Healthy Kids Healthy Families
Currently, one in four children aged 5 – 12 years old in NSW are overweight or obese. Traditional therapies focusing on the overweight child give the child and their family the unrealistic expectation that the child is responsible to change. This stigmatises the child and adds to a low self esteem and results in a high withdrawal rate from therapy. Evidence indicates that group programs for weight loss are the most effective, and in the case of children, groups where parents are the main agents for change are the most effective. There are currently no group programs, family based or otherwise for children on the North Coast of NSW. The program proposed comprises of a family-based weight management program, first modeled on The Family Weight Management Program developed at Westmead Children’s Hospital in 1998, then further reviewed and improved at Orange in western NSW. The program runs at night for two hours over 9 weeks and covers topics including:
- healthy eating for the family;
- recipe modifications;
- behaviour modifications;
- managing overeating; and
- building self-esteem.
Results from the program conducted at Westmead indicate a significant decrease in BMI’s of children and their siblings post-intervention (The Family Weight Management Program Manual, 2002).
In Lismore, it will be run by a team of community health staff; community dietitian; school health nurse and occupational therapist. With the exception of the community nutritionist, all positions will be participating in the program as part of their usual workload.
Parents of children will participate in the workshops while children take part in active play with the occupational therapist. . The purpose of the active play sessions is to increase physical activity at home and improve flexibility, strength, endurance and co-ordination. On two occasions the children and parents work together in interactive workshops.
Aims and objectives
Aim
To provide a cost effective treatment program for overweight or obese children aged 5 – 12 years and their families.
Objectives
- To decrease the waist circumference and reduce BMI toward the ideal of overweight and obese children attending the Program
- To reduce sedentary activities and increase physical activity levels of children and families participating in the program
- To improve the flexibility, strength, endurance and coordination of overweight or obese children participating in the program
- Families will decrease intake of high fat or high sugar drinks, snacks and meals and increase intake of fruits, vegetables and water.
- To promote more effective parenting styles that improve family lifestyle behaviour
Expected outcomes
It is expected that children will:
- reduce body mass index toward the ideal level for age,
- reduce waist circumference,
- decrease sedentary activities,
- increase physical activity,
- decrease intake of high fat or high sugar drinks, snacks and meals and
- increase intake of fruits, vegetables and water.
We also aim for improvements in children’s self image and positive changes in parenting styles.
Key performance indicators
The success of the project will be measured by:
Process Evaluation
Parents and children’s participating rates and satisfaction with the course will be monitored.
Impact Evaluation
Changes in activity, dietary intakes and parenting styles will be reported
by parents
Changes in children’s self image will be measured using validated tools.
Outcome Evaluation
Body mass index and waist circumference will be measured pre and post course. Parents may also elect for their children to have free medical assessments by the Community Paediatrician which will test for indicators of diabetes, some nutrient deficiencies, endocrine disorders and abnormal blood lipid levels. Any changes in these indicators will be monitored.
Progress
The original intent of the family based weight management project was to pilot and review the program in Lismore surrounds then roll out to two other centres in the North Coast Area Health Service Richmond Valley Network. The pilot program was successfully run in Lismore but failed to occur in the two other centres within the given timeline of the funding.
Referral of Children and Their Families
Referrals for participating families were sought from health professionals,
school counselors, paediatricians, GP's, and local hospitals or directly
from families via school newsletters and ads in local papers. The age
range for overweight/obese children was changed from 5-10 years to 8-12
years .
The Initial Interview
After referrals were received, program participants were directed through
the Initial Interview process. This is an individual appointment time
with the whole family. It was recommended that the referred child have
a medical assessment with their Paediatrician or GP prior to commencing
the program. An assessment form was provided.
The Initial Interview provided an opportunity to collect baseline information for each family.
The information collected included:
- Anthropometry, medical history and demographics
- Family Eating & Activity Habits questionnaire was filled out
- Child’s history of being bullied
- Bodywise Parent Questionnaire
Bodywise - 6 concurrent Parent and Children separate Sessions
The pilot program parent and child sessions in Lismore was run by a community
dietitian, Child, Family and Adolescent Health Nurse and paediatric physiotherapist.
With the exception of the community dietitian, all positions that participated
in the program did so as part of their usual workload. With input from
the paediatric physiotherapist, Southern Cross University Exercise and
Nutrition students and resources from SPARC (Sport & Recreation NZ)
more physical activities including exercises for low tone and active play
were incorporated into the children’s sessions. This adjustment to the
program proved successful with 100% enjoyment of the games by the participating
children, see results above. The purpose of the active play sessions is
to increase physical activity at home and improve flexibility, strength,
endurance and co-ordination.
Parents of children participated in the information workshops consistent with NHMRC Clinical Practice Guidelines with national healthy eating and physical activity guidelines as well as parenting skills and eating behaviours. Recent evidence-based dietary information from the Children’s Hospital Westmead Weight Management team was included in the nutrition information. The positive process evaluation by the parents for the Lismore program, including participation rates and satisfaction (see above) with the session content and delivery, has confirmed the success of the program.
Post Program – individual family ‘booster sessions at 3,6,9 &
12 months later
The first 3 month post program follow up occurred with the first Lismore
program. As the project was unable to be conducted in the Casino and Ballina
areas, a decision was made to finalise the project early. Further booster
sessions will continue as part of the community dietitian’s core business
in the Lismore area for the group’s participants.
Education of local GP's, and relevant health professionals
To ensure the sustainability of a family based weight management program
in the region, identification and engagement of families is crucial. A
seminar for GP training is in the planning stages. Despite the GP training
not taking place within the project framework, plans for a paediatric
specific GP training seminar by the Northern Rivers Division of General
Practice is planned for March 2009.
The remaining funds have been returned to NSW Health.