Journal of Human Nutrition and Dietetics (1999), 12 (Suppl. 1), 99±100

# 1999 Blackwell Science Ltd. 99

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Abstract: `New Image': Evaluation of the

effectiveness of the 1996 `New Image'

programmes

C. Collins*, D. Fee{ and U. Chappiti{*School Nurse, {SRD, North-west Anglia (NHS) Trust, Peterborough, UK

Background

In Peterborough, childhood obesity has been

identified as an area of concern by various health

professionals. As a result, a variety of strategies

have been tried. Conventional approaches, such

as one-to-one consultations focusing on weight

loss, have limited success. Little emphasis has

been given to addressing the barriers to changing

other contributing factors. It was recognized that

overweight children frequently portrayed or pre-

sented with other problems affecting their social,

psychological and physical well being. Encoura-

ging young children to adopt a healthy diet and a

healthy level of physical activity may be the key to

their future well being. Improving self-esteem and

body image may be instrumental in achieving this

goal, and have benefits in other areas. The `New

Image' programme was developed as a lifestyle

approach to help achieve weight maintenance in

adolescent overweight girls.

The `New Image' programme

The programme was organized and run by a

multidisciplinary team of health professionals

which included two community nursing sisters,

one community dietitian, one community paedia-

trician and one physiotherapist. The programme

consisted of eight sessions each lasting an hour

and took place after school in the late spring and

summer to avoid dark evenings. The sessions

covered advice on healthy eating, food prepara-

tion, sport and exercise, looking good (skin care,

makeup, and clothing), body image and self

esteem and was supported by various commercial

organizations. A circular was sent to all General

Practitioners (GPs), school nurses, community

paediatricians (school doctors), hospital paedia-

tricians and dietitians explaining the aim and

structure of the course and inviting referrals for

overweight girls aged 12±16 years. A personal

invitation was sent to all girls referred, giving

them information regarding the programme, time

and location. The invitation included a reply slip

which required parental consent.

Evaluation

The aim of the evaluation was to assess the

effectiveness of the pilot `New Image' programme

by answering the following questions:

1 Did the programme achieve weight control in a

group of overweight girls aged 12±16 years?

(Overweight was defined as weight two centiles

above that for height, and weight control was

defined as no appreciable change in body mass

index (BMI) during the 8 weeks of the course and

at 18 months' follow-up.)

2 Did the girls who attended the course make

any long-term changes in eating patterns at 18

months' follow-up?

3 Does a lifestyle approach programme achieve

changes in self-esteem and improve self-image as

well as induce a more positive attitude to exercise?

Methods

Quantitative data, heights, weights and BMIs,

were collected from the programme data (taken at

the start and end of the 8 weeks) and measure-

ments of height and weight were taken at the

follow-up interview (& 18 months later). ACorrespondence: C. Collins, City Health Clinic,

Wellington St, Peterborough PE1 5DU.

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100 C. Collins et al.

# 1999 Blackwell Science Ltd, J Hum Nutr Dietet 12 (Suppl. 1), 99±100

qualitative study using a semistructured inter-

view was carried out retrospectively with con-

senting participants and parents/guardians either

on the school site or in the subjects' homes. Food

diaries kept during one week of the programme

were compared with responses to follow-up

interview questions on changes to eating patterns

to determine whether long-term changes had

been made.

Results

Fifteen girls aged 12±16 years participated in the

pilot `New Image' programmes and of these 10

agreed to be interviewed for the follow-up & 18

months later.

Heights and weights were available for 11 of

the girls at the beginning and end of the 8-week

course and for 7 girls at the 18-month follow-up.

During the 8-week course there was a mean

weight increase of 1.8 kg (range±1 to +5 kg). A

further mean weight increase of 9.2 kg (range 1.8±

17.1 kg) was recorded at the 18-month follow-up.

These weight increases resulted in an increased

mean BMI (11 subjects) from 28.2 to 28.8 kg/m2

during the 8-week programme and from 28.8 to

31.2 kg/m2 (7 subjects) at the follow-up.

The girls appeared to have made a number of

changes to their eating patterns which were

observed by comparing their food diaries kept

during one week of the programme and with the

information given at the follow-up interview. The

main changes were identified as follows:

. ate more varieties of high fibre bread;

. skipped fewer meals;

. chose more healthy snacks, e.g. fruit rather

than crisps and chocolate;

. expressed a more positive attitude towards

healthy eating and trying out new foods.

Eight out of the 10 girls at follow-up said that

they participated in more physical activity. These

activities included swimming, cycling, walking,

football, keep fit, aquafit and were in addition to

school PE. None of the participants claimed to

have decreased their physical activities.

In response to a question about what they had

hoped to gain from the programme, eight out of 10

girls said that they hoped to gain confidence and

only three said that they hoped to lose weight. All

of the girls interviewed at follow-up said that the

programme had boosted their confidence or

improved their self-esteem in some way. However,

the session least remembered and enjoyed was

the session on `Body Image' and none of the

participants remembered seeing the video on

body image. All 10 subjects at follow-up said

that they would recommend the `New Image'

programme to other girls.

Conclusion

The number of girls who participated in the two

pilot `New Image' programmes was small and the

numbers participating in the evaluation was even

smaller so it is not possible to reach any firm con-

clusions about the effectiveness of this programme.

The `New Image' programme did not achieve

weight control during the programme for the 11

girls for whom start and end height and weight

data were available or during the follow-up

period for the seven girls for whom weight and

height data were collected at 18 months.

Some changes to eating patterns were reported

by some of the girls but there is insufficient

evidence to reach a conclusion that any long-term

changes had been made to eating patterns. Any

changes to eating patterns did not appear to aid

weight control.

Using a programme with a lifestyle approach

appears to have achieved some improvement in

confidence and self-esteem and in the amount

of physical activity taken in most if not all of

the girls.

Recommendations

. The `New Image' programme is re-run with a

much greater emphasis on healthy eating and

portion control, but in conjunction with

exercise and self esteem work. The programme

is run as above and the key family members

are included in a parallel programme.

. The programme is to be evaluated as an

intervention to prevent overweight and obesity

in pre-teenage girls when eating habits are less

established and peer pressures are less.

. The programme is piloted with overweight

teenage boys, using appropriate male staff.

. A wider variety of exercise opportunities

should be made available to participants on

the programme.

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