices is currently underway, and the CHErIsH team looks forward to updating stakeholders on the outcomes of this important research.

To coincide with European Obesity Day, the Association for the Study of Obesity in Ireland (ASOI) is also hosting its annual conference and AGM this week (17th-18th May). The conference will feature leading national and international experts in the field. Oral presentations will include a discussion by Dr Sharleen O’Reilly on barriers and enablers to successful extended breastfeeding in women with high BMIs, and a presentation by Marita Hennessy on obesity prevention during the first 1,000 days.  

CHErIsH launch receives coverage in local media

The CHErIsH team were delighted to receive great coverage of their recent launch event in the local media.

The launch event, which took place at the Mallow Primary Healthcare Centre (MPHC) last month, attracted considerable media attention, with articles and photographs appearing in the local Mallow Star newspaper as well as The Corkman newspaper. 

Article on CHErIsH launch in Corkman newspaper

Local photographer Seán Jefferies was also on hand on the day to take a collection of photos featuring members of the CHErIsH team and practitioners and staff from MPHC who will be involved in rolling out the intervention. These include Dr Tony Heffernan, a GP from MPHC who is leading the intervention, and the CHErIsH Principal Investigator, Professor Patricia Kearney from UCC’s School of Public Health, both of whom launched the event.

Article in Mallow Star newspaper
GPs from MPHC attending the event

Coverage of the event also appeared in the latest edition of EPI News – the newsletter of the School of Public Health at UCC. The CHErIsH team are grateful to all those who attended on the day and for the excellent coverage received.

CHErIsH launch features in latest edition of EPINews at School of Public Health, UCC

Next phase of CHErIsH study gets underway this month

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The CHErIsH (Choosing Healthy Eating for Infant Health) team are delighted to be commencing the next phase of their HRB-funded research on a pioneering intervention aimed at promoting healthy early infant feeding practices in primary care. This next phase seeks to explore the feasibility of the intervention, which will begin at the state-of-the-art Mallow Primary Healthcare Centre (MHPC) – one of the leading centres for primary healthcare in Ireland.

To mark the beginning of this exciting new phase of research, a special launch event was organised by the CHErIsH team at its feasibility site in Mallow. The event, held last week on Tuesday 12th March, featured a ‘launch lunch’, which was attended by healthcare practitioners (GPs and nurses) from the MPHC who will be involved in rolling out the intervention. Launching the event was Professor Patricia Kearney from the School of Public Health at UCC, who is Principal Investigator for the study, and Dr Tony Heffernan, a GP at the MPHC who is leading the study. Also attending the launch were members of the CHErIsH team – Dr Elaine Toomey from NUIG and Dr Caragh Flannery, Dr Kate O’Neill and Susan Calnan from UCC’s School of Public Health.

The feasibility study marks the latest phase of development and implementation of the CHErIsH intervention, which has been designed by a team of researchers from UCC, NUIG and Trinity College Dublin (TCD) – in partnership with practitioners at the MPHC, led by Dr Heffernan, the HSE Nurture Programme, and parents and primary caregivers from the CHErIsH public and patient involvement group. The multi-component intervention seeks to improve early infant (aged 0–2 years) feeding practices, such as breastfeeding and the introduction of solid foods, to improve health outcomes and reduce the risk of overweight and obesity in childhood and later life.

Speaking about this latest phase of the research, CHErIsH team member, Dr Elaine Toomey of NUIG, commented: ‘We are so delighted to be at this exciting stage of the CHErIsH study. It’s been a real honour to have worked so closely with the excellent team in Mallow and the HSE Nurture programme, to develop something that we think has the potential to make a valuable contribution to child health. We are really looking forward to learning as much as we can from this testing to inform the next steps of research’.  

Results from the study will help to determine the feasibility of the intervention, which will informing further testing to determine the effectiveness of the intervention in other primary care sites. The CHErIsH team look forward to updating readers on more news about this pioneering intervention over the coming months.

By Susan Calnan

 

‘Exploring intervention fidelity in trials of interventions to change infant feeding behaviours – are we testing what we think we’re testing?’

CHErIsH researcher Dr Elaine Toomey has recently written a blog post for the SPHeRE (Structured Population and Health-Services Research Education) programme on one of the CHErIsH study research papers.

Find the original blog here, or read on below:

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The first two years of life represent an important stage in a child’s development. In particular, how and what a child is fed during this time has an important influence on their subsequent development. For example, infant feeding behaviours such as the early or inappropriate introduction of solid foods into a child’s diet have been associated with the later development of childhood obesity [1, 2]. Childhood obesity is an urgent global concern, with serious health, economic and social implications both for the individual and the wider health system. Therefore infant feeding behaviours represent a potential target for the prevention of childhood obesity and a worthwhile focus for behaviour change intervention research.

