Kim Roberts and Mary Rudolf The first thousand days Perhaps the - - PowerPoint PPT Presentation

The HENRY approach to tackling child obesity Kim Roberts and Mary Rudolf

The first thousand days

“Perhaps the single most important cultural shift that is needed is to invest in the development of children in their early years (from minus nine months to 2 or 3 years old). These early years are absolutely central to the developmental fate

• f a child.”

Professor Sir Ian Kennedy Getting it Right for Children and Young People

Predicted weight status in Year 6

• f children who start school
• bese or severely obese

Graphic adapted from: Changes in weight status of children between the first and final years of primary school. Public Health England 2017

Predicted weight status in Year 6

• f children who start school

a healthy weight

Source: Changes in weight status of children between the first and last years of primary Graphic adapted from Changes in weight status of children between the first and final years of primary school. PHE 2017

Graphic adapted from: Changes in weight status of children between the first and final years

• f primary school. Public Health England 2017

Obesity prevalence among children aged 2-4 years

Health Survey for England 2015

11 % upper CI 13.2% lower CI 9.3%

Parents want the best for their children

We were desperate, we knew we needed to change but didn’t know

• how. It was affecting

the kids I really want to be a good dad but now she’s a toddler there are lots of times when I just feel out of my depth when she says no and takes no notice

What do children need for a healthy start? Messages from research

• Timely and sensitive support for their parents
• Confident and happy parents (most of the time)
• Loving secure relationships and positive attention
• Healthy habits right from the start of life
• A healthy family lifestyle:
• Eating habits and mealtime routines
• Eating well
• Activity and sleep

I sit there giving her advice and I know she’s not going to follow any of it …

Health visitor describing her work with the mother of an obese 3 year old

Sensitive and timely support for parents

Creating the conditions for change

• Supportive relationship – practitioner

effectiveness

• Emotional readiness and energy for

change – confidence and motivation

• The space and opportunity to reflect,

gain knowledge and understanding – and decide how to put this into practice in own life and family

Building effectiveness as practitioners

Qualities: Non- judgemental Partnership Modelling Skills: Relationship Empathy Strengths Raising the issue Solution- focused Knowledge: Risk factors Whole family healthy lifestyle Healthy start

2 day training

A healthy start in childcare

• Resources and support
• 1 day training for settings
• Modelling and relationships
• Early feeding
• Mealtime and snack routines
• Portions and portion sizes
• Eat Better, Start Better menu planning
• Audit and action planning

Impact on practitioners

• 13,000 practitioners trained
• 70% still using the skills 4 years later

I’ve been on many training courses and felt I left with some more tricks in my backpack. But HENRY has changed me as a

• person. It’s about being the

approach, not doing it. I’ve thought about what it’s like for parents in the last two days in a way I never have before.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 1 2 3 4 5 < 12 months > 12 months

Very little impact

Significantly improved

85% < 12 months 91% > 12 months e-survey up to 4 years later; n=354

Impact on practitioners

Brown et al, Community Practitioner 2013

Aspects of Course Regularly, Often, All the Time Value of empathy 76% (276) Key parenting skills 72% (261) Healthy nutrition 71% (256) Working in partnership 70% (250) Solution-focused support 70% (251) How emotions affect behaviour 70% (251) Eating patterns and habits 67% (240) Physical activity 65% (238)

Changes to practice up to 4 years later

Brown et al, Community Practitioner 2013

• Positive changes in

practitioners’ lifestyles

• Enhanced confidence to

approach and discuss lifestyle issues with families

• Healthier meals, snacks and

portion sizes

• Persistent change and impact
• n the culture and practice of

the wider team Impact on practice and policy in early years settings

Willis et al, J Hum Nutr Diet 2012

I think they’re more confident in tackling & bringing up things … I’ve noticed that people are talking about lifestyle more, and are concerned about it

Building networks of support

One of the things I enjoyed most about the HENRY programme was spending time with other parents. I found that talking about my experiences and hearing they had many of the same struggles really helped me feel better about the things I find difficult.

• 125% increase in parents

who felt ‘supported’ often or very often

Models of volunteering

Around 100 active volunteers:

• Breastfeeding peer

supporters

• Parent champions
• Healthy start mentors
• Outreach volunteers

A pause for reflection

• What thoughts have been triggered by the workshop content so far?
• Questions and comments?

Integrated support for a healthy happy childhood

Pregnancy Breastfeeding Starting solids Parenting Family lifestyle

Healthy Families

Training the early years and public health workforce to deliver HENRY group programmes:

• Pregnancy

Healthy Families in the Making

• Early Years

Healthy Families Right from the Start

• The primary years

Healthy Families Growing Up

Creating the conditions for change

The message: a healthy start in life The messenger: creating the conditions for change

• Early nurture and

feeding

• Parenting skills
• Healthy family routines
• A balanced healthy diet

for the whole family

• Active play, physical

activity and sleep

• Emotional well-being
• Building relationships

based on trust and respect

• Working in partnership
• Empathy
• Strengths-based
• Building motivation
• Solution-focused

Supporting parents’ wellbeing

HENRY helped me realise how important ‘me-time’ is. I found that by recharging my batteries, little things didn’t get on top of me so I wasn’t shouting at them as much. My confidence has improved – I feel I am a better mother to my child and also a better partner. My relationship has improved.

