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We offer a holistic 'whole child' and 'whole school' approach to help create an embedded culture of positive mental health and wellbeing, and we offer measurement tools to allow schools to show the impact of their activities.

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We offer a holistic 'whole child' and 'whole school' approach to help create an embedded culture of positive mental health and wellbeing, and we offer measurement tools to allow schools to show the impact of their activities.

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Most of our work is delivered to those responsible for young people - schools, families, colleges, universities, the workplace and primary care - through consultancy, training and the provision of educational and practical resources.

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Mental health training, information and resources

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The charitable activity of the Charlie Waller Trust: mental health training, information and resources, policy guidance and templates, online learning materials including video sessions, webinars and podcast interviews.

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Eating Disorders - Pedagogy in Practice webinar recording

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Eating Disorders - Pedagogy in Practice webinar recording

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The Chartered College of Teaching is delighted to have partnered with ACAMH to present a FREE online training series, 'Pedagogy in practice', exclusively for teachers and school leaders.

This series focuses on pedagogical approaches and practical strategies that can be used to support a range of aspects of pupil mental health in school. It gives attendees a unique opportunity to take part in interactive expert webinars looking at how to approach key topics in school.

About the session

'Eating Disorders - Pedagogy in Practice' will explore what Eating Disorders are, how to spot the signs in students across key stages, barriers that may arise for students (and staff trying to support them) and practical strategies to overcome these barriers. This webinar will also signpost attendees to suggested further reading links in order to substantiate what they will have learned during the webinar itself.

Presentations will be given by: Saira Saeed, Victoria Wilson and Rebecca Lipscombe of Beat, who will be joined by our panelists: Jan Forshaw (Head of Education, Coram Life Education) and Jenny Barksfield (Deputy CEO & Director of Education, PSHE Association).

Event attendees will have access not just to the event itself but to supporting materials and resources to help them embed effective practice in their schools.

- Experienced Leader, DSL, SENCO, Medical Lead, Senior Mental Health Lead within the Secondary sector. Saira has worked in Secondary education for the last 17 years and has extensive experience as an English and PSHE teacher, DSL, SENCO and Medical Lead in a number of inner-city Secondary schools in the West Midlands. She was a key member of teams in two separate Secondary Schools that worked effectively to see the removal of Special Measures and receive 'Good' Ofsted judgements. Saira has successfully devised and strategically led the implementation of effective SEND, Medical and Safeguarding systems in a number of schools throughout her career to date. As she is passionate about all things Safeguarding and SEND, she always strives to share her knowledge with others whenever she can in order to support best practices becoming the norm in as many settings as possible. Saira Saeed

Victoria Wilson, Consultant Nurse and School Nurse, Girls Day School Trust - Victoria has a background in various paediatric nursing settings, has been a school nurse for an independent school in Newcastle for 11 years and is the Consultant Nurse for the Girls Day School Trust. Passionate about young people, her role is to support pupils in school access health care for them to reach their academic potential. In the role of Consultant Nurse, Victoria supports nurses and staff in the GDST schools, with training, policies, and access to appropriate health information to support the pupils they care for.

Rebecca Lipscombe, LMS Co-ordinator, Beat - Rebecca has worked at Beat and is an LMS coordinator. Her role is to ensure that the online platforms (SPOT & POD) run smoothly and that any issues are resolved swiftly. Rebecca also works towards the continued development of the platform in terms of creating new e-learning modules and making sure the sites are user-friendly. Rebecca also works on the promotion of SPOT & POD and attends events to spread the word on how great the platforms are!

Jan Forshaw, Head of Education, Coram Life Education - Jan began her career teaching across primary and middle schools, including senior leadership roles, in Bradford, West Yorkshire. Children's wellbeing and mental health was always at the heart of her work as a teacher and influenced her move to children's health and wellbeing charity Coram Life Education. She has been Head of Education at Coram Life Education since 2009, having been Director of Training and before that an educator and senior trainer. Jan oversees development of the diverse education programmes at Coram Life Education which include provision of high-quality education workshops in school and its acclaimed SCARF online PSHE (including statutory RSHE) curriculum. She understands that within education the teacher's role is crucial in helping children to thrive - socially, physically, mentally and academically - and works hard to ensure that Coram Life Education's ethos and practices prioritise relevant, practical and timely support for teachers, alongside the provision of the highest-quality, inspiring programmes and resources that children deserve and need, to be their best.

Jenny Barksfield, Deputy CEO & Director of Education, PSHE Association - Jenny has worked in PSHE education for over 25 years. She was Head of PSHE and Citizenship at a large secondary school for 10 years before joining the Association team, initially as Training and Development Lead. She is now the PSHE Association's Deputy CEO and Director of Education, leading on partnership projects with government departments, local authorities, MATs, charities, and corporate partners, as well as leading the Association's team of subject specialists. Jenny's team are the leading national experts in PSHE education, splitting their time between writing teaching resources and guidance, quality assuring materials from others, delivering training, and providing advice and support to members around the world. Jenny has a Post Graduate Certificate in Educational Research and her co-authored book Understanding PSHE education in secondary schools was published in October 2016.

This webinar is part of a series of FREE online events exclusively for teachers and school leaders, and offer insights into best practice in supporting children and adolescents building on the latest evidence base. They are brought to you as part of an exciting new partnership between The Association for Child and Adolescent Mental Health (ACAMH) and the Chartered College of Teaching, two charities who are dedicated to supporting teachers to make a difference to the mental wellbeing of children and young people.

These sessions are designed to help close the knowledge gap in a range of topics that now form part of the statutory Relationship, Sex and Health Education (RSHE) curriculum. We think it is important to help equip teachers with knowledge in areas that may be less familiar to them and to help them consider how they might most effectively deliver these topics to children and adolescents as part of the curriculum.

These sessions will build on previous webinars run by ACAMH, attendees are strongly encouraged to watch back the 'Ask the Expert' series, and can now watch back here All of these sessions plus a host of other free resources for teachers can be found on ACAMH's 'Ask the Expert: Eating Disorders', hosted on 13 September. Teacher Hub.

The Association of Child and Adolescent Mental Health is a unique multi-disciplinary organisation, and charity, established for over 60 years committed to 'Sharing best evidence, improving practice' .
Full membership information and the benefits of being a member of the Chartered College of Teaching can be found here Develop your expertise through our Certificate for Evidence-Informed Practice programme

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Eating Disorders - Pedagogy in practice : My College

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The Chartered College of Teaching is delighted to have partnered with ACAMH to present a FREE online training series, 'Pedagogy in practice', exclusively for teachers and school leaders. This series focuses on pedagogical approaches and practical strategies that can be used to support a range of aspects of pupil mental health in school.

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Eating Disorders ‘Ask The Expert’ – recording

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Eating Disorders ‘Ask The Expert’ – recording

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For this session we welcomed Dr. Dasha Nicholls to share her knowledge and insights into eating disorders, specifically exploring the signs and impact of disordered eating and guidance on how best to respond. Dr. Dasha Nicholls is Clinical Reader in Child Psychiatry at Imperial College London and Honorary Consultant Child and Adolescent Psychiatrist at Central and North West London NHS Trust. Her research and clinical work is concerned with feeding disorders, eating disorders and higher weight in children and adolescents, with a particular focus on early intervention.

Slides from the session

About the 'Ask the Expert' sessions

This FREE 'Ask the Expert' online event is exclusively for Teachers, and offers insights into the latest evidence-base around anxiety in children & adolescents. They are brought to you as part of an exciting new partnership between The Association for Child and Adolescent Mental Health (ACAMH) and Coram Life Education (CLE), two charities who are dedicated to making a difference to the mental wellbeing of children and young people.

Following our pilot events in Autumn 2021 / Spring 2022, we have a series of 'Ask the Expert' events over the coming year, to help close the knowledge gap in a range of topics that now form part of the statutory Relationship, Sex and Health Education (RSHE) curriculum. We think it is important to help equip teachers with knowledge in areas that may be less familiar to them, which is grounded in academic rigour.

Our 'Ask the Expert' sessions are primarily aimed at knowledge building, we will be working on other initiatives to help evolve pedagogical approaches based on the evidence we share at these 'Ask the Expert' events.

About the event

Around 1.25 million people in the UK suffer from eating disorders. These disorders can cause serious harm, both physically and emotionally, and they have the highest mortality rate of any mental illness. Early diagnosis, intervention and treatment is critical.

As anchor institutions in society, schools play an important role in identifying, referring and supporting pupils who may be at risk of developing eating disorders. As teachers, it is important to be aware of some of the clues, cues and signs of disordered eating behaviour, in order to better support children & young people who are experiencing difficulties in maintaining a healthy relationship with food.

Key Takeaways

To identify the types of eating disorders and know how they differ from 'normal' concern about eating, weight and shape

Recognise the early signs of disordered eating behaviour and how best to respond

Understand the impact eating disorders may have on learning

Know about the types of effective psychological treatments that are available

Know who to contact and where to turn if you need more help

Resources

Eating disorders
Eating disorders: an introduction to anorexia nervosa, bulimia nervosa and other eating disorders. From this topic guide, you can find the latest blogs, events, publications, videos and podcasts.

6-minute film, Jenny Langley, author of 'Boys Get Anorexia Too' talks about her experience when her son developed an eating disorder.

Understanding Eating Disorders
8min film with Dr. Dasha Nicholls, learn details on the different kinds of Eating Disorders.

In Conversation... Eating Disorders with Dr. Dasha Nicholls
In this podcast,Dr. Dasha Nicholls talks about eating and feeding disorders in children and young people.

Developments in Eating Disorders Research
As everyone's thoughts are dominated by the impact of COVID-19 on mental health and wellbeing, it seems pertinent to start by thinking how people with or at risk of eating disorders may have been affected. Research suggests that the impacts differ according to the type of eating disorder concerns and behaviours. ByDr. Dasha Nicholls

Other FREE Events

Visit our Teacher Hub for a host of free resources and events.

About the Speakers

Dr. Dasha Nicholls is Clinical Reader in Child Psychiatry at Imperial College London and Honorary Consultant Child and Adolescent Psychiatrist at Central and North West London NHS Trust. Her research and clinical work is concerned with feeding disorders, eating disorders and higher weight in children and adolescents, with a particular focus on early intervention. Until 2018 she was Joint Head of the Feeding and Eating Disorders service at Great Ormond Street Hospital. She led development of the Managing Medical Emergencies in Eating Disorders guidance (2022), was a member of the NICE Guideline Committee and NICE quality standards committee for eating disorders, as well helping develop the commissioning guidance for children and young people's eating disorders services (CYP EDS). She co-led the National Whole Team training for CYP EDS in 2017/18.

Dasha is also the Clinical and Strategic Director for National Audits and Research at the Royal College of Psychiatrists, and past chair of the Eating Disorders Faculty. She is the past President of the Academy of Eating Disorders, and instigated development of the British Eating Disorders Society. She co-founded the Child and Adolescent Psychiatric Surveillance System (CAPSS) for research into rare disorders and events in child mental health.

Coram Life Education is the leading provider of relationships, health, wellbeing, and drugs education to almost half a million children across the UK, delivered under the strapline 'Helping Children Make Healthy Choices'. Trained Educators use evidence-based, interactive, creative methods and resources to stimulate curiosity and imagination amongst children in 1 in 10 English and Scottish primary schools (2,041 schools).

Our memorable life skills sessions are currently delivered as 'Life Base' in school or as 'SCARF Live Online' sessions via Zoom. Coram Life Education takes a three strand approach addressing children's knowledge, skills and attitudes, and programmes are aligned with the National Curriculum (Citizenship, PSHE Education), covering all Key Stages. Coram Life Education helps schools meet their statutory requirements for Relationships and Health Education, children's Spiritual, Moral, Social and Cultural development, and Ofsted inspection criteria for personal development, behaviour and welfare. Coram Life Education's programmes are also aligned with Scotland's Curriculum for Excellence. Recognising the role of the community and home life in influencing children's choices, we design our programme with schools and deliver special sessions and assemblies for parents and carers to amplify our effectiveness.

