Background: Reviews of primary research in developed countries and policy in the UK demonstrate there is a lack of evidence from well conducted RCTs on lifestyle interventions for childhood obesity (NICE 2006, SIGN 2003, Oude Luttikhuis et al. 2009). Objectives: To develop, implement and evaluate the Y W8? family focused childhood obesity treatment programme using a randomized controlled trial. Methods: The programme was developed using Bartholomew’s Intervention Mapping framework. Using this stepped process a needs analysis was undertaken, a steering group formed, focus groups were completed in local schools and interviews took place with parents of obese children. The determinants identified by these processes were combined with relevant theories and information gathered through a literature review to develop the programme. Y W8? is a 12 week course for families with children aged 8–13 years designed to assist with weight management. The RCT was designed as an individually randomised parallel-group trial with a waiting-list control group. Children in the intervention group (n=59) had their height, weight, self-reported physical activity levels, self-reported fruit and vegetable consumption and a measure of self-esteem recorded at pre- and post-assessment, whilst only height and weight was collected from the children in the control group (n=55). Results: Twelve week (post course) results showed a significant difference in change in BMI z-score between the control and intervention group, mean difference = -0.12 (95% CI: 0.09 to 0.16, F (1, 98) = 54.04, p < 0.0005), with the control group increasing and the intervention group decreasing their BMI z-score. Analysis showed this positive effect on weight status did not adversely affect linear growth. For the intervention group 81% of children completed the programme. Implications: This RCT offers evidence to support the use of family-based treatment programmes in the treatment of childhood obesity and displays positive results in the short-term, at a lower cost than similar interventions. The thesis also demonstrates how a public health programme can be implemented and sustained in routine NHS practice.

Made available in DSpace on 2016-06-02T20:19:04Z (GMT). No. of bitstreams: 1 DissNTF.pdf: 922511 bytes, checksum: aa3fd5e4f734104cb6412bdf0bc56152 (MD5) Previous issue date: 2007-02-02 / Financiadora de Estudos e Projetos / The purpose of this study was to assess the effects of a weight reduction program on the plantar pressure behavior during standing and walking of obese children. Thirty children, divided into three groups (obese experimental group, obese control group and non obese group), both genders, aged between nine and eleven years old volunteered to this study. The data were collected before and after a weight reduction program with duration of three months. The evaluations included static footprints and plantar pressure variables under six areas of the foot during standing and walking using the Pedar System (Novel GMBh). The results revealed that there was a decrease in the pressures under the midfoot area for the experimental group after the training program, but plantar pressure changes were not observed under other foot areas. An increase in the pressure-time integral was observed after training for the same obese group. In addition, the obese children presented greater contact areas and pressures when compared to non-obese, which can indicate increased risk of injuries due to the excessive load supported by the lower limbs of the obese children. However, the body weight was only poorly related to the plantar pressures, indicating that others factors may interfere on pressure distribution patterns. The correlations between the variables in the midfoot area indicated that it is not possible to assess the dynamic function of the feet from static measures, mainly in obese children, since the excess of adipose tissue in the feet and the medial arch changes may not allow the appropriate interpretation of these measures. Because the plantar pressures measured in this study were not sensitive enough to the training program of three months and, therefore were less influenced by it, the planning of weight reduction programs of longer durations and applied as early as possible is recommended, in order to promote important changes in the plantar pressure behavior and, consequently, to prevent structural and functional disorders in the children s feet. / O objetivo deste estudo foi verificar os efeitos de um programa para redução da massa corporal em crianças obesas sobre o comportamento das pressões plantares e caracterizar os efeitos da obesidade. Foram avaliadas 30 crianças, divididas em três grupos (grupo de obesos experimental, grupo de obesos controle e grupo de eutróficos), de ambos os sexos, com idades entre nove e onze anos. As avaliações foram realizadas antes e depois do programa de intervenção, que teve duração de três meses e incluíram medidas de impressões plantares estáticas e de distribuição de pressão plantar, na postura ereta e na marcha por meio do sistema Pedar (Novel GMBh). A partir dos resultados obtidos constatou-se que o grupo de obesos experimental apresentou diminuição das pressões na região do médio-pé após a intervenção, mas não foram observadas variações das pressões em outras regiões do pé. Um aumento na variável integral pressão-tempo foi observado após a intervenção para o mesmo grupo. As crianças obesas mostraram maiores áreas de contato, pressões e integral pressãotempo quando comparadas às eutróficas, o que pode indicar risco aumentado de lesões, devido à sobrecarga excessiva suportada pelas extremidades inferiores de crianças obesas. Porém, a massa corporal mostrou-se pobremente relacionada com as pressões plantares, indicando que outros fatores podem interferir nos padrões de distribuição de pressão. As correlações entre as variáveis na região do médio-pé indicaram que se deve ter cautela ao inferir a função dinâmica do pé a partir de medidas estáticas, principalmente em crianças obesas, já que o acúmulo de tecido adiposo nos pés e as modificações do arco medial podem dificultar a interpretação dessas medidas. Em virtude da pequena influência do programa de intervenção sobre as variáveis de pressão plantar, recomenda-se o planejamento de programas, com maior tempo de duração e aplicados o mais precocemente possível, a fim de que estes sejam capazes de promover modificações importantes no comportamento das pressões plantares e, dessa forma, prevenir mudanças estruturais e funcionais nos pés de crianças, além de evitar a progressão de outros problemas relacionados à obesidade e melhorar a qualidade de vida dessas crianças.