• 80% of parents report

improved emotional wellbeing

Parenting

• Desire, knowledge and confidence to provide the

best start

• Responsive and emotionally literate parenting
• Skills and strategies to hold boundaries

Now she’s a toddler there are lots of times when I just don’t know what to do when she says no and takes no notice Giving the kids some choice changed my

• utlook on parenting and

I think about their point of view more often. Things quickly became calmer as a result

Parenting styles

DICTATORIAL/ AUTHORITARIAN AUTHORITATIVE UNINVOLVED/ NEGLECTFUL INDULGENT responsive in charge

Guided choices

“Eat up your carrot.” “What would you like for your snack?” “Here’s some carrot and some apple for you – help yourself.”

DICTATORIAL AUTHORITATIVE INDULGENT Here’s some carrot for your snack, eat up Here’s some carrot and tomato for your snack …. you choose What would you like for your snack?

Infant feeding

• Drop-in sessions and baby cafés
• Home visits
• Telephone support
• Baby-friendly training for early years

staff

• Community events to promote a

breastfeeding-friendly culture

We are still breastfeeding four months on and it's very much due to the great help I got

Starting solids

I will use home-made foods with my child – I never thought you could at this age.

96% of parents report greater confidence to introduce solids

• Window of opportunity to develop a

baby’s palate

• Babies have an inbuilt preference for

familiar tastes and textures

• Start with vegetables and
• ther savoury tastes
• Repeated exposure

Responsive feeding

Mealtime atmosphere

I eat with my son at mealtimes at the table instead of in front of the telly now I realised if I want them to eat healthy food I need to eat them too. Who else are they going to copy?

• 80% of parents report

healthier mealtime behaviour

• 40% reduction in TV meals

Growing up eating well

• Healthy balance
• Child-sized portions
• Reducing energy dense foods and sweet

drinks

• Increasing fruit and vegetable

consumption

• Family mealtimes
• Avoiding using food for emotional reasons

That’s why we all came on the HENRY programme. Knowing what’s healthy and how much to give them is worrying, especially when they can’t talk.

89% increase in number of children eating fruit and veg 5 times a day

Emotional dimension of food

• Bribes, rewards and comfort
• What messages do we

communicate about food?

• Moderation in all things including

moderation

• Don’t stop it, swap it – non-food

praise, encouragement and comfort

Being active

I moved from Pakistan when I got married. When I had a baby I thought it was too cold to take him out so we just stayed in the flat for the first year

• 36% of children spend more time being active
• 31% reduction in number of children watching

more than 2 hours TV a day

Impact on families

91% parents report a healthier family lifestyle

The HENRY programme has been just what I needed to make me stop and think. I have changed my whole family’s eating habits for healthier ones and we all feel better for it. We spend more time together rad enjoy each

• ther’s company now.

I’ve realised that being healthy is not just about food, but family life in general

Parental self-agency

Dumka 1996

5 10 15 20 Parental self-agency Setting limits Mean score Pre-course Post-course Follow-up

*P<0.001 *P<0.001

Sure of self Doing a good job Perseverance Problem solving Mealtimes TV/computer Active play Bedtime General Willis et al, Pediatric Obesity 2014

Eating behaviour

Golan 1998

2 4 6 8 10 12 14 16 Family eating behaviour Children eating with adults Structured mealtimes Parental eating behaviour Mean score Pre-course Post-course Follow-up

*P<0.001 *P<0.001 *P<0.001 *P<0.005

Lower scores indicate desired behaviours

Eating together TV off for meals Home cooked food Take away food

Willis et al, Pediatric Obesity July 2014

Willis et al, Pediatric Obesity 2014

Changes in adults’ food consumption

Hammond 1993

5 10 15 20 25 30 Cooked veg Salads Fresh fruit Water

• No. times consumed / wk

Pre-course Post-course Follow-up 2 4 6 8 10 12 14 Cakes, biscuits Sweets, chocolate Sweet drinks

• No. times consumed / wk

Pre-course Post-course Follow-up *P=0.007 *P<0.001 *P<0.02 *P<0.001 *P=0.003 *P<0.001 *P=0.005 Willis et al Pediatric Obesity 2014

Changes in children’s food consumption

* p=0.007 * p<0.001

2 4 6 8 10 12 14 16 18 20 Cooked veg Salads Fresh fruit Cakes, biscuits

• No. times consumed / wk

Pre-course Post-course Follow-up

* p=0.007 * p<0.02 * p<0.001 * p<0.02

Willis et al Pediatric Obesity 2014

Obesity among reception aged children in Leeds by deprivation quintile

National child Measurement Programme 2009/10 to 2016/17

5 6 7 8 9 10 11 12 9/10 to 13/14 10/11 to 14/15 11/12 to 15/16 12/13 to 16/17

Obesity prevalence for reception (%) Grouped Years

Most deprived quintile Least deprived quintile Middle quintile

Rudolf et al Pediatric Obesity 2019

Take home messages

 Parents want to get their children off to a healthy start –

• ur job is to provide the kind of support they need

 Training for practitioners so they have the skills and confidence to create the conditions for change  Supporting parenting efficacy and wellbeing – because it’s parents who get children off to a healthy start  Early life and childhood is a crucial opportunity to make a difference to long-term outcomes  Change is possible!

Contact us

www.henry.org.uk info@henry.org.uk @HENRYhealthy

Next steps

• What are we doing in our area to integrate support for behaviour change,

parenting efficacy, healthy eating and activity?

• Where are the gaps and the opportunities to address them?
• One thing I am going to do/ take forward as a result of today