Preventing child obesity: A long-term evaluation of the HENRY approach

Article · July 2013with39 Reads
Source: PubMed
Abstract
Childhood obesity has reached epidemic levels, yet many health professionals lack confidence in working with parents around lifestyle change. HENRY (Health Exercise Nutrition for the Really Young) aims to tackle this through training practitioners to work more effectively with parents of preschoolers around obesity and lifestyle issues.We evaluated the long-term impact of HENRY training on health professionals' knowledge, skills and confidence in tackling obesity prevention. All practitioners trained 2007-11 (n = 1601) were invited to complete an online survey. 237 emails (14.8%) were undeliverable; 354 (26.0%) of the remainder completed the survey. A majority (67%) reported using knowledge and skills gained on a regular basis in their professional lives. Sessions on the importance of empathy and key parenting skills were considered particularly useful, with 78% and 74% respectively reporting regular use of these skills. Effects on respondents' personal lives were also reported: 61% applied the knowledge and skills at home, identifying for example, more shared family mealtimes and reduced portion sizes. The impact endures, with 71% of those undergoing training > 12 months ago, stating that they continued to use concepts in their professional lives. The findings suggest that brief training can have a sustained impact on practitioners' professional and personal lives.
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Rebecca E Brown MB BS
Academic Clinical Fellow in Paediatrics, Queens
Medical Centre, Nottingham
Thomas A Willis
BSc PhD
Research Fellow, Leeds Institute of Health Sciences,
University of Leeds
Nichola Aspinall
BSc MB BS MRCPCH
Paediatric Speciality Trainee, Leeds Teaching
Hospitals NHS Trust, Leeds
Candida Hunt
Co-founding Director of HENRY, HENRY, Oxford
Jackie George
Programme Manager, HENRY, Oxford
Mary CJ Rudolf
MB BS BSc DCH FRCPCH FAAP
Professor of Child Health, University of Leeds, UK
and Professor of Public Health, Bar Ilan Faculty of
Medicine in the Galilee, Israel
Correspondence: mary.rudolf@mail.biu.ac.il
Abstract
Childhood obesity has reached epidemic levels, yet
many health professionals lack confidence in working
with parents around lifestyle change. HENRY
(Health Exercise Nutrition for the Really Young)
aims to tackle this through training practitioners to
work more effectively with parents of preschoolers
around obesity and lifestyle issues.We evaluated
the long-term impact of HENRY training on health
professionals knowledge, skills and confidence in
tackling obesity prevention. All practitioners trained
2007–11 (n=1601) were invited to complete an
online survey. 237 emails (14.8%) were undeliverable;
354 (26.0%) of the remainder completed the survey.
A majority (67%) reported using knowledge and
skills gained on a regular basis in their professional
lives. Sessions on the importance of empathy and
key parenting skills were considered particularly
useful, with 78% and 74% respectively reporting
regular use of these skills. Effects on respondents
personal lives were also reported: 61% applied
the knowledge and skills at home, identifying for
example, more shared family mealtimes and reduced
portion sizes. The impact endures, with 71% of those
undergoing training >12 months ago, stating that
they continued to use concepts in their professional
lives. The findings suggest that brief training
can have a sustained impact on practitioners
professional and personal lives.
Key words
Childhood obesity; lifestyle change; obesity
prevention; professional skills; professional training
Community Practitioner, 2013; 86(7): 23–27.
No conflict of interest declared
Preventing child obesity: a long-term
evaluation of the HENRY approach
Introduction
Childhood obesity is one of the most serious
public health challenges facing the 21st
century. The rate of obesity among children
in Britain is one of the worst in Europe, with
one in four children aged four to five years
being overweight or obese (National Child
Measurement Programme (NCMP), 2011).
Obese children are likely to remain obese
into adulthood (Baird et al, 2005; Venn et al,
2007) and are at increased risk of conditions
including type 2 diabetes, hypertension and
atherosclerosis (Juonala et al, 2011). Childhood
obesity places a huge financial burden on
healthcare systems even during primary school
(Au, 2012).
