1. H3 HEAT Target and Max in the Middle Dr Graham Foster Consultant in Public Health Medicine

2. Evidence Review Primary and secondary approaches Individual needs and community development Not stigmatising Whole school approaches Change physical activity, diet and behaviour Long term view not one off projects or short term support

3. Examples of best practice No single programme is model, but key elements can be identified

4. Multi-agency planning day

5. Existing Services and Programmes Fit for Girls Physical Activity Co-ordinators Breakfast Clubs Healthy Tuck shops Leisure Centres and Sports Clubs Hungry for Success

6. Existing Specialist Services Primary Care Community Dieticians Specialist Obesity Clinic YUFF Programme

7. Childhood Obesity in Scotland

8. And it just gets worse By age 40 almost 60% of females in Central Scotland are overweight or obese For males 50%

9. Conclusions Build on what we already have Community / Family approach Introduce a universal Level 1 - Max Join up the existing Level 2 Expand the specialist Level 3 - YUFF

10. Max in the Middle Why are we doing it? What is it?

11. Max in the Middle School Based Programme Whole class approach Drama Dance Empowerment Parental Involvement

12. What is - Max in the Middle History – –behavioural intervention whole class approach –substance misuse –pilots on healthy behaviours An 18 hour, intensive school based, whole class intervention promoting healthy behaviours and engaging parents and families

13. Benefits - Max in the Middle Universal– –No Exclusions / withdrawals –Highly innovative –Exciting –Memorable –Not work –Links to Curriculum for excellence –Links to Community –Local Focus and relevance –Kids love it and want to participate –Families get enthused and engaged

14. Meeting Monday

15. Meet the Team Size up the class / school Break the ice Build confidence Play games Do some dance

17. Tasty Tuesday

18. All about Food Parental volunteers Food is not dangerous Handle food, taste food, enjoy food Memorable Messages Healthy eating plate etc

19. Workout Wednesday

20. Elements of fitness Physical Activity as ADL Local Opportunities Clubs and Groups Walks, games, transport More dancing

21. Thursday is Rehearsal Day

22. Friday - Performance

23. Children do invites All welcome Big attendances even in most deprived/least engaged schools Opportunity to meet the parents Interaction NOT in front of school

24. Review of 2008/9 Max in 21 primary schools, 600 children 200 obese children completed a Max week Positive internal evaluation Only NHS Board to deliver agreed number of interventions

25. 2009 to 2011 42 schools per year, Approx 1200 children All introduced to level 2 (engagement) 40 referrals - YUFF/Specialist service NHS Health Scotland evaluation

26. 2012 so far 84 schools per year, Approx 2100 children 42 Full Max Experience (18 Hours) Primary 6 42 Max Lite (1 in Service day of teacher training and 6 1 hour school visits) Primary 5 Heights and Weights on all children (our greatest challenge) Planning for Sustainability

27. Small changes count 150 kcal xs per day = 7kg per year 150 kcal = 1 sandwich or »1 can of coke or »1/2 Mars bar

28. Thank you

29. Primary prevention – avoiding development of unhealthy weight Secondary prevention – early detection of unhealthy weight to avoid development of health problems Individual needs addressed within a community development approach Evidence Base for Max Programme

30. Ideally multi-level: individual, school & community Whole-school approaches should be used in schools, ideally Schools-based approaches need support from families & communities Multi-component with behaviour change strategies to: Increase physical activity Improve eating behaviour Promote behaviour Change All components tailored to the setting

31. Parental/carer obesity major risk factor for child obesity Parents should be actively involved Parents encouraged to have main responsibility for lifestyle changes Change can be hampered by complex living and working Participant engagement is fundamental to effectiveness Stakeholders (families, schools, others) need to be included Short term interventions and one-off events are insufficient

32. Need to tailor advice and address potential barriers Consider groups such as ethnic minorities, low incomes etc Overweight and obese children with significant co- morbidities or complex needs should be referred to specialists