Implementing a settings approach to health promotion: Working together to promote outcome focused programmes in Childhood Obesity Experiences from the UK Aoife Prendergast Lecturer, Institute of Technology, Blanchardstown

Introduction: Obesity “Global Epidemic” Recognized internationally as a major public health challenge. Unfortunately, there are no exemplar populations abroad to learn from as no country has been successful in turning the tide on obesity.

Lessons Learned My own UK Experience NHS: Primary Care Trust Public Health Leeds Metropolitan University Great Ormond Street

UK Interventions: Lessons Learned However there is an ever increasing and improving body of evidence and some promising interventions such as the Carnegie Weight Management (CWM) Programme which is currently being delivered in Peterborough in the UK.

CWM Peterborough Settings Approach Community Only targeted programme

CWM is a UK national programme led by Leeds Metropolitan University Delivered locally by health promotion specialist staff at NHS Peterborough. The programme aims to improve the health of children between two and 17 years of age who are overweight or obese. It also provides families with the relevant support and information to help them make healthy, informed choices to maintain a healthy weight.

Type of Programme Club programme It runs as a 12 week programme For 3 ½ hours each week Young people are to attend with a parent or carer. Parents are key to the programme and they help to implement back in the home what has been learnt on club. After the 12 weeks there is 3 month follow on support programme

NHS Peterborough: Primary Care Trust The commissioning process for the programme started in October 2009 and delivery began in May The city currently has one of the highest childhood obesity rates for Year 6 children. Results from the 2008/2009 school year show that one in seven (13.8%) reception age children are overweight and almost one in ten (9.2%) are obese.

Three age specific 12 week programmes were delivered 2-4 years, the first of it’s kind in the UK 4-10 years years Delivered in settings across Peterborough for children and their parents or carers. There has been a high proportion of referrals for the programme. It is the first time that the pioneering programme has been extended to include children between the age of two and four.

Focus of Programme The programme focuses on a number of elements that directly influence and affect a child’s weight. These include diet and nutrition, physical activity, anthropometric measurements, behavioural change to the sustainability of change. It is delivered as a 12-week intervention with a six month and 12-month follow-up period.

Results and Conclusions Continual evaluation concludes that there has been: Reduction in body fat composition, Reduction in waist circumference and weight As well as improved self image and self esteem for children undertaking the programme.

Sustainability: Follow on Support To further support children undertaking the programme, a post-Carnegie programme, Movers and Shakers is currently being delivered by health promotion specialist staff in partnership with Vivacity. The programme is delivered over a six week period and introduces participants to locally available to further encourage sustained behaviour change. Two age groups are targeted throughout the Movers and Shakers programme, 5-10 years and years

Carnegie Club outcomes Change ChildrenParents Body mass (kg) BMI (kg.m -2 ) BMI SDS NA Waist (cm) % Body fat Fitness (l.min -1 )

Stakeholder Engagement Stakeholder engagement is a key success criterion in order to reach those at risk who will benefit most from the programme and ensure equality of access. More than 800 stakeholders have been informed of the programmes including clinicians and non- clinical practitioners. A successful outcome of the programme was the number of referrals received through all the potential routes and particularly those that are able to access Peterborough’s six priority areas

Stakeholder Engagement Plan GP’s, SNT, Public Health, Healthy Schools, Sports Teams, Dietitians, Paediatricians, Child Health Teams, HVT, Children centre's Key Partnership Boards Media & Communications Businesses Community STAKEHOLDERS SELF REFERRALS

To Replicate….. Using lessons learned Utilising the settings approach addressing the contexts in which people live, work and play, including: –the needs and capacities of people in the setting –make the setting itself more healthy

Observations Many challenges exist Hardest part is that professionals are not equipped with the right language and skills to talk sensitively and helpfully with children and families about overweight and obesity. Referral Procedures Sustainable behaviour change

Multi – disciplinary approach – includes physical activity, dietary and lifestyle education and a cognitive behavioural approach Adheres to the NICE guidance for safe weight loss

What we need Behaviour Change and Motivation is key Urgent need to address this problem and come up with realistic solutions Targeted programmes Social Media: Change 4 Life Key Stakeholders on board

Conclusions Overall, there has been a marked increase in the efforts to prevent obesity over the past 5–10 years; however, we are still virtually at the starting line. Let us hope that the next 10 years will see a much greater policy (and research) response to making the food and physical activity environments less obesogenic so that the health promotion efforts to encourage healthier choices have some chance of working.