Change4Life: Government initiative to reduce Childhood Obesity in England
Background
Change4Life, a public health program in England, effective since January of 2009 and organized by the Department of Health is the country’s first national social marketing campaign to reduce obesity (NHS, 2009, pp. 13). More specifically aimed at families with children under twelve years old, the initiative seeks to reduce childhood obesity and foster healthy and happy children, who in turn grown into happy and healthy adults. In recent years, a rise in obesity numbers and a decrease in physical activity led the Change4Life campaign to challenge the behaviors of English families that lead to excess weight gain (Change4Life, 2009, pp.1). In hoping to eliminate obesity from the earliest stages of life, Change4Life works to not only adjust citizen’s weight, but their overall health and well-being through education and easily-accessible information. In essence, this campaign aims to encourage people to lead overall healthier lives, using the slogan “eat well, move more, live longer,” which is a message strong enough to have gained over a million individuals committing to the program since its inception over three years ago (NHS, 2012, pp.1).
Aims and Objectives As mentioned previously, the Change4Life policy was aimed at parents and children to foster healthy living from childhood all the way into adulthood. Change4Life’s aim is generally to inspire a “broad collection of people,” including the NHS, local authorities, businesses, charities, schools, families, community leaders, and in fact, anyone working with families and individuals – to play a part in improving the nation’s health and well-being by encouraging everyone to eat well, move more and live longer (NHS, 2009, pp.1). Being introduced in a manner that did not single out one particular group, but served to enhance the lives and well-being of the entire English population, Change4Life was not only introduced in a manner that targeted the entire population, but intended to achieve a bettering of this population from the get-go, regardless of any obstacles that stood in the way.
Policy Options Proposed and carried out by the Department of Health and its attributed agencies, Change4Life was founded after seeing a need for such a program amongst the English population and drawing inspiration from other successful behavior change campaigns set in place in other countries (NSMC, 2011, pp.1). In developing the program, the Department of Health and its sponsors weighed a variety of program options in order to come to the eventual Change4Life program. While other programs could focus on certain aspects of health and well-being such as diet, exercise, education, etc., Change4Life was set in motion to become a program that is all-encompassing. In the initial planning stages of the program, it became clear that more individualised, single-mission programs would not serve the country as well as one such as Change4Life. In viewing the status of the country in 2009, it was understood that initiatives focusing on food or exercise along would simply not do. Dr. Thomas Kelly of the Bow Group’s Health and Education Policy Committee said, “In order to tackle the obesity epidemic facing Britain, it is clear we must empower individuals to . . . achieve behavioral change on a scale not witnessed before” (The Bow Group, 2009, pp.1).
Policy Process Before the implementation of Change4Life into English society, the Department of Health and its supporters worked for months to garner support from sponsors, businesses and the public as well as working on a “three-year marketing strategy to drive, coax, encourage and support people through each stage of the behavior change journey” (NSMC, 2011, pp.1). Additionally, the government set into motion advisory committees on obesity to truly understand the problem that existed within the country, only to disband these groups after the planning stages were entirely over. This expert group, which was present in past health initiatives within the country, drew significantly from past experience and empirical research to support the development and delivery of the Change4Life program, among other lesser-known initiatives (Wise, 2011, pp. 1). Perhaps one of the most successful aspects of the Change4Life program and its policy process is the slow and steady manner in which it was founded, introduced to the public, and now implemented. Rather than bombarding individuals with scads of information, Change4Life was designed to be a process, which as many individuals know, parallels the process of maintaining one’s own health and well-being. In breaking the program up into steps and categories, Change4Life presents a more feasible approach to change, encouraging gradual steps and changes in behavior that will evidently lead to bigger changes in a way that will improve the overall health and well-being of the entire nation. Rather than implementing a program that supported severe changes which would likely burn out after an initial period of existence, Change4Life does not require an overhaul of one’s current habits, but small changes that eventually become commonplace in one’s own life, supporting health in the long-run.
Policy Outcomes In viewing the planning and implementation processes attributed to the Change4Life initiative, one can immediately see the type of dedication and research put into ensuring that this initiative indeed followed through with everything it set out to achieve. With over one million mothers saying that their families eat better and are more active thanks to the choices provided them by Change4Life, the success of this program is highly visible (NHS, 2010, pp.1). However, while the program is heralded by many as an overarching success, certain individuals and groups argue that this is not the case. The government and the Change4Life program have consistently been criticized for augmenting the campaign with “corporate partnerships” with companies like Nestle, PepsiCo and Mars (The Guardian, 2009, pp.1). While the government has long stood by the notion that it takes a fully national movement to fight obesity, which will need the aid of such companies, certain critics believe that these companies, who benefit on the sale of sugary treats, can never truly aid this cause. These critics argue that these “responsibility deals” forged with companies will “not turn the obesity epidemic around,” and can only add to it, but Change4Life supporters vehemently disagree (Boseley, 2011, pp.1).
Conclusion
While critics will continue to argue that the Change4Life program cannot ever be a true success with the existence of companies and groups who make their money off the sale of fattening products, the truth remains that since its start in 2009, the Change4Life program has done more to benefit English families than any other program the country has seen. With over a million individuals citing their use of Change4Life advice and education, government data has shown that in its first few years of existence, people are making more positive changes to their shopping habits, eating better, and being more active, all thanks to Change4Life (NHS, 2010, pp.1). As with anything in life, change must come gradually, but in viewing the gradual adherence to Change4Life and its standards for living, each passing day brings the England closer to universal health and happiness.

