Setting: The Alive N’ Kicking (ANK) programme

The Weight Management Centre (WMC) is an organisation providing overweight/obesity and weight management services and training throughout the UK (Weight Management Centre, 2017).

Commissioners such as Sheffield City Council, appoint WMC for different programmes on contracts of up to three years in overweight/obesity management, targeting both children and adults. The ANK programme is one of the programmes offered for children and adolescents who are overweight or obese (Alive and Kicking, 2017). There has been a growing demand for the ANK programme by local authorities and public health teams in recent years (Alive and Kicking, 2017). The WMC serves as a framework to train partners to deliver weight management programmes in their communities (Weight Management Centre, 2017). Commissioners need to fulfil a number of requirements such as providing the facilities and staff before technical training is provided to full-time and part-time staff, freelancers or volunteers (Weight Management Centre, 2017).

The programme, offered by the WMC and commissioned by the Sheffield City Council, is a 11-12-week weight management programme targeted at overweight and obese children and adolescents.

ANK programme adheres to National Institute for Health and Care Excellence (NICE) guidelines (Alive and Kicking, 2017) and it is built upon the transtheoretical model (Prochaska and DiClemente, 1983), self-efficacy theory (Bandura, 1977) and protection motivation theory (Rogers, 1975) and uses a variety of behavioural change methods such as motivational interviewing (Alive and Kicking, 2017, Hall et al., 2012). The programmes objectives are to help “overweight children and young people and their families to reach and maintain a healthier weight (Everyone Health, 2019). The programme is specifically designed to provide age appropriate messages, activities and behavioural change strategies that will benefit the whole family” (Alive and Kicking, 2017). ANK consists of the following five components to increase physical activity and to improve the quality of diet; learning about healthy eating & nutrition, making small, easy changes to help benefit your family's health, food preparation sessions to learn to make fruit kebabs, smoothies and healthy wraps, to shop healthier by learning how to read food labels and finally activity sessions to learn that exercise can be fun, play new games and build your skills and confidence (Alive and Kicking, 2017).

The programme includes children and adolescents from five to 19 years of age. Separate programmes, which have been described in section 4.3.1.1 are delivered according to the following age groups:

infants and juniors (5 – 11 years of age), seniors (12 – 15 years), and young persons (16+ years) (Everyone Health, 2019).

4.3.3.1. Infants and juniors (ages 5-11 years)

The 10-12-week infant and junior programme focuses primarily on the role and responsibility of the caregiver or parent combined with activities for the children (Alive and Kicking, 2017, Everyone Health, 2019). Parents and caregivers meet once a week for a 90-minute session covering topics such as healthy eating, sugary, drinks, food tasting, healthy school meals and reducing sedentary behaviours (Alive and Kicking, 2017, Everyone Health, 2019). The main aim of these sessions is to guide parents towards a healthy lifestyle for the whole family (Alive and Kicking, 2017, Everyone Health, 2019).

Additionally, children can join the weekly physical activity hour for games and challenges (Alive and

Kicking, 2017, Everyone Health, 2019). The programme is structured to take 10-20 children/families with a minimum of two staff delivering the programme (Alive and Kicking, 2017). Results indicate that 4,742 families have completed the ANK programme in 13 different locations in the UK, including Bristol, West Sussex, Northamptonshire, and Sheffield (Alive and Kicking, 2017).

4.3.3.2. Seniors (ages 12-15 years)

In this part of the programme, the focus is more on the young person instead of the parent. The aim is to create greater responsibility for maintaining a healthy lifestyle for the young person therefore they are included in all activities and workshops related to weight management, nutrition and health together with their parents (Everyone Health, 2019). Next to the theoretical sessions, this programme also involves weekly drop-off sessions, where parents drop their children off to participate in group physical activity classes delivered by the programme (Everyone Health, 2019).

4.3.3.3. Young persons (16+ years)

This programme offers the young people full responsibility for their health choices. The programme offers theoretical classes on for example energy balance, snacking, school food and snacking and ends with a half hour physical activity class (Everyone Health, 2019). The classes are flexible and can be adapted to individual classes, small or bigger groups. The classes are often accompanied by an additional physical activity class throughout the week, but can be adapted to the needs of the adolescents (Everyone Health, 2019).

4.3.3.4. The Sheffield ANK programme

This section will describe the ANK programme offered in Sheffield based on the information the researcher gathered during the visits at the interview sites. Most information derives from conversations with the programme manager and the session leaders during the sessions. In Sheffield, only one programme of the ANK programmes is offered, which combines the infant and junior, senior and young people groups. The above age groups are combined due to a lack of participants for each age group. The majority of children who participate in Sheffield are between the ages of five to 13

years. The physical activity sessions are delivered by physical activity experts from the Why Weight Sheffield programme, a programme that offers city wide programmes on weight management (Weight Management Centre, 2017). While children attend physical activity sessions, nutrition sessions are delivered to their parents in a separate room. Those sessions are delivered by trained staff of Why Weight Sheffield. During most weeks, children are asked to participate in the information sessions for the first 15-20 minutes before starting their activity session. During other weeks, parents are asked to join the physical activity sessions to enhance physical activity within the whole family and to demonstrate parental support for their children.

The 10-12-week sessions are given 12 times a year. Usually four of those sessions are given during the same weeks at different days and different locations (Alive and Kicking, 2017). Throughout the year, three blocks of sessions are delivered. Every block comprises three to four separate sessions of 10-12 weeks. After completing the first block a new block of sessions starts. The locations of the sessions are chosen based on the number of referrals received and the place where the participants are living. In addition to the three blocks offered throughout the year, the programme offers three summer clinics.

One summer session consisted of physical activity sessions for the children, and nutritional information sessions for the parents. This session lasted nine weeks in total. Further two sessions are offered during the summer sessions, each lasting five to six weeks. These sessions consist of 60-minutes physical activity for children and do not include nutritional information for parents (Everyone Health, 2019). Parents and their children who participated in the summer sessions were usually invited to return for the full-time September sessions.

Participants were informed about the programme through referrals from the school nurse or their local general practitioner across the city of Sheffield (Alive and Kicking, 2017). Some parents searched themselves for obesity management programmes for their children in their community or heard from friends, who have previously participated. Furthermore, the ANK programme is advertised at local community centres. New participants are encouraged to join and enjoy priority for spaces in the programme. Previous participants are invited to join again if spaces are available.

Parents were asked by the Why Weight Sheffield staff to fill out a form with general information about the child at the beginning of a block of sessions. The booklets contain questions on general health of children and any family related illnesses. The booklet was kept by ANK and was taken to every session to keep track of weight and height of children. Every session started with weighting and measuring the child to check their BMI. The classification of overweight and obesity used in the ANK programme and in this research are as defined by the WHO-UK (World Health Organisation Europe, 2019). Overweight/obesity status was above the 91^st centile among all children, as this was the requirement to participate in the ANK programme.