Programmes tackling obesity prevention may
be best targeted at pre-school children before
excess weight gain and unhealthy behaviours
are established (Edmunds, 2005; Skouteris et al,
2011). However, healthcare professionals have
reported a lack of confidence in addressing
lifestyle and weight issues with parents (Redsell
et al, 2011; Story et al, 2002) and efforts to
do so have been reported to be dismissive or
judgemental (Edmunds, 2005). Recent reviews
have highlighted the paucity of preventive
programmes targeting pre-school children
(Bond et al, 2009; Campbell and Hesketh,
2007). None have analysed the perspective
of the healthcare provider delivering the
intervention, nor undergone an evaluation of
their impact beyond the first two years.
HENRY (Health Exercise and Nutrition for
the Really Young) core training is a two-day
course, which aims to enhance skills and help
community and health professionals become
more effective, sensitive and confident when
working with parents of very young children
around lifestyle change and obesity prevention
(see Box 1) (Rudolf et al, 2010). Other obesity
prevention interventions tend to target specific
causative factors of childhood obesity, eg,
physical activity (Reilly et al, 2006), parenting
skills (Harvey-Berino and Rourke, 2003) or
television viewing (Dennison et al, 2004).
HENRY, in contrast, has a multi-faceted
approach that aims to provide practitioners
with a toolbox of skills to enable more effective
interaction with parents of pre-school children
in any contact setting.
Childhood obesity rates are highest in
lower socioeconomic groups (Townsend et al,
2012) and HENRY has focused on Sure Start
childrens centres, which are, typically, situated
in deprived areas. Initial evaluation suggests
that health professionals report enhanced
confidence following training (Rudolf et al,
2010). Interestingly, several also described
steps they had taken to improve their personal
lifestyle – an important finding as 60% of local
authority and NHS employees are reported
to have an unhealthy weight (Department
of Health (DH), 2009). This personal
experience of lifestyle change may enhance
their effectiveness with parents (Perrin et al,
2005). Qualitative research confirmed that
community and health professionals had made
changes to both their personal and professional
lives in the months following training (Willis
et al, 2012).
While initial evidence is promising it is
necessary to ascertain whether any effects
upon health professionals’ knowledge, skills
and confidence endure in the longer term.
We aimed to assess this through use of an
online survey sent to all health professionals
undergoing HENRY training since 2007.
Methods
Sample
Participants were course attendees who had
given consent to be contacted for follow-up
at the time of training and had provided their
email addresses.
Procedure
An online questionnaire was sent to all
health professionals completing HENRY
core training between 2007 and 2011. It was
based on that used on completion of training
courses (Rudolf et al, 2010); questions aimed
to capture the impact of HENRY core training
on professional practice. The questionnaire
was piloted on 25 HENRY course leaders,
who provided feedback and suggested slight
modifications. Participants were asked to
provide details of occupation, where and when
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training took place and examples of how the
HENRY approach had influenced clients and
practitioners’ own lives. Five-point Likert scales
were provided to record health professionals
change in confidence in discussing lifestyle
and weight issues with parents (1: very little
5: significantly improved; 3 corresponded
to an improvement) and the extent to which
knowledge and skills gained on the course
had been used (1: never 5: all the time). A
covering email explained the purpose of the
questionnaire with a hyperlink to the survey. A
reminder email was sent two weeks later. Best
practice guidelines were followed regarding
the sending of mass emails (Koenig and
Herrick, 2003). Advice was sought, confirming
that formal ethics approval was not needed
as the information was collected for service
evaluation purposes.
Data analysis
When analysing quantitative responses the
sample was split into two groups: short term
(those completing HENRY core training
within the previous 12 months) and long term
(those who attended >12 months ago). The
five-point scale items were dichotomised, such
that responses of ‘Never/Occasionally’ were
grouped to indicate limited use of training,
while ‘Regularly/Often/All the time’ were
combined to indicate regular use of training.
