Squirrels explore clinical research in new videos by teenagers in Southampton. The ‘In a nutshell’ series explains how to take part in clinical research and why it matters. The videos were co-created by a youth panel from the LifeLab programme. The teenagers considered how to engage young people with research happening in Southampton. There was a focus on encouraging positive lifestyle choices. Panellists interviewed researchers from the NIHR Southampton Biomedical Research Centre (BRC). The animated series is being shared with young people across Hampshire. The full series is available on YouTube. A new Clinical Research magazine containing articles written by the teenagers will also be released in the coming days. The magazine will be posted online. Free printed copies will be available at University Hospital Southampton. Empowering young people LifeLab is a research-based educational programme created by the University of Southampton in collaboration with the BRC and University Hospital Southampton. In a first for LifeLab, the group of young people were employed by the University of Southampton to form a youth panel. This panel met over 12 weeks. They were supported by the LifeLab team and communicators from the hospital trust’s Southampton Centre for Research Engagement and Impact. The project was sponsored by the National Institute for Health and Care Research. (NIHR). Working with the RCM Agency, they formed the concept for an ‘In a nutshell’ series. Over three animations, a scurry of squirrels takes the audience through: - What is clinical research? - Why is clinical research important? - How can I take part in clinical research? The animations have subtitles which have also been translated into several other languages: Farsi, Punjabi, Polish, Romanian and Russian. Dr Kath Woods-Townsend, LifeLab Programme Manager, said: “The animations created by our inaugural youth panel are fantastic. They are a great reflection of the hard work and effort the students involved put in. “We created the youth panel as another way for LifeLab to engage with young people and get them actively involved in learning about their own health and creating solutions that could improve it. “The ‘In a nutshell’ series demonstrates how they understood the brief and produced something to inspire their own communities around clinical research; informing people about what clinical research is and how and why people can get involved. I am very proud of them. “The worth and longevity of the animations means they will continue to be shared and utilised by our local school communities, the NIHR Biomedical Research Centre and us at LifeLab.” New youth panel LifeLab Youth Panels actively involve young people in creating and delivering solutions that could improve their own health and that of their peers. Youth Panel members are formally employed by the University and paid for their time. Applicants can be aged from 14. Being part of a Youth Panel provides students with the opportunity to contribute their ideas, perspectives and experiences of health issues, work in a team, communicate effectively and maintain confidentiality. LifeLab is currently recruiting members for the spring term youth panel, which will focus on vaping and its effects on young people. If you’re interested, you can find more information and how to apply here.

A genetic test has successfully predicted gut narrowing in patients, paving the way for more tailored management. Some patients with Crohn’s disease develop strictures – narrowed sections of the gut caused by scar tissue. This can make it difficult for food to pass through and, if severe, may even cause a blockage. Researchers at the NIHR Southampton Biomedical Research Centre, led by Professor Sarah Ennis, Professor of Genomics at the University of Southampton, have shown it’s possible to use the NOD2 gene to identify patients at high risk. This could help them and the healthcare professionals treating them to manage their condition better. What is Crohn’s disease? Crohn’s disease is a lifelong condition where parts of the digestive system become inflamed. It is a type of inflammatory bowel disease and affects people of all ages. The main symptoms are diarrhoea, stomach aches and cramps, blood in poo, fatigue and weight loss. These usually start in childhood or early adulthood, and may be constant or come and go every few weeks or months. When they come back, it's called a flare-up. There's no cure, but treatment can help reduce or control the symptoms. The exact cause of the disease is unknown, but certain genes are known to increase the risk of developing it. Predicting who might get strictures The researchers analysed clinical and genetic data from 373 children and 272 adults with Crohn’s disease. Using the presence of mutations within the NOD2 gene, they developed an algorithm which allocated each person to a high-risk group or a low-risk group. They then tested this algorithm on a subgroup of 161 people with Crohn’s disease, to see how well it could predict who developed strictures. Of the 30 people in the high-risk group, 56.7 percent developed strictures. This compared to 21.4 percent of the of 131 people in the low-risk group. Adding in extra details on the part of the gut affected by the disease improved the predictive ability of the algorithm further. The results are published in the journal Inflammatory Bowel Diseases. Dr James Ashton, first author of the paper and Clinical Lecturer in Paediatric Gastroenterology and Genomics, says: “People with Crohn’s disease can experience a wide range of symptoms, which vary greatly in their severity. Knowing the patients who will get significant complications is very challenging. This study shows NOD2 can help us predict which patients are most likely to develop strictures. If used in clinical care, this could help to personalise treatments for these patients.”

