Childhood obesity remains a high-priority issue in the UK and worldwide. The long-term solution is a systems approach to prevention that tackles structural, social, political and economic environments at all levels.110,111 However, we must also offer effective targeted interventions for children who already have excess weight and, importantly, our intervention approaches must be inclusive of children from all sociocultural backgrounds.
Building on evidence that community-based family interventions can have a positive effect on children’s weight,12,17,21 we sought to culturally adapt a group-based community children’s weight management programme for 4- to 11-year-old children and their families. Although the focus of the cultural adaptation was to increase programme acceptability for families from Pakistani and Bangladeshi communities, the overarching aim was to develop an adapted programme that allowed enough flexibility and tailoring to meet the needs of all families, recognising the complex and fluid diversification that occurs within our communities. Overall, we have successfully achieved this aim and have developed an interactive and responsive programme that incorporates evidence from the children’s weight management literature. The key feature of the programme is the theoretical underpinning of the adaptations, which we achieved through the gathering of qualitative data from Pakistani and Bangladeshi families and the use of two theoretical frameworks, which enabled the articulation of the cultural and behavioural needs of the families and the types of adaptations needed to address these. In contrast with many cultural adaptations of health promotion interventions, our approach resulted in a programme that was adapted at the deep structural level57,58 and was designed to be responsive to the contexts, values and beliefs that differ, not only across different cultural communities, but also from family to family.
Evaluation of the adapted children’s weight management programme in the feasibility study demonstrated that the programme was feasible to deliver and highly acceptable to families from all communities, with increased retention of families in the adapted programme compared with the standard children’s weight management programme. Qualitative evaluation provided an opportunity to explore how the adaptations were received in practice. The feasibility study also highlighted some key areas that would need to be addressed in the design and methodology of a future trial to evaluate the clinical effectiveness and cost-effectiveness of the adapted programme. A major issue that emerged was that of attrition within the study. This would need to be addressed in both the design and sample size in a future trial. Overall, given the high acceptability and feasibility of delivery of the adapted children’s weight management programme, consideration should be given to conducting a clinical effectiveness and cost-effectiveness trial. However, the design of such a trial would need to incorporate the lessons learned from this feasibility study and employ multiple strategies to minimise attrition. In addition, the design of a future trial would differ from the feasibility study design in terms of having randomisation at the individual level and a control arm with no or minimal intervention, the acceptability of which has not been assessed within this study.
Two other broader recommendations have also arisen from this study. The first is the need for consideration of how to practically conduct experimental evaluations of complex interventions to change dietary and physical activity behaviours in a real-world setting where there are constraints on public health resources. The second is the need for further research into the engagement of children and families in weight management or healthy lifestyle interventions, with a particular focus on uptake of these programmes. Future research in this area would complement the findings of this study and enable interventions to be designed so that both uptake and retention are maximised.