Prevention of obesity :exploring strategies for intervention in preschool

Abstract

The proportion of overweight and obese children in England has increased considerably since 1995. One in five children starting reception class is now overweight or obese. Proposed reasons for this are numerous and indeterminate. They include infant feeding methods, genetics, change in eating habits and patterns, and increased sedentary behaviours. The preschool years are considered to be an optimal time to intervene in an attempt to reverse this trend. However, interventions to prevent or treat overweight in preschool-age children in the UK are scarce, with most research being conducted in the US and Australia. Previous research has demonstrated some positive results in changing some health behaviours, however, positive trends in overall obesity rates are lacking. Further research to determine which prevention strategies and methods are acceptable and operational in a ‘real world’ setting is required. Ninety-eight per cent of UK preschool-aged children now attend some form of childcare. Preschool settings may provide valuable opportunities to access children and their families not only for promoting healthy lifestyles, but also to develop and evaluate behaviour-change interventions. This thesis presents a feasibility study of a behaviour-change nursery practitioner-led intervention conducted in four preschool centres in the North East of England. The study is underpinned by the MRC Framework: Developing and Evaluating Complex Interventions. The research was conducted in four phases: a preliminary qualitative study with parents of preschool children and nursery practitioners; development of a behavioural-change intervention; implementation of the intervention; and intervention evaluation. Qualitative data revealed underlying complex communication issues between practitioners and parents regarding food provision, and roles and responsibilities. Preschool centres appeared to have difficulties with enforcing school health policies. ‘Gatekeeper’ permission and lower-hierarchal compliance were on-going problems throughout the study. The majority of nursery practitioners and parents stated ‘liking’ and ‘finding’ the intervention methods and activities acceptable and positive changes in family health behaviours were reported. This study shows that a preschool centre behaviour-change intervention is feasible, however, as demonstrated, further work with nursery practitioners is required to determine how personal attitudes and school policy application can be enhanced to progress such an intervention. iii Feasibility studies of this type are important to inform further obesity prevention strategies research. The findings from this study are likely to have policy relevance and contribute to the body of literature.