WIXLIB

Journal of ObesityOf those recruited onto the programme, approximately90% reported that they attended because of this recruitmentstrategy. The remainder were recruited through word ofmouth, referrals from healthcare professionals or other(unknown) sources.The OBOL programme recruits the whole family, whereone or more member of the family is an “unhealthy weight”(underweight, overweight, or obese). This means that a participating child or adult may not be an unhealthy weight. Thetarget age range for children is 7–16 years old, who must beaccompanied by a parent although siblings outside this agerange are included (especially where childcare facilities arean issue).Baseline characteristics of the individuals were recordedat the first session. Physiological data and behaviour data wascollected at the first and last sessions, using the same datacollection instruments, as follows;2.2.1. Physiological Measures. Weight was measured to thenearest 0.1 kg; fat percentage, total body water (TBW),and visceral fat were measured using bioimpedance onthe medically approved Tanita scales (BC420 MA). Heightwas measured to the nearest 1mm with Leicester heightmeasure; Child Growth Foundation, London. BMI (weightin kg/(height in m)2 ) was used for adults. For children thiswas converted into Z scores using UK 1990 data (ColesLMS). Waist circumference was measured to the nearest0.1 cm. Measurements were taken at the start and end of theprogramme.2.2.2. Measurement of Knowledge and Behaviour. Healthyeating knowledge was estimated through a healthy eatingquiz which looked at participants’ knowledge of the Eat Wellplate, vitamins, hidden fats and sugars, and so on. Participant’s eating behaviours were recorded using a 24 hour recallquestionnaire focusing on fruit and vegetable portions andfast food/unhealthy snacks intake.Activity was measured through recall of previous week’sactivity. Clients self reported how many times they tookpart in activity for more than 30 minutes. During theprogramme, the measurement technique was altered fromasking about activity in general to using specific activities(including household duties and walking up stairs) asprompts. Analysis here only included scores taken usingprompts. Both measures were taken at the start and the endof the programme.2.2.3. Ethics Approval. The analysis described in this paperwas a formative evaluation for the purpose of improving theservice offered. Clients gave permission for the data to beused for these purposes.2.2.4. Statistical Analysis. The data analysed was routinelycollected by the programme as part of the on-going monitoring arrangements and was used retrospectively for thisevaluation. Data quality issues were dealt with by excludingresults where there was a clear data entry error (missing3or decimal point error). Where results were outliers of thedistribution, the likelihood of the result being correct wasconsidered, and if it was a physiological possible result, it wasincluded within the analysis.Statistical analysis was carried out using paired t-tests tocompare the before and after measurements of individualparticipants, where both start and end data was provided.Subgroup analysis was carried out where relevant (e.g.,BMI/BMI percentile reduction was only an objective in thosewho were overweight or obese at entry to the programme).Outcome data at course completion was available for thecohort included in this evaluation; longer term outcomes arenow being captured where possible.3. ResultsThe programme was attended by 272 children and 182adults (parent/carer) via 30 different courses, run in differentlocations and times (January 2008 to May 2009), butfollowing the same format. Of these, 221 children (81%) and137 (75%) adults completed the programme. Physiologicaldata was recorded at the start and end of the interventionfor 186 children and 107 adults, and the evaluation resultsare obtained from this group. Rates for completion weresimilar by ethnic group. The reasons given for dropping outof the course were varied (including parent starting newemployment and difficulties within families). The averageage of the children was 8 years, but the range was as wideas 0 to 15 years since; although the target range was 7–16 yrs,siblings were encouraged to participate.Table 2 shows the characteristics of the participants whocompleted and those who failed to complete the programme.It demonstrates that the weight profile of children attendingthe program is broadly similar to that measured in Year6 through the NCMP programme in Coventry and tothe Health Survey for England data for 2–15 year olds[22]. For adults, there are a higher proportion of obeseparticipants (38%) than reflected in the current Coventrypopulation estimate of 25.6% [1]. The programme attractedan ethnically diverse group, with a lower proportion of thoseof white British ethnicity than estimated from the 2001census [23]. The programme also attracted families from themore deprived areas in Coventry, with 252 (77%) of the 326attendees for whom postcode was available, coming from thetwo most deprived quintiles.A comparison of the characteristics of those who failed tocomplete the programme with those who completed it showsthat boys were less likely to drop out than girls, and that thoseof mixed ethnicity were more likely to drop out (thoughthis is based on small sample size). There was no significantdifference by BMI category, deprivation, or healthy lifestylebehaviours.Overall, the vast majority of participants (86%) weremade aware of the programme through their child’s school(which may include the school nurse), and a further 8% hadheard through advertising or word of mouth. Very few ( 5%)were recommended via their family doctor.