Data were compared between the two groups
with the use of Chi-squared tests using 2x2
contingency tables. Statistical difference was
set at the 5% level of probability. Quantitative
data analyses were performed with use of IBM
SPSS Statistics 19.0. No data were available on
non-responders.
Responses to open-ended questions were
examined inductively by constructing thematic
categories. A framework analysis approach
(Ritchie and Lewis, 2003) was adopted, which
has been successfully applied elsewhere (eg,
Staniford et al, 2011). This approach allows
incorporation of themes established a priori
while still permitting the emergence of de novo
concepts. Familiarisation with data from open-
response questions was achieved by repeated
rereading. Key concepts expressed in the data
led to the creation of thematic categories; while
the HENRY content areas (see Box 1) were
considered as themes at this stage, new concepts
were also detected and categorised. Coding was
performed using the NVivo9 software package
(QSR International, Melbourne, Australia). All
coding was completed by one author (RB) and
reviewed independently by a second author.
As new concepts emerged these were grouped
into themes, and where there was a difference
of opinion the data was re-examined and a
consensus decision was reached. Data were
then placed in charts consisting of headings
and sub-headings derived from the thematic
framework (see Table 1).
Results
Emails were sent to 1,601 individuals; 237
were returned undeliverable and 362 of the
remaining 1,364 completed the survey. Eight
responses were excluded due to missing data,
resulting in 354 participants included in the
analysis (response rate 26.0%). Numbers were
evenly split between short-term (i.e. trained
within the last 12 months, n=173, 48.9%) and
long-term (trained >12 months ago, n=181,
51.1%). Respondents were widely distributed
in terms of their course location (Figure 1).
A broad range of community and health
professionals were represented: nursery nurses
(14.5%), childrens centre workers (13.4%)
and health visitors (12.6%) were among the
largest groups, reflecting the proportions of
professionals attending HENRY core training.
The remainder (59.5%) comprised other health
professionals, social workers and childrens
centre staff.
Impact upon professional practice
Confidence
The majority of respondents reported
increased confidence in working with families
around lifestyle and weight issues, indicated by
a score of three or more on the five-point scale.
Overall, 85.0% (147/173) in the short-term
and 90.1% (163/181) in the long-term groups
reported improved confidence (Figure 2). A
Chi-square test indicated no difference in the
responses of the two groups.
Knowledge and skills
Substantial proportions of respondents
reported that they continued to use knowledge
and skills gained in their professional practice.
Overall, 64.0% of the short-term group used
The HENRY approach
Three facets underpin the HENRY approach (for more detail see Hunt and Rudolf, 2008):
Family partnership approach
Solution-focused brief therapy
Reflective practice
Course content
The training focuses on five key areas:
Parenting skills
Healthy eating behaviours
Healthy nutrition
Physical activity
Emotional wellbeing
Box 1. HENRY – Health Exercise Nutrition for the Really Young
Table 1. Thematic framework displaying key themes and sub-themes
Parenting skills
Communication styles
with children
– Guided choice
– Authoritative style
Healthy eating behaviour
– Eating as a family
– Reduced television time
– Feeding cues
– Mealtime routines
Themes established a priori De novo themes
Healthy nutrition
– Healthy choices
– Healthy snacks
– Portion sizes
– Weight loss
Physical activity
– Family focused
– Parents from groups
– Incorporate into routine
Emotional wellbeing
– Time to relax
– Impact on child’s wellbeing
Parental empowerment
– Independence
– Peer support
Modelling a healthy lifestyle
Advocate to family and
friends
– Work–life balance
New service development
– Delivery of existing courses
– New courses
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the new knowledge and skills regularly, often
or all the time. In the long-term group, this
figure was 70.6%. The two groups did not
significantly differ in the distribution of
their responses.
