Percentage overweight and obese children in Primary 1 (Local Authority funded schools) in Lothian
Source: Child Health Surveillance Program, ISD Scotland
Overweight and obesity levels have increased dramatically in all age groups over the past thirty years. It is estimated that up to two thirds of adults and one third of children and young people are now overweight or obese (see Figure 1 & Table 1). Problems of this scale are not simply the result of a lack of will power by individuals. There is clear evidence from the English school surveillance programme, and more recently from the Scottish school surveillance programme, that overweight and obesity in childhood increases with deprivation. Last year’s Public Health annual report  looked at obesity and the environment, highlighting the need to make neighbourhoods more friendly for walking and cycling and to change food production, distribution and composition. This article focuses specifically on child healthy weight.
Initiatives and interventions
“Overweight and obesity levels have increased in all the age groups over the last 30 years.
In December 2007, the Scottish Government announced a new target  for NHS Boards to deliver a family-centred weight management intervention to overweight and obese children and young people, with a focus on healthy eating, physical activity and behavioural change. In Lothian we were set a target of delivering such a programme to almost 3000 children. This was the first time that government policy was accompanied by investment to tackle child healthy weight across Scotland. Colleagues from a wide range of different organisations in Lothian (NHS, local authorities, leisure organisations, voluntary sector and universities) met to identify the best way to meet this target.
Definitions of overweight and obesity in children and adults 
A calculator estimating BMI centile (children) and BMI (adults) is available at the following link: www.nhslothian.scot.nhs.uk/getgoing/index.htm
Colleagues from across the statutory and voluntary sectors were concerned about the impact of screening and targeting the large numbers of overweight/obese children and young people required to meet the Scottish Government target. There was general concern that such an approach could cause stigma for families and harm the relationship between professionals and parents. As a result, we started to consider two distinct approaches as an alternative:
- prevention of overweight/obesity for families, regardless of weight, in a school/community setting; and
- treatment for groups and individuals if overweight or obese, but on a referral basis.
However, in early 2008 there were few high quality studies published in scientific journals on approaches to preventing childhood overweight and obesity. We searched for promising interventions, following leads from colleagues, conferences, reports and other sources. There was considerable interest in a French study called Ensemble, Prévenons L'Obésité des Enfants (EPODE) – which translates as ‘together, let’s prevent obesity in children’ – and its predecessor Ville Santé (‘healthy town’).
Childhood obesity prevalence data in Villé Santé (Healthy Town) and in CT (Control Town) 
A conference presentation provided some data unavailable elsewhere at that time. These studies took a whole-town approach, starting small (Ville Santé ran in the towns of Fleurbaix and Laventie with populations of 2,222 and 4,444 respectively) before expanding to larger towns with populations of up to 100,000 with EPODE. The French approach evolved in three stages, starting with schools and extending to include the whole town (for example large employers, supermarkets and food outlets) and, towards its later stages, expanding to include specific support for individuals when required (health coaching). The French approach involved a combination of social marketing run from central offices in Paris, and local involvement (leadership by the town mayor and community development) to tailor the programme to meet local requirements and maximise uptake.
Prevalence data of obesity according to socio-economic criteria in 2004 in VS and CT 
The preliminary results of the French approach were striking. Between 1992 and 2004 the proportion of children who were obese in the two towns fell from 11.4% to 8.8% (see Figure 2). Over the same period the proportion of obese children in two ‘comparison towns’ without the intervention increased from 12.6 to 17.8%. Crucially, the benefits were greatest for those children living in higher levels of deprivation (see Figure 3). The study was finally published in December 2008 . The findings appeared to fit closely with our plans so we obtained agreement from the Scottish Government in early 2009 that we would adapt the EPODE preventive approach as the major focus of our work. Schools have been central to the development of the preventive programme which has involved the following stages:
- identifying communities;
- consultation with professionals and communities;
- delivery of community development and social marketing approaches; and
- evaluation in each of the four local authority areas in Lothian.
By working with schools and colleagues in community learning and development and the voluntary sector we have been able to engage with families in areas of multiple deprivation, addressing healthy eating, cooking on a budget, physical activity and the links to wider health and wellbeing. This work is expected to lead to sustainable changes that will impact on the family and wider community, leading to further opportunities in training, volunteering and employment for some participants.
In addition to this community-based preventive approach we have worked with colleagues in two Scottish universities to develop a weight management programme called ‘Get Going’. This enables parents or professionals to seek specialist support for a child or young person who is obese or overweight. Many treatment services struggle to engage with children and families. This programme provides an opportunity to work with local families, communities and professionals to design more responsive and effective services.
- The French EPODE study provides evidence to support a community-based approach to preventing overweight and obesity in children and young people. This approach is being adapted for use in four communities in Lothian.
- Data from England and, more recently, Scotland suggest that overweight and obesity is more common in children and young people in more deprived communities.
- Programmes aimed at reducing the prevalence of overweight and obesity should monitor their impact on health inequalities.
- Community involvement is central to the success of programmes geared at reducing overweight and obesity in childhood.
- The evaluation of the Get Going treatment programme will help NHS Lothian plan weight management services for children and young people for the future.
- Child healthy weight programmes – and related national targets – should balance prevention and treatment.
- Long term action is required to reduce the impact of overweight and obesity in children and young people.
- Services need to be redesigned with young people and their parents so that they are able to engage with families and communities more effectively.
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