Fun 4 Life Weight Management Programme

Background

The Fun 4 Life Weight Management Programme is part of a wider Walsall programme, Walsall Active Youth (WAY). It is delivered by Walsall Council in partnership with Walsall teaching Primary Care Trust (tPCT). This includes work in children’s centres, schools and piloting Skillz 4 Sport, which is a specialised programme for children with low skill ability.

The aim of the Fun 4 Life programme is to educate children and their families about healthy lifestyles and physical activity to help them to make positive lifestyle changes for life. The first pilot project ran between January 2004 and June 2005. The success of this pilot has led to the funding of a three year programme to pilot a range of interventions to prevent and treat childhood obesity. The aim of the clinic pilots is to run the programme in a variety of settings and times to see what works best for families.

What is the problem you are trying to solve?

Obesity levels nationally are soaring with a high percentage of children now being overweight or obese. Within Walsall a small study was conducted which concluded that 30% of children living within the borough are overweight or obese. We are striving to measure as many children as possible within schools to be able to develop a picture of child obesity levels. This will inform the implementation plan and which areas will be prioritised.

What local organisations are involved?

The Fun 4 Life programme is based on the Carnegie Clubs model which has been developed by Carnegie Weight Management Group (Leeds Metropolitan University). The instructors undergo a vocational certificate with Leeds Metropolitan which has been developed to provide local staff with the skills needed to deliver the Carnegie Clubs programme in a safe and effective way. This includes a five day training course, 12 weeks of reflective practice and a final assignment. The reflective practice, which is carried out by our core staff, is essential to the delivery of future programmes ensuring that staff can learn the ethos of the clinic. The programme is fully supported by Carnegie Weight Management Group.

The coordinator is based with Walsall tPCT and the outreach workers with Walsall Council. This gives opportunity for cross-agency working/support. We are currently establishing links with departments, such as psychology and dietetics, who will provide local support where needed.

The project steering group meets on a monthly basis to oversee and support the programme. There is representation from the tPCT, Sport and Leisure Development Services, leisure centres, New Deal, Healthy Schools and Early Years.

How many people are running this project and who are they?

The team comprises one Active England programme coordinator (based at Walsall tPCT), two active lifestyle officers (based at Walsall Council) and nine casual instructors (based at Walsall Council) trained to deliver the clinics.

What local population are you targeting?

Currently, the programme targets overweight or obese children who are 8-16 years of age and living in the borough of Walsall. The location of the clinics will take place in areas of deprivation in the first instance and then move around the borough depending on venues available that are suitable for the clinic.

Family participation is essential for the success of the programme and, as a result, a parent or guardian must commit to attending the lifestyle sessions of the clinics. These are delivered in two separate sessions, one for the parents/guardians and one for the children.

How many people are you targeting?

The Fun 4 Life Clinic in Walsall aims to target 50 children in year 1 of the project, 100 children in year 2, and 150 children in year 3.

Interventions

What interventions are you using to address the problem?

The Fun 4 Life Clinic is a 12 week programme designed for 8-16 year olds who are overweight or obese. Each session, which runs once a week, includes 30 minutes of monitoring and evaluation, two hours of physical activity (split over two one-hour periods), and one hour of lifestyle education. The aim of the physical activity sessions is for the participants to try a variety of activities which are inclusive and more importantly FUN! For example, games, street dance, swimming and canoeing. The education sessions include looking at the balance of good health, healthy drinks, five-a-day, food labels, screen time (how many hours of TV and video games they watch and giving them alternatives) and different forms of physical activity.

During the 12 week programme the children increase their physical activity levels and feel more confident in taking part in activities. This enables the team to signpost the children to external sports clubs and facilities. Goal setting is central to the lifestyles programme and children set their own goal for the following week. The parents are also required to take part in the education part of the programme in a separate session. This enables the parent/guardian to understand what their child has learnt during the session, set their own goals and enable them to support their child more effectively. A maximum of 25 children and their families can attend the programme with a minimum of six staff to run the clinic.

Is the project design based on evidence? If so, please state reference.

Yes, please see references. ^{1 2 3 4 5 6 7 8 9}

Outcome

What outcomes or planned outcomes are you measuring?

We are evaluating the process, impact and outcome of this project. Baseline data will be collected in year one to be improved upon in years 2 and 3.

Examples of outcomes we are collecting include: how many children access the service; how many have a decrease in body mass index (BMI)/body fat percentage; changes in body image; fitness level through a walking test; increase in self esteem levels; increase in physical activity levels and long term success of the programme.

Do you have any outcomes or results yet? If so, what are they?

Between April and July 2006, the Saturday morning intervention was delivered each week for a total of 12 weeks in a local secondary school. The family based programme consisted of physical activity, nutrition, physical activity education and behaviour modification. BMI, body composition, waist circumference, and aerobic fitness were assessed before and after the intervention. Statistical analysis was performed on an intention to treat basis.

