Public Health Dietetic ANNUAL REPORT

Public Health Dietetic ANNUAL REPORT Produced by Pip Collings & Jacqui Copp April 2007

INTRODUCTION This report is a very brief summary of the work of Public Health Dietetics for East Berkshire. It gives an overview of the key programmes which have been delivered in East Berkshire between April 2007 and. The work across East Berkshire to promote healthy eating to the public. The purpose of this role is to help people stay well through a balanced diet. Below is a summary of current healthy eating work in East Berkshire. Programmes Schools Nutrition Network..2 School Meals..3 Smiling for Life. 5 Food in Schools....6 Food Awareness Week....7 Catering for Health.....9 Food for Thought 10 HEAT Pack..11 4f Club (Bracknell). 12 Summer School Cook Project (Slough)..13 What s Cooking (Slough).. 14 Community Café (Slough) 15 Healthy Eating Club (Slough).......16 Reading Royal Results (RBWM).17 Reports and Resources.18 For further information about any of the programmes in this report please see the Berkshire Health Promotion Website at www.bhps.org.uk/healthyeating or contact: Pip Collings Public Health Dietitian Tel. 01753 638673 email pip.collings@berkshire.nhs.uk Jacqui Copp Public Health Dietitian Tel. 01753 638752 email jacqui.copp@berkshire.nhs.uk Both at George Ward, St Mark s Hospital, Maidenhead SL6 6DU 1

Schools Nutrition Network E A S T B E R K S H I R E Introduction In January 2003, the Schools Nutrition Network was established. This network was set up to provide a forum for people working in schools to promote healthy eating, to discuss their work and plan future programmes. The main aims are to: Help prevent duplication of efforts Provide opportunities to share resources and ideas Help ensure consistent messages are given to schools and Early Years Settings Promote existing projects in schools and Early Years Settings Provide opportunities for partnership working Help identify gaps Help match schools/ Early Years Settings and projects Ensure healthy eating work is targeted effectively Ensure priorities identified by local Action Plans are being met Provide an opportunity to see each other face to face, to encourage further communication when new projects/ideas arise Membership NHS Local Authority Other Dietitians Early Education and Childcare Chef Oral Health Promotion Healthy Schools Consultants School Meals contractors School Nurses School Meal Contract Managers Health Activists Trading Standards Health Visitors/ Environmental Health Skill Mix Team School Food Adviser This network has grown over the last year with over 90 members to date. It has helped to strengthen the healthy eating work in schools and Early Years Settings. There is a network in each locality, Slough is chaired by Pip Collings and RBWM is chaired by Jacqui Copp. In Bracknell Forest, the network has evolved into The Choosing Healthy Living Group. This group covers Nutrition, Physical Activity for children and adults, and was chaired by Claire D Cruz. It is now chaired by Angela Snowling 2

SCHOOL MEALS Aims To ensure schools provide balanced, healthy school meals which conform to national and local standards. To ensure all schools are aware of Government legislation To ensure the LEA contracted menus meet Government legislation To ensure LEA contracted menus meet local specification To improve nutritional quality of the menus Target group All schools in East Berkshire The sit on the menu planning groups with Local Authorities and Catering Contractors to develop the school lunch menus. Together we ensure that the menus meet government legislation in addition to the local contract specification. Training events are run periodically for cooks, bursars, heads and teachers. Partners Local Authority school meal contracts manager Catering contractors: Bracknell Forest Caterhouse Catering Services Slough Scolarest RBWM - Harrisons Targets Ensure 100% LA school menus meet national and local specifications Progress All LEA menus in East Berkshire meet the Government legislation for School Meals. SCHOOL MEALS GRANT (SLOUGH) All Local Authorities have been issued with a grant to help schools implement the new regulations and improves school food. Slough Borough Council set up a working group (Schools Catering Strategy Group) to develop a local strategy. Members have been drawn from a local primary and secondary school, Slough Borough Council and Berkshire Healthy Schools Programme The local Public Health Dietitian is an active member of this group. This group decides on the priorities for funding, in consultation with all LEA schools. Progress The School Food Advisor - follow up audits to establish whether there have been improvements since the first audit and whether schools are complying with new standards. Further healthy eating advice will be included with school place offer letters. A seminar for schools on meeting the new nutritional standards. Cooks, parents and children s chef sessions. Further funding for schools with a high proportion of pupils receiving free meals, Development of Captain Healthway primary school resources to promote healthy eating 3

