An evaluation of an obesity prevention programme for 2-4 year old children

Abstract

Abstract
Background: Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being (Waters et al, 2010). In the UK, nearly a third (31%) of boys and more than one in five girls (28%) aged between 2 and 15 years were classified as either overweight or obese in 2013 (National Obesity Forum, 2014). In Lancashire, 23.5% of reception age children were found to be either overweight or obese, worse than the national average of 22.6%, suggesting that over 3,000 children aged 4-5 from the County have an excess weight issue (Collins, 2018). Statutory organisations wished to address this rising issue through the provision of an educational programme delivered to parents with young children through Children’s Centres. The limited evidence base with regards successful intervention to date prompted the development, implementation and evaluation of a locally designed programme, Be Active Eat Healthy. This study examines the effects of the programme on young children’s BMI z-score and family lifestyle behaviour. Trial Design: This study was a multi-centre, cluster randomised, controlled trial (CRT) with a matched pair design. The intervention was at two levels; Centre Level with Centre staff, policy and practice, and at Family Level through staff implementing the curriculum, following guidance and promoting healthy eating and physical activity. Methods: This cluster randomised controlled trial recruited 97 parents with 2-year old children from 10 Children’s Centres across Lancashire, containing 12 district local authorities. Each Children’s Centre was recruited, and assessed using the Children’s Centre Assessment Tool (CCAT). In the five intervention Centres, staff received training, a curriculum and resources, and assistance to improve policy and practice with regards healthy eating and physical activity promotion. The five Control Centres did not receive any intervention and continued with their usual programme. The CCAT was repeated 12-months later to assess changes in staff training, curriculum, policy and practice. At a family level, families were recruited from each Centre, both intervention and control, and baseline data was collected via a face-to-face interview. This included the measurement of parent and child height and weight, and family lifestyle behaviour using a series of six questionnaires; The Food Choice Questionnaire (Steptoe et al 1995), Child Eating Behaviour Questionnaire (Wardle et al 2001), The Parental Feeding Style Questionnaire (Wardle et al 2002), Family Nutrition and Physical Activity Questionnaire (Ihmels 2009), International Physical Activity Questionnaire (www.ipaq.ki.se/ipaq.htm), Warwick-Edinburgh Mental Wellbeing Scale (University of Edinburgh 2006). The height and weight of the child was measured at four time points through the 2-year study period; baseline, 6 months, 12 months and 24 months, and all the questionnaires were repeated at 24 months. Results: The primary outcome = final BMI z-score with initial BMI z-score as covariate between age 2 and 4 years (p = 0.002; change difference 0.49; 95% CI 0.17 to 0.80). Parent reported outcomes showed improvements for both groups across the range of questionnaires. Children in the intervention group showed an increase satiety responsiveness, and improvements in bedtime routine/amount of sleep and breakfast patterns. Conclusion: A Centre level intervention with staff training and parent information showed a trend in reducing BMI z-score of children aged 2-4 years. Assessing Children’s Centres against criteria informed by national guidance can help drive improvements in practice and raise awareness of the need to promote health and lifestyle issues to families. Training Children’s Centre staff in practical food skills, and physical activity can improve their skills and confidence and enable them to give advice and support to families regarding healthy eating and physical activity, which results in a healthy Children’s Centre environment.