Parents in the Southampton area are being urged to support a new respiratory virus study. RSV (Respiratory Syncytial Virus) is one of the leading causes of hospitalisation in all infants worldwide. It affects 90% of children before the age of two. RSV often causes only mild illnesses, like a cold. However, for some babies, it leads to more severe lung problems such as bronchiolitis and pneumonia. In recent months, there has been a resurgence of RSV following the easing of COVID-19 public health measures. The HARMONIE study is looking at how strongly babies can be protected from serious illness due to RSV infection, by giving them a monoclonal antibody immunisation. Protecting babies HARMONIE is a collaboration between Sanofi, its partner AstraZeneca, and the National Institute for Health and Care Research (NIHR). Dr Katrina Cathie, UHS consultant paediatrician and Southampton study lead, says: "RSV is a common seasonal virus that affects nearly all babies before the age of two. It is difficult to know which babies will develop severe problems, so more research is needed to work out the best way of protecting all babies in the future. "The HARMONIE study is looking at how strongly babies can be protected from illness caused by RSV infection through a single dose of Nirsevimab, a long-acting antibody that was approved by the UK regulator this week.” Professor Saul Faust, Director NIHR Southampton Clinical Research Facility, adds: "There are a few different technologies in development at the moment for the prevention and treatment of RSV. The HARMONIE study will help us to gather essential data to support decision-makers like the JCVI as they work out the best way of adopting the different technologies within the NHS. “We’re looking for babies up to 12 months old to take part in this important study. I'd encourage anyone interested in finding out more, to visit the study website and answer a few questions to see if their baby is eligible to take part: rsvharmoniestudy.com.” Aria’s story Aria Burlison was only 12 days old when she caught RSV. Her mother, Christine Burlison, had never heard of RSV and thought it was just a cold. “We noticed after a few days of being home that Aria had started to get a little cold,” she says. “She got a bit snotty and a bit sneezy. We just thought ‘She’s got a little cold, don’t know where it’s come from, but I’m sure she’ll be fine again in a couple of days’ time’.” But as the days went by, Aria’s condition got worse. She started finding it hard to breathe, sucking in the area under her ribs, and her crying suddenly stopped. “Suddenly she went from screaming to floppy on my shoulder,” she recalls. It was then that Christine realised something was wrong. She called 111 and they arranged for an ambulance to take Aria to Southampton General Hospital. When they arrived, she was hooked up to breathing apparatus and given oxygen. She was diagnosed with RSV and bronchiolitis. She had to stay in for seven days. “It’s any parent’s worst nightmare – that your baby can’t breathe,” says Christine. “That’s what we were dealing with.” Their second child, Jude, also caught RSV, when he was eight months old. But this time the family knew how to spot the signs, and he was only in hospital for a few hours. Christine says anything that could prevent other families having to go through the same experiences as theirs did would be amazing. International study Nirsevimab is a long-acting antibody aiming to protect all infants from birth entering their first RSV season with a single dose. It has recently been approved by both the Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMA). Participants of the HARMONIE study will be randomly assigned into one of two groups. One group will receive the antibody dose, and in the other group no injection will be given. More than 20,000 infants across three countries (United Kingdom, France and Germany) will take part in the study, from August 2022 to March 2023. Find out more about the study by visiting the HARMONIE website: rsvharmoniestudy.com. Photo: Aria Burlison is treated at Southampton General Hospital. Courtesy: Christine Burlison

