1. Tackling Childhood Obesity Together (TCOT)
A Whole-System Approach
Eva Hrobonova, Deputy Director of Public Health

2. In this presentation we will
Tackling Childhood Obesity Together (TCOT)
In this presentation we will
Describe briefly the design and implementation of a sustainable whole area-based system approach to
prevent overweight and obesity in children,
making healthy choices easier,
achieving a culture and behaviour change.
2. Share our experiences and achievements resulting from this approach across the three boroughs so far.

3. Tackling Childhood Obesity Together (TCOT)

4. Tackling childhood obesity programs - effective elements
Tackling Childhood Obesity Together (TCOT)
Tackling childhood obesity programs -  effective elements 
Visible and vocal political leadership
A vision shared by all parties
These things have been in place in successful child obesity programmes in Europe, Australia and the USA:
Commitment from senior leaders and influential figures, with regular engagement
Priorities which are clear, shared, and ambitious. These should stimulate debate

5. EDUCATION AND LEARNING
Tackling Childhood Obesity Together (TCOT)
Our vision
Children and families tell us that being active and eating well can be hard because:
They are worried about traffic, pollution and safety on roads, which can restrict travel and play.
High fat, high sugar fast food can seem more accessible than healthy food. Opportunities to be active can be limited on large housing estates.
They want better access to safe indoor and outdoor play facilities and leisure services close to where they live.
They perceive some parks and open spaces as being unsafe and too far from their homes to easily access.
They may not be confident in their cooking skills and understanding of nutrition. Eating well on a tight budget can be very difficult.
They experience difficulties accessing healthy weight services, receive inconsistent messages about healthy lifestyles and feel a stigma associated with being overweight.
TRANSPORT
HOUSING AND PLANNING
LEISURE AND CULTURE
PARKS AND OPEN SPACES
EDUCATION AND LEARNING
HEALTH AND HEALTHCARE
By 2019 we will work with our partners to intensify our efforts to:
Make active travel the norm for children and families by encouraging cycling and good traffic flow, tackling pollution and promoting safe walking routes.
Promote healthier catering practices, improve access to fresh fruit and vegetables and promote physical activity within the design of new developments.
Ensure all children and families have access to a range of leisure services and safe places to play in all weathers.
Encourage all children and families to make regular use of local parks and open spaces by improving perceptions of safety and accessibility.
Ensure all children and families have opportunities to learn about cooking and low-cost healthy eating within school and wider community settings.
Ensure healthy weight services are easily accessible to all that need them and that children and families receive consistent messages about healthy lifestyles.
LOCAL SOLUTIONS NEED TO COMPLEMENT NATIONAL DRIVE

6. Key aims and objectives
Tackling Childhood Obesity Together (TCOT)
Key aims and objectives
The overall objective of the 5 year TCOT programme is:
The following outcomes have been identified:
Children and families are more physically active in their daily lives
Children and families develop a positive food culture within their families and communities
Children and families are able, and supported, to make healthier choices
Additional key objective:
Evaluate and disseminate results
An additional number of key measurable outcomes have been identified within each component part of the multifaceted programme.
To halt and reverse the rising trend in childhood
obesity across the Tri–borough area.

7. Tackling Childhood Obesity Together (TCOT)
Implementation
Construct locally viable logic model for programme including commissioning of services
Communicate appropriately to various audiences to secure understanding of and buy-in for programme of majority of officers/stakeholders
Ensure that all audiences understand the asset based, incremental nature of the multifaceted programme and the long lead time to measurable outcomes
Be flexible and ready to adopt changes but evidence our steps

8. TCOT - one system, three strands
Tackling Childhood Obesity Together (TCOT)
TCOT - one system, three strands
Individuals/families
Environment
Community
supports
informs
1. Provision of comprehensive healthy weight services accessed by children and their families, workforce training
Education
Health Care
Voluntary Sector
2. Whole council partnership to ensure that environment and facilities support newly learnt behaviours and identified needs
Communications
ASC
FCS
Planning
Leisure
Housing
Transport
Parks
Legal
Retail
Employers
Private Providers
NHS and other providers
3. Engaged communities tell us ‘what works’ for them
Local agencies work
together to deliver solutions
Research, evidence and evaluation, consultation with communities underpin plans and resources, including unified messages agreed by lead councillors and partners within and outside the organisation.