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Eating Disorders 'Ask The Expert' - recording - ACAMH

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For this session we welcomed Dr. Dasha Nicholls to share her knowledge and insights into eating disorders, specifically exploring the signs and impact of disordered eating and guidance on how best to respond. Dr. Dasha Nicholls is Clinical Reader in Child Psychiatry at Imperial College London and Honorary Consultant Child and Adolescent Psychiatrist at Central and North West London NHS Trust.

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Mental health guides and resources for schools

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Resources Downloadable versions of our resources are available here for you to view or download. Please note that we are currently unable to post out resources and will let you know when the situation changes. Do download resources and print them, and feel free to share with others.

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https://www.theguardian.com/society/2022/nov/08/why-nhs-support-services-are-failing-children-in-distress

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Last week was my final one in the NHS after 10 years in a child and adolescent mental health service (Camhs). I'm the 28th clinical member of staff to move on in the last two years. When I came back to the NHS 10 years ago, there was a layer of more experienced staff above me and a few grandees above them. Now, people with four or five years' post-qualification experience are the wise old hands.

I completely agree with your editorial ( 6 November) highlighting the important role that educational mental health practitioners play, and we have been lucky to also have children's wellbeing practitioners adding enormously to the service. But young people with complex needs are now facing an 18-month wait for a first appointment, often spending months being batted between Camhs and social care as both services creak under the strain, only to find that neither service can adequately meet their needs.

Long waiting times, a staff exodus and an inability to meet rising demand have opened the door to "exciting new opportunities to work with partner organisations" - privatisation. Some of our initial waiting lists and cognitive behavioural therapy waiting lists have been farmed out to a private company whose clinicians have no local knowledge and cannot meet young people face to face. It feels very different from the same clinician working in NHS and private roles in the same city.

The Camhs service I have left is still staffed by dedicated, caring and talented people who are desperate to do the right thing for families. When I left, the most common thing I heard was: "Well, you have to look after yourself." My concern is that it is becoming difficult for many to do both - work in the NHS and look after yourself - and the people who will suffer will be those seeking help.
Dr David Fong
Clinical psychologist

The rise in prescriptions for antidepressants to young people under 18 is a symptom of 12 years of neglect in Camhs ( GPs giving antidepressants to children against guidelines, 4 November). The underresourcing of Camhs has been regularly cited by clinicians and parents frantic to get help for their children. GPs have no choice but to prescribe medication because waiting times for talking therapy are too long. Research shows a correlation between poverty and mental illness among young people, leading to higher rates of self-harm and suicide. A generation of young people are under greater stress than at any time, and the prospects for their future mental health will be jeopardised further with more budget cuts on the way.
Steven Walker
Former head of Camhs, Anglia Ruskin University

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Why NHS support services are failing children in distress | Letters

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Letters: Dr David Fong says child and adolescent mental health services are struggling to cope with rising demand and a staff exodus. Plus a letter from Steven Walker

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We hope you found the event both engaging and rewarding.

As part of our work to ensure the events we run meet the needs of the profession, we would value your feedback.

Thank you in advance, we look forward to seeing you at another event soon.

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We hope you found the event both engaging and rewarding.

As part of our work to ensure the events we run meet the needs of the profession, we would value your feedback.

Thank you in advance, we look forward to seeing you at another event soon.

To view our privacy policy, please visit:
https://chartered.college/website-privacy

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Pedagogy in Practice: Eating Disorders - session evaluation

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We hope you found the event both engaging and rewarding. As part of our work to ensure the events we run meet the needs of the profession, we would value your feedback. Thank you in advance, we look forward to seeing you at another event soon.

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Gillick competency and Fraser guidelines

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Gillick competency and Fraser guidelines

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Introduction

Gillick competency and Fraser guidelines help people who work with children to balance the need to listen to children's wishes with the responsibility to keep them safe.

When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is 'Gillick competent' or whether they meet the 'Fraser guidelines'.

Although the two terms are frequently used together and originate from the same legal case, there are distinct differences between them.

Both Gillick competency and Fraser guidelines refer to a legal case from the 1980s which looked at whether doctors should be able to give contraceptive advice or treatment to young people under 16-years-old without parental consent.

Applying Gillick competence and Fraser guidelines

The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. But Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.

You should always encourage a child to tell their parents or carers about the decisions they are making. If they don't want to do this, you should explore why and, if appropriate, discuss ways you could help them inform their parents or carers. For example, you could talk to the young person's parents or carers on their behalf.

If the young person still wants to go ahead without their parents' or carers' knowledge or consent, you should consider the Gillick and Fraser guidelines. The following information looks at how this can be applied in practice.

Gillick competence

Gillick competence

Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings. For example, if a child or young person:

would like to have therapeutic support but doesn't want their parents or carers to know about it

is seeking confidential support for substance misuse

has strong wishes about their future living arrangements which may conflict with their parents' or carers' views.

Medical professionals need to consider Gillick competency if a young person under the age of 16 wishes to receive treatment without their parents' or carers' consent or, in some cases, knowledge.

If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their decision, treatment can still proceed if the child has been assessed as Gillick competent.

There is specific guidance for medical professionals on using Gillick competence - see case history and legislation.

Assessing Gillick competence

There is no set of defined questions to assess Gillick competency. Professionals need to consider several things when assessing a child's capacity to consent, including:

the child's age, maturity and mental capacity

their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact

their understanding of the risks, implications and consequences that may arise from their decision

how well they understand any advice or information they have been given

their understanding of any alternative options, if available

their ability to explain a rationale around their reasoning and decision making.

Remember that consent is not valid if a young person is being pressured or influenced by someone else.

Children's capacity to consent may be affected by different factors, for example stress, mental health conditions and the complexities of the decision they are making. The same child may be considered Gillick competent to make one decision but not competent to make a different decision.

If you don't think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their parents or carers before proceeding.

In complex medical cases, such as those involving disagreements about treatment, you may wish to seek the opinion of a colleague about a child's capacity to consent (Care Quality Commission, 2019).

Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020).

Refusal of medical treatment

Gillick competency can be used when young people wish to refuse medical treatment.

However, if a young person refuses treatment which may lead to their death or severe permanent harm, their decision can be overruled. More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation.

Child protection concerns

The child's safety and wellbeing is paramount.

When you are assessing Gillick competency if you have any concerns about the safety of the young person you should check whether previous child protection concerns have been raised, and explore any factors that could put them at risk of abuse.

You must always share child protection concerns with the relevant agencies, even if this goes against a child's wishes.
> Find out more about recognising and responding to abuse

Fraser guidelines

Fraser guidelines

The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners.

Following a legal ruling in 2006, Fraser guidelines can also be applied to advice and treatment for sexually transmitted infections and the termination of pregnancy (Axton v The Secretary of State for Health, 2006).

Using the Fraser guidelines

Practitioners using the Fraser guidelines should be satisfied of the following:

the young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).

the young person understands the advice being given.

the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment.

it is in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent.

the young person is very likely to continue having sex with or without contraceptive treatment.

(Gillick v West Norfolk, 1985)

Child protection concerns

When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns:

Underage sexual activity is a possible indicator of child sexual exploitation and children who have been groomed may not realise they are being abused.

Sexual activity with a child under 13 should always result in a child protection referral.

If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of child sexual abuse or exploitation.

You should always consider any previous concerns that may have been raised about the young person and explore whether there are any factors that may present a risk to their safety and wellbeing.

You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to.

> Find out more about recognising and responding to abuse

Case history, legislation and guidance

Gillick v West Norfolk and Wisbech Area Health Authority 1986

In 1982 Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice or treatment to under 16-year-olds without parental consent.

The case went to the High Court in 1984 where Mr Justice Woolf dismissed Mrs Gillick's claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgment delivered by Mr Justice Woolf:

"...whether or not a child is capable of giving the necessary consent will depend on the child's maturity and understanding and the nature of the consent required. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent" (Gillick v West Norfolk, 1984).

What are the Fraser guidelines?

The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985), which apply specifically to contraceptive advice.

Lord Fraser stated that a doctor should always encourage a girl aged under 16 to inform her parents or carers that she is seeking contraceptive advice (or allow the doctor to inform the parents or carers on her behalf). But if she cannot be persuaded to do so they can proceed to give contraceptive advice and treatment as long as certain conditions are met. This includes making sure it's in the girl's best interests for advice to be given and that she understands the advice.
> Find out more about using the Fraser guidelines
What is Gillick competence?

Lord Scarman's comments in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985) are often referred to as the test of "Gillick competency". He said:

"...it is not enough that she should understand the nature of the advice which is being given: she must also have a sufficient maturity to understand what is involved."

He also commented more generally on parents' versus children's rights:

"parental right yields to the child's right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision."
> Find out more about assessing Gillick competency
Legislation and guidance

Gillick v West Norfolk and Wisbech Area Health Authority went to the House of Lords and is often used as a legal precedent across the UK.

In Scotland, the Age of Legal Capacity (Scotland) Act 1991 sets out when children have the legal capacity to make decisions. Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures.

Medical guidance

In England, the Department of Health and Social Care provides guidance for medical professionals on the legal framework they need to consider when obtaining valid consent to examination, treatment or care (Department of Health and Social Care, 2009).

In Northern Ireland the Department of Health provides consent guides for healthcare professionals (Department of Health, 2003).

In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006).

References and resources

References and resources

Axton v The Secretary of State for Health (The Family Planning Association: intervening) (2006) EWHC 37. As cited in Family Law Week.

Care Quality Commission (2019). Brief guide: capacity and competence to consent in under 18s (PDF). Care Quality Commission.

Department of Health (2003). Consent guides for healthcare professionals. [Accessed 02/02/2020].

Department of Health and Social Care (2009) Reference guide to consent for examination or treatment (second edition). London: Department of Health and Social Care.

Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. 581. As cited in Children's Legal Centre (1985) Landmark decision for children's rights. Childright, 22: 11-18.

Gillick v West Norfolk & Wisbech Area Health Authority, UKHL 7 (17 October 1985) Available via (BAILII) in The law reports (appeal cases) [1986] AC 112.

Scottish Executive Health Department (2006). A good practice guide on consent for health professionals in NHS Scotland (PDF). Edinburgh: Scottish Executive

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about children's rights on the Childline website.

You can also download or order Childline posters and wallet cards.

Elearning

Our online and face-to-face training courses can help develop your understanding of how to protect children from abuse and safely recruit staff and volunteers to work with children:

Further reading

For further reading about Gillick competency and Fraser guidelines, search the NSPCC Library catalogue using the keywords "Gillick competency" and "Fraser guidelines".
> Find out more about the Library and Information Service

Introduction

Gillick competency and Fraser guidelines help people who work with children to balance the need to listen to children's wishes with the responsibility to keep them safe.

When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is 'Gillick competent' or whether they meet the 'Fraser guidelines'.

Although the two terms are frequently used together and originate from the same legal case, there are distinct differences between them.

Both Gillick competency and Fraser guidelines refer to a legal case from the 1980s which looked at whether doctors should be able to give contraceptive advice or treatment to young people under 16-years-old without parental consent.

Applying Gillick competence and Fraser guidelines

The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. But Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.

You should always encourage a child to tell their parents or carers about the decisions they are making. If they don't want to do this, you should explore why and, if appropriate, discuss ways you could help them inform their parents or carers. For example, you could talk to the young person's parents or carers on their behalf.

If the young person still wants to go ahead without their parents' or carers' knowledge or consent, you should consider the Gillick and Fraser guidelines. The following information looks at how this can be applied in practice.

Gillick competence

Gillick competence

Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings. For example, if a child or young person:

would like to have therapeutic support but doesn't want their parents or carers to know about it

is seeking confidential support for substance misuse

has strong wishes about their future living arrangements which may conflict with their parents' or carers' views.

