Health Ian Wake
21st Century Playgrounds Tackling childhood obesity in South West Essex Ian Wake Deputy Director of Public Health
Overview • Who are NHS South West Essex • What is Childhood Obesity and why is it a Public Health Issue • Our Rationale • The Programme • Some outcomes
What is Childhood Obesity? â€˘â€ˆ The most widely used and convenient means of assessing body composition is the Body Mass Index (BMI). From an epidemiological point of view, overweight is commonly defined as exceeding the 85th centile and obesity as exceeding the 95th centile.
Why Childhood Obesity? • Major risk factor for other diseases • Rapid increase in the last 30 years
Associated co-morbidities Adults • type 2 diabetes • coronary heart disease (CHD) • hypertension • various cancers • Osteoarthritis • Psychological problems
• • • • •
• Children and teenagers
hypertension hyperinsulinemia dyslipidaemia type 2 diabetes psychosocial dysfunction • exacerbation of existing conditions • orthopaedic problems
Why Childhood Obesity? • Major risk factor for other diseases • Rapid increase in the last 30 years
Rationale: • SWE – 33% children in YrR and Yr6 are overweight or obese = 1 in 3 – Lost reality of a ‘healthy weight’ child
• Childhood obesity is incredibly complex: – Balance between consumption and activity – Multi-factorial causes – Little evidence base on interventions – Very emotive subject area – 95% of parents with an overweight child DO NOT identify their child as being overweight – No direct correlation between deprivation and obesity in SWE
Influences on Childhood Obesity Transport Parental / Home
- - School travel policy
- Parental BMI
- - Public Transport vs Car Ownership
- - Cycling Lanes
- Parents attitudes to obesity
Individual / Biological - Whether breast fed or not
- Home leisure pursuits
- Genetics
- Parental work patterns
- Self Esteem
- Diet at home
- Attitude to exercise
- Parental Income - Parental cooking skills - Community Safety Fears
Wider Environment
Primary Care - - Diagnosis and monitoring - - Medical intervention - - MEND referral - - Dietetics
School - School meal nutrition - PHSE in schools - Cooking skills in schools - - Level of structured PE - - School grounds/environment
- Access to retail outlets selling fresh fruit and vegetables - Access to Leisure Services - Community Groups - Housing type - Access to green spaces
Rationale: • SWE – 33% children in YrR and Yr6 are overweight or obese = 1 in 3 – Lost reality of a ‘healthy weight’ child
• Childhood obesity is incredibly complex: – Multi-factorial causes – Little evidence base on interventions – Very emotive subject area – 95% of parents with an overweight child DO NOT identify their child as being overweight – No direct correlation between deprivation and obesity in SWE
• Health Inequalities by Life Expectancy
Brentwood
Billericay
A127 Basildon New Town
South Ockendon Grays Tilbury
Rationale:
Rationale NICE 2006 • Minimise sedentary activities during play time • Provide regular opportunities for enjoyable active play and structured physical activity • Use a whole-school approach to develop life-long healthy eating and physical activity practices • Ensure school policies help children to eat a healthy diet, be physically active and maintain a healthy weight Foresight 2007 • Range of opportunities in the built environment to increase physical activity and help tackle obesity. • Provision of facilities for sport and formal exercise, supplemented by actions to increase usage, particularly among disadvantaged groups
Case for change • For all children and young people in SWE to have access to high quality outdoor educational areas that encourage physical activity for all. • To improve the fundamental movement skills of all children and young people • To enhance the 2hr physical activity offer in line with the 5hr target. • For all schools to achieve the Healthy Schools Standards.
The Programme Environmental Site Survey Tailored package of equipment/playground zoning ROSPA accredited safety inspection
Zonal Playground Markings: Improving Fundamental Movement Skills
Climbing / Jumping equipment: Increasing Physical Activity
Creative Play Equipment: Drama stages Yoga Bugs
Programme Environmental Site Survey Tailored package of equipment/playground zoning
CPD Programme for multidisciplinary school team
ROSPA accredited safety inspection Independent Evaluation of the Programme by Leeds Metropolitan University
Dec Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec I N 16 randomly selected schools S One day of observation at each round (Two observers) T A Questionnaire Questionnaire L ONE TWO L A Teacher interviews T Pupil Pupil Pupil Pupil interviews interviews interviews interviews I O Trainer Trainer Trainer Trainer Trainer reflexivity reflexivity reflexivity reflexivity reflexivity N
Research • How many EXTRA pupils engage with playground PA? • How do pupils engage with playgrounds (range of multi-skill variables + miscellaneous) • How has this come about (compared to before)? • What, if anything, made the impact? • How sustainable are these impacts?
What we required in return • Memorandum of Understanding Signed by each school – Sign up to and accreditation of Healthy School Standard by March 2010 – Participation in the research – Release of staff to CPD programme
Programme roll out • • • • •
£3.2 million investment 161 schools Sign up through Children’s Trust Boards Sign up of Directors of Children’s Services Letter to all heads followed by heads briefing Briefing of Healthy Schools Coordinators and Extended Schools Cluster Coordinators • Site visits / Installation October 08 to March 09 • Launch
Challenges • Convincing head teachers the scheme was free • Timescale • Logistics of checking work had occurred within schools • Local partnership arrangements
Positives • Sign up to Healthy Schools Programme • Improved Partnership Working • Raised Health Improvement up the agenda • Sustainable benefit for a one off investment
Some quotes Firstly can I say what a difference this initiative has already made to the outside areas of our small village school. To see children actively involved in climbing, playing and role-playing were before they would have just huddled in the corner of the play ground is fantastic. Michael Thomas, Head teacher Mountnessing Church of England Primary School
Pupils are keen to run, are motivated in sports and physical activities during playtimes and lunch times. Pupils who have social difficulties are developing team skills and interacting more with other pupils Head Teacher, Whitmore Infants and Nursery
Some quotes Our children are very keen & Enthusiastic about the equipment and have used it continually we have seen some real leadership qualities arising from our year 6 children as they guide and support the younger children Head Teacher – Graham James Primary
Form time - 3 form groups each day (75 students) on table tennis. Trim trail, climbing wall. During break/lunch trim trail very popular climbing wall used by mainly boys table tennis games - sixth form and younger students . Deputy Head, Brentwood County High School
If we want more evidence-based practice, we need more practice-based evidence. L. W. Green (2004)
? Any Questions
Health Ian Wake