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

by Beth Bradshaw | 26 November, 2021 11:32 am

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:

 

What does a Health Gains Approach look like?

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

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[1] 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

 

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)
  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 / [2]jill.harrison@boltonft.nhs.uk[3]


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[4]
 

Harvard Implicit

Association Test

 

Self-test to measure weight bias. Harvard Implicit Association Test[5]
Today’s Dietitian A short course in weight-inclusive care  

Weight-Inclusive Care: Evidence and Best Practices[6]

 

 

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[7]

 

Websites

Title Details Link
 

Fiona Willer

 

 

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

 

Fiona Willer Website[8]

 

Health Not Diets[9]

 

 

Ellyn Satter

 

 

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

 

Ellyn Satter Institute[10]
 

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[11]
 

HAES

Health at Every Size

 

Health without a focus on weight loss.  

HAES Research Library[12]

 

HAES Healthsheets[13]

 

The Feeding Doctor  

Dr Katja Rowell M.D. Responsive Feeding specialist

 

The Feeding Doctor[14]

 

Links:
  1. professional overview: https://www.youtube.com/watch?v=cMPu381Zkks
  2. gemma.holdsworth@boltonft.nhs.uk / : mailto:gemma.holdsworth@boltonft.nhs.uk
  3. jill.harrison@boltonft.nhs.uk: mailto:jill.harrison@boltonft.nhs.uk
  4. Unpacking Weight Science: https://www.unpackingweightscience.com/
  5. Harvard Implicit Association Test: https://implicit.harvard.edu/implicit/selectatest.html
  6. Weight-Inclusive Care: Evidence and Best Practices: https://ce.todaysdietitian.com/WeightInclusive
  7. London Centre for Intuitive Eating Courses: https://learnwithlcie.teachable.com/courses
  8. Fiona Willer Website: https://www.fionawiller.com/
  9. Health Not Diets: https://healthnotdiets.com/
  10. Ellyn Satter Institute: https://www.ellynsatterinstitute.org/
  11. Intuitive Eating: https://www.intuitiveeating.org/
  12. HAES Research Library: https://drive.google.com/drive/folders/10O7uRK88SASa-4YFYV5Tyk1ElGuufCiX?fbclid=IwAR1iu1LqtbPy5mrbjKdAQIJgnT3YHVRdyhK6pseSHRTKL-uBqCemthLgVec
  13. HAES Healthsheets: https://haeshealthsheets.com/resources/
  14. The Feeding Doctor: https://www.thefeedingdoctor.com/about

Source URL: https://foodactive.org.uk/weight-stigma-local-case-study-a-health-gains-approach-in-a-0-19-service-weight-inclusive-practices-with-children-young-people-and-families/