NSW Centre for Overweight and Obesity at the CHW Clinical School

Group Leader
Prof Louise A Baur
Professor, Discipline of Paediatrics, University of Sydney
Chair, Board of Directors, NSW Centre for Overweight & Obesity, University of Sydney c/- Clinical School, CHW
Phone: 61-2-9845-3393 (direct)
Fax: 61-2-9845-3389
Email: louiseb3@chw.edu.au

NSW Centre for Overweight and Obesity (COO)

Current research program

The Obesity Research Group and its collaborators undertake a range of research studies looking at the causes and consequences of child and adolescent obesity and its effective management and prevention. The core group is relatively small but there are long-standing research links with the CHW Institute of Endocrinology and the NSW Centre for Overweight & Obesity (mainly based at the Medical Foundation Building, USyd main campus), as well as with other research groups.

The research program and set-up reflect the following:

• The absence of funding, until very recently, for a clinical department at CHW dealing with obesity. There was an associated lack of infrastructural support for obesity-related research. Hence the need to build links with other departments.
• The relatively "green-field site" state of paediatric obesity research in Australia and internationally in the late 1990s and early 2000s, together with the inherent cross-disciplinary nature of the obesity problem, ultimately encouraging collaborative work on a series of fronts.
• Prof Baur is the leader of both the CHW Obesity Research Group and the NSW Centre for Overweight & Obesity (Chair of the Board of Directors) based at the USyd main campus. A challenge for the future is determining how to grow obesity-related research efforts at both sites. In addition, the central role of Prof Baur poses a potential vulnerability for the CHW research effort in obesity.

Research areas

The following list of research only includes work undertaken by the core Obesity Research Group.

1. Clinical aspects of obesity and insulin resistance in childhood and adolescence:

The Loozit Study
This is the first RCT of a community-based program for treatment of overweight and obese adolescents. The study is funded by a bequest, the Foundation for Children, and various other smaller grants. Recruitment is proving challenging.

CIs: L Baur (PI), J O'Connor, M Kohn, V Shrewsbury (PhD student), K Steinbeck (RPAH), S Shah (SWAHS), AJ Hill (University of Leeds).

The PEACH (Parenting, Eating & Activity for Child Health) Study
This is the first RCT of a community-based parenting intervention for management of overweight and obesity in primary school children, and the second largest RCT of treatment of paediatric obesity. The study compares the effect of the addition of parenting program on a parent-focussed healthy lifestyle program, on childhood obesity outcomes. The study is run in both Adelaide and Sydney and participants are currently being followed up at 3 years following baseline.

Results from the 2 year outcome data analysis show a significant difference between treatment groups at the end of the 6 month treatment intervention (ie the parenting group had a more significant reduction in adiposity). However, the group differences were not maintained thereafter, although both treatment groups had a sustained reduction in both BMI z-score and waist circumference z-score compared with baseline for a further 18 months following cessation of the intervention.

We are currently in negotiation with two state departments of health to fund an effectiveness and implementation trial of the PEACH Program. We have also submitted grant applications to test the effect of different maintenance programs following the initial PEACH Program.

CIs: A Magarey (PI; Flinders University, L Baur (CI of the Sydney arm), K Steinbeck (RPAH), L Daniels (QUT).

Child protection aspects of severe paediatric obesity.
This is a preliminary study exploring the ethical and legal aspects of severe childhood obesity. The two papers (one published, one submitted) highlight a novel and controversial aspect of aspect of childhood obesity.

CIs: L Baur (PI), Shirley Alexander, Roger Magnusson (Faculty of Law, USyd), Bernadette Tobin (ACU)

Other research in this broad area is being undertaken by Dr Sarah Garnett, NHMRC Clinical Research Fellow, in Institute of Endocrinology, with Prof L Baur as a CI (Prof Baur was Dr Garnett's PhD supervisor).

2. Measurement of physical activity in children:

This series of studies looks at the very under-researched area of how to measure physical activity and sedentary behaviour in preschool-aged children. It has involved a qualitative study of parents' and carers' understandings of physical activity in young children, the development of a questionnaire (the Pre-PAQ) to assess physical activity in young children and its subsequent validation against accelerometry and observation (currently underway). This research area, the focus of Ms Genevieve Dwyer's PhD studies, is funded by two external competitive grants.

