Research and analysis

PHE centres: East of England

Updated 15 February 2021

Cambridgeshire

The local authority undertook an iterative approach to increase child and parental engagement in health-related behaviour change. The overall objective was to reduce childhood obesity. At the time that this research took place there was a Healthy Weight Strategy for 2016 to 2019, however, a strategy had already been in place since 2008. The strategy stated that ‘efforts to address unhealthy weight need to be collaborative and across the whole system.’

The strategy had 5 objectives:

1. Create an environment which promotes and supports a healthy weight.
2. Encourage healthy lifestyle behaviours for nutrition and physical activity.
3. Ensure everyone is supported throughout their life to maintain a healthy weight.
4. Engage and enable individuals and communities to take responsibility for their health.
5. Address healthy weight inequalities.

The local authority undertook this work knowing the impact that a healthy weight has on health across the life course and the associated higher risk of long-term conditions.

At the time this research took place the Joint Strategic Needs Assessment (JSNA) described Cambridgeshire as a relatively rural area, with lower population density than in England and the East of England but notably higher density in Cambridge. The 2015 population was estimated at 650,000. Peterborough is excluded from the above as it is overseen by Peterborough City Council.

Local approach

A proportion of senior staff had been in post for a number of years and this provided stability to the childhood obesity work.

Strategy

Cambridgeshire utilised its local assets, including Cambridge University’s Centre for Diet and Activity Research that is represented on the Public Health Reference Group (PHRG), which developed the whole-systems based Healthy Weight Strategy. In addition, the PHRG consulted directly with members of the public in a number of ways including via lifestyle programmes and focus groups. Particular effort was made to involve hard reaching groups. The county council commissioned the 5 lower tier authorities under it to develop their own community-led physical activity programmes as part of their own health and wellbeing plans. The county council provided support by encouraging collaboration and learning from each others’ practice, arranging county wide events and the county’s School Sports Partnership was used to evaluate the programmes.

Services

The county council commissioned Lifestyle Services. These provided programmes for adults, children and families across Cambridgeshire.

The Soil Association’s Food For Life programme was commissioned in an area of high deprivation and this was rolled out to more areas in need of ‘universal plus’ services.

Tier 1 services included universal healthy eating work in the community and in children’s centres, with an investment in junior park runs.

Work was being undertaken with the joint commissioning unit for 0 to 19 year olds to try to synchronise services where possible. This way, school nurses and health visitors provided consistent messages, and all staff were aware of the available services and referral routes.

National Child Measurement Programme

The National Child Measurement Programme (NCMP) was part of the provision commissioned from Lifestyle Services. The provider was already working with schools, easing access into the Children and Families Weight Management Programme for those identified by the NCMP and increasing parental engagement (although this was a challenge). Alternative methods of delivery and promotion had also been tested in order to increase engagement. This was a focus and an iterative approach was taken, as parents had to attend the programme with their children. The programme was 3 to 6 months long, involving physical activity and eating habits. All staff were trained in behaviour change methods and the service included advice from dietitians and physical activity experts.

The exit plan was to get people to engage with the universal services available in their district. The county council constantly reviewed what was and wasn’t working. The attrition rates for the programme were quite high, about 30% completed the course, and those who completed it might not have been the ones who needed it most. The NCMP letter to parents caused a number of angry phone calls each year. Cambridgeshire had a particular problem in that a number of well-educated parents felt able to criticise the basis of the programme or the scientific ability of the people running it. Those parents were difficult to engage in the child and family weight management programme.

A report was completed by the data analyst and each school received 3-year aggregated data. When a school requested more detail this was given wherever possible, whilst ensuring individuals were not identifiable. In further relation to data sharing, data was not sent to GPs. There was a general feeling that GPs were not concerned about childhood obesity in the same way as adult obesity: they felt it was a lifestyle issue and there was nothing they could do about it. However, GPs knew all the referral routes and there was a pathway for children and young people with an underlying medical condition that was causing the overweight or obesity. There was an excellent paediatric endocrinologist at Addenbrookes Hospital. Even when a child had a condition such as type 2 diabetes, they would see a specialist, so their GP was not seen as pivotal.

Outcome

At the time this research took place it was too early to say whether this approach would reduce childhood obesity.

Further work

The strategy was in place until 2019.

