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? •  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

• Children and

teenagers •  hypertension •  hyperinsulinemia •  dyslipidaemia •  type 2 diabetes •  psychosocial

dysfunction •  exacerbation of

existing conditions •  orthopaedic

problems

Adults

•  type 2 diabetes •  coronary heart

disease (CHD) •  hypertension •  various cancers •  Osteoarthritis •  Psychological

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

Primary Care

- - Diagnosis and monitoring

- - Medical intervention

- - MEND referral

- - Dietetics

Parental / Home

- Parental BMI

- Parents attitudes to obesity

- Home leisure pursuits

- Parental work patterns

- Diet at home

- Parental Income

- Parental cooking skills

- Community Safety Fears

Transport

- - School travel policy

- - Cycling Lanes

- - Public Transport vs Car Ownership

Individual / Biological

- Whether breast fed or not

- Genetics

- Self Esteem

- Attitude to exercise

Wider Environment

-  Access to retail outlets selling fresh fruit and vegetables

- Access to Leisure Services

- Community Groups

-  Housing type

- Access to green spaces

School

-  School meal nutrition

-  PHSE in schools

- Cooking skills in schools

- - Level of structured PE

- - School grounds/environment

Influences on Childhood Obesity

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

Tilbury Grays

South Ockendon

Basildon New Town

Billericay Brentwood

A127

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

ROSPA accredited safety inspection

CPD Programme for

multi-disciplinary school team

Independent Evaluation of the Programme by Leeds Metropolitan University

Dec Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec I N S T A L L A T I O N

Questionnaire ONE

Questionnaire TWO

Teacher interviews Pupil

interviews Pupil

interviews Pupil

interviews Pupil

interviews

Trainer reflexivity

Trainer reflexivity

Trainer reflexivity

Trainer reflexivity

Trainer reflexivity

16 randomly selected schools One day of observation at each round (Two observers)

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