Co-development and feasibility testing of tailored intervention resources to support families of children with avid eating behaviour

The prevalence of obesity in childhood has rapidly increased over the last few decades (Di Cesare et al., 2019), increasing from 9 to 14% between 2006 and 2020. (NHS England, 2023). Obesity during childhood is associated with several health and social consequences. Research shows children who experienced obesity were more likely to experience depression than their healthy-weight counterparts (Quek et al., 2017). Obesity in childhood is also associated with poor heart function (Raj, 2012), higher risk of developing diabetes (Bhadoria et al., 2015), cancers, premature death (Must et al., 1992) and obesity in adulthood (Simmonds et al., 2015). In 2014, obesity had an estimated cost of £6.1 billion on the NHS and costs the wider UK healthcare economy £27 billion per year (Public Health England, 2017). Given these health and economic costs, it is crucial to understand how to support families and children to minimise the risk of developing obesity.

Rates of childhood obesity in the most deprived areas of the UK are more than double the rates in the least deprived areas (NHS England, 2023). The association between income and childhood obesity is complex. Wang & Lim (2012) found access to energy-dense foods alongside low socioeconomic status increased the risk of childhood obesity. Birmingham has the second highest rate of child poverty across the UK (Birmingham City Council, 2016) and the second highest number of fast food and takeaway restaurants in England (Public Health England, 2018), putting Birmingham children at a higher risk of becoming obese compared to their peers across the nation. Thus, an intervention targeting this population would have wide benefits to the region.

This project aims to develop a successful intervention to help children and their families living with obesity. Some children are more vulnerable to obesity due to genetic susceptibility (Schrempft et al., 2018). Complex factors shape eating behaviour and nutrition during childhood, so a one-size-fits-all intervention may not be appropriate. Interventions need to be tailored to the individual needs of families and children.
Families and stakeholders will be heavily informed about the intervention. Information regarding children's eating behaviour and the delivery, reach, and accessibility of the intervention will be obtained via various methods to develop an outcome that is beneficial for all parties involved.

Focus groups with families of children living with obesity will be conducted to understand the barriers and facilitators to effective feeding behaviours and to obtain information about how families seek health information and in which format. These discussions will be transcribed and analysed using thematic analysis. Additionally, stakeholders who work with children living with obesity will be invited to explore their views in creative workshops. The insight gained from the previous two stages will inform the material, content and delivery of the intervention. The intervention will also be informed by the COM-B model and the APEASE (Acceptability, Practicality, Effectiveness, Affordability, Side-effects, and Equity) criteria to increase the likelihood of behaviour change via evidence-based theory.

The intervention materials developed will be shared with families, who will share their thoughts on ease of comprehension, helpful elements, perceived benefits of materials, and facilitators or barriers to using the intervention. This data will identify areas for further improvement and refinement before a future feasibility trial.

Three academic reports are expected to be produced: one outlining the findings from the focus groups, another summarising the data from the creative workshops, and a final paper reporting the development and feedback of the intervention itself.