The HENRY approach to tackling child obesity Kim Roberts and Mary Rudolf
The first thousand days “Perhaps the single most important cultural shift that is needed is to invest in the development of children in their early years (from minus nine months to 2 or 3 years old). These early years are absolutely central to the developmental fate of a child.” Professor Sir Ian Kennedy Getting it Right for Children and Young People
Predicted weight status in Year 6 of children who start school obese or severely obese Graphic adapted from: Changes in weight status of children between the first and final years of primary school . Public Health England 2017
Predicted weight status in Year 6 of children who start school a healthy weight Source: Changes in weight status of children between the first and last years of primary Graphic adapted from Changes in weight status of children between the first and final years of primary school . PHE 2017 Graphic adapted from: Changes in weight status of children between the first and final years of primary school . Public Health England 2017
Obesity prevalence among children aged 2-4 years 11 % upper CI 13.2% lower CI 9.3% Health Survey for England 2015
Parents want the best for their children I really want to be a good dad but now she’s a toddler there are lots of times when I just feel out of my depth when she says no and takes no notice We were desperate, we knew we needed to change but didn’t know how. It was affecting the kids
What do children need for a healthy start? Messages from research • Timely and sensitive support for their parents • Confident and happy parents (most of the time) • Loving secure relationships and positive attention • Healthy habits right from the start of life • A healthy family lifestyle: • Eating habits and mealtime routines • Eating well • Activity and sleep
Sensitive and timely support for parents I sit there giving her advice and I know she’s not going to follow any of it … Health visitor describing her work with the mother of an obese 3 year old
Creating the conditions for change • Supportive relationship – practitioner effectiveness • Emotional readiness and energy for change – confidence and motivation • The space and opportunity to reflect, gain knowledge and understanding – and decide how to put this into practice in own life and family
Building effectiveness as practitioners 2 day training Knowledge: Skills: Risk factors Relationship Whole family Qualities: healthy Empathy lifestyle Non- Strengths judgemental Healthy start Raising the Partnership issue Modelling Solution- focused
A healthy start in childcare • Resources and support • 1 day training for settings • Modelling and relationships • Early feeding • Mealtime and snack routines • Portions and portion sizes • Eat Better, Start Better menu planning • Audit and action planning
Impact on practitioners • 13,000 practitioners trained • 70% still using the skills 4 years later I’ve been on many training courses and felt I left with some more tricks in my backpack. But HENRY has changed me as a person. It’s about being the approach, not doing it. I’ve thought about what it’s like for parents in the last two days in a way I never have before.
Impact on practitioners 50% e-survey up to 4 years later; n=354 45% 40% 35% 30% < 12 months 25% 85% < 12 months > 12 months 91% > 12 months 20% 15% 10% 5% 0% 1 2 3 4 5 Significantly Brown et al, Very little impact improved Community Practitioner 2013
Changes to practice up to 4 years later Aspects of Course Regularly, Often, All the Time Value of empathy 76% (276) Key parenting skills 72% (261) Healthy nutrition 71% (256) Working in partnership 70% (250) Solution-focused support 70% (251) How emotions affect behaviour 70% (251) Eating patterns and habits 67% (240) Physical activity 65% (238) Brown et al, Community Practitioner 2013
Impact on practice and policy in early years settings • Positive changes in practitioners’ lifestyles • Enhanced confidence to approach and discuss lifestyle issues with families • Healthier meals, snacks and portion sizes I think they’re more confident in tackling & • Persistent change and impact bringing up things … I’ve on the culture and practice of noticed that people are talking about lifestyle more, the wider team and are concerned about it Willis et al, J Hum Nutr Diet 2012
Building networks of support • 125% increase in parents who felt ‘supported’ often or very often One of the things I enjoyed most about the HENRY programme was spending time with other parents. I found that talking about my experiences and hearing they had many of the same struggles really helped me feel better about the things I find difficult.
Models of volunteering Around 100 active volunteers: • Breastfeeding peer supporters • Parent champions • Healthy start mentors • Outreach volunteers
A pause for reflection • What thoughts have been triggered by the workshop content so far? • Questions and comments?
Integrated support for a healthy happy childhood Family lifestyle Parenting Starting solids Breastfeeding Pregnancy
Healthy Families Training the early years and public health workforce to deliver HENRY group programmes: • Pregnancy Healthy Families in the Making • Early Years Healthy Families Right from the Start • The primary years Healthy Families Growing Up
Creating the conditions for change The message: a healthy start The messenger: creating the in life conditions for change • Early nurture and • Building relationships feeding based on trust and • Parenting skills respect • Working in partnership • Healthy family routines • Empathy • A balanced healthy diet • Strengths-based for the whole family • Building motivation • Active play, physical • Solution-focused activity and sleep • Emotional well-being
Supporting parents’ wellbeing • 80% of parents report improved emotional wellbeing HENRY helped me realise how important ‘me - time’ is. I found that by recharging my batteries, little things didn’t get on top of me so I wasn’t My confidence has improved – I feel I am a shouting at them as much. better mother to my child and also a better partner. My relationship has improved.
Parenting • Desire, knowledge and confidence to provide the best start • Responsive and emotionally literate parenting • Skills and strategies to hold boundaries Now she’s a toddler there are lots of times when I Giving the kids some just don’t know what to do choice changed my when she says no and outlook on parenting and takes no notice I think about their point of view more often. Things quickly became calmer as a result
Parenting styles in charge DICTATORIAL/ AUTHORITATIVE AUTHORITARIAN UNINVOLVED/ INDULGENT NEGLECTFUL responsive
Guided choices DICTATORIAL AUTHORITATIVE INDULGENT “Here’s some carrot “What would you like “Eat up your for your snack?” carrot.” and some apple for you – help yourself.” Here’s some carrot Here’s some carrot What would you like for your snack, eat up and tomato for your for your snack? snack …. you choose
Infant feeding • Drop-in sessions and baby cafés • Home visits • Telephone support • Baby-friendly training for early years staff • Community events to promote a breastfeeding-friendly culture We are still breastfeeding four months on and it's very much due to the great help I got
Starting solids 96% of parents report greater confidence to introduce solids • Window of opportunity to develop a baby’s palate • Babies have an inbuilt preference for familiar tastes and textures • Start with vegetables and other savoury tastes I will use home-made foods with my child – I • Repeated exposure never thought you could at this age.
Responsive feeding
Mealtime atmosphere • 80% of parents report healthier mealtime behaviour • 40% reduction in TV meals I eat with my son at mealtimes at the table instead of in front of the telly now I realised if I want them to eat healthy food I need to eat them too. Who else are they going to copy?
Growing up eating well 89% increase in number of children eating fruit and veg 5 times a day • Healthy balance • Child-sized portions • Reducing energy dense foods and sweet drinks • Increasing fruit and vegetable That’s why we all came on consumption the HENRY programme. Knowing what’s healthy and • Family mealtimes how much to give them is • Avoiding using food for emotional reasons worrying, especially when they can’t talk.
Emotional dimension of food • Bribes, rewards and comfort • What messages do we communicate about food? • Moderation in all things including moderation • Don’t stop it, swap it – non-food praise, encouragement and comfort
Being active • 36% of children spend more time being active • 31% reduction in number of children watching more than 2 hours TV a day I moved from Pakistan when I got married. When I had a baby I thought it was too cold to take him out so we just stayed in the flat for the first year
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