When asked about the frequency with
which they used key elements of HENRY, the
components reported used most frequently
were the value of empathy (78.1%), key
parenting skills (73.7%) and healthy nutrition
(72.2%). Response frequencies differed
between groups on the use of key parenting
skills (r
(1;n=353)=6.67; p=.011), healthy
nutrition (r
(1; n=353)=7.16; p=.009) and
physical activity (r
(1; n=352)=4.31; p=.041).
In each case those in the long-term group
reported using these components more
frequently than those in the short-term group.
Impact upon personal life
An impact of the course upon respondents’
personal lives was observed: 57.5% of the short-
term group, and 63.9% of the long-term group
reported that they used the knowledge and
skills gained regularly, often or all the time. The
specific components of the training that were
used most frequently in their personal lives
were healthy nutrition (71.3%), eating patterns
(69.9%) and physical activity (68.2%). Chi-
square tests revealed a significant difference
in the responses to working in partnership
(r
(1; n=347)=8.22; p=.005), and a marginal
significant difference on key parenting skills
(r
(1; n=340)=4.11; p=.05). In both instances,
those in the long-term group reported using
these components more frequently than those
in the short-term group.
Qualitative results
Data are presented in themes, beginning with
the five HENRY content areas and followed
by new themes identified through analysis.
Participants described the impact of training
in terms of their professional and personal
lives. In addition, several provided examples
of the influence of their work upon their client
families, as illustrated in italics.
Parenting skills
Changes to parenting styles and the effect on
behaviour were noted by several respondents
as examples of the impact on client families.
Increased quality and duration of family
time was most notable, alongside control of
behaviour through guided choice (a parenting
technique recommended as part of the HENRY
approach) and the setting and enforcement of
clear limits.
‘Managing childrens behaviour in a positive way
through offering choices and setting clear limits.
‘Spend more time doing a family activity
at weekends.
Healthy eating patterns
Maintenance of healthy eating patterns are
a key component of the HENRY approach.
Many participants highlighted how important
this was in encouraging a more relaxed,
family-centred approach to mealtimes. Other
key factors that emerged included reducing
television time, seated mealtimes, and
awareness of hunger and fullness cues.
‘One family ate in front of the TV every night -
since completing the HENRY course they all sit at
the table and have quality family time.
‘Tuning into mealtimes has made mealtimes
less stressful.
Healthy nutrition
Healthy nutrition was acknowledged by many
respondents as having a notable impact on
clients and families. Particular reference was
made to portion size and the demonstrative
resources provided on the course, and replacing
snack choice with healthier alternatives.
‘We appear to see less sweets and crisps being
eaten in our playroom.
‘Many of the parents that I consult with find the
healthy plate and especially the portion size chart
very useful.
Physical activity
Increased physical activity was noted by many
respondents in both professional and personal
responses. A wide range of activities were
mentioned, from walking and more time in
the park, to more purposeful fitness activities
such as swimming or dancing. Commonly
mentioned was an increase in the amount and
regularity of exercise and partaking in such
activities as a family.
‘[Families have] added more walking to school,
nursery and the park into their routine.
‘[The group] meets up regularly to attend
exercise groups or park trips.
All the family are doing something fitness-based
recreationally.
‘[I] am engaging in a running programme from
very little exercise.
Emotional wellbeing
Many respondents clearly recognised the
importance of reflecting on the information
concerning emotional wellbeing provided
during HENRY core training. For some,
this took the form of a softer approach and
for others highlighted the need to have a
more balanced relationship, taking time for
themselves which would allow them to give
more in return.
Another mum realised the importance of having
time for herself to recharge her batteries.
‘Helped me to reflect and not be too hard
on myself.
‘Some families have recognised the direct impact
of their emotional health on their childrens
wellbeing.
