childhood obesity prevention: Fiona Dickens Public Health Programme - PowerPoint PPT Presentation

Putting research to work in childhood obesity prevention: Fiona Dickens Public Health Programme Manager Swindon Borough Council

Challenges and priorities • Evidence base : not clear what works, what does not work or is less effective, cost effective or difficult to sustain. • Translating evidence into action at local level: – Should we stop doing anything? – Should we start to build a better evidence base?

Challenges and priorities Translating evidence into action at local level: – Re-consider our overall approach: a life course approach or focus on specific projects in schools and/ or early years? – Should we focus on doing one thing really well that is most likely to work or do a number of small programmes e.g. focus on a multicomponent school programme.

Challenges and priorities Translating evidence into action at local level: – What about health inequalities- will we end up increasing the gap if we go for quick wins? – Are there any projects we can work on across a wider area? – What if we do nothing at all at local level?

Involving Parents & Children Geraldine Cooney Public Involvement Consultant University of Bath

Research is not just for researchers – it cannot lead to improvements unless the right people join in No matter how complicated the research or how brilliant the researcher, patients and the public always offer unique invaluable insights

Working ‘with’ people not ‘about’ or ‘for’ them • Consultation • Collaboration/ Co-production • User/Community led

Parents Interviewing Parents (PIP project)

PIP Headlines • Team of 4 trained interviewers • Recruitment issues – ongoing • Relaxed, comfortable interviews • Context – parent/family perspective • Support & help – practical, emotional

’ Bottom up’ approach • Avoids ‘us’ and ‘them’ ‘We are helping our daughter…I resent the interference..’ • Reduces Negativity ‘..you are being heavily criticised as being an irresponsible parent’ • Creates Dialogue ‘I felt judged and unable to reply to anyone...’ • Identifies Solutions ‘I think a phone call would have been better…there wasn’t a comfortable chat.’ ‘I would like to see a weight range of where she should be for her height and age.. BMI does not mean a bean to the normal person..’

“ There should be a place for people that have got issues to be able to talk to someone, like counselling. But at school. Where you could go…you know, just to help…I don’t think she [daughter] had the chance to have someone she could speak to.”

NCMP Research update ……a whistle -stop tour of recent relevant research Fiona Gillison, Department for Health, University of Bath f.b.gillison@bath.ac.uk Collaborators: Lou Atkinson, Coventry University (and Warks. Public Health) Sanne Gerrards & Stef Kremers, Maastricht University, NL Jeff Niederdeppe, Cornell University, USA

Talk Outline • Research studies; Parents’ views of the NCMP 1. Should we adjust for children’s level of maturity? 2. 3. What are the risks of harm 4. Development of a health communication approach • What does this research suggest? 1. Applying narrative messaging 2. Shifting formats

The challenge • 75-83% UK parents of overweight children are not aware their child is overweight • Parents are essential in tackling childhood obesity • Interventions/projects that involve parents significantly more effective than those which don’t • If the NCMP system isn’t working for us – can research provide ideas of different approaches that may help?

What limits positive impact of NCMP? • Parents’ priorities for judging a child’s health don’t coincide with ours • Consider well-being and lifestyle as a priority • Some believe labelling children as overweight is ‘risky’ • Parents don’t have full trust in the measures • Not convinced by BMI is valid (esp. around puberty) • Not convinced by ‘1 - off’ measures • Parents’ don’t believe we (or they) can realistically do anything to change their child’s weight • Avoiding conflict (Lou Atkinson, Coventry University)

Why don’t parents believe it? 18 16 14 1 12 10 2 8 6 4 2 0 Weight not a Healthy Risk of harm BMI not valid Puberty Will naturally Parent-only health risk lifestyle /child is resolve responsibility mitigates risk normal Gillison, Beck & Lewitt, 2014; Public Health & Nutrition

