The London Borough of Brent’s approach to obesity includes a life course perspective that highlights the importance of pre-natal and early-life factors in childhood obesity. Research shows that adult obesity is very difficult to treat, emphasising how important it is to work with families to put in place early preventative measures.
The challenge
Brent has some of the highest childhood obesity rates in London. Some 41.7 per cent of children in Year 6 were recorded as overweight or obese in 2018/19. Ethnicity data shows that children with the highest rates of excess weight in the diverse borough are from black Afro-Caribbean backgrounds. The council is beginning work to look at any cultural factors that may be contributing.
Brent’s inner-city environment, with the busy North Circular ring road running through it, is a potential barrier to physical activity and healthy lifestyles.
The approach
In the face of rising obesity rates, the council is in the process of refreshing the Brent Obesity Strategic Plan that ran from 2010-2014. The new focus will start from the very beginning; looking at pregnancy and new-borns, attempting in the first instance to build on relatively positive breast feeding rates among new mothers in the borough which are above the national average.
A new initiative in the 0-19 public health contract (health visiting and school nursing) - Maternal Early Childhood Sustained Home visiting (MECSH) model – has been introduced with positive early signs. The proactive programme, developed in Australia, is a structured programme of home visiting for families at risk of poorer maternal and child health and development outcomes. The programme is aimed at woman who identify in pregnancy as vulnerable. During a series of 25 visits from birth to the age of two, a trained health visitors works with the parent to support and empower her. Anti-obesity advice and training, and related elements like oral health, are part of the programme.
Encouraging mothers to get active with their babies and toddlers, making sure they understand the importance of not having the child in the pram/pushchair all the time and giving them time on the floor to move around is also covered.
“Research shows that habits set in the very early years endure and where they are negative, prove difficult to break,” said Marie McLoughlin, Consultant in Public Health. “This model is about parents being taught the skills they need to make healthy choices.”
Other early years measures include:
- Breast feeding champions and breast-feeding peer supporters across the borough.
- A rolling programme for parents in children’s centre covering food labelling, introducing babies to solids and what a balanced diet looks like. A similar programme for one-year-olds and up to school age is being established.
- The council’s Public Health Team include sugar awareness in the Junior Citizen Scheme, which reaches approximately 3,200 children in Year 6.
- To establish when weight gain is occurring to enable better targeting, health visitors will weigh and record children at the 1 year and at 2.5 year reviews. Researchers will also investigate factors behind the high BME obesity rates.
The impact
Since it was introduced about two years ago, about 160 mothers have benefited from the MECSH programme. Feedback is overwhelmingly positive. “It has made a real difference to many of the mothers,” said McLoughlin, “empowering them to be good parents.” The borough runs a healthy early years award for nurseries, children centres and childminders with 72 settings taking part, meeting criteria in breastfeeding, healthy eating, physical activity and mental wellbeing. With support from an Infant feeding coordinator, health visitors have achieved UNICEF Baby Friendly Initiative Stage 3 accreditation, while children’s centres have Stage 2 and are working towards Stage 3. Lessons learnt
The refreshed strategy and action plan will take a whole systems approach aimed at encouraging more people around the table to take responsibility, whether it be planning, transport, marketing, media, private business and big business.
“In previous years, although everyone was very positive, I don’t think from a strategic point of view we really had the cross council connections and by-in that we needed and so we are making sure that now happens,” said McLoughlin.
How will the approach be sustained?
High level by-in of the new strategy will ensure it is sustained over time. The new strategy and task and finish group will be the product of roundtable agreement among the cabinet member, committed senior people in commissioning groups and the council’s chief executive and directors.
Cllr Krupesh Hirani, Lead Member for Public Health, Culture and Leisure at Brent Council, said:
“Like many inner city neighbourhoods with high levels of deprivation, Brent is not immune to the growing obesity crisis.
“We are working hard to combat this issue and implement a number of initiatives dedicated to improving the health and well-being of residents and particularly children and young people in Brent.
“We will continue to look for new and innovative ways to tackle this problem, and the new strategy and action plan will be the key driver with multiple agencies working together.”
Contact
Marie McLoughlin, Consultant in Public Health