New themes relating to clients
and families
Parental empowerment
Several respondents reported that clients and
parents had increased confidence and self-
esteem as a result of attending the eight-week
HENRY parenting course. In some cases this
was transmitted beyond course attendees to
their family and friends, illustrating how parents
Figure 1. Location of HENRY core
training courses
Number of
respondents
31 or more
21 to 30
11 to 20
1 to 10
None
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PROFESSIONAL AND RESEARCH: PEER REVIEWED
became advocates for a healthier lifestyle.
Shared group sessions were notable for
the amount of interaction between parents,
allowing them to see that others faced similar
issues. This allowed parents to reach positive
conclusions through mutual discovery and
facilitated guidance rather than a more
traditional teaching approach. In some cases
this extended to forming peer networks
ensuring continued mutual support after the
course ended.
‘It has helped me to empower parents to help
themselves more rather than being “too guided”
by professionals.
‘It is great to see families building relationships
with each other.
New themes relating to healthcare
professionals
New service development
Following HENRY training many participants
reported having altered their approach in the
service they provided. This included having
a greater awareness of how to engage with
clients and making use of alternative methods
of delivery and communication. New
services introduced following training were
focused on healthy nutrition and targeted
recognising infant feeding cues, portion sizes
and identifying healthy alternatives. They
included cookery and smoothie-making
courses, modifications to existing postnatal
courses, and weaning courses to focus on
infant feeding cues and appropriate portion
sizes.
‘Parents enjoy smoothie-making sessions that
we like to run in school holidays for all the
family to have a go.
‘I have created a “Healthy Lunchbox” course,
aimed at a school with no working kitchen, so
young people have to have lunchboxes. Some of
the HENRY philosophy is evident in the course.
Modelling a healthy lifestyle
Many respondents made reference to
themselves becoming role models for their
clients. They reported involving their whole
family in lifestyle changes, offering their
children healthier snacks, reducing portion
sizes and increasing family physical activity.
They noted that they were educating friends
and family. Many also commented about their
increased credibility in advocating for families
because of their first-hand appreciation of the
challenges in tackling lifestyle change.
‘I have made small changes, which have been
achievable and this has helped me to encourage
families to make small steps too.
‘It defeats the objective if I do not present myself
as a healthy looking individual to parents
already struggling to set good eating habits.
‘Has motivated me to ensure that my family do
a regular physical activity together at weekends.
Discussion
HENRY aims to prevent childhood obesity
through equipping practitioners with a
toolbox of skills necessary to discuss the often
difficult topics of lifestyle and weight issues.
Initial evaluation suggested the approach
was highly valued and produced an increase
in practitioners confidence levels (Rudolf et
al, 2010). The present work suggests that this
impact is sustained in the long term. Health
professionals continued to use the knowledge
and skills gained during their training on a
regular basis. Neither the course nor its delivery
have changed over time; yet, significantly, more
respondents using some of the knowledge and
skills on a regular basis had trained more than
12 months previously. A potential explanation
is that time is needed for skills to be fully
embedded into practice.
Encouragingly, consistent with previous
evaluation work (Willis et al, 2012), health
professionals reported increased confidence
in discussing lifestyle and weight issues with
parents, attributing this to their HENRY
training. Health professionals have reported
a lack of confidence in recognising and
addressing lifestyle and weight issues (Redsell
et al, 2011; Story et al, 2002) so these findings
are of particular importance. A substantial
proportion of the sample (88%) reported that
the training had heightened their confidence in
this area. Numbers were equally high in both
the short- and long-term groups, suggesting
that the impact of training upon professional
confidence is enduring.
The most pertinent aspects from the
HENRY core training used in respondents’
professional practice comprised the more
emotional elements (the value of empathy
and parenting skills) areas not traditionally
considered part of obesity prevention training.
This is particularly relevant in light of evidence
that parents often find professionals to be
judgemental and dismissive (Edmunds, 2005);
parenting skills are key to changing a family’s
lifestyle behaviours (Rudolf, 2009).