Should we take account of puberty? Change in classification of overweight accounting for maturity in boys 11% of obese girls were no longer 100 obese when 80 adjusting for 60 maturity 40 20 0 Change in classification of overweight overweight obese accounting for maturity in girls Consistent classification Change in classification 100 80 32% of overweight 60 girls were no longer 40 overweight when 20 adjusting for maturity 0 overweight obese Consistent classification Change in classification N=407 Year 6 children in BANES & Wiltshire

Is it ‘risky’ for parents to tell their child they are overweight? • Only 4 intervention studies – all unlike NCMP • Interventions training parents to communicate positively; Outcomes measured Effects Perceived pressure to be thin Body satisfaction Eating disorder symptoms Unhealthy weight loss behaviours

Is it ‘risky’ for parents to tell their child they are overweight? • 40 studies reporting observations (from surveys); Parent Child body Child poorer Child behaviour dissatisfaction wellbeing dysfunctional eating Encouragement 0.3 0.5 0.2 to lose weight Criticism / teasing 0.2 0.2 0.2* reduced ‘dieting’ Encouragement improved - healthy lifestyle** satisfaction * Stronger association in girls; ** only 2 studies

Conclusions so far… • We may be inadvertently classifying some more advanced children as overweight when they are not • Anything we do that results in parents encouraging a child to lose weight is not a neutral activity – even if it is not the cause, more encouragement is associated with poorer wellbeing Could acknowledging and adjusting for these concerns increase the impact of NCMP feedback?

Narratives and story telling • How can we reduce ‘reactance’ so our message is read? • Narrative messages (stories) of ‘people like you’ with an embedded health message • If constructed well, work by: • Reducing reactance (counter-arguing) • Reducing perceived invulnerability • Increasing relevance • Increasing self-efficacy of the required action • Communicating complex ideas to people with lower levels of education Niderdeppe & Byrne, 2012

Can we put this research into practice? 1. Adjustments to the NCMP feedback - more tailored letter (e.g., maturation status, activity level) - advise on positive ways to talk to children about weight - narrative message to reduce reactance and enhance self-efficacy (sent with a letter or ahead, available online) 2. Achieve the same aims through other means - work with schools raise the profile of the importance of a healthy weight, ahead of NCMP - facilitate face to face feedback e.g., health checks, health events, parents’ evenings - - involve parents in weighing and monitoring (e.g., between Reception and Year 6)

Research Round-Up • What works in childhood obesity prevention? • School based initiatives • Community based approaches • Family based initiatives • How do childhood obesity prevention initiatives impact health inequalities?

Results of Systematic reviews Waters et al (Cochrane review), 2011 • 37 independent studies: average – 0.15 kg.m 2 (BMI points) • bigger effect sizes for younger ages • no evidence of adverse effects FACTORS ASSOCIATED WITH BETTER OUTCOMES • School curriculum including healthy eating, physical activity and body image • Increased PA opportunities in schools • Improved nutrition within schools • Supportive physical and cultural environments • Educational support for teachers in relation to health promotion activities • Participation and awareness among families

Results of Systematic reviews Wang et al, 2015 • 139 intervention studies analysed (outcomes at 6 mo.) Setting Outcome Support School only (43%) Significant BMI Moderate (PA or diet) poor (combined) School + home (23%) Significant BMI High (PA only) Moderate (combined) School + home + Significant BMI High (combined) community (7%) School + community (4%) Significant BMI Poor (PA or diet) Moderate (combined) Home-based (4%) No effect Community-based (7%) Significant BMI Moderate (if incl. schools) Poor (if schools not incl.)

School-based interventions Vasques et al, 2014 • 52 studies • Very small sizes of effect less than 0.1 – meaningful effect = 0.2 • Better results if including both nutrition education and physical activity sessions • No difference between in-school and after-school projects

Content of interventions Hendrie et al, 2012 • 15 studies delivered school- or community-based interventions AND involved parents • Components distinguishing effective interventions were; • provision of information about the behavior – health link (providing knowledge), • prompting practice (repeating behaviour many times), • planning for social support • modelling useful in the home, not in school • greater intensity of family involvement