4Journal of ObesityTable 2: Baseline data for OBOL participants, comparing those who completed the course with those who did not complete.AdultsCompleted courseChildrenMaleFemaleNot known18119013%87%111110 5AsianBlackMixedWhiteNot givenOther227 59311 518%6%2%75%3910 512938 5ObeseOverweightHealthy weightUnderweightNot known533645 539%26%33%2%472319 5 546Mean68.210.52.91.51.252%25%21%1%1%1-Most deprived2345-Least deprivedNot providedHealthy living quizWeekly activityFruit and vegetable consumptionCrisps, chips, and sweetsFast foodSD18.76.01.51.21.0P value AdultsChildrenDid not complete %738016%84%1635031%69%0.680.8750.0170.155 5 5 533 5010%7%5%79%5 5632 70936%29%33%2%6647 5 341%31%23%3%3%19156 5 0.990.8580.613BMI4019%163014%1313063%1573% 5 50Deprivation quintile7347%164731%123221%900% 5 51% 31.51.41.21.3SD12.47.61.51.21.3SD22.98.11.51.21.3P value is test difference between completed and dropped out.SD: Standard deviation.3.1. Behaviour Change. Table 3 shows the results for allmeasures of behaviour that were recorded for OBOL participants. There was a statistically significant improvementin knowledge of healthy eating and physical exercise both inadults and children, with an increased score of 11.5 points(out of 100) for children and 13.9 for adults (95% confidenceintervals 8.6–14.5 and 10.9–16.9, resp.).Both adults and children achieved a statistically significant increase in their weekly activity levels, of over 3 30minutes (for adults) and 3 60 minutes (for children) perweek. It is possible that this change is in part due to theactivity element of the programme, however this would be amaximum of 45 minutes, considerably less than the increaseseen.The number of participants consuming 5 or moreportions of fruit and vegetables a day increased from 21%to 33%, with an increase of 0.57 portions ( 95% confidenceinterval of 0.31–0.83, P 0.001) per day for childrenand 0.76 portions (95% confidence interval of 0.47–1.06,P 0.001) per day for adults. There was also a significantreduction in the amount of chips, crisps, sweets, and fizzydrinks consumed per day. The reduction was of 0.32 portionsper day (95% confidence interval of 0.11 to 0.52, P 0.002)for children and 0.34 portions per day (95% confidenceinterval of 0.07 to 0.61, P 0.01) for their parents.Fast food consumption also decreased, but this was notstatistically significant for children with a reduction of 0.21portions per week, (95% confidence interval of 0.45 to 0.03, P 0.08), but was for their parents with a reductionof 0.34 portions per week (95% confidence interval of 0.16 to0.51, P 0.001).3.2. Physiological. Table 4 shows the physiological outcomes, comparing baseline measures with those recorded atcourse end. This analysis was carried out for overweight

Journal of Obesity5Table 3: Summary of behaviour change among the 293 OBOL participants (107 adults and 186 children) for whom baseline and outcomedata was available.Change (average)Children (n 155)Adults (n 91)Children (n 162)Adult (n 89)Children (n 172)Adult (n 97)Children (n 169)Adult (n 97)Children (n 137)Adult (n 99)95% Confidence intervalPAverage at end of programmeKnowledge11.58.614.5 0.00179.313.910.916.9 0.00181.6Activity (adults units of 30 minutes, children units of 60 minutes per week)3.92.55.2 0.00113.93.72.25.2 0.00113.9Fruit and vegetable portions per day0.570.310.83 0.0013.580.760.471.06 0.0013.63Crisps, chips, sweets and, carbonated drinks per day 0.32 0.11 0.520.0021.64 0.34 0.07 0.610.0130.91Fast food per week 0.21 0.450.0260.081.21 0.34 0.16 0.51 0.0010.84Table 4: Physiological changes, comparing baseline with course end measures for overweight or obese participants.nBody fat %BMIWaist circumferenceHip circumferenceHeart rateSystolic blood pressureDiastolic blood pressureExpiratory volumeVisceral fatTWB%66676763676565684848Body fat %BMI percentileWaist circumferenceHeart rateSystolic blood pressureDiastolic blood pressureExpiratory volume57545750484858mean change (%)95% confidence intervalAdults obese and overweight 1.75%( 3.08– 0.41) 0.78%( 1.41– 0.14) 1.95%( 2.82– 1.06) 1.32%( 1.99– 0.64) 1.94%( 4.97–1.1) 3.68%( 6.83– 0.53) 2.34%( 5.51–0.84)7.56%(3.31–11.8) 0.68%( 4.7–3.34)1.26%(0.53–1.98)Children obese and overweight 3.20%( 6.15– 0.25) 1.82%( 3.14– 0.5) 1.56%( 2.54– 0.58) 6.24%( 11.56– 0.91)2.94%( 2.81–8.69)6.11%( 2.84–15.06)9.13%(5.35–12.9)and obese participants only, since this group might beexpected to see changes due to their behaviour change. Foroverweight and obese parents and children, a number ofmeasures including BMI (BMI percentile for children),body fat % and waist circumference showed a statisticallysignificant difference at the end of the course compared tothe initial measurement. Each of the statistically significantchanges reflected an improvement; however, the scale ofimprovements was small and is unlikely to be clinicallysignificant. Although these changes are not expected toimpact on the short-term health of the individuals, ifStandard .85%14.23%2.57%0.0100.016 0.001 0.0010.2120.0220.151 4.67%0.0330.0070.0020.0220.3170.181 0.001this reported behaviour change is sustained, future healthimprovements should be anticipated.Intention to treat analysis, which assumes no change forthose who dropped out of the course, was also carried out;compared to the data shown, the same measures were foundto be statistically significant, but with a smaller size effect.4. DiscussionA change in knowledge of healthy lifestyles and behaviourin terms of physical activity and healthy eating has been

