Endocrine Abstracts

Child obesity is a major public health concern in England and worldwide. It is a risk factor for the onset of type 2 diabetes and other comorbidities. Young people from the most deprived communities, from ethnic minority backgrounds or with learning disabilities are particularly at risk. NHS England funded the establishment of Complications of Excess Weight (CEW) pilot clinics, two of which serve the Midlands region. These provide specialist multidisciplinary whole-family support to young people living with severe obesity and a comorbidity related to their weight. A realist theory-informed qualitative evaluation, led by NHSE Midlands and OHID Midlands was conducted to understand how the clinics aligned with local obesity care services and population need. Four group interviews were conducted on Microsoft Teams between November 2022 and April 2023; they included CEW clinical leads, local public health and healthcare commissioners and commissioned weight management service providers from the Midlands. The discussions were supported with epidemiological data and evidence from literature reviews. The conversations were transcribed and thematically analysed. Initially, CEW was framed as a hospital-based, clinically led service, which was accessible via secondary care referral. While offering a bespoke and personalised approach, eligibility and outcomes were framed in strongly clinical terms (BMI centile threshold and comorbidities, weight and comorbidity management). However, it emerged that the success of the clinics also depended on alignment and partnership with local obesity care and social support services. The young people and their families who accessed the service had highly complex social and health needs, including a high proportion with learning disability and autism spectrum disorders and were not well served by existing services. To improve engagement and achieve positive clinical outcomes, CEW clinics needed to address the wider social needs of the family and reduce socio-economic barriers to access. A sustainable outcome included improved social outcomes for the family as well as clinical improvements. The evaluation highlighted opportunities to improve integration of CEW with local services in the Midlands and to deliver specialist support in a way that is sensitive to local need and in a way that reduces inequalities in access, experience and outcomes.