The Healthy Lifestyle Programme for Treatment and ... · Programme would enable disadvantaged families to access education for obesity prevention. The programme and pilot study took

© University College London

CONFIDENTIAL

The Healthy Lifestyle Programme for

Treatment and Prevention of Obesity in

Preschool Children

September, 2013_____________________________________________________________________________________From: The Childhood Nutrition Research Centre, UCL Institute of Child Health, 30 Guilford Street,

London WC1N 1EHE mail: [email protected]

Tel: 020 7905 2770Fax: 020 7831 9903


BACKGROUND

Childhood obesity has reached epidemic proportions across the world. Evidence suggests thatmost obesity is established during the early years.(Gardner et al. 2009). Prevalence of obesity inpreschool children has increased since 1989 to levels similar to those seen in school-agedchildren.(Bundred et al. 2001) The most recent UK National Diet and Nutrition Survey reportedthat 1 in 2 children aged 2-3 years are overweight or obese (boys: 20% overweight; 34% obese,girls: 29% overweight, 21% obese).(NDNS 2011) Data collected in 2012 by the National ChildMeasurement Programme show that 9% of children in reception year, aged 4-5, are obese (NCMP2013).

Evidence suggests that obesity established early in life tracks throughout childhood and intoadulthood.(Serdula et al. 1993) Factors that influence obesity development include infant size andgrowth. Rapid growth in infancy has been identified as an important risk factor for laterobesity.(Baird et al. 2005) Nutritional factors in infancy and early childhood are also influential.Breast fed infants have a lower risk of obesity compared with their formula fed counterparts andearly introduction of solid foods may also increase obesity risk. (Weng et al. 2012) Early childhoodis a particularly pivotal time during which long-term dietary habits become established. Thereforeinterventions that aim to achieve appropriate nutritional practice during this period are urgentlyrequired. However, interventions that aim to reduce the risk of obesity in preschool children arelacking.(Flynn et al. 2006)

Childhood obesity is associated with adverse short and long term health outcomes. For instance,obesity in children is a key risk factor for adult obesity and chronic diseases such as diabetesmellitus and cancer.(Parsons et al. 1999;Serdula, Ivery, Coates, Freedman, Williamson, & Byers1993) The cost of this is considerable in terms of public and individual health, and health carecosts. Prevention of obesity in childhood is therefore a key target for health promotion and publichealth policy.

Rationale for Study

Guidance for prevention, management and treatment of obesity was issued from the NationalInstitute for Health and Clinical Excellence (NICE) in 2006 and reiterated in 2011. This bodyrecommends that interventions for childhood obesity should include advice on achieving a healthydiet, address lifestyle risk factors within the family and social settings, and incorporate strategies forbehavioural change. Importantly, interventions must include at least one other familymember.(NICE 2006) NICE guidelines also recommend that nurseries and childcare facilitiesshould minimize sedentary activities and provide regular opportunities for active play andstructured physical activity. However, despite these recommendations, currently, there are nopublished data from successful interventions for the prevention of pre-school obesity in the UK.

The Trim Tots Intervention integrates the NICE recommendations in a single comprehensiveprogramme for obesity prevention in pre-school children. The intervention has been tested in twostudies using a randomized controlled trial (RCT) design. The first was a pilot study conducted in'high risk' children who were either already overweight (defined as BMI ≥ 91st centile on the UK1990 growth reference (Freeman et al. 1995) or whose weight had crossed upwards by at least


one centile space (upward centile crossing) and were at risk of becoming overweight. The RCTtested the feasibility of the intervention in a community based setting in children aged 1-5 years.

Following the successful completion of the pilot treatment study a second RCT was conducted in awider population to include children not overweight or at increased risk of becoming so.

