Professor Louise Baur holds the Chair of Child & Adolescent Health at the University of Sydney and is a consultant paediatrician at the Sydney Children’s Hospitals Network. She received the 2021 NHMRC Elizabeth Blackburn Investigator Award – Public Health (Leadership) for her work leading an interdisciplinary program of research in preventing obesity in childhood and providing safe, effective treatments to children and adolescents living with obesity.
For the past three decades I have worked as paediatrician in a multidisciplinary clinic in a tertiary children’s hospital caring for children and adolescents with moderate to severe obesity. It’s challenging but incredibly rewarding work. However, over the years, this experience of working with such children and their families has made me consider many research questions. In the process I’ve partly morphed into a public health physician, while retaining my strong clinical interest.
Firstly, I became increasingly interested in what could be done to prevent obesity in the first place.
Secondly, my team and I wanted to better understand how to provide safe and effective treatments for those affected by obesity.
And thirdly, we wanted to see how we could implement these prevention and treatment strategies into routine services.
Professor Louise Baur AM with NHMRC Chair Caroline Homer AO at the 2021 NHMRC Research Excellence Awards. Photo credit: NHMRC/PewPew Photography.
Obesity prevention approaches
For more than 15 years, I have worked with Dr Li Ming Wen and other colleagues at the University of Sydney and Sydney Local Health District on several linked studies aimed at preventing the development of obesity and risk factors for obesity in early childhood. The Healthy Beginnings suite of studies started with a trial of home-visiting by early childhood nurses to pregnant women and new mothers to support healthy infant feeding and healthy family lifestyle behaviours. The trial led to improved child weight status and infant feeding at age 2 years, the first study globally to prevent obesity in early life.
The Healthy Beginnings team’s research has subsequently included studies investigating the use of SMS and phone coaching to support healthy infant feeding, and now web-based support. We now believe that a range of strategies – home visiting, tele-health, on-line, group programs, cultural adaptation of programs for priority populations, and no doubt much more – is needed to support parents of young children in providing healthy nutrition, sleep and play opportunities. We recognise that different approaches will suit different individuals and families.
Not long after the first Healthy Beginnings study commenced, I became aware – around the table at a conference dinner! - that three other groups in Australasia were about to start trials also aiming to prevent obesity in the first 2 years. We therefore established the Early Prevention of Obesity in Childhood (EPOCH) Collaboration and agreed to share data for a prospective meta-analysis, the first such globally. Fifteen years later, this work has evolved into a collaboration involving multiple other trials from around the world, involving many more participants. We now have the opportunity to understand which specific elements of interventions to prevent obesity in early life work best for which populations.
The EPOCH Collaboration became the kernel of the multi-state NHMRC EPOCH Centre of Research Excellence, which ran from 2016-2021, and now its successor, EPOCH-Translate CRE (2022-2026). I have been, and am, the Director and “mother hen” of these two CREs. We are addressing the overarching question of “How do we embed effective, scalable, cost-effective interventions to transform obesity prevention in early childhood? We have brought together not just trialists, but also health economists, health promotion specialists, big data analysts, modellers, dietitians, physical activity experts, primary care clinicians, health services leaders and implementation scientists from across Australia and NZ. This range of disciplines is needed in order to tackle the complex issue of childhood obesity. As a paediatrician working on my own, I would never have been able to undertake the sorts of studies that are needed.
The variety of work being undertaken by my colleagues – junior and senior - under the EPOCH-Translate CRE umbrella is quite astonishing. Most importantly, there is a spirit of trust and cooperation which means people want to share data and work across traditional discipline silos.
My Investigator grant will support aspects of these various studies, including the development of recommendations for targeting early childhood obesity prevention in different settings in Australia and beyond.
Treatment of obesity
Obesity is such a common, and often very serious, health issue that a focus on prevention alone is inadequate. There must also be effective treatments for those people affected by the disease. Over the past 2 decades I have led or participated in many trials of therapy in children or adolescents with obesity. We have had the benefit of very strong links with the Weight Management Clinic at The Children’s Hospital at Westmead, a service I established in the 1990s. This has allowed quite a rapid two-way translation of findings and observations between clinicians and research teams.
At the moment we are looking at the somewhat vexed issue of whether interventions aimed at weight reduction may promote disordered eating and worsen psychological health. Systematic reviews reassure us that in general this is not the case for professionally delivered obesity treatment. In order to investigate this further, post-doctoral fellows Drs Natalie Lister and Hiba Jebeile have established the Eating Disorders in weight-related Therapy (EDIT) Collaboration. This is a global network of more than 30 trialists who have agreed to share individual participant data to identify individual features of adolescents with obesity that are associated with eating disorder risk or resilience during and after weight management. Using these data, we will then be able to tailor standard treatments to protect individuals at risk.
My Investigator grant will allow us to develop and disseminate safe and effective models of care to support children and adolescents with obesity in Australian healthcare settings.
International advocacy for obesity
In other parts of my life, I am involved with obesity advocacy through the World Obesity Federation. I am currently President-Elect of WOF and will become its President for two years as of July 2022. Somewhat counterintuitively, there are many more people living with obesity in low and middle-income countries than in high income countries. COVID-19 has also shone the spotlight on obesity because having a high BMI is one of the major risk factors for severe COVID, and COVID restrictions in turn have led to increased obesity prevalence rates in many countries. World Obesity is working closely with WHO to raise awareness of this issue in member countries, and to support strategies to prevent obesity and to implement primary care treatment for people with obesity. My role in World Obesity will provide additional opportunities to disseminate our research findings.