Policy Evaluation While critics will continue to argue that Change4Life initiative cannot ever be a true success with the existence of leading manufacturers of fatty, sugary and snack products together to promote healthy lifestyle. They continued to question how enthusiastic are Coca-Cola and Pepsi going to try to help children swap away from sugary drinks? whilst working with the government to promote healthy lifestyle (Guardian, 2009, pp1).
One thing is that three years after it was launched by the Labour government in 2009, Change4life has had a major impact on the lives of many English families. In 2010, the coalition gorvnement announced that the programme had their support and was going to expand Change4life porgramme to tackle alcohol addictions problems in England ( The Gaurdian, 2012, pp1). Sunday 5 February 2012 10.15 GMT). The health secretary, Andrew Lansley, said that he recognised the positive impact that Change4Life has had on families’ attitudes and behaviours and he was willing to expand the initiative from eating and moving more only, to helping people stop drinking exccessly (The Guardian, 2012, pp1) .
The evaluation part of this essay will outline the impact Change4life has had on families since it was launched in 2009. It will attempt to evaluate the achievement of Change4life using logic model of analysis- formative evaluation. A logic model, according to Millar et al, can help to examine context, implementation and outcomes of the policy (Millar et al, 2001,73). The model will be used to analyse Change4life’s activities, outputs and short-term outcomes, and its impact on families.
However, since Change4life is still in its implementation process, data / evidences that will presented here are based on the project short term outcomes from DH Change4life One Year On Report (NHS, 2010,pp1).
Millar, A., R.S. Simeone, and J.T. Carnevale. 2001. Logic models: a systems tool for performance management. Evaluation and Program Planning 24:73-81.

Evaluate if the policy worked or did not work
Change4life inititiative is a part of Healthy Weight, Healthy Lives policy. The programme had an initial budget of £75 million for a 3-year social marketing campaign when it was first launch by Labour in January 2009. The project focused on families, particular with those with children under 11. Change4life was to support the overall Healthy Weight, Healthy Lives strategy by: creating a segmentation model that allows resources to be targeted to those individuals who are most in need of help (i.e. whose attitudes and behaviours place their children most at risk of excess weight gain); providing insight into why those individuals hold those attitudes and behave as they do; creating a communications campaign to change those attitudes; providing ‘products’ (such as handbooks, questionnaires, wall charts, web content) that people can use to help them change their behaviours; signposting people to services (such as breastfeeding cafés, accompanied walks, free swimming and cookery classes); and bringing together a coalition of local, non-governmental and commercial sector organisations that will use their influence to change behaviour. This will be much more than a government information campaign. The main role of Change4life was to create a movement, in which everyone in society plays their part, helping to create fundamental changes to those behaviours that can lead to people becoming overweight and obese.
Change4Life’s initial focus is on families with children aged 5–11, particularly on those whose current behaviours and attitudes indicate that their children are at increased risk of excess weight gain. These families, grouped into distinct ‘clusters’ using a method that combined qualitative and quantitative techniques, account for approximately 64% of all families and are biased towards low income groups. In first year focused on families with children under 11 years in clusters 1, 2 and 3 who were defined as at-risk and subsequently, the campaign was to expand higher-risk families. In order to promote behavior change, the campaign involved anyone who had interst in preventing obesity, this is including government department and non-government organisations, teachers, healthcare professionals, community groups, businesses, charities or individual members of the public, including government department The campaign involved advertising on advertising on television, newspapers and outdoor digital. In first year the campaign targeted to reach 99% of families living in England, 82% of mothers with children under 11 were to recognize change4life logo; 100,000 families to complete How are the Kids? Questionnaires; 200,000 families to join Change4life; 33,333 families to still be involved with Change4life
The 1.4 million families who have children aged under 2 .
The 1.4 million families who have children age The 1.6 million families with children aged 2 to 10 whose children are most at risk of weight gain
Pregnant women .
Those ethnic minority communities (particularly Black African, Bangladeshi and Pakistani) where levels of childhood obesity are particularly high.
The DH believed that the programme would provide families with the skills, tools and knowledge needed to change their behaviours by :
Creating a societal movement in which everyone plays their part, helping to create fundamental changes to those behaviours that can lead to people becoming overweight and obese
Creating a segmentation model that would allow resources to be targeted to those individuals most in need of help (i.e. whose attitudes and behaviours place their children most at risk of excess weight gain)
Providing insight into why those individuals hold the attitudes and behave as they do
Creating a communications campaign to change those attitudes
Providing ‘products’ (such as handbooks, questionnaires, wall charts and web content) that people could use to help them change their behaviours
Signposting people to services (such as breastfeeding cafés, accompanied walks, free swimming and cookery classes)
Bring together a coalition of local, non-governmental and commercial sector organisations to use their influence to change behaviour (NSMC, 2011, pp.1).
Table below shows the government’s achievement against its targets of the first of Change4life achievement in February 2010.