SLOUGH SCHOOL MEALS SURVEY Between November 2007 and February 2008, the School Food Adviser, in partnership with the PHD organised a survey of school meals in all Slough schools. Results Primary Secondary Total School Meals 3216 2456 5672 Packed Lunches 4160 1772 5932 Comparisons with the standards Majority of primary schools are meeting the 2007 revised food based standards for lunchtimes. However, most secondary schools are not meeting the standards due to small details. 26 primary schools and 3 secondary schools are already complying with the 2008 nutritional standards Those with direct contracts that are not already complying with the nutritional standards are working towards them School Meal Uptake 2006/7 2007/8 National average Primary 29% 31% 42 Secondary 31% 29% 43 What were children provided with? Primary schools Primary School Meals 2004 Primary School Meals 2006 Primary School Meals 2007 Primary Packed Lunch 2007 Balanced Meals NA 88% 93% 31% Vegetables 78% 87% 89% 8% Fruit 17% 40% 46% 45% Milk/Dairy Drinks 19% 23% 28% 8% Secondary schools Secondary School Meals 2004/5 Secondary School Meals 2006/7 Secondary School Meals 2007/8 Secondary Packed Lunch 2007/8 Balanced Meals NA 40% 38% 19% Vegetables NA 20% 21% 18% Fruit NA 4% 11% 30% Fruit based drinks (includes smoothies) NA 28% 34% 14% 4

SMILING FOR LIFE Aims To improve the oral and general health of 0-5 year olds in Berkshire. To raise awareness of the importance of oral and nutritional health amongst the children and group leaders To encourage the adoption of written healthy snacks policies in Early Years Settings All children to be drinking from a cup by the age of one year. Target groups 0-5 year old children prioritising deprived areas. Early Years Settings were visited and given advice on healthy snacks. They were encouraged to produce a written snacks policy promoting fruit and vegetables and prohibiting high salt, sugary foods and drinks. Any group with a written healthy snacks policy will be eligible for the Smiling for Life Nutrition Award. This provides a credit towards the Healthy Schools Award. Healthy snacks and drinks are defined as: Healthy drinks Milk and water only Healthy snacks Sugar-free, low salt foods Partners Oral Health Promotion Advisers Health Visitors Early Years/Sure Start Teams Berkshire Healthy Schools Programme Results Targets New targets were set when the new pack was produced: 10 packs per PCT 5 Visits per PCT 2 Awards per PCT Due to fantastic support from Shah- Bano Razvi in the Health Visiting team, these have been stretched further in Slough. BRACKNELL 2004/05 2005/06 2006/07 2007/08 Total Visits 3 3 28 8 44 (47%) Packs 8 12 25 17 50 (54%) Awards 3 2 16 6 29 (31%) SLOUGH 2004/05 2005/06 2006/07 2007/08 Total Visits 1 10 75 13 70 (84%) Packs 2 13 64 10 70 (84%) Awards 2 11 16 13 39 (47%) WINDSOR & MAIDENHEAD 2004/05 2005/06 2006/07 2007/08 Total Visits 11 5 22 15 49 (47%) Packs 9 7 22 35 74 (70%) Awards 3 3 9 8 21 (20%) 5

Aims To improve the oral and general health of 5-18 year olds in Berkshire through dietary change. To promote the adoption of a Whole School Food Policy. The Food in Schools Nutrition Award will be offered as an incentive. Target groups East Berkshire schools The Food in Schools Toolkit is a national resource available to all schools to help them implement healthy eating initiatives. A local resource has been produced to provide guidance for schools in the development of their Whole school Food Policy. This has recently been updated in the light of the school food regulations and changes to the Healthy Schools criteria. Partners Berkshire Healthy Schools Programme Targets To update and print new Whole School Food Policy Guidelines. Progress New guidelines have been developed and printed and will be distributed with the Food Awareness Week packs in April 2008. There is a national shortage of Food in Schools Toolkits. These have been updated, but there are no plans to reprint them. Future training cannot be organised without toolkits. 6