6demonstrated during the course of the programme. If thesechanges in behaviour are sustained, this might be expectedto lead to a reduction in health risk factors for adults [24–26]. In addition, since parents are the primary mediatorsof change, [13] parental eating and physical activity choiceswill inevitably impact on the home environment, makingit more conducive to positive change in children [15].Research supports this assumption by demonstrating thatweight control interventions delivered within a family-basedcontext have yielded very promising long-term results in thetreatment of childhood obesity [27]. This 10-year followupstudy demonstrated that 34% of obese children maintaineda decrease in BMI percentile, and 30% were no longeroverweight. This was only the case where at least one parentwas involved in the intervention; if neither parent had beeninvolved the benefits only lasted 5 years.Overweight and obese adults and children have alsoshown small but statistically significant changes in physiological parameters (BMI/BMI percentile, waist circumference,and body fat) in the short term. This highlights the possibilityof utilizing the programme to both prevent and treatchildhood obesity, since family-based lifestyle interventionswith a behavioural program aimed at changing diet andphysical activity together with thinking patterns have beenshown to be effective at treating childhood obesity, [5].The effectiveness of the recruitment strategy in reachinghigher deprivation groups, with a cross section of ethnicity,suggests that taking a “high visibility” approach in the localcommunity is effective, even though it is labour and timeintensive. Importantly in the context of the prevention ofchildhood obesity, the proportion of obese adults (33%)was higher than estimates of the local population (26%).The recruitment strategy was inclusive and reached thetarget audience, as demonstrated through observation of thedemographic profile of course participants shown in Table 2.This was achieved through promotion of OBOL in thetarget communities rather than through applying exclusions.This type of “inclusive” approach to recruitment supportsMarmot’s philosophy on tackling health inequalities; interventions that are “universal but targeted at those most atneed” [28].Another indirect benefit could also be that “inclusivity”reduces negative attitudes towards overweight/obese people.As Faith et al. suggests obese and nonobese individualsworking together on a common problem might be aneffective means for reducing antiobese attitudes [29]. It couldbe argued that “One Body, One Life” has a common goalof helping clients to lead a healthier life. Clients often shareexperiences and work together to come up with strategies ofhow they can do this in their everyday life. A byproduct ofthe programme could be that non overweight/obese clientsimprove their attitudes toward overweight and obese people.At a societal level this could have numerous benefits [29].5. Limitations of ResearchClearly this is an evaluation of a service and not a researchprogramme, and there are limitations to the study. ForJournal of Obesityexample, there is no control group, and so spontaneouschanges in behaviour of the whole population cannot beruled out. Given the study design, a further limitation is thatthe findings only relate to short-term impact, during the 10–12 weeks of the programme, and it is not known whetherchanges are sustained. Efforts are underway to improve this;as with other like services, collection of longer term outcomedata is problematic [30].It should also be noted that the results were self-reported,and that participants may have overstated improvements intheir healthy eating and physical activity. This could havebeen influenced by the demand characteristics of the settingand is known as the “teaching test” where clients report whatthey think the programme leader wants to hear [31].Moreover, the data collection tools that were used for thecourses described in this evaluation were developed specifically for this programme. However, to provide consistency,minimize the “teaching test” and allow better comparisonwith other programmes, validated questionnaires are recommended. Since this evaluation the programme has started touse such questionnaires.6. Future ResearchResearch into the prevention and treatment of obesity is stillemerging, and there are still many areas that are not fullyunderstood. One area of interest that is highlighted withinthis research is the longer term impact of interventions. Inrelation to the following areas are changes maintained overa period of time. Do children or adults benefit most frominterventions over time? Is it changes in eating habits, orchanges in physical activity levels that are most effectiveat helping a client to maintain a healthy weight? Finally,more research is needed into understanding what type ofprogramme best suits particular types of clients that is atreatment only programme needed just for obese clients, orin some circumstances can a more inclusive approach bemore beneficial?Conflicts of InterestThere are no conflicts of interest. It should be noted thatMarsha Towey is the manager of the team who deliver the“One Body One life” programme. The PCT commissionedthe programme as part of Coventry’s Healthy Weight Strategy, the commissioning team was led by Berni Lee. RuthHarrell was part of this commissioning team.AcknowledgmentsThe authors would like to thank the One Body One Lifeteam, without their hard work, enthusiasm, and passionthese results would not have been possible. This programmewas funded by the following organizations: Coventry CityCouncil, NHS Coventry, and the Football Foundation.