TRIM TOTS PROGRAMME

The Trim Tots programme aims to prevent obesity and promote a healthy lifestyle in parents/carersand young children aged 1-5 years. It has been designed by a multidisciplinary team of healthprofessionals including dietitians, paediatricians, exercise instructors and clinical psychologists toprovide education and training in nutrition and lifestyle factors that will lead to the adoption ofhealthy dietary habits and physical activity levels. The programme meets current NICErecommendations for the prevention of childhood obesity.(NICE 2006)

Trim Tots is designed to help parents/carers of young children develop the knowledge and skillsneeded to establish healthy dietary and activity patterns for the whole family. It also aims toincrease children’s understanding of foods and nutrients using nutrition workshops incorporatingmusic, art and craft. Physical activity is encouraged through play based activities that children andadults take part in together (‘Funbursts’) and adult exercise sessions. Healthy eating is taughtthrough adult nutrition education sessions (‘WaistWise’’) which encourage behavioral change.

Main sessions are held weekly for the first 12 weeks of the programme. Each 2-hour session isbased on a specific aspect of nutrition. Each session breaks down into a series of workshops: artand craft, music and movement, healthy snack, adult nutrition education (WaistWise), children’splay-based physical activities (Funbursts and StretchStory) and adult exercise. Behaviour changeis encouraged by setting SMART goals for parents/carers relative to each session. Supportinginformation is provided in the form of fact sheets, a list of useful websites and other resources. Afinal session provides an overview of the previous sessions and consolidates learning so far(Appendix 1).

Consolidation sessions are held weekly for the second 12 weeks of the programme and aim toconsolidate knowledge gleaned during the 12 main sessions. Consolidation sessions are practicaland interactive and provide opportunities for parents and children to translate knowledge intopractice. For example, families take part in cooking, food labeling and portion size activities(Appendix 2).

TRIM TOTS STUDY DESIGN

The Trim Tots Programme is based on established physical activity workshops and so is likely tobe effective in the short -term. However, data showing long-term efficacy are required before anyobesity programme can be accepted as a public health intervention. Therefore, the feasibility ofthe Trim Tots intervention was tested using a randomized controlled trial, generally recognized asthe most robust scientific method.

METHODSParticipants

Sure Start Children’s Centres were the main recruitment partners for the pilot study. Children’sCentres were selected as ideal venues as they are at the heart of the Government’s strategy to


deliver better outcomes for children and families. These centres are also placed within easyaccess for families living in areas of medium to high social deprivation and therefore the Trim TotsProgramme would enable disadvantaged families to access education for obesity prevention. Theprogramme and pilot study took place in South Oxhey Children’s Centre, Hertfordshire an area witha high prevalence of childhood overweight and obesity. (Table 1).

Table 1 Prevalence of Preschool Obesity in South Oxhey

Children’s Centre % Obese % Overweight/Obese

2009/10 2010/11 2009/10 2010/11

South Oxhey 7.5 10 24.8 24.4

Recruitment

Patient information sheets provided as easy to read, comprehensive booklets were produced toinform families about the programme and the research including details of measurements and timecommitments. The study was advertised within South Oxhey Children’s Centre’s via newsletters,leaflets and posters. Other local children’s centres, health clinics, and playgroups were contactedby CNRC research staff who explained the programme to staff and families interested in takingpart. Adverts and articles were placed in local newspapers and magazines. Parents wishing toparticipate were given an information sheet and invited to contact the research team by phone,email or in writing for more information.

Eligibility

Parents or carers with one or more children aged 1-5 years with BMI at or above the 91st centile orshowing upward centile crossing according to the UK 1990 growth reference, able to attend the 24week programme with their toddler were invited to attend a screening visit. Exclusion criteriaincluded major congenital disease, illness or social problems in parent/carer or child, andtemporary residents or those likely to leave the area. Families who had already taken part in aprevious intervention aimed at obesity prevention in pre-school children were also excluded. Thestudy was approved by National and Local Research Ethical Committees.