Our findings suggest that the HENRY
approach truly addresses practitioners needs,
and it was particularly rewarding to see
the additional impact upon staff members
personal lives. The aspects of the course that
had greatest influence in this area included
healthy nutrition, eating patterns and physical
activity. As 60% of local authority and NHS
employees are reported to be an unhealthy
weight (DH, 2009), this is important,
especially as our qualitative data suggests that
1 2 3 4 5
Percentage of respondents
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Confidence (1=very little to 5=significantly improved)
Figure 2. Impact of HENRY Core Training (within/outside last 12 months) upon respondents’
confidence in discussing lifestyle and weight issues with parents
Less
than 12
months
(%)
More
than 12
months
(%)
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respondents felt that the changes they made
helped increase their credibility as advocates.
Parental empowerment and acting as role
models to their peer group was another strong
theme to emerge, another important feature
for a successful obesity prevention programme
(Bond et al, 2009).
Of particular note in the qualitative analysis
was the emergence of de novo themes, which
were amalgamations of the existing five
HENRY elements and their underlying facets,
bringing additional benefits not designed into
the original course. For example, the family
partnership approach and ongoing reflective
practice in conjunction with the key HENRY
area of parenting skills gave rise to parental
empowerment. In turn, the five HENRY areas
along with parental empowerment are likely to
have led to modelling a healthy lifestyle. Finally,
practitioners, by participating in the HENRY
programme, picked up on the three underlying
facets, particularly solution-focused and family
partnership approaches, and have proceeded to
use these to enhance existing services or create
new services related to the HENRY key areas.
This cascade of benefits that extend beyond the
primary outcome of the training merits further
study to be fully understood.
Limitations
The evaluation has certain limitations. Our data
are drawn from responses to an online survey,
which inevitably relies on self report. This
method was chosen to reach a large number
of participants at distant locations. However,
a high proportion of email addresses were
invalid or likely to have been inactive, possibly
due to the high turnover of staff in childrens
centres and other primary care settings. The
response rate of 26%, although modest, is
sizeable considering the length of time that
had elapsed between training and the survey
for many participants this had been a number
of years. Another important consideration is
responder bias. It is possible, if not probable,
that health and community professionals who
completed our survey had a greater interest in
the subject of childhood obesity and the work
of HENRY than the non-responders.
Conclusion
Health and community professionals reported
an increase in confidence and continued to use
knowledge and skills gained some years after
they completed HENRY core training. They
described implementing changes in both their
professional and personal lives, with tangible
The literature shows that health professionals lack confidence when working with
parents around lifestyle change
HENRY offers a new approach to working with parents of infants and pre-schoolers to
prevent obesity
Practitioners completing an online survey up to four years after HENRY training
reported increased self efficacy and ongoing use of knowledge and skills learned
Empathy and parenting skills were topics that were considered particularly useful
The impact of the training appears to endure in practitioners’ professional work and in
their personal lives
Key points
outcomes on families with whom they worked.
It is hoped that this will contribute towards the
achievement of the ultimate aim of the HENRY
programme to have a measurable impact on
childrens obesity levels.
Acknowledgement
The authors wish to thank Bridgette Bewick
and Alexandra Gilbert.
References
Au N. (2012) The health care cost implications of
overweight and obesity during childhood. Health Serv
Res 47(2): 655–76.
Baird J, Fisher D, Lucas P, Kleijnen J, Roberts H, Law
C. (2005) Being big or growing fast: systematic review
of size and growth in infancy and later obesity. BMJ
331(7522): 929.
Bond M, Wyatt K, Lloyd J, Welch K, Taylor R. (2009)
Systematic review of the effectiveness and cost-
effectiveness of weight management schemes for the
under fives: a short report. Health Technol Assess 13(61):
1–75.
Campbell KJ, Hesketh KD. (2007) Strategies which aim
to positively impact on weight, physical activity, diet
and sedentary behaviours in children from zero to five
years. A systematic review of the literature. Obes Rev
8(4): 327–8.