FOOD AWARENESS WEEK Aims To educate Primary school children and teachers about healthy eating and physical activity to help address the problem of childhood obesity. To increase knowledge of key messages of the campaign To increase children s intakes of fruit and vegetables Target group All primary schools in East Berkshire Intensive interventions focused in areas of deprivation to help tackle inequalities. day Key messages for 2007: 1. Eat at least 5 portions of fruit and vegetables a day 2. The Balance of Good Health (left now the Eatwell Plate) 3. At least one hour of physical activity every All Berkshire primary schools were contacted and invited to participate in the campaign. A resource pack was developed with local teachers to provide good, evidenced based, education material to help teachers deliver the key health messages of the campaign. To help redress inequalities, primary schools were identified for intensive health promotion work, using dental screening records, obesity rates from the National Child Measurement Programme data and free school meal data. Extra activities were organised for these schools including bowl painting to encourage breakfast, fruit kebabs, fruit salads, Health Fairs and a restaurant. Partners Food Awareness Week was planned and delivered by the Public Health Dietitian in partnership with: Oral Health Promotion School Food Adviser Health Activists School Nurses Health Visitors Berkshire Healthy Schools Programme School Meal Catering contractors Trading Standards Environmental Health Targets Recruit 20 schools 50% of participating children to know key messages 50% of participating children to increase fruit and vegetable intakes. 7

Progress Number of participating schools in each locality Bracknell Slough W&M Total For East Berkshire 35 (83%) 11,595 children 39 (91%) 20,153 children 67 (91%) 16,475 children 141 (89%) 48,223 children Results of pack evaluation Question Very useful Useful Not useful Not answered How useful was the pack? 61% 34% 5% 3% Results of health promotion intervention What percentage of children know they should eat at least five portions of fruit and vegetables a day? Bracknell Slough W&M Average for East Berkshire 91% 88% 91% 90% What percentage of children are familiar with the Balance of Good Health? Bracknell Slough W&M Average for East Berkshire 84% 82% 81% 82% What percentage of children knew they should have at least an hour of physical activity every day? Bracknell Slough W&M Average for East Berkshire 72% 84% 81% 79% What percentage of children ate more fruit and vegetables due to the campaign? Bracknell Slough W&M Average for East Berkshire 68% 71% 72% 70% Green boxes indicate improved results on previous year 8

CATERING FOR HEALTH Aims: To promote the provision of healthy food options and healthy catering practices prepared to good hygiene standards. : To recognise healthier catering practices in 10 establishments To run a training event for food officers Target groups Local food businesses This is a joint project between Berkshire East PCT, Bracknell Forest and Slough Borough Councils Environment Health Teams and local food businesses Partners Bracknell Forest Borough Council environmental health Slough Borough Council Local food businesses Targets 10 awards Results Bracknell Slough Forest Number of awards 12 24 Number of beneficiaries 25,220 Progress The award has now been incorporated in to the Bracknell Forest Local Area Agreement for 2007 2008. A training session for Environmental health staff across Berkshire took place in May 07, with the hope that the programme will be adopted across the whole region. 9

Aims To provide information and training for carers and professional care workers to ensure their charges receive nutritious food appropriate to their needs. Determine the main components of a balanced diet Provide up-to-date information appropriate to the client group Target group Managers, chefs, cooks and carers working with older people This half day training programme has been updated this year and piloted with a group of carers in Slough. Evaluation Note there was a problem with venue, we had to use very small room for training, hence comments on space etc. 1 = excellent 5 = very poor 1 2 3 4 5 Almost all of the information was new and/or 4 7 2 3 2 relevant to me Information was presented in a clear and 10 4 2 1 0 easily understandable way I will be able to apply today s learning 9 6 0 1 1 Progress This training will be offered to care workers across East Berkshire in 2008/9. n=21 10