Screening

At the screening visit children’s height and weight were measured and their BMI calculated.Parents were asked to provide details of recent growth history if available. Families of ineligiblechildren were politely advised that their child was not suitable for this particular study and offered abooklet providing advice on feeding toddlers. Families who met inclusion criteria were given theopportunity to ask questions and discuss their participation. A detailed information sheet wasprovided which parents were advised to read carefully and discuss with their family, friends and amember of the research team before deciding to take part in the study. Full written informedconsent was then obtained from parents wishing to take part. A letter was sent to each child’s GPinforming of their patient’s involvement in the study.


Measurements

Families were randomly assigned to either immediate or delayed intervention thereby ethicallyallowing a control group. All measurements were carried out by trained staff in accordance withCNRC’s standard operating procedures. Measurements were taken at study baseline andrepeated at 6 months from baseline and at 6 and 24 months after completing Trim Tots. (Table 2)

Table 2: Study Measurements

AnthropometryHeight, Weight, Head, Waist and Limb circumferences

Body compositionSkin-fold thickness at four sites, Total body water estimated from the dilution of deuterium

Physical ActivityAccelerometry, Questionnaires

Cardiovascular Health and FitnessBlood Pressure, Pulse Wave Velocity and Heart Rate Variability

General and Dietary BehavioursQuestionnaires


TREATMENT TRIAL RESULTS

105 children were recruited between June 2008 and December 2010. 90 children consented andcompleted baseline measurements. 88/90 (98%) children with BMI above the 91st centile orupward crossing in centiles for weight were randomly assigned to either immediate intervention (n= 46) or waiting list control (n = 42) groups (Figure 1). The mean attendance for the programmewas 73%. 64/88 (73%) children (mean age 2.5 years) provided measurements before and aftercompleting the intervention. BMI and BMI z-score were lower in children completing the 6 monthintervention than controls (mean difference for BMI z-score: - 0.9 z scores; 95% CI: (-1.4 to -0.4, P= 0.001) and this difference remained after adjustment for age and sex (P = 0.002). A reduction incentral obesity was suggested by a trend towards lower waist circumference (mean difference: -2.7cm, 95% CI: -5.7 to -0.2, P = 0.07). 42/88 (48%) were measured 2 years following completion ofthe intervention. Mean BMI z-score was lower compared with baseline (mean difference: - 0.3 zscores; 95% CI: (-0.5 to -0.1, P = 0.004).

Figure 1 Flow of participants through randomized controlled trial

TrimTots significantly reduced the risk factors of toddlers becoming obese in later life.

Table 2: Key statistics from Trim Tots Obesity Treatment Trial:

88 children joined the Trim Tots programme 59% Male, mean age yearsMean BMI was 18.5 BMI adjusted for age 1.3 z scores97% of carers were mothers 53% of mothers were overweight/obese48% were from non-manual occupations 81% were of Caucasian ethnicity75% (64 toddlers) completed Trim Tots 60% (39) were followed up 2 years later

Compared with toddlers not yet taking part in Trim Tots:

BMI was lower on average (more than one centile space on the BMI chart) Waist circumference was lower on average by 2.7 cm


Trim Tots was well accepted and enjoyed by participating families.

85% of parents reported their understanding of healthy eating had improved 75% reported they could read and interpret food labels better 83% now had a better understanding of food portion sizes 90% reported they found all Trim Tots components enjoyable and useful All parents said they would participate in the programme again All parents said they would recommend Trim Tots to a friend

Significant improvements were reported for activity and food related behaviours after takingpart in Trim Tots. Many parents reported positive changes in themselves and their children.

