LEAP’s Community, Activity and Nutrition Programme (CAN)
Dr Sophie Hedges, Senior Data Analyst at the Lambeth Early Action Partnership (LEAP), discusses her recent presentation of evidence at the Health and Care Analytics conference, sharing how LEAP’s community-based antenatal programme helps pregnant women and birthing people with a BMI over 25 to eat healthily and increase their physical activity levels.
What is the Community Activity and Nutrition (CAN) service?
LEAP’s CAN service supports pregnant women and birthing people with a BMI of 25 or over to eat well and increase their physical activity levels.
The CAN service is not about dieting or losing weight. CAN is based on making small but specific changes to eating and physical activity behaviours to help pregnant women maintain better control of their blood sugar levels, thereby providing them with more energy.
The Body Mass Index (BMI) measure uses a person’s height and weight to work out if their weight is within a healthy range. Although many women who carry excess weight have no problems in pregnancy and deliver a healthy baby, a high BMI can contribute to a range of problems including miscarriage, gestational diabetes, and high blood pressure. In addition, it may cause babies to be born with below or above average birth weight, which in turn can lead to health risks in childhood and later life.
Women meet with CAN midwives at the start and end of the programme, and work with health improvement facilitators over the course of eight one-hour sessions. Midwives also follow up with women six months after the birth of their baby.
During weeks 14 and 28 of pregnancy, CAN service participants work with the health improvement facilitator to develop their own unique eating and activity plan to make healthy changes in their lives.
Participants discuss different physical activities and nutrition topics, set weekly dietary goals such as food swaps, and explore recipe adaptation and healthier ways to prepare family meals. Participants learn how to maintain a healthy diet and find more out about food and the way the body absorbs and processes different food groups.
Loretta completed the CAN programme when she was pregnant with her daughter.
Loretta explains:
“When I was pregnant, I wanted to change my way of thinking about food, and learn a new way of having a healthy, balanced diet for myself and my baby. We set ourselves weekly goals, not trying to change everything at once. The approach was positive. I learned through CAN how to implement simple changes to my daily life, like walking more and choosing healthier foods when shopping”.
What is the evidence that the CAN programme works?
In 2017/18, 41% of women in the LEAP area booking for maternity services had a BMI greater than or equal to 25. Looking at the ethnicity of participants in the programme: 54% were Black, 24% White, 12% Other, 6% Asian and 4% Mixed.
LEAP gathered and analysed data on levels of physical activity at 3 different timepoints from 485 CAN service participants. The International Physical Activity Questionnaire was used. The analysis adjusted for ethnicity and neighbourhood deprivation. The data showed that individuals participating in the CAN programme significantly increased their physical activity levels during pregnancy and beyond.
Participation in the CAN programme resulted in a significant increase in walking – more than 1 hour 30 minutes of additional walking per week. Although there was no antenatal change in moderate or vigorous activity, there was significant increase postnatally. Participants were much more likely to be meeting the minimum level of activity recommended by Chief Medical Officer (150 minutes per week) after participating in the CAN programme.
At the start of programme, Black participants spent the least time in physical activity and White participants the most – a difference of over an hour a week in time spent walking and around half an hour in time spent in moderate/vigorous activity.
Activity levels increased for participants of all ethnicities – but there was no change in the gap between ethnic groups. This echoes findings from national surveys. The reasons may reflect differences in parity, access to space for exercise, discrimination, or cultural differences.
In conclusion, the tailored, non-judgmental approach of LEAP’s CAN service has helped participants to increase their activity levels and receives very positive feedback.
The LEAP team has also presented a webinar about the CAN service for the Office of Health Improvement and Disparities (OHID), which indicates that services addressing maternal weight are a national public health priority.
About A Better Start
A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.
Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.
The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier
The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.
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Visit the A Better Start website to find out more.