1. Tom Lake
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6 Week Sport-Based Healthy Eating Intervention for Year 6 Students in Barnstaple Primary
Schools
3000 Words
Executive Summary
A role-model based childhood obesity intervention programme can make a positive
contribution to young people’s lives.
My proposal involves implementing a dual-curriculum, offered to Year 6 classes in Primary
Schools of the Barnstaple catchment area. The curriculum consists of six weeks of two back-
to-back 45 minute lessons; one educational classroom or kitchen-based lesson and one
practical multi-sports lesson with a healthy eating theme. The programme will be free for
the schools, funded entirely by Exeter City Football Club, through applied funding from
Active Devon, the County Sports Partnership for Devon.
Sessions will run by the Community Coaches from Exeter City in the Community; a
registered charity from whom a team of seven coaches work in the North Devon area. All
coaches are to be paid to achieve the Level 2 Award in Food Safety (Chartered Institute of
Environmental Health, 2015) allowing them to safely demonstrate food handling and
preparation. Later lessons include student participation in creating uncooked snacks such as
fresh fruit salads, vegetable batons and sandwiches, demonstrating a healthier way of
eating.
The educational lessons will consist firstly of classroom-based educational activities, with
lessons four and five practical-based food preparation. A first-team footballer from Exeter
City will visit the school in lesson six, assisting with the lesson and providing autograph and
photo opportunities.
Physical activity sessions will take the form of structured physical education lessons,
allowing teachers to use their planning, preparation and assessment time (PPA) in this
session. The lessons will be inclusive for all and focus on key themes of healthy eating,
delivered through a multi-skills programme using various types of sporting equipment.

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Once the programme is successfully completed, students will be accredited through an
internal certification system and given opportunities to participate further in discounted
extra-curricular activities, such as after-school and holiday clubs.
Assessing Policy Implications and Relevance to Local and National Priorities
The topic of childhood obesity and fitness is often presented as one of the greatest threats
to global, let alone national health (Karnik and Kanekar, 2012, pp1-7). Jones (2012a, pp27-
28) further demonstrates this, explaining that decreasing food quality and physical activity
levels have contributed to rising rates of obesity in the United Kingdom.
Intervening on childhood obesity and physical activity can be viewed as a largely proactive
idea, as improving health in young people can hopefully alleviate issues in later life.
Referring to the Ottawa Charter for Health Promotion (World Health Organisation (WHO),
1986, in The Open University, 2014a) the development of personal skills and knowledge of
public health are both applicable to the lifestyles of young people and also reflect the
movement away from clinical interventions to a health promotional approach.
There are also economic justifications for combatting childhood obesity; in 2012 alone
obesity cost the United Kingdom economy an estimated £47.9 billion and the National
Health Service (NHS) £6 billion (Dobbs et al, 2014, pp19-23). In comparison, this is greater
than the national defence budget, yet under 1% of the health budget is spent on childhood
obesity (Dutta, 2014), demonstrating the need for cost-effective anti-obesity programmes.
Nationally, concern is growing about the types of food children are consuming, contributing
to the lack of nutrients needed for current and future health. Ruxton and Derbyshire (2011,
pp20-33) suggest only 22% of boys and 7% of girls meet the national five-portions-a-day
target, whilst in 2012 only 21% of children in England met the recommendations of three
days per week of sixty minutes of vigorous activity (Townsend et al, 2015, pp25-27).
In Barnstaple, my targeted intervention location, the situation is worse. North Devon, and
the Barnstaple catchment area in particular, has the greatest number of obese Reception
and Year 6 children in the county (National Child Measurement Programme, 2007, in Devon
Primary Care Trust, 2008, pp7-9). The South West also suffers against national averages,
with only 13% of boys meeting physical activity guidelines in comparison with 25% in the
South East of the country (Townsend et al, 2015, p8).