All parents reported an increase in their child’s physical activity 79% cut down on the amount of time their child spends watching TV All parents reported improvements in their child’s eating behaviour 69% reported greater enjoyment in eating including acceptance of more foods 70% said their child ate more servings of fruit per day 75% said their child’s liking for fruit increased 79% changed their child’s usual snack from juice or sugary drinks to a suitable alternative

There were many comments from parents taking part in Trim Tots – most were positive:

What did you like most about Trim Tots? What did you like least about Trim Tots?Helped us to understand about nutrition and the kidsenjoyed the music

There was nothing I disliked

Getting my children to mix with other children, talks,and arts and craftsInformation and the children’s activities and the people

Everybody was Friendly and Polite Nothing

Enjoyed the music sessions and art the most

C having fun and learning about different foods

It felt like we were helping and benefiting from theresearchMusic and Funburst sessions The art work was aimed to high for my child

The Trim Tots staff were very good with the children

The people were so nice

The singing and dancing I would have preferred if it was just foroverweight children

A fun way of looking at cooking. Brings opportunities toexercise with my children

Chest stickers on the overnight monitor

Music, Craft, health, weight and learning about theright portion sizesGood activities for the Children and introduced us tonew foods

Some activities not suitable for under 2’s

The Music sessions, meeting new people and tryingdifferent foods with my kids

Waist Wise. Art and craft art sessions were notalways age appropriate

Music sessions, trying new snacks, meeting newpeople. Cookery session.

Art and craft and Waist Wise

Educating both me and my child and socialising. Good Sometimes the sessions went on a few minutes


opportunity to learn new recipe ideas. too long for my child’s attention

Both my children looked forward to the singing andmusic sessions

Nothing. It’s good fun and informative

Music sessions were great fun Not always able to make all the sessions

L loved the music sessions and singing too NOTHING! It’s good fun and informative

The singing and dancing was great fun Found it difficult to attend all sessions

New ideas for Healthy living and eating and makingfood fun

Not being able to do physical activity

People running it are great at their job The bad singing at the start and end – Hellosong

Learning new activities and better knowledge of foodand dietThe staff are friendly and approachable, knowledgeableabout food and enthusiasticThe information about recipes was very useful and theadvice given at the cooking session

Craft - sometimes too long spent on this

Waist wise, music sessions, socialising with parents Art as it was too advanced for age

Feedback from the Children’s Centre was very enthusiastic, both in terms of the opportunity TrimTots provided to achieve local and national targets relating to child obesity and health inequalitiesas well as with respect to outcomes achieved.


TRIM TOTS OBESITY PREVENTION TRIAL

In the next stage of the Trim Tots project public health consultants and senior early years’ staff inHertfordshire were invited to collaborate in a wider roll out of the programme to test its feasibility ina range of community settings. The aim was to integrate Trim Tots into the early years setting andexpand the participating population to include all children and not only those at higher risk ofobesity development. This would allow evaluation of Trim Tots both as a treatment for obesity butalso as a preventative measure.

A steering group was formed and interested stakeholders were invited to join. The final steeringgroup comprised members of this initial panel and parents who had taken part in the RCT(Appendix 3). Letters of support for Trim Tots as an appropriate healthy lifestyle intervention inpreschool children were sought and obtained from commissioners of health and educationinitiatives within Hertfordshire.

Following consultation with Hertfordshire early years’ staff 35 children’s centres expressed interestin the Trim Tots programme. Three further Trim Tots programmes were planned in areas ofHertfordshire with high overweight and obesity prevalence (Table 3).

Table 3: Hertfordshire overweight and obesity statistics at Trim Tots start

Children’s Centre % Obese % Overweight/Obese

2009/10 2010/11 2009/10 2010/11

South Oxhey 7.5 10 24.8 24.4

Broxbourne 12.6 12.7 28.5 28.6

Welwyn and Hatfield 7.1 8.6 19.6 22

Funding was provided by each of three hub children’s centres in South Oxhey, Broxbourne andWelwyn/Hatfield. South Oxhey Children’s Centre funded a programme independently.Hertfordshire PCT provided funding for 1 programme in the Broxbourne area where four centrescollaborated to provide a venue and staff to assist with delivery of the programme. Children’scentre managers in Welwyn and Hatfield collaborated to provide funding, venues and staff for athird programme. Details of Hub and collaborating centres can be found in (Appendix 4).

