Child healthy weight HHSCP (Paediatric Guidelines)

Warning

NHS Highland (North) promote an approach of health gain above weight loss, and define someone’s healthy weight as the weight they are when adopting healthy behaviours. A healthy relationship with food, movement and activity, and healthy relationships with ourselves and those around us are encouraged.
‘Child Healthy Weight’ has been a major priority for the Scottish Government for several years, and will remain so for the foreseeable future. NHSH strongly believe that ‘health’ is the most important aspect of this – physical, mental, social and emotional health. The approach is based on nurturing the strengths and abilities of individuals, families and communities to make the best choices they can within the real life circumstances they face. It is an approach that is inclusive, positive, non-judgemental and person centred. It looks to create supportive environments, and draw out the skills and resources of all participants to be as healthy as they can be.
Healthy behaviours can impact health regardless of weight change and that smaller people can have the same health issues as larger people, e.g. diabetes, heart disease, joint problems, depression. It is possible to make improvements in health independent of weight change.

The weight-inclusive approach encourages people to:

  • Eat a varied, healthy balanced diet of food that they enjoy - promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite and pleasure.
  • Exercise for enjoyment, not to lose weight - promoting individually appropriate, enjoyable, life enhancing physical activity, rather than exercise that is focussed on a goal of weight loss.
  • Promote all aspects of health and well-being for people of all sizes - recognising that health and wellbeing are multidimensional and they include physical, mental, social, spiritual, occupational, emotional and intellectual aspects.

For children the focus is more on:

  • ‘How We Eat’ as well as ‘What we Eat’
  • Parents offer a varied and balanced diet and lead by example, eat meals as a family and encourage an enjoyable active lifestyle
  • Parents and carers should encourage body confidence and emphasise that everyone is a different shape and size
  • Listening to our bodies – identifying emotional and hunger cues, what are you hungry for? E.g. is it food, fresh air, a pick me up, water, sleep
  • Children (and adults) often need to re-learn how to tune in to their bodies gauge of hunger and fullness. Ideally they would eat when they are hungry and stop when they are full.
  • Avoid referring to food as good or bad, move toward foods you should have more of or less of.
  • If a child has their weight measured by a professional and it is well below or above a ‘healthy range’ then a conversation about weight may take place.

Health & weight interventions offered to children and families in Highland, reflect the fact that weight management is complex and multifactorial; they acknowledge that both life circumstances and lifestyle make a difference to weight and health.

They aim to support and empower children and young people to make positive and sustainable changes to their health and wellbeing and to:

  • Improve the quality, variety and quantity of the food eaten
  • Maintain inherent abilities to gauge their body’s need for food – responding to internal cues of hunger, thirst and fullness
  • Improve skills to make better choices about food and health, appropriate to different social and cultural circumstances
  • Carers become good role models – promoting good food choices and fit and healthy bodies.
  • Take part in physical and social activity to improve wellbeing
  • Build good self-worth, self-care and body respect
  • Develop a healthy body image

Referral pathway

Health & weight interventions offered to children and families in Highland, reflect the fact that weight management is complex and multifactorial; they acknowledge that both life circumstances and lifestyle make a difference to weight and health.

Outcome: provide inequality sensitive interventions with children and families which support them to:
improve the quality, variety and quantity of the food eaten

  • Maintain inherent abilities to gauge their body’s need for food – responding to internal cues of hunger, thirst and fullness
  • Improved skills to make appropriate choices regarding food and health, appropriate to different social and cultural circumstances
  • Carers become good role models - promoting appropriate food choices, fit and healthy bodies.
  • Engage in physical and social activity to improve wellbeing
  • Build good self worth, self care and body respect

In order to meet these outcome children and families will be offered different levels of support and intervention, depending on their health behaviours, circumstances and needs.

Referrals are accepted via your local dietetic department: paediatricdietitians@highland.gov.uk

Tier 1 - Population-wide health improvement work

Smart Starts

Nursery/Early Learning and childcare programme designed to show how food can have a positive influence on your health and wellbeing, rather than be a threat to it; and that physical activity and movement is primarily about having fun, rather than following and exercise regime.  Cala Learning

High 5

Primary school based health and wellbeing programme delivered by the teacher. Lesson plans were developed by Health Improvement Specialists around Food and Nutrients, balanced meals, physical activity, Critical consumer skills, body confidence.
NHS Highland, Highland Council and CALA work together to deliver the sessions to teachers who then deliver the programme in the classroom.   Highfive

Active Play

A fun and inclusive programme delivered in primary schools by local play charities designed to increase children’s levels of Physical activity and physical literacy. It encourages free-play, conflict resolution, inclusion of all abilities and development of self esteem and leadership skills.

Contact – Care and Learning Alliance, Tel: 01463 222569, Email: info@calachildcare.co.uk

Tier 2 - Community family intervention

The X Programme was first introduced in NHS Highland (North) in 2009. It has now been updated and is delivered in a tier 2 setting with children and families on a digital platform, and in line with our weight inclusive approach. The primary goals are around developing healthy relationships with food and eating, nurturing support and communication within the family, enjoying being physically active, and building confidence and long term self-care and overall positive health and wellbeing.

It is a family focused, interactive, lifestyle change programme, which encourages healthy eating and promotes physical activity as well as addressing the behavioural, social and psychological causes of weight gain. It has been developed based on the principles of health behaviour change and aims to motivate participants to feel positive about making sustainable lifestyle changes.

It is important to recognise that families will have been through an extensive and complex journey to get to this point, and may have experienced many challenges, difficulties and perhaps levels of trauma that may or may not be associated with their weight or body shape. Their experiences are crucial to helping families understand together how health and happiness can be improved.