Dennison BA, Russo TJ, Burdick PA, Jenkins PL.
(2004) An intervention to reduce television viewing by
preschool children. Arch Pediatr Adolesc Med 158(2):
170–6.
Department of Health (DH). (2009) Healthy Weight,
Healthy Lives: One Year On. London: DH.
Edmunds LD. (2005) Parents’ perceptions of health
professionals responses when seeking help for their
overweight children. Family Pract 22(3): 287–92.
Harvey-Berino J, Rourke J. (2003) Obesity prevention
in preschool native-american children: a pilot study
using home visiting. Obes Res 11(5): 606–11.
Hunt C, Rudolf M. (2008) Tackling child obesity
with HENRY: A handbook for community and health
practitioners. London: CPHVA.
Juonala M, Magnussen CG, Berenson GS et al.
(2011) Childhood adiposity, adult adiposity, and
cardiovascular risk factors. New Engl J Med 365(20):
1876–85.
Koenig S, Herrick M. (2003) Bounce handling process,
email delivery rejection, and receiving system policies.
Email deliverability summit II. San Francisco, CA:
Institute for Social Internet Public Policy.
National Child Measurement Programme (NCMP).
(2011) National Child Measurement Programme
(2009/10 school year). Available from: www.http://
www.ic.nhs.uk/statistics-and-data-collections/health-
and-lifestyles/obesity/national-child-measurement-
programme-england-2009-10-school-year [Accessed
May 2012].
Perrin EM, Flower KB, Ammerman AS. (2005)
Pediatricians’ own weight: self-perception,
misclassification, and ease of counseling. Obes Res
13(2): 326–32.
Redsell SA, Atkinson PJ, Nathan D, Siriwardena AN,
Swift JA, Glazebrook C. (2011) Preventing childhood
obesity during infancy in UK primary care: a mixed-
methods study of HCPs’ knowledge, beliefs and
practice. BMC Family Pract 12: 54.
Reilly JJ, Kelly L, Montgomery C et al. (2006) Physical
activity to prevent obesity in young children: cluster
randomised controlled trial. BMJ 333(7577): 1041.
Ritchie J, Lewis J. (2003) Qualitative Research Practice:
A Guide for Social Science Students and Researchers.
London: Sage Publications Ltd.
Rudolf M. (2009) Tackling obesity through the Healthy
Child Programme: A framework for action. Available
from: www.noo.org.uk/mary_rudolf [Accessed June
2012].
Rudolf MCJ, Hunt C, George J, Hajibagheri K, Blair
M. (2010) HENRY: development, pilot and long term
evaluation of a programme to help practitioners work
more effectively with parents to prevent childhood
obesity. Child Care Health Dev 36(6): 850–7.
Skouteris H, McCabe M, Swinburn B, Newgreen V,
Sacher P, Chadwick P. (2011) Parental influence and
obesity prevention in pre-schoolers: a systematic review
of interventions. Obes Rev 12(5): 315–28.
Staniford LJ, Breckon JD, Copeland RJ, Hutchison
A. (2011) Key stakeholders’ perspectives towards
childhood obesity treatment: a qualitative study. J Child
Health Care 15(3): 230–44.
Story MT, Neumark-Stzainer DR, Sherwood NE et al
(2002) Management of child and adolescent obesity:
attitudes, barriers, skills, and training needs among
health care professionals. Pediatrics 110(1 Pt 2): 210–4.
Townsend N, Rutter H, Foster C. (2012) Age differences
in the association of childhood obesity with area-level
and school-level deprivation: cross-classified multilevel
analysis of cross-sectional data. Int J Obes 36(1): 45–52.
Venn AJ, Thomson RJ, Schmidt MD, Cleland VJ, Curry
BA, Gennat HC, Dwyer T. (2007) Overweight and
obesity from childhood to adulthood: a follow-up of
participants in the 1985 Australian Schools Health and
Fitness Survey. Med J Aust 186(9): 458–60.
