MEND (Mind, Exercise, Nutrition…Do It!) Program – MEND 7-13

Categories

Categories associated with best practice:

  • Children (ages 6-12) icon
  • Best Practices
  • Cardiovascular Disease
  • Community/ Neighbourhood
  • Diabetes icon 3
  • Healthy child development
  • Healthy Eating
  • Mental Health Icon 2
  • Personal health practices and coping skills
  • Physical Activity
  • Recreation/ Fitness/ Sport Facilities
  • Secondary School Icon 1
  • Social Support Networks

Determinants of Health: Personal health practices and coping skills, Social support networks, Healthy child development

Overview

The MEND (Mind, Exercise, Nutrition… Do It!) Program is a community intervention aimed to empower families of overweight and obese children to adopt and maintain healthy lifestyles. This program combines all the elements known to be important when treating and preventing overweight and obesity in children, including family involvement, behaviour change, practical education in nutrition, and increasing physical activity. MEND is not a diet, nor is designed for rapid weight loss. The purpose of the program is instead to bring about incremental and lasting improvements in families’ dietary intake, fitness levels and overall health to help encourage healthy growth and weight management. MEND offers three programs to meet the needs of: seven to 13 year olds, five to seven year olds and two to four year olds. This annotation is specific to the MEND program for seven to 13 year olds.

The MEND Program has two phases. The first is the intensive phase, during which families attend 20 biweekly, 2-hour sessions over the course of 10 weeks. The first part of the session is based on theory and is delivered in a workshop-style lesson format to all parents and children. These lessons alternate between being “Mind” and “Nutrition” focused. They are designed to teach practical skills around nutrition, education about healthy food choices and behaviour change techniques to support the implementation of new habits. During the second portion of the session, the children participate in fun land- or water-based physical activity, while the parents partake in an hour of guided discussion.

The second phase of the program is follow-up support to graduate families that lasts for two years. Families who
participated in MEND have the option to continue to be motivated and supported by MEND World activities and resources, including the MEND World webpage, the MEND World passport and the quarterly MEND World magazine. There are also local MEND World activities, such as continued exercise sessions, discounts to local fitness centres, Healthy Growth Checks, anthropomorphic, fitness and psychosocial measurements.

The impacts of the MEND Program have been evaluated in a number of studies, including studies employing randomized controlled designs. MEND has been found to positively impact physical health and physical health behaviours, including improved Body Mass Index (BMI) and waist circumference, cardiovascular fitness, physical activity and sedentary behaviours. Some studies have also found that MEND results in improved children’s self-esteem, parent self-efficacy, and reduced psychological distress in children.

Primary Source Document

Sacher PM, Kolotourou M, Chadwick PM, Cole TJ, Lawson MS, Lucas A, Singhal A, Randomized controlled trial of the MEND Program: A family-based community intervention for childhood obesity. Obesity; 18(Supplement 1): S62-S68

Contact information of developer(s) and/or implementer(s)

Developed by Great Ormond Street Hospital for Children NHS Trust and University College London Institute of Child Health,

Intervention Focus

Intervention Goal / ObjectiveLevel(s) TargetedEquity Focus
Empower children and adults to reach or maintain a healthier weight.
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.
Empower children and adults to become fitter, healthier and happier.
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.

Health Issue(s) that is/are addressed by the Intervention

Health Promotion

  • Healthy Eating
  • Mental Health
  • Physical Activity

Risk Reduction

    Specific Activities of the Intervention

    • Educational health information offered
    • Group process/program
    • Provision of planning tools and evaluation tools

    Priority/Target Population for Intervention Delivery

    Life Stage

    • Children (age 6-12 years)

    Settings

    Educational Settings

    • Secondary/Middle school

    Community Setting

    • Community/neighbourhood
    • Recreation/fitness/sport facilities

    Outcomes

    Outcomes and Impact Chart
    Level of ImpactDescription of OutcomeEquity Focus
    Individual LevelAt 6 months, sedentary activity levels were significantly lower in the intervention than the control group, adjusted for baseline (-5.1 h/week, P = 0.01). For the intervention group, there were decreases in sedentary activity levels at the 6-month follow-up only. Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.
    Individual LevelAt 6 months, both waist circumference and BMI were highly significantly less in the intervention than the control group, adjusted for baseline (-4.1 cm and -1.2 kg/m2, respectively, or -0.24 and -0.37 z-scores (all P < 0.0001). In the control group waist circumference and BMI did not change significantly during the 6 months (P = 0.3 and 0.8, respectively). For the intervention group, there were significant reductions in waist circumference and to a lesser extent, BMI, at both the 6 and 12 month follow-ups.Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.
    Individual LevelAt 6 months, physical activity levels were significantly higher in the intervention than the control group, adjusted for baseline (?3.9 h/week, P = 0.04). For the intervention group, there were increases in physical activity levels at both the 6 and 12 month follow-ups.Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.
    Individual LevelAt 6 months, recovery heart rate was significantly less in the intervention than the control group, adjusted for baseline (-20.3 beats/min, P = 0.003). For the intervention group, there were significant reductions in recovery heart rate at both the 6 and 12 month follow-ups.Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.
    Individual LevelAt 6 months, global self-esteem (maximum score of 4) was significantly higher in the intervention than the control group, adjusted for baseline (0.3, P = 0.04). For the intervention group, self-esteem was higher at both the 6 and 12 month follow-ups as compared to baseline.Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.

    Adaptability

    Implementation History

    • Multiple implementations - Different settings/populations/providers - The intervention showed significant adaptability as it has been implemented in different settings or with different populations or by different provider(s). This can include multiple implementations during the same time period. Each implementation of the intervention must have been substantially the same and must have demonstrated positive results for the primary objectives of the intervention.

    Expertise Required for Implementation within the Context of the Intervention

    • Specialized skills training provided as part of the Intervention - The intervention does not require individuals or groups with highly specialized training, but requires that individuals or groups be trained as part of the implementation of the intervention.

    Are there supports available for implementation

    Yes. Training, evaluation and implementation supports

    Are there resources and/or products associated with the interventions

    Yes. Expert teaching resources raise awareness of the benefits of eating healthy foods and regular physical activity for children; online system to store and access participant data; MEND delivery kit.