Medical professionals need to consider Gillick competency if a young person under the age of 16 wishes to receive treatment without their parents' or carers' consent or, in some cases, knowledge.

If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their decision, treatment can still proceed if the child has been assessed as Gillick competent.

There is specific guidance for medical professionals on using Gillick competence - see case history and legislation.

Assessing Gillick competence

There is no set of defined questions to assess Gillick competency. Professionals need to consider several things when assessing a child's capacity to consent, including:

the child's age, maturity and mental capacity

their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact

their understanding of the risks, implications and consequences that may arise from their decision

how well they understand any advice or information they have been given

their understanding of any alternative options, if available

their ability to explain a rationale around their reasoning and decision making.

Remember that consent is not valid if a young person is being pressured or influenced by someone else.

Children's capacity to consent may be affected by different factors, for example stress, mental health conditions and the complexities of the decision they are making. The same child may be considered Gillick competent to make one decision but not competent to make a different decision.

If you don't think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their parents or carers before proceeding.

In complex medical cases, such as those involving disagreements about treatment, you may wish to seek the opinion of a colleague about a child's capacity to consent (Care Quality Commission, 2019).

Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020).

Refusal of medical treatment

Gillick competency can be used when young people wish to refuse medical treatment.

However, if a young person refuses treatment which may lead to their death or severe permanent harm, their decision can be overruled. More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation.

Child protection concerns

The child's safety and wellbeing is paramount.

When you are assessing Gillick competency if you have any concerns about the safety of the young person you should check whether previous child protection concerns have been raised, and explore any factors that could put them at risk of abuse.

You must always share child protection concerns with the relevant agencies, even if this goes against a child's wishes.
> Find out more about recognising and responding to abuse

Fraser guidelines

Fraser guidelines

The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners.

Following a legal ruling in 2006, Fraser guidelines can also be applied to advice and treatment for sexually transmitted infections and the termination of pregnancy (Axton v The Secretary of State for Health, 2006).

Using the Fraser guidelines

Practitioners using the Fraser guidelines should be satisfied of the following:

the young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).

the young person understands the advice being given.

the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment.

it is in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent.

the young person is very likely to continue having sex with or without contraceptive treatment.

(Gillick v West Norfolk, 1985)

Child protection concerns

When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns:

Underage sexual activity is a possible indicator of child sexual exploitation and children who have been groomed may not realise they are being abused.

Sexual activity with a child under 13 should always result in a child protection referral.

If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of child sexual abuse or exploitation.

You should always consider any previous concerns that may have been raised about the young person and explore whether there are any factors that may present a risk to their safety and wellbeing.

You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to.

> Find out more about recognising and responding to abuse

Case history, legislation and guidance

Gillick v West Norfolk and Wisbech Area Health Authority 1986

In 1982 Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice or treatment to under 16-year-olds without parental consent.

The case went to the High Court in 1984 where Mr Justice Woolf dismissed Mrs Gillick's claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgment delivered by Mr Justice Woolf:

"...whether or not a child is capable of giving the necessary consent will depend on the child's maturity and understanding and the nature of the consent required. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent" (Gillick v West Norfolk, 1984).

What are the Fraser guidelines?

The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985), which apply specifically to contraceptive advice.

Lord Fraser stated that a doctor should always encourage a girl aged under 16 to inform her parents or carers that she is seeking contraceptive advice (or allow the doctor to inform the parents or carers on her behalf). But if she cannot be persuaded to do so they can proceed to give contraceptive advice and treatment as long as certain conditions are met. This includes making sure it's in the girl's best interests for advice to be given and that she understands the advice.
> Find out more about using the Fraser guidelines
What is Gillick competence?

Lord Scarman's comments in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985) are often referred to as the test of "Gillick competency". He said:

"...it is not enough that she should understand the nature of the advice which is being given: she must also have a sufficient maturity to understand what is involved."

He also commented more generally on parents' versus children's rights:

"parental right yields to the child's right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision."
> Find out more about assessing Gillick competency
Legislation and guidance

Gillick v West Norfolk and Wisbech Area Health Authority went to the House of Lords and is often used as a legal precedent across the UK.

In Scotland, the Age of Legal Capacity (Scotland) Act 1991 sets out when children have the legal capacity to make decisions. Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures.

Medical guidance

In England, the Department of Health and Social Care provides guidance for medical professionals on the legal framework they need to consider when obtaining valid consent to examination, treatment or care (Department of Health and Social Care, 2009).

In Northern Ireland the Department of Health provides consent guides for healthcare professionals (Department of Health, 2003).

In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006).

References and resources

References and resources

Axton v The Secretary of State for Health (The Family Planning Association: intervening) (2006) EWHC 37. As cited in Family Law Week.

Care Quality Commission (2019). Brief guide: capacity and competence to consent in under 18s (PDF). Care Quality Commission.

Department of Health (2003). Consent guides for healthcare professionals. [Accessed 02/02/2020].

Department of Health and Social Care (2009) Reference guide to consent for examination or treatment (second edition). London: Department of Health and Social Care.

Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. 581. As cited in Children's Legal Centre (1985) Landmark decision for children's rights. Childright, 22: 11-18.

Gillick v West Norfolk & Wisbech Area Health Authority, UKHL 7 (17 October 1985) Available via (BAILII) in The law reports (appeal cases) [1986] AC 112.

Scottish Executive Health Department (2006). A good practice guide on consent for health professionals in NHS Scotland (PDF). Edinburgh: Scottish Executive

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about children's rights on the Childline website.

You can also download or order Childline posters and wallet cards.

Elearning

Our online and face-to-face training courses can help develop your understanding of how to protect children from abuse and safely recruit staff and volunteers to work with children:

Further reading

For further reading about Gillick competency and Fraser guidelines, search the NSPCC Library catalogue using the keywords "Gillick competency" and "Fraser guidelines".
> Find out more about the Library and Information Service

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Gillick competence and Fraser guidelines | NSPCC Learning

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Gillick competency is often used to assess whether a child is mature enough to consent to treatment. Fraser guidelines are used for issues relating to sexual health.

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Eating disorder toolkit
https://saphna.co/homepage/toolkits/eating-disorder-toolkit/

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National Institute for Health and Care Excellence

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National Institute for Health and Care Excellence

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Eating disorders: recognition and treatment | Guidance and guidelines | NICE

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Eating disorders: recognition and treatment | Guidance and guidelines | NICE

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Evidence-based recommendations on assessment, treatment, monitoring and inpatient care for children, young people and adults with eating disorders

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NHS treating record number of young people for eating disorders

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More young people than ever before are receiving treatment for eating disorders according to the latest figures, the NHS said today.
Almost 10,000 children and young people started treatment between April and December with record demand for services - an increase of a quarter compared to the same period last year and up by almost two thirds since before the pandemic.

NHS chiefs today said that young people and their families should seek help without delay if they were concerned, with community services now available in every part of the country.
Professor Prathiba Chitsabesan, NHS Associate Clinical Director for Children and Young People's Mental Health and psychiatrist advised young people and their loved ones to use trusted online resources if they had concerns and wanted to seek help.
Professor Chitsabesan added that some of the signs to look out for included behaviours such as making rules about what or how they eat, eating a restricted range of foods or having a negative self-image about their weight and appearance. Young people's problems with food can begin as a coping strategy or a way of feeling in control but may lead to more restrictive patterns of eating and behaviours. The rise could be attributed to the unpredictability of the COVID-19 pandemic, feeling isolated, disruption to routines and experiences of loss and uncertainty.

The NHS is investing an additional £79 million into children's mental health services because of increased demand during the pandemic, with funding being used to ensure at least 2,000 more children and young people start eating disorder treatment.

Mental health services, including eating disorder services, are being backed by an additional £2.3 billion every year in additional funding until 2023/24 as part of the NHS Long Term Plan's commitment to improving mental health services.

Claire Murdoch, NHS Mental Health Director said: "NHS services remained open throughout the pandemic as hard-working mental health staff worked to deliver care to more people than ever before.

"The NHS continues to see record-high numbers of young people for eating disorders and it is vital anybody who might need care comes forward as quickly as possible so the NHS can get you any care you may need.

"Parents can find information on potential symptoms, such as binge eating, feeling guilty after eating, and negative self-image, and other signs of a potential eating disorder are available on the NHS website and they should not hesitate to contact the NHS if they think their child might need some support".

One of the people that the NHS has helped is Alice who was 17 years of age when her mother referred her to NHS eating disorder services, with an initial conversation with the NHS taking place the day after referral.

Alice said: "I felt so anxious when my Mum had made the referral as I didn't know if I could be helped - those fears soon disappeared after speaking to my clinician over the phone only a day after the referral was made. If it wasn't for the call so soon after, I don't know if I would have answered my phone; I would have probably tried to pretend it wasn't happening and disengage. The assessment was gentle and informative, I felt understood by my clinician. It wasn't so scary after all".

Following the assessment, it was determined cognitive behavioural therapy was the best way forward for Alice who says she is now doing much better.

Alice said: "I couldn't believe that my treatment began only six days after my assessment. I was expecting to wait weeks or even months. I truly believe that if it wasn't for the rapid intervention so soon after referral, I would be in a very different position. Thankfully, with the support from my clinician, I can report that I am doing much better. I was hesitant to seek support but I'm glad I did, I would say to anyone else in a similar position to take that step as it could save your life".

In the guidance, Professor Chitsabesan recommends helpful support from charities doing important work in this area including BEAT which has designated pages to help young people who may be struggling with an eating problem, including an eating disorder, and provide advice.

The signs and symptoms of eating problems can vary from person to person. However, a combination of the below symptoms could be a sign that a child might need additional support:

preoccupation with checking calorie or other ingredient content in food

eating a restricted amount or range of foods

binge eating

more controlling behaviours such as rules about eating, insisting on making their own meals or only using certain utensils and cutlery

negative self-image about their weight and/or appearance

secretiveness or avoiding eating with others

feeling guilty after eating

repeatedly weighing themselves

vomiting after eating, or going to the toilet immediately after eating

compulsive or excessive exercising

abnormally low or high weight or changes in weight or body shape

long-term weight stagnation or failure to grow

complaining of poor concentration, dizziness, tiredness or feeling cold

getting stressed at mealtimes

low mood, anxiety or irritability

social withdrawal.

Professor Prathiba Chitsabesan advised parents over the pandemic on steps they can take to support their child which includes:

Take time to talk to with the child or young person you care for: young people may find it difficult to accept that they have a problem or that they may need help. Some young people may find it easier to talk while doing something together such as playing a board game or engaging in a craft or other activity. Find a time when you will not be disturbed and both of you feel calm. If they find it difficult to talk to you, encourage them to talk to another trusted adult such as a family member, teacher or GP.

Make time to listen to them: create a calm safe space where they can communicate how they are feeling without judgement. Try to avoid saying things that could feel accusatory, critical or dismissive.

Try to understand the problems and provide reassurance that you have heard them and are there to help: ask how they are feeling rather than focussing all the conversation on their eating or weight as this can often be more productive. Complimenting them on things other than their appearance can help the young person feel valued and is less likely to be interpreted negatively.

Encourage regular mealtimes as a family: sitting down together for regular mealtimes as a family can help encourage social and healthy eating behaviours and help monitor any concerns about eating problems. Keep the conversation neutral.

Keep an eye on the young person you care for. Consider if eating problems persist, deteriorate and/or are impacting on the young person's day to day living: seek specialist health advice and support and increase vigilance, including checking if the young person is losing weight, developing secondary physical health symptoms (see list above) or accessing websites/social media content that is pro-eating disorders.

Help the child or young person you care for do positive activities which means they aren't isolating themselves: positive activities including safe contact with family and friends can provide a distraction from negative and intrusive thoughts and may help the young person open up about their feelings.

Provide structure and routine (including for sleep): frequent changes to routine and restrictions can cause some children and young people to feel more anxious and upset. Many children and young people may also experience difficulties with their sleep. Providing structure through the development of daily and weekly timetables, including bedtime routines can be helpful in providing some predictability for young people in this unsettled time and distraction from negative thoughts.

