PoHeFa – Communication around healthy weight, overweight and obesity Fiona Dickens Public Health Manager NHS Swindon

What is PoHeFa? ‘Policy, Health and Family Learning’ European partnership including NHS Swindon and NHS Somerset in the UK Can compare approaches across different countries Aims to improve the quality, effectiveness and sustainability of health promotion interventions Includes looking at how information is communicated and received between health professionals, families and young people

What we did Focus groups in Swindon and Somerset Young people, families and health professionals Transcribed and analysed Key themes identified Recommendations to feed into training and future work

Links to health literacy …the capacity to access, understand and use health information effectively to make appropriate health decisions How do families and young people communicate with health professionals about weight and obesity? Are the current communication methods right for different target groups? How well are messages received? Are people receptive to information? What do people want and need to know to enable them to make informed choices about their weight via lifestyle and eating choices? Access Understand Use

Literature Review Barriers to communicating for health professionals Lack of time Lack of access to / confidence in guidelines Lack of motivation to work with obese patients Lack of training / evidence Lack of belief that people are motivated to change behaviour Potentially conflicting messages from other sources Concern over insulting / offending patients But … Strong communication is known to help effective translation of health promotion messages

What we found (1) Overweight as a ‘social norm’ and lack of awareness regarding the appropriate weights for infants and children at different stages “But if you look at their social networks, they’ll be full of people who are overweight and obese, so they can, they’re part of normal, there’s an impression of normality to it.” “..when we say our children are not overweight, what we mean is, that they are not different to anyone else’s children but the norm has become slightly overweight and the same with adults” The role and responsibility of the GP/ health practitioner in informing and challenging patients about their weight “...it’s also supporting them through it, not being judgemental, not saying ‘don’t do this’,‘don’t do that’, just saying ‘well I would just limit that, or encourage this’, or ‘why don’t you try this’”

What we found (2) The difficulties of communicating with people about their weight without it being perceived as an insult. This links to the issue of whether being overweight and / or obese is a medical or lifestyle problem. The influence of different family generations and their perceptions of food and the challenges in breaking the cycle for children from overweight families Concern over the helpfulness and approach of the National Child Measurement Programme “But the interesting thing is that the parents of children who are really obese never, never ring; it’s always the parents who’ve just gone over by a couple of pounds and they are awful. The phone calls are awful, they eff-and-blind, they are vile.”

What we found (3) The complexity of tackling obesity in children when they are influenced by parents / school / health professionals / media – potentially all providing different messages. “There’s loads of things saying what you should eat and what you shouldn’t it.. it puts people off - you’re being told to eat that and not eat that” For young people the importance of television programmes for information and in shaping perceptions. Key to making change is to focus on self-esteem and building confidence so people feel empowered to make positive choices around healthy lifestyles “I think unless you ask for help, or go looking for help, you don’t get it. You go to your doctor’s and they basically say, go to a dietician or do this or just bung you a leaflet without much information.”

What we found (4) Gaps in information between the ages of 2 and starting school Recognition for young people of the impact on mental health that being over or underweight can have “...I know some people who are quite big, they do get bullied and they started self-harming, and then it causes all different problems and it doesn’t always end up the best.” Barriers to children being active such as concern about safety and children being at risk on the streets / in parks compared to a more sedentary at home using computer games.

What we found (5) In Somerset … there was more focus on portion sizes, the lack of knowledge/skills around cooking, and for mothers, on milk volumes for babies “It would be handy for them to say that a portion size is this, whatever. I have never had any of that” In Swindon, discussion often focused on social issues such as cost, transport, family set up and working life there was more detailed discussion around whether obesity was a clinical or social issue and the impact of this on communication people wanted more than leaflets and booklets to provide a more active level of support “But when I’ve got 3 children and you can proper budget, you can’t go and spend £20 a week on fresh fruit and vet. It’s cheaper to buy nuggets, pizzas, frozen chips and all that than it is to buy healthy stuff.”

Recommendations (1) Training for professionals to consider Weight as a contentious issue and managing conflict Understanding barriers, beliefs and motivators Types of information needed e.g. portion sizes, cookery skills Routes of communications Where – e.g. via children centres, schools How – e.g. facebook, twitter Interplay of school, media, home influences

Recommendations (2) Strengthening information provision for older children Positively encouraging messages across generations Greater consistency of messages by medical community Ensuring interventions reach those most in need Addressing cost, transport and safety as barriers to a more active lifestyle Information on low cost alternatives to food as a treat or reward Focus on what can be done to stay healthy rather than what can’t