Specialist children’s weight services need long-term investment and flexible care

Specialist NHS services for children and young people living with severe obesity need long-term investment, strong multidisciplinary teams and flexible support if they are to deliver lasting benefits, according to new research involving Sheffield Hallam University, Leeds Beckett University and the University of Bristol.

The findings come from the ENHANCE study, a national evaluation of NHS Complications of Excess Weight (CEW) services in England. Two newly published papers from the study explored both how CEW services were designed at national level and how they are being delivered by frontline teams.

CEW services provide care for children living with severe obesity, and related complications. During their evaluation, ENHANCE study researchers found service design to be relatively flexible from the outset.

This approach was aimed at facilitating the building of an evidence base for future commissioning. Evidence gathered in this way would then guide what services should ultimately look like, and how they should work.

Interviews with senior figures involved in policy, commissioning and service development showed services designed around a broad specification. This gave local teams flexibility to respond to the needs of children and families in their area.

A second study, based on interviews with 28 multidisciplinary team members across 7 pilot services, found that this flexibility is essential in practice. Staff described supporting children and families facing a wide range of challenges beyond weight-related health complications, including:

• Poverty
• Neurodiversity
• Mental health difficulties
• Housing problems
• Safeguarding concerns

Teams said care needed to be tailored to each child and family, using a mix of face-to-face, online and group appointments. This benefited from the support of strong relationships across health, education, community and social care services.

The studies also highlighted pressures facing CEW services, including:

• Workforce shortages
• Limited capacity
• Inconsistent local care pathways
• Uncertainty over long-term funding

Staff raised concerns about gaps in follow-on support after discharge, particularly for young people moving from paediatric to adult services.

The findings build on earlier ENHANCE research showing that CEW services are helping children and young people maintain greater weight loss over time and reach groups often underserved by existing services.

Dr Karen Coulman, Associate Professor in Obesity Research and Practice at Bristol Medical School and co-lead author of one of the papers, said:

“These studies show why specialist services for children and young people living with severe obesity must be built for the long term. CEW services were designed to generate evidence about what works, and what we are seeing is that children and families need flexible, holistic care that reflects the full complexity of their lives.

“If care is to be equitable and effective, services must be properly resourced, staffed by strong multidisciplinary teams, and better connected to wider health and care systems.”

The researchers say future service planning should focus on long-term commissioning, fully staffed multidisciplinary teams, stronger onward pathways and continued involvement of children, young people and families in shaping care.