553540 research-article2014
RSH0010.1177/1757913914553540In PracticeIn Practice
In Practice
In Practice Every contact counts – so how can we raise the issue of weight in a way that helps? HENRY (Health, Exercise, Nutrition for the Really Young) is a national charity working to give babies and young children a healthy start in life and to prevent child obesity. Here, HENRY Chief Executive Kim Roberts considers how to effectively initiate conversations about sensitive lifestyle and weight issues when working with young families. that 60% of National Health Service Ask health practitioners about the subject (NHS) practitioners are themselves they find it most difficult to have a personal overweight.3 Practitioners who struggle conversation about and many will say weight. When HENRY was founded in with their own weight often tell us that 2006, we carried out some research to find they feel ill-equipped and embarrassed out more about what was needed to turn when they are expected to help others to around the rising rates of child obesity. achieve a healthy weight. Parents reported that they were often made to feel guilty for their children’s weight when The Need For Training they sought help or were dismissed as I sit there giving her advice and I know being unnecessarily anxious. At the same she’s not going to follow any of it… time, health practitioners talked of their discomfort about raising the issue of rapid These words of a health visitor weight gain in infancy, particularly when describing her work with the mother of an mothers were obese themselves, and felt obese three year old are not uncommon that they lacked the training, skills and time on a HENRY training course. And yet, to work with parents on the problem.1 health and community practitioners have a vital role to play in protecting children from This lack of confidence appears to be the emotional and physical consequences widespread and is accompanied by a of obesity – and need the support and sense of low self-efficacy. A survey of 137 children’s centre staff revealed markedly low training to fulfil this role effectively. We have seen that raising the issue of confidence scores (average 4.1 on a scale obesity is not straightforward. Initiating of 10) when working on issues related to effective conversations about weight and obesity prevention.2 An earlier survey of community paediatricians in Leeds showed lifestyle is a skilled piece of work that requires thought, confidence and that 17 of 18 surveyed felt they were ineffective in raising the issue understanding. Recognising this, managing obesity and of obesity is not perhaps not surprisingly straightforward HENRY provides tailored courses for health and early that they found the work years practitioners as well unrewarding (Rudolf M, as group and one-to-one programmes for 2006, personal communication). parents. Its Healthy Families: Tackling Although sobering, these findings are Child Obesity with HENRY workforce perhaps not surprising. Weight and overdevelopment package is accredited by the eating are complex emotional, as well as Royal Society for Public Health and has physical, issues, bound up in feelings of shame, personal attractiveness (or lack of enabled over 8,000 practitioners across the UK to raise sensitive weight issues it) and low self-esteem. Attitudes to food more effectively. are established early in life and are often Longitudinal research4 shows that brief intimately connected with messages about love, comfort and reward. HENRY training leads to lasting There is also the matter of our own improvements in practice, with 71% of lifestyle and weight issues, given the practitioners continuing to use the HENRY importance of modelling for effective approach up to five years after training. practice. The Boorman Review estimated Crucially, the training has an impact on
312 Perspectives in Public Health l November 2014 Vol 134 No 6 Downloaded from rsh.sagepub.com at LAKEHEAD UNIV on April 7, 2015
practitioners’ personal as well as professional lives, with 61% reporting that they had made positive changes in their own lifestyle.
Opening The Door Professor David Haslam, Chair of the National Obesity Forum and one of HENRY’s patrons, reckons that in his general practitioner (GP) surgery, he ‘wins or loses’ a patient in the first minute of any conversation about weight. So what is the crucial thing that needs to happen in that first minute? As with many things, it all comes down to building a relationship. Establishing rapport before the sensitive issue of obesity is raised will vary from individual, to individual but is likely to involve: •• Showing genuine pleasure to see someone; •• Being interested in aspects of their life, home and child that are not directly related to weight; •• Noticing and commenting on the positives; •• Sharing something appropriate about yourself; and •• Seeking their ideas and opinions. Creating trust is even more important than usual when it comes to dealing with sensitive issues around weight; one minute is long enough for someone to decide whether they are going to be judged or respected – and whether they feel safe to engage in a longer dialogue about weight. Practitioners who come along to HENRY training courses often imagine that they will learn a magic formula to initiate successful conversations about lifestyle. They leave the training realising that they themselves are the key to breaking through the resistance they encounter in their work with families.