HEALTHY EATING for ADULTS TRAINING Aims To provide information and advice to help members of the community eat healthily To provide off the shelf resources to help community group leaders/health activists/health professionals educate their members about healthy eating To provide a 6 week training programme for community groups Method A new training resource has been developed along the lines of the food Awareness week pack. This resource includes information for trainers, worksheets for participants and equipment and food packaging to support the activities. The pack was piloted with the Family Welfare Association in Slough, and changes were made in response to their comments. Topics include: The Eatwell Plate Nutritional Requirements Fats Food Labels + Iron Take Aways + Calcium Progress Copies of the training pack will be made available for loan through Berkshire Health Promotion Resources Service and promoted to community groups. Further session will be developed over time. 11

Forest) THE 4 F- CLUB (Bracknell Aim The aim of the 4 F Club is to educate families of obese children in elements of weight management in a fun and family friendly environment. The aim of the pilot is to evaluate the effectiveness of the program. The sixteen session program will ensure the children and their families have the opportunity to explore areas of weight management. Target groups The program is designed for the families of obese children aged between 8 12 years. The maximum capacity of the course is 12 families. The course runs twice a week at Coopers Hill Youth Centre in Bracknell. The course is open to all families of obese children who are committed to attending both sessions each week. Recruitment has been via Schools and School Nurses, GP surgeries, Health Visitors, Dietitians. Publicity for the course has been through the local papers and radio stations. Families do not need a medical referral to attend. The course will cover areas such as Healthy eating principles, Exercise, Barriers to change, Healthier catering practices, Shopping, Labelling, Activity sessions, Monitoring weights and heights Partners The program is funded by Bracknell Forest Borough Council and delivered by the Public Health Dietitian, School nursing and a free lance activity instructor. Targets The aim of the pilot is to evaluate the program looking at various outcomes such as reduction in BMI measure and waist circumference. Progress Both pilot courses were completed, with a total of 11 families attending the programme. The main conclusions that can be drawn from the first of two eight week pilot programmes are: Where the course was completed it was effective and customer satisfaction was high. The numbers of beneficiaries were greater that the number attending the course because of the whole family approach. This needs to be factored into any comparisons made to interventions that do not focus on whole family changes. Results showed a positive outcome for those completing the course. The results showed a smaller reduction in BMI than results claimed on the MEND programme, although the small numbers on the two pilot courses mean it is difficult to drawn any long term conclusions from the data. 12

COOK PROJECT (Slough) Aims 1. To improve the cooking skills of teenagers in Slough 2. To promote healthy eating and improve the diets of teenagers 3. To generate interest in the catering profession Participants will be trained: 1. To handle knives and other kitchen equipment 2. To prepare raw foods 3. To cook and present meals 4. To prepare and serve a presentation dinner 5. To be familiar with the Balance of Good Health Target group 14 20 year olds in Slough Partners Slough Estates, Chef, Craft Guild of Chefs, Arramark, TVU The project was run as part of Thames Valley University s summer school programme. Students were interviewed by the chef and dietitian to ensure commitment. Two courses were run in the kitchens of Slough Estates offices Advanced and Basic cook projects. At the end of the course, each student invited 2 guests to a presentation dinner for 50 people including the Mayor of Eton. Targets Recruit 20 students 100% to have cooked at least part of each meal by the end of the course 70% to have increased confidence in their cooking skills by the end of the course 50% to know the Balance of Good Health Evaluation Advanced Basic In-Brief Enjoyed course 100% 100% 100% Improved confidence in 100% 100% 100% cooking? Could cook dishes at home? 91% 100% 67% Would like a career in catering? 45% 13% 67% (9% maybe) (38% maybe) Knew at least 3 of the 5 food 100% 100% 100% groups Correctly labelled Balance of 91% 88% 33% Good Health Identified 3 main causes of nutrient losses in cooking 100% 75% NA Progress Due to the high demand for this course, an additional week was added called Cook Course In-Brief. The students learnt to produce a selection of cold dishes on this course. At the end of the week they helped to produce a buffet for 150 people at the TVU Summer School Party. 13

