Diet and nutrition
What evidence is there for effective intervention?
National Institute for Health and Clinical Excellence (NICE)
Public Health Guidance
Behaviour change at population, community and individual levels (PH6)Maternal and child and nutrition. (PH11)
Prevention of cardiovascular disease. (PH25)
Physical activity and dietary intervention for weight management before, during and after pregnancy. (PH27)
Preventing type 2 diabetes - population and community interventions. (PH35)
Managing Overweight and Obesity among Children and Young People: Lifestyle Weight Management Services (PH47)
Behaviour Change: Individual Approaches (PH49)
Overweight and Obese Adults – Lifestyle Weight Management (PH53)
Nutrition Support in Adults. (CG32)
Postnatal Care. (CG37)
Obesity: The Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children (CG43). (CG43)
Food Allergy in Children and Young People (CG116)
Lipid Modification: Cardiovascular Risk Assessment and Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease (CG181)
Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults (CG189)
Department of Health
National Service Framework for Children, Young People and Maternity Services: Maternity Services.
Infant Feeding Recommendation.
Healthy Lives, Healthy People: A Call to Action.
Interventions to Promote Breastfeeding
The UNICEF Baby friendly Initiative (BFI) suggests the following core practices in maternity and community services.
- The delivery of an appropriate mix of education and/or support programmes routinely delivered by health professionals, practitioners and peer supporters. This includes:
- Informal, practical breastfeeding education in the antenatal period, delivered in combination with peer support programmes to women on low incomes.
- A single session of informal breastfeeding education delivered during the antenatal period, targeting women on low incomes.
- Practical breastfeeding support from a health professional/practitioner in the early postnatal period.
- Peer support programmes in antenatal and/or postnatal periods to women on low incomes.
- Changes to policy and practice within the community and hospital setting including:
- Supporting effective positioning and attachment.
- Encouraging unrestricted baby-led breastfeeding.
- Encouraging the combination of supportive care.
- Teaching breastfeeding technique and reassurance for women with ‘insufficient’ milk.
- Peer or volunteer support to be delivered by telephone in late antenatal and early postnatal periods to complement face to face support.
- Breastfeeding education and support from one professional in the antenatal and early postnatal period.
- One-to-one, needs-based professional education in the antenatal period and peer support for up to 1 year targeting white, low income women.
- Media programmes that use local images for specific target groups, including teenagers.
A systematic review of professional support interventions for breastfeeding (Hannula et al, 2008) concluded that:
• Interventions expanding from pregnancy through to birth and the postnatal period were more effective than interventions concentrating on a shorter period.
• Intervention ‘packages’ using various methods of education and support from well-trained professionals were more effective than interventions concentrating on a single method.
• During pregnancy the effective interventions were interactive, involving mothers in conversation
• The BFI approach when combined with ‘hands off teaching’ was effective.
• Interventions that were effective during the postnatal period were: home visits; telephone support and breastfeeding centres combined with peer support.
• Professionals need breastfeeding education and the support of their organisations to act as breastfeeding supporters.
• Mothers benefit from breastfeeding encouragement and guidance that supports their self efficacy, feelings of being capable and empowered and that is tailored to their individual needs.
Children and Young People
One of the biggest challenges when trying to improve the diets of women, children and families is how to help them change their behaviour (rather than just their knowledge and attitudes). NICE guidance (see links above) emphasises that a multidisciplinary approach (involving and supporting the families themselves and the wider community) is the most effective option. It is important that professionals involved adopt a non-judgemental, informal and individual approach based on advice about food, rather than just nutrients.
Overall, the evidence suggests that dietary interventions which recognise the specific circumstances facing low income families, teenage parents and mothers from minority ethnic or disadvantaged groups are likely to be more effective than generic interventions. NICE suggest that services need to be accessible and applicable to everyone, including those with learning, physical or other disabilities. NICE also emphasise the importance of monitoring and evaluating new interventions.
Knai, et al. (2006). Getting children to eat more fruit and vegetables: A systematic review.
Townsend et al. (2011). The more schools do to promote healthy eating, the healthier the dietary choices by students.
A systematic review showed the effectiveness of 'paraprofessionals' (trained and supervised community food workers and health trainers) or peer educators who are trained and supervised by nutritionists to deliver education and skill-based programmes to low-income populations. The review found that managers will need to ensure that the intervention has been developed from a theoretical base, has a specific message about increasing fruit and vegetable consumption, and has a component about behaviour change (Cilska et al, 2004).
Story et al (2008). Creating healthy food and eating environments: Policy and environmental approaches.
Pomerleau et al (2005). Interventions designed to increase adult fruit and vegetable intake can be effective: A systematic review of the literature.
Jolly K, Ingram L, Khan KS. et al. (2012). Systematic review of peer support for breastfeeding continuation: meta-regression analysis of the effect of setting, intensity, and timing. British Medical Journal, 344, d8287
Kaunonen M, Hannula L. & Tarkka MT. (2012). A systematic review of peer support interventions for breastfeeding. Journal of Clinical Nursing, 21 (13-14), 1943 – 1954
Government Office for Science (2007) Tackling Obesities: Future Choices. London: Author
Lara J, Hobbs N, Moynihan PJ. et al. (2014). Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials. BMC Medicine, 12, 60
McGill R, Anwar E, Orton L. et al. (2015). Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health, 15, 457
Moran VH, Morgan H, Rothnie K. et al. (2015). Incentives to promote breastfeeding: A systematic review. Pediatrics, 135 (3), e687 - e702
National Obesity Observatory – for a wide variety of publications and information related to obesity
Renfrew MJ, McCormick FM, Wade A. et al. (2012). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD001141