The prevention programme was open to all children with no specific exclusions relating tooverweight or obesity status. The programme took place within a range of children’s centres thatvaried in size, geographic location and facilities, in Broxbourne and Welwyn and Hatfield and at aleisure facility within easy access of South Oxhey children’s centre. The eleven participating siteswere drawn from a diverse range of centres to test whether Trim Tots could be run successfully indifferent settings.

A training programme was developed and delivered to programme leaders, who were experts innutrition and physical activity and programme facilitators who were early years professionals basedwithin the children’s centres.


Trim Tots leaders were provided with comprehensive training that incorporated all programmecomponents by the Trim Tots team. Leaders received a complete set of teaching manuals(containing structured lesson plans), together with a full kit of teaching aids (including bespokepuppets, recordings of songs and stories created for Trim Tots by an experienced children’s artist)needed to deliver the programme. Leaders participated in training of Trim Tots facilitators. 16 staffmembers from the participating children’s centres were trained as Trim Tots facilitators.

91 children in total were recruited from these 3 hub centres for whom 85 provided baselinemeasurements. Measurements were completed in 64/85 (75%) children after taking part in TrimTots.

PREVENTION TRIAL RESULTS

91 children were recruited to take part in the programme that ran between September 2011 andDecember 2012. Consent to take part was given for 85 children and all completed baselinemeasurements. Children were randomly assigned to either immediate intervention (n = 38) orwaiting list control (n = 47) groups (Figure 2). The mean attendance for the programme was 73%.64/85 (75%) children (mean baseline age 2.1 years) provided measurements before and aftercompleting the intervention. When groups were compared BMI and BMI z-score (BMI adjusted forage and sex) were lower in children completing the 6 month intervention than controls who had notyet taken part in Trim Tots (mean difference for BMI z-score: - 0.3 z scores; 95% CI: -0.3 to 0.8) P= 0.3). A reduction in central obesity was suggested by a lower waist circumference (meandifference: -2.5 cm, 95% CI: -4.8 to 0.03, P = 0.05) (Table 3).

When considering individual children before and after taking part in Trim Tots significant reductionswere seen in blood pressure and skinfold thickness (a measure of body fatness) (Table 4).


Figure 2 Flow of participants through randomized controlled trial

Compared with toddlers not yet taking part in Trim Tots:

BMI was lower on average (by one third of a centile space on the BMI chart) Waist circumference was lower on average by 2.5 cm

Table 3: Key statistics from Trim Tots prevention trial

85 children joined the TrimTots programme 51% Male, mean age 2.1 yearsMean BMI was 17.4 BMI adjusted for age and sex was 0.5 z scoresMean waist circumference was 48.5 cm Mean skinfold thickness was 29.4 mm95% of carers were mothers 53% of mothers were overweight/obese59% were from non-manual occupations 69% were of Caucasian ethnicity75% (64 toddlers) completed TrimTots Children are being followed up 1 year later

After completing Trim Tots significant reductions were reported for:

Blood pressure Body fatness (as measured by skinfold thickness at four sites)


Table 4: Changes in blood pressure and body fatness before and after Trim Tots

Before Trim Tots After Trim Tots SignificanceControl Intervention Control Intervention Control Intervention

Mean Blood Pressure (mmHg)

77 76 77 71 0.8± 0.02*

Sum of skinfold thickness 28 29.3 28 26.2 0.7 0.02**Means this could only be found by chance in 1 out of 50 children±Means this could happen by chance in 40 out of 50 children

Trim Tots was well accepted and enjoyed by participating families.

All parents reported their understanding of healthy eating had improved All parents reported they could read and interpret food labels better All parents now had a better understanding of food portion sizes 90% of parents reported they found all Trim Tots components enjoyable and useful 95% of parents said they would participate in the programme again All parents said they would recommend Trim Tots to a friend

Significant improvements were reported for activity and food related behaviours after takingpart in Trim Tots. Many parents reported positive changes in their children.