WHAT S COOKING? PIOLT (Slough) Aims To develop and deliver cooking sessions with a professional chef To learn the skills needed to produce food on a large scale in a set time frame To inform students about healthy eating To assess cooking skills of students and work with staff to develop these including: o Knife skills o Working with raw ingredients o Introduce new recipes To produce a buffet for 70 older people at the Senior Citizen Event at the school Partners Craft Guild of Chefs Slough & Eton School 4 practical cooking sessions with professional chefs to learn catering skills 2 healthy eating sessions with dietitian to learn about the school food regulations and discuss potential foods for the tuck shop Produce buffet for 75 senior citizens at the school s Annual Christmas Event Evaluation Improved cooking skills 100% Increased confidence in cooking 100% Improved diet 48% n =21 Progress This was a pilot scheme which proved very successful. Future programmes of this nature would benefit from greater assessment and feedback to students on their progress. 14

COMMUNITY CAFÉ (Slough) Aims To work with the Food for Thought Community café to promote healthy eating. To provide on going support for community cafe eg via the Healthy Eating group Assist in the development and production of a community recipe book Organise and deliver four high profile events in the café to raise awareness of particular nutritional issues. Target group Members of the Britwell community, particularly mothers of young children This project is funded by the Big Lottery Fund via the SHAPE project in Slough. The Public Health Dietitian took over this role in October 2004. Work with the café included regular quarterly events in the café to promote different aspects of healthy eating, recipe book development and help and advice with other events and menus. Due to changes in the organisation of Sure Start, this project finished at the end of June 2007. The café closed in August 2007. Events Two events were run this year. 8 th June 2007 Salad Caterpillar Due to safety concerns, this event was run in the local nursery rather than the café. 20 children prepared a caterpillar made from fresh vegetables and then ate it, with help from café and nursery staff. 15 th June 2007 Food Awareness Week benefits of fruits and vegetables A large display promoting the key messages of the campaign was erected in the café. Along side this display, a selection of exotic fruit and vegetables were laid out and customers encouraged to taste each one. A short quiz was designed and circulated to the customers to assess knowledge of the key messages and encourage the customers to study the display. Evaluation The events were very successful with the majority of the clients correctly answering the evaluation questions. 15

HEALTHY EATING CLUB (Slough) Aims To provide healthy eating information for the local community at regular drop-in sessions. To provide resources and advise on various aspects of healthy eating for the community To respond to the needs of the community by listening to requests and regularly consulting on topics and activities for future sessions To provide weight loss advice where appropriate Target Group Adults from the Britwell Estate in Slough From September 2005 the Public Health Dietitian took over the running of this group. A detailed programme was devised to cover different aspects of weight management and healthy eating. Record cards and food diaries were developed and together with food portion booklets were used to help the group manage their weight. In total the Healthy Eating Club had 59 members, of these 51 (86%) were given personalised diet plans, based on their requirements. Attendance was very erratic, and most people only tended to stay for a few weeks. Reasons for this were explored and were to do with personal circumstances rather than the Club. At the end of the club we had 12 regular attendees. Results Questions Yes No Not answered Did the Healthy Eating Club meet your expectations 9 0 0 Do you have a clearer understanding of healthy eating 9 0 0 Did you receive a copy of the recipe book 7 1 1 If so have you tried any of the recipes 5 2 2 Have you been able to follow your personal diet plan 6 3 0 Did you find the cookery demonstrations useful 7 0 2 How do you think your diet has changed since attending the Healthy Eating Club? Not too bad now I have lost weight so I m happy Really well I have lost weight Quite a bit, but I have only managed to keep 1 stone off Lots Not too bad now, enjoy coming Very good By sizes of food Of the 28 regular attendees (ie more than 3 consecutive months), 12 lost weight. This amounted to a total of 27.4 kg an average of 2.3 kg each. The time span for this weight loss varies from 1-21 months. The greatest weight loss was seen between 1-3 months. 16

