Childhood nutrition and obesity programmes (FOI)

Request 

Please can the Public Health team answer the following questions -

A

Over the past 5 years which programmes specifically addressing childhood nutrition and obesity have been delivered in Jersey, either at home, school or in the community and at what cost and what has the benefit/results been?

B

The new Food Dudes programme - please can they provide the efficacy data from the programme rolled out in other jurisdictions which justified the delivery of the programme in Jersey. 

C 

What is the projected cost to deliver this to all primary schools in Jersey and what is the timeline for delivering this programme.

D

What other programmes does Public Health have in plan for the next 3-5 years that address this issue and at what cost? 

Response 

A 

Family Food and Fitness 

Family Food and Fitness is a free programme that can help families around diet and exercise. It aims to support long-term behaviour changes through a combination of: 

• cooking classes
• sports
  
• other fun activities. 

This is an eight-week programme led by registered dietitians and qualified physical activity specialists. It can be accessed by whole families.

Food Dudes
Food Dudes is a behaviour change programme to help children develop taste and liking for a wide variety of fruits and vegetables. The programme is carried out in schools using the following techniques which are grounded in evidence of what works in human psychology research: 

• role modelling
• fun and educational rewards
• repetition.

The programme has been adopted by hundreds of primary schools in Ireland, the UK and elsewhere where it achieved positive health-related outcomes for children taking part.
Primary school meals partnership (Flourish)
Public Health and CYPES (Children, Young People, Education and Skills) work with local charity Caring Cooks to provide a daily lunch service in some primary schools as an alternative to lunch boxes. Meals provided are balanced, nutritious and dietitian-approved. They aim to support children with their: 

• learning
• healthy growth
• positive health outcomes later in life.

Healthy Start

Healthy Start is a local programme providing vouchers for fresh fruit and vegetables to low-income parents of young children. It aims to increase access to good nutrition for parents and their child during the crucial early stages of growth and development.
UNICEF Baby friendly breastfeeding initiative
The UNICEF Baby Friendly Initiative is based on a global accreditation programme developed by UNICEF and the World Health Organisation (WHO).
The programme supports breastfeeding and parent-infant relationships by working with public services to improve standards of care and best practice. It has been implemented in Jersey to train local professional working with young families to build on the good work of these services.
Benefits
As referenced in the Food and Nutrition strategy , progress towards achieving strategic aims will be measured at a population level through publicly available statistics reports and through an 'outcomes-based accountability' methodology. For example, the children and young people's survey available on gov.je  shows an increase in children consuming their recommended minimum five portions of fruit and vegetables per day, from one in four children in 2018 to one in three children in 2022, in line with investment in this area through the work of the Food and Nutrition Strategy.
These high-level indicators do not prove causality in their own right, but an outcomes-based accountability approach means putting evidence-based interventions in place that have been demonstrated to achieve outcomes and monitoring population trends to ensure they begin showing positive change which confirms investments are achieving the aims and objectives. Internal performance measures are also available, which evaluate each initiative at a programme level, reporting on more granular outcome measures.
Food and Nutrition Strategy (gov.je)
Public Health Costings breakdown
2018: £67,540.66
2019 £179,601.78
2020: £39,583.55 (Public Health fully diverted to COVID-19 pandemic response and very little business as usual continued.)
2021: £53,825.4 (Public Health still largely diverted to COVID-19 pandemic response and very little business as usual continued.)
2022: £167,006.60
Delivery staff costs (full on-costs including pension)

 1 x PublicHealth Registered Dietitian: £74,630 p/a

1 x Registered Nutritionist (from October 2020): £50,489 p/a
B
Outcomes of the Food Dudes programme:

• Substantial and long-lasting increases in consumption of fruit and vegetables especially in poorest eaters
• Decreases in consumption of sweet and fatty foods – 20-50%
• Highly reliable regardless of location and social deprivation
• Benefits extend to whole family.

This is underpinned by leading research in behaviour change and well evaluated:

• Used in all primary schools in Ireland – half a million children
• Used in West Midlands, London and Scotland – 150,000 children
• Also California, Utah, Sicily and Milan
• Won awards for example from WHO and UK Chief Medical Officer's Gold Award.

