Project Energize: Targeting childhood obesity
As part of our Food for Thought series, we look at a programme designed to tackle the high rate of childhood obesity by considering both food and exercise.
Its aim was simple: Get kids active and educate them about healthy foods.
And Project Energize has been so successful, it has been implemented not just domestically - in Waikato, Counties Manukau and Northland - it has now crossed the globe to Ireland.
The programme began in 2005 as an experiment in Waikato primary schools set up as a 'randomised control trial' - with 62 schools participating and another 63 schools used for comparison. It has now expanded to service 242 primary and intermediate schools from Coromandel to Taumaranui.
When the programme was last evaluated, in 2011, the childhood obesity rate of participants was down 3 per cent compared to before the programme launched and 78 per cent of schools reported improved quality of daily fitness.
Hamilton Energize team leader Richard Battersby said results continued to follow this trend, with children in the programme running faster, weighing less and having improved overall fitness levels.
In Waikato, the district health board contributes around $2 million a year, while in Northland it's funded by the health board and Sport Northland to the tune of close to $650,000 annually.
Schools develop their own plan in consultation with children, teachers, parents and wider school community, and an adult - an "energizer" - joins to implement the programme and assist teachers.
The Energizer team promotes messages related to nutrition and activity. Children also learn about practical things, such as the number of teaspoons of sugar in a fizzy or sports drink.
Sport Waikato chief executive Matthew Cooper said the real key for the programme's success is that it provides resources, including the energizers who go into schools to provide healthy lifestyle coaching.
"To fight childhood obesity, it's not just about getting fit or playing sport - it's a balanced approach about eating well and being active," he said.
In Northland, 82 schools are involved this year, said Anna Markwick of Sport Northland, up from 12 when the programme started there in 2013.
There are nine kaimahi [energizers] that work in Northland schools, Markwick said.
"Rather than adding something on top of a full school programme the kaimahi help them with enhancing what they do to have a greater impact on their student physical activity levels and healthy eating," she said.
She said the results have been pleasing, with children consuming more water and less sugary drinks.
HELPING OBESE OR OVERWEIGHT CHILDREN
According to the New Zealand Health Survey 2015/16, one in nine children aged 2-14 years were obese, with a further 21 per cent overweight. In 2015, Health Minister Jonathan Coleman announced a wide-ranging package to tackle childhood obesity, targeting children, families and mothers with a focus on nutrition and lifestyle advice. In addition to DHB-funded programmes like Project Energize and Bodywise, a total of 22 separate initiatives were announced, including referring more overweight children for dieting and exercise interventions from the age of 4.
One health expert charged with getting obese children healthy is clinical psychologist Natalie Parkes. Parkes works with three others, a medical officer, a dietician and an activity coordinator, in implementing Bodywise, a Waikato DHB child weight management programme.
"Our programme is a group programme, we discuss their concerns and get a picture of the lifestyle of the family," Parkes said.
"It runs over 12-13 months and we see children from 5-12 years. We talk about healthy portions, how to read labels, how to get your child to eat colourful vegetables... behaviour type strategies and some parenting tips because it's the [adults] in the home who are food shopping."
Children who come to see Parkes and her team are referred from their family doctor. They receive about 90-100 referrals each year, but only 37 per cent take part in the programme.
Parkes said parents were often surprised as to how cheap it could be to eat healthily.
"Most of the change is coming from the parents, they do the groceries and dish out the food. So they're all getting the health message at the same time."
TEETH CAN REVEAL THE PROBLEM
Children's oral health is not commonly associated with obesity but principal dental officer Rob Aitken said bad oral health was often a sign of a poor diet.
Aitken started working as a dentist more than 40 years ago and initially, dentistry was treatment-focussed. He said people had only just started to make the connection between diet and oral health.
"We would see people's teeth and treat them when they needed attention," he said.
"When I joined the [Waikato oral health] service, I think by and large still, we were just changing from a treatment-focussed approach to a preventative approach. And of course if we could prevent decay, how much better is that than mopping up the affects of decay after it's happened.
"In the last decade, [society has] started a focus on diet, not only in oral health, but in general health. We've become a lot more fitness orientated, much more appreciating the role of what we eat and the effect it has on our body, not just our teeth."
Aitken said although sweets had been available throughout history, "the display of sweets, the display of soft drinks, is more prevalent".
"You've got a few minutes to spare while standing at the checkout and you look around you and there are sweets on both sides and a fizzy drink chiller when you get there," Aitken said.
PROJECT ENERGISE GOES INTERNATIONAL
Project Energize was adapted for primary schools in County Cork, Ireland, in 2013. The Cork Institute of Technology (CIT) was looking for a programme that delivered on both physical activity and nutrition and was impressed by Energize. The Irish equivalent programme is called Project Spraoi (pronounced Spree), with a dedicated team working in local primary schools to deliver the initiative.
Sport Waikato helped with the development of the programme. Spraoi is delivered in four schools to 1030 students aged 7 and 8. Project Spraoi coordinator Dr Tara Coppinger explained that the school students would be monitored on improvements made in the areas of nutrition, increases in physical activity and decreases in sedentary time.
"We have masters and PhD students supporting the programme. Once we saw a presentation of Energize we decided to use the best practice model and adapt it to an Irish setting. The response from the school community so far has been very encouraging," Coppinger said.
BY THE NUMBERS
* One in nine children aged 2 - 14 years are obese
* 21 per cent are overweight
* 15 per cent of Maori children are obese
* 30 per cent of Pacific children are obese
* Children living in the most deprived areas are three times as likely to be obese as children living in the least deprived areas.
* The child obesity rate increased from 8 per cent in 2006/07 to 11 per cent in 2014/15.
* Source: 2015/2016 New Zealand Health Survey