Tackling Childhood Obesity Together TCOT A WholeSystem Approach

Tackling Childhood Obesity Together (TCOT) A Whole-System Approach Eva Hrobonova, Deputy Director of Public Health

Tackling Childhood Obesity Together (TCOT) In this presentation we will 1. Describe briefly the design and implementation of a sustainable whole area-based system approach to – prevent overweight and obesity in children, – making healthy choices easier, – achieving a culture and behaviour change. 2. Share our experiences and achievements resulting from this approach across the three boroughs so far.

Tackling Childhood Obesity Together (TCOT)

Tackling Childhood Obesity Together (TCOT) ckling childhood obesity programs - effective elemen Visible and vocal political leadership These things have been in place in successful child obesity programmes in Europe, Australia and the USA: A vision shared by all parties Commitment from senior leaders and influential figures, with regular engagement Priorities which are clear, shared, and ambitious. These should stimulate debate

Tackling Childhood Obesity Together (TCOT) Our vision Children and families tell us that being active and eating well can be hard because: They are worried about traffic, pollution and safety on roads, which can restrict travel and play. High fat, high sugar fast food can seem more accessible than healthy food. Opportunities to be active can be limited on large housing estates. They want better access to safe indoor and outdoor play facilities and leisure services close to where they live. They perceive some parks and open spaces as being unsafe and too far from their homes to easily access. They may not be confident in their cooking skills and understanding of nutrition. Eating well on a tight budget can be very difficult. TRANSPORT HOUSING AND PLANNING LEISURE AND CULTURE PARKS AND OPEN SPACES EDUCATION AND LEARNING They experience difficulties accessing healthy weight services, receive inconsistent messages about healthy lifestyles and feel a stigma associated with being overweight. HEALTH AND HEALTHCARE By 2019 we will work with our partners to intensify our efforts to: Make active travel the norm for children and families by encouraging cycling and good traffic flow, tackling pollution and promoting safe walking routes. Promote healthier catering practices, improve access to fresh fruit and vegetables and promote physical activity within the design of new developments. Ensure all children and families have access to a range of leisure services and safe places to play in all weathers. Encourage all children and families to make regular use of local parks and open spaces by improving perceptions of safety and accessibility. Ensure all children and families have opportunities to learn about cooking and low-cost healthy eating within school and wider community settings. Ensure healthy weight services are easily accessible to all that need them and that children and families receive consistent messages about healthy lifestyles. LOCAL SOLUTIONS NEED TO COMPLEMENT NATIONAL DRIVE

Tackling Childhood Obesity Together (TCOT) Key aims and objectives The overall objective of the 5 year TCOT programme is: To halt and reverse the rising trend in childhood obesity across the Tri–borough area. The following outcomes have been identified: Ø Children and families are more physically active in their daily lives Ø Children and families develop a positive food culture within their families and communities Ø Children and families are able, and supported, to make healthier choices Additional key objective: Ø Evaluate and disseminate results An additional number of key measurable outcomes have been identified within each component part of the multifaceted programme.

Tackling Childhood Obesity Together (TCOT) Implementatio n ØConstruct locally viable logic model for programme including commissioning of services ØCommunicate appropriately to various audiences to secure understanding of and buy-in for programme of majority of officers/stakeholders ØEnsure that all audiences understand the asset based, incremental nature of the multifaceted programme and the long lead time to measurable outcomes ØBe flexible and ready to adopt changes but evidence our steps

Tackling Childhood Obesity Together (TCOT) TCOT - one system, three strands Individuals/families 1. Provision of comprehensive healthy weight services accessed by children and their families, workforce training Education Health Care Voluntary Sector supports Environment informs 2. Whole council partnership to ensure that environment and facilities support newly learnt behaviours and identified needs Communications ASC FCS Planning Leisure Housing Transport Parks Legal Retail Employers Private Providers NHS and other providers Community 3. Engaged communities tell us ‘what works’ for them Local agencies work together to deliver solutions Research, evidence and evaluation, consultation with communities underpin plans and resources, including unified messages agreed by lead councillors and partners within and outside the organisation.

