TeesCAKE (Tees Consumption and Activity for Kids Experience)

  • Topic: Combination of Cancers
  • Institution: University of Durham
  • Country: United Kingdom
  • Status: Completed

Scientific abstract

(View plain language abstract)

Background

The prevalence of childhood obesity is high in most developed countries, particularly within areas of social deprivation. Childhood obesity is an independent risk factor for adult obesity, and a variety of health-related diseases. Developing and implementing affordable and successful strategies to reduce the prevalence of childhood obesity, without increasing health inequalities, is a key public health priority.

Aim

To assess whether a school-based health promotion programme (called TeesCAKE), delivered through partnership working, can prevent excess weight gain in children from socially deprived backgrounds aged 9-10 years at six, 12 and 18 months.

Methods

The TeesCAKE project was an exploratory randomised control trial. The TeesCAKE programme ran over one school year, and consisted of three elements which were delivered at different times during the school year; 1) an eight week activity programme delivered by Middlesbrough Football Club, 2) an eight week dance programme delivered by a dance team and 3) an eight week food preparation programme delivered by the researchers. The primary outcome measure was change in body mass index (BMI). Secondary outcome measures included change in; waist circumference, food preference, eating habits and physical activity levels. Measurements were taken at six, 12 and 18 months. In addition, interviews were conducted with school staff, and focus groups were conducted with a sub sample of children post-intervention to explore their opinions, perceptions and impact of the TeesCAKE programme.

Four primary schools in the North East of England took part in the project. Two schools received the TeesCAKE programme (284 children in one school year, aged 9-10 years) and the other two schools acted as controls (264 children). Height, weight and waist circumference were collected using appropriate validated equipment by experienced researchers at baseline, six, 12 and 18 months. BMI was calculated using International Obesity Taskforce (IOTF) cut off reference points. Food preference, eating habits and physical activity measures were also collected at these time points. The difference in change over time between the intervention and control groups were based on an individual level analysis, not accounting for any potential cluster effect due to schools being the unit of randomisation.

Results

Individual level analysis reveals statistically significant positive effects for BMI at 6 and 18 months and waist circumference at 18 months in favour of the intervention schools. Although these effect sizes are trivial, their direction of travel is encouraging. Children and the school staff liked the TeesCAKE programme, although boys seemed to enjoy exercise more than girls. Girls didn’t like getting out of breath, tired, or ‘sweaty’. Engaging parents and families with the programme was very difficult, and presented a barrier to behaviour change.

The TeesCAKE programme was relatively cheap and potentially sustainable due to partnership working with local services. However, maintaining good partnership working requires one person to co-ordinate the links, and regular face to face meetings may be useful.

Conclusions

The TeesCAKE programme shows promise, as a relatively cheap and sustainable intervention to preventing obesity in 9-10 year old children from poorer backgrounds. Key elements of success include; being perceived as fun by the children, being delivered within the normal school day, and the delivery of services through partnership working. Importantly, we did find that these partnership dynamics can be fragile, and require a central co-ordination point and regular face to face meetings. We identified a number of barriers to behaviour change, which we suggest require further research. First, we found that there are various aspects of exercise, which girls don’t like, including ‘getting tired’ and ‘sweaty’. Second, and in line with the existing evidence base, we found that it is very difficult to engage with the parents and families of these children.

Plain language abstract

Hypothesis

A school-based health promotion programme (called TeesCAKE), which aims to increase the amount of fruit and vegetables eaten, and the amount of exercise taken, will protect children from poorer backgrounds aged 9-10 years from becoming obese.

Background

Childhood obesity is a key public health priority in many developed countries, particularly in areas of deprivation. Obese children are at greater risk of developing various health-related illnesses in later life, can suffer from bullying, and often under achieve at school. We know that being physically active and eating a healthy diet can help protect against unwanted weight gain. However, getting children to change their behaviour is difficult. We know that getting parents and families involved is important, and programmes are more likely to work if the children think they are fun and their friends are doing it too. The TeesCAKE programme included these key elements, and used existing local (to the school) delivery services, which worked in partnership on this project.

Methods

Four primary schools in the North East of England took part in the project. Two schools received the TeesCAKE programme (284 children in one school year, aged 9-10 years) and the other two didn’t (264 children). The TeesCAKE programme was made up of three elements which were delivered at different times during the school year; 1) an eight week activity programme delivered by Middlesbrough Football Club, 2) an eight week dance programme delivered by a dance team and 3) an eight week food preparation programme delivered by the researchers.

Key findings

Children and the school staff liked the TeesCAKE programme, although boys seemed to enjoy exercise more than girls. Girls didn’t like getting out of breath, being tired or ‘sweaty’. Getting parents involved was very hard. For some children, their parent’s reluctance to buy fruits and vegetables and try new recipes, or encourage their children to do more exercise out of school, was a real barrier. The project was only conducted in schools in poor areas, and so a combination of financial problems and cultural ‘norms’ might have explained some of our results.

Children who attended the TeesCAKE schools were less obese at 6 and 18 months, and their waist circumference was smaller at 18 months. This tells us that the TeesCAKE programme can work, but perhaps not as well as we had hoped. However, we have learnt a lot from this project, and why we need to involve children from the start in developing successful programmes which they will enjoy.

The TeesCAKE programme was relatively cheap, and was designed to be sustainable, because the different elements of it were provided by local services working together in partnership, as part of their general community service. Although all partners enjoyed being part of the project, it was sometimes difficult to maintain good communication between partners, particularly when staff who delivered parts of the programme left for new jobs. Maintaining good partnership working requires one person to co-ordinate the links, and regular face to face meetings may be useful.