Support children and young people with disabilities: children and young people with disabilities including those with autism spectrum disorder or learning disabilities may find the impact of COVID-19 particularly difficult to manage. It is important to explain change and manage any anxiety and distress they may be experiencing as this may impact on their eating behaviours including restrictive patterns of eating or overeating. Seek advice if they are already in contact with specialist health and social care services or contact your GP. The National Autistic Society have helpful advice on their website on how to deal with this uncertain time.

Seek specialist advice and support quickly if you think the young person you care for has physical symptoms secondary to weight loss, suicidal thoughts or are self-harming: It is important that you do not ignore these and that you speak to a GP or crisis mental health help line urgently to get the right help and support - or contact some of the services detailed below.

Finally, as a parent or carer, look after your own mental health too: this will help you to best support yourself and those you care about. Remember to talk to your family and friends about how you are feeling and seek help for yourself from the NHS and other support services if it's all getting too much.

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NHS treating record number of young people for eating disorders

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More young people than ever before are receiving treatment for eating disorders according to the latest figures, the NHS said today. Almost 10,000 children and young people started treatment between April and December with record demand for services - an increase of a quarter compared to the same period last year and up by almost two thirds since before the pandemic.

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Useful, free resources for primary schools 

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Useful, free resources for primary schools 

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Learning about Children's Mental Health through Film

Nip in the Bud is regularly adding new FREE resources - short films and fact sheets - to raise mental health awareness among primary school staff, teacher trainees, anyone working with children, parents, carers and young people.

Early intervention is key, so the negative impacts of these conditions can be 'nipped in the bud' and so reduce the risk of them becoming entrenched. Our films cover Expert Information on different conditions, Real Life Experience, Emotional Wellbeing and Coping with the Aftermath of Covid.

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Learning about Children's Mental Health through Film Nip in the Bud is regularly adding new FREE resources - short films and fact sheets - to raise mental health awareness among primary school staff, teacher trainees, anyone working with children, parents, carers and young people.

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Recommended by Dasha Nichols at the Ask the Expert session

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Recommended by Dasha Nichols at the Ask the Expert session

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Is your school's health promotion doing any good?

Schools often wish to address:

health promotion

body confidence, satisfaction or acceptance,

obesity

disordered eating prevention

eating disorder prevention

You should only use programs that have been validated as safe and effective.

Below I will explain the surprising truth that if your school is relying only on common sense to teach health promotion, your programs are probably not working. Worse, they could be doing great harm. You might also start to think differently about obesity.

I've already discussed what you can do to help those with an eating disorder. Now you can discover prevention programs and address body image problems and disordered eating. I'll also introduce you to food-neutral language, and by the end of this page you will have become highly sensitised to diet talk!

Health promotion and body confidence programs that have multiple benefits

There are a number of well-researched programs to promote a positive body image (other terms are body satisfaction, body acceptance, body confidence). Depending on the program, outcomes include an increase in body confidence and self-esteem, a reduction in disordered eating and in weight control behaviours (purging, diet pills), improvements in nutrition and physical activity, and a reduction in behaviours that are often associated with obesity.

Because negative body image is one of the risk factors involved in eating disorders, some programs have also shown a reduction in the number of pupils later developing an eating disorders.

We therefore have three reasons for using validated programs.

They may help to prevent eating disorders in those at risk (though sadly no program has been shown to reduce the incidence of anorexia)

They are very likely to increase body satisfaction in the large number of pupils who are very preoccupied with a negative body image

They may be effective in promoting healthy behaviours... which means you are doing effective health promotion

A fourth reason is that if you are under pressure to 'fight obesity' (see further down), you can argue that these programs are likely more effective than any other initiative.

Body confidence programs challenge cultural images of self-worth and often have a media literacy component to counter toxic cultural messages of thinness or tone for women and muscularity for men.

The benefits to your school could be major. 70 to 80% of young girls opt out of activities because of low body confidence. Negative body image is present in 25 to 75% of children and adolescents. There is harm in 'fat-talk'. There is harm in youngsters aspiring to the looks of male or female models. There is harm in a culture of body dissatisfaction. It increases stigma for pupils in larger bodies. It is linked to poor self-worth, poor confidence and poor self-acceptance/self-esteem. For some it is linked with depression.

I would urge you to take body confidence just as seriously for boys as for girls. There is fast-growing pressure on males to be lean and muscular, and they don't have the equivalent of feminism to counteract it.

Different programs target different age groups and sexes. Some require expert staff or have a 'train the trainer' system, while others are freely available and may be led by teachers or even peers.

This is a big field and I have tried to get experts to give us some shortcuts. Here are some of the programs which are recommended by reputable sources:

The Body Project for small groups girls in secondary/high school and university

Dove Confident Me : Dove Self-Esteem Project for boys and girls 8 to 16 years (an extension of The Body Project)

Free Being Me: delivered to girl-only groups through the girl guiding organisation (an evaluation is underway but hasn't been completed yet)

Media Smart : for girls and boys in late primary and 11-14 years. Impressive results from several studies indicate it is helpful for both ED and obesity risk factors.

Planet Health for 12-14 years

Happy Being Me

Healthy Bodies

Healthy schools-healthy kids for 9-14 years

I don't know which of these is the best (you can read a review of the first four here). To keep things simple you could safely go for the program that seems to be backed by the biggest studies and that has been used widely in several countries. This is The Body Project. The sessions need to be delivered in small groups of 8 - 15 students. Teachers need training before they can deliver this program in schools. Unfortunately the female version is the only evidence-based version, yet nowadays, young males need just as much help with body attitude as females do. There are two male versions that are experimental and have some way to go: 'Body Project Pride' and 'More Than Muscles'.

For 8 to 16 year old boys and girls in schools and scout groups I suggest you can safely go with the equivalent of The Body Project for younger pupils, and the materials for teachers are freely available online: see the five sessions in Dove Confident Me. There is more information on Dove Self-Esteem Project.

The school's role in preventing exercise compulsion

Many people with an eating disorder develop a harmful obsessive, compulsive relationship with exercise. Exercise can also provide a trigger for the start of an eating disorder, when a person over-exercises and under-eats because they believe the sport requires it.

There are many things that schools and sports clubs and gyms can do to create a positive attitude to exercise. I recommend you read the 'Coach and Trainer toolkit' from NEDA. It's comprehensive and practical.

Eating disorder prevention: don't use guest speakers

Sometimes schools hope to raise awareness and prevent eating disorders with a guest speaker who has recovered from an eating disorder. The idea is to warn pupils of the horrors of eating disorders and get them never to go down that road. But there is no evidence that this is effective prevention. Worse, youngsters vulnerable to an eating disorder will use whatever they hear as a 'how-to- manual. They may also decide they should be a 'better anorexic' than the speaker by eating less, weighing less and exercising more.

One sign that a speaker is not well-informed of the risks is if any of their materials disclose before-and-after photos or if they quote numbers: how much weight they lost, how much they weighed before or after, how many calories they ate. These numbers are well-known in the field to be 'triggering'.

If you are tempted to get a speaker in to 'raise awareness' or 'reduce stigma' there is also a danger that the speaker has outdated theories of causation and of treatment (so much has changed in the last few years), so you could get a lot of misinformation and end up with more stigma. For instance many recovered people are certain that starving was a way for them to exert control over their lives, whereas nowadays the thinking is that this is a post-hoc rationalisation. The urge to restrict is driven by biology, and the person has no control over it.

Anorexia memoirs present risks similar to those of guest speakers.

Health promotion and why common sense doesn't work

Just now I introduced you to validated health and body confidence programs which you can safely use.

Health promotion programs, on the other hand, are a bit of a minefield, to the extent that if I was the head of a school I would steer clear of them.

These are the programs that teach healthy nutrition and encourage physical activity (why is sleep rarely mentioned?!) The aim of these programs may be health for all, but often the underlying motivation is to 'fight obesity'.

The latest and biggest 2018 study, published in the BMJ (the highly reputable British Medical Journal), indicates the failure of a promising, common sense, school 'obesity-prevention' program. The program taught healthy eating and ran cooking workshops for families. It increased physical activity in schools and promoted the benefits of exercise, even nurturing links with sporting heroes. All this sounds great, yet the program had no effect on pupils' diet, habits or weight. On a positive note, it reportedly did no harm, though I question whether the sample size was large enough, and the follow-up long enough, to detect any harm in those vulnerable to anorexia.

An editorial in the same BMJ concludes that anti-obesity programs haven't been working and that we need to 'try something else'. I will return to obesity further down.

Why health promotion can endanger your pupils' health

So it looks like health promotion programs are not working.

What I now want to highlight is they may not be safe. In fact there are many first-hand accounts of great harm being done.

Harm is done when pupils are told that it is bad to be overweight, and when they are exhorted to:

eat more 'healthy'

exercise more,

cut out sugar

cut out 'junk' food,

read nutrition labels

keep food diaries,

add up calories or fat units

use an activity tracker.

Most people see these messages as pretty sensible, so what's wrong with them? How could health promotion do the opposite of what it's supposed to do?

"The class was taken to a supermarket to learn to read food labels. My son, age 8, learned that a red label on fats or sugars was 'bad'. He took it to heart - he's a very conscientious boy who wants to please and do things right, and his thinking is very black-and-white. This is how the anorexia started. Now it's very hard to feed him what he needs to grow as he's genuinely scared of 'red' foods."

Some pupils' health will deteriorate if their understanding of 'healthy' is to restrict food or to over-exercise. If this persists they could suffer from disordered eating and increased body dissatisfaction.

The majority of your pupils hopefully still have well balanced intuitive hunger and satiation cues that serve their body's needs. They are in danger of losing these if they get the message that their body cannot be trusted and that instead, healthy eating requires rules, eating less, consulting labels or counting calories. (If this is new to you, you could start by reading about 'intuitive eating')

For pupils at risk of developing an eating disorder, school health promotion is very often the trigger for the illness. These pupils conscientiously start eating 'healthier' by cutting down on 'unhealthy' foods. They may exercise more and want to replace body fat with muscle. Soon they are compelled to take these behaviours to dangerous extremes.

Some pupils will take your health messages very literally (while others will quickly forget them and resume their normal habits). Especially when they're young, they can get very black-and-white about fats or sugars being dangerous or 'wrong'. This can lead to malnutrition and the start of an eating disorder.

Pupils in larger bodies may feel stigmatised. There may be an underlying message that fat people are morally deficient. Other pupils' prejudices may be reinforced. We are, after all, in a society that judges people according to their size and body shape. Your messages could inadvertently increase obesity if overweight pupils experience more stigma, weight-teasing and shame.

Pupils in any size bodies may get the message that they are only worthy if their body is a certain (average or below-average) weight. This easily becomes more prominent in their minds than anything else, including academic achievements. This gets in the way of developing a healthy sense of self.

And as I'll explain below, the last thing you want is for your health promotion message to leads pupils to diet.

Produced by a secondary school &sent as a calorie burn challenge.
This is NOT ok. For a start it is WILDLY inaccurate &would burn far more calories than stated.
Schools do NOT do this. It is not a healthy safe or supportive way 2encourage activity.
Yes this is being challenged pic.twitter.com/ZxL1CnrIJO
- Dr Emily Kate (@ekd1v07) February 25, 2021

More expert resources on this topic: from dietitian Leslie Schilling... from author and doctor Katja Rowell... from Sunny Side Up, a mother/dietitian team
Lunch matters!

Given all that doesn't work with health promotion, what can you do? One thing you can do is make it easy for pupils to get regular nutrition.

What should your school canteen serve? When Jamie Oliver started his schools campaign he did a great job in challenging the dismal food that used to be served in canteens. Ideally plenty of the food on offer will be freshly cooked or baked. Your cafeteria offerings should be varied and attractive, and priced or bundled in such as say that a meal covers all the food groups. That way pupils get a balance of nutrients and learn by experience what a normal meal consists of - this surely is more effective than lecturing them about what they ought to eat.

