NHS England has opened 21 specialist clinics for children and young people aged 2–17 with severe or complex obesity, and this evaluation will determine whether they actually work. Severe childhood obesity is rising in the UK, but there is little evidence on what kind of specialist care—if any—improves outcomes for these children. The clinics offer tailored, holistic support, but no one has systematically assessed which models of care are effective, for whom, and at what cost. This evaluation fills that gap. If successful, the findings will directly shape how NHS England rolls out and commissions these clinics nationally from 2024/25. The results could determine whether the clinics reduce obesity-related complications, improve quality of life, and narrow health inequalities—or whether they need redesigning. The economic analysis will tell the NHS whether the clinics are worth the investment compared with standard care. The project is applied health services research with an immediate practical purpose: to inform national commissioning decisions. It is not fundamental science. Its impact will be felt in clinic waiting rooms, referral pathways, and NHS budget allocations, not in laboratories.
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Background: 21 Complications of Excess Weight (CEW) clinics have been commissioned by NHS England. The CEW clinics to deliver tailored holistic support to children and young people (CYP), aged 2-17 years, who live with severe or complex forms of obesity. Thus, a comprehensive evaluation of the CEW clinics is required. Aims: 1) To undertake a co-produced, comprehensive mixed-methods clinical and economic evaluation of the CEW clinics, which develops the evidence base and understanding of optimal models of care, and 2) to contribute to the national CEW clinic framework development to support future roll out and commissioning by 2024/25. Research Question & Methods: The evaluation comprises five interconnected work packages (WP) to determine: 1. What care is being delivered across the clinics and what services are provided at each clinic? 2. What different workforce models are used? 3. What are the cross-organisational or integrated models of care across the patient pathways? 4. What do children and families perceive to be the barriers and facilitators to service engagement and commitment over time? 5. What measures and data sources are required to assess programme outcomes and impacts at different levels and timelines? 6. What are the demographic and clinical characteristics of CYP referred to CEW clinics and how do they compare to the general population of children living with obesity? 7. How do the CEW clinics influence and contribute to inequalities in access, experience and outcomes? 8. What is the cost-effectiveness of the programmes of care? 9. What models of care work (or not) for whom, why and in what context? WP1 Project management, coproduction, public and patient involvement and engagement and dissemination (Months 1-32): will a) facilitate coproduction with all stakeholders and embed insights from CYP and their families/caregivers across every WP; b) co-ordinate dissemination and communication; c) contribute to the development of the national CEW framework to support future commissioning activity; and d) provide overarching project management and cohesive cross-site working. WP2 Mapping the delivery and workforce models of CEW clinics (Months 1-24; RQs 1-3,5&7): will use documentary reviews, surveys, process mapping, semi-structured interviews and focus groups with commissioners and NHSE / CEW staff. WP3 Exploring the views and experiences of CYP and their families attending CEW clinics (Months 1-32; RQs 4,5,&7): will be underpinned by a realist informed approach using surveys, interviews, questionnaires and focus groups with CYP and families. These findings will be aligned to, and integrated with, quantitative process and outcome data from the CEW national dataset. WP4 Clinical and economic data evaluation (Months 1-32; RQs 6-8): will assess service user demographics, analyse clinical, quality-of-life and cost outcomes over time, and provide an economic evaluation of each CEW delivery model. WP5 Triangulation (Months 1-32; RQ9): A triangulation protocol will be co-developed to bring together the findings and display them in a convergence coding matrix. Anticipated delivery timeframe & impact: December 2023-July 2026. Inform the national CEW clinic framework development to support future roll out and commissioning by 2024/25.
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