Leading change

Health visitors at the Black County Partnership NHS Foundation Trust (BCPFT) have worked with public health colleagues to tackle childhood obesity in the West Midlands town of Dudley, through structured education for mothers. The programme supports the prevention agenda and empowers parents in making informed food choices for their children. The health visitors also undertook research to show the positive impact of their work.

Where to look

There is unwarranted variation in the number of obese or overweight children in the West Midlands town of Dudley:

• 25.7% of reception children compared to the national average of 22.1% nationally;
• 37.9% of Year 6 children compared to the national average of 34.2%.

Health visitors at BCPFT and the Dudley Office of Public Health decided to try and do something about this, to change health outcomes for local children and young people.

What to change

Before the change, some parents lacked basic cooking skills, nutritional knowledge, as well as knowledge of appropriate physical activity. Research shows that to address childhood obesity, three key beliefs held by parents need to change (Lakshman et al., 2012):

1. Babies cannot be overfed (on formula milk);
2. Crying always signals hunger;
3. Growth is determined by genes rather than nutrition.

Additionally, exceeding recommendations for weight gain during pregnancy also increases odds of a child being overweight or obese (Sridhar et al., 2014).

How to change

Mothers who had been referred by their midwife into the Healthy Pregnancy Support Service because their own BMI was above 26 were invited to attend the ‘Let’s Get Kids Fit’ course.

This required participants to attend once a week for six weeks, with each session lasting one and a half to two hours. Sessions were equally divided into theory (basic nutrition, child development and age-appropriate physical activity) and practical cookery with basic ingredients. The sessions were highly visual and designed to be interactive. Written resources consolidated learning from the sessions and these were bright, colourful and user friendly. On completion of the course, participants received a Sports England ‘My First Start to Play’ bag containing a variety of toys to encourage play. The sessions took place in local children’s centres because they were suitably equipped.

What started as a targeted course is now being rolled out as a universal programme to all first time postnatal mothers. Following feedback, the nutrition information is covered in less depth and the additional time is used to do two more sessions on birth experience and an introduction to Baby Massage called ‘Holding and Reassurance’. These courses have been well attended and have generated excellent feedback.

Adding value

The health visitors gained ethical approval to research whether the course changed mothers’ views on the three key beliefs identified by Lakshman et al (2012). This was investigated by ‘before and after’ questionnaires and focus groups. The results were presented at the Community Practitioner and Health Visitors Association annual conference in 2017:

Better outcomes – A key finding was that mothers recognised the importance of healthy eating right from the start. One mother commented “I think as well, it’s about the importance of making stuff from scratch. That’s the biggest thing I’ll take from the course…not that I didn’t think it was important before but after all the things we did on food labels and salt and sugar and fat, that’s the better way to go, just so that you know what you are putting into your baby.”

The course was effective in changing views, particularly around the belief that babies cannot be overfed. At the beginning of the course, 47% agreed that babies cannot have too much milk, compared with only 8% at the end. This shows the potential of such education to prevent obesity in infants. The original programme had a small targeted cohort, but the shift to universal roll-out of a revised programme provides potential to measure impact on local childhood obesity levels. However, this will not be known until children enter reception and data is collected via ‘The National Child Measurement Programme’. Mothers attending the postnatal groups are generally consenting to having their details shared which will enable monitoring of attendees who are later referred into the weight management service but it will take a few years to gather this information.

Better experience – Mothers who have taken the course say they have gained the confidence in preparing home-cooked meals rather than using convenience foods. This has the potential to be cheaper for families on a low income.

Better use of resources – The courses are an important addition to efforts to prevent obesity in children. Excess weight at a young age is linked to the ill-health and premature mortality associated with obesity in adulthood. It is estimated that obesity costs the NHS £6.1billion a year. Costs to the wider economy are put at around £27billion annually (Public Health England, 2015).

Challenges and lessons learnt for implementation

Multi-disciplinary working in the current pressures is difficult and the courses were affected by changes in the way local authority children’s centres are run. Family Support Workers were originally going to be involved, but they were redeployed to work with families requiring a higher level of intervention.

It helps to assume a fairly basic level of knowledge. For example, the material originally prepared on different fats and sugars and their effects on the body was too detailed.

For more information contact

Julie Greenway
Team Leader and Health Visitor
Jgreenway1@nhs.net