Whenever we're concerned about someone's eating habits because they could be missing out on nutrients, it's useful to think in terms of adding particular foods to their meals, rather than removing so-called 'junk foods'.

As we've seen, you should avoid labelling foods as good or bad. You should also remember that eating is not just about nutrients - at times it's about celebration, social interactions, and of course, pleasure . Finally, your reason for providing good nutrition should be to serve pupils' health, not to 'fight obesity' (more on obesity later).

Don't allow activities to compete with lunch or snacks. Do you have sports or arts clubs running while children should be eating? If you care about health promotion, find another solution. With younger children, and depending on school hours, make sure they also eat a snack mid-morning and mid-afternoon. With older children, make time for snacks. Most of us need to fuel up to some extent every 3 or 4 hours - in your staffroom it's probably normal to have a nice cup of tea and a bite of something to top up the energy levels. If you have clubs running into late afternoon or evening, consider that a fair number of pupils will have forgotten to bring a snack from home, so review what is available for them to buy.

If staff in the dining room regularly see a pupil putting tiny amounts of food on their tray, have a system for this pupil's situation to be assessed, and if you have significant concerns, involve the parents. In primary school it may usefully be part of the culture for portions to be served by the lunch staff, for the adults to check that children are not binning their meal, and for a young child to be gently prompted to have more if they have chosen tiny quantities.

Conversely, make sure nobody shames a pupil for eating 'too much':

There are coaches who go into the cafeteria and shame pupils/athletes for eating unhealthy foods, or make weight comments. These coaches are often role models so their comments have a lot of influence.

I would love to give you evidence-based guidelines on meals and snacks in school. In so many schools, 'common sense' results in policies that backfire. One source that might help steer you (it's not all perfect) is the Ellen Satter Institute, because some of what they recommend is based on research (the devil is in the detail, though). See for instance ' Prevention of child overweight in the school setting'.

Why your school should be no-diet zone

One of the most helpful actions your school can take is to create a non-dieting culture.

Here are some reasons you really don't want your pupils to diet:

Depriving the body of energy or nutrients is counter to the development needs of children and adolescents.

While pupils are feeling hungry and weak from a diet, and their brain is not getting its large energy needs met, they are less able to concentrate, reflect and learn.

Calorie restriction, 'clean' or 'healthy' eating is at the root of much disordered eating. 'Clean' eating is often a weight-loss diet in disguise.

For those with a vulnerability, dieting, 'clean' or 'healthy' eating is the most common trigger to a diagnosable eating disorder.

For pupils with an eating disorder who are working on recovery, it is risky to be surrounded by people who diet. It makes them want to diet too, which makes them very vulnerable to a relapse of the illness.

Pupils may get stuck in a cycle of disordered eating, as each diet leads to weight gain.

Yes, weight gain. Dieting during childhood and adolescence predicts future weight gain and obesity. In adults, weight regain is generally the rule, with at least one-third of dieters regaining more weight than they lost (an incentive to stop the diet talk in the staffroom?) You probably haven't heard this often enough to believe it, so I invite you to google it - for instance writer and TED speaker Sandra Aamodt provides numerous links to the research on her website www.sandraaamodt.com).

With adolescents the weight-gain effect of dieting is very strong. If you think your pupils weigh too much, let me be clear: your pupils' weight-reduction efforts are likely to result in extra weight gain. Dieting makes them 2 to 5 times more likely to transition from average weight to overweight in the next two years.

If you need more convincing, here's the take-home message from the American Academy of Pediatrics in Preventing Obesity and Eating Disorders in Adolescents:

"Dieting, defined as caloric restriction with the goal of weight loss, is a risk factor for both obesity and eating disorders. Dieting behaviors were associated with a twofold increased risk of becoming overweight..."

and here's the bit that is seriously worrying in terms of physical and mental health:

"... and a 1.5-fold increased risk of binge eating at 5-year follow-up"

Sadly for those of us with an underweight child suffering from anorexia, dieting does not make them gain weight. They really get a raw deal.

The main reason your school should very much discourage dieting is that dieting is bad for your health. Deny the body its nutritional needs and you have the potential for disruptions in a person's growth, metabolism, endocrine system, nervous system, and so on. The body and brain need nutrition, they need fat, they need calories.

When people diet and the diet 'fails', they often get into yo-yo dieting, with their weight cycles up and down. Research indicates that this in itself has long-term adverse consequences on cardiometabolic health.

If you've ever gone hungry, remember what it's done to your mental state, your mood, your ability to concentrate and learn. There's even a term for it: 'hangry'. Are you trying to teach biology to a classroom of hangry pupils?

Never encourage diets and make it known that diets are counterproductive. If staff insist on dieting, ask them to be very discreet.

Why your school should discourage fasting

Sometimes schools lead a fast to fundraise or to raise awareness of poverty in other parts of the world. This is highly dangerous, as food restriction is a common starting point for an eating disorder in vulnerable individuals, and you are bound to have vulnerable individuals in your school. For those in treatment or who are well but vulnerable to relapse, fasting is harmful: they should be eating every 3 or 4 hours and guarding against energy deficits.

For all your other pupils, given our society's dieting culture, a fast may covertly be used as a worthy excuse to lose weight or to engage in a fashionable 'cleanse' or 'detox'. It could be the start of a longer diet, and you now know why the last thing you want is for pupils to diet.

A fast gives the wrong message from a school about the role of nutrition and about respect of the body's needs. There are surely other ways of nurturing empathy and promoting action for people in poverty.

For anyone with an eating disorder, it's important to have a dispensation from religious fasts on medical grounds.

Deal with fat talk

If you use a validated program for body confidence, you will learn to recognise negative body talk, or 'fat talk' and you will have strategies to deal with comments on people's weight and appearance.

Examples of 'fat talk' or diet talk to be discouraged are:

"I'm so fat",

"She's so skinny",

"I'm so bad, I had a doughnut"

"Now I've eaten so much, I must go to the gym"

"I'm getting beach-body-ready"

"I'm on a diet"

"How many calories in this?"

"Her tummy sticks out"

"He's got a great six-pack"

"Tonight we go clubbing and burn calories"

Such talk reinforces body dissatisfaction, identifying one's value with one's looks. It creates pressure to force one's body into an unhealthy mould. It contributes to shame among larger pupils or among anyone who thinks they should be thinner. It 'triggers' those battling an eating disorder. Consider size-ism and fat talk to be just as rude, discriminatory and harmful as racism or sexism.

Why your school should use food-neutral language

We commonly talk of food in terms of good, healthy, bad, clean, naughty, or junk. In some schools, particular meals served in the canteen are labelled 'healthy', while chips on a Friday are implied to be a naughty treat.

What's wrong with labelling food good or bad? Well, it's not scientific. All foods serve a purpose, whether for nutrition, pleasure, celebration or social bonding. Different people will benefit (or be harmed) by different foods in different quantities at different times.

If you've come out of an exercise session hungry and shaky, then a muffin is a healthier choice than an apple.

If you are celebrating with friends then pizza and cake have an important social function.

If you are underweight with anorexia, the healthiest choice may be a portion of chips, and you will not be recovered until you are able to enjoy pizza and ice cream.

The only foods we can objectively label as bad are those that will give you food poisoning.

Pupils are likely to be exposed to many 'rules' about food. For some this gives rise to guilt or shame (they think they ought to stick to the rules but can't). It may be the start of yo-yo dieting or of a restrictive diet.

At the other extreme, those who follow the rules obsessively can end up malnourished (as in ' orthorexia '). For someone vulnerable to an eating disorder, describing foods as 'healthy' or 'naughty' reinforces an obsessive attention to rigid food rules. It could trigger an eating disorder or relapse. Recovery from an eating disorder means freedom from food rules, finding satisfaction in a wide variety of foods, and becoming attuned to the needs met by various foods.

Examples of food-neutral language

To use neutral language you can refer to food as:

sustaining you

giving you energy or nutrients

feeling good

feeding a hard-working brain

satiating hunger

responding to appetite

stabilising blood sugar levels

being balanced

offering variety

being satisfying or delicious

being central to social interactions and celebrations

"The school asked her to journal her food intake for a week and count the calories. Foods were deemed as good and bad. She said she wanted to be healthier, so we happily bought her more fruits and vegetables and granola. She lost weight, became obsessed with counting calories and restricting her eating, and it spiralled out of control as she got deep into an eating disorder."

You could bring food-neutral talk to the staffroom. When I have lunch in a school staffroom, I often notice staff discussing their weight-loss diets and referring to the doughnuts on the table as 'naughty'.

Are your teaching materials food-neutral and body-shape-neutral?

Review the materials you give: do they label foods as good or naughty? Do they overvalue thinness? Are lazy or stupid characters usually depicted as fat? These prejudices are so ingrained in our society that you may find them in many teaching materials that are otherwise good. If you need to keep these materials, I suggest you bring the hidden judgements out in the open.

"Her Spanish class was doing a unit on food vocabulary. When I learned Spanish it was all about paella, tapas - a cultural sharing. In my daughter's class it was all about labelling foods as good and bad, along with dialog about working out at the gym or exercising after eating. They showed pictures of a skinny model and of an overweight person. Seems they were trying to cram information about diet and health into curriculum. After the class my 11-year old stepped up her dieting."

In the following example, the teaching method might have been weight-neutral in the teacher's mind, but I doubt it was for most of the 14-year olds in the class:

In science class they were learning about the gravitational forces on different planets. Each student had to walk to the front of the class, weigh him/herself and calculate what they would weigh on different planets! How could it possibly be a good idea to make middle school kids weigh themselves publicly?

My daughter advocated well for herself, telling her teacher that she 'wasn't allowed to know her weight for medical reasons.' But she had to say this publicly, and she had to stand firm when the teacher pushed back.

Animal welfare: spare pupils the horrors of the meat industry

Don't expose pupils to emotional sessions showing the horrors of the meat industry. For those currently affected by an eating disorder, becoming vegetarian or vegan is a strategy to eat less. It increases their rigidity around food, which delays their recovery. Also, an eating disorder can begin when someone loses weight because they've cut out meat without introducing alternatives.

Balance these risks against the unknown benefits: among the meat-eaters who are not vulnerable to an eating disorder, how many might eat less factory-farmed meat as a result of watching a gruelling documentary?

I care a lot about animal welfare, and I suggest a more responsible way forward: have the school source its food from ethical providers.

"My daughter stopped eating meat while recovering from anorexia, after the home economics teacher showed the class an emotional film about factoring farming and abattoirs. The other pupils went on eating meat. And the eggs provided for the class, and in the canteen, were cheap eggs from battery hens."

'Obesity prevention'

What do the experts recommend?

Schools are under pressure to prevent childhood obesity, the idea being that if you catch it early you will arrest the 'obesity epidemic'. Indeed many government and health bodies see obesity as a rising problem for the health of the nation, and accordingly, they run public health interventions which may well involve schools.

Some interventions are ineffective and some are harmful, even though they may seem like they're following 'common sense'. The harm can be to everybody, not just those vulnerable to an eating disorder. See this comprehensive round-up of the subject: ' Going too far? How the public health anti-obesity drives could cause harm by promoting eating disorders' (Tan, Corciova, Nicholls, 2019)

It may surprise you that the most effective prevention approaches do not focus on weight. In their report Preventing Obesity and Eating Disorders in Adolescents, the American Academy of Pediatrics, concerned about the relationship between health, obesity, and eating disorders, recommend the following 'evidence-based strategies'. My comments are in italics.

don't diet: dieting with the goal of weight loss is a risk factor for both obesity and eating disorders. Make the school a no-diet zone.

have family meals: they are associated with improved dietary quality, and have been shown to protect girls from disordered eating behaviours

parents avoid 'weight talk' (encouraging their children to diet or talking about their own dieting), as studies have shown that weight talk is correlated with overweight and disordered eating behaviours (note that we don't know about causation). On the other hand there is correlation between 'overweight' adolescents using fewer unhealthy weight-control behaviours and parental talk that focuses only on 'healthful eating behaviours'. Presumably you could substitute 'parents' with 'teachers' and this would still be true.

don't allow weight teasing: adolescent girls who were teased about their weight were at approximately twice as likely to be overweight 5 years later. Family teasing predicts the development of overweight status, binge eating, and extreme weight-control behaviours in girls and overweight status in boys. Family talk is outside your control, but you can give weight-teasing zero tolerance in schools.

promote a health body image: adolescents who are more satisfied with their bodies are less likely to diet and more likely to favour healthful eating and exercising. Use a validated body confidence program.

