National Institute for Health Research

NIHR CLAHRC for South Yorkshire

South Yorkshire Cohort Christine Smith Obesity Theme Project Manager

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

Obesity

• Major public health problem • Causes of obesity are “embedded in an extremely complex biological system set within an equally complex societal framework” • Major changes in work patterns, transport, food production, food sales and shifts in values over the past five decades Healthy Weight, Healthy Lives 2006 Foresight Report 2007 © Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

NICE 2006

• NICE clinical guidelines for obesity • fundamental flaws in the methodology of existing studies have hindered the ability to identify effective public health and clinical interventions.

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

Research Requirements

• for short, medium and longer term research and surveillance • for research to read across to other policy and research agendas, e.g. LTC • to evaluate policies aimed at tackling obesity including impact on health inequalities • to evaluate long term impact of interventions including assessing cost effectiveness • for research to target large population groups and evaluation of ‘natural experiments’. Healthy Weight, Healthy Lives 2006 © Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

Obesity Theme Advisory Group

Proposed Studies Advisory Group

Children And Adolescents

Coproduction

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

Evaluation

Core Team

Families

South Yorkshire Cohort

Sustainability

NIHR CLAHRC for South Yorkshire

South Yorkshire Cohort

• Research and evaluation facility • Cohort multiple RCT methodology • Large observational longitudinal cohort • Facility for nested studies • RCTs • Qualitative studies • Quantitative observational work

Relton, BMJ 2010 © Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

SYC Aim

• To obtain information that will aid decisions about NHS healthcare commissioning, with regards to management and self management of health, with reference to obesity & weight management amongst adult patients aged 16yrs+.

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

SYC Research Priorities

• Obtain data on patient: • • • • •

Weight & height NHS & non NHS healthcare resource use Quality of life Demographics/social class Chronic disease status

• Identify current use of weight prevention/management/reduction interventions (both NHS & non NHS) and gather information on any associated short and long term improvements • multiple trials facility • research resource for qualitative research

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

SYC Method

• Development of SYC Questionnaire • User testing

• Development of data management system • CTRU • On-line form

• • • •

Approvals Recruit GP practices Recruit 20,000 adult patients Feedback of data

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

Consent

• Survey • Longitudinal observational study • ‘We would like to contact you again’

• Multiple Trials Facility • ‘We would like to use the information you provide to look at the benefits of health treatments’

• Multiple Trials Facility + Health Records • ‘We would like to look at your health records’ © Copyright, NIHR CLAHRC for South Yorkshire, 2010

Pilots

NIHR CLAHRC for South Yorkshire

•

Prize draw incentives •

•

complete

Waist measurement and access to GP records •

•

Results pending

No reminder questionnaire •

data collection

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

Pilot 1

• Maximise recruitment rates through financial incentives • None, £10, £100, £200

• Dual site GP Practice, Rotherham • 1544/10293 adults (15%)

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

Results: Response Rates Response

Survey Cohort

Response rate 32%

Longitudinal Observational Cohort

25%

Trials Cohort

24%

Trials + Health Records Cohort

21%

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

Results: Incentives

NIHR CLAHRC for South Yorkshire

Incentive

Survey

Longitudinal Study

Trials

£0

25.5

26.0

26.8

Trials + HR 27.1

£10

25.7

24.7

24.9

24.4

£100

23.9

23.7

22.8

22.3

£200

24.9

25.5

25.5

26.2

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

• • • • •

Results: Responders

Survey Cohort Mean age 53.2 (population 45.9%) 40% male (population 46.6%) 93.1% White British (population 93.6%) Lower response rate from lower income

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

Results: BMI Health Survey for England 2008

Pilot 1

Underweight

1.8

1.2

Healthy Weight

36.8

38.2

Overweight

36.9

36.1

Obese

24.5

19.4

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

Pilot 1 Summary

NIHR CLAHRC for South Yorkshire

• 21% response rate • Potential areas to watch • • • •

Younger age Men Ethnic groups Low income groups

• Incentive

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

NIHR CLAHRC for South Yorkshire

Nested Studies

• Ian Brown • Decision Aids

• Amy Evans • The effects of obesity on bone structure and strength

• Clare Relton • Pounds for Pounds, pending

• Stuart Parker • Frailty, Pre-frailty and Resilience in an Older Population: Exploring Transitions, in preparation

© Copyright, NIHR CLAHRC for South Yorkshire, 2010

Thankyou

NIHR CLAHRC for South Yorkshire

CLAHRC-SY Barnsley PCT

Stakeholders GPs

Obesity Team

© Copyright, NIHR CLAHRC for South Yorkshire, 2010