Journal of ObesityReferences[1] R. Craig, J. Mindell, and V. Hirani, Health Survey for England2008: Physical Activity and Fitness, vol. 1, Health and SocialCare Information Centre, 2009.[2] Department of Health, Healthy Weight Healthy Lives: A CrossGovernment Strategy for England, Crown, England, UK, 2008.[3] B. Kolody and J. F. Sallis, “A prospective study of ponderosity,body image, self-concept, and psychological variables inchildren,” Journal of Developmental and Behavioral Pediatrics,vol. 16, no. 1, pp. 1–5, 1995.[4] C. D. Summerbell, E. Waters, L. D. Edmunds, S. Kelly, T.Brown, and K. J. Campbell, “Interventions for preventingobesity in children,” Cochrane Database of Systematic Reviews,no. 3, Article ID CD001871, 2005.[5] H. Oude Luttikhuis, L. Baur, H. Jansen et al., “Interventionsfor treating obesity in children,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD001871, pp. 1–185, 2009.[6] C. Tyler, C. A. Johnston, and J. P. Foreyt, “Themed review:lifestyle mangement of obesity,” American Journal of LifestyleMedicine, vol. 1, pp. 423–429, 2007.[7] G. S. Goldfield, H. A. Raynor, and L. H. Epstien, “Treatmentof pediatric obesity,” in Handbook of Obesity Treatment, T.A. Waddent and A. J. Stunkard, Eds., vol. 1, pp. 532–555,Guildford, New York, NY, USA, 2002.[8] A. Bandura, Social Learning Theory, Prentice Hall, EnglewoodCliffs, NJ, USA, 1977.[9] A. Bandura, Self-Efficacy: The Exercise of Control, Freeman,New York, NY, USA, 1997.[10] S. T. St Jeor, R. L. Brunner, M. E. Harrington et al., “Aclassification system to evaluate weight maintainers, gainers,and losers,” Journal of the American Dietetic Association, vol.97, no. 5, pp. 481–488, 1997.[11] K. D. Brownell and J. P. Foreyt, Eds., Handbook of EatingDis-Orders: Physiology, Psychology, and Treatment of Obesity,Anorexia and Bulimia, Basic, New York, NY, USA, 1986.[12] D. Berry, R. Sheehan, R. Heschel, K. Knafl, G. Melkus, andM. Grey, “Family-based interventions for childhood obesity: areview,” Journal of Family Nursing, vol. 10, no. 4, pp. 429–449,2004.[13] L. H. Epstein, “Family-based behavioural intervention forobese children,” International Journal of Obesity, vol. 20, no.1, pp. S14–S21, 1996.[14] T. A. Wadden and A. J. Stunkard, Handbook of ObesityTreatment, Guildford, New York, NY, USA, 2002.[15] P. M. Watson, D. Lindsey, P. Katie et al., “A whole familyapproach to childhood obesity management (GOALS): relationship between adult and child BMI change,” Annals ofHuman Biology, vol. 38, no. 4, pp. 445–452, 2011.[16] C. E. Murray and T. L. Murray, “Solution-focused premaritalcounseling: helping couples build a vision for their marriage,”Journal of Marital and Family Therapy, vol. 30, no. 3, pp. 349–358, 2004.[17] B. O’Connell, Solutions Focused Therapy, Sage, London, UK,1998.[18] M. F. Hoyt and I. K. Berg, “Solutions-focused couple the

The One Body, One Life (OBOL) programme has been designed with these principles in mind. 2.Methods 2.1. Development of One Body, One Life Programme. The OBOL programme is underpinned by a solutions-focused approach. This approach focuses on the client’s perception of