For more on what schools can do, the Academy for Eating Disorders, in their ' Guidelines for childhood obesity prevention programs' recommend:

'Interventions should focus on making children's environments healthier rather than focusing solely on personal responsibility. In the school setting, these include:

serving healthy meals,

providing opportunities for fun physical activities,

implementing a no-teasing policy, and

providing students and school staff with educational sessions about body image, media literacy, and weight bias.'

In short, the recommendations for obesity prevention are the same as the ones regarding disordered eating and body dissatisfaction. If you use the dos and don'ts on this page, use a validated body confidence program and steer clear of anything to do with weight, you are doing the best that is currently known towards all these health aims.

If you're happy with this, you can skip to the end. But if you are finding it hard to believe that nothing more can be done in 'the war against obesity', then feel free to read on.

Is obesity prevention your job? The short version

You may be confused about what's wrong with tackling pupil's weight. Maybe you want to 'fight obesity' head on?

I am not an expert on obesity even after hours of research, and my guess is that school staff are even less so. So I'll share my conclusions so far, based on what I have read and discussed with experts.

Anti-obesity programs could harm all pupils (i.e. those classified as overweight or obese, those of average or low weight, and those vulnerable to an eating disorder)

Anti-obesity programs in schools don't work - there is no long-term behaviour change or weight loss (and in any case, we should not be aiming for children and young people to lose weight)

Any obesity intervention that leads to dieting is highly likely to produce long term weight gain, disordered eating behaviours and adverse health effects

What matters most for health is a healthy lifestyle (and good genes and body confidence)

High weight does not automatically equal poor health (the same with low weight - it's all very individual)

It shouldn't be your job to pronounce on an individual's weight and health and what to do about it. Let the experts put their own house in order before you get involved.

If you're curious about all this, read on, as I go into some level of detail to explain what may be pretty surprising to you. Otherwise feel free to skip to the end.

Obesity - where's the problem?

Definitions first: someone is categorised as 'overweight' or 'obese' when their body mass index (BMI), which computes their height and weight, is over a particular figure.

The message we most commonly hear is that overweight or obesity causes health problems. It is often bundled with the simplistic message that the cause of overweight is excessive eating and not enough exercise, presumably because of ignorance or lack of self-discipline. 'Fighting obesity' or 'obesity prevention' usually mean getting all of us to eat less and exercise more. Those assumption is that those who are overweight should lose weight, or at least not gain any more.

In scientific papers you will find a more nuanced message that obesity is associated with increased risk of health problems. These writers are aware that correlation isn't the same as causation. When an obese person is in poor health, the cause may not be their high body fat. The body may be doing something that causes poor health and - through poorly understood mechanisms -high body fat.

There is an even less well-known view and we should all pay attention to as it as it is promoted by a number of health experts, and backed up by reports in scientific journals. It goes like this. An above-average weight does not mean poor health. 'Thin' doesn't always mean 'healthy' and 'fat' doesn't always mean 'at risk'.

For instance, in your school right now, those at the greatest risk to health are probably those with insufficient body fat. How many girls are failing to have a regular menstrual cycle because of low weight and/or low nutrition?

An individual categorised as overweight or obese may be in excellent health right now and also long term. They may be healthier than their neighbour of average size. And this doesn't just apply to the odd lucky individual. There are studies that look at entire populations and find no problem with overweight or obesity. It seems that a marginally high weight may be protective to health. Some experts are scratching their heads over what they call the 'obesity paradox'. They expect obese people to be in worse health, so they wonder how come obese people have been shown to survive various health conditions better than average-weight people.

Some experts argue that lifestyle is what predicts health. Mortality is better correlated with healthy lifestyle habits than with weight. Everyone needs good nutrition and some amount of movement (and I would add, sufficient sleep). These are the lifestyle factors we need to focus on to improve the nation's health.

To find out more, I recommend this compilation of the research: ' What's Wrong With the 'War on Obesity?' You could also check out ' Health at every size', a movement supported by many health professionals, and is therefore not as outlandish as you may think.

In summary we have two main views:

The traditional view: weight is a problem when you're in the overweight or obese categories.

The view such as the one described in 'Health at every size': weight is not a problem

and in between we have various shades of 'There seems to be an association between obesity and poor health and if that's true, then there might be a common factor causing both'.

Whichever view you buy in to, the recommendations are the same. You can safely contribute to pupil's health by concentrating on a healthy lifestyle and on body confidence, whatever a person's size. Use a validated body confidence program, and don't get involved in weight issues.

'Yes, but...' (if you really want to 'fight obesity')

If in spite of all the nuanced thinking above, you are certain that something must be done to prevent children going into the overweight or obese categories, your first hurdle will be to choose an anti-obesity program that won't waste everybody's time, since (as I mentioned in the health promotion section) anti-obesity programs are not working. They are having no effect on pupils' eating or exercise habits.

Nor are they having an effect on pupils' weight, and that is a good thing. A school cannot safely intervene on any individual's weight. The blanket approach - to eat less and exercise more - would be the equivalent of a weight-loss diet, and we know that such diets are likely to lead to weight gain and long-term disordered eating behaviours.

As a school you do not have the competence to judge whether any pupil's weight is problematic or healthy. Assuming someone's weight is judged excessive, it is very much an expert clinician's job to work out a solution that doesn't have adverse physical and mental effects.

Perhaps your aim is to reduce obesity in the future, reducing the rate of weight gain of young people. To do that you would need to understand the causes of overweight and obesity.

For most laypeople, it is common sense that people become overweight because they eat too much and are sedentary. But experts nowadays say that causation is complex and poorly understood. For instance, there is research in the factors that affect the hormones that regulate appetite, fat storage and metabolism. Semi-starvation (dieting) is a sure culprit, and so perhaps are antibiotics in early life, sleep, stress, and some of the bacteria in your gut (to name just a few).

For some individuals there is an overlap between an eating disorder (in particular, binge eating disorder), body dissatisfaction and obesity. Disordered eating behaviours can disrupt how appetite is regulated and can mess with metabolism.

In short, there is no uniform mechanism behind obesity, but a whole lot of individual factors. So blanket approaches (such as urging people to exercise more) don't work.

If you do take the simplistic view that people are in higher weight categories because they are sedentary and eat too much, you must find a way to promote a healthy lifestyle while making sure it doesn't lead to dieting. A validated body confidence program might help you there (and it might also challenge your beliefs about obesity).

Work with the 'First do no harm' principle. Are you sure that your obesity messages are not leading to dieting, disordered eating, eating disorders, increased body dissatisfaction, stigma, bullying?

"In science class, the kids were shown a video of a woman having liposuction, and there was much hilarity about how gross the fat looked. My girl got the message that the less body fat, the better. In her whole school life she only ever had one class - sex education - where an adult stressed the need for body fat."

Think of the cost-benefit equation. You probably have a far greater number of pupils at risk from disordered eating. They may well subvert your health promotion message by going on diets, over-exercising, bingeing or purging. Whereas obesity may or may not be linked to health in the far future, your actions could push a vulnerable child into an eating disorder, putting their health at immediate, serious risk.

In 'fighting obesity' there is a danger of making thinness an ideal. If as a result, your pupils go on a diet, you could inadvertently be setting them up for a lifetime of disordered eating as they fight the weight they gained from dieting.

So there are big risks to a school's anti-obesity initiatives, and maybe no payoff whatsoever.

How could we possibly be barking up the wrong tree? One reason there is so little guidance for you is that there is virtually no collaboration between health departments working on obesity, and mental health services with expertise on body image, disordered eating and eating disorders. Another reason is that we are all bathing in a culture which judges thin to be good, beautiful and healthy, and fat to be bad and shameful.

Can you assess a pupil's health based on their (over)weight?

The short answer is no. You're a member of school staff, not a health professional. You should never be expected to comment on a pupil's health just because their weight falls into the overweight or obese category.

A health professional cannot gauge someone's health status based on weight either. What they can do - unlike you - is carry out a raft of assessments and tests. So if you're asked to make judgements on the health of your pupils based on their weight, I advise you to resist. You are not competent to do so and your actions could do harm.

A shoe store can tell us what size shoe they sell the most of, yet we cannot predict which shoe will best fit any individual. Likewise an individual's health status and their physical needs cannot be deduced from a number off a chart or from their looks. There is general agreement among experts that BMI is only a statistical tool (just like a shop owner may want data on the most common shoe sizes) and that when BMI is used for any particular individual you get flawed results.

A pupil's BMI might be high because they have more muscle than average (muscle weighs more than fat). Or because they were weighed at a weird time when they had a lot of fluid retention or were wearing Doc Martens. They might indeed be larger than average while being perfectly healthy, with a weight that suits them biologically. A noticeable increase in weight may be a preparation for a growth spurt or maturation. To keep growing 'up', many young people will go through phases of growing 'out'.

In short, there are many reasons why the alarm you raise may be a false alarm, and when it comes to questions of obesity, false alarms can cause harm.

* More from me on BMI: 'What do BMI and Weight-for-height mean?" and the YouTube below *

Don't weigh pupils

In some parts of the world, schools weigh pupils and notify parents of their child's body-mass index (BMI), flagging up those classified as overweight or obese. Yet the child may be perfectly healthy, with a weight that suits their health. You can do harm by sounding a false alarm because in our society, weight is a more emotional issue than, say, iron levels. When children learn that others consider their weight to be excessive, they often engage in diets and in other disordered eating behaviours - in other words they put their health at risk. Most parents are very unlikely to know the science of weight and dieting, and upon receiving a notification of their child's weight being above average, may well do harm by pushing their child to diet. For the most vulnerable, these school reports are often at the origin of an eating disorder.

For these reasons I suggest that if your school is forced to weigh and measure children according to a national data collection programme, you don't send individual reports to families, and you make the weighing process as smooth and trivial as possible. Such programs seem common in the USA. In Scotland it happens in Primary 1; in England the National Child measurement Programme (NCMP) measures all children in Reception and in Year 6. Parents can chose to withdraw their child from the process, and I think that is a wise decision.

Pupils who seem to be getting thinner

Whereas I am unhappy with schools writing to parents about their child having falling in the overweight or obese category, I do believe you should raise concerns when you think a pupil is getting thinner.

Every young person's weight is supposed to increase as they grow and this goes on into their twenties. Flat-lining, for a young person, is the equivalent of an adult's weight loss.

If you see a young person going from fat to average, they may be dangerously ill from partial starvation.

Although you are not health experts, in these cases I do believe you should alert parents so that professionals can assess this pupil's health. The risks of malnutrition and/or of an eating disorder are immediate and serious. If it turns out the pupil is fine in mind and body, there is less risk that your false alarm will cause them to engage in disordered eating. It's less risky to be told 'you might be too thin' than 'you might be too fat', given our society's thin-bias.

To be clear: please only comment on thinness in a health context. "You're so thin" in a social context (usually meant as a compliment) is 'fat-talk' and not helpful.

While I know a lot about eating disorders and quite a lot about disordered eating, I don't consider myself an expert on health promotion, body image or obesity. There are experts in each individual field, but nothing much to link it all up. As a result it seems an impossible task for schools to know what is effective and what does no harm. That's what I am trying to do in this page. I will keep updating this as I learn more. Join my mailing list for news.