Seventeen children (10 girls and seven boys, aged 12.8±1.8 years) and at least one parent/carer per child were recruited to the programme, which had a mean attendance of around 77%. There were significant improvements in the BMI, waist circumference, and the level of physical activity among the children, but the body fat percentage was maintained.

Is your project relevant to a government target or guideline?

Public Service Agreement 3: ‘To halt the year-on-year rise in obesity among children under 11 by 2010 in the context of a broader strategy to tackle obesity in the population as a whole.’ ¹⁰

Feedback

What obstacles did you have to overcome to set up this project?

As the clinic requires a sports area, classroom and (if possible) a swimming pool, there have been difficulties in booking facilities at the best possible times for families. Also, the costs of hiring facilities varies from venue to venue and are very expensive. We are currently working with Healthy Schools and other partners to negotiate reduced venue costs.

Receiving enough referrals from health care professionals has proved challenging. Raising awareness through presenting at various events has helped, but it is envisaged that the development and promotion of the referral pathway will eliminate this problem.

What have you learned about the project so far?

To receive an adequate number of referrals to the clinics it is essential to make sure health care professionals are aware of a programme occurring a few months in advance. As venue hire has proved difficult, some programmes have been set up at short notice. We are working hard with local facilities to plan them 12 months in advance. Partnership working is essential to receive referrals and to make sure the project is fully supported.

The programme has experienced difficulties in terms of intake as a result of weight management clinics being set up in a school where only pupils of that school can attend. Schools do need to be fully integrated within the programme, for example, PE teachers made aware that children are participating in the project. This is so that they can support the children in the physical activity changes they are trying to make.

The physical activity sessions have to be as fun as possible, using all games, which increase skill ability. Activities must engage all the children and sessions must be adaptable to enable children to compete at their level.

Parents must be involved as much as possible in the clinic, so that they understand the whole process that the children are going through to make behaviour changes. The focus is not on weight loss, but on behaviour change through goal setting. We encourage the parent to talk to the children about their goals and what is covered in the lifestyle sessions at home.

What would you do differently?

Schools could have been involved in the project from the beginning to identify where there is a need for clinics.

To ensure that children across the borough are able to access the programme, we are currently developing referral pathways to establish clear and effective routes for health care professionals to refer into the service. These will follow National Institute for Health and Clinical Evidence and Department of Health guidelines. It is envisaged that the criteria for referral will be as follows: children 8-16 years of age; and > 98 ^th percentage centile or > 91 ^st percentage centile with co-morbidities.

References:

1. Barton SB, Walker LL, Lambert G, Gately PJ, Hill AJ. Cognitive change in obese adolescents losing weight. Obesity Research. 2004; 12 (2): 313-119.
2. Gately PJ, Cooke CB. The use of a residential summer camp programme as an intervention for the treatment of obese and overweight children. A description of the methods used. Obesity in Practice. 2003;5: 2-5.
3. Gately PJ, Cooke CB, Barth JH, Bewick BM, Radley D, Hill AJ. Residential weight loss programmes can work: a cohort study of acute outcomes for overweight and obese children. Paediatrics. 2005; 116: 73-77.
4. Gately PJ, Cooke CB, Butterly RJ, Mackreth P, Carroll S. The effects of a children's summer camp programme on weight loss, with a 10 month follow-up. International Journal Obesity Related Metabolic Disorder. 2000;24(11): 1445-52.
5. Gately PJ, Cooke CB, Butterly RJ, Knight C, Carroll S. The effects of an eight week diet, exercise, behaviour and educational programme on a sample of children attending a weight loss camp. Paediatric Exercise Science. 2000;12: 413-423.
6. Gately PJ, Radley D, Cooke CB, Carroll S, Oldroyd B, Truscott JG et al. Comparison of body composition methods in overweight and obese children. Journal of Applied Physiology. 2003;95(5): 2039-46.
7. Holt NL, Bewick BM, Gately PJ. Participants’ perceptions of attendance at a residential weight-loss camp. Child: Care, Health and Development. 2005;31 (2), 223–231
8. Radley D, Gately PJ, Cooke CB, Carroll S, Oldroyd B, Truscott JG. Estimates of percentage body fat in young adolescents: a comparison of dual-energy X-ray absorptiometry and air displacementplethysmography. European Journal of Clinical Nutrition. 2003;57(11):1402-1410.
9. Walker LL, Gately PJ, Bewick BM, Hill AJ. Children's weight-loss camps: psychological benefit or jeopardy? International Journal of Obesity Related Metabolic Disorder. 2003;27(6): 748-54.
10. Department of Health. National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06 and 2007/08. 2004. www.dh.gov.uk (search for 3533, accessed 12 April 2007).