Healthy attitudes

Jibes from the playground echo around Ifechi’s head: “You’re so fat, they use your belt to measure the equator”. At 12 years old, he’s desperate to lose weight, but the teasing makes things worse.

Ifechi is too self-conscious to get in the swimming pool, but every day after school he picks up a large packet of Haribo sweets, which he says makes him feel better, at least for a while.

But things are starting to change, Ifechi is sitting cross-legged and attentive in a leisure centre in east London as part of Tower Hamlets’ Building Powerful Communities programme. Surrounded by other children and parents in bright T-shirts, today’s class is about the “secret names for sugars” – dextrose, sucrose, glucose.

“Haribo has triple the amount of sugar I’m supposed to have in a day,” Ifechi says, wide-eyed.

Along with his mum and little brother, Ifechi has committed to an intensive 10-week programme with two sessions each week. The programme aims to get families eating healthier food and living more active lives and is a joint enterprise between NHS East London and the City, the London Borough of Tower Hamlets, Bupa and charity Mend.

Started in September 2011, the scheme aims to reach 10,000 people by 2013, working not just with families, but also providing teaching resources to schools and training for health professionals.

But why Tower Hamlets? With 25.6 per cent of children aged 10 to 11 obese, this borough has the second highest obesity rate in London and the fourth highest in the UK. Excess weight is leaving local people at risk of heart disease and diabetes and the associated health costs are projected to cost the borough nearly £90m a year by 2015.

High levels of poverty
“It’s easier to be obese than slim in this part of the world,” says Cathie Shaw, senior public health strategist for Tower Hamlets. “It’s a built-up urban area with high levels of poverty. There’s not enough green spaces or back gardens, congested roads with lots of traffic make it difficult to walk and cycle and there are large numbers of fast food outlets.”

Many of the parents in the class are as overweight as their children, struggling to stay healthy in a world that often feels like it is conspiring against them. Many would like to exercise more, but say that parks feel unsafe and leisure centres are expensive or over-subscribed. Healthy food is too pricey or too time-consuming to prepare, particularly when many parents are working long hours.

“Me and my wife just don’t have the time to be healthy,” says Mohammed Uddin, a father with two children in the class. “I work as a kitchen assistant and she works in the teaching department. To save time we drop them by car.”

Junk food meanwhile is cheap, quick and easily available. Even at the leisure centre where the health classes are held, the only food available comes from a vending machine packed with sugary drinks, crisps and Ifechi’s weakness – jumbo packs of Haribo.

The Building Powerful Communities programme is effective because it acknowledges these challenges rather than ignoring them, says Phil Veasey, strategic partnerships director at Mend. It looks at the life of the parent and the child: where they live, how they work and where they play, and suggests changes that work with these realities.

Workers will go with families on their weekly shop, look at their daily menu choices and help schedule in exercise.

“We’re taking the obesity crisis from the desks of GPs to the doorsteps of local communities,” Veasey explains. “We’re on a behaviour change journey to give people the tools they need to return to a healthy weight. It’s empowering to learn how to control your own diet. No one teaches you how to read those labels. We just need to provide a bit of support.”

Rosemary Genfi, Ifechi’s mother, is a single mother of two, who suffers from diabetes and she is unable to work because of high blood pressure. “At first I didn’t understand it. I was arguing and telling them it was hard to do it. It’s no good just saying ‘no sweets’ – we need an alternative. We can’t just stop like that.”

Now workers on the programme have been recommending substitutes for Rosemary and things have improved. She is clutching a pack of wheat crispbreads that she is using as a replacement for crisps and says her boys are drinking more fruit juice than fizzy drinks.

Ifechi’s younger brother, 10-year-old Ekenechi, who was used to putting four large spoons of sugar onto already sweet cereal, is finding things a little harder.

“It’s not brilliant because it’s really hard to change habits,” he says. “But I want to be fit and I don’t want to die before I have to.”

Getting wiser
Uddin’s children are also getting wiser. He says that since enrolling on the programme, his two children want to do more sports, pushing him to take them to badminton and the swimming pool. In the supermarket they are demanding healthier products. Chips are now made in the oven rather than fried. Even Uddin and his wife have got healthier, with his wife taking up Zumba exercise classes and cycling with her children to school.

“People who go through this programme can’t stop talking about it,” says Veasey. “They notice real shifts. Scientists just talk about measuring their weight and BMI but families tell me that this has changed their lives – how they now eat and play together; how they’re more confident to play sports; how they’re not being bullied and they have more friends. Their life is just much better quality.”

Of course there are still challenges. Veasey says recruitment is the biggest hurdle. At present the system works through referrals. Health professionals, teachers and other practitioners recommend the programme to their users, who all attend by choice.

“Families find it difficult to commit to a programme twice a week,” says Veasey. “Recruitment is also hard because overweight is now the norm. In family parties everyone looks the same. Size 12 is now size 14.”

But once families are on the programme, the retention rate is 86 per cent, and the results seem to be extremely positive. So far Mend says 140 families have been helped to become fitter and healthier through one of its family-based programmes and 705 children have used Mend’s schools resources.

The class that Ifechi and his family are attending along with the Uddin’s and others is specifically aimed at seven- to 11-year-olds and their parents, but there are strands for younger age groups. The project also has an athlete mentoring programme, which provides families with a chance to have classes with former sports champions.

Wider strategy
The programe is part of a wider strategy led by Tower Hamlets Council. “We’re working with local restaurants and takeaways to change the preparation of their food, changing the types of oils they use, or increasing the availability of fresh fruit and vegetables,” Shaw explains. “This is part of a much wider programme of environmental change. Some people call it the nanny state, I call it the responsible state.”

The feedback so far has been positive, with families who have been through the programme volunteering to become positive ambassadors, encouraging others to take it up.

And for the families, the small steps to a healthier attitude to life are starting to yield results. “We’re eating more healthily and getting more exercise,” says Ifechi. “Now I have fifty-fifty bread, not just plain white, and I eat brown rice and brown pasta. I eat less sweets and sugary stuff. We walk more and play more football. They haven’t weighed us, so I don’t know if I’ve lost weight yet, but I feel better.”


Obesity in Tower Hamlets