The Obesity Health Alliance is hosting a series of expert blogs in support of the launch of their Local Government Position Statement. Fifth, we hear from Nicola Calder RNutr., Food Active Programme Lead, Health Equalities Group, on the need for well supported and delivered, consistent, population-wide child measurement:
The National Child Measurement Programme (NCMP) measures the height and weight of children in Reception class (aged 4 to 5 yrs) and year 6 (aged 10 to 11yrs), to understand the prevalence of overweight and obesity in primary school aged children in England. NCMP is a nationally mandated public health programme, with the Office for Health Improvement and Disparities providing strategic leadership and support whilst local authorities are responsible for conducting and collating measurement data (mandated) and providing feedback to parents and carers on their child’s result (non-mandated).
The NCMP was originally established as a national surveillance programme and plays a key role in making the case for government intervention on childhood obesity. NCMP is also a useful source of data that can be used to consider delivery of local interventions, and services, targeting particular areas that may be experiencing higher levels of obesity in childhood.
Historically the NCMP has also been considered as a useful mechanism to engage with families in providing help and support to promote healthier weight. However, both the literature and anecdotal evidence suggest that the current approach to feeding back NCMP data to parents/carers via a letter, may cause panic, distress, worry as well as anger and annoyance[1], in addition to compounding the effects of weight stigma. This may go some way to understanding why the uptake of local service provision is low[2]. Some may argue that the NCMP may therefore be counterproductive in proactively engaging families to consider opportunities to take part in local activities and programmes to promote well-being.
In recent years, Food Active’s North West local authority network* has identified the NCMP as a priority, requesting more information and knowledge exchange in delivering the programme, specifically providing feedback and communicating with families to effectively onward refer into weight management support where appropriate.
As a result, in Spring 2023, Food Active hosted a workshop to share learning and best practice relating to the NCMP process. This also provided an opportunity to consider the barriers and challenges to engaging families in wider support where feedback identified children of a higher weight. Guest speakers included Professor Fiona Gillison, Professor of Health Psychology (University of Bath) and Alison Gahagan, NCMP Programme Manager (OHID), a number of local authorities also presented examples of good practice. Following on the from the workshop, a dedicated hub was launched to host case studies from within the North West network to share a range of approaches.
An element of best practice shared included consultation facilitated with local parents to gather feedback and ideas for improving and /or co-producing letters and approaches to engaging families to help to mediate some of the negative implications, such as:
- Amending the language within the letter to focus on the benefits to children’s overall health and wellbeing, taking the emphasis away from a child’s weight
- Removing the BMI score, alternatively providing height and weight measurements only and a link to the NHS BMI calculator
- Signposting information to local health and wellbeing services and support provided to all families; not solely those who have a score outside of the healthy weight range. This has been used as an opportunity to share information on a wide range of holistic services and wrap-around support available in local areas.
- Direct follow-up telephone calls made by the local school health team to families where a child has been identified as very overweight. This allows for a supportive conversation with families addressing any health and wellbeing concerns and to make referrals into local services. Team members involved in making phone calls are provided with additional training and support to ensure these conversations are conducted in a supportive and engaging way.
- Reducing the length of letters to make them easier to understand for parents, including QR codes to access websites where further support can be accessed if required.
Local authorities have reported a reduction in complaints from parents through amending the feedback process. Whilst engagement and consultation with parents on the NCMP has been a challenge, this is vital in preventing parents and carers from disengaging and recognising that each local authority may require a different approach to meet the needs of their local populations.
In summary, since its inception the NCMP has provided an incredibly useful national data set to monitor trends in the prevalence of overweight and obesity and to consider the development of appropriate policy and targeted interventions to promote healthier weight in children. As more local authority areas review mechanisms to engage children and families and consider compassionate, trauma informed approaches, we need to strike a balance between recognising the importance of the mandated elements of the NCMP and how to effectively communicate with families to build empathy, empowerment and increase access to appropriate local support.
Author biog: Nicola Calder RNutr., Food Active Programme Lead, Health Equalities Group
Nicola lead’s the Food Active Programme at Health Equalities Group, coordinating the programme across the North West, whilst delivering a range of projects, such as Food Active’s ‘Why Weight to Talk’ training and supporting implementation of Food Active’s Healthy Weight Declaration.
*Food Active is a programme of work advocating for local, regional and national action to promote healthier weight and reduce health inequalities, delivered by the Health Equalities Group (registered charity number: 1110067). The programme is commissioned by 20 local authorities across the North West on an annual basis, who help to shape the key themes, outputs and activities that sit under the programme’s core objectives:
- Influence policy to promote healthier weight at local and national level.
- Develop tools, campaigns, and training opportunities to promote healthier weight, including balanced diet and physically active lifestyles, to populations who suffer the greatest level of health inequalities.
- Undertake research and develop strategic partnerships to lobby and advocate on issues pertaining to healthier weight and the impact of both the food and built environment.
Find out more about Food Active’s work, follow, listen and subscribe here: https://linktr.ee/food_active
[1] Nnyanzi LA. Combating childhood obesity: Reactions of children aged 10-11 years towards the National Child Measurement Programme. J Child Health Care. 2016 Dec;20(4):464-472. doi: 10.1177/1367493515604493. Epub 2016 Jul 25. PMID: 26447217
[2] Sallis A, Porter L, Tan K, Howard R, Brown L, Jones A, Ells L, Adamson A, Taylor R, Vlaev I. Improving child weight management uptake through enhanced national child measurement programme parental feedback letters: A randomised controlled trial. Preventive medicine. 2019; 121:128-135.
Photo Credit: World Obesity Forum