Healthy weight for life strategy in Malta
In Malta, a life-course approach guided the development and implementation of a multifactor initiative to tackle overweight and obesity across the lifecourse (for 2012–2020). Healthy Weight for Life was structured around the continuum of the life-course, with initiatives designed to address barriers to and enablers of a healthy weight at each life stage or in each transition period and to be delivered in multiple settings such as preschools, schools, workplaces, communities and care homes.
The life-course approach in the programme
Programmes targeted parents and children together to address the intergenerational perspective of a life-course approach. Initiatives focusing on nutrition and physical activity were delivered in the prenatal period and childhood to promote the best possible start in life, and also in transitional periods such as adolescence and pregnancy. Healthy Weight for Life has also resulted in numerous programme initiatives, many targeting specific stages in the life-course and delivered in settings relevant to these periods (e.g. the Lunchbox programme in schools, Kinder educational programme for preschool children). Healthy Weight for Life also operationalized a life-course approach by adopting an intersectoral approach across multiple disciplines such as policy, education and individual-level behaviour change.
Domains of actions
Three domains were devised:
• healthy eating
– develop policies across government to promote healthy diets;
– promote breastfeeding; and
– support schools and families in providing healthy meals and snacks for children;
• physical activity
– develop policies across government to promote physical activity;
– ensure three hours of physical activity a week for schoolchildren; and
– support local councils in creating environments that promote physical activity;
• health services
– increase and improve adult weight-management and physical activity classes;
– increase and improve parent craft and breastfeeding classes; and
– establish multidisciplinary clinics for the management of excess weight in adults and children.
Key elements measured
The elements measured were:
• process indicators for activities and outputs in implementation;
• changes in the environment, knowledge or behaviour as short-term and intermediate outcomes; and
• changes in health or health equity as long-term outcomes.
• The final evaluation is planned for 2020. Process evaluation of the project was carried out using measurements of school uptake and attendance and questionnaires.
• Programme implementation was conducted using focus groups, toolkits and questionnaires (using a before–after design in participating schools).
• Health equity-related outcomes are being considered.
• Monitoring and evaluation is also being conducted through disaggregation of intermediate and long-term health outcomes across social groups.
• Assessment of effectiveness (e.g. increasing rates of physical activity) will occur through evaluation studies.
The report also suggested that evaluation will be considered throughout the process and sharing of experiences between countries and disseminating tools will support efforts further.
Facilitators and barriers
Facilitators for implementing a life-course approach include:
• sustained involvement of diverse stakeholders in planning and implementation;
• intersectoral approach involving central government, including ministries of education, employment and finance; sports sector; media and nongovernmental actors; local councils and community groups; and the private sector (e.g. restaurants);
• political commitment, supportive legislation and policies; and
• inclusion of people participating in the initiative through opportunities to present their perspectives (e.g. school authorities, teachers, parents, children)
Facilitators for monitoring and measurement include:
• use of mixed methodologies, including qualitative approaches (focus groups for the Schools on the Move programme) and quantitative data (e.g. epidemiological data on obesity) for the evaluation of the overall framework);
• indicators and targets based on existing surveys, improved feasibility and efficacy, and efforts to maximize overlap with the country's NCD strategy;
• effective leadership, strong communication and the establishment of working groups; and
• public consultation and engagement
• influence of external factors on outcomes measured for a complex issue such as obesity;
• difficulty in conducting process evaluations for a large multicomponent strategy; and
• requirement for additional resources to expand actions.