Leeds: We need to talk about HENRY

Leeds: We need to talk about HENRY

In these hideously divisive times, we grasp like drowning men at anything remotely akin to good news. The recent news that a major UK city – Leeds – may have finally reversed decades of growing childhood obesity is undoubtedly a cause for serious celebration.

The city, as the Guardian newspaper trumpeted, has done what no UK city has been able to do, or for that matter many other major cities elsewhere, perhaps with the notable exception of Amsterdam, and that is to apparently reverse childhood obesity. It appears to have delivered the right results by focusing on early years settings and deprived families in particular. But its main weapon has been HENRY (Health, Exercise, and Nutrition for the Really Young), a programme that helps parents set boundaries for their children, including taking a firm stance over healthy eating and bedtimes.

‘Leeds makes history’ and ‘Saves hundreds of four and five year olds from dangerous weight gain in one year’ trumpeted some of the other newspaper headlines. Politicians too were eager to latch on to this piece of good news. Health and social care secretary Matt Hancock enthusiastically tweeted about the “pivotal role parents play” in tackling this seemingly intractable problem.

HENRY, a charity used by countless other public health departments, was launched in 2007 as a response to the clear need for a preventive initiative in the fight against childhood obesity. It is focused on infants up to the age of five and crucially involves their families. But the question remains, why has HENRY been so notably successful in Leeds, but not necessarily elsewhere in the UK?

HENRY is an eight-week programme based upon authoritative rather than authoritarian parenting, says HENRY’s chief executive Kim Roberts.

“Authoritarian parenting is when children are told what to eat and what to do, such as being banned from leaving the table until they have eaten their sprouts,” she explains.

It is a very different approach from parents asking children what they want to do or to eat, as in the more prevalent style of permissive parenting. But it does allow for a degree of self-determination by children by allowing them to respond to carefully selected questions about, for example, whether they want carrots or broccoli with their evening meal. Instead of being ordered to bed, children are asked where they would like their bedtime story to be read to them.

No matter how impressive initial evaluations of HENRY appear, one swallow does not a summer make. While it would also certainly be wrong to denigrate Leeds’ achievement – the establishment of a very crucial principle, that childhood obesity really can be reversed – the statistics upon which that assertion is based, are very limited, to say the least.

While HENRY seems an amazing programme, and one that is relatively inexpensive to deliver at the cost of about £50 per family. It is only one piece, albeit an important one, of the anti-obesity jigsaw. The emphasis on early years and good parenting is vital, but so too is the work being done in schools. One will not work properly without the other. We should not allow Peter to rob Paul in policy terms, in these straitened times.

There is no magic silver bullet, asserts Dr Charlotte Evans, associate professor in public health and nutrition at the School of Food Science and Nutrition at the University of Leeds.

“HENRY is one of the few programmes that targets pre-school children that councils can buy into – there is nothing better around – but it is part of a bigger picture,” says Evans.

“No individual programme will have much of an impact on its own,” she adds. “It must be part of a whole-system approach that tackles things like sugar consumption, the fast food environment and the marketing of junk food.”

The figures taken from England’s National Child Measurement Programme (NCMP) over 2009-17 found that the proportion of children entering primary school in Leeds (aged between four and five) who were obese fell from 9.4% in 2009-10 to 8.8% in 2016.

The reduction was chiefly among the most deprived children – from 11.5% to 10.5% over the period – where the problem is worst, but also occurred among affluent children (6.8% to 6.0%). In terms of numbers, the results equated to 625 fewer reception class children who were obese in 2016-17 than in 2009-10.

No similar reduction in obesity was seen in other English cities and the prevalence of obesity in older year six children (aged between 10 and 11) remained unchanged in Leeds and elsewhere.

While the figures are encouraging, they are too selective to be that statistically significant, according to those who monitor childhood obesity for other English councils.

The NCMP data published by Public Health England (PHE) merely shows a return to 2013-14 levels of 9.5% in each case, asserts Tom Frost, public health intelligence analyst at Swindon Borough Council.

“As for being the first UK city to lower childhood obesity, the data is easy to cherry-pick from the NCMP,” he says, citing Bath as a more statistically significant example as the city managed to reduce obesity in reception class from 10.8% in 2011-2012 to just 7.4% in 2015-2016.

Similarly figures for Newcastle over the same periods as Leeds, using the same measure, fell from 12.10% to 11.25% and its figure for 2017-2018 was 11.16%, points out Eugene Milne, director of public heath at Newcastle.

“So, between 2009-2010 and 2017-2018, obesity by this yardstick fell in Leeds by 4.68%, whereas in Newcastle it fell by 7.81%,” he points out. “Does this make Newcastle the first UK city to lower its obesity rate? Or does it mean that the Leeds data have been misleadingly over-interpreted?”

The danger in all of this is that programmes such as HENRY, with its emphasis on parents and individual behavioural choice, might be allowed to predominate over all other interventions, possibly even obscuring or worse, undoing recent school food reforms.

As Dr Evans emphasises, HENRY is an entirely laudable programme, the best in class of its kind, but initiatives such as these must never be allowed to become either-or situations. Further figures are clearly needed along with a fuller evaluation of HENRY.

Obesity is an intractable issue and one that is increasing disproportionately amongst the poorest sections of British society. Future policy decisions must be based upon the right decisions, as well as a great dollop of common sense, rather than on that which is politically expedient, no matter how strong the temptation to grasp at nettles.