1. Quantitative Evaluation of NHS Grampian‘s Grow Well Choices Programme (September 2011 - July 2013) Emily Stevenson, Public Health ST2 Mary Bellizzi, Health Improvement Officer, Aberdeenshire Caroline Comerford, Health Improvement Co-ordinator Pauline Maloy, Primary Care & Public Health Analyst

2. Background to Child Healthy Weight 2008-2011, Health boards required to ensure a number of overweight children completed a weight management programme (Heat target H3). Further CHW target for April 2011 – March 2014. 1,556 overweight and obese children (BMI>91 st centile) completed a CHW programme in Grampian (≥40% to children in two most deprived local SIMD quintiles) NHS boards have taken a range of approaches to achieving their individual targets. School-based approach supported by a more targeted programme has been the favoured model of delivery. Specific content varies greatly between boards.

3. Grow Well Choices (GWC) GWC NHSG’s school based programme. Based on NHS A&A’s ‘Jump Start Choices’. Primary school children (largely P5-P7), whole class approach. Piloted September 2011, rolled out across Grampian in October 2011. HEAT target ceased in March 2014, but GWC continues to run.

4. Delivery Run by 3 Community Health Partnerships (CHPs) All schools invited to take part (N=243) If accepted, head teacher selected class to participate. Trained health coaches delivered weekly sessions over 7-8 weeks, each lasting one hour. Prior to first session (pre-programme), at end of last session (post-programme) and 6 months later (follow- up), children’s heights and weights were measured. Opt out to measurements. Results transcribed into CHSP-S. Information sent to ISD, report returned to health board with computed variables for BMI, BMI percentile, BMI standard deviation score (BMI-SDS)

5. Session 1 – Being Active and Healthy Session 2 – Eatwell Plate Session 3 – Energy Balance Session 4 – Sugars Session 5 – Snacks (parents/carers observing) Session 6 – Fats Session 7 – Eating Out Session 8 – Review (optional) Session 1 – Being Active and Healthy Session 2 – Eatwell Plate Session 3 – Energy Balance Session 4 – Sugars Session 5 – Snacks (parents/carers observing) Session 6 – Fats Session 7 – Eating Out Session 8 – Review (optional) Main Components

6. Week 4 – Sugars and tooth hockey

7. Data Analysis Pre and post programme data available from start of programme until July 2013 (N=5365, 1186 were O/O) Follow-up data was available from start of GWC until March 2013. However, >50% did not have 6 month measurements taken (N=2057, 439 were O/O) At time of analysis, 77% of all schools in Grampian had participated. Statistical analysis only performed on pre- and post- programme data. Analysis undertaken for whole group and O/O subgroup. Follow-up data restricted to descriptive presentation. BMI-SDS used – standardised measure

8. Results Mean age 10 years old. Majority of children from Primary 5 and 6. 77.7% of children were of a healthy weight, 0.2% were underweight, 12.8% overweight and 9.2% obese (including severely obese).

9. Comparison of pre- and post-programme BMI-SDS – Obese and overweight children

10. Table 2: Paired samples t-test for the population mean difference in BMI- SDS (overweight and obese children)

11. Multivariate linear regression After adjusting for pre-programme BMI-SDS, post-programme BMI-SDS was statistically smaller in: - Children in SIMD 5 compared to SIMD 1 - Children who started the programme in Spring compared to Autumn.

12. Compared to whole of Scotland

13. Table 6: Change in BMI-SDS for overweight and obese children and by gender, pre- and post- programme and follow-up. What happens to BMI-SDS after CHW programme ceases? 6 month follow-up data

14. Pre-programme BMI-SDS by difference between follow-up and post programme BMI-SDS Pre-programme BMI-SDS by difference between follow-up and pre-programme BMI-SDS

15. Discussion Many limitations e.g. No control group Quadratic like relationship seen Greater reduction in boys (all children), and in O/O group Variation between time of year Deprivation appears to play a part

16. What these results add? Similar findings to the Scotland wide evaluation. Provides information on what happens to BMI-SDS in these children 6 months after the programme has ceased. Additional supporting evidence for effectiveness of GWC on BMI-SDS albeit illustrating potential need for a longer programme or more sustainable approach. Explores confounding factors.

17. Does a reduction of BMI-SDS of this size have a considerable impact on health? AuthorReduction in BMI-SDS associated with improvements in body composition and cardiometabolic measures Ford et al. (2010)≥0.25 Reinehr et al. (2004)≥0.5 Kolsgaard et al. (2011)≥0.0-<0.1 We found a change in BMI-SDS of 0.051 in overweight and obese children. Change in BMI-SDS relatively small, at a population level could have considerable importance if sustained over time.

18. With thanks to the GWC teams in the 3 CHPs, Dr Fiona Murray (NHSG Public Health Researcher), and Dr Neil Scott (University of Aberdeen Statistician). emily.stevenson@nhs.net

19. References 1.Ford A, Hunt L, Cooper A, Shield J. What reduction in BMI-SDS is required in obese adolescents to improve body composition and cardiometabolic health. Arch Dis Child 2010;95:256-261. 2.Reinehr T, Andler W. Changes in the atherogenic risk factor profile according to degree of weight loss. Arch Dis Child 2004;89:419-22. 3.Kolsgaard M, Joner G, Brunborg C, Anderssen S, Tonstad S, Andersen L. Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo Adiposity Programme Study – a hospital/public health nurse combined treatment. BMC Pediatrics 2011, 11:47.