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Statistics also reveal that in the county, North Devon has the worst levels of circulatory
diseases and coronary heart disease mortality in people under 75 (NHS Devon, 2011, p8) of
which poor diet and lack of exercise are both contributory factors. Whilst this is a national
problem, with 26% of deaths in England attributable to cardiovascular diseases (Townsend
et al, 2014, p22), it is important that the lifestyles of young people are monitored to avoid
these statistics increasing.
The evidence collected suggests that creating a national behavioural change in early years
can promote a healthier lifestyle, saving money for the NHS which can be prioritised
elsewhere. It also demonstrates that in North Devon children are exercising less than
regional counterparts, resulting in continual cycle where the most obese Year 6’s in the
county are leaving North Devon primary schools, passing the problem onto secondary
schools and beyond.
My proposal can directly tackle both issues of inactivity and poor diets in children. Devon
Primary Care Trust (2008, pp14-17), in their Healthy Weight Strategy for Devon, actually
identify five out of their twenty-five recommendations are to improve childhood obesity
and exercise. This demonstrates the realisation of the issues and subsequent need for
intervention, which can make a positive difference to both the nutritional understanding
and physical activity levels of children in the Barnstaple catchment area and beyond.
Exploring and Analysing Current Interventions
To create a competent and systematic proposal, the use of a planning model such as the
one created by Nutbeam and Harris (2004, in Sidell and Douglas, 2010, p256) can help to
ensure that the demand is evident enough to justify an intervention. Having used phase one
of the planning model to establish that the issue of healthy eating and activity in children is
a worthwhile cause for intervention, phase two involves finding a solution and creating
objectives and strategies for a successful intervention.
Nationally, high profile interventions have attempted to curb childhood and adult obesity,
with varying results. Non-intrusive methods, such as those exhibited in the Change4Life
programme (Department of Health, 2009, p15) and the development of the Active Kids
initiative (J Sainsbury PLC, 2014), have helped to deliver change, however these
programmes are difficult to quantify to demonstrate their success.

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Some programmes are more quantifiable; the Walk Once a Week programme (Living
Streets, 2012) costs just £1.31 per head and provides students who walk to school
collectable badges, increasing walking by 26%. This perhaps creates a greater impact as
parents can be involved too, addressing the concerns of Bandesha and Litva (2013, pp179-
184) that time is a constraint that prevents engagement; the school drop is a busy time yet
is usually allocated as parent and child time. There are of course exceptions to this with
working families and shift workers but the main rationale is that some parents are with their
children at that time anyway, making participation more likely.
Other initiatives specifically target schools, for example The School Fruit and Vegetable
Scheme (NHS, 2013) and National Healthy Eating Week (British Nutrition Foundation, 2014)
giving student’s exposure to healthier foods. These projects, whilst offering healthier
alternative foods, still don’t solve the issue of encouraging parents or carers to change their
eating habits, which has been shown to be the most effective treatment in child obesity in a
study based in Israel (Golan et al, 1998, p1133).
There are also programmes that simply collect data and give personalised advice to parents
about their child. The National Child Measurement Programme (Public Health England,
2013, pp5-6) measures the height and weight of children in Reception and Year 6, producing
body mass index score (BMI) and subsequently contacting parents if this BMI is too high,
offering advice on alternative healthier lifestyles. This is a non-compulsory intervention, yet
has a 99% participation rate due to its opt-out only basis (Public Health England, 2013, p7),
however this high rate maybe due to parent’s fears of their child being in a minority,
creating the ethical argument regarding emotionally forced participation and going against
social normality.
Unreliability is also a factor; the BMI measurement for children is questionable due to
growth patterns of children (Jones, 2012b, p430) which can distort scores, subsequently
leading to bad publicity for the programme (Thompson, 2015) and possibly a lower
participation rate. This frank language can possibly add harm (Devon, 2013) with evidence
suggesting a link between body image dissatisfaction and eating disorders (Butryn and
Wadden, 2005, pp290-291).