53% of parents reported an increase in their child’s physical activity 43% cut down on the amount of time their child spends watching TV 55 % said their child’s liking for fruit increased 56% reported their child ate more types of vegetables

There were many comments from parents taking part in Trim Tots – most were positive:

What did you like most about TrimTots What did you like least about Trim TotsMusic, songs, art and cooking sessions All good

Food labeling info, opportunity to exercise with the children Could use the folder with the information at the start

Art and cooking sessions

Information and getting my children to try new foods Couldn’t make all sessions and that they are finished

Information, exercise and music

Nutrition and exercise, E would eat different foods at snacktime

Music sessions, art and craft, information on portion sizesfor children Sometimes too many paper handouts

The music is wonderful, M loves the CD, he still does all thedances we learned, but 24 weeks is too long with a little one In the later sessions there were no arts and craft

Art and craft sessions very good and varied It was a shame that some weeks were really quiet

Each child’s individual needs catered for, different andinventive, enjoyed the programme very much, staff alwayshelpful and accommodated my younger daughter too, greatfun thank you

Fun and interesting to do with the children The end!!

The music and funburst sessions Nothing


Education on healthy eating and the awareness I now have

Learning about foods, C really enjoyed all the activities Nothing

Art and craft and the cooking sessions. Although I have notbeen good at keeping up, I found the exercise part useful

The Waist Wise part

Art and craft and the cooking session The waist wise part

Doing something fun and interesting with my children

My child really enjoyed the sessions The art and craft sessions were for older children

Teaches children to cook healthy foods

Getting out of the house, the staff were lovely My children wouldn’t let me join the exercise class!

Nutrition and fitness sessionsTowards the end it was very repetitive for olderchildren

Meeting others, Waist Wise sessions The scary puppets!!

Very helpful to understand what children like to do most Nothing

Nothing

Music, dancing, recipe book, info and tips on healthy eating My son not wanting to join in

The music sessions, arts and crafts My daughter was not keen on Touchy and Feely

Watching the development of the children

Fun and energetic, you get to learn a lot to help yourchildren lead a healthy life Need more practice at the food sessions

Very interactive, both the parents and the children canenjoy and maintain a healthy lifestyle Nothing

Meeting new friends, and getting used to other children How early it started

Music, puppets and food labels Not enough cooking

All the activities and the idea of the programme Should have more sessions

It was structured and it was good that there were activitiesfor the parents

Towards the end the sessions became less structuredand slow to get going

Good ideas, well organized, fun, unusual and educational Sitting on the floor doing arts and crafts

The music and the dancing - fantastic We only did one cooking practical

Differences Between Trim Tots Treatment and Prevention Trials

Results varied according to the two trials. This was not surprising because the populations differedat the start. In the treatment trial there was a large difference in BMI in children who hadcompleted Trim Tots compared with those who had not yet taken part. This may be explained bythe fact that more children were overweight or obese at the start of the treatment trial comparedwith those in the prevention trial 45/88 (50%) versus (20/85 (20%) for treatment and prevention trialrespectively.

A smaller reduction in BMI was reported for children taking part in the prevention trial. This wouldbe expected as most were in the healthy BMI range at the start of the study. Furthermore,reductions in skinfold thickness and waist circumference indicate that the level of body fatdecreased for children taking part in Trim Tots. It is likely that muscle mass increased and thiswould offset possible reductions in BMI.

Behaviour changes were also less marked in children taking part in the prevention programme.This can probably be explained by the lower prevalence of overweight and obesity in this groupwhich suggests that diet and lifestyle was more conducive with a healthy bodyweight and fewerchanges were needed to achieve a healthy diet and lifestyle.