In Practice
In Practice
People change not because they are told to, but when the conditions are right.
From Telling To Enabling Creating these conditions for change is the key task for practitioners when tackling obesity. HENRY training brings together elements of the evidence-based behavioural change strategies to create a framework made up of four stages: •• Stage 1: Building and maintaining a trusting relationship. •• Stage 2: Exploring to develop understanding and motivation. •• Stage 3: Moving forward with solution-focused support. •• Stage 4: Reviewing progress.
more fluid than a stage-by-stage illustration can easily represent: working in a genuine partnership means being responsive, spontaneous and flexible, and being led by the parent’s needs and pace. The thoughts and feelings that we experience when discussing our lifestyle and contemplating change can help us to move forward – or can get in the way and make change less likely. Actively listening to parents’ concerns with empathy and focusing on their strengths are therefore integral to developing readiness to change. Discussing lifestyle issues with a reflective, empathic listener helps someone to gain new insight, work through their emotions and find new determination to make changes. It can be a challenge for busy professionals to listen and get to know someone, rather than immediately focusing on problems and offering advice. Independent evaluation5 shows, however, that the HENRY approach works, leading to thousands of children getting a healthier and happier start in life.
Kim Roberts Chief Executive, HENRY CASE STUDY A mother of an obese child (4 years old, weighing over 6 stone) was referred to HENRY. She was confused and defensive, convinced that the reason for her son’s
These stages are repeated as different elements of a healthy family lifestyle are explored, goals and strategies are identified and implemented and progress is reviewed. In practice, the process is
excessive weight gain had not been diagnosed, despite confirmation that no underlying medical condition was causing the child’s obesity. A HENRY practitioner provided regular structured support to this mother over a two month period, during which she felt valued, heard and respected. She was helped to identify her existing strengths, as well as gain a clearer understanding of her family’s lifestyle and its impact on her son’s weight. Although providing a loving environment for her children was paramount to her, she realised that her own painful mealtime experiences as a child were affecting her parenting, leading to a lack of boundaries around what and when her children were eating. She now has greater self-belief, while accepting that there are changes she can make that will support a healthier family lifestyle and a healthier weight for her son. The family no longer watches TV at meal times, often eats together as a family and is more active. Consumption of high-fat and high-sugar foods has been reduced. The boy’s food preferences have also changed: he now readily eats fruit and is less attracted to sweets. As a result, his weight has stabilised and he has even lost a few pounds – as has his older sister.
References 1.
2.
Edmunds L. The primary prevention of obesity: The developmental research to support the pilot study of an intervention in infancy. A report undertaken for the Royal College of Paediatrics and Child Health, RCPCH, London, September 2006. Rudolf MC, Hunt C, George J, Hajibagheri K, Blair M. HENRY: Development, pilot and longterm evaluation of a programme to help practitioners work more effectively with parents of babies and pre-school children to prevent childhood obesity. Child: Care, Health
3.
4.
and Development 2010; 36(6): 850–7. Available online at: www.henry.org.uk/clinicalstudies (Last accessed 25th September 2014). Boorman S. NHS Health and Well-Being 2009. Available online at: http://www. nhshealthandwellbeing.org/pdfs/NHS%20 Staff%20H&WB%20Review%20Final%20 Report%20VFinal%2020-11-09.pdf (Last accessed 25th September 2014). Brown RE, Willis TA, Aspinall N, Candida H, George J, Rudolf MC. Preventing child obesity:
5.
A long-term evaluation of the HENRY approach. Community Practitioner 2013; 86(7): 23–7. Available online at: www.henry.org.uk/ clinical-studies (Last accessed 25th September 2014). Willis TA, George J, Hunt C, Roberts KPJ, Evans CEL, Brown RE et al. Combating child obesity: Impact of HENRY on parenting and family lifestyle. Pediatric Obesity 2013; 9(5): 339–50. Available online at: www.henry.org.uk/ clinical-studies (Last accessed 25th September 2014).