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Despite its remoteness, there have been interventions in both North Devon and Devon as a
whole, using a variety of methods. Attempts by PEDPASS (2010, pp19-23) to incorporate
cycling qualifications for Key Stage 2 students are ongoing, therefore its success cannot be
determined until the project’s conclusion in 2016. Other programmes have a clearer
projection of their success; the backlash from parents due to the confiscation of foods
deemed unhealthy by staff at Caen Primary School made both regional and national news
(Langston, 2014; Russell, 2014) which in an era of improved communications can damage
the reputation of the school.
Two other local programmes, Two Moors Primary School’s chef intervention (Healthy
Schools Plus, 2011, pp1-2) and the Food for Life Partnership at Collaton Primary School
(Food for Life, 2015) involve children interacting and working with the school and outside
chefs to create meals and taste new foods. These programmes offer varying characteristics;
children at Two Moors School created purchasable cookery books, whilst Collaton Primary
School incorporated themes into the National Curriculum such as ‘Indian days’ where they
tried different cultural delicacies.
From analysing these different approaches, there isn’t any local interventions’ focusing on
both the healthy living and active lifestyle elements on children. By using these two
different stimuli in the same fashion as Mottola et al (2010, pp265-272) the intervention
may appeal to more people, particularly those who struggle academically or in physical
education. This approach also helps to reduce inequalities in public health; giving poorly-
nourished children a chance to experience a wider range of healthier foods, whilst similarly
adding more structured exercise and play into a child’s life.
Further Outlining the Proposal
Using phase three of the Nutbeam and Harris planning model (2004, in Sidell and Douglas,
2010, p256), it is evident that to make a successful intervention lessons need to be learnt
from previous programmes, to generate public support.
Having studied prior interventions, it is clear that in an era of increased communication any
proposal must be deeply analysed before it begins, to ensure a welcomed response. This
also involves community empowerment and a bottom up approach, ensuring influence is
‘not flowing from a single institutional or structural source’ (McGuirk, 2000, in Brigden,

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p220). As seen with Caen Primary School, this didactic approach can indicate too much of a
nanny state and is summarised well by Lott (2014, in Russell 2014) who states the
programme made a ‘shift from encouragement to enforcement’.
By creating a programme which is voluntary to schools rather than a targeted approach,
there are elements of the upstream approach and distributed leadership (Jones, 2008, in
Bowns and Griffiths, 2012, p94) from the club, to the coaches, to the schools and then the
pupils. This upstream approach also follows the principles of McKinlay and Marceau (2000,
in The Open University, 2014b) in that there must be a sociocultural awareness; a realisation
that the programme is being delivered to impressionable children and its aimis to
encourage, not demand change.
The evaluation and success of the programme therefore must simply be in participatory
numbers, as opposed to believing that an in-school programme will help a child to change
their family’s eating habits, particularly accepting the varying socioeconomic statuses of
each family involved. Recognising limitations of an approach can be beneficial and afford
the programme more credibility, with Judge and Bauld (2006, pp341-344) suggesting
attempting too much change can cause disillusionment and negatively affect the success of
a programme.
It can also be difficult to gauge public opinion on interventions, with the example of the
James Report (1997, in Jones, 2012b, p432), being criticised for being too invasive. This
demonstrates the difficulty in assessing public opinion and the need for degrees of
community participation (Scriven, 2007, in Scriven, 2012, p381) to demonstrate whether an
intervention is needed. Public opinion will be achieved by using a cascade approach; firstly
determining the opinions of the twenty two primary schools in the Barnstaple area through
promotional literature and meetings, then school assemblies to gather support from
students.
This collaboration with individual schools to offer personalised programmes demonstrates
the flexibility and respect that partnerships need to work (Scriven, 2012, p380) with the
school being able to implement their own evaluation process to measure whether to
continue with the partnership. Student and staff feedback sheets could form the basis of the
feedback for Exeter City Football Club, with the six week programme a school-termly

