In some London boroughs a third of children leaving primary school at the age of 11 are overweight or obese. We know overweight children are much more likely to become obese adults, so this major public health problem must be tackled early. The government’s child obesity public service agreement target aims to slow down this harmful trend.
The national child measurement programme weighs and measures children in reception (four to five years) and year six (10-11 years). Feedback to parents will become mandatory shortly, so schools, PCTs and others working with children need to understand the implications of healthy and unhealthy weight and how to deal with parents’ reactions to the information they receive.
Developing and delivering targeted interventions
London’s regional public health group commissioned the London teaching public health network to develop and deliver targeted interventions to address unhealthy weight in small children. A stocktake of PCTs showed they were at very different stages in developing plans to tackle childhood obesity as a public health issue. Some had already commissioned sophisticated intervention programmes, while others had not. None were aware of interventions suitable for children found to be overweight in reception classes.
Two rapid reviews of the literature that were commissioned to find out what might work demonstrated the dearth of published and unpublished evidence in this area.
We wanted to do two things:
- offer training to frontline workers to acquire the competencies needed when encountering children and their families for whom weight was considered a health risk;
- develop and pilot a community intervention for families with children aged four to seven years at risk of unhealthy weight.
Training was addressed through a one-day brief intervention programme for anyone working with children or families. It aimed to enable those trained to raise the subject of healthy vs unhealthy weight and to signpost parents to appropriate local services or facilities.
In PCTs, we had discovered widespread recognition of the need for training diverse staff groups, from NHS, local government and the third sector.
Our expectation that some groups, particularly nursing and medical staff, would view themselves as already competent, was incorrect. So we ran two to four training days per PCT, with a mix of staff. While some knew more than others about specific aspects of child health and weight, none had comprehensive competencies to tackle the issue effectively and sensitively with families – for example, a nutritionist would enlighten the group with recipe ideas, but a teaching assistant could explain how to motivate six year olds to be physically active.
Many (including health professionals) had difficulty understanding BMI (body mass index) in children. While it is undesirable for everyone to be measuring children, we believe that people who work with children should be able to explain BMI to a parent who asks them, particularly given that this is the measure used for national child measurement programme feedback. We therefore commissioned a handy ‘wheel’ for indicating low, normal and overweight BMI in children, which has proven useful in the field.
To date, 561 people – from at least 88 different occupations across all sectors in 13 PCT areas - have completed brief intervention training. Responding to participants’ feedback, we put in place phone and email helplines to support anyone conducting brief intervention post-training. We also asked participants to complete a reflective log as part of their learning. 95 per cent of participants reported feeling confident to raise the topic of healthy weight following training.
Evaluation showed the added value of the learning to participants themselves, whose own newly raised awareness influenced them to make changes for the benefit of their own families.
Community intervention is targeted at families with children aged four to seven years. Using the sparse evidence available and an expert advisory group, we developed a four day training programme for prospective trainer. Criteria for undertaking the training were experience of work with families or children, CRB clearance and a commitment to use the training once completed, but there were no educational requirements. As with our brief intervention training, participants came from diverse occupational backgrounds.
Having trained 35 people in four London boroughs, we piloted CHALK (Creating Health for Active Local Kids) with 104 children and their families. CHALK consists of five 90 minute sessions.
Out of school programmes have a reputation for attracting the articulate middle classes, which would exacerbate health inequalities in child obesity. So, to reach families who might not normally engage with such initiatives, we offered flexibility in delivery - during the pilot, we ran CHALK as:
- after school activity
- daily over the half-term break
- on Saturdays
- at a mix of venues – including schools, mosques, community and leisure centres.
In partnership with the Healthy Living Alliance, families were recruited through local voluntary sector organisations, helping to build bridges between statutory and voluntary sectors.
CHALK was highly rated by children and parents, and by trainers keen to run it again. But will the changes apparent at the end of the programme stick long enough to improve the health of these families? We hope to follow a cohort to find out. Meanwhile, early outcomes are very promising – a cookery group was set up as a direct result of parents participating in CHALK in one venue, a recipe exchange scheme was started at another, parents shopped with their children for fruits and vegetables that they had first tasted at CHALK, families discovered their local park.
These new initiatives build local capacity to tackle an important public health issue and are cost effective. We are exploring the scope for further delivery of these programmes, now the funded project has ended.
But in the impending climate of NHS belt-tightening, we hope tackling childhood obesity will not be overlooked.
Fiona Sim and Raheelah Ahmad are based at the London teaching public health network, London School of Hygiene and Tropical Medicine.