Nutrition & Food Science

Healthy lifestyle project for overweight and obese children: a pilot study
Mary Tyers

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Mary Tyers, (2005),"Healthy lifestyle project for overweight and obese children: a pilot study", Nutrition &
Food Science, Vol. 35 Iss 5 pp. 298 - 302
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Healthy lifestyle project for

overweight and obese children:
a pilot study
Mary Tyers

298

Nutrition and Dietetic Department, University Hospital of

North Staffordshire, Stoke-on-Trent, UK
Abstract
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Purpose To describe a year-long pilot programme, based at a leisure centre combining access to a
modified version of the existing Physical Activity Referral Scheme (Exercise on Prescription) in
North Staffordshire with dietary intervention.
Design/methodology/approach A small group of overweight and obese children and their
families participated in a year-long programme with psychologist input in initial design. The
programme entailed dietary intervention, incorporating behavioural approaches coupled with advice
and encouragement to access physical activity opportunities. School nurses recruited 16 primary
school-aged children whose BMI fell within the inclusion areas of the BMI centile charts for
overweight or obesity.
Findings Sixteen children with their families were initially involved in the programme of dietary
and physical activity intervention and encouragement. Twelve children completed the year. Ten of the
12 children (83 per cent) had an improved BMI centile status (three children marginally so). A total
75 per cent of children had an improved waist circumference centile by the end of the project. Dietary
markers showed an all-round improvement in the quality of childrens diets. Children became more
physically active, participants citing that they were walking more and most were achieving 16-30
more minutes a day in various forms of physical activity.
Research limitations/implications Statistical advice is sought to obtain numbers of children
required to run a comparative study with a control group (dietary intervention only) alongside
intervention described in pilot study.
Originality/value The number of children involved has been small but the scheme appears to
have been an effective means of enabling children and their families to achieve a healthier weight and
lifestyle over the period of the programme.
Keywords Children (age groups), Obesity, Diet, Activity sampling, Schools, Nurses
Paper type Research paper

Introduction
Families with overweight and obese children are requesting help and would benefit
from treatment programmes. There is a lack of evidence of the efficacy of treatment
programmes for overweight and obese children. It appears (Health Development
Agency, 2003) that targeting parents and children together (family based interventions
involving at least one parent with physical activity and health promotion) is effective.
It has been suggested (SIGN, 1996; NHS CRD 2002) that it would be beneficial to target
Nutrition & Food Science
Vol. 35 No. 5, 2005
pp. 298-302
# Emerald Group Publishing Limited
0034-6659
DOI 10.1108/00346650510625485

The North Staffordshire Directorate of Health Promotion who funded the Physical Activity
Consultant and coordinate the Physical Activity Referral Scheme. School Nurses: Mary Cooke,
Sue Needham and Sandy Hammond. Child and Adolescent Psychologist, Carol Martin. Glendale
Leisure and Staffordshire Moorlands District Council. The Nutrition and Dietetic Department.
University Hospital of North Staffordshire.

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high risk children for more intensive treatment programmes based on a joint approach
which can be summarised as involving:
.

healthy eating,

increased physical activity,

behavioural approaches,

involvement and support of family.

The programme aimed to facilitate families making specific dietary changes, being
involved in increased everyday activities and the children themselves in preferred
activities at the local leisure centre. This would enable overweight or obese children
achieve an improved BMI profile.
Subjects
School nurses recruited 16 primary school aged children (10 girls and 6 boys) initially
to participate in the programme. Eight of the children were in receipt of free school
meals indicating limited family income. Twelve children (7 girls and 5 boys) completed
the year. Two children from one family discontinued the programme after an initial
consultation and two more half way through the programme giving no reason, despite
a letter requesting feedback being sent.
Methodology
The involvement of a Child and Adolescent Psychologist helped ensure that the
programme was approached in a sensitive and non-stigmatising way. Children were
included in the programme if BMI fell within the inclusion areas of the BMI centile
charts for overweight or obesity.
The International Obesity Task Force have recommended cut-offs on the British
Childhood BMI charts for obesity and overweight in children. These correspond to the
adult definitions of overweight (BMI >25) and obesity (BMI >30) at age 18 (Cole, 2000).
There is some evidence however that BMI measurements alone which give no
indication of body fat distribution, in children, may be masking even higher levels of
overweight and obesity than is currently realised (McCarthy, 2003). Trends in waist
circumference during the past 10-20 years have greatly exceeded those of body mass
index particularly in girls. Measuring BMI alone is therefore likely to be
underestimating the prevalence of obesity in young people. For this reason waist
circumference data was collected at the beginning and end of project period. This
information was related to the published waist circumference percentiles in British
children aged 5-16.9 years (McCarthy, 2001).
Dietary markers (intake of fruit and vegetables, sugary drinks, crisps and sweets
and chocolates) giving an indication of the quality of diet taken were collected from
detailed diet histories the beginning and end of the programme.
Participants, always with at least one main carer, (other family members were
encouraged to attend if possible) were given the opportunity of seeing the dietitian,
during daytime, in at the leisure centre on 5 occasions over a yearlong period for
dietary education and intervention. Dietary targets were agreed initially and at each
subsequent appointment if needed. Motivational charts with stickers were used as
suggested by the psychologist to encourage children make agreed changes. There were
also dietary educational activities throughout the year. These included children
collecting wrappers and pictures of foods and drinks consumed and placing them, after

