BMI, or who were younger, male, white, from families with an
employed primary earner or who lived in less deprived areas. BMI
also fell more if the child attended more programme sessions and
if the programme group was relatively small, suggesting a ‘dose’
effect. Increase in self-esteem was less for children with high
baseline self-esteem, Asian children and partial completers. SDQ
fell more in children with high baseline SDQ, Black compared with
white children and for participants attending programmes where
height data were rounded. SDQ reductions were smaller for boys,
children living in more deprived neighbourhoods, children
participating in programmes where the programme manager
had delivered more programmes, non-completers and partial
completers.
Our findings therefore show that the intervention, although
benefiting all groups to some extent, may also have the potential
to widen existing ethnic4 and socioeconomic5 inequalities in
childhood overweight and psychosocial outcomes. Such findings
may provide the potential for developing programmes such as
MEND (for example, by modifying content, training and implementation)
to make them more successful for groups who
currently respond less well to the intervention.
Although an obesogenic environment is thought to promote
the development and maintenance of childhood overweight,29
little work has assessed whether weight management interventions
are moderated by features of the wider environment. We
found that the outcomes associated with the MEND intervention
did not vary with urban/rural characteristics or indicators of the
food and built environment. However, measures of area deprivation
did appear to moderate changes in BMI and SDQ associated
with the intervention, independent of individual socioeconomic
circumstances, and this may be capturing unmeasured environmental
characteristics that impair successful weight management