Central Bedfordshire

The local authority implemented a whole-systems approach to reduce the obesogenic environment, target personal responsibility and upskill people to make healthier choices.

Central Bedfordshire Excess Weight Partnership Strategy 2016 to 2020:

The aim of the strategy is to bring together, coordinate and focus the contributions of all local authority departments and partner organisations. By aligning our efforts we will work to create an environment across Central Bedfordshire which supports every child, young person, adult and older person to achieve and maintain a healthy weight.

The cost of obesity to the NHS and on people’s lives required action to try to reduce the burden posed by ill health.

At the time this research took place (2015), Central Bedfordshire was a mainly rural area in the East of England, with a population of 274,000, including 65,200 children and young people aged 0 to 19.

Local approach

Central Bedfordshire acknowledged that public health can’t tackle this problem alone and that obesity is everyone’s business. They made the best use of existing assets in order to take all opportunities to disseminate messages and to ensure messaging was consistent, whilst also encouraging personal responsibility.

Strategy document

At the time this research took place, Central Bedfordshire had already been implementing partnership working and what is now recognised as a whole-systems approach to obesity for 10 years. The overarching strategy document was the Excess Weight Partnership Strategy 2016 to 2020. This was developed in partnership with 14 local authority departments including planning, environmental health, staff wellbeing action group, transport, parks and leisure and libraries, as well as with partners from other services including school nurses, health visitors, children’s centres, midwives and weight management providers. The Healthy Weight Strategic Group met twice a year to combine strategies. The strategy was complemented with an action plan that stated what every partner would do. This was monitored quarterly.

Service provision

Central Bedfordshire and Bedford Borough Council combined assets by using the same staff and providing the same services (they were also working with Milton Keynes, but not on the NCMP, as it was commissioned differently there). There was a clear excess weight pathway, with tiers linked to each other. Services for children and families were provided at tier 1 and tier 2, with community paediatrics support at tier 3. Clear and accessible information on the services provided is included in the JSNA.

National Child Measurement Programme

The NCMP was embedded into year reception and year 6 health reviews so that it was completely normalised. The participation rate was high (99%). The school nurse service was responsible for the NCMP and health assistants weighed and measured the children.

Central Bedfordshire sent letters out to the parents of children measured as under, over and very overweight. A local version was used rather than the Public Health England (PHE) template. It gave details of the tier 2 provider and invited parents to make contact. This was followed up 4 weeks later by the school nurse contact in order to increase the numbers taking up the offer.

Data was fed back to schools and the local authority was able to track its data from year R to year 6, meaning the right population at the right time can be targeted. Data was used to target interventions to the areas of greatest need.

Outcome

At the time this research took place it was too early to say whether this approach would reduce childhood obesity.

Further work

The strategy is in place until 2020 and contains the actions for partners.

Advice to other local authorities

The importance of passion and persistence, of knowledge and experience. Childhood obesity is everyone’s business but it’s still driven from the centre so it always remains someone’s responsibility.

Essex

The local authority used iterative practice, including partnerships and schemes to increase schools engagement in healthy living. This was part of a wider, whole-systems approach. The project was to last 3 years and the aim was to halt the rise in childhood obesity and increase physical activity.

At the time this research took place Essex had an estimated population of 1,310,835 (city population, 2011), with 12 districts under Essex County Council. Braintree district covered 3 towns and multiple villages in Mid Essex. Ten schools from across the area volunteered to participate.

Local approach

Essex County Council was supporting a pilot in the District of Braintree in a number of schools. It was an awareness raising and signposting campaign based initiative. It used the already existing Livewell Brand to promote the programme.

In addition, Essex was supporting a number of initiatives to prevent and manage childhood obesity. Essex public health team commissioned the Healthy Schools Programme. At the time this interview was conducted, it had been in place for over 17 years and was well established and many schools chose to focus on healthy lifestyles. Ninety-eight percent of over 450 Essex Schools were engaged in the programme. A potential reason for the high levels of engagement may have been the increased level of support schools received and the links with the Child and Family Wellbeing service.

The County Sports Provider (Active Essex) also supported schools by looking at their physical activity offer and the use of their sports premium. In 2015 Essex County Council started to promote the daily mile. The Director of public health (DPH) was extremely enthusiastic about it and every primary school was written to informing them of the scheme (more than 400). Following this, Active Essex put together their own offer of support for schools. Up-take of the Daily Mile was hard to evaluate as schools were not required to tell the county that they were using it. However, schools could pin themselves on the national daily mile map so that the county council could see whether they were involved. If they had engaged via Active Essex, then their participation was recorded – there was an attempt to get more data around this.

