Can embedding the MapMe intervention, a tool to improve parental acknowledgement and understanding of childhood overweight and obesity, in the National Child Measurement Programme lead to improved child weight outcomes at one year?

Research Question: Can embedding the MapMe intervention in the National Child Measurement Programme (NCMP) lead to improved child weight outcomes? Background: Childhood overweight and obesity (OW/OB) is a Public Health England (PHE) priority. Parents are key to managing children’s weight, but tend to struggle to recognise OW/OB, and so do not take action. In England, the NCMP measures the weight status of 4-5 and 10-11 year-olds and reports results to parents via letter. Parents are often surprised by, and mistrust the result. More support is required to help parents understand and act upon the letter. The ‘Map Me’ intervention includes Body Image Scales (BIS) (images of underweight to very OW children of NCMP age, to help parents recognise child weight status), and information on healthy eating, physical activity, consequences of child OW and further support. MapMe was tested in ~300 OW/OB children who showed improved Body Mass Index (BMI) Z scores after 1 year. These findings now need to be confirmed in a larger study and, if confirmed, we need to establish how the intervention works, and if it cost effective. Objectives: 1. Update MapMe 2. Assess the impact of enhanced NCMP letters including MapMe (delivered using 2 different approaches) on child BMI Z score at 1 year 3. Examine mechanisms of impact of MapMe 4. Examine the cost/benefit of MapMe 5. Assess the impact of MapMe enhanced NCMP letter on health inequalities and psychological outcomes 6. Explore the implementation and acceptability of the MapMe enhanced NCMP letters and potential for national adoption Methods: Parents and key stakeholders will be consulted on how MapMe can be improved. The improved MapMe will then be examined by a Randomised Controlled Trial across 9 Local Authorities (LAs). Schools within each LA, will be randomised to 1 of 3 groups: 1) MapMe BIS and link to web-based MapMe added to the NCMP post-measurement letter; 2) as group 1, plus an additional ‘booster’ letter with the link to web-based MapMe sent 6 months later; 3) standard NCMP letters (control). Child BMI Z score changes will be assessed at 1 year. A sub-group will be recruited for a process evaluation examining: parents’ perceptions of child weight status; changes in child food intake, activity, and parental help seeking. Child quality of life, use of NHS/LA services will inform an economic evaluation. Data on self-esteem, eating disorder risk, deprivation and ethnicity will be used to evaluate psychological impact and health inequalities. Views from NCMP teams and parents will explore experiences and implementation of MapMe. Timelines for delivery: Total study duration is 36 months. MapMe update (months 1-6); Health-related and cost impacts of MapMe, and process and acceptability evaluations (months 7-29); Analysis and dissemination (months 30-36). Anticipated impact: If found to be effective MapMe will be incorporated into routine NCMP delivery and hosted by NHS Choices: providing a minimal cost, national scale intervention capable of improving the weight status of children with OW/OB. Dissemination: A Public Health England co-hosted workshop for NCMP commissioning and delivery teams; feedback to participating families, school nursing, NCMP teams, health practitioners, local and national policy makers (informed by the public involvement panel); dissemination at conferences and in open-access academic journals.