9. Strand 1 - Family healthy weight services
Tackling Childhood Obesity Together (TCOT)
Strand 1 - Family healthy weight services
727 families engaged in group programmes
522 families attended 1:1 sessions
46 schools engaged with and receiving additional support from My Time Active, reaching some 3,296 children in years one and four with workshops run in every school
1,436 practitioners trained on key healthy eating and physical activity topics
69% of eligible families utilise Healthy Start vitamins and vouchers
All in first year of running

10. Initial Results from the Healthy Weight Services
Tackling Childhood Obesity Together (TCOT)
Initial Results from the Healthy Weight Services
In the second year of running the Mind Exercise Nutrition Do It (MEND)
Mums programme has shown on completion:
- 56% of completers reduced BMI
- 43% of completers reduced waist circumference
- over 50% of completers increased their physical activity
- decrease in average sedentary time by 45 minutes (2 boroughs)
- preliminary indication of increased self-esteem.
Mini programme has shown on completion
- average increase in physical activity of 5.9 hours
- the average number of times a day fruit and veg were consumed increased by 14%.

11. Strand 2 – whole council approach
Tackling Childhood Obesity Together (TCOT)
Strand 2 – whole council approach
Three layered approach:
Political commitment
Themed departmental pledges
Every contact counts
Combining the WHO ‘Health in All Policies’ approach with a themed ‘sugar smart’ strategy to engage internal and external partners.
Reshape the environment to make healthier choices, easy choices.

12. Ensuring that environments support newly learnt behaviours
Tackling Childhood Obesity Together (TCOT)
Ensuring that environments support newly learnt behaviours
Whole GP practice approach – pilot of GP and housing officers training on estates with high prevalence of obesity
Healthy school meals contract
Healthier catering commitment
Oral health resource pack
Initiated projects, delivering improvements
Fit and Healthy Hackathon
Healthy schools and Healthy early years
Fun, Free Fitness
Food growing projects
Healthy Start vouchers accepted in markets
Rose Vouchers

13. Whole Council Approach Continued
Tackling Childhood Obesity Together (TCOT)
Whole Council Approach Continued
Creation of 2 new play streets
Work with housing to identify community spaces for MEND programmes
Implementation of the voluntary sugar levy
Recently initiated projects, improvements anticipated
Sugar smart Campaign
Encourage play by removing the “no ball games” signs on estates
Oral health animation
Develop and establish a social supermarket

14. Strand 3 - community pilot
Tackling Childhood Obesity Together (TCOT)
Strand community pilot
Testing novel model targeting children and families in all settings where they live, play and learn.
Aimed at increasing community capacity, promoting healthy lifestyles and preventing unhealthy weight gain in children.
Components include environmental change, capacity building, social marketing and evaluation.

15. Tackling Childhood Obesity Together (TCOT)
Evaluation and evidence
Methods and design
Combining academic and pragmatic approaches
Development of ‘theory of change’ and logic model to capture key drivers of system changes
Annual lifestyle surveys via local schools, extended NCMP, process data, interviews with key stakeholders
Methodological paper published in Public Health (Elsevier), 2016
Baseline data - children
50.2% use active transport
79.6% engaged in active play at school
40.3% not engaged in active play after school
85.6% engage in screen time activity after school
73.1% ate fruit or veg fewer than 5 times
58% eating unhealthy snacks

16. Tackling Childhood Obesity Together (TCOT)
Evaluation and evidence 2
30 small grants of up to £1,500 awarded to schools and community organisations to fund new activities to promote healthy eating
Four community health events attended by over 1,700 children and parents – Party in the Park (summer) Feel Good Fun Days (autumn)
Eight workshops with community organised to collaboratively plan local actions
Bespoke training for local organisations attended by 65 staff and volunteers
Foundation phase community partner survey indicates that 90% of responders are aware of the behaviour change GoGolborne works to promote and 83% understand the role they can play in helping children and families to eat well and be active
Health promotion materials distributed to 2,000 families twice a year
Extended National Child Measurement Programme reaching 2,000 children

17. Case Study – 5 a day your way
Tackling Childhood Obesity Together (TCOT)
Case Study – 5 a day your way
5ADAY assembly in schools, wallchart challenge
5ADAY Fun day event
localised 5ADAY magazine, shopping bags, after school snack stalls, work to promote Healthy Start on markets, lots of grant funded projects
“The 5ADAY song and the wallchart have really inspired my girls to get interested in healthy eating – thank you so much for all your efforts.” (local parent)  

18. Tackling Childhood Obesity Together (TCOT)
Acknowledgements
Credit and thanks go to the TCOT team including:
Ellie Lewis, GoGolborne Programme Lead
Kate May, Public Health Senior Strategic Relationship and Outcomes Officer
Eszter Vamos, Specialist Registrar in Public Health and Academic Clinical Fellow
Elizabeth Dunsford, Commissioner (children and families),
Connie Junghans, Epidemiologist
Jonathan Pearson–Stuttart, Specialist Registrar in Public Health
Libby Rhodes, Communications and Engagement Officer
and to all our politicians, external partners and colleagues who have been instrumental in the implementation of this programme – and will all gain from its success!