Table 5.

Recommendations for the dissemination of an upscaled child obesity management program

1. Health system	Recommendation 1.1: Governments should continue to invest in community based healthy lifestyle programs for families as part of a universal service delivery model for the treatment of overweight and obese primary school aged children. This investment should be embedded in the policy and strategic context for community and primary care. Recommendation 1.4: Primary health care services are well positioned for ongoing service provision of childhood overweight and obesity management services. Recommendation 1.2: Government investment in programs should include routine performance monitoring for participating health services and program monitoring to ensure health gains continue to be achieved. Programs should include a quality improvement cycle to improve outcomes. Recommendation 1.3: The establishment and monitoring of local level performance targets for program delivery are needed to ensure childhood obesity management services are prioritised by providers.
2. Implementation at scale	Recommendation 2.1: A Model of Care and implementation plan should be closely aligned with and informed by national Clinical Practice Guidelines and the WHO Commission on Ending Childhood Obesity Report. Recommendation 2.2: A consistent and coordinated approach to paediatric weight management services across the State including eligibility, availability and type of service with the ability to deliver services to families at the point in which people engage with the health care system. Clinical Practice Guidelines should be extended to describe care pathways with the approach involving all National, State and Private health service providers involved in the management of childhood overweight and obesity across the continuum of care in clinical, community and primary health care settings across a complexity of cases. A shared vision by all, referral pathways and communication between providers is needed, as services to families of children who are already overweight or obese do not sit in only one part of the health care continuum. Recommendation 2.3: Upscaling of programs requires a deep understanding of administrative enablers and barriers to embedding childhood obesity management into the core business of the health service, including links to internal funding structures and medical record charting of occasions of service.
3. Recruitment of families and promotion of the program	Recommendation 3.1: Programs should market directly to families as it is unlikely that the families who would benefit from the program are all interacting with the health care system. Health professional referrals alone are not adequate. Recommendation 3.2: Children impacted on parent’s interest in taking action on their weight status. Marketing directly to children is likely to be complex but warrants further investigation. Recommendation 3.3: Care should be taken to not further sensationalise childhood obesity in the media, and therefore it is critical to ensure that marketing is solution focussed and not problem focussed.
4. Engagement of families	Recommendation 4.1: Future investment and expansion of PEACH™ must apply a quality improvement framework to ensure modifications and changes which led to an improvement can conclusively demonstrate they are worthwhile. Recommendation 4.2: The evaluation of up-scaled programs should focus on reducing the burden on participant families whilst maintaining the integrity of evaluation datasets for ongoing monitoring and surveillance.