Willis TA, Potrata B, Hunt C, Rudolf MCJ. (2012)
Training community practitioners to work more
effectively with parents to prevent childhood obesity:
the impact of HENRY upon Childrens Centres and
their staff. J Hum Nutr Diet 25(5): 460–8.
PROFESSIONAL AND RESEARCH: PEER REVIEWED
    • The Simple Feeding Elements Scale (SFES; Mohebati, in preparation) was developed from the Health Exercise and Nutrition for the Really Young (HENRY) programme, an intervention aimed at preventing obesity within the first few months of an infant's life (Brown et al., 2013; Rudolf et al., 2010). The scale was also used as part of the EMPOWER clinical trial (http://www.ncbi.nlm.nih.gov/pubmed/
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  • [Show abstract] [Hide abstract] ABSTRACT: Aim. The aim of this study was to analyse ordinary and additional physical activity in preschool children from Piła and to investigate their favourite ways of spending leisure time. Material and methods. Parents of 165 preschoolers from Piła filled in questionnaires on general information about their children and their families, the children's ordinary and additional physical activity, and their favourite ways of spending leisure time. Statistical analysis was performed by the IBM SPSS Statistics 21 computer programme. The studied population was divided according to gender. Results. Gender had statistically significant influence on parents' answers to the questions about familial osteoporosis and about their opinion on their children's body weight, as well as the percentages of children who preferred playing with a ball and rollerblading/roller skating during sunny weather and drawing/painting, playing with building blocks, playing computer games, playing with dolls and playing with toy cars during rainy weather. Conclusions. In comparison to the previously studied preschool children from other regions of Poland, the studied preschoolers from Piła were characterised by reduced ordinary and additional physical activity. To reverse these unfavourable changes, it is necessary to educate preschoolers' parents, preschool staff and local authorities about the possibilities of increasing the children's physical activity and reducing their time spent in a passive way. Children, irrespective of gender, should be encouraged to various kinds of physical activity.
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  • Article · Feb 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose – The purpose of this paper is to review the evidence base for effective public health interventions which aim to improve the diet of children aged zero to three years. Design/methodology/approach – General review. Findings – Key approaches and components of effective interventions include: repeated tasting, parental modelling, use of rewards, moderate restriction of “unhealthy” foods alongside an increase in portion sizes of fruits and vegetables, culturally appropriate messages, culturally acceptable health care provider, sufficient intensity of intervention, and an intervention which targets parental self-efficacy and modelling. Interventions which provide home visits (rather than require visits to a GP surgery or local community centre) financial incentives and/or mobile phone reminders may increase retention, particularly for some individuals. Recruiting mothers into programmes whilst they are pregnant may improve recruitment and retention rates. Originality/value – Allows for key public health interventions, approaches and components to be explored and identified. This will ensure that there is guidance to inform the development of new interventions for this age group and more importantly recommend that those components which are most successful be incorporated in policy and practice.
    Full-text · Article · Jun 2014
  • Article · Dec 2015
  • [Show abstract] [Hide abstract] ABSTRACT: This paper explores the social context of food practices in primary schools in England based on research conducted in 2013–2014 as part of the Sheffield School Food Project. Drawing on the capability approach, and social quality theory, the theoretical framework informed a research methodology enabling exploration of ways in which food practices are related to developing pupil well-being and building school communities. It was found that complex social processes influence the roles of food in primary schools in England. These processes enhance and diminish the likelihood of pupils consuming balanced meals, drinks and snacks across the school day. Moreover it was found that, in addition to nutritional outcomes, food practices are related to wider aspects of individual well-being and the social culture of schools. A key outcome of the research was the development of the School Food Self-Evaluation Toolbox (SET). The School Food SET and related resources aim to empower children and their school communities by providing a set of tools to support the self-evaluation and development of food practices in schools.
    Article · Mar 2016
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