A School Meals Advisory Service was available to all county-run schools who provided in-house catering. They had a specialist team who looked at nutrition in schools’ menus. They provided an analysis and 3 weekly menus, including 2 courses every day and provided children with the opportunity to have fruit or yoghurt instead of pudding. Uptake was reasonable although exact figures were not available. Data was collected and evaluated on how many children had school meals and the differences between year groups, for example, if there was a drop off after the universal free school meals end for children.

Essex provided a whole school food policy support pack as part of Livewell Child, in downloadable format from the website which schools could choose to adopt. It covered packed lunches, drinks in schools, celebrations, parent teacher association events and breakfast or afterschool clubs, thus, all aspects of food in schools were covered. This, however, had been difficult to evaluate as schools were not required to use it.

Essex commissioned a Children’s Weight Management Programme (CWMP). This was a family intervention with a set number of weeks that covered nutrition and physical activity. Details of this service were included in the NCMP feedback letter to parents. This service was based on group work with the ability to access one-to-one support. Parents who wanted to use the service needed to participate along with their children. In terms of the strategy that underpinned these interventions, they all fit into the ‘children and young people will have the best start in life’ core outcome.

Essex County Council had its own Active Travel team to provide support on planning active travel to organisations and to promote national competitions with schools as well as initiatives such as walk to school week or month.

With regard to fast food licencing, many lower tier authorities were considering it to varying extents, as this is the responsibility of the planning authority. The county council was considering whether county level advice or guidance would be helpful to support this.

Deprivation

There was no specific focus on deprivation but Braintree as a pilot site was chosen as it was the district in Essex with the highest increase in weight between reception year and year 6 pupils. The Braintree pilot schools covered a wide demographic range. The schemes and programmes were predominantly universal. However, learning and outcomes from the Braintree pilot could assist in future targeting of more deprived areas and working with schools within those areas.

National Child Measurement Programme

The NCMP was delivered by the commissioned Child and Family Health service provider that had a designated NCMP lead to coordinate the process. Children identified were offered the CWMP in the NCMP results letter which used the PHE template but with local information included. The CWMP was based on group work with the ability to access one-to-one support. At the time this research took place there was no routine NCMP feedback provided to schools or GPs.

The Child and Family Health service provider delivered the NCMP programme in schools and then referred to the CWMP for weight management support as required. Importantly, there was a more sensitive triage being put in place which included variables of deprivation and social care to determine what support was offered for the Livewell Child pilot.

Outcome

All 10 schools had a quality assured Enhanced Healthy Schools action plan in place with quantitative and qualitative outcomes to be met within the 3 years.

Further work

It had been acknowledged that the previous weight management interventions focused on individuals and families and at the time this research took place, they were focusing more widely on a whole-system approach. There was an ambition to roll out Livewell Child to other areas of Essex.

Hertfordshire

The local authority took a holistic approach to managing childhood obesity with a particular focus on ensuring consistent messages within schools and the community. Their objective was to reduce childhood obesity levels.

At the time this research took place, Hertfordshire, located in the East of England, had an estimated population of 1,154,800 (Hertfordshire Insight, 2014).

Local approach

There was an awareness that focusing on obesity may expand across other topics within the JSNA, including mental health, wellbeing, physical activity and nutrition.

At the time this research took place a Healthy Weight Network had already been set up for a year to bring together several agencies in order to ensure that all were providing consistent messages in relation to education, catering, children’s services, and school nurses.

A Family Weight Management Service called BeeZee Bodies was being delivered, which consisted of a 17-week programme, one half with sessions on nutrition, portion sizes, with a second half of sessions run by various sports coaches. Within this programme, adults and children both did both halves, and this was available to anyone on or over the 91st percentile aged 5 to 15. NCMP identification leads, GPs or nutritionists were able to offer this service, but people could also self-refer.

A holistic approach was taken from the understanding that obesity in children and young people is linked to mental health, wellbeing, physical activity, emotional health and self-esteem. Hertfordshire incorporated mental health as an integral part of the obesity programme. There was a Hertfordshire healthy weight strategic plan which covered all ages, and whose version was valid until 2019. The local authority had been involved in the Leeds Beckett whole-systems study (they applied but were not selected as a pilot area), and they were trying to apply some of the lessons from this project.

