Does a community-based practical food skills intervention (CookWell)

assist weight reductionW.L. Wrieden1, A.S. Anderson2, E. Dowler3, K.

Valentine2 and P.J. Longbottom2

1School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, AB25 1HG, 2Centre for Public

Health Nutrition Research, University of Dundee, Dundee DD1 9SY and 3Department of Sociology,

University of Warwick, Coventry CV4 7AL

BackgroundFor many socially disadvantaged families,

practical issues limit access to a healthy varied diet.

• low disposable income

• limited access to good quality food at affordable prices

• minimal cooking facilities and skills

• poor neighbourhoods have fewer opportunities for health promoting activities than more affluent communities

Background• For women being overweight or obese was

associated with SIMD quintile.

(Scottish Health Survey 2008)

Background• NICE (2006) recommend that weight management

programmes should use a balanced, healthy-eating approach.

• Lower socioeconomic groups more likely to believe that losing weight required a lot of cooking skills and involved eating differently from others in the household (Siu, Giskes and Turrell 2011)

• Lack of cooking skills likely to a barrier to fruit and vegetable consumption or healthy eating (Larson et al. 2006; Winkler and Turrell 2010)

• Possible link between poor cooking skills, being overweight and ready meal consumption (van der Horst et al. 2011).

Background• In 2001 there were over

170 food and health projects in low-income communities in Scotland (HEBS 2001).

• One third of these had a cookery skills component.

• …funding allowed limited evaluation in some cases.

• CookWell project allowed full evaluation of food skills programme

The ‘CookWell’ programme – a food skills programme to promote

healthy eating

Overall aim:To develop and assess the impact of a community-based practical food skills intervention (CookWell) in low-income communities on food intake, food preparation methods and cooking confidence.

Cookwell

• A 10-week programme of cooking skills classes

• 8 communities across Scotland: Addiewell, Alloa, Ardler, Edinburgh, Ferguslie, Greenock, Hawick, Kirkcaldy

• Community development approach

• Informed by consumer needs

Evaluation

• Quasi-experimental design:– Intervention group– Delayed intervention group (control)– Pre- and post-measures:

• Budgetary (shopping diary)• Dietary (food diary and food frequency

questionnaire)• Height (at baseline), weight• Cooking skills (questionnaire)

The Research

Piloting ofmeasures

ExploratoryResearch

(FGs)

Design ofintervention

and measures

BaselineMeasures

T1

Intervention

Control

Immediatefollow-upMeasures

T2

6-monthfollow-upMeasures

T3

Qualitativeresearch

(Interviews)

Identification of sites

Recruitment

Evaluation

• Height at baseline T1 and weight recorded at T1,T2 &T3

• Only those giving consent for these measurements included

• Changes in BMI and weight compared for intervention and delayed intervention groups (T2 –T1) and (T3 – T1)

Results• 93 participants, • 50 completed 7-day food diaries at T1 and

T2. • 40 completed diaries at T3. • The mean age of all groups was similar with

an overall mean age of 32.3 (SD, 10.2) years and an age range of 16 to 65 years at T1

• 36 (Intervention n=24, Control n=12) weighed at T1,T2 &T3

• 41 (Intervention n=27, Control n=14) weighed at T1 & T3

Mean Portions per week (intervention group)

Results• Mean BMI was between 26 and 28,

similar to the mean for the Scottish population.

• Slight decrease in mean weight (-0.6 kg) for intervention subjects from T1 to T3 compared with an increase (mean 1.8 kg) seen in control subjects (P=0.052).

• Significant difference in BMI change (P<0.05)

Mean weight at baseline (T1), after intervention (T2) and 6 months later (T3)

Mean BMI at baseline (T1), after intervention (T2) and 6 months

later (T3)

Intervention SD Control SD

T1 28.19 6.54 26.10 4.51

T2 27.79 6.55 26.22 4.77

T3 27.95 6.90 26.74 5.08

Mean change in BMI(P values for difference between intervention and control)

P= 0.049

P = 0.186

Results

oNo significant differences in change in weight or BMI between T1 and T2

oHowever 6 months after intervention mean BMI reduced (-0.2) in intervention group but increased (+0.6) in controls (P=0.049) for those weighed at T1,T2 and T3

o Inclusion of those who were weighed at T1 and T3 but not T2 gave mean BMI reduction (-0.4) in the intervention group but increase (+0.8) in the control group (P=0.014).

Discussion• Both groups recorded their food intake –

difference unlikely to be due to the effect of keeping a food diary.

• Increase seen in control subjects is not surprising given the general tendency to increase in weight with age.

• Larger than would be expected from the Scottish Health Survey data (

• The true significance of these results is difficult to gauge.

• Should we give more emphasis on cooking skills in weight management programme

Funded by the Food Standards Agency