November 2014 Vol 134 No 6 l Perspectives in Public Health 313 Downloaded from rsh.sagepub.com at LAKEHEAD UNIV on April 7, 2015
RSH0010.1177/1757913914553540In PracticeIn Practice
In Practice
In Practice Every contact counts – so how can we raise the issue of weight in a way that helps? HENRY (Health, Exercise, Nutrition for the Really Young) is a national charity working to give babies and young children a healthy start in life and to prevent child obesity. Here, HENRY Chief Executive Kim Roberts considers how to effectively initiate conversations about sensitive lifestyle and weight issues when working with young families. that 60% of National Health Service Ask health practitioners about the subject (NHS) practitioners are themselves they find it most difficult to have a personal overweight.3 Practitioners who struggle conversation about and many will say weight. When HENRY was founded in with their own weight often tell us that 2006, we carried out some research to find they feel ill-equipped and embarrassed out more about what was needed to turn when they are expected to help others to around the rising rates of child obesity. achieve a healthy weight. Parents reported that they were often made to feel guilty for their children’s weight when The Need For Training they sought help or were dismissed as I sit there giving her advice and I know being unnecessarily anxious. At the same she’s not going to follow any of it… time, health practitioners talked of their discomfort about raising the issue of rapid These words of a health visitor weight gain in infancy, particularly when describing her work with the mother of an mothers were obese themselves, and felt obese three year old are not uncommon that they lacked the training, skills and time on a HENRY training course. And yet, to work with parents on the problem.1 health and community practitioners have a vital role to play in protecting children from This lack of confidence appears to be the emotional and physical consequences widespread and is accompanied by a of obesity – and need the support and sense of low self-efficacy. A survey of 137 children’s centre staff revealed markedly low training to fulfil this role effectively. We have seen that raising the issue of confidence scores (average 4.1 on a scale obesity is not straightforward. Initiating of 10) when working on issues related to effective conversations about weight and obesity prevention.2 An earlier survey of community paediatricians in Leeds showed lifestyle is a skilled piece of work that requires thought, confidence and that 17 of 18 surveyed felt they were ineffective in raising the issue understanding. Recognising this, managing obesity and of obesity is not perhaps not surprisingly straightforward HENRY provides tailored courses for health and early that they found the work years practitioners as well unrewarding (Rudolf M, as group and one-to-one programmes for 2006, personal communication). parents. Its Healthy Families: Tackling Although sobering, these findings are Child Obesity with HENRY workforce perhaps not surprising. Weight and overdevelopment package is accredited by the eating are complex emotional, as well as Royal Society for Public Health and has physical, issues, bound up in feelings of shame, personal attractiveness (or lack of enabled over 8,000 practitioners across the UK to raise sensitive weight issues it) and low self-esteem. Attitudes to food more effectively. are established early in life and are often Longitudinal research4 shows that brief intimately connected with messages about love, comfort and reward. HENRY training leads to lasting There is also the matter of our own improvements in practice, with 71% of lifestyle and weight issues, given the practitioners continuing to use the HENRY importance of modelling for effective approach up to five years after training. practice. The Boorman Review estimated Crucially, the training has an impact on
312 Perspectives in Public Health l November 2014 Vol 134 No 6 Downloaded from rsh.sagepub.com at LAKEHEAD UNIV on April 7, 2015
practitioners’ personal as well as professional lives, with 61% reporting that they had made positive changes in their own lifestyle.
Opening The Door Professor David Haslam, Chair of the National Obesity Forum and one of HENRY’s patrons, reckons that in his general practitioner (GP) surgery, he ‘wins or loses’ a patient in the first minute of any conversation about weight. So what is the crucial thing that needs to happen in that first minute? As with many things, it all comes down to building a relationship. Establishing rapport before the sensitive issue of obesity is raised will vary from individual, to individual but is likely to involve: •• Showing genuine pleasure to see someone; •• Being interested in aspects of their life, home and child that are not directly related to weight; •• Noticing and commenting on the positives; •• Sharing something appropriate about yourself; and •• Seeking their ideas and opinions. Creating trust is even more important than usual when it comes to dealing with sensitive issues around weight; one minute is long enough for someone to decide whether they are going to be judged or respected – and whether they feel safe to engage in a longer dialogue about weight. Practitioners who come along to HENRY training courses often imagine that they will learn a magic formula to initiate successful conversations about lifestyle. They leave the training realising that they themselves are the key to breaking through the resistance they encounter in their work with families.