Researchers are working with the Institute for Fiscal Studies (IFS) to evaluate the Healthy Start scheme in England. They aim to find out why nearly half of eligible low-income families with young children have not been claiming support for healthy food. The research team combines expertise from the University of Southampton and City, University of London. It is the first national, independent full evaluation of the scheme. What is Healthy Start? Healthy Start was first offered in 2006. It gives low-income families with young children extra financial support to buy fruits, vegetables, beans and pulses, milk and infant formula. Yet before the scheme went digital in autumn last year, nearly half of eligible families were not taking up the support on offer. The amount of financial support offered as part of the Healthy Start scheme increased in April 2021 for the first time in ten years. It is hoped this will help families with the cost of living crisis. “How well an adult eats can often be traced back to the foods they ate as a child,” explains Dr Christina Vogel, Associate Professor in Public Health Nutrition at the University of Southampton. “But the high cost of healthy foods, compared to unhealthy, processed foods makes providing a healthy diet a real challenge for many low-income families.” Understanding the barriers The research team, led by Dr Vogel, will conduct a thorough evaluation of Healthy Start. They aim to understand barriers to uptake, and assess whether the scheme improves the healthiness of the food families buy and eat. They will also look at whether it improves children’s health and school performance. This will include a detailed analysis in Southampton, London and Manchester to find out how the scheme is working locally. To do this, they will work closely with local authorities, health and care providers, and other community organisations. Together with social enterprise ‘Activmob’, the researchers will hear from families, retailers and community members. They will also work with charities The Food Foundation and Tommy’s to make sure findings from the study are relevant to eligible families. The team at IFS will assess the impact the recent rise in the vouchers’ value has had on the food bought by eligible families across England. They will also investigate how food buying patterns have changed over the 15 years the scheme has been offered. Recommendations to improve the scheme The project is funded by an award of over £850,000, for the next two and a half years, by the National Institute for Health and Care Research (NIHR). The findings and solutions families and professionals suggest will be shared with the Department for Health and Social Care (DHSC) and local authorities to help improve the system. Dr Vogel said: “At a time when every pound counts, our research team will be finding out why some people who can claim these funds don’t, what it is like to use the new payment card, and what effect this extra support has on the foods families buy and eat.” “It’s important that families can benefit from an improved scheme which will make it easier for them to get the extra support that is on offer.”

Southampton researchers are using a protective bacteria that naturally lives in our nose to develop a new meningitis vaccine. Dr Adam Dale from the NIHR Southampton Biomedical Research Centre’s Microbiology, Immunology and Infection theme will lead a new study. Preventing silent carriers Meningitis is an infection of the protective membranes that surround the brain and spinal cord. If not treated quickly, it can cause life-threatening infection and result in permanent damage to the brain or nerves. One bacterial species that causes meningitis is Neisseria meningitidis. This commonly lives in the nose and throat without causing symptoms. It transmits from person-to-person through close contact. Infections can be life threatening in those who do not have protective immunity. This most commonly occurs in babies and young children. There are vaccines that can be used to prevent infections caused by N. meningitidis. The most effective vaccines offer protection against both disease and silent (asymptomatic) carriage in the nose and throat. Preventing silent carriage reduces person-to-person transmission and is the basis of so-called ‘herd immunity’. However, not all N. meningitidis vaccines protect against silent carriage. This can reduce their effectiveness and limit herd immunity. To improve this, researchers need to develop new ways of preventing the silent carriage of N. meningitidis. ‘Good’ vs ‘bad’ bacteria People with a type of ‘good’ bacteria in their nose are known to be protected against N. meningitidis. This good bacteria, Neisseria lactamica, is a cousin of the disease-causing bacteria. It is completely harmless. Professor Robert Read’s research group has previously shown that people deliberately infected with the good bacteria are protected from silent carriage with N. meningitidis. In a recent study, led by Dr Dale, researchers found this may be due to generation of immune responses towards N. meningitidis triggered by the ‘good’ bacteria. In a further study, led by Dr Jay Laver, these immune responses were enhanced. The researchers did this by engineering the good bacteria to harmlessly make components of N. meningitidis that are easily recognisable by the human immune system. In planned work, Dr Dale’s team will study the body’s responses to contact with this modified ‘good’ bacteria in more detail. He hopes to tease out exactly how people who have the good bacteria in their nose are protected. Dr Dale, NIHR Clinical Lecturer in Infectious Diseases & Medical Microbiology at the University of Southampton, said: “This study could give us new insights to help answer the question of exactly how Neisseria lactamica protects people. “It could pave the way to a new vaccine that would not only protect against life-threatening infection caused by N. meningitidis, but also prevent its silent spread to babies and children.”

