Weight Stigma Local Case Study: A Health Gains Approach in a 0-19 Service – Weight inclusive practices with children, young people and families.

Weight Stigma Local Case Study: A Health Gains Approach in a 0-19 Service – Weight inclusive practices with children, young people and families.

Gemma Holdsworth is a Healthy Families Specialist and Jill Harrison is Healthy Families Practitioner based within the Healthy Families team, which is community service within the 0-19 years Integrated Health & Wellbeing Service, Bolton NHS ft. They presented their Health Gains approach at the #FoodActive2021 Conference and have kindly submitted an indepth case study to share more detail about their approach and how they went about it. 

In March 2020 the pandemic brought an abrupt halt to our family group programmes. This enforced hiatus gifted us the opportunity that we had been looking for. A deep dive into CPD told us that our well-intentioned approaches to the health of children and young people in bigger bodies, had the potential to cause harm. This realisation triggered the inevitable decision to let go of the traditional practices we had been faithful to for over a decade. It was with some courage, inspiration and skills-development that we started to create our current approaches.


Why are we promoting a Health Gains Approach?

We chose the descriptor of Health Gains Approach for our new range of resources. It captures our purpose, and focuses our attention on encouraging enjoyable, sustainable, health-promoting habits. Our focus is now away from weight, and the potential for stigmatisation, and towards sustainable health behaviours.


Who do we serve?

Our work is with the families of children and young people in bigger bodies, from the ages of 2-19 years.


What are our outcomes?

Our new resources stem from evidenced practices that support physical, mental and social wellbeing. Our outcomes promote:

  • The stable growth of children
  • Positive parental feeding practices and sustainable habits
  • Healthy relationships with food, eating and bodies


What does a Health Gains Approach look like?

During the last 12 months we developed resources in 3 key areas:

  • Trust Guidelines and Pathway
  • Peer Training
  • Family Interventions

We wanted to ensure that our new approach is robust, and communicated well, within the community services and beyond. So far we have trained 250 staff in the rationale and communication model, and in the use of Level 1, Brief Intervention resources.

Our Level 2 programme is an intensive, 10-week programme delivered to parents by the Healthy Families team. Each week we release short, carefully structured, motion graphic videos, each with a key parenting message. We chose Ellyn Satter’s Division of Responsibility (sDOR) as our core-feeding model. Through this, we encourage structured, responsive feeding and enjoyable mealtimes. Each family has an assigned coach to guide the parent through the programme and to personalise content to the strengths and idiosyncrasies of each family.

This short professional overview video captures our approach.


What motivated us to change our approach?

In truth, we were ready for change. For some time we had been uncomfortable with the practice of weighing kids, and using these metrics to measure the outcomes of our programmes. Our ‘measurement nights’, with the look of upset or delight on young faces, we now realise could sow the seeds for a lifetime of shame and an unhealthy relationship with food, eating and bodies.

Our prescriptive nutrition messages were in line with good practice, our sessions were fun and interactive, and family feedback told us we were non-judgemental. Yet we were still, implicitly, stigmatising young bodies.


What did we learn during the last 12 months?

Where to start? Our learning continues on so many levels, as the resources we have recommended will start to indicate.

The approach we created is still in its infancy. As we transitioned our approach, we experienced ambivalence within ourselves. We debated, wrestled and challenged information that jarred against our long held, stubborn beliefs.

Once we were ready to take our approach out to our peers and families, we braced ourselves for resistance. We soon learned, though, that others are ready for change, too. In the main, we experience acceptance, relief, interest and enthusiasm for fresh ways of thinking and working.


Paediatrician feedback following an update presentation:

‘It’s likely the audience will change their clinical practice around use of language and weight, and how to discuss changes in weight with families and young people.’


Enhancing Families Team Leader feedback about new Level 1 resources:

‘I think in terms of weight stigma etc. that parents can be resistant, and the ‘what you need to do is…..’ approach generates more resistance. I love how the (resource) is focused on positives and I think it is a tool that will really stimulate a parent’s awareness.’


Family Feedback Highlights – Level 2 pilot programme:

This Has Transformed our Mealtimes

  • 100% would recommend to family or friend
  • Videos are ‘just right’ in content, length and ease of understanding
  • Positive relationship with coach 10/10
  • 70% of families now eating family meals without devices
  • 70% of families creating meal and planned variety-snack structure
  • 70% kids recognising hunger and fullness


Three things we would recommend to others taking a similar approach:

  1. Listen to, and believe, the lived experience of kids and adults in bigger bodies. A wonderful example of this is Angela Chesworth’s guest blog and presentation on the 2021 Conference Hub.
  2. Gather information from a multitude of sources (recommended list below)
  • CPD / Training
  • Weight Bias: Harvard Implicit Association Test for weight
  • Books
  • Literature
  • Podcasts
  • Social media
  1. Old beliefs die hard, and may take time to loosen. Enjoy discussions and debates, and challenge the new information with at least one trusted, flexible-minded other.


Contact details:

If you would like to get in touch with Gemma and Jill to find out more, please use the following contact details: gemma.holdsworth@boltonft.nhs.uk / jill.harrison@boltonft.nhs.uk

Recommended resources

Professional Training

Title Details Link

Unpacking Weight Science



Fiona Willer, Advanced Accredited Practicing Dietitian and lecturer at Queensland University. A range of training for health professionals and dietitians.


Unpacking Weight Science

Harvard Implicit

Association Test


Self-test to measure weight bias. Harvard Implicit Association Test
Today’s Dietitian A short course in weight-inclusive care  

Weight-Inclusive Care: Evidence and Best Practices



London Centre for Intuitive Eating


LCIE offer a range of courses for professionals and individuals, along with weight-inclusive guides to a range of conditions. London Centre for Intuitive Eating Courses



Title Details Link

Fiona Willer



Fiona Willer, Advanced Accredited Practising Dietitian and lecturer at Queensland University.


Fiona Willer Website


Health Not Diets



Ellyn Satter



Registered Dietitian and Family Therapist promoting evidenced models: Division of Responsibility (sDOR) and Eating Competence  (ecSatter)


Ellyn Satter Institute

Intuitive Eating




Evelyn Tribole, Registered Dietitian and Elyse Resch, Registered Dietitian. Intuitive Eating, promoting a healthy relationship with food, mind and body. Suitable for adults and adolescents


Intuitive Eating


Health at Every Size


Health without a focus on weight loss.  

HAES Research Library


HAES Healthsheets


The Feeding Doctor  

Dr Katja Rowell M.D. Responsive Feeding specialist


The Feeding Doctor


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