Other initiatives Hertfordshire was running included Girls Active, daily mile, junior park runs and a project commissioned from BeeZee Bodies which included gathering intelligence from teenagers on the barriers around health and wellbeing. This intelligence was then used to advise schools and colleges, and to design a tool for social media to help break down these barriers.

In primary schools, life skills programmes were being linked to physical activity. Further, in the younger cohort, messages from the oral health, healthy weight and healthy diet agendas were being linked, ensuring that they were consistent. Hertfordshire offered some feedback for PHE to try and ensure that health messages across topics were consistent. For example, dentists advising against fruit as a snack while suggesting babies have it as a snack when moving onto solids.

Deprivation

Deprivation was a focus to a degree, for example through collaborative work with the healthy children’s centre programme who were able to target areas of deprivation using the intelligence gained by children’s centres. Deprivation, however, was not a focus for all topics within the JSNA.

BeeZee Bodies was asked to target areas of deprivation in its contract and it had always exceeded targets. Welwyn Hatfield had a programme as a result of this targeting and St Albans also had a programme due to demand rather than specific targeting.

National Child Measurement Programme

A significant factor to note may be that 6 schools opted out of the NCMP, however, no one knew which areas they were in. Nevertheless, the participation rates were good in schools that did take part and were higher in reception than in year 6.

The NCMP was a part of the commissioned school nurse service who does all aspects and then returns the data to the local authority for them to upload. Both the school nurse service and local authorities used a designated data employee to act as the main link of communication. In addition, there was a monthly contract management meeting for any concerns to be discussed.

Further, the public health team delivered training to school nurses and staff involved in the NCMP on how to take the measurements to ensure accurate data and on the importance of the programme. This had been very successful and was repeated every year.

Schools were sent the PHE feedback on their performance against the local average. Local authorities saw this letter as an opportunity and included additional local information, for example, on the daily mile. GPs, however, did not routinely receive feedback on the NCMP except in Broxbourne, where there was a historic agreement that GPs would be sent individual level data on the condition that they use the data. This was set up before the current post holder was in situ at the time this research took place, but it was believed that this was driven by the GPs from that area. Broxbourne was one of the areas that had high levels of cooperation. There was no end date on this agreement. A sentence had been added to the NCMP consent letter to ensure parents knew they could consent for the data to be shared with GPs.

The NCMP letter was based on the PHE template but amended based on local feedback, with some words changed to reduce offence. It was looked at every year in order to take all feedback into consideration. The letter mentioned BeeZee Bodies and also included a flyer, which had been updated to include a set of FAQs that had been tested with previous participants in an attempt to reduce common fears and misconceptions about the service. It was believed that there was not a school nurse who had a lead role in childhood obesity.

The clinical commissioning group (CCG) had identified that there were no tier 3 services in the county and this was a gap they were trying to fill. Tiers 1 and 2 were well linked.

Outcome

At the time this research took place it was too early to say if this approach would help reduce childhood obesity in the area.

Lessons and challenges

Hertfordshire had commissioned research with teenagers in relation to healthy eating. This provided extensive information, with particular emphasis on the influence of peers and the dining environment. This research demonstrated that some small changes could result in behaviour change. Hertfordshire also learnt that immediate benefits were far more influential for young people than longer term benefits in health. The physical activity projects put in place had been informative in terms of how best to engage with primary schools, and how to link mental health and physical activity messages rather than approach them in isolation.

Hertfordshire had found that there was a real determination from a wide range of professionals for promoting healthy weight, however, the main barrier appeared to be time or capacity and budgets. Approaches that required minimal time commitments from partners and did not require a budget were therefore the most achievable at the time this research took place. Nevertheless, a lot can be achieved without budget, such as promoting key messages, ensuring consistent messaging, and effective signposting.

An important observation or challenge identified was that one of the biggest gaps Hertfordshire had (reflected nationally) was parental engagement.

Further work

The DPH acknowledged that the previous weight strategy focused on individuals and families and at the time this research took place they were focusing more widely on the environment. They had hoped to follow in the footsteps of neighbouring Hull, in limiting new takeaways close to schools.

