Assessment 1c MEND Evaluation

Fagg et al. 2014- From trial to population: a study of a family-based community intervention for childhood overweight implemented at scale

Upton et al. 2012- The effectiveness of local child weight management programmes: an audit study

Kolotourou et al. 2015- Long-Term Outcomes following the MEND 7–13 Child Weight Management Program

Sacher et al 2012- Randomized Controlled Trial of the MEND Program: A Family‐based Community Intervention for Childhood Obesity

Means at Baseline.

Baseline and 6 months after finishing programmes.

Largest programme, biggest coverage and most resources.

Compared 7 different child weight management family-based intervention programmes in the West Midlands

Largest decreases in waist circumference, BMI S.D., BMI and weight loss.

Limited evidence of the long-term effectiveness of these models.

Random Subsample of children who attended the programmes

Study Design

Results

Random subsample of 165 children who attended MEND in London. Community settings under MEND conditions(not for research)

Baseline to 2.4 years after finishing programme.

Additional info

MEND was free for families and had funding from many places including National Lottery.

Baseline measurements were part of the MEND standardised control background during the participants first session

Intervention content and training was provided following standardized procedures.

MEND is delivered by a wide range of health, physical activity and social care professionals, community practitioners who had no previous expertise in the management of pediatric obesity and had never delivered a MEND Program were given training.

An uncontrolled pre-follow-up (2.4 years) design

Follow ups were in public venues, family homes

This wasn't part of the standard MEND 7–13 service

Psychometric measures was sent to all participants in advance. Height, weight, and waist circumference were measured by the research team during measurement sessions and home visits.

Measurements

Rosenberg’s Self-Esteem Scale used with children

All measurements were done correctly and by professionals

Body esteem was assessed using Mendelson’s Body Esteem Scale

Strengths and Difficulties Questionnaire for parents emotional distress

Boys

Girls

53% of participants were male, 47% female

90% were obese.

Age= 10.3 years (±1.8),

37% of children were white, 63% of ethnic background

36% belonged to single-parent families, 64% both parents

31% of parents were unemployed, 69% had jobs

52% owned their home, 48% of families did not

No physical improvements

Improved self-esteem

Could be down to puberty

Psychological improvments

Improved BMI, Waist Circumference and Weight maintanence

Adoption and implementation of these interventions at scale might be associated with loss of effectiveness

obesogenic environments may moderate the effects of interventions

Also measured if family and neighbourhood affected biological and psychosocial outcomes.

Results

Of 21,132 families, 8,127 were involved in the research

Might widen existing ethnic and socioeconomic inequalities in childhood overweight and psychosocial outcomes. Need to make it more specific to different groups

effective in reducing BMI of obese children at 6 months from baseline

compare changes in BMI under service conditions with those observed under research conditions

Between 2007 and 2010, the MEND 7–13 intervention was implemented on a large scale, with MEND programmes (hereafter ‘programmes’) rolled out across all regions of England. The intervention was delivered by local community-based‘ delivery partner’ organisations

Measurements

Rosenberg’s Self-Esteem Scale used with children

All measurements were done correctly and by professionals

Body esteem was assessed using Mendelson’s Body Esteem Scale

Strengths and Difficulties Questionnaire for parents emotional distress

implemented at scale and under service conditions, was associated with improvements in BMI and in psychosocial outcomes.

Participants were given a free 12-week family pass, 32% of families used this on average five times.

Results

Mean attendance for the program was 86%.

116 children
60 children in intervention, 54 started and completed MEND. 37 of the 60 were seen at 6 months and 50 were seen at either 6 or 12 months.
56 control group.

Conducted between Jan 2005 and Jan 2007. 5 different areas.

6 months

12 months

Control group didn't change.

waist circumference and BMI were significantly less in the intervention than the control group (−4.1 cm and −1.2 kg/m2),

reductions in waist circumference and BMI. Less adipose, increased cardiovascular health and psychological well‐being.

More physically active, reduced sedentary activities and were fitter. Indicated by the reduction in recovery heart rate following the 3‐min step test, lower BP.

Matches or exceeds results from other treatment trials, 4 times the average

Strengths

acceptability to families

multicentre delivery

consistent session delivery

use of multiple health markers

Limitations

short follow-up time limits conclusions about the long‐term effects of the intervention.

Results suggest MEND is a promising intervention to obesity problem in children. Further research needed to measure the effectiveness on a larger scale using methods.

RE-AIM

Adoption – The total number settings and intervention agents (people who deliver the program) who are willing to use the program. E.G. How do I develop organizational support to deliver my intervention?

 Implementation –Do the people who adopted the intervention, deliver it in a reliable way, using the intervention’s protocol, including consistency of delivery as intended and the time and cost of the intervention. At the individual level, implementation refers to clients’ use of the intervention strategies. E.G. How do I ensure the intervention is delivered properly?

Effectiveness– The impact of the intervention on vital outcomes, including potential negative effects, quality of life, and economic outcomes. E.G. How do I know my intervention is effective?

Maintenance –The long-term effects of a program on outcomes after 6 or more months after the most recent intervention contact. E.G. How do I incorporate the intervention so that it is delivered over the long term?

Reach – The total number of individuals who were initially willing to participate in the intervention. E.G. How do I reach the targeted population with the intervention?