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National consensus to develop core outcomes for the evaluation of complications from excess weight (CEW) clinics: results of a national Delphi process
  1. Philippa Anna Stilwell1,2,
  2. Billy White3,
  3. Catherine Graham1,
  4. Emma Rigby4,
  5. Julian P H Shield5,6,
  6. Rachael Brandreth1,7,
  7. Sophie Solti1,
  8. Richard Owen1,
  9. Simon Kenny1,8,9
  10. CEW Delphi Collaborators
    1. 1 NHS England and NHS Improvement London, London, UK
    2. 2 Paediatrics, Evelina London Children's Healthcare, London, UK
    3. 3 University College London Hospital–Great Ormond Street Obesity Service, University College London Hospitals NHS Foundation Trust, London, UK
    4. 4 Association for Young People's Health, London, UK
    5. 5 NIHR Bristol Biomedical Research Centre, University Hospitals of Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
    6. 6 Institute of Child Health, University of Bristol, Bristol, UK
    7. 7 Dietetics, Royal Cornwall Hospitals Trust, Cornwall, UK
    8. 8 Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
    9. 9 School of Life Sciences, University of Liverpool, Liverpool, England
    1. Correspondence to Dr Philippa Anna Stilwell, NHS England and NHS Improvement London, London, UK; philippa.stilwell{at}


    Objective In 2021, centres across all seven NHS-England regions were selected to develop pilot clinics with the aim of treating children and young people (CYP) living with complications relating to excess weight (CEW). We led a process to develop core outcomes to enable the evaluation of these clinics.

    Methods A two-round Delphi process, virtual steering group meetings and two patient representation workshops were used to agree the most important outcomes for both clinicians/allied professionals and representative prospective service users.

    Results A total of 119 clinicians/allied professionals were invited to contribute to the Delphi process: 62 (52%) agreed and completed round 1 and 47 of these (76%) went on to complete round 2. Six young people (age range 13–17 years) and six parents were involved in two patient representation workshops and their experiences fed into virtual steering group meetings, via a representative.

    There were 44 outcomes assessed in round 1 and 21 outcomes assessed in round 2. There were 16 core outcomes selected: anthropometric, glucose tolerance/insulin resistance/type 2 diabetes, blood pressure, lipid profile, breathing problems, identification of aetiology, non-alcoholic fatty liver disease, idiopathic intracranial hypertension, anxiety, depression, self-esteem, quality of life, school attendance, dietary habits including disordered eating, exercise and activity habits.

    Conclusions Use of an online Delphi process, patient representation workshops and virtual steering group meetings has enabled the development of core outcomes for clinical obesity services with eight physical health, five mental health and three self-management outcomes. Further work is needed to develop outcome measures to complete a core outcome set. These will be used to guide the evaluation of novel regional clinics for the treatment of complications of excess weight.

    • child health
    • health services research

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    • Collaborators CEW Delphi Collaborators: James Law, Pooja Sachdev, Laura Stewart, Peter Green, Elizabeth Nash, Nikki Davis, Louisa Ells, Dasha Nicholls, Jo Searles, Natalie Selby, Birgit Westphal, Rhian Augustus, Senthil Senniappan, Martha Ford Adams, Ken Ong, Emma Webb, Neil Wright, Thomas Carrol and Gin Thian Peh.

    • Contributors PAS made substantial contributions to the conception and design of the work, drafted the work, approved the final version to be published and agrees to be accountable for all aspects of the work. BW, CG, ER, JPHS, RB, SS, RO, SK made substantial contributions to the conception and design of the work, revised the work, approved the final version to be published and agree to be accountable for all aspects of the work. SK acted as guarantor

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.