620 Development of a national framework for clinics to treat Complications Related to Excess Weight (CEW). (17th August 2022)

• Record Type: Journal Article
• Authors: Stilwell, Philippa; Solti, Sophie; Graham, Catherine; Brandreth, Rachael; Owen, Richard; Mitchell, Raziya; Kenny, Simon
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A343
• Page End: A344
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.554
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: The NHS Long Term Plan (2019) committed to treat a further 1, 000 children a year for severe complications related to their obesity in order to prevent children going on to require more invasive treatment in future. The objectives of this work were to: Explore the evidence base to support the development of a framework outlining the ideal model of care for treating children and young people (CYP) with comorbidities related to severe obesity; Develop clinics across England to meet the Long Term Plan commitment of treating 1, 000 extra children a year; Develop a core outcome set of metrics to develop the evidence base around the patient demographic and understand what works in terms of service provision. Methods: From 2019 – 2021, a literature review of tier 3 weight management services was conducted in order to better understand the existing evidence-base for optimal service design. In areas where the evidence base was weak, subject matter experts were consulted. Existing commissioning arrangements for obesity services across the whole patient pathway (tier 1 to 4) were mapped. Finally, a national Delphi process was run amongst three stakeholder groups (physical health, mental health and patient voice) in order to seek consensus regarding a core outcome set. Results: In 2021, a Framework for clinics to treat complications related to excess weight (CEW) was finalised, outlining a biopsychosocial model, delivered by a multi-disciplinary team. The Delphi process identified provisional physical and mental health outcomes to evaluate the clinics (body profile, glucose tolerance, blood pressure, lipid profile, obstructive sleep apnoea, identification of whether there is an underlying cause for the obesity, non-alcoholic fatty liver disease and idiopathic intracranial hypertension, anxiety, depression, self-esteem, quality of life and school attendance). Conclusion: The Framework was used by national and regional commissioners to develop an expression of interest. In 2021 15 centres 1 across 7 NHS regions were selected to pilot clinics, and are currently preparing to start seeing patients. With over a million CYP now living with obesity, the CEW clinics are not designed to provide the solution to the obesity epidemic but will address the important problem of related disease in a minority of these children, and reduce burden on other paediatric specialties currently treating CEW who may lack the capacity/skill-sets to address lifestyle change. Specialist teams with inter-disciplinary input from dietetics, social care, psychology and others will offer holistic care to this vulnerable cohort. The service evaluation will support in understanding whether there is an optimal approach nationally. 1 1) Derriford Hospital, 2) Southampton University Hospitals, 3) Kent and Medway CCG, 4) East London (King's College London Hospital and Bart's Health NHS Trust), 5) West London (Great Ormond Street Hospital, University College London Hospital, Tavistock and Portman NHS Foundation Trust), 6) Addenbrooke's Hospital, 7) Norfolk and Norwich University Hospitals, 8) Birmingham Women and Children's, 9) Nottingham Children's Hospital with Leicester Royal Infirmary, 10) Sheffield Children's Hospital, 11) Alder Hey Children's Hospital, 12), Manchester Children's Hospital, 13) Royal Preston, 14) Leeds Teaching Hospital, 15) South Tees Hospital