For more information

We've come to the end of a whole section for schools. If you missed the beginning, the menu/portal is on this page. If you would like more help directly from me, do get in touch. Please also get in touch with any corrections or suggestions.
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Schools health promotion, body confidence, diets, disordered eating and obesity: what to do?

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Schools often wish to address: health promotion body confidence, satisfaction or acceptance, obesity disordered eating prevention eating disorder prevention You should only use programs that have been validated as safe and effective. Below I will explain the surprising truth that if your school is relying only on common sense to teach health promotion, your programs are probably not working.

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Since 2004, Dove has been building self-esteem in young people – and by 2020, we’ll have helped 40 million through our educational programmes.

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Resources to support teaching about body image

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Resources to support teaching about body image

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Question of weighing children in schools

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Question of weighing children in schools

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Produced by the Office for Health Improvement and Disparities, part of the Department of Health and Social Care.

1. Executive summary

The National Child Measurement Programme ( NCMP), also known as the School Height and Weight Checks, is a mandated annual programme delivered by local authorities, which involves measuring the height and weight of all school children in reception and year 6. Over 99% (17,000) of eligible state-maintained schools across England, including academies, usually participate in the NCMP.

Support from schools is crucial to delivering the NCMP. This guidance provides information for school leaders, staff and governing bodies on key tasks that schools can help with to ensure the programme runs smoothly.

Delivering the NCMP provides vital information that enables local authorities and their partners to plan for and invest in key services to tackle obesity and its wider determinants. It also provides the opportunity to raise parents' awareness of overweight and obesity, its consequences and healthy lifestyle choices.

Although most children in reception and year 6 are a healthy weight, the NCMP data consistently shows that prevalence of obesity doubles between reception year and year 6 (from around 10% to around 20%). More than 1 in 4 children aged 4 to 5 years and 4 in 10 aged 10 to 11 years are overweight or obese (27.7% and 40.9% respectively). The 2020 to 2021 NCMP annual report showed large increases in the proportions of children living with overweight (including obesity), obesity, and severe obesity compared to previous years of around 4.5 percentage points. These increases in child obesity and severe obesity prevalence in 2020 to 2021 follow the COVID-19 pandemic which resulted in school closures and other public health measures. More data is needed to know whether this is a long-term increase.

There are significant inequalities in terms of very overweight prevalence in children from the most deprived compared with least deprived areas, and between different children from different ethnic groups.

The term 'very overweight' refers to the clinical weight status 'obese'. While the use of the word obese is a clinical classification, the sensitivity and stigma around using this term is acknowledged. The Office for Health Improvement and Disparities ( OHID) encourages all conversations and correspondence with parents in relation to their child's weight status to use the more acceptable term 'very overweight' instead. Children identified as very overweight are more likely to be ill, be absent from school due to illness, experience health-related limitations and require more medical care than children identified as a healthy weight. Very overweight children are also more likely to suffer from dental caries, type 2 diabetes, breathing difficulties and bone and joint problems and experience mental health problems such as depression, poor mental well-being, bullying and weight stigma. Additionally, children living with obesity are five times more likely to become adults living with obesity.

A child's weight category affects their health and wellbeing. Growing healthily and maintaining a healthy weight is important not only for a child's physical, social and mental wellbeing but also for their capacity to do well at school., From September 2020, health education is a statutory requirement for schools. Relationships and sex education (RSE) and health education does not apply to independent schools, who must meet the Independent School Standards as set out in the Education (Independent School Standards) Regulations 2014. It does however, apply to academies and free schools. The new health education curriculum can support schools with teaching pupils how to make good decisions about their own health and wellbeing - a statutory duty that Ofsted inspectors evaluate.,

The wellbeing of children and families is very important. Measurements are conducted in a sensitive way, in private and away from other children. The weight and height information is shared with the parent or carer in a feedback letter, where letters are provided. No individual information is shared with the children themselves, teachers or the school. It is a parent's choice if they share the information with their child. If a parent is concerned about their child's growth, weight, body image or eating patterns, NCMP feedback letters provide national and local information to support parents and advise on when to seek further support from a school nurse or General Practitioner.

Parents do react in different ways to receiving their child's NCMP feedback, so guidance is available to help school nursing teams and NCMP delivery staff have supportive conversations with parents about the NCMP and their child's health and growth. See the NCMP conversation framework for talking to parents.

The emotional impact of the NCMP has been researched. Studies show that body image, self-esteem, weight-related teasing and restrictive eating behaviours do not change as a result of being measured or receiving feedback. It was also found that most children (96%, 351 children) are indifferent or unconcerned about being weighed or measured. The small number of children (4%, 13 children) that disliked the process were mainly from year 6, children aged 10 to 11 years. This reinforces the need for sensitivity when weighing and measuring older children.,

2.1 Background

The NCMP, also known as school height and weight checks, was established in 2006. Over 99% (approximately 17,000) of eligible state-maintained schools, including academies, participate in the programme. Over 1 million children in reception and year 6 usually have their height and weight measured in schools as part of the programme.

The Office for Health Improvement and Disparities ( OHID) has responsibility for the national oversight of the NCMP. The surveillance components of the programme are a mandated public health function of local authorities. Local commissioners and providers have been advised to follow the government COVID-19 guidance required to help enable the safe delivery of the NCMP.

Data collected through the NCMP is returned to NHS Digital, where it is analysed. A report summarising local and national data is then published. Local areas use this high-quality data to inform the development and delivery of services to tackle child obesity. Nationally it is used to track trends in child obesity levels over time, to inform policy and is key to monitoring progress of the government's Childhood Obesity Plan chapter 2.[footnote 10] Advancing our health: prevention in the 2020s,[footnote 11] (chapter 3 of the Childhood Obesity Plan) sets out how the programme can align with digital approaches to support families and health professionals. Tackling child and adult obesity is a renewed and strengthened priority for the government, as is shown in its recently published tackling obesity strategy.

2.2 Weight status in primary school

National data from the NCMP shows that the prevalence of children living with obesity doubles from around 10% of children at the start of primary school to around 20% at the end of primary school. Additionally, year-on-year, the data has shown that obesity prevalence in the most deprived 10% of areas in England is more than twice that in the least deprived 10%.[footnote 12] This gap in obesity prevalence by deprivation continues to widen for both reception and year 6, and for those children with severe obesity, this gap rises to more than 4 times for both year groups.

A small sample of 4 local authorities was analysed longitudinally to examine how weight status tracks between reception and year 6. The findings[footnote 13] suggest that excess weight is likely to persist or worsen during primary school. Those children living in the most deprived areas and certain black and minority ethnic communities may be at higher risk of retaining or gaining an unhealthy weight. An infographic of the findings to show changes in the weight status category of children between the first and final years of primary school is shown in figure 1 below.

Figure 1: Key findings from the 2017 tracking study

This infographic shows changes in the weight category of children between reception and year 6 from a small sample of 4 local authorities that were analysed longitudinally:

for children who were a healthy weight in reception (this is the vast majority: 83% of all children, n=28,092), most remained a healthy weight in year 6. Less than 10% of healthy weight reception children became obese (including severe obesity), and less than 2% became underweight by year 6

for the 9% (n=3,128) of all children who were overweight in reception, approximately 30% remained overweight, while almost 30% became obese and a further 13% became severely obese. Around 27% of these children returned to a healthy weight

for those children who were obese, but not severely obese (representing 3%, n=1,143 of all reception children), just over a third remained obese and around a third developed severe obesity by the time they reached year 6 - the percentage of obese reception children who become overweight or healthy weight were around 20% and 10%, respectively

for the 3% (n=963) of children in this sample who were severely obese in reception, most remained severely obese with a further 29% of boys and 27% of girls becoming obese, and the remaining small proportion transitioned to overweight (under 10%) or healthy weight (under 5%)

For more information please refer to the OHID report.

2.3 Achieving a healthy weight is important

When children are a healthy weight, they feel better about themselves. They find it easier to play and learn and they are more likely to grow up healthy too. Helping them to be a healthier weight when they are a child can set up their health and wellbeing for life.

2.4 Facts about childhood obesity

Children who are overweight or very overweight are more likely to develop a variety of illnesses in childhood and later life, such as high blood pressure, high cholesterol, increased risk of type 2 diabetes (pre-diabetes), breathing difficulties, dental caries and bone and joint problems.[footnote 14],[footnote 15] Health is not the only issue. Children living with obesity are also impacted by emotional and social issues such as:

poorer emotional well-being

being at a higher risk of depression

developing an eating disorder in older children

lower body image and self-esteem

teasing or bullying

behavioural problems

avoidance of active play or learning opportunities in school sport and PE [footnote 16],[footnote 17],[footnote 18],[footnote 19]

Children living with severe and persistent obesity are more compromised. It's important to note that many children living with obesity are psychologically well, have high self-esteem and do not suffer major depression.

This can have an impact on:

a child's attendance, as they may need to miss school for medical appointments or treatment

a child's learning and academic achievement

a child's sleep - sleep deprived children are less likely to perform well academically

staff training and expertise, because staff may need to provide extra support to children with health problems arising from overweight and obesity to ensure they manage their condition effectively during the school day

2.5 The importance of school participation

Supporting the NCMP and embedding it in a whole school approach to health and wellbeing will:

support pupils to gain the knowledge and skills required for good health and wellbeing

support the delivery of the new health education curriculum which became a statutory requirement in September 2020

help schools to demonstrate to Ofsted that they are considering the health and wellbeing of their pupils and helping them know how to keep physically healthy

Supporting the delivery of the NCMP in your school ensures that vital information is available to help local authorities and their partners plan, target and deliver services to promote children's healthy weight and growth - manage both underweight and excess weight (overweight and obesity) and in turn address the issues set out above.

Local authorities may also share individual height and weight measurements and calculated weight category with each child's parent by sending a letter, typically via post from the NCMP provider directly to the parent. OHID have produced a template letter (also known as a specimen result letter to parents) for local authorities which can be used and adapted locally. This letter contains links to the NHS BMI healthy weight calculator and the Better Health Families website - both of which can support and encourage parents to monitor their child's growth and to adopt healthier lifestyle behaviours. This is particularly important for parents and families who may need additional support to achieve and maintain a healthier weight due to the impact lockdown has had on healthy lifestyle behaviours.

Because many children in England are now carrying excess weight, parents and health professionals often cannot tell, just by looking at a child, whether he or she falls within a healthy weight range. This is why taking an objective measurement by trained health professionals through the NCMP and sharing that information with parents is important.

Information on the prevalence of school overweight and obesity, over a 3 year average, compared with local and national averages, can be shared with schools via a bespoke NCMP School Feedback Letter. Local authorities send these letters. The letter also includes details of resources to encourage whole school action to increase health and wellbeing, including healthy eating and increasing physical activity (see resources section). In conjunction with action taken by local authorities, this can make a real difference in preventing the continued increase of excess weight in children from reception to year 6, benefiting not only the health and wellbeing of pupils but also their learning and achievement in school.

Healthy eating and food in schools

Research on the impact of Universal Infant free school meals (UIFSM) policy in England found evidence that by the end of the school year, those exposed to UIFSM have significantly better bodyweight outcomes than they otherwise would, and are more likely to be of a healthy weight, less likely to be obese, and have a lower BMI.

Government guidance on school food is designed to create a culture and ethos of healthy eating. Ofsted's Common Inspection Framework includes a judgment on personal development, behaviour and welfare. As part of reaching this judgment, inspectors will look at the extent to which schools are successfully supporting pupils to gain knowledge of how to keep themselves healthy and make informed choices about healthy eating and fitness. The school food standards webpages offer practical guidance to help school leaders and governing bodies adopt a whole school approach to food.

Physical activity in schools

Public Health England (now OHID) previously published a resource for headteachers which brings together key guidance and policy documents on increasing physical activity in children and young people alongside local examples, called 'What works in schools and colleges to increase levels of physical activity in children and young people'. It has been produced to support schools and colleges in order to develop and implement practical, effective evidence-based approaches utilising 8 key principles as shown in figure 2.

