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Journal of Human Nutrition and Dietetics (1999), 12 (Suppl. 1), 99±100
# 1999 Blackwell Science Ltd. 99
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Abstract: `New Image': Evaluation of the
effectiveness of the 1996 `New Image'
programmes
C. Collins*, D. Fee{ and U. Chappiti{*School Nurse, {SRD, North-west Anglia (NHS) Trust, Peterborough, UK
Background
In Peterborough, childhood obesity has been
identified as an area of concern by various health
professionals. As a result, a variety of strategies
have been tried. Conventional approaches, such
as one-to-one consultations focusing on weight
loss, have limited success. Little emphasis has
been given to addressing the barriers to changing
other contributing factors. It was recognized that
overweight children frequently portrayed or pre-
sented with other problems affecting their social,
psychological and physical well being. Encoura-
ging young children to adopt a healthy diet and a
healthy level of physical activity may be the key to
their future well being. Improving self-esteem and
body image may be instrumental in achieving this
goal, and have benefits in other areas. The `New
Image' programme was developed as a lifestyle
approach to help achieve weight maintenance in
adolescent overweight girls.
The `New Image' programme
The programme was organized and run by a
multidisciplinary team of health professionals
which included two community nursing sisters,
one community dietitian, one community paedia-
trician and one physiotherapist. The programme
consisted of eight sessions each lasting an hour
and took place after school in the late spring and
summer to avoid dark evenings. The sessions
covered advice on healthy eating, food prepara-
tion, sport and exercise, looking good (skin care,
makeup, and clothing), body image and self
esteem and was supported by various commercial
organizations. A circular was sent to all General
Practitioners (GPs), school nurses, community
paediatricians (school doctors), hospital paedia-
tricians and dietitians explaining the aim and
structure of the course and inviting referrals for
overweight girls aged 12±16 years. A personal
invitation was sent to all girls referred, giving
them information regarding the programme, time
and location. The invitation included a reply slip
which required parental consent.
Evaluation
The aim of the evaluation was to assess the
effectiveness of the pilot `New Image' programme
by answering the following questions:
1 Did the programme achieve weight control in a
group of overweight girls aged 12±16 years?
(Overweight was defined as weight two centiles
above that for height, and weight control was
defined as no appreciable change in body mass
index (BMI) during the 8 weeks of the course and
at 18 months' follow-up.)
2 Did the girls who attended the course make
any long-term changes in eating patterns at 18
months' follow-up?
3 Does a lifestyle approach programme achieve
changes in self-esteem and improve self-image as
well as induce a more positive attitude to exercise?
Methods
Quantitative data, heights, weights and BMIs,
were collected from the programme data (taken at
the start and end of the 8 weeks) and measure-
ments of height and weight were taken at the
follow-up interview (& 18 months later). ACorrespondence: C. Collins, City Health Clinic,
Wellington St, Peterborough PE1 5DU.
Paper 09 Disc
100 C. Collins et al.
# 1999 Blackwell Science Ltd, J Hum Nutr Dietet 12 (Suppl. 1), 99±100
qualitative study using a semistructured inter-
view was carried out retrospectively with con-
senting participants and parents/guardians either
on the school site or in the subjects' homes. Food
diaries kept during one week of the programme
were compared with responses to follow-up
interview questions on changes to eating patterns
to determine whether long-term changes had
been made.
Results
Fifteen girls aged 12±16 years participated in the
pilot `New Image' programmes and of these 10
agreed to be interviewed for the follow-up & 18
months later.
Heights and weights were available for 11 of
the girls at the beginning and end of the 8-week
course and for 7 girls at the 18-month follow-up.
During the 8-week course there was a mean
weight increase of 1.8 kg (range±1 to +5 kg). A
further mean weight increase of 9.2 kg (range 1.8±
17.1 kg) was recorded at the 18-month follow-up.
These weight increases resulted in an increased
mean BMI (11 subjects) from 28.2 to 28.8 kg/m2
during the 8-week programme and from 28.8 to
31.2 kg/m2 (7 subjects) at the follow-up.
The girls appeared to have made a number of
changes to their eating patterns which were
observed by comparing their food diaries kept
during one week of the programme and with the
information given at the follow-up interview. The
main changes were identified as follows:
. ate more varieties of high fibre bread;
. skipped fewer meals;
. chose more healthy snacks, e.g. fruit rather
than crisps and chocolate;
. expressed a more positive attitude towards
healthy eating and trying out new foods.
Eight out of the 10 girls at follow-up said that
they participated in more physical activity. These
activities included swimming, cycling, walking,
football, keep fit, aquafit and were in addition to
school PE. None of the participants claimed to
have decreased their physical activities.
In response to a question about what they had
hoped to gain from the programme, eight out of 10
girls said that they hoped to gain confidence and
only three said that they hoped to lose weight. All
of the girls interviewed at follow-up said that the
programme had boosted their confidence or
improved their self-esteem in some way. However,
the session least remembered and enjoyed was
the session on `Body Image' and none of the
participants remembered seeing the video on
body image. All 10 subjects at follow-up said
that they would recommend the `New Image'
programme to other girls.
Conclusion
The number of girls who participated in the two
pilot `New Image' programmes was small and the
numbers participating in the evaluation was even
smaller so it is not possible to reach any firm con-
clusions about the effectiveness of this programme.
The `New Image' programme did not achieve
weight control during the programme for the 11
girls for whom start and end height and weight
data were available or during the follow-up
period for the seven girls for whom weight and
height data were collected at 18 months.
Some changes to eating patterns were reported
by some of the girls but there is insufficient
evidence to reach a conclusion that any long-term
changes had been made to eating patterns. Any
changes to eating patterns did not appear to aid
weight control.
Using a programme with a lifestyle approach
appears to have achieved some improvement in
confidence and self-esteem and in the amount
of physical activity taken in most if not all of
the girls.
Recommendations
. The `New Image' programme is re-run with a
much greater emphasis on healthy eating and
portion control, but in conjunction with
exercise and self esteem work. The programme
is run as above and the key family members
are included in a parallel programme.
. The programme is to be evaluated as an
intervention to prevent overweight and obesity
in pre-teenage girls when eating habits are less
established and peer pressures are less.
. The programme is piloted with overweight
teenage boys, using appropriate male staff.
. A wider variety of exercise opportunities
should be made available to participants on
the programme.
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