New research has shown a test could help diagnose fatty liver disease without the need for liver biopsy. Prof Chris Byrne from the NIHR Southampton Biomedical Research Centre's Nutrition, Lifestyle and Metabolism theme worked closely with researchers in China to develop the test. The results are published in the journal Hepatology International. They showed the test could reliably identify inflammation and fibrosis (scarring) of the liver. If diagnosis is made early in the liver condition, it could help save lives. Difficult diagnosis Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new term that is being used to re-define non-alcoholic fatty liver disease (NAFLD). A diagnosis of MAFLD includes a diagnosis of fat in the liver plus the presence of increased body fat or type 2 (adult) diabetes. It is estimated to affect around a quarter of the world’s population, the number of people affected by MAFLD is increasing. In the early stages of MAFLD, many people are unaware they have it. If MAFLD progresses, the liver becomes progressively more inflamed and scarred. It finally the liver stops working properly, requiring a liver transplant. So it is important to diagnose MAFLD early and detect liver inflammation and scarring. The ‘gold standard’ for diagnosing liver inflammation and scarring is a liver biopsy. This allows examination of the liver under the microscope. Liver biopsy is expensive. It also requires putting a needle into the liver, which may cause problems afterwards such as bleeding of the liver as it heals. Research is therefore focusing on avoiding liver biopsy and developing better tests that do not need one. Developing a new diagnostic test The researchers compared 142 patients with biopsy-confirmed MAFLD against a group of 327 people who had not been diagnosed with the disease. They assessed various tests that detect N-terminal propeptide of type 3 collagen, a precursor protein made when scar tissue forms. They combined the best tests to create a sequential algorithm that reliably identified liver inflammation and scarring – a sign the disease is getting worse. Prof Byrne, a University Hospital Southampton Consultant and Professor of Endocrinology & Metabolism at the NIHR Southampton Biomedical Research Centre, said: “This new non-invasive test that includes a measurement of Pro-C3, as well as a simple scanning measure of liver stiffness, platelet levels and diabetes status shows considerable potential. The new test could remove the need for liver biopsy to reliably diagnose MAFLD. The test could be used to prioritise patients whose disease is progressing, so they can make life-saving changes to their lifestyle before it’s too late.”

Southampton researchers have formed a new partnership with scientists in Thailand. Together, they aim to lay the groundwork for the introduction of a pneumonia vaccine. The study will be led by Professor Stuart Clarke from the University of Southampton and NIHR Southampton Biomedical Research Centre. He will work with researchers at Mahidol University and Siam University in Bangkok. Leading cause of child deaths Pneumonia is a leading cause of mortality in children. Worldwide it accounts for 16% of all deaths of children under five years old. In 2015 it killed more than 920,000 children. The commonest cause of pneumonia in young children is the bacterium Streptococcus pneumoniae. A vaccine against this is often given in western countries. But a lack of evidence-based public health policy in Thailand limits vaccine introduction. Supporting future vaccination programmes The researchers will use bacteria previously isolated from the lungs of children with pneumonia. These will come from children across the country. They will analyse these to discover which strains of Streptococcus pneumoniae they contain. The study will provide insights that will help prepare for the introduction of a vaccine. It will also be an opportunity to help educate early career researchers in Thailand. Professor Clarke, Professor of Microbiology and Public Health and Honorary Consultant in Public Health, said: “There is relatively little information on pneumococcal epidemiology across Southeast Asia, which is concerning due to the risks associated with pneumococcal infection and a rise in antimicrobial resistance.”