| |Year 1 target |Year 1 achievement |
|Reach (% of all mothers with children under 11 who had an opportunity to see the |99% |99% |
|advertising campaign | | |
|Awareness (% of all mothers with children under 1 who recalled seeing the |82% |87% |
|Change4Life advertising | | |
|Logo recognition (% of all mothers with children under 11 who recognised the |44% |88% |
|Change4Life logo | | |
|Response to How are the Kids? (total number of questionnaires returned |100,000 | 346,609 |
|electronically, by post or from face-to-face marketing | | |
|Total responses (including website visits, telephone calls, returned |1,500,000 |1,992,456 |
|questionnaires | | |
|Sign-up (total number of families who joined Change4Life |200,000 | 413,466 |
|Sustained interest (total number of families who were proven to still be |33,333 | 44,833 |
|interacting with Change4Life six months after joining) | | |

COI Artemis contained data for 54 campaigns across a variety of government departments, enabling comparisons to be made in terms of efficiency and effectiveness ( DH 2010,p.1)

The government claimed that in its first few years of its existence, over a million people cited their use of Change4Life advice and education. The data reported that 413,466 families joined Change4Life after a year. About 346,609 families sent in “How are the Kids?” questionnaires, of whom 288,487 (85%) provided enough information for the Department of Health to provide them with a personalised response. The Government claimed that How are the Kids ,responses continued to come in at average of over 200 per day even after TV advertisement was suspended. The campaign included How Are The Kids?, a questionnaire that asks parents about their children’s diet and activity. Families who returned questionnaires to the Change4Life team were sent personalised responses, giving tailored information and advice about each child. However,

Three in 10 mothers who were aware of Change4Life claim to have made a change to their children’s behaviours as a direct result of the campaign. This equates to over one million mothers claiming to have made changes in response to the campaign
The number of mothers claiming their children do all 8 behaviours increased from 16 per cent at the baseline to 20 per cent by quarter 4
The proportion of families having adopted at least four of the behaviours has increased, suggesting the campaign has persuaded people with much less healthy lifestyles to make an effort to improve their health
Basket ( Basket analysis’ uses data provided by retailers to track actual shopping behaviour ) analysis found differences in the purchasing behaviour of 10,000 families who were most engaged with Change4Life relative to a control group. In particular, there were changes in the purchases of beverages among Change4Life families, who favoured low-fat milks and low-sugar drinks .

Analysis of data from that National Child Measurement Programme indicates that children from the Pakistani, Bangladeshi and black African communities were more likely to become overweight or obese than their white British counterparts.
However, according to data provided by DH Change4life One Year On report, just over 3,000 carribean, 6,000 indians, 6000 pakistani over 2,500 africans joining Change4life ( NHS2010, p1).
In terms of partnership working, the government benefited from nationwide support of the NHS, schools and local communities across the country. The findings show that :

44 per cent of primary schools, hospitals, general practices, town and village halls, children’s centres, pharmacies, nurseries, libraries and leisure centres displayed Change4Life materials
Over 25,000 local supporters used Change4Life materials to help them start conversations regarding lifestyles, with over 1 million people
NHS staff ordered over 6 million items of Change4Life material to distribute to the public
Primary schools generated over 50,000 sign-ups to Change4Life.

What are trends in obesity changing? In November 2009, the National Heart Forum published Obesity trends for children aged 2–11 years and 12–19 years. This compared previous forecasts of obesity prevalence based on Health Survey for England (HSE) obesity data to new updated forecasts based on data between 2000 and 2007. This suggested that obesity might be levelling off in children.
One month later, data from the National Child Measurement Programme (NCMP) for the 2008/09 school year and from the HSE for the 2008 calendar year both showed that the trend in childhood obesity was flat when compared with the previous year.

While the new data are encouraging, they show a levelling off, not a decline. Rates of obesity are still unacceptably high and it would be dangerous to become complacent at this stage

did the government investment attract other marketing spend?

The original investment in the DH campaign attracted:

●● £1.5 million in spend from other government departments.

●● A further £7.5 million of national partner activity.

●● £12,457,572 in free media space for the launch.

●● £532,393 in free media around the sponsorship of Channel 4’s The Simpsons.

●● £200 million in commitments by the Advertising Association consortium.

●● Considerable as-yet-unquantified activity by local supporters, regional and local
NHS, local authorities, schools and healthcare professionals