Figure 2: Promising principles for practice from - 'What works in schools and colleges to increase levels of physical activity in children and young people'.

Figure 2 shows the 8 promising principles for practice from 'What works in schools and colleges to increase levels of physical activity in children and young people', presented in a circle diagram with 'develop and deliver multi-component interventions' at the centre. Radially around this core principle are the following 6 principles, arranged in a clockwise manner:

1. ensure skilled workforce

2. engage student voice

3. create active environments

4. offer choice and variety

5. embed in teaching and learning

6. promote active travel

The eighth principle 'embed monitoring and evaluation' is considered to be a cross-cutting principle that encompasses all the above principles.

3. The role and responsibilities of local authorities

Delivery of the programme, including the height and weight measurements and returning relevant data to NHS Digital, is a statutory function of local authorities set out in legislation. Local authorities, or the provider organisations they commission, will follow the process shown in the Deliverable elements of NCMP document when implementing the programme and in doing so will be responsible for:

ensuring that, either, a registered medical practitioner, registered nurse, for example school nurse, or registered dietitian oversees the implementation of the programme

securing the class-list information on children in reception and year 6, including school name and unique reference number, pupil name, gender, date of birth, ethnicity code, home address and postcode, by liaising either directly with schools or with their local authority education officer - a parent's email address and telephone number may also be required if digital communication methods are being used and proactive feedback calls are planned by the local authority or NCMP provider

It is lawful under the General Data Protection Regulation ( GDPR) and Data Protection Act ( DPA) 2018 for schools to continue to provide class lists to the local authority or those working on behalf of the local authority to carry out the height and weight measurements. For more information, see section 5, 'Supporting NCMP and the General Data Protection Regulation ( GDPR) and Data Protection Act ( DPA) 2018: advice for schools'.

3.1 Developing and disseminating a pre-measurement letter to parents

As consent is not the lawful basis for processing NCMP data under the GDPR and DPA 2018, there is no requirement for schools to obtain the consent of parents in order to provide class lists to school nursing teams and NCMP providers. However, local authorities are required to take steps to ensure parents understand the value of having their child measured and are provided with a reasonable opportunity to withdraw their child from participating in the programme.

OHID has developed a specimen pre-measurement letter for parents, which ensures that the information provided to parents on the processing of their children's height and weight data meets the requirements of the GDPR and DPA 2018. The letter also acts as the privacy notice and must be sent to all children eligible to take part in the NCMP. Parents must be sent this letter at least 2 weeks before the measurements are scheduled to take place.

3.2 Raising awareness of the programme among parents, school leaders and staff, children and governors

Many NCMP leads will seek to include short articles in school newsletters, provide governors with information and deliver assemblies to ensure parents, children and teachers understand what the programme involves and why it is done. The local NCMP lead is your first point of contact and could be your local authority public health team or an NCMP provider such as a school nursing service or commissioned service that delivers the height and weight measures.

3.3 Planning for and carrying out the height and weight checks

Planning the logistics of measuring children's height and weight and liaising with schools to arrange appropriate days and times to take measurements. Current national and local infection control guidance should be referred to in order to inform the planning and delivery of NCMP measurements. The following links advise on the necessary adjustments required to help enable the safe delivery of the NCMP:
Emergency planning and response for education, childcare, and children's social care settings Health protection in education and childcare settings
Taking the height and weight measurements of children in reception and year 6 and returning the data collected to NHS Digital. This contributes to the annual national statistics report publication.

3.4 Optional feedback

Check with your local NCMP lead whether feedback to parents and/or feedback to schools is provided.

Feedback to parents

Providing parents with feedback, within 6 weeks of measurement, either in the form of a result letter or through a telephone call. The feedback provides parents with individually tailored information on their child's height, weight and weight category (either underweight, healthy weight, overweight, or very overweight), together with signposting to sources of local support and advice as well as national support such as a link to the Children's weight page on the Better Health Families website.

Feedback to schools

Providing schools with feedback on how overweight and obesity prevalence at their school compares with the local or national average by sending the NCMP school feedback letter.

4. Supporting delivery of the NCMP in your school

Your local authority is responsible for delivering the NCMP. However, the programme has been most successful in areas where schools have provided support. Therefore, local NCMP leads may contact your school to ask for your help in the following ways.

4.1 Providing them with a class list for all children in reception and year 6

The class list should contain the school name and unique reference number, and the name, gender, date of birth, ethnicity code, home postcode, home address and home telephone number of each pupil. It is lawful under the GDPR and DPA 2018 for schools to continue to provide class lists to NCMP providers for the purposes of the NCMP. For more information, see section 5: 'Supporting NCMP and the General Data Protection Regulation ( GDPR) and Data Protection Act ( DPA) 2018: advice for schools'.

Check there are no new starters missing from the class list

Some local authorities request the class list electronically to move towards a paperless way of working.

Letting them know if there are any children on the class list who are not eligible to participate in the height and weight checks because they are unable to stand unaided

The NCMP lead can make alternative arrangements for these children (a specimen letter to parents of children unable to be measured unaided can be sent to parents).

Letting them know that there are children with Down's syndrome

Children with Down's syndrome should be included in the NCMP activity on measurement day as appropriate. However, the NCMP provider will need to use a specialist growth chart and provide parents with an adapted result letter.

4.2 Facilitating the dissemination of the pre-measurement letter to parents

The local authority is responsible for ensuring that parents are informed about the NCMP, including how their child's data will be stored and processed. The pre-measurement letter also gives parents the opportunity to withdraw their child from the programme. Your local NCMP lead may seek your support to send pre-measurement letters electronically or through the pupil post. Local authorities may also ask for the pre-measurement leaflet for parents: school height and weight measurements to be disseminated along with the pre-measurement letter for parents. This leaflet helps parents understand the NCMP process and why healthy weight is important for a child's health and wellbeing.

Letting the local authority know if any parents have withdrawn their child

Although parents will be asked via the pre-measurement letter to let the local authority or service provider know if they have chosen to withdraw their child, some parents may respond directly to the school. Relaying this information to the NCMP delivery team will ensure that parents' wishes are respected.

Confirming a convenient day and time for NCMP staff to come into the school to measure the height and weight of children in reception and year 6

Providing a room where children's height and weight can be measured and a member of staff to help with supervising children's movement to and from the room

Ideally it is important that each child's height and weight is measured in privacy, without being seen or heard by other pupils. Schools will need to identify a private area, with adequate space and appropriate flooring (such as a level, non-carpeted flooring to ensure that scales give an accurate reading). If a separate room is not available, a screened-off area can be used.

The availability of facilities for handwashing is of increased importance for NCMP staff, students and school staff to help with infection control.

Raising awareness of the NCMP

The NCMP has been successful in areas where governors, parents and children have a good understanding and awareness of the programme and its importance. The local NCMP lead may liaise with you to arrange engagement sessions such as plan an assembly where the NCMP lead can talk to children about the programme, include an article on the NCMP in the school newsletter, or share information on the programme with governors.

Embedding NCMP as part of a whole school approach to health and wellbeing

A whole school approach[footnote 20] is one that goes beyond the learning and teaching in the classroom to pervade all aspects of the life of a school including:

culture, ethos and environment - the health and wellbeing of students and staff is promoted through the hidden or informal curriculum, including leadership practice, the school's values and attitudes, together with the social and physical environment

learning and teaching - using the curriculum to develop pupils' knowledge, attitudes and skills about health and wellbeing

partnerships with families and the community - proactive engagement with families, outside agencies, and the wider community to promote consistent support for children and young people's health and wellbeing

Embedding the NCMP as part of a whole school approach to health and wellbeing can complement teaching about physical health, fitness and healthy eating which are an integral part of statutory health education.

Make full use of the 'Our Healthy Year' resources

A pack of resources called Our Healthy Year is available for head teachers, reception and year 6 teachers, to help them teach pupils about leading healthy lifestyles in the years in which they are weighed and measured as part of the NCMP. There are ideas for whole school activities and suggestions for engaging parents.

Some parents wish to discuss their child's result with someone. So giving the parent the correct details that the NCMP lead has provided to you will help parents receive support quickly.

5. Supporting NCMP and the General Data Protection Regulation (GDPR) and Data Protection Act 2018 (DPA 2018): advice for schools

Under the GDPR all processing of personal data must have a lawful basis. The legal foundation for the NCMP is provided in local authority regulations[footnote 21],[footnote 22]. This statutory authority means that the lawful basis for the NCMP is provided by the Articles of the GDPR covering:

compliance with a legal obligation

exercise of official authority

provision of health or social care

public interest in the area of public health

Consent is not the lawful basis for the processing of NCMP data.

Schools have a legal obligation to release pupil's personal information. Schools do not require parental consent to share a pupils' personal information for the purposes of participating in the NCMP.

As consent is not needed to lawfully process NCMP data under the GDPR and DPA 2018, there is no requirement for schools to obtain the consent of parents to provide class lists to school nursing teams and NCMP providers. This sharing continues to be lawful under the GDPR and DPA 2018. All parties involved should be following information governance guidance regarding the secure transfer of personal data.

The NCMP Regulations state that parents must be given an opportunity to withdraw their child from the programme. This requirement is covered by sending them a pre-measurement letter at least 2 weeks prior to being measured. OHID has developed a specimen pre-measurement letter (to parents) for local authorities, which complies with the requirements of the GDPR and DPA 2018 including detailed information on what happens to the child's data and information on how to withdraw. Schools may be asked to support dissemination of this letter to parents (see section 'Supporting Delivery of the NCMP in your School').

Further guidance on schools sharing information with the school nursing team or providers for the NCMP is provided in the NCMP Operational Guidance.[footnote 23]

Key point

No change is required to the way in which the NCMP data is collected and processed for this to continue to be lawful under the GDPR and DPA 2018.

6. Resources

Emergency planning and response for education, childcare, and children's social care settings and Health protection in education and childcare settings: advice on the necessary adjustments required to help enable the safe delivery of the NCMP from an emergency planning and health protection perspective.

NCMP operational guidance: guidance for local commissioners, providers and schools on running the NCMP.

Deliverable Elements of NCMP (PDF, 200KB): a table showing an overview of the programme with links to relevant documents.

Specimen pre-measurement letter to parents, specimen letter to parents of children unable to be measured unaided and specimen result letters to parents: specimen letters for local authorities to adapt based on local arrangements.

This 'Information for schools guidance' and specimen pre-measurement letter for head teachers: to be sent to head teachers in advance of starting the height and weight checks every school year.

Pre-measurement leaflet for parents: school height and weight measurements: to send with the pre-measurement letter. This leaflet helps parents understand the NCMP process and why a healthy weight is important for a child's health and wellbeing. Available for download only from OHID 's Campaign Resource Centre. Please note, a free account will need to be set up on the campaign resource centre to download this resource.

Post-measurement leaflet for parents: Better Health Families top tips to keep your family healthy and happy: to send with the result letters. This leaflet provides simple tips to help families eat well and move more and highlights the additional ideas available on the Better Health Families website. These are available from OHID 's campaign resource centre. Please note: a free account will need to be set up on the campaign resource centre to order copies of this resource.

6.2 NCMP School feedback letters

School feedback cover letter template: letter templates for local authorities to send to schools participating in the NCMP. Intended to be edited, to include details of any local primary care providers, weight management and support services.

School feedback example letter: an example of a letter sent to schools by their local authority which includes non- identifiable average 3-year NCMP data.

School feedback cluster example letter: an example of a cluster letter sent to schools by some local authorities, which includes non-identifiable 3-year NCMP combined data for 2 or more schools.

6.3 Better Health Families resources

Our Healthy Year: a downloadable pack of Better Health Families resources called Our Healthy Year is available on the school zone. These include resources for head teachers, reception and year 6 teachers to help them teach their pupils about healthy lifestyles. Includes ideas for whole school activities to encourage eating well and moving more, as well as suggestions for engaging parents. Teachers can subscribe to school zone resources by signing up with their name, email address and school details to keep