Lighten Up and Tighten Up
Introduction
The project was initiated as a result of community development work carried out by the Community Development Dietician amongst ‘Sure Start’ parents in deprived areas of Wrexham. People in these communities requested a ‘Weight Watchers’ approach to help them manage their weight, but without the financial, travel and childcare costs of attending a commercial programme.
In 2001 a successful bid was made to the Welsh Assembly to fund a pilot weight management programme which ran May – August 2002. Details of this bid are provided in the back up pack provided with this report.In February 2003, the Welsh FSA and the National Assembly for Wales published a nutrition strategy for Wales entitled "Food and Well Being". A key feature was the implementation of strategies to prevent and manage obesity among the population. Respondents believed that ‘Lighten Up and Tighten Up’ will be one of the key contributors delivering against this strategy in NE Wales.
The programme is also recommended as one of the strategies for implementing the National Service Framework for diabetes locally.
Project concept:
"Lighten Up & Tighten Up" is a 12-week weight management, lifestyle change programme that aims to help individuals within disadvantaged communities lose weight and improve their health.
Project Aims & Objectives
The aims of the "Lighten Up & Tighten Up’ project are as follows:
to support groups of individuals within disadvantaged communities needing and wanting to lose weight
- to assist individuals in making small, achievable and realistic changes to their lifestyle
- to facilitate a "holistic" approach towards healthy eating and achieving weight loss
- to encourage peer support and leadership throughout the project.
Partners
Key partners for the project include:
- Local GP practices
- Fresh Start – GP Exercise referral scheme – co-ordinated by the Sports Development Officer, Wrexham County Borough Council
- Groundwork Wrexham – Walking the Way to Health scheme
- Dieticians
- Smoking cessation specialists
- ‘Sure Start’ health visitors
- Leisure Centre Manager
Target audience
The project is specifically aimed at overweight adults with a Body Mass Index (BMI) greater than 25, living in areas within the Welsh Assembly Index of Multiple Deprivation in North East Wales (Gwersyllt, Caia Park, Brynteg and Plas Madoc).
Although the rationale for the project was initially to support people involved in ‘Sure Start’ programmes, "Lighten Up & Tighten Up" now embraces the participation of other adults within the community.
Methodology
Recruitment onto the programme is achieved through a number of routes:
- self-referral (by those in the community with a BMI > 25)
- referrals from partners e.g. individuals accessing smoking cessation services who are experiencing weight gain
- dietetic clinics i.e. instead of 1:1 appointments with the dietician.
The Project Officer has met with community groups in target areas to further refine:
- the most convenient day and time to run the programme
- which venues are appropriate
- preferences for the course content.
The course content is based on making lifestyle behaviour changes, particularly dietary and physical activity changes, in order to facilitate weight loss. Weekly sessions last between 1 ½ - 2 hours, depending on the numbers attending and the topic being covered. Topics include:
- healthy eating
- understanding food labels
- supermarket tour
- cook and eat session (if practical)
- improving self-confidence
- becoming more active
- stress management
Since the first pilot programme which ran in mid-2003 the Project Officer has delivered a total of 4 "Lighten Up & Tighten Up" courses in locations designated as being of multiple deprivation.
Funding/timing
£159,000 over 3 years was awarded by the Welsh Assemblies Inequalities Fund in 2001. A full time Project Officer was recruited with a two-year contract in early 2002. After the first year the project was under spent by 50% as the Community Dietitian had anticipated greater transport and other costs. In order to secure the funds for the duration of the project (2005) a further bid to the Welsh Assembly was made for an extension of the "Lighten Up & Tighten Up" programme into another county. This has been approved.
Partners
Groundwork Wrexham (local Walking the way to Health Scheme)
Leisure Services (Wrexham County Borough Council)
North East Wales NHS Trust
Sure Start
Fresh Start (GP exercise referral scheme)
Barriers
The attendance rate for the courses is averaging 50% which was considered to be high. Follow up showed reasons for non-attendance included, sickness, caring for others, inconvenient class timing and time taken to travel. The dieticians felt that a 12 week programme was perhaps too long to have full commitment from attendees.
The community development officer added that there are "subtle elements at play in the community which are hard to quantify". By this statement she was alluding to segmentation within different housing estates in the community. Integration of individuals from these factions may be a barrier to attending the course.
She also felt that it takes a long time (12-24 months) for a professional to be accepted into local communities, and that it is important to get to know the groups before "unleashing projects on them". She commented that disadvantaged communities are bombarded with lots of short-term projects often with no real investment for the future.
Evaluation
The pilot programme has been evaluated and written up.
Data collected during the pilot included quantitative and qualitative information.
Quantitative data:
* weight and waist circumference measurements were taken at each session
Qualitative data:
- group members were invited to complete a Health & Lifestyle Questionnaire on weeks 1 and 12 to assess lifestyle behaviour change
- at week 12, a course Evaluation Questionnaire was completed to obtain feedback on the course as a whole.
The Project Officer sends in quarterly monitoring reports to the Welsh Assembly using a pro forma. She uses this to record achievements, outcomes and barriers over the preceding three month period.
Sustainability/future plans
The Community Development Dietician will review the programme early in 2004, including discussion with programme partners prior to application for further funding beyond the current round.
There are a number of options for the development of the current programme which were identified in the Proposed Extension bid for "Lighten Up & Tighten Up". These include:
- planning and delivering a ‘Train the Trainers’ course for interested community members/workers/local leisure centre staff/health care professionals, so that they could deliver a ‘modified’ version of the programme
- strengthening links with local projects e.g. Fresh Start/Kick Start (exercise on referral) and ‘Walking Your Way To Health’ (local Groundwork links), so that participants are able to gain the maximum benefit from attending the programme
- developing a validated college course (Open College Network) centred on providing training for developing community food initiatives. Those undertaking the course could then contribute to supporting local initiatives, such as "Lighten Up & Tighten Up" programmes.
Lessons Learnt
Get to know the groups before setting up the programme. Find out what they want from attending and manage expectations. Keep sessions practical and informal. Let the group take a lead in terms of course content.
Investigate non-attendance by an independent person. Work more closely with key partners at the planning stage, especially the fitness instructors within local authorities. Look at the feasibility of including a physical activity element in every session.
Monitor and evaluate the programme more closely, so that improvements and refinements can be made in the future. Consider having the evaluation collated and interpreted independently.
Disseminate the programme more widely, with training input and support from the dieticians, rather than the leading role.
Contacts
Lead contact:Kylie Quigg,
Job Title: Project Officer,
Address:
Nutrition and Dietetic Department,
Gladstone Centre,
Maelor Hospital,
Croesnewydd Road,
Wrexham,
LL13 7TD.
Tel: 01978 727159.
Email: kylie.quigg@new-tr.wales.nhs.uk