Tackling Childhood Obesity Together (TCOT) Strand 1 - Family healthy weight services • 727 families engaged in group programmes • 522 families attended 1: 1 sessions • 46 schools engaged with and receiving additional support from My Time Active, reaching some 3, 296 children in years one and four with workshops run in every school • 1, 436 practitioners trained on key healthy eating and physical activity topics • 69% of eligible families utilise Healthy Start vitamins and vouchers All in first year of running

Tackling Childhood Obesity Together (TCOT) Initial Results from the Healthy Weight Services In the second year of running the Mind Exercise Nutrition Do It (MEND) • Mums programme has shown on completion: - 56% of completers reduced BMI - 43% of completers reduced waist circumference - over 50% of completers increased their physical activity - decrease in average sedentary time by 45 minutes (2 boroughs) - preliminary indication of increased self-esteem. • Mini programme has shown on completion - average increase in physical activity of 5. 9 hours - the average number of times a day fruit and veg were consumed increased by 14%.

Tackling Childhood Obesity Together (TCOT) Strand 2 – whole council approach Three layered approach: • Political commitment • Themed departmental pledges • Every contact counts Combining the WHO ‘Health in All Policies’ approach with a themed ‘sugar smart’ strategy to engage internal and external partners. Reshape the environment to make healthier choices, easy choices.

Tackling Childhood Obesity Together (TCOT) Ensuring that environments support newly learnt behaviours Whole GP practice approach – Healthy school meals contract Healthier catering commitment Healthy schools and Healthy early years Food growing projects pilot of GP and housing officers training on estates with high prevalence of obesity Oral health resource pack Initiated projects, delivering improvemen ts Healthy Start vouchers accepted in markets Fit and Healthy Hackathon Fun, Free Fitness Rose Vouchers

Tackling Childhood Obesity Together (TCOT) Whole Council Approach Continued Creation of 2 new play streets Implementation of the voluntary sugar levy Sugar smart Campaign Oral health animation Recently initiated projects, improvemen ts anticipated Develop and establish a social supermarket Work with housing to identify community spaces for MEND programmes Encourage play by removing the “no ball games” signs on estates

Tackling Childhood Obesity Together (TCOT) Strand 3 - community pilot • Testing novel model targeting children and families in all settings where they live, play and learn. • Aimed at increasing community capacity, promoting healthy lifestyles and preventing unhealthy weight gain in children. • Components include environmental change, capacity building, social marketing and evaluation.

Tackling Childhood Obesity Together (TCOT) Evaluation and evidence Methods and design • Combining academic and pragmatic approaches • Development of ‘theory of change’ and logic model to capture key drivers of system changes • Annual lifestyle surveys via local schools, extended NCMP, process data, interviews with key stakeholders • Methodological paper published in Public Health (Elsevier), 2016 Baseline data - children • • • 50. 2% use active transport 79. 6% engaged in active play at school 40. 3% not engaged in active play after school 85. 6% engage in screen time activity after school 73. 1% ate fruit or veg fewer than 5 times 58% eating unhealthy snacks

Tackling Childhood Obesity Together (TCOT) Evaluation and evidence 2 • 30 small grants of up to £ 1, 500 awarded to schools and community organisations to fund new activities to promote healthy eating • Four community health events attended by over 1, 700 children and parents – Party in the Park (summer) Feel Good Fun Days (autumn) • Eight workshops with community organised to collaboratively plan local actions • Bespoke training for local organisations attended by 65 staff and volunteers • Foundation phase community partner survey indicates that 90% of responders are aware of the behaviour change Go. Golborne works to promote and 83% understand the role they can play in helping children and families to eat well and be active • Health promotion materials distributed to 2, 000 families twice a year

Tackling Childhood Obesity Together (TCOT) Case Study – 5 a day your way • 5 ADAY assembly in schools, wallchart challenge • 5 ADAY Fun day event • localised 5 ADAY magazine, shopping bags, after school snack stalls, work to promote Healthy Start on markets, lots of grant funded projects “The 5 ADAY song and the wallchart have really inspired my girls to get interested in healthy eating – thank you so much for all your efforts. ” (local parent)

Tackling Childhood Obesity Together (TCOT) Acknowledgements Credit and thanks go to the TCOT team including: • Ellie Lewis, Go. Golborne Programme Lead • Kate May, Public Health Senior Strategic Relationship and Outcomes Officer • Eszter Vamos, Specialist Registrar in Public Health and Academic Clinical Fellow • Elizabeth Dunsford, Commissioner (children and families), • Connie Junghans, Epidemiologist • Jonathan Pearson–Stuttart, Specialist Registrar in Public Health • Libby Rhodes, Communications and Engagement Officer and to all our politicians, external partners and colleagues who have been instrumental in the implementation of this programme – and will all gain from its success!