To date, studies have found that the effectiveness of infant feeding interventions to prevent childhood obesity to be somewhat variable and inconsistent [3, 4]. However, little is known about the actual implementation of the interventions within these trials, and the ‘fidelity’ with which they were put into practice. Intervention fidelity refers to the extent to which an intervention is actually implemented as intended by the researchers who designed it [5]. For example, are all aspects of the intervention delivered by the providers as planned? Do participants actually attend or engage with the intervention, do they receive or use intervention materials or resources as intended? Intervention fidelity is an important methodological aspect of behavioural studies, as without knowledge of intervention fidelity we are only really assuming that the intended intervention is being tested.

In a recent systematic review [6], we explored the use and reporting of different strategies to enhance and assess intervention fidelity within trials of infant feeding interventions delivered by healthcare professionals to prevent childhood obesity. We also explored the associations between fidelity score and study quality, intervention effectiveness and publication year. Using a systematic search strategy we identified 10 trials represented in 16 papers. Across these studies, the average use and/or reporting of strategies to enhance (e.g. training manuals/protocols) and/or assess intervention fidelity (e.g. delivery checklists) was moderate (54%), ranging from 28.9% to 76.7%. No patterns were observed between levels of fidelity reporting/use and study quality, effectiveness or publication year. Interestingly, although six studies reported using a method to assess fidelity of intervention delivery, only 2 studies explicitly reported the results of this fidelity assessment.

The moderate use/reporting of fidelity strategies within trials of infant feeding interventions identified in our review suggest that previous findings of inconsistent effectiveness may not fully reflect the intended interventions. As a result, our study identified a number of recommendations that could improve the methodological quality of future trials of infant feeding interventions, to ensure that these trials are a more accurate test of the intervention in question. These include 1) ensuring adequate focus on how intervention providers are trained and the knowledge and skills needed to deliver the intervention as intended, 2) ensuring adequate focus on the fidelity of treatment within comparator or control groups and 3) ensuring better reporting across all aspects of fidelity, in particular the results of fidelity assessments. In doing so, improved intervention fidelity will facilitate better interpretation and understanding of the findings of such trials, and provide more information to support the translation of successful interventions into policy and practice.

 

  1. Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM: Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review. Am J Prev Med. 2016;50:761-779.
  2. Pluymen LPM, Wijga AH, Gehring U, Koppelman GH, Smit HA, van Rossem L: Early introduction of complementary foods and childhood overweight in breastfed and formula-fed infants in the Netherlands: the PIAMA birth cohort study. Eur J Nutr. 2018;57:1985-1993.
  3. Matvienko-Sikar K, Toomey E, Delaney L, Harrington J, Byrne M, Kearney PM: Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review. Appetite. 2018;123:56-71.
  4. Redsell SA, Edmonds B, Swift JA, Siriwardena AN, Weng S, Nathan D, Glazebrook C: Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood. Maternal & Child Nutrition. 2016;12:24-38.
  5. Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, Ogedegbe G, Orwig D, Ernst D, Czajkowski S: Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2004;23:443-451.
  6. Toomey E, Matvienko-Sikar K, Heary C, Delaney L, Queally M, B Hayes C, M Kearney P, Byrne M, Choosing Healthy Eating for Infant Health study t: Intervention Fidelity Within Trials of Infant Feeding Behavioral Interventions to Prevent Childhood Obesity: A Systematic Review. Annals of Behavioral Medicine. 2018:kay021-kay021

Fresh faces in CHErIsH!

Lots of changes and new updates for the CHErIsH study team over the last while! Our wonderful CHErIsH post-docs Dr Michelle Queally and Dr Karen Matvienko-Sikar have both taken up new positions and will continue to work on CHErIsH in an advisory capacity. Michelle has started a post-doctoral research position with CÚRAM, the Centre for Research in Medical Devices working on recruitment to clinical trials, while Karen will be starting her HRB Applying Research into Policy and Practice fellowship in January 2019! We wish them both the best of luck in their new endeavours and will be looking forward to hearing their updates!
Coming onto the CHErIsH team, we are delighted to welcome Dr Kate O’Neill and Dr Caragh Flannery! Kate has a background in Public Health and Health Promotion, Epidemiology and Health Economics, and will join us to work with Michelle on our health economics evaluation. Kate recently passed her viva under the supervision of Prof Patricia Kearney and Dr Sheena McHugh in UCC. Kate’s PhD, which focused on the cost of diabetes in Ireland in 2013. Caragh recently passed her viva under the supervision of Prof Molly Byrne in NUI Galway. Caragh was part of the HRB SPHeRE PhD programme in Population Health and Health Service Research and her PhD focused on health behaviour change in the area of pregnancy and gestational diabetes.
We are so thrilled to have such a growing team with fantastic expertise. CHErIsH is currently in the third phase of development and will be starting to explore the feasibility of the intervention with our partners in the Mallow Primary Healthcare Centre in the upcoming months. Watch this space for more project updates coming soon! 🙂