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commitment from both parties to ensure continuity and the opportunity to positively
influence as many students as possible without sudden cancellations.
In terms of targeted populations; the programme focusses on Year 6’s in an area statistically
deemed as struggling with childhood obesity and activity (NHS Devon, 2011, p8; Townsend
et al, 2015, p8) rather than targeting individuals, which can stigmatize and demoralise them
(Bird and Whitehead, 2012, p58). From a safety point of view, Year 6’s are the oldest in
Primary School and with knives involved in the food preparation, there is a need to follow
the ethical and moral themes of the Health Cities Network (WHO, 2009, in Dooris, 2012,
pp354-355) of creating an environment that supports health, wellbeing and safety.
There are merits to intervene in Secondary School where students have access to a larger
array of fast food, yet the size difference makes planning and intervening difficult,
particularly ethically if only some students get the experience while others do not.
Phase four of Nutbeam and Harris’ planning model (2004, in Sidell and Douglas, 2010, p256)
involves implementing the programme, where the hard work of planning becomes a reality.
During the introductory phases of the programme, continual assessment would be applied,
using similar methods such as those shown by Hawe (1998, in Sidell and Douglas, 2012,
p269) by ensuring correct protocol is followed and participants are enjoying the experience.
This should be done by all parties involved, cementing the idea of partnership and equal
decision making as to how to improve the programme for future participants.
Reflective Analysis
Phase five, the final stage of the planning model by Nutbeam and Harris (2004, in Sidell and
Douglas, 2010, p256), encompasses the need to evaluate the programme, measuring it
against initial targets and offering methods of development for the future.
This evaluation can be done against pre-defined targets such as quantitative measurements
of participation and qualitative opinions of affected personnel, or in a more detailed
approach, similar to that of Hawe et al (1998, in Scriven, 2012, pp257-258). This
approach evaluates both the impact and outcome which can be vastly different; for example
the impact of the programme may have reached the desired number of students due to its
strong, easy repeatability, yet its outcome of encouraging behavioural change may not be
fulfilled.

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What both of the planning models (Nutbeam and Harris 2004, in Sidell and Douglas, 2012,
p256; Hawe et al (1998, in Sidell and Douglas, 2012, pp257-258) do not evaluate however is
the moral and ethical implications that the approach brings unless highlighted in qualitative
feedback. Offering a free health programme strongly appeals to schools in a recessive
economy, although the secondary aim of securing new sign-ups and fans may be subliminal
but could still be considered unethical by some. This is demonstrated further by Walker and
Kent (2009, p760), who suggest disregarding the idea of corporate social responsibility is
counter-productive to a company’s reputation.
This draws parallels with the smoking case study of Activity 21 (The Open University, 2014c)
in which the shopkeeper, in a recessive economic environment sells to underage customers
to keep him in business. Whilst the fundamentals of business are to capitalize on supply and
demand, following this model in an aggressive fashion may present a weakness and limit
business in the future.
As Bowns and Griffiths (2012, p80) identified, agencies need to work together when dealing
with multifaceted public health issues. The proposal involves the collaboration of five
parties; Exeter City Football Club as providers, Active Devon as funders, the Chartered
Institute of Environmental Health as educators, the school as the facilitator and the
parents/carers and children as participants.
The amount of partners used in the programme therefore presents an attractive proposition
to schools; the strength of using experts in their respective fields allows the highest quality
product to be produced, delivering a greater experience to all participants involved.
This collaboration presents a potential weakness; food preparation training is needed for
the coaches yet with Devon an isolated part of the country these courses are infrequent and
limited (Plymouth City Council, 2015, p4). With training fundamental to the programme, this
reliance on outside agencies could have a knock-on effect on elements of the programme,
such as start dates and promotional literature.
In addition to this reliance on outside agencies there is also dependence on coaching staff;
of whom the club has invested in via paid-for qualifications to help run the course. With only
seven staff, should one or two leave the club loses two important elements; the importance
of continuity in teaching (Fuss et al, 2008, p792) and also the necessary training, recreating

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the vicious cycle of being at the mercy of available training courses to continue the
programme.
To summarise, there are many principles that practitioners need to be aware of before
implementing any public health policy. There must also be an acceptance that working in
the public domain will rarely present universal agreement and many alternative viewpoints.
Interventions where practitioners undertake detailed research, collaborate with others and
empower communities stand a better chance of making a difference to the livelihood of
others, in our ever-changing world of public health.

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