CIs: L Baur (co-PI), G Dwyer (PhD student, co-PI), J Higg (Charles Sturt University), L Hardy (USyd).

3. Health service delivery and paediatric obesity

Promoting healthy kids - everyday, everywhere.
This study, newly funded by the NSW Health Western Child Health Network, aims to build the capacity of area health service professionals to promote nutrition and physical activity and address overweight and obesity in children. It will be the first study to development and evaluate a health professional training package in simple paediatric obesity assessment and management.

CIs: L Baur (co-PI); C Newman (co-PI) and L Johnson (SWAHS); L King (NSW Centre for Overweight & Obesity).

4. Inflammation, obesity and insulin resistance:

This study, the focus of Ms Charmaine Tam's PhD studies, explores the associations between insulin resistance, inflammation (and insulin resistance in otherwise healthy children and adolescents. The novel aspect of the study is the analysis of subcutaneous and visceral fat samples taken from children undergoing elective surgery. The study involves investigation of adipokine gene expression in fat samples and histopathological studies of macrophage infiltration in fat samples.

CIs: C Tam [PhD student], C Cowell (co-PI; CHW Institue of Endocrinology), L Baur (co-PI), M Wong (CHW Immunology), Leonie Heilbron [Garvan Institute], K Clement (INSERM, Paris)

Major achievements in last 10 years

In a series of studies, initially in infants and then in older children, our team was the first to show that muscle metabolic abnormalities (muscle membrane lipid fatty acid profile, intramyocellular lipid), characteristic of insulin resistance ("pre-diabetes"), are present in apparently healthy children at familial risk for the development of disorders associated with obesity and diabetes. A further study of a birth cohort of healthy 8 year old children in western Sydney (the Nepean study, in collaboration with the Institute of Endocrinology) has shown that abdominal fat is inversely associated with birth size and positively associated with a clustering of risk factors for diabetes and heart disease. These findings highlight the very early onset of metabolic abnormalities that predispose to these common diseases.

Our work on obesity and insulin resistance has included a behavioural epidemiological focus, in an attempt to identify modifiable risk factors that could be targeted in intervention studies. In a follow-up of the birth cohort to the age of 15 y, we have identified promoters of active commuting in this group of young people (social connections, living near to peers, parental perception of road safety) as well as factors in the family food environment that are associated with the consumption of less healthy food choices in adolescence (e.g., maternal consumption of less healthy food choices, access to less healthy food choices within the home). We have also identified a range of factors in mid-childhood that predict the development of obesity (especially central obesity) in adolescence. These include watching more than 2 hours/day of television, increased consumption of soft drinks, lack of vigorous activity and parental obesity.

We are also involved in a series of clinical studies dealing with obesity and insulin resistance ("pre-diabetes") in childhood and adolescence. These include the first study of a community-based parenting intervention to treat overweight children (the PEACH Program). Given the exciting results of this study, the research team is currently negotiating with two state health departments (NSW and South Australia) about implementation of the intervention in community health care settings.

In collaborative work with the International Obesity Taskforce, a major report was presented to the World Health Organisation, with the aim of highlighting the impact of childhood obesity among WHO's member nations. In response, WHO established an Expert Consultation on Obesity in 2005.

A series of studies by our group has shown, for the first time, the high prevalence of overweight and obesity amongst children and adolescents attending a range of clinical settings for whatever reason (GPs, hospital inpatients and outpatients etc). Other firsts in this area that we have documented: the relative lack of service provision for overweight and obese children, the increased cost of hospitalisation for obese children and the lack of training opportunities for clinical staff in clinical obesity management. Such data have been vital in raising the awareness of Australian State and Federal Health departments for the need for a coordinated model of care for the treatment of paediatric obesity and the importance of obesity prevention.

