Elsevier

Public Health

Volume 140, November 2016, Pages 109-118
Public Health

Original Research
Community-based pilot intervention to tackle childhood obesity: a whole-system approach

https://doi.org/10.1016/j.puhe.2016.07.013Get rights and content

Highlights

  • We describe the methodology of a novel multistrategy approach to prevent childhood obesity.

  • The programme is piloted in the Golborne ward of the Royal Borough of Kensington and Chelsea in London.

  • The intervention targets children aged 0–16 years in all settings where they live, learn and play.

  • Components include environmental change, capacity building, social marketing and evaluation.

Abstract

Objectives

Go-Golborne is a pilot intervention to prevent childhood obesity in the Royal Borough of Kensington and Chelsea between 2014 and 2018. It is a multistrategy approach targeting children aged 0–16 years and their families in all settings where children live, learn and play. This paper describes the methodology and the practical steps in the development of Go-Golborne.

Study design

The programme uses a quasi-experimental design for the evaluation of changes in weight status using data from the extended National Child Measurement Programme across local schools. For specific behavioural change objectives, baseline self-reported lifestyle measures will be compared against annual follow-up data over the 3-year study period. Qualitative methods will be used to explore the perceptions of stakeholders and participants and organizational change.

Methods

Go-Golborne aims to mobilize everyone in the community who has a role or interest in shaping the local environment, norms and behaviours across a range of sectors. A community network of local organizations has been established to codesign all programme activities. The Steering Group of Council officers support programme implementation and environmental changes. The programme has identified six specific behaviour change objectives representing the key areas of need in Golborne and all activities in the council and the community target these objectives during specific programme phases. Key components include community capacity building, community-wide social marketing, environment and policy change and evaluation.

Results (Progress)

The programme is currently at the beginning of its implementation phase with activities in the community and council targeting the first behaviour change objective.

Conclusions

The pilot aims to test the effectiveness of this approach to support behaviour change and prevent unhealthy weight gain in children using multiple strategies. This programme will inform the development of an intervention model that defines essential programme components, accountability of partner organizations delivering obesity prevention programmes and the effective use of existing assets.

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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