Pioneering biomedical research is set to almost double in Southampton following a major funding boost. The National Institute for Health and Care Research (NIHR) has announced over £25 million for the NIHR Southampton Biomedical Research Centre (BRC) over the next five years. The NIHR BRC is a longstanding partnership between University Hospital Southampton NHS Foundation Trust (UHSFT) and the University of Southampton, working together to translate scientific discoveries into new treatments, diagnostics and medical technologies for patients. Southampton has spearheaded NIHR-funded nutrition and respiratory research since 2008. Major breakthroughs in deliberate allergen exposure and lifelong prevention of fractures have improved treatments and guidance for patients in the south and across the UK. Most recently, the BRC played a key role in responding to the COVID-19 pandemic. Southampton researchers across different disciplines enhanced prevention, diagnostics and treatments at incredible pace and scale, including fast tracking COVID-19 drugs into large scale trials. Many of these researchers have received recognition in Her Majesty’s Queen’s Honours for their tireless response. New research themes This latest significant investment will enable new themes for Data Health and Society; Microbiology, Immunology and Infection; and Perioperative and Critical Care. The funding is an increase of around 80% from the £14 million received in 2017-2022. Professor Mike Grocott, Director Designate of the NIHR Southampton BRC, who led the bid, said: “Southampton has a proven ability to translate discovery research into benefit for patients and the public, the health and care system, and the broader economy. I am delighted that the NIHR has recognised this and will dramatically increase our research capacity and capability in the coming years. We look forward to working with patients and other stakeholders in our local and regional communities to deliver on this great opportunity.” The new BRC is also committed to increasing patient and public involvement and will continue developing a person-centred, collaborative and inclusive research culture. Professor Mark Smith, Vice-Chancellor of the University of Southampton, said: “We are extremely proud of our partnership with University Hospital Southampton NHS Foundation Trust and this significant increase in funding is a testament to the ground-breaking work taking place across our communities. “Our interdisciplinary teams will continue to work together to improve diagnostics and treatments for patients in the UK and around the world.” David French, Chief Executive Officer at University Hospital Southampton NHS Foundation Trust, said: “Pioneering research and innovation are vital to continuous improvement of patient care and they are at the heart of our Trust’s strategy. I am delighted that this multi-million pound investment opens a new chapter in our 50-year partnership with the University of Southampton, helping to turn more discoveries into treatments for patients.” The BRC is closely tied with the NIHR Southampton Clinical Research Facility (CRF), an extensive, dedicated space for early-stage clinical research in the heart of University Hospital Southampton. Funding boost The NIHR has awarded nearly £800 million to 20 new BRCs across England. Biomedical research in the North and Midlands gets a significant funding boost, with nearly £250 million of the funding invested outside of London, Oxford and Cambridge. A new Biomedical Research Centre has been funded in the south west. The centres, part of NIHR’s research infrastructure, receive substantial levels of sustained funding to attract the best scientists and create an environment where experimental medicine can thrive. Over the past nine years, the BRCs have supported almost 60,000 studies and published 55,000 research papers, as well as supported the career development of more than 14,000 junior doctors and research scientists. Professor Lucy Chappell, Chief Executive of the NIHR, said: “Research by NIHR Biomedical Research Centres has led to a number of ground-breaking new treatments, such as new gene therapies for haemophilia and motor neurone disease, the world-first treatment for Creutzfeldt–Jakob disease, a nose-drop vaccine for whooping cough, and the first UK-wide study into the long-term impact of COVID-19. “This latest round of funding recognises the strength of expertise underpinning health and care research across the country and gives our nation’s best researchers more opportunities to develop innovative new treatments for patients.”

A Southampton doctor is raising awareness of how data-driven health research has an environmental impact. She suggests greater focus on ‘green IT’ could help protect the environment. Professor Anneke Lucassen is co-lead of Data, Health and Society at the NIHR Southampton Biomedical Research Centre. She looked at the environmental impacts of using Data-Driven and Artificial Intelligence technologies (DDAI) in health research. She said: “These technologies are rapidly changing how health research is conducted. Health data collection and storage is massively expanding and there is a compelling need to consider the environmental impact and how we can reduce it. “Health-related DDAI research can have tremendous health benefits but its adverse environmental impacts are often not recognised beyond the power to run, say, the computer that’s using the technology. But DDAI have an increasing environmental footprint including: · the energy required to generate, process and store large amounts of data · the materials required to build data centres · an increase in e-waste from the disposal of electronic appliances The UK was used as a case study. Anneke and colleague Dr Gabrielle Samuel looked at all the available literature, including published papers and the Web, to see how the environmental impact of DDAI is being discussed. Their findings showed that there is currently very little awareness of, and engagement with, these issues. Prof Lucassen said: “Until recently, these issues were not considered relevant for the health sector. We now need to engage more effectively to think about ways to make DDAI more environmentally sustainable. “Ideas to improve the environmental impact, called ‘green IT’, can be quite simple from turning off electrical equipment when not being used, to looking at improving energy consumption at data centres and better e-waste recycling. Other ideas include looking at the type of storage needed for data. The more accessible the data needs to be, the greater the footprint, and it may be that some data needs to be stored but it can be done with much lower energy costs. “As we embark on the new data, health and society theme in Southampton, it is important we build this awareness into our plans.” Read the full paper here.

Southampton researchers are to bring new insight into COVID-19 risk factors for children in South Africa. Most research during the pandemic has focused on middle to high income settings. This has led to successful vaccination and public health programmes to combat COVID-19. This new study will build understanding for children from low-income populations. It is led by Professor John Holloway from the University of Southampton and NIHR Southampton Biomedical Research Centre. Risk factors Working with researchers at the University of Cape Town, Professor Holloway will analyse samples from 450 children who are part of the Drakenstein Child Health Study cohort in Cape Town. This will identify the major risk factors of the SARS-CoV-2 infection. The research will study disease spectrum, long-term outcomes, the role of antibody testing, and identify new targets for treatment in children. Global partnership The study is funded by an NIHR Global Effort on COVID-19 (GECO) grant and also supported by a Global Partnership Award from the University of Southampton. Professor Holloway said: “We are very proud to be starting this international study that will provide valuable information about Covid infections in children. This is a very different population to those that have been studied so far in the pandemic which mostly have been from resource rich settings. “As well as providing data that can be used to develop targeted interventions, it will also support training of South African scientists in the bioinformatic methodologies needed to analyse genomic data.”