Peer reviewed evaluation reports including efficacy outcome data; 

Newson, R. S., Lion, R., Crawfrod, R. J., Curtis, V., Elmadfa, I., Feunekes, G. I. J., Hicks, C., Liere, M., Lowe, C. F., Meijer, G. W., Pradeep, B. V., Reddy, K. S., Sidibe, M., & Uauy, R. (2013). Behaviour change for better health: nutrition, hygiene and sustainability. BMC Public Health, 13(Suppl 1):S1. Doi: 10.1186/1741-2458-13-S1

Pears, S.L.; Jackson, M.C.; Bertenshaw, E.J.; Horne, P.J.; Lowe, C.F.; & Erjavec, M. (2012) Validation of food diaries as measures of dietary behaviour change. Appetite. 58(3), 1164-1168

Camoes-Costa, V.; Erjavec, M.; & Horne, P.J. (2011) The impact of body-part naming training on the accuracy of imitative performances in 2- to 3-year old children. Journal of the Experimental Analysis of Behavior. 96(3), 291-315.

Camoes-Costa, V.; Erjavec, M.; & Horne, P.J. (2011) Comprehension and production of body part labels in 2 to 3-year-old children. British Journal of Development Psychology. 29(3), 552-571.

Gurteen, P.M.; Horne, P.J.; & Erjavec, M. (2011) Rapid word learning in 13- and 17-month olds in a naturalistic two-word procedure: looking versus reaching measures. Journal of Experimental Child Psychology. 109(2), 201-217.

Horne, P.J.; Greenhalgh, J.; Erjavec, M.; Lowe, C.F.; Viktor, S.; & Whitaker, C.J. (2011) Increasing pre-school children's consumption of fruit and vegetables. A modelling and rewards intervention. Appetite. 56(2), 375-385.

Hardman, C.A.; Horne, P.J.; & Lowe, C.F. (2011) Effects of rewards, peer-modelling and pedometer targets on children's physical activity: A school-based intervention study. Psychology and Health. 26(1), 3-21.

Lowe, C.F.; & Horne, P.J. (2009) 'Food Dudes': Increasing Children's Fruit and Vegetable Consumption. Cases in Public Health Communication & Marketing. 3, 161-185.

Hardman, C.A.; Horne, P.J.; & Lowe, C.F. (2009) A home-based intervention to increase physical activity in girls: the Fit'n'Fun Dudes program. Journal of Exercise Science and Fitness. 7(1), 1-8.

Greenhalgh, J.; Dowey, A.J.; Horne, P.J.; Lowe, C.F.; Griffiths, J.H.; & Whitaker, C.J. (2009) Positive- and negative peer modelling effects on young children's consumption of novel blue foods. Appetite. 52(3), 646-653.

Horne, P.J.; Erjavec, M.; & Lovett, V.E. (2009) The effects of modelling, local stimulus enhancement, and affordance demonstration on the production of object-directed actions in 6-month-old infants. British Journal of Development Psychology. 27(2), 269-281.

Horne, P.J.; Erjavec, M.; & Lovett, V. (2009) The effects of modelling, local stimulus enhancement, and affordance demonstration on the production of object-directed actions in 6-month-old infants. British Journal of Developmental Psychology. 27(2), 269-281.

Horne, P.J.; Hardman, C.A.; Lowe, C.F.; Tapper, K.; Le Noury, J.; Madden, P.; Patel, P.; & Doody, M. (2009) Increasing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland: the Food Dudes intervention. European Journal of Clinical Nutrition. 63(5), 613-618.

Erjavec, M.; Lovett, V.E.; & Horne, P.J. (2009) Do infants show generalized imitation of gestures? II: The effects of skills training and multiple exemplar matching training. Journal of the Experimental Analysis of Behavior. 91(3), 355-376.

Horne, P.J.; Hardman, C.A.; Lowe, C.F.; & Rowlands, A.V. (2009) Increasing children's physical activity: a peer modelling, rewards and pedometer-based intervention. European Journal of Clinical Nutrition. 63(2), 191-198.