Luton

The local authority took a holistic whole-family approach focusing on partnership working and parental engagement. Their objective was to reduce childhood obesity.

At the time this research took place Luton was a large town in Bedfordshire England, with an estimated population of 211,000 (2014).

Local approach

The ethos in the health and wellbeing strategy was to start interventions early.

The local authority initiated a number of main actions.

Breastfeeding

At the time this research took place Luton’s breast-feeding rates at 6 weeks were consistently higher than the England average.

An infant feeding team provided information on breast feeding and supported mothers to establish breast feeding. All mothers were phoned 48 hours after birth and offered a home visit.

Luton health visitor service was baby friendly accredited and the antenatal education programme included breastfeeding information.

Local programmes

Healthy Early Years settings Accreditation programmes (including Children’s centres), Family Food First programme and Healthy smiles programme (previously Healthy Under 5s) ensured settings met set standards to promote healthy eating, physical activity and oral health.

Flying Start strategy

Prior to the Flying Start strategy, children’s centres promoted healthy eating and physical activity and ran programmes including healthy cooking programmes. This was then strengthened with the Flying Start strategy. The children’s centres were Flying Start children’s centres, and this meant that:

1. Interventions ran primarily through children’s centres including parenting programmes such as HENRY (Health, Exercise, Nutrition in the Really Young) which started in 2016, Take 5 cafes which provide information on feeding and 5 to thrive messages.

2. Flying start included a learning and development programme that involved raising the HENRY issue of weight (this reached over 200 staff in Luton) and developing healthy lifestyle behaviours in the early years. In addition, the health visiting team received mandatory training on starting solids and oral health.

3. Flying start also aimed to create system changes through a partnership approach with all health and wellbeing organisations to create the most effective delivery models and best use of resources.

4. The strong focus on evaluation also contributed to an effective influence on key outcome areas. By working together with the University of Bedfordshire, Luton was monitoring the HENRY programme in terms of maintaining healthy lifestyle changes over time and also suitability for the cultural diversity of the town.

Luton Early Years Team and Active Luton

These teams worked in partnership to offer sessions within childcare settings and children’s centres to provide physical activity sessions for children under 5 and their parents. A bag of physical play resources was provided to all settings to encourage the focus on physical activity. Active Luton was commissioned through Flying Start to deliver Me Time Family in 2014 offering subsidised activities (£1 per activity) for families with children under 5 in the 5 most deprived wards. This grew, and at the time this research took place, over 20 different sessions per week across the town were offered.

Public health worked closely with Luton Culture to promote healthy eating and lifestyles. For example, libraries held healthy events like Healthy Easter and promoted the Change4Life campaign.

In the year before this research took place, an oral health dietitian had begun working with the school nurse team to deliver sugar swap workshops and oral health education in schools, providing direct support to the 4 primary schools with the highest rates of obesity.

School nurses participated in ‘raising the issue of weight’ training and 2 school nurses had completed Mind Exercise Nutrition Do it! (MEND) 5 to 7 training and delivered the programme.

Traditionally there was a focus on increasing numbers into the weight management programmes. At the time this research took place there was more of a holistic approach such as reducing the obesogenic environment and increasing physical activity (for example, through the Luton Food plan).

Deprivation

Overall, deprivation and tackling health inequalities was a focus in Luton. This had been translated into practice through targeting programmes in the most deprived wards and commissioning with a requirement to engage a percentage of residents from the most deprived wards.

National Child Measurement Programme

The NCMP measurement programme was conducted by the school nursing team. If parents of an overweight or obese child did not opt out of a referral to Live Well Luton (LWL), LWL attempted to make contact through both a phone call, text and letter. Parents whose contact details had been checked to be correct and were still not responsive had their child’s details and NCMP information forwarded to their GP with the recommendation that they were contacted to discuss the child’s weight. Schools received routine feedback on group, not individual data, but GPs did not receive any feedback.

Weight management programmes which were run by LWL over 12 weeks were linked in with the NCMP through the NCMP working group, which met quarterly to review the data collected. The group included the school nurse lead, public health link worker, dietitian and LWL (providers of the weight management programmes). There was also a CCG coordinated Obesity Pathway group (Luton and Dunstable hospital, dietitian and the health visitor lead were the core members of this group). The NCMP working group fed into this.