CHILDREN’S CENTRE PERSPECTIVE

Informal feedback from the Children’s Centres has been encouraging. Staff noted that nutritionalinformation provided to parents and carers was comprehensive and well received. Fewer childrencompleted Trim Tots programme at South Oxhey (66% versus 78% at Broxbourne, Welwyn andHatfield). This suggests the children’s centre maybe preferable to alternative community settings.Further feedback is invited following provision of this report.

SUMMARY AND FUTURE AIMS

The Trim Tots Programme was acceptable to both families and center staff and resulted in asignificant reduction in obesity risk. Longer term follow-up, 2 years after taking part, found theeffect on BMI to be sustained. These findings suggest that Trim Tots is a feasible intervention forprevention of obesity in preschool children.

In its most recent update (2011) NICE concluded its current guidance on management of childhoodobesity was still relevant. The prevention of obesity in childhood is of highest public health priorityand Trim Tots was highlighted in this report as a study that is particularly relevant.

Trim Tots offers an evidence based, cost effective and sustainable programme that can help earlyyears agencies, including children’s centres, achieve government obesity targets as outlined instrategic documents such as Healthy Weight – Healthy Lives (2008).

Future plans include expanding further within Hertfordshire where 35/82 Children’s Centres haveso far expressed an interest in running a programme (Appendix 5). The programme proved to bevery popular with families and children. A waiting list, restricted to a number of participants neededfor one programme at each hub centre, is currently held at CNRC (Table 5).


Table 5: Number of families on waiting lists for participation in Trim Tots

Children’s Centre Number of FamiliesSouth Oxhey 24Broxbourne 26Welwyn/Hatifeld 27


Appendix 1 Format of Trim Tots Main Sessions

ART & CRAFT WORKSHOP (40 MINUTES) Trim Tots Art Workshops convey healthy lifestylemessages and encourage parent and child interaction in a creative environment. Some workshopsare activity based while others are simply fun (to allow families to become accustomed to the artenvironment). Art Workshops have a nutritional focus and address a range of topics.

MUSIC & MOVEMENT (20 MINUTES) sessions provide an opportunity for physical activity foradults and children. Trim Tots music sessions have been designed to engage emotions and getchildren excited and involved. Different styles of music and movement are explored. The sessionsare very active and give parents the opportunity to exercise alongside their children. Activities likethese promote self confidence, improve co-ordination and enhance gross motor skills.

HEALTHY SNACK (15 MINUTES) Trim Tots snack time is an opportunity to introduce new foodsto families and focus on healthy balance, affordability and reasonable preparation time. Thesnacks are designed to encourage adults and children to try new foods and improve their diets byincluding foods from the major food groups in the recommended proportions. Snack timeintroduces the concept of a healthy balanced snack. We present colourful platters of foods fromthe five main food groups and use these to promote a healthy balanced diet.

FUNBURSTS (15 MINUTES) structured play sessions provide a safe environment for active playand promote the importance of exercise in everyday life. The sessions are designed to provideshort (10-15 minute) bursts of activity and aim to help children achieve the recommended 180minutes of moderate physical activity daily recommended by NICE (National Institute of ClinicalExcellence).

WAISTWISE (15 MINUTES) are nutrition education workshops developed by registered dietitiansand nutritionists. These mini tutorials are designed to avert the focus from weight reduction toimproving diet, physical activity level and body fatness. The nutrition workshops provide ageappropriate advice and training to help achieve these aims. All food groups are discussed andtopics include ‘energy balance’, fussy eating, portion control and food labeling. Behavior change isencouraged by setting SMART goals.


ADULT EXERCISE (15 MINUTES) Trim Tots Adult Exercise sessions have been designed toencourage increased physical activity with the aim of improving health and fitness. Regularexercise has been shown to benefit short and long-term health and is an important part of weightmanagement. Each weekly session teaches participants how to exercise safely demonstrating bothaerobic and body conditioning exercises.

