1. The MEND Programme: Healthy lifestyles for the whole family Dr. Gordon MacMillan

2. School-based policies have delivered limited results: Majority of primary school pupils bring crisps, sweets or chocolate into school to eat during break. Decline in school meal take up. Primary 7 pupils display less healthy eating behaviour than younger children. Source: Glasgow Centre for Population Health 2007

3. Figure 17.2 Work place counselling – body mass index (BMI [kg/m 2 ]) over time Figure 17.4 Whole school approach – body mass index (BMI [kg/m 2 ]) over time Figure 17.3 Counselling by primary care staff – body mass index (BMI [kg/m 2 ]) over time Figure 17.5 Family-based interventions, BMI over time Effectiveness of different programme types Only family-based interventions have a significant effect on BMI, which is sustained over time (NICE, Obesity, Full Guidance December 2006)

4. Rates of child obesity continue to rise

6. Parents have most influence over child health Socio-economic status. Breastfeeding. Patterns of sedentary / active behaviour. Structure of mealtimes. Attitudes towards foods.

7. Schools can engage with parents & help them to: Offer children healthy, balanced diets. Select and prepare food with children. Manage food in the home. Encourage and reward active lifestyles. Instill positive attitudes towards healthy foods.

8. And food service providers can support children to: Manage stimuli to eat. Withstand peer pressure. Distinguish between healthy and unhealthy diets. Understand food labeling. Get involved in the selection & preparation of food. Adopt healthy lifestyles.

9. Components of an effective response to child obesity: Involves parents and children. Informal, engaging and fun. Empowers parents and children. Community based. Founded on robust clinical evidence. Delivers measured health & social outcomes.

10. MEND Programme comprises 20 x 2-hour group sessions (10 weeks) Introduction and farewell 8 Mind 8 Nutrition 18 Exercise 2 Measurement sessions (Pre & Post)

11. Content – Mind Goal & rewards Role modeling Stimulus control - hunger vs. craving Problem solving Positive parenting e.g. bullying, sleep etc Self-esteem & confidence (5 / 8 sessions – parents only) Applying social learning theory & behaviour modification techniques:

12. Content - Exercise Land & water based Group play Non-competitive Graded activities  self-esteem (dance, voice & drama) Fun

13. Content - Nutrition Customised healthy eating Not a diet Educating & empowering families No forbidden foods Many convenience and ready-meals promoted Organic products not promoted (All sessions - parents & children)

14. Regional and national funding partners

15. Number of funded MEND Programme sites (free for participants)

16. Cumulative funded children on MEND programmes (free for participants)

17. Cumulative frontline staff through One Day Training (free for participants)

18. 20 year research partnership UCL Institute of Child Health

19. Evidence Base (Research) Feasibility study 2002-3 (Sacher et al, 2005) Pilot 2004-5 (Sacher et al, 2006) RCT 2005-7 (Sacher et al, 2007) Research team Paul Sacher Dr Paul Chadwick Prof. Tim Cole Maria Kolotourou Dr Margaret Lawson Prof. Alan Lucas Dr Atul Singhal

20. UCL Institute of Child Health

21. 86% mean MEND Programme attendance 68% of children attended ≥ 16 / 18 sessions 97% MEND Programme retention rate 79% study retention rate (12 months) Attendance and retention

22. Contact gordon.macmillan@mendprogramme.org www.mendprogramme.org www.chipscotland.co.uk