READING ROYAL RESULTS PILOT (Windsor) Aim: The aim of the project is to evaluate an intervention in secondary schools to see if it has any impact on individual fitness, dietary knowledge or extra curricular activity taken. : The overall objective of the intervention is to improve the fitness and increase the knowledge of the balance of good health in the children taking part in the project. Target Groups: To target a selected class from year 9 in both Windsor Girls and Windsor Boys Schools. : The project will consist of a 6 week plan of sessions. Each session will be composed of a nutritional educational section incorporated into a practical exercise session. Partners: Reading Football Club, Windsor Boys School and Windsor Girls School Targets: As this is a pilot intervention all aspects of the project will be evaluated. Information will be collected on the children s fitness and dietary knowledge and the beginning and end of the intervention and again at a 6 week follow up session. Progress: Despite the small scale of the project the results are suggestive of positive key outcomes: Increased fruit and vegetable intakes Increased physical activity Improved pulse rates Outcomes for the 5 a day message and the recommended physical activity message were not clearly improved. Smaller class sizes were more responsive and larger classes need to be broken into smaller groups which needs increased staffing levels. Delivering the nutritional messages in a non classroom environment had a positive response from the children. Messages on exercise and healthy eating can be effective regardless of who delivers them and could be incorporated into the current year 9 PE curriculum. 17

REPORTS AND RESOURCES REPORTS & STRATEGIES Publication Food Awareness Week Report Date Annually since December 1999 Contents and thorough evaluation of campaign to promote healthy eating in primary schools across Berkshire Publication Annual Report Date Annually since April 2000 Contents Summary of year s work Publication Berkshire Healthy Eating Strategy (Chapters 2 & 3) Date 2001 Contents Diet and Health; The Balance of Good Health Evidence-base and recommendations Publication Date Contents Cook Report Annually since September 2001 (+ video) Report and evaluation of cook projects run in partnership with Thames Valley University, Local chef, SEGRO. Video produced in 2001. Publication Smiling for Life Progress Report Date December 2001 February 2007 Contents Report and evaluation of programme to promote healthy snacks policies in Berkshire Early Years Settings Publication Food Garden Report & video Date December 2001 Contents Report and evaluation on Food Garden pilot project in a Bracknell Forest primary school Publication Water in Schools Report Date January 2003 Contents Report and evaluation of pilot project in a Slough primary school to promote the drinking of water Publication School Food Seminar Report Date April 2007 Contents Report and evaluation of seminar for East Berkshire teachers Publication Berkshire East Obesity Strategy assisting Angela Snowing obesity lead Date Contents Strategic vision, direction, planning framework and action planning 18

PACKS Publication Date Contents Food Awareness Week Pack February 2008 inclusion of colour and interactive activities Information and activity sheets for schools to teach children about healthy eating and physical activity Publication Food for Thought training and delegates pack Date April 2003 Updated December 2007 Contents _ day training package + detailed nutritional information for carers, cooks and managers of residential homes for older people Publication Smiling for Life Pack Date September 2002 March 2006 Updated and expanded to include childminders and mealtimes Contents Activities and information for Early Years Settings to promote healthy snacks and drinks. Guidance on how to produce a healthy snacks policy. Publication Whole School Food Policy Guidelines Date January 2005 Updated March 2008 to cover new school food regulations Contents Information for teachers on what to include in a Whole School Food Policy Publication Healthy Eating for Adults Training Pack (HEAT) Date January 2008 Contents 6 training sessions for Health professionals and voluntary sector to promote healthy eating to community groups LEAFLETS Publication Healthy Eating Leaflet Date June 2001 Contents Healthy eating information for the public Publication Be Cool Drink Water! Leaflet & video Date May 2002 Contents Information for primary school children on importance of drinking water Publication Healthy Eating for Primary School Children leaflet Date December 2002 Updated September 2006 Contents Healthy eating advice for primary aged children Evaluation tool/ Meal or No Meal Educational leaflet Date February 2007 Contents Guidance for a balanced meal 19

POSTERS AND DISPLAYS Publication Healthy Eating for young children Date August 2005 Contents Posters and handouts for Health Visitor 8 month drop in sessions. Pictorial ideas for healthy snacks and meals Display Food Awareness Week Date June 2006 Contents Key messages for campaign Display Healthy Packed Lunches Date June 2006 Contents Ideas for healthy packed lunches Display Children s Centre Displays Date December 2007 Contents 6 displays for parents of 0-5 year olds Display Healthy Weaning Display Date June 2008 Contents Table top display for Health visitors All current reports are available online at www.bhps.org.uk/healthy eating/ph Dietitians Reports. All resources are available from Berkshire Health Promotion Resources Service. 20