Abstract:
Background: Childhood obesity is of major concern in New Zealand with 12% of NZ children considered obese. High childhood BMI is known to be highly predictive of adult obesity, which is a key risk factor for type 2 diabetes, strokes, ischemic heart disease and hypertension. The estimated cost of treating obesity and its associated health implications in NZ is 4.4% of total healthcare spend. A healthy diet and regular physical activity play key roles in reaching a healthy weight. However, current methods of promoting healthy eating and exercise have not resulted in significant change. The Positive Parenting and Active Lifestyle programme (PPAL programme) targets parents as the moderators of healthy lifestyle behaviour, as a means of treating overweight/obesity in children. It is an already established community programme operating in New Zealand. Objective: The primary objective was to review the effectiveness of the PPAL Programme on the healthy lifestyle behaviours of at-risk children. To support the primary objective a systematic review was initially conducted to review the effectiveness of existing programmes. Methods: The systematic review included randomised control trials (RCT) and quasi-experimental trials conducted in the community or non-exclusively in schools for the prevention/treatment of childhood obesity in Australian and New Zealand. Subsequently, a mixed-methods review of the PPAL programme was undertaken. Participants in the community programme were parents of children aged 2–4 years, with BMIs in the 91st centile or greater. Pre- and post- programme questionnaires (n=12) were completed by families and were assessed with participant characteristic data collected throughout the referral process. Additionally, focus groups and quality improvement meetings with programme organisations were thematically analysed. The sets of data were then compared via methodological triangulation Results: The quantitative data revealed that only 3.5% (n=27) of the families referred by the B4SC team completed the programme. However, in those that did complete the programme significant changes occurred in two self-reported behaviours: eating together as a family (p=0.039) and the hours the child spent on a device (p=0.0046). All other behaviours saw positive change but were not significant. Qualitative analysis revealed that a number of barriers existed that resulted in poor uptake of the programme by families: other family priorities, a language barrier, lack of interest in the programme and lack of access to the programme. It also highlighted a pattern of poor communication processes and different referral pathways available for the programme. Conclusion: The PPAL programme failed to meet the needs of the overweight/obese child population it aimed to service. A high number of barriers, long (17-week) weight focused programme and poor communication resulted in low uptake of the programme by families. Moving forward, targeting community organisations such as churches or early childhood education centres with high populations of overweight/obese children with a shorter length, health and growth focused programme appears promising.