In Practice
In Practice
People change not because they are told to, but when the conditions are right.
From Telling To Enabling Creating these conditions for change is the key task for practitioners when tackling obesity. HENRY training brings together elements of the evidence-based behavioural change strategies to create a framework made up of four stages: •• Stage 1: Building and maintaining a trusting relationship. •• Stage 2: Exploring to develop understanding and motivation. •• Stage 3: Moving forward with solution-focused support. •• Stage 4: Reviewing progress.
more fluid than a stage-by-stage illustration can easily represent: working in a genuine partnership means being responsive, spontaneous and flexible, and being led by the parent’s needs and pace. The thoughts and feelings that we experience when discussing our lifestyle and contemplating change can help us to move forward – or can get in the way and make change less likely. Actively listening to parents’ concerns with empathy and focusing on their strengths are therefore integral to developing readiness to change. Discussing lifestyle issues with a reflective, empathic listener helps someone to gain new insight, work through their emotions and find new determination to make changes. It can be a challenge for busy professionals to listen and get to know someone, rather than immediately focusing on problems and offering advice. Independent evaluation5 shows, however, that the HENRY approach works, leading to thousands of children getting a healthier and happier start in life.
Kim Roberts Chief Executive, HENRY CASE STUDY A mother of an obese child (4 years old, weighing over 6 stone) was referred to HENRY. She was confused and defensive, convinced that the reason for her son’s
These stages are repeated as different elements of a healthy family lifestyle are explored, goals and strategies are identified and implemented and progress is reviewed. In practice, the process is
excessive weight gain had not been diagnosed, despite confirmation that no underlying medical condition was causing the child’s obesity. A HENRY practitioner provided regular structured support to this mother over a two month period, during which she felt valued, heard and respected. She was helped to identify her existing strengths, as well as gain a clearer understanding of her family’s lifestyle and its impact on her son’s weight. Although providing a loving environment for her children was paramount to her, she realised that her own painful mealtime experiences as a child were affecting her parenting, leading to a lack of boundaries around what and when her children were eating. She now has greater self-belief, while accepting that there are changes she can make that will support a healthier family lifestyle and a healthier weight for her son. The family no longer watches TV at meal times, often eats together as a family and is more active. Consumption of high-fat and high-sugar foods has been reduced. The boy’s food preferences have also changed: he now readily eats fruit and is less attracted to sweets. As a result, his weight has stabilised and he has even lost a few pounds – as has his older sister.
References 1.
2.
Edmunds L. The primary prevention of obesity: The developmental research to support the pilot study of an intervention in infancy. A report undertaken for the Royal College of Paediatrics and Child Health, RCPCH, London, September 2006. Rudolf MC, Hunt C, George J, Hajibagheri K, Blair M. HENRY: Development, pilot and longterm evaluation of a programme to help practitioners work more effectively with parents of babies and pre-school children to prevent childhood obesity. Child: Care, Health
3.
4.
and Development 2010; 36(6): 850–7. Available online at: www.henry.org.uk/clinicalstudies (Last accessed 25th September 2014). Boorman S. NHS Health and Well-Being 2009. Available online at: http://www. nhshealthandwellbeing.org/pdfs/NHS%20 Staff%20H&WB%20Review%20Final%20 Report%20VFinal%2020-11-09.pdf (Last accessed 25th September 2014). Brown RE, Willis TA, Aspinall N, Candida H, George J, Rudolf MC. Preventing child obesity:
5.
A long-term evaluation of the HENRY approach. Community Practitioner 2013; 86(7): 23–7. Available online at: www.henry.org.uk/ clinical-studies (Last accessed 25th September 2014). Willis TA, George J, Hunt C, Roberts KPJ, Evans CEL, Brown RE et al. Combating child obesity: Impact of HENRY on parenting and family lifestyle. Pediatric Obesity 2013; 9(5): 339–50. Available online at: www.henry.org.uk/ clinical-studies (Last accessed 25th September 2014).
November 2014 Vol 134 No 6 l Perspectives in Public Health 313 Downloaded from rsh.sagepub.com at LAKEHEAD UNIV on April 7, 2015