New research in Southampton will delve into the underlying causes of asthma. The study will explore whether inflammation in the womb influences whether the baby will later develop asthma. Dr Hans Michael Haitchi will co-lead the study from the NIHR Southampton Biomedical Research Centre and University of Southampton. He will work with the University's Dr Alexandra Kermack and Dr Rob Ewing. The research is also supported by Dr Matthew Coleman from the Princess Anne Hospital. Pro-inflammatory environment Children whose mother has allergic asthma and is overweight during pregnancy are more likely to develop asthma. The reason for this is not fully understood. In this study, researchers seek to determine whether the underlying cause for this is a pro-inflammatory environment in the womb. Women having an elective caesarean birth at the Princess Anne Hospital will be asked if they would like to take part. If they agree, the researchers will collect samples of the fluid that surrounds the baby in the womb (amniotic fluid), cord blood and placenta during the birth. Scientists will measure asthma-related inflammatory and immune markers in these samples. They will then analyse how the mother having asthma and being overweight affects these. Ongoing pregnancy research The study is part of the Maternal Environment in Pregnancy (MEP) study at the University Hospital Southampton. It will be funded by the British Medical Association Foundation for Medical Research’s The James Trust grant 2022. Dr Haitchi, Associate Professor in Respiratory Medicine, said: “Several possible asthma mediators will be analysed together, with clinical data from mums and babies using multiple novel research techniques. “This may help us to explain why children born to asthmatic mothers who are overweight have an increased risk of developing asthma.”

A Southampton-led study has found almost a quarter of children needing surgery in 102 UK hospitals were overweight or obese. It calls for BMI to be routinely measured and for more support to address the burden of childhood obesity. Surgery carries a risk for everyone, but it is greater for children with obesity. This is because they are more likely to have health conditions which increase their risk of complications. Despite this, no UK data currently define the implications of childhood obesity for anaesthesia and surgery. Now a national study, led by Dr Mark Edwards and a team of trainee anaesthetists, has shown that children needing surgery in the UK are more likely to be obese than in the UK population as a whole. Yet they found children’s BMI is not routinely calculated, so may not be accounted for in assessments of risk during surgery. It is the first study in the UK to estimate the amount of obesity in children needing surgery. Greater risk of complications Rates of childhood obesity are increasing worldwide. In the UK, nearly a quarter of under-fives are overweight or obese. This increases to more than a third by the time children start secondary school. As children and teenagers with obesity are around five times more likely to become obese adults, this can have long-term consequences for their health. Children with obesity are more likely to have health conditions such as hypertension, type 2 diabetes, asthma, obstructive sleep apnoea, fatty liver and gastro-oesophageal reflux disease. These all increase their risk of complications during surgery. Assessments of surgery risk The Prevalence of perioperative childhood obesity in children undergoing general anaesthesia in the UK (PEACHY) study analysed data from 4,232 children having surgery at 102 hospitals in the UK. The results, published in the British Journal of Anaesthesia, found 24 percent of the children, aged between two and 16 years, were overweight or obese. Yet 76 percent of the hospitals did not routinely calculate children’s BMI before surgery, meaning this could not be considered in assessments of surgery risk. In some cases, this led to children’s risk being incorrectly assessed. For example, 39 percent of children with severe obesity were risk stratified as being equivalent to a healthy child of normal weight. Two-thirds of hospitals offered no weight management or lifestyle advice to children who were overweight or obese, or to their parents. The researchers suggest this is a valuable missed opportunity to help these children achieve a healthy weight and avoid long-term health problems. Dr Zoë Burton, trainee lead for the study and now a Consultant Paediatric Anaesthetist at Sheffield Children’s Hospital, said: “This large multicentre cohort study suggests a concerning prevalence of children with obesity needing surgery in the UK. “These results should be used to inform optimal provision of care for these children, and support healthcare initiatives, such as measuring BMI and offering advice on achieving a healthy weight, that could have lifelong benefits for these children’s health.”