Quantitative Evaluation of NHS Grampian‘s Grow Well Choices

Programme (September 2011 - July 2013)

Emily Stevenson, Public Health ST2Mary Bellizzi, Health Improvement Officer, Aberdeenshire

Caroline Comerford, Health Improvement Co-ordinatorPauline Maloy, Primary Care & Public Health Analyst

Background to Child Healthy Weight

• 2008-2011, Health boards required to ensure a number of overweight children completed a weight management programme (Heat target H3).

• Further CHW target for April 2011 – March 2014. 1,556 overweight and obese children (BMI>91st centile) completed a CHW programme in Grampian (≥40% to children in two most deprived local SIMD quintiles)

• NHS boards have taken a range of approaches to achieving their individual targets.

• School-based approach supported by a more targeted programme has been the favoured model of delivery. Specific content varies greatly between boards.

Grow Well Choices (GWC)• GWC NHSG’s school based programme.• Based on NHS A&A’s ‘Jump Start Choices’.• Primary school children (largely P5-P7), whole class

approach. • Piloted September 2011, rolled out across Grampian in

October 2011.• HEAT target ceased in March 2014, but GWC continues to

run.

Delivery

• Run by 3 Community Health Partnerships (CHPs)• All schools invited to take part (N=243)• If accepted, head teacher selected class to participate.• Trained health coaches delivered weekly sessions over 7-8

weeks, each lasting one hour.• Prior to first session (pre-programme), at end of last session

(post-programme) and 6 months later (follow-up), children’s heights and weights were measured. Opt out to measurements.

• Results transcribed into CHSP-S. Information sent to ISD, report returned to health board with computed variables for BMI, BMI percentile, BMI standard deviation score (BMI-SDS)

Session 1 – Being Active and Healthy

Session 2 – Eatwell Plate

Session 3 – Energy Balance

Session 4 – Sugars

Session 5 – Snacks (parents/carers observing)

Session 6 – Fats

Session 7 – Eating Out

Session 8 – Review (optional)

Session 1 – Being Active and Healthy

Session 2 – Eatwell Plate

Session 3 – Energy Balance

Session 4 – Sugars

Session 5 – Snacks (parents/carers observing)

Session 6 – Fats

Session 7 – Eating Out

Session 8 – Review (optional)

Main Components

Week 4 – Sugars and tooth hockey

Data Analysis• Pre and post programme data available from start of

programme until July 2013 (N=5365, 1186 were O/O)• Follow-up data was available from start of GWC until March

2013. However, >50% did not have 6 month measurements taken (N=2057, 439 were O/O)

• At time of analysis, 77% of all schools in Grampian had participated.

• Statistical analysis only performed on pre- and post-programme data.

• Analysis undertaken for whole group and O/O subgroup.• Follow-up data restricted to descriptive presentation. • BMI-SDS used – standardised measure

Results

• Mean age 10 years old. Majority of children from Primary 5 and 6.

• 77.7% of children were of a healthy weight, 0.2% were underweight, 12.8% overweight and 9.2% obese (including severely obese).

Comparison of pre- and post-programme BMI-SDS – Obese and overweight children

Table 2: Paired samples t-test for the population mean difference in BMI-SDS (overweight and obese children)

Multivariate linear regression

• After adjusting for pre-programme BMI-SDS, post-programme BMI-SDS was statistically smaller in:

- Children in SIMD 5 compared to SIMD 1

- Children who started the programme in Spring compared to Autumn.

Compared to whole of Scotland

Table 6: Change in BMI-SDS for overweight and obese children and by gender, pre- and post- programme and follow-up.

What happens to BMI-SDS after CHW programme ceases? 6 month follow-up data

Pre-programme BMI-SDS by difference between follow-up and post programme BMI-SDS

Pre-programme BMI-SDS by difference between follow-up and pre-programme BMI-SDS

Discussion

• Many limitations e.g. No control group• Quadratic like relationship seen• Greater reduction in boys (all children), and in

O/O group• Variation between time of year• Deprivation appears to play a part

What these results add?

• Similar findings to the Scotland wide evaluation.

• Provides information on what happens to BMI-SDS in these children 6 months after the programme has ceased.

• Additional supporting evidence for effectiveness of GWC on BMI-SDS albeit illustrating potential need for a longer programme or more sustainable approach.

• Explores confounding factors.

Does a reduction of BMI-SDS of this size have a considerable impact on health?

Author Reduction in BMI-SDS associated with improvements in body composition and cardiometabolic measures

Ford et al. (2010) ≥0.25

Reinehr et al. (2004) ≥0.5

Kolsgaard et al. (2011) ≥0.0-<0.1

We found a change in BMI-SDS of 0.051 in overweight and obese children. Change in BMI-SDS relatively small, at a population level could have considerable importance if sustained over time.

With thanks to the GWC teams in the 3 CHPs, Dr Fiona Murray (NHSG Public Health Researcher), and Dr Neil Scott (University of Aberdeen

Statistician).

emily.stevenson@nhs.net

References

1. Ford A, Hunt L, Cooper A, Shield J. What reduction in BMI-SDS is required in obese adolescents to improve body composition and cardiometabolic health. Arch Dis Child 2010;95:256-261.

2. Reinehr T, Andler W. Changes in the atherogenic risk factor profile according to degree of weight loss. Arch Dis Child 2004;89:419-22.

3. Kolsgaard M, Joner G, Brunborg C, Anderssen S, Tonstad S, Andersen L. Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo Adiposity Programme Study – a hospital/public health nurse combined treatment. BMC Pediatrics 2011, 11:47.