Healthy lifestyle
project

299

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300

discussion, on a large Balance of Good Health mat. Children with their parents also
completed a food diary forming another discussion point. Work sheets from the British
Dietetic Associations Food Firsts Eat 2 B Fit educational pack were also used to
reinforce changes being negotiated with the families.
The families also had the opportunity of receiving expert advice on achieving a
more physically active lifestyle by a Physical Activity Consultant. This input was
accessed by modifying an existing arrangement of the adults scheme whereby suitable
patients are able to obtain a prescription from their G.P to access a 10 week course at
the local leisure centre gym coupled with two consultations with a physical activity
consultant. As most gym-based activities are unsuitable for children, the programme
offered was modified to include, at no cost for the involved child, swimming,
badminton, football, table tennis and trampolining. An important emphasis taken by
the physical activity consultant, however, was that increasing everyday activities such
as walking were of equal importance. British Heart Foundation resources were used to
help reinforce and motivate children. At all times the whole family was encouraged to
be involved in both aspects of the programme and make family based changes. With
this in mind two family walks were organised specifically for the group of children and
their families.
Results
Sixteen children with their families were initially involved in the programme of dietary
and physical activity intervention and encouragement.
Incidence of presence of family history of obesity and associated health problems as
reported by the families (Table I).
Ten of the12 children (83 per cent) had an improved BMI centile status (although
three children only marginally so), one child stayed on the same centile and one childs
weight profile worsened. At the beginning of the programme 67 per cent children
were obese and 33 per cent were overweight. At the end 56 per cent were obese and
44 per cent overweight. In total, 75 per cent of children had an improved waist
circumference centile by the end of the project. Advice sought from a statistician
deemed this was a pilot study with a small number of children. Results are represented
graphically in Figure 1.
Using dietary markers as an indication of altered diet it appeared that the children
generally achieved a healthier diet by the end of the project (Table II).
All participants claimed that they and their families have become more physically
more active as a result of the scheme and plan to continue to be so. All participants
cited that they were walking more and most were achieving 16-30 minutes of increased
physical activity a day. Five children had guardians who themselves became
participants on the Physical Activity Referral Scheme as a result of their childrens
involvement. This probably indicates that whole families were becoming more
physically active as a result of their childrens involvement in the programme.
One child had not taken part in school P.E. for several years but was now doing so.

Table I.

Obesity
Diabetes
Heart Disease

One side of family

Both sides of family

44% (7)
25% (4)
25% (4)

50% (8)
25% (4)
44% (7)

Healthy lifestyle
project

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301

Figure 1.

Dietary marker
Fruit and vegetable intake
Frequency of sweets/
chocolate intake
Frequency of crisp intake
Sugary Drink
Consumption

Pre-programme

Post-programme

Average intake 2 portions/

day.
Average frequency of
consumption 3/week
Average intake of
5 packets/week
50%
50%

Average intake of 3.5

portions/day
Average frequency of
consumption 2/week
Average intake reduced to
3 packets/
92%
8%

Table II.

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302

Conclusion
The number of children involved in this pilot programme has been small but the
scheme appears to have been an effective means of enabling children and their families
achieve a healthier lifestyle. This conclusion is based on patient and their families self
reporting of attained physical activity levels and changes in dietary intake as indicated
by dietary markers. However BMI profiles and waist circumference centile data also
support this conclusion showing general improvements in both weight and in
decreased central fatness. Various suggested modifications were made by the families
to improve the scheme. These were notably that offering special aerobic or circuit
training type classes and more frequent support would be beneficial.
The children will be screened for height, weight and therefore BMI by their school
nurses a year on from the completion of the project.
There are plans to modify the physical activity options and re-run the scheme in
another town nearby. Referrals will be sought from the Primary Care Team as well as
school nurses and in collaboration with Sure Start. Advice from a statistician will
establish a statistically significant sample size.
References
Cole, T.J. et al. (2000), Establishing a standard definition for child overweight and obesity
worldwide international survey, BMJ, Vol. 320, pp. 1240-53.
Health Development Agency (2003), The Management of Obesity and Overweight: An Analysis of
Diet, Physical Activity and Behavioural Approaches, Health Development Agency.
McCarthy, D. et al. (2003), Central overweight and obesity in British Youth aged 11-16 years
cross sectional surveys of waist circumference, BMJ, Vol. 326, pp. 624.
McCarthy, D. et al. (2001), The development of waist circumference percentiles in British
children aged 5-16.9 years, European Journal of Clinical Nutrition, Vol. 55, 902-7.
NHS CRD (Centre for reviews and Dissemination) (2002), The prevention and treatment of
childhood obesity, Effective Health Care, Vol. 7 No. 6.
SIGN (1996), Obesity in Scotland: Integrating Prevention with Weight Management. A National
Clinical Guideline, SIGN, Edinburgh.
Further reading
Edmund, et al. (n.d), Scottish Intercollegiate Guidelines Network (SIGN) Obesity in Scotland:
Integrating prevention with weight management, Childhood obesity.
Anon (2001), Evidence based management of childhood obesity, BMJ, Vol. 323, 20 October.
Gibson, P. et al. (n.d), An approach to weight management in children and adolescents (2-18
years) in primary care, produced for the Royal College of Paediatrics and Child Health and
National Obesity Forum.
Prescott-Clarke, P. et al. (1997), Health Survey for England 1995, The Stationery Office, London.
Anon (2001), School based programmes on obesity, BMJ, Vol. 323, 3 November.
Third newsletter of All Party Parliamentary Obesity Group www.nationalobesityforum.org.uk
Whitaker, R.C. et al. (1997), Predicting obesity in young adulthood from childhood and parental
obesity, N. Engl. J. Med., Vol. 337, pp. 869-73.

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