To assess the effectiveness of a school-based obesity prevention programme.
NIHR Public Health Research
Brief description of the work
The Healthy Lifestyles Programme (HeLP) was a home grown year-long, multi-component school-based obesity prevention intervention delivered to all Year 5 children (9-10 year olds) within a primary school. The intervention was developed following the Medical Research Council’s framework for the development and evaluation of complex interventions and used an intervention mapping approach to design programme components and their associated behaviour change techniques. Target behaviours were to replace screen time with physical activity and replace energy dense snacks with health alternatives. The programme consisted of a mix of whole school and Year 5 focussed activities, with several opportunities to bring parents into the school. Key to engaging the children were the drama based activities delivered by actors from a local theatre company.
The effectiveness trial (2012-2016)
The trial of effectiveness (ISRCTN15811706) was funded by NIHR PHR (10/3010/01) and involved 32 schools (16 intervention, 16 control) and 1300 children and their families across Devon. Children were followed up at 18 and 24 months post baseline. The primary outcome measure was BMI SDS at 24 months. Secondary outcomes included Body Fat, Waist Circumference, Physical Activity and Food Intake. HeLP was delivered as intended and over 90% of children received the whole programme. We achieved 94% follow up for the primary outcome measure and obtained complete 7 day accelerometer data on 80% of the children. Despite high engagement of schools, children and families no differences were observed in BMI SDS or levels of physical activity between intervention and control children at either 18 or 24 months. Marginal differences in favour of the intervention were observed in the consumption of unhealthy snacks. There was no evidence of differential effects by gender, SES or school size.
Although schools are an ideal setting in which to deliver population based interventions, school-based interventions might not be sufficiently intense to affect both the school and home environment and hence the weight status of children. Future research should focus on more upstream determinants of obesity and use whole systems approaches. The findings were highlighted in an NIHR signal in recognition of their significance in addressing childhood obesity. See results.
Price L, Wyatt K, Lloyd J, Abraham C, Creanor S, Dean S, et al. Are We Overestimating Physical Activity Prevalence in Children? Journal of Physical Activity & Health. 2018;15(12):941-5.
Wyatt K, Lloyd J, Creanor S, Green C, Dean SG, Hillsdon M, et al. Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children. Public Health Res. 2018;6(1).
Lloyd J, Creanor S, Logan S, Green C, Dean SG, Hillsdon M, et al. Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial. Lancet Child Adolesc Health. 2018;2(1):35-45.
Price L, Wyatt K, Lloyd J, Abraham C, Creanor S, Dean S, Hillsdon M Children's Compliance With Wrist-Worn Accelerometry Within a Cluster-Randomized Controlled Trial: Findings From the Healthy Lifestyles Programme. Pediatr Exerc Sci. 2018;30(2):281-7.
Lloyd J, Dean S, Creanor S, Abraham C, Hillsdon M, Ryan E, et al. Intervention fidelity in the definitive cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP) trial: findings from the process evaluation. Int J Behav Nutr Phys Act. 2017;14(1):163.
Lloyd J, McHugh C, Minton J, Eke H, Wyatt K. The impact of active stakeholder involvement on recruitment, retention and engagement of schools, children and their families in the cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP): a school-based intervention to prevent obesity. Trials. 2017;18(1):378.
Lloyd J, Creanor S, Price L, Abraham C, Dean S, Green C, et al. Trial baseline characteristics of a cluster randomised controlled trial of a school-located obesity prevention programme; the Healthy Lifestyles Programme (HeLP) trial. BMC Public Health. 2017;17(1):291.
Creanor S, Lloyd J, Hillsdon M, Dean S, Green C, Taylor RS, et al. Detailed statistical analysis plan for a cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children. Trials. 2016;17(1):599.
Lloyd J, Wyatt K. The Healthy Lifestyles Programme (HeLP) - An Overview of and Recommendations Arising from the Conceptualisation and Development of an Innovative Approach to Promoting Healthy Lifestyles for Children and Their Families. Int J Environ Res Public Health. 2015;12(1):1003-19.
Lloyd JJ, Wyatt KM. Qualitative findings from an exploratory trial of the Healthy Lifestyles Programme (HeLP) and their implications for the process evaluation in the definitive trial. BMC Public Health. 2014;14:578.
Wyatt KM, Lloyd JJ, Abraham C, Creanor S, Dean S, Densham E, et al. The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial. BMC Trials. 2013;14:95.
Wyatt K, Lloyd J. Development of a novel, school-located, obesity prevention programme, The Healthy Lifestyles Programme (HeLP). Education and Health. 2013;31(2).
Green C, Auguste PE, Lloyd JJ, Wyatt KM. Modelling of future outcomes to estimate the cost effectiveness of interventions related to child and adolescent overweight and obesity. The Lancet. 2012;380:S43.
Lloyd JJ, Wyatt KM, Creanor S. Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP): a novel school-based obesity prevention programme. BMJ Open. 2012;2(3).
Lloyd JJ, Logan S, Greaves CJ, Wyatt KM. Evidence, Theory and Context - Using intervention mapping to develop a school-based intervention to prevent obesity in children. Int J Behav Nutr Phys Act. 2011;8(1):73.
Wyatt KM, Lloyd JJ, Creanor S, Logan S. The development, feasibility and acceptability of a school-based obesity prevention programme: results from three phases of piloting. BMJ Open. 2011;1(1):e000026.
Public Health Devon, Devon County Council, Devon Association of Primary Head Teachers, Exeter Chiefs, Attik Dance, Just4Funk, Plymouth Raiders
For more information contact: Dr Jenny Lloyd