Hardman, C.A.; Horne, P.J.; & Rowlands, A.V. (2009) Children's pedometer-determined physical activity during school-time and leisure-time. Journal of Exercise Science and Fitness. 7(2), 129-134.

Erjavec, M.; & Horne, P.J. (2008) Determinants of imitation of hand-to-body gestures in 2- and 3-year-old children. Journal of the Experimental Analysis of Behavior. 89(2), 183-207.

Whitaker, S.; Lowe, C.F.; & Wearden, J.H. (2008) When to respond? And how much? Temporal control and response output on mixed-fixed-interval schedules with unequally probable components. Behavioural Processes. 77(1), 33-42.

Horne, P.J.; Lowe, C.F.; & Harris, F.D.A. (2007) Naming and categorization in young children: V. Manual sign training. Journal of the Experimental Analysis of Behavior. 87(3), 367-381.

Horne, P.J.; & Erjavec, M. (2007) Do infants show generalized imitation of gestures?. Journal of the Experimental Analysis of Behavior. 87(1), 63-87.

Lowe, C.F.; Horne, P.J.; Hardman, C.A.; & Tapper, K. (2006) A peer-modeling and rewards-based intervention is effective in increasing fruit and vegetable consumption in children. Preventive Medicine. 43(4), 351.

Horne, P.J.; Hughes, J.C.; & Lowe, C.F. (2006) Naming and categorization in young children. IV. Listener behavior training and transfer of function. Journal of the Experimental Analysis of Behavior. 85(2), 247-273.

Lowe, C.F.; Horne, P.J.; & Hughes, J.C. (2005) Naming and categorization in young children: III. Vocal tact training and transfer of function. Journal of the Experimental Analysis of Behavior. 83(1), 47-65.

Horne, P.J.; Tapper, K.; Lowe, C.F.; Hardman, C.A.; Jackson, M.C.; & Woolner, J. (2004) Increasing children's fruit and vegetable consumption: A peer-modelling and rewards-based intervention. European Journal of Clinical Nutrition. 58(12), 1649-1660.

Horne, P.J.; Lowe, C.F.; & Randle, V.R.L. (2004) Naming and categorization in young children: II. Listener Behavior training. Journal of the Experimental Analysis of Behavior. 81(3), 267-288.

Lowe, C.F.; Horne, P.J.; Tapper, K.; Bowdery, M.; & Egerton, C. (2004) Effects of a peer modelling and rewards-based intervention to increase fruit and vegetable consumption in children. European Journal of Clinical Nutrition. 58(3), 510-522.

Tapper, K.; Horne, P.J.; & Lowe, C.F. (2003) Helping children eat fruit and vegetables. The Psychologist. 16, 18-21.

Lowe, C.F.; Horne, P.J.; Harris, F.D.A.; & Randle, V.R.L. (2002) Naming and categorization in young children vocal tact training. Journal of the Experimental Analysis of Behavior. 78(3), 527-549.

Henry, L.M.; & Horne, P.J. (2000) Partial remediation of speaker and listener behaviors in people with severe dementia. Journal of Applied Behavior Analysis. 33(4), 631-634. 

The following full-access peer reviewed articles are attached: 

• Food Dudes evaluation 2016
• EJCN 2008 Horne et al Ireland
• Food Dudes pre-school

Please also see:
Increasing children's lunchtime consumption of fruit and vegetables: an evaluation of the Food Dudes programme | Public Health Nutrition | Cambridge Core
 C
Costs of initial roll out is £290,400, where all primary school year groups receive Food Dudes.
After initial role out, (phased over 2022 and 2023), the programme only targets reception years as new children enter primary school. The cost of delivering this to all primary schools is £83,904.
D

Planned expansion of evidence-based programmes highlighted in response to question one. These programmes have so far been piloted in 2019, then discontinued due to the COVID-19 pandemic, and are now re-launching to pilot level. For example, the Healthy Start fruit and vegetable voucher scheme was piloted and evaluated among low-income families of 0–1-year-olds and is being expanded to match provision of the UK counterpart scheme (reaching low-income families with 0–3-year-olds). The budget and projected spend to expand these programmes across the community to ensure equity of access is £858,545 recurrent plus inflation.