In relation to service tiers for weight management, tiers 1 to 2 were linked in respect to how they were commissioned, however, there was not as strong a link between tiers 2 to 4. Work was being done to strengthen this through the CCG group.

Weight management programme

In April 2010, Luton PCT commissioned MEND training for 2 to 4 year olds in addition to its programme for 7 to 13 year olds. The programme was a lifestyle programme for families who may have an overweight child aged 2 to 4 year, supporting both the child and parents, and giving both exercise and food advice for parents. At the time this research took place, a further weight management service had recently been commissioned for 5 to 15 year olds. All children were included in the weight management programme unless the parents opted out. This had improved participation rates significantly.

It was mandatory for a parent or carer to attend the child weight management programme. It was child focussed, but the whole family was involved.

LWL was the providers of the weight management programmes. They provided physical activity on referral. The 16 year olds were referred to the adult weight management programme.

Service users provided feedback at the end of the child weight management programmes to help shape future programmes. Health Watch was the voice of the users and provided a way to receive feedback from the public. The child weight management programme was monitored on a quarterly basis though the working group.

Outcome

At the time this research took place it was too early to say if this approach would help reduce childhood obesity in the area.

Lessons and challenges

The local authority learnt the value of good partnership working.

Further work

At the time this research took place Luton was next looking at the Luton Food Plan which involved working to make healthier food options more available, ‘getting the house in order’ (for example school meals), vending offers and Grow Your Own. There had been over 20 focus groups about this in children’s centres. Luton was introducing a universal ‘introducing solids to your baby’ session that had been piloted. In addition, Luton was looking into school meals to make them healthier alongside Luton catering.

Advice to other local authorities

Good partnership, working, and dedication to the same cause.

Peterborough

The local authority took an iterative, whole-systems approach with a focus on schools and parental engagement. They identified a whole-systems approach as a pragmatic response to a problem that public health could not resolve alone. Support was needed to make sustainable changes and reduce childhood obesity. Their objective was to reduce childhood obesity.

At the time this research took place Peterborough was a metropolitan area within Cambridgeshire and had an estimated population of 197,000.

Local approach

Peterborough worked in collaboration with various partners, seeking to create whole-system solutions. The main partnership was through the Healthy Schools Peterborough programme that worked with primary and secondary schools and referral units. It was an accreditation programme that also provided schools with planning and development support. As well as this, it facilitated access to quality assured, commissioned health and wellbeing services that supported the agreed healthy school plans for each school. The weight management services and physical activity programme (Let’s Get Healthy) was tailored to each specific school and delivered at primary schools that were identified as in need. The weight management service had a focus on parental involvement as well as nutrition and diet in the home. It was also altered to work with the south Asian community as information on ingredient alternatives to help reduce high sugar and fat used in traditional recipes was included.

Let’s Get Healthy was delivered in schools and community settings. At the time this research took place, it had been moved into targeted schools and inclusion widened to enable peers of those identified as most in need to attend. Hosting in schools gave the programme additional validity as it was an environment parents could trust and where children felt comfortable. All this helped parents to get involved and engage with the service and it was hoped that this change would make for a higher retention rate. This whole approach was underpinned by a determination to consider the parents’ perspective in the formation of interventions and services: they were to be pragmatic and easy to fit comfortably into family lives.

When this research was conducted, the weight management service was in 9 or 10 primary schools out of 60. These schools had been targeted using NCMP data to identify school catchment areas with high childhood obesity prevalence (looking at trend data). The Healthy Schools Peterborough programme was also being rolled out across all schools at the time this research took place. It was a commissioned programme that provided a 3-step accreditation with the aim of recognising schools for what they were doing. It also aimed to gather intelligence on what schools were doing so they could maintain records and have an awareness of how the schools were using the programmes. Other schemes or initiatives

The Soil Association’s Food for Life programme was also commissioned in approximately 30 primary schools. This took a whole-school approach to nutrition education, working both with children and their caterers.

In terms of a whole-system approach, the council had an active travel plan. This worked across the community more broadly and fed specifically into schools.

Work was being done in order to attempt to limit fast food outlets around schools.

There was a healthy Peterborough campaign with a themed activity every month. This was used to fit in with national themes where possible, such as Stoptober, and the Change4Life campaign. The idea was to promote wellbeing for all within the city.

Outcome

At the time this research took place, it was too early to say if this approach would help reduce childhood obesity in the area.