STRETCH STORY (15 MINUTES) Trim Tots incorporates a collection of themed stories that allowchildren to stretch, relax and calm down after their active play while simultaneously providing anopportunity for a story with an important health message.


Appendix 2 Format of Trim Tots Consolidation Sessions

Consolidation sessions mirror main sessions but are more practical. For example a practicalweighing and measuring session in week 21 consolidates more theoretical teaching of portionsizes in week 9.


Appendix 3

Steering Group MembersDr Hilary Angwin Public Health Consultant Hertfordshire PCTAnka Johnston Children's Healthy Weight Manager NHS HertfordshireDr Julie Lanigan Dietitian, Trim Tots Principal Investigator ICH, UCLProfessor Atul Singhal Paediatrician, Trim Tots Principal Investigator ICH, UCLSarah Collins Trim Tots programme manager/Trial co-ordinator ICH, UCLKerry Lanigan-Coyte Community Artist, Trim Tots Artistic Developer NYSA ProjectsTheresa Matcham Children’s Centre Manager *St. Alban’s CCClare Leahy Family Representative South Oxhey CCIrene Winning Family Representative Arlesdene, CCKatie Cresswell Family Representative Arlesdene, CC

*Previously manager at South Oxhey Children’s Centre


Appendix 4

Children’s Centres Participating in Trim Tots Roll Out

Hub Centre Participating Children Centres and Contact Details ParticipantsSouthOxhey/Watford

South Oxhey Childrens CentreNorthwick Road, South Oxhey, Herts, WD19 6NLManager:Pauline WilliamsTel:020 8700 2203Email: [email protected]

28

Broxbourne (29) Arlesdene Childrens CentreBlindman’s Lane, Waltham Cross, Herts, EN8 9DWManager: Ann LittlerTel: 01992 626879Email: [email protected]

12

Three Parks Children’s CentreWalton Road, Hoddesdon, Herts, EN11 0LNManager: Wendy WrightTel ; 01992 904442Email: [email protected]

4

Longfield Childrens CentreLongfield Lane, Cheshunt, Waltham Cross, EN7 6AGManager: Maggie MobleyTel: 01992 90610Email: [email protected]

7

Greenfield Children’s CentreHurst Drive, Waltham Cross, Herts, EN8 8DHManager: Pat BishopTel: 01992 7060779Email: [email protected]

6

Welwyn &Hatfield (34)

Howe Dell Childrens CentreThe Runway, Hatfield, Herts, AL10 9AHManager: Penny BriggsTel: 01707 263291 x2Email: [email protected]

6

De Havilland Children’s CentreTravellers Lane, Hatfield, Herts, AL10 8TQManager: Sarah BowyerTel: 01707 346624Email: [email protected]

4

Birchwood Children’s CentreBirch Way, Crawford Road, Hatfield, Herts, AL10 0PDManager: Kathryn EvansTel: 01707 262648Email: [email protected]

6

Tenterfield Childrens CentreLondon Road, Welwyn, Herts, AL6 9JFManager: Caroline O'FlahertyTel: 01438 714564

4

mailto:[email protected]





Email: [email protected]

Creswick Children’s CentreSir John Newsom Way, Welwyn Garden City, Herts, AL7 4FLManager: Val GarlandTel: 01707 343512Email:[email protected]

6

Oaktree Childrens CentreHolwell Road, Welwyn Garden City, Herts, AL7 3RPManager: Ria LonghurstTel: 01707 375079Email: [email protected]

8




Appendix 5

Recruitment and measurement summary

Hub Centre Recruited Baseline Data 6 Month Data(Study baseline + 6 months)

South Oxhey 28 24 16Boxbourne 29 28 22

Welwyn/Hatfield 34 33 26

Totals 91 85 64


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The Healthy Lifestyle Programme for Treatment and ... · Programme would enable disadvantaged families to access education for obesity prevention. The programme and pilot study took