Key publications with comments on their significance

• Ball E, O'Connor J, Abbott R, Steinbeck KS, Davies PSW, Wishart C, Gaskin KJ, Baur LA. Total energy expenditure, body fatness and physical activity in children aged 6 - 9 years. Am J Clin Nutr 2001; 74: 524-8. Abstracted in 2002 Year Book of Sports Medicine, Nieman D (ed), Mosby-Year Book Inc, St Louis, USA.
  This study, and some related ones, helped define the energy needs and body composition of both healthy children (this study), and children with anorexia nervosa.
• Baur LA, O'Connor J, Pan DA, Storlien LH. Relationships between maternal risk of insulin resistance and the child's muscle membrane fatty acid composition. Diabetes 1999; 48: 112-116.
  This study was the first to show just how early the muscle and blood abnormalities of insulin resistance (the metabolic precursor to the metabolic syndrome, also known as syndrome X) are present in children born to high-risk mothers - in this case, before the age of 2 years.
• Lobstein T, Baur L, Uauy R. Obesity in children and young people: A crisis in public health. Report of the International Obesity TaskForce Childhood Obesity Working Group. Obesity Reviews 2004; 5:4-104.
  This major report was a collaborative undertaking with the International Obesity Taskforce. The report was formally presented to the World Health Organisation, with the aim of highlighting the impact of childhood obesity among WHO's member nations. In response, WHO established an Expert Consultation on Obesity.
• Garnett SP, Cowell CT, Baur LA, Shrewsbury VA, Chan A, Crawford D, Salmon J, Campbell K, Boulton TJC. Increasing central adiposity: the Nepean longitudinal study of young people aged 7-8 to 12-13 years. Int J Obesity 2005; 25:1843-1849.
  This study, from the Nepean Study (a longitudinal cohort of children in western Sydney), together with related ones, has helped to identify a range of modifiable risk factors for the development of obesity, over time, in school-aged children. These studies have also highlighted the significant heath problems associated with obesity, even in childhood.
• Golley RK, Magarey AM, Baur LA, Steinbeck KS, Daniels LA. Twelve-month effectiveness of a parent-led, family focused weight management program for pre-pubertal children - a randomized controlled trial. Pediatrics 2007; 119:517-525.
  This study, the pilot to the PEACH Study, is the first community-based trial of a parenting intervention aimed at treating childhood obesity.

Research Team

Based at CHW:

Management of child & adolescent obesity

• Ms Janice O'Connor BSc(Hons), MNutrDiet, Senior Research Assistant
• Ms Kristy McGregor BNutrDiet, Research Assistant
• Ms Anthea Lee BSc, MnutrDiet, Research Assistant
• Ms Vanessa Shrewsbury BnutrDiet, PhD Student

Measurement of physical activity in young children

• Ms Genevieve Dwyer BApplSci (Phty), MApplSci (Phty), PhD Student
• Ms Jessica Finlay B Ex Sports Sci, Research Assistant

Australasian Child & Adolescent Obesity Research Network

• Ms Sandra Harris, Administrative Officer
• Ms Vanessa Shrewsbury BHealthSci (Nutr Diet) (Hons), Secretary

Obesity and child protection issues

• Dr Shirley Alexander MBChB, FRCPCH, FRACP, Academic Fellow

Obesity, inflammation and insulin resistance

• Ms Charmaine Tam BSc(Hons), PhD Student

Based at USyd main campus:

• NSW Centre for Overweight & Obesity (COO)
• Ms Lesley King BSc(Hons), MPH, Executive Officer, COO

Research support (2005-2008)

NHMRC/ARC

• For studies based wholly or in part at CHW:
  1 NHMRC project grant, total funding $400,000
• For studies based in Sydney, of which L Baur is a CI:
  1 NHMRC Strategic Award project grant, total funding $1.9 million
• For studies based in other cities, of which L Baur is a CI:
  1 NHMRC Strategic Award project grant, total funding $650,000
  3 NHMRC project grant, total funding $1.51 million

Other Government competitive funds

• For studies based wholly or in part at CHW:
  1 NSW Health Child Health Network project grant, total funding $380,000
• For studies based in Sydney, of which L Baur is a CI:
  1 Dept Health & Ageing grant, total funding $128,000

Government non-competitive funds

• NSW Health infrastructural support for NSW Centre for Overweight or Obesity, total funding $2.5 million
• NSW Health funding for Australasian Child & Adolescent Obesity Research Network (ACAORN), total funding $200,000

Other competitive funds

• For studies based wholly or in part at CHW:
  7 project grants, total funding $441,000

Other non-competitive funds

• For studies based wholly or in part at CHW:
  2 project grants, total funding $228,000

Opportunities for Students

Postgraduate Research available at the University of Sydney.