Can a co-produced, culturally and religiously-sensitive childhood intervention help create healthy behaviours?
Excess body weight is a source of national health concern with obesity linked to Type 2 diabetes, heart disease, and cancer[1,2]. Obesity is a complex issue driven by multiple factors – our environment, our biology, our culture, our behaviour. Without attempts to intervene and prevent excess weight gain, childhood overweight and obesity is likely to track into adolescence and adulthood, affecting the health and wellbeing of individuals, their families, their communities, and services.
With more than 1 in 5 children in Reception (aged 4-5), and more than 1 in 3 children in Year 6 (aged 10-11) who are overweight and obese in England, there are growing concerns and calls for action particularly as failure to act may continue to widen the inequalities in excess weight. We know those living in more deprived areas are more likely to be overweight than those in less deprived areas. Inequalities extend to ethnicity, with the number of overweight and obese children of Pakistani-origin rising to 2 in 5 by age 10-11.
To help address this growing concern, the Government has launched a childhood obesity plan to significantly reduce the number of children with obesity by 2030 by uniting efforts across councils, schools, businesses, health professionals, and families. With the transfer of public health services from the NHS to local authorities in 2013, local councils have a critical role to play in addressing childhood obesity. This led to the Government funding a three-year council-led initiative called the Obesity Trailblazer, which aims to tackle obesity and the inequalities between those living in the most and least deprived areas. Bradford was one of five successful local authorities selected as Trailblazer sites and works closely with us at Born in Bradford, a member of the Early Life & Prevention theme of the Yorkshire and Humber ARC, Well Bradford, and the JU:MP physical activity program.
Bradford is the fifth largest metropolitan district in the UK with high levels of deprivation and ethnic diversity. Over a third of our population live within the 10% most deprived neighbourhoods and almost a quarter of the population are of South Asian origin (predominantly Pakistani), rising to almost 40% among the younger age groups[6,7].
Religion plays a large role in the lives of our South Asian population. From our Born in Bradford cohort data, we found that over 85% of South Asian children identify as Muslim and 90% of Muslim children attend Madrassas (after school centres for Islamic education). There are 120 registered Islamic Religious Settings (IRS; Mosques, Madrassas, Women’s Circles) in Bradford and these religious settings are a central pillar and source of everyday structure, knowledge, and engagement for South Asian communities.
Bradford’s Obesity Trailblazer project seeks to address the pervasive inequalities in exposures to key drivers of obesity experienced by our South Asian families by identifying, engaging, and training leaders and volunteers in IRS to deliver tailored, evidence-based, and co-produced interventions using an Islamic narrative and behaviour change techniques. We will also support the IRS to influence and work alongside other organisations (such as schools), community assets (such as the voluntary sector), and policy and decision-makers (the local authority) to influence more structural drivers of obesity in their immediate geography, such as the high density of takeaways and lack of safe and high-quality green spaces.
Our exploratory work with focus groups and in-depth interviews found that Islamic leaders, volunteers, workers, and parents were receptive to an obesity intervention set in an IRS. We identified existing health promotion interventions in IRS  and examined over 50 recommended obesity behaviour targets (diet, physical activity, sedentary time, and community/environmental changes) and whether they would be appropriate, acceptable, feasible, and in line with Islamic teachings. For example, the recommendation that children eat meals with the family was agreed by Islamic leaders to be acceptable, appropriate, in accordance with Islam, and would be a feasible behaviour change. Similarly, the recommendation that Imams emphasise the social, physical, spiritual, and mental health benefits of maintaining a healthy weight was also considered satisfactory. However, while it was agreed that the consumption of fizzy drinks were a health problem and that drinking water instead of fizzy drinks would be in accordance with Islamic teachings, it was noted that barriers related to cultural desirability would hinder a switch to water.
Understanding what our community thinks is a key part of our work. A walk-around with adults and children using the “Our Voice Discovery Tool” app helped us identify and record our community’s thoughts about their environment; this allows decision-makers to directly “hear” community voices and inform their actions. This work has led to an example of community asset linking and a planned structural change. Our community identified fly tipping and a lack of space to play as key issues; subsequently, an area of wasteland owned by a private care home was identified and an agreement brokered to turn the site into a green play area for children attending the Al Mustafa Centre, a nearby IRS.
This early work helped us engage with the IRS community to identify local drivers as well as solutions. With promising intervention approaches identified from our scoping review and positive engagement from our IRS leaders and volunteers, we have an active two-and-a-half more years of Obesity Trailblazer activities planned. Working closely with the Council of Mosques to identify four pilot IRS settings, we are focusing on developing and piloting our model of working within IRS and will work closely with our four pilot IRS settings to co-produce our materials and approach. In later years, we will pilot our prototype model across additional IRS and develop and conduct a monitoring and evaluation plan to understand key implementation and process outcomes (such as reach and fidelity) and proximal outcomes (such as changes in dietary intake, physical activity, sedentary behaviour, and sleep).
What we hope to achieve is an acceptable, feasible, and culturally-relevant suite of interventions that will be sustainable due to their tailored implementation in engaged Islamic Religious Settings. Stay tuned for updates!
Abdullah A, Peeters A, de Courten M, et al. The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies. Diabetes Res Clin Pract 2010;89:309–19. doi:10.1016/j.diabres.2010.04.012
Finer N. Medical consequences of obesity. Medicine (Baltimore) 2015;43:88–93. doi:10.1016/j.mpmed.2014.11.003
Skelton JA, Irby MB, Grzywacz JG, et al. Etiologies of obesity in children: Nature and nurture. Pediatr Clin North Am 2011;58:1333–54. doi:10.1016/j.pcl.2011.09.006
Simmonds M, Llewellyn A, Owen CG, et al. Predicting adult obesity from childhood obesity: A systematic review and meta-analysis. Obes Rev 2016;17:95–107. doi:10.1111/obr.12334
Public Health England. Public Health Profiles. https://fingertips.phe.org.uk (accessed 9 Jan 2020).
City of Bradford Metropolitan District Council. Ethnicity in Bradford. 2017. https://ubd.bradford.gov.uk/media/1348/ethnicity-in-bradford.pdf
City of Bradford Metropolitan District Council. Indices of Deprivation 2019. 2019. https://ubd.bradford.gov.uk/media/1534/indices-of-deprivation-2019-intelligence-bulletin.pdf
Rai KK, Dogra SA, Barber S, et al. A scoping review and systematic mapping of health promotion interventions associated with obesity in Islamic religious settings in the UK. Obes Rev 2019;20:1231–61. doi:10.1111/obr.12874
This blog was written by Tiffany Yang, Senior Research Fellow, Healthy Childhood theme, Y&H ARC.13 January 2020