Obesity prevention in the early years:a holistic approach

Kim Roberts

Starting with the research

• Practitioner effectiveness

• A healthy family lifestyle:

• Parenting

• Eating and feeding behaviour

• Healthy nutrition

• Activity and sleep

• Emotional well-being

• Establishing healthy habits and food

preferences right from the start of life

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

of a child.”

Professor Sir Ian Kennedy

Getting it Right for Children and Young People

Why focus on the very young?

• Habits are formed early in life

• A window of opportunity – parents are receptive

to support

• Almost 1 in 4 children are already overweight or

obese by the time they start school

• Overweight children are at risk of numerous

lifelong physical and emotional health problems

• Obesity is extremely difficult to reverse

Predicted weight status in Year 6 of children who start school

obese 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 of 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

of 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%

Laying the foundations for life

• Quality of womb environment significantly

influences future mental and physical health

• Eating habits start in the womb

• Excessive weight gain in pregnancy is linked to

high birth weight – a risk factor for obesity

The early years last a lifetime

Pregnancy

Breastfeeding

Starting solids

Parenting

Family lifestyle

An ecological model

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

Readiness for change

Creating the conditions for change

The message: a healthy start

in life

The messenger: creating the conditions for change

• Breastfeeding

• 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

Effective practice

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

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1 2 3 4 5

< 12 months

> 12 months

Confidence in working with families

Very little impactSignificantly

improved

85% < 12 months

91% > 12 months

e-survey up to 4 years later; n=354

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 on the culture

and practice of the wider team

I think they’re more

confident in tackling and

bringing up things …

I’ve noticed that people

are talking about lifestyle

more, and are concerned

about it

Practice and policy in children’s centres

Willis et al,

J Hum Nutr Diet 2012

Pregnancy

• Emotional and physical well-being in pregnancy

• Nest building – what sort of home environment

and family lifestyle do we want our baby to come

into?

• Early brain development – responding to the

baby’s needs

• Infant feeding

Early feeding

• Support for breastfeeding

• Optimal bottle feeding

• Starting solids to her great help.

•

• I don't know what I would have done without such easy

access to breast feeding support.

We are still

breastfeeding four

months on and it's

very much due to

the great help I got

Taking babies on a taste journey

• Window of opportunity to develop a

baby’s palate

• Babies have an inbuilt preference for

familiar tastes and textures

• Start with vegetables and other savoury

tastes

• Repeated exposure

Responsive feeding

Healthy Families programme

• 8 week programme - experiential and

interactive

• Group or 1-to-1

• Around 40 local authorities

• Over 10,000 parents

• Popular with parents: average retention rate of 83%

Parenting

• Desire, knowledge and confidence

to provide a 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

Parenting styles and feeding styles

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?

Mealtime atmosphere

• Sitting together with no distractions

such as TV

• Sociable – chatting and encouraging

• Not rushing – going at their pace

• Modelling parents eating and

enjoying healthy food with their

children

I’ve realised I need to

eat with him and eat

healthier foods –

who else is he going to

copy?

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

Healthy nutrition

• Healthy balance

• Child-sized portions

• Reducing energy dense foods and sweet

drinks

• Increasing fruit and vegetable

consumption 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.

Being active

• Maximum of 2 hours screentime a day and

some TV free days

• Babies - as much time unrestrained as

possible

• Young children who are walking - active for

at least 3 hours per day

• Adults - active for at least 30 minutes a day

Parental self-agency Dumka 1996

0

2

4

6

8

10

12

14

16

18

Parental self-agency Setting limits

Mean

sco

re

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

July 2014

Eating behaviour Golan 1998

0

2

4

6

8

10

12

14

16

Family eating behaviour

Children eating with adults

Structured mealtimes Parental eating behaviour

Me

an

sc

ore

Pre-course Post-course Follow-up

*P<0.001

*P<0.001

*P<0.001

*P<0.005

Lower scores indicate desired behavioursEating together

TV off for meals

Home cooked food

Take away food

Willis et al,

Pediatric Obesity

July 2014

Changes in adults’ food consumptionHammond 1993

0

5

10

15

20

25

30

Cooked veg

Salads Fresh fruit Water

No

. ti

me

s c

on

su

me

d /

wk

Pre-course Post-course Follow-up

0

2

4

6

8

10

12

14

Cakes, biscuitsSweets, chocolateSweet drinks

No

. ti

me

s c

on

su

me

d /

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

July 2014

5 a day

• 21% children in families starting HENRY programme eat 5 a day

• 41% children in families completing HENRY programme eat 5 a day

Models of volunteering

• Breastfeeding peer

supporters

• Parent champions

• Healthy start mentors

• Outreach volunteers

An event for

families to make

HENRY aprons

before the start of a

volunteer-led family

cooking course

Healthy start mentors:structured 1-to-1 support

• 1-to-1 programme delivered by volunteers

using HENRY approach to supporting

behaviour change

• High quality training and materials –o 5 days training

o Supervision and support

o Resources for volunteers and families

• Overcoming cultural and language barriers

• Early evidence suggests that family outcomes

mirror those achieved when programme is

delivered by paid practitioners

Effective partnership:a local case study

P8-year pare• 7-year partnership with Leeds Public Health

Department (originally PCT)

• City Council working in partnership with CCGs

• All health visitors and children’s centre staff HENRY-

trained – over 1,200 staff

• Local staff trained to deliver practitioner

training, family group programme and 1-to-1

intervention

• Now training childcare workforce

• Volunteer parent champions and healthy start mentors

working in local communities

7.5

8

8.5

9

9.5

10

10.5

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

Ob

es

ity p

reva

len

ce in

re

ce

pti

on

(%

)

Year

Leeds

England

Embedding prevention: Leeds obesity rates at age 5

HENRY implemented as part of city-wide obesity strategy

NCMP dataset 2008/09 – 2016-17

In conclusion

Holistic and multi-layered approach:

• Equipping health and early years practitioners with

the skills and confidence to create the conditions

for change

• Supporting parenting efficacy and well-being – so

parents have the skills, knowledge and confidence

to get their children off to a healthy start

• Building healthier communities and peer support

networks

Policy into practice

• What are the challenges?

• Where are the opportunities

at national and local level?

Contact us

www.henry.org.uk

www.henry.org.uk/shop

@HENRYhealthy