Healthy Lifestyle Programme for Children
Introduction
The Healthy Lifestyle Project is a pilot project based at South Moorlands Leisure Centre in Cheadle, involving a small group of overweight and obese children and their families. They participated in a yearlong dietary intervention programme coupled with access to a modified version of the Physical Activity on Referral Scheme for adults in North Staffordshire.
This pilot healthy lifestyle project originated from initial developmental work to adapt the Physical Activity Referral Scheme in Stoke for children as a way of managing childhood obesity in the area.Given the increasing prevalence in obesity among children, and the National Diet and Nutrition Survey (2000) findings that 40% of boys and 60% of girls failed to meet the recommended one hour a day of moderate intensity exercise, the Community Dietician wanted to develop a pilot project that would tackle these locally.
There appears to be limited evidence on the efficacy of treatment programmes for overweight and obese children, but there is some evidence that family based interventions are effective. In addition, SIGN (Scottish Intercollegiate Guidelines Network) have set out a framework for an evidence based approach to weight management, including the following elements:
- healthy eating
- increased physical activity
- behavioural approaches
- involvement and support of the family.
-The Healthy Lifestyle Project links with the local implementation of the National Service Framework for diabetes which highlights the importance of preventing diabetes through effective obesity management.
The District Leisure Centres Manager at the County Council indicated that existing health schemes, such as the GP Exercise on Referral Scheme and the Cardiac Rehabilitation Scheme, had brought the PCT and the Council closer together over the last 5-6 years. He was keen to strengthen these links by supporting family based programmes and one of the Local Authority’s priorities is to tackle obesity.
Partnership
Staffordshire Moorlands PCT
Directorate of Health Promotion
Glendale Leisure.
Project aims
The overall aim of the programme is to:
"Enable families with obese or overweight children achieve a healthier weight and lifestyle".
The objectives for the programme are:
- to bring together up to 25 obese and overweight primary school aged children for a year long dietary and physical activity programme
- to educate families on healthy eating based on the principles of the ‘Balance of Good Health’
- to facilitate families making specific dietary changes so that obese and overweight children achieve an intake which will allow weight loss or weight maintenance
- to negotiate with children and their families means of becoming more physically active in everyday life
- to arrange with children to participate on a range of preferred activities based at South Moorlands Leisure Centre
- to measure the effectiveness of the programme by measuring BMI and waist circumference of participating children, families reporting of changes in amount of physical activity taken and in changes in quality of diet.
Target audience
The pilot project was aimed specifically at overweight or obese primary school age children (4-11 years), using the International Obesity Taskforce (IOTF) cut-offs for defining overweight and obesity in childhood.
Five target schools were selected for pilot. The school nurse sent out a carefully constructed letter (with input from a Child and Adolescent Psychologist) to all families. Children of interested families were then screened by the school nurse for height and weight. No specific needs assessment was carried out on the target group.
The Community Dietician subsequently assessed this data for suitability for inclusion in the programme i.e. if the BMI fell within the inclusion areas using the IOTF cut-offs. It had been planned to recruit 25 families but the response rate was low and only 16 were sampled. Of these 12 families went on to complete the yearlong programme. For the next stage of the project this will be extended to include 4-16 year olds (children over 16 can access the Physical Activity Referral Scheme).
Methodology
The year long programme combines access to a modified ‘child friendly’ version of the existing Physical Activity Referral Scheme (‘Exercise on Prescription’) in North Staffordshire, with dietary intervention.
The overweight and obese children and their families were invited to attend five one-to-one sessions with the dietitian over the year consisting an initial consultation and then at one and three monthly intervals thereafter. A total of three sessions were also made available with the physical activity consultant along with free access to a range of activities at the South Moorlands Leisure Centre.
Dietary input or activity included the following elements:
- agreed dietary targets based on the FSA’s ‘Balance of Good Health’
- diary keeping
- motivational charts and stickers
- additionally, families were set small tasks between sessions, for example: asked to bring in empty food packets from home to discuss the labels and nutritional content of the different foods.
Examples of the resources used in this project are included in the back up pack which augments this report.
The pilot programme ran for 1 year from October 2002 and has been evaluated and written up as a Project Report. As a result of the success of the pilot there are plans to extend the programme.
Resources
The Community Dietitian obtained agreement for:
- 1-2 dietetic sessions per week
- regular input from a fitness professional at the local leisure centre (under private contract but managed by the District Council)
- free use of the leisure centre facilities for the participants
Barriers
The main problem the Community Dietician had was in ‘convincing’ the PCT that the project would be successful, without evidence to back up her proposal. In addition, negotiating with the County Council for free access to activities proved a challenge.
Initial negative media coverage (e.g. Fat Club in the Moorlands) contributed towards negative perceptions surrounding the project. Co-ordinating time with the physical activity consultant was difficult. The fitness professional had other constraints on his time, and in the end, was unable to fulfil his commitment to the project.
The health promotion specialist felt that securing future funding is likely to be the next barrier to implementing the project further and felt that it was also important to look at recruitment onto the programme and how this is presented to people. She felt this could be improved to attract more people.
Evaluation
Quantitative anthropometric measurements were collected at each visit, including height, weight, BMI and waist circumference. Qualitative data was collected using dietary markers at the beginning and end of the project. Markers used included the consumption of fruit and vegetables, sugary drinks, crisps and sweets and chocolate.
Parental and child reporting was used to record any dietary changes. The Research and Development Department at the University of North Staffordshire NHS Trust helped with the development of the end of project questionnaire (see back up pack). This was used to establish behaviour change and satisfaction with the programme.
The Project Report gives a more detailed breakdown of the results but in brief:
- the evaluation appears to indicate that the scheme has been an effective means of enabling children and families achieve a healthier lifestyle
- this is borne out by the self reporting dietary and lifestyle changes in the end of programme questionnaire
- improved BMI profiles and waist circumference data for the majority of the children
- all children reporting self-benefits from taking part, with comments such as "feeling healthier" and "being able to wear more fashionable clothes"
- all participants and their families claiming to be more physically active as a result of the scheme
Sustainability
The PCT has agreed to run a further pilot for a year in another leisure centre in Leek, building on the learnings from this first pilot. If funding can be secured there is a longer term plan to cascade the programme across North Staffordshire which would involve four PCTs. It is unclear at this stage whether funding would be sought internally or externally.
With the appointment of a new exercise advisor on the Exercise on Referral Scheme, the Council were able to include the children’s project as part of his remit. This has meant that it will no longer be necessary to identify funds to support the physical activity consultant’s time input.
Lessons Learnt
Ensure the physical activity element is included in the programme with input, involvement and commitment from the local authority and exercise advisor at the start.
Adapt the programme in line with previous participant’s comments including:
- development of specific physical activities for the group, such as aerobics classes and consider opening these up to other family members
- more frequent visits to the dietician and/or physical activity specialist
- better planning of family walks to be closer to home.
Consider routes for on-going support at the end of the programme e.g. the school nurse or other local support networks that might be available. Ensure any press coverage is appropriate given the interest in the topic area.
Explore the reasons for the low uptake at the recruitment stage and consider different recruitment procedures (e.g. via GP referrals). Work more closely with the local authority to strengthen links and to discuss and negotiate the logistics of running the programme in leisure settings. A realistic pricing policy needs to be established for the physical activity component.
Consider independent evaluation and audit of the scheme.
Lead contact:
Name: Mary Tyers,
Job Title: Senior 1 Community Dietitian,
Address:
Nutrition and Dietetic Department,
University Hospital of North Staffordshire,
Stoke-on-Trent.
Tel: 01782 552113.
Email: mary.tyers@uhns.nhs.uk