Throughout the programme, parents should be encouraged to be role models for their children and to take the main responsibility for lifestyle changes within the family.

Aims

  • Improve the quality and variety of the diet, and achieve an appropriate quantity of food in order to meet optimal growth
  • Maintain inherent abilities to gauge their body’s need for food – responding to internal cues of hunger, thirst and fullness
  • Improved skills to make appropriate choices regarding food and health, appropriate to different social and cultural circumstances
  • Carers become good role models - promoting appropriate food choices, fit and healthy bodies.
  • Engage in physical activity which meets the National recommendations
  • Build good self worth, self care and body respect

Criteria

Any child between 2 – 16 (or up to 18 if appropriate) who has a high growth chart reading (>91st centile) or who would like to have a better relationship with food, or who would like to improve their body confidence.
Exceptions can be made for children and families who do not meet the criteria but who would benefit from attending a tier 2 intervention.

How to Refer

How to Refer – The X Programme (scot.nhs.uk)

Families can self-refer via local paediatric dietetic service (paediatricdietitians@highland.gov.uk).

Professional Referral via local paediatric dietetic service (paediatricdietitians@highland.gov.uk).

Tier 3 - Specialist weight management

The Y Programme

“Y” is a Highland-wide tier 3 - child health and weight programme for children and young people (CYP) with a weight well above the average for their height and age. Specialist support is available to CYP and their families to achieve improved health and wellbeing. “Y” signifies that the programme is designed around You. The programme is delivered in partnership with Youngsters and their families. They lead the way. Health goals will be individualised depending on family’s ability and particular circumstances.

Structure

A question and answer session is offered to all new referrals to discuss expectations, concerns and hopes of participating in the Y- programme.

For those who opt in, the programme is delivered in 8 consecutive weekly or fortnightly sessions including the assessment session. After these sessions have ended further appointments are offered at 6 months and 1 year.
Appointments are with Registered Dietitians.

Appointments are offered via Near Me, phone and email information.

It is a family focussed approach. It is recommended that one parent or carer should be involved in consultations unless a CYP, of consenting age, wish to attend on their own.

Aims

  • Improved self-worth and increased self-esteem.
  • An increase in favoured physical activity.
  • A reduction in sitting down behaviour.
  • Improved diet quality.
  • Better-quality sleep.

Criteria

Any child who has a BMI > 99.6 centile, or had a significant change in BMI and/or other significant co-morbidities*(see list below for examples).

*Prader Willi Syndrome
Parent or carer has a history of an eating disorder
Complex Medical history
Complex social history
Type 1 Diabetes
Type 2 Diabetes

Any child who has a history of dieting behaviours or disordered eating, is worried or anxious about their weight, and/or has experienced stigma or social isolation due to weight issues.

Any child under 2 who has had a deviation through 2 or more growth centiles.

Any child or young person whose health did not improve on the X-programme.

How to Refer

Families can self-refer via local paediatric dietetic service (paediatricdietitians@highland.gov.uk).

Professional Referral via local paediatric dietetic service (paediatricdietitians@highland.gov.uk).

Child heath and weight referral form

Child healthy and weight referral form

(NHSH Intranet access required) You may need to copy and paste this link into a new window.  

Signposting

E Learning

‘How We Eat’ - designed to help parents/carers and those working with and for young children and families to support and guide young children to develop eating strategies which will help them make appropriate food choices, and appreciate that people come in all shapes and sizes. Calalearning

"Healthy Body Image and Body Confidence’ - designed to encourage children to feel confident about their bodies no matter what age, body shape, size and appearance.  Calalearning healthy body image and body confidence

‘Child Health & Weight’ - for people who work with children to have an increased understanding of the weight-inclusive approach and wider issues around child health and weight, and knowledge of how to apply this to their practice.  Child Healthy Weight (calaelearning.co.uk)

Challenging Weight Stigma – Learning Hub - evidence based online resource, aimed at increasing awareness of weight stigma and the impact it has on individuals, as well as identifying actions that can be taken to address it.
Public Health Scotland’s (PHS) virtual learning platform.

Challenging Weight Stigma – New Learning Hub Launched - News - Public Health Scotland

Information Leaflets

The Health Improvement Resources Service (HIRS) provide health information and an extensive health improvement resources library which covers the Highland Health and Social Care Partnership.

The library offers a wide range of health related materials for loan, free of charge to everyone working or living within the Highlands.

HIRS

Please visit website at HPAC to order resources.

Everyday Eating for Children
Everyday Eating for Children - Polish Version
Everyday Eating for Less
The Highland Food Guide
The Highland Food Guide - Polish Version

Toddler and Young Children: food, mood and health guidance

Outlines best practice on body confidence and eating well for children aged one to five years in NHS Highland. It highlights the important role child care providers have in food and health education in the early years. All who are involved in the health and wellbeing of children have a key role in ensuring that additional help and support are in place at the earliest stages. toddler-guidance-food-mood-and-health-final-version-may-2023.pdf (scot.nhs.uk)


Standards for the delivery of tier 2 and tier 3 weight management services

The purpose of these standards is to ensure a consistent, equitable and evidence-based approach to the treatment of overweight and obesity for children and young people up to the age of 18 years across weight management services in Scotland. The standards model a tiered approach to weight management services which broadly mirrors The UK Obesity Care Pathway.

Last reviewed: 01/09/2022

Next review date: 30/09/2025

Author(s): Paediatric Department .

Version: 1

Reviewer name(s): Julie Johnson, Paediatric Dietetic Lead, Sarah Mackenzie, Health Improvement Specialist, Valerie Macdonald, Senior Health Improvement Specialist .

Document Id: TAM524

Internal URL: https://nhshighlands.azurewebsites.net/umbraco/#/content/content/edit/12011