Original ResearchCommunity-based pilot intervention to tackle childhood obesity: a whole-system approach
Introduction
Childhood obesity has been at the forefront of public health policy in the UK and other developed countries for several years.1, 2, 3, 4 However, public health measures do not appear to have brought about population-wide shifts in unhealthy weight, and their effectiveness has been increasingly debated.5 England has one of the highest rates of childhood obesity in Western Europe.6 According to data from the National Child Measurement Programme (NCMP), one in five children is obese or overweight when they start school in reception year (aged 4 – 5 years) and this proportion rises markedly to one in three by year 6 (aged 10 – 11 years).7
On current trends, more than half of the adult population is predicted to be obese by 2050 in England.8 This means that majority of children who are growing up today will have an unhealthy weight later in life. Therefore, a whole population approach is required, universally targeting children regardless of their weight status. Schools have been utilized as primary environments for shaping children's physical activity and dietary behaviours. However, it has proven difficult to demonstrate the success of school-based interventions that are introduced without corresponding community involvement to prevent obesity.9, 10, 11, 12 Generally, interventions focussing on individual decision making through education and behaviour change programmes have had limited success.13, 14
Community-based initiatives are now widely regarded as a promising approach to make a substantial contribution to the promotion of healthy lifestyles and obesity prevention.15, 16, 17, 18, 19, 20
As part of recent high-level changes in the organization and funding of health and social services in England, public health functions have been conferred on local governments from the National Health Service.4 Locally led planning has been assisted by a range of national guidelines on obesity prevention, information resources and toolkits.21, 22 However, guidelines are often perceived to be too broad to provide sufficient practical recommendations to guide the formulation of complex system-wide programmes.23 Practical guidance would include defining an intervention model with essential programme components, guidance on the use of existing local assets, and well-defined roles and accountability of partner organizations delivering the intervention. The pressure for prompt intervention along with budgetary limitations may not allow local authorities to adequately consider the design and evaluation of programmes, trial new interventions and accumulate practical experience.24 Importantly, the methodology and results of local programmes rarely get disseminated in the peer-reviewed literature.
The ‘Go-Golborne’ programme has been developed as a pilot intervention in the Golborne ward of the Royal Borough of Kensington and Chelsea (RBKC) in London, England, between 2014 and 2018. It is a system-wide multistrategy approach targeting children aged 0–16 years and their families, that aims to increase community capacity, promote healthy eating and physical activity, facilitate the reduction of the ‘obesogenic’ environment, and ultimately prevent the development of unhealthy weight in children. The pilot aims to test the effectiveness of the designed approach, and use the knowledge gained to define an intervention model that might be replicable on a wider scale in RBKC and other communities. The pilot is currently in its ‘themed programme phase’. This paper aims to describe the methodology and the practical steps in developing the Go-Golborne programme.
Section snippets
Frameworks informing the programme
The formulation of the programme has been informed by several frameworks including the Best Practice Principles for community-based obesity prevention developed in Australia by the Collaboration of Obesity Prevention Sites (CO-OPS).23 This framework was developed based on best evidence and professional consultations to provide practical knowledge on planning and implementation. The principles cover community engagement, programme design, evaluation, implementation and governance.23
We used the
Discussion
Childhood obesity remains a pressing public health problem despite persisting and consolidated efforts by national governments in England and internationally. There are no simple solutions to address the complexity of factors influencing obesity influences and achieve a population-wide shift in unhealthy weight, given the wide spread reduction in physical activity opportunities and ready availability of unhealthy food options as part of modern life. Community-based interventions are promising
Ethical approval
University of Kent Research Ethics Approval (SRCEA 150).
Funding
This programme has been fully funded by the Royal Borough of Kensington and Chelsea in London, England. CM is funded by an NIHR Research Professorship award.
Competing interests
None declared.
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