Slimming World and 'exercise on prescription' schemes, but these are usually
adult-based. One of the largest national schemes available at this strategy.
Food for Thought MENDING THE GROWING PROBLEM OF CHILDHOOD OBESITY CO PY RI RE GH PR T O SH DU ER CT BO IO RN N E PR G O IBB HI S BI LI TE M D IT ED
Alison Oldam Consultant Clinical Psychologist Northumberland Tyne and Wear NHS Trust Helen Aylott Assistant Psychologist Assistant Psychologist Northumberland Tyne and Wear NHS Trust Paul Sacher Senior Research Fellow UCL Institute of Child Health, London
here is no argument about the fact that childhood obesity in the UK is a serious problem. According to the Department of Health, childhood obesity affected 14.3% of 2-10 year olds in England in 2004. This was almost 5% more compared to the 1995 figures, and the estimated prevalence for 2010 is 20% if nothing is done, meaning that one million children will be obese. What can we do to reverse this growing epidemic of childhood obesity?
T
Obesity strategy task forces cover a wide range of interventions. Some of these are population-based interventions, such as changes to school dinners and promotion of the ‘five a day’ fruit and vegetables scheme. Other interventions target only the overweight and obese, for example, organisations such as Slimming World and ‘exercise on prescription’ schemes, but these are usually adult-based. One of the largest national schemes available at this strategy level for children is MEND. MEND is a multi-component programme which stands for (M)ind, (E)xercise and (N)utrition…(D)o it!. It was developed by Paul Sacher, Senior Research Fellow at the MRC Childhood Nutrition Research Centre at the Institute of Child Health and Dr Paul Chadwick, clinical psychologist and specialist in the field of child obesity. MEND can now be purchased as a package with ongoing support costs. The MEND Programme combines all the elements known to be vital in treating and preventing overweight and obesity in children, including family involvement, behaviour change, practical education in nutrition and increasing physical activity. Crucially, it involves a parent or carer attending all the sessions as it recognises that a child does not function in a vacuum and the involvement of the family is essential in order to make long-term lifestyle changes. It seems this element of the programme, alongside its multi-component nature, is the key to its success.
Our results are in line with those found in the research studies. c The majority of children halted their weight gain, with some beginning to lose weightd
297
CO PY RI RE GH PR T O SH DU ER CT BO IO RN N E PR G O IBB HI S BI LI TE M D IT ED
Food for Thought
The programme runs twice weekly for nine weeks. Each two-hour session has an hour of exercise plus an alternating interactive hour of Mind (behaviour change) or Nutrition education. Mind sessions are primarily for the parents and carers and cover topics such as goals and rewards, identifying triggers for healthy or unhealthy behaviours, increasing self-esteem, the importance of role-modelling and how to handle bullying. Exercise sessions focus on children having fun while being physically active and learning about how the muscles and circulatory system work in relation to staying fit and healthy. The structured exercise programme is graded and incorporates both land- and water-based activities (depending on facilities) that focus on developing team work rather than being individually competitive. The nutrition sessions are all attended by both parents and children and include healthy eating advice customised for overweight and obese children. The programme covers topics such as food groups, refined versus unrefined carbohydrates, sources of fat, sugar and salt, label reading, portion sizes and fussy eating. The emphasis is placed on practical education around menu planning, recipes, visiting the supermarket, fruit and vegetable tasting, cooking and dealing with special occasions. No foods are forbidden; instead families are given advice and support on how to adopt a ‘MEND-Friendly’ lifestyle.
HOW EFFECTIVE IS MEND? Paul Sacher and colleagues have completed a number of studies supporting the effectiveness of the MEND programme. Details of these can be found on the MEND website (www.mendprogramme.org). Overall, these studies showed significant improvement in several health outcomes such as reduced waist circumference, improved cardiovascular fitness, increased participation in sports, reduced screen time and increased self-esteem. Importantly, the majority of these outcomes were not just maintained but continued to improve during the follow-up, suggesting that the programme can be effective in the long term. The impressive average attendance rate of 86% suggested that the families not only benefited from the programme but also enjoyed attending. 298
The first MEND Programme started in September 2006 in South Tyneside. It is currently funded through the Neighbourhood Renewal Fund. The regional MEND team consists of a Consultant Clinical Psychologist and an Assistant Psychologist (both from Northumberland, Tyne and Wear NHS Trust), a Senior Paediatric Dietitian (from South Tyneside Foundation Trust), three Sports Development Officers and a Health Development Officer (from South Tyneside Council with the support of the Health Improvement Officer for Children from South Tyneside Primary Care Trust). Using both a leisure centre and school as venues, the team has completed two programmes with a further two groups in progress. The intervention has been offered to 42 families so far. On completing the programme, MEND graduates are given the opportunity to attend follow-on exercise sessions at their local leisure centre.
ENCOURAGING RESULTS
Seventeen out of 20 families from the first two groups completed the programme. Our results are in line with those found in the research studies. The majority of children halted their weight gain, with some beginning to lose weight. Comparison of pre- and post-intervention data revealed statistically significant mean reductions in weight (-6.0 kg, p=0.01), waist circumference, (-8.7 cm, p=0.001), body mass index (BMI; -3.5 kg/m2, p=0.003) and recovery heart rate (-2.7 beats per minute, p=0.016). Children’s levels of need, as measured by the Strengths and Difficulties Questionnaire, were also found to decrease across the course of the intervention, with decreases in scores for emotional symptoms and hyperactivity and increases in scores for scholastic competence and physical appearance. As the emphasis of the MEND Programme is on family-based lifestyle changes, the parents and carers were also assessed. The parents showed significantly reduced weight (-2.4 kg, p=0.3) and BMI (-2.3 kg/m2, p=0.04). Attendance rate for the programmes was also high (86.4%). These data are supported by positive anecdotal feedback from families, some of which illustrates how taking a family approach can have an impact at a wider level. For instance, in one of the families, a sibling overcame her constipation problem and stopped requiring medication for it as a result of applying the MEND advice in everyday family life. Even the family’s dog lost weight as a result of being walked more!
CO PY RI RE GH PR T O SH DU ER CT BO IO RN N E PR G O IBB HI S BI LI TE M D IT ED
Other parents also reported favourable changes, such as their children having more energy, sleeping better and having better skin. What has also been observed in the local programme was the transformation of the parents’ initial reluctance to learn – mainly stemming from their perception that they already knew all about healthy eating - to the recognition of how much MEND had taught them at the end of the programme. The initial results from the first MEND groups in South Tyneside appear to suggest that the impressive findings from the MEND feasibility, pilot and randomised controlled studies are beginning to be mirrored nationally as families across the country begin to reap the benefits and enjoyment of the intervention. This suggests that this type of family-based approach offers an effective intervention for the growing problem of childhood obesity.
• MEND website – www.mendprogramme.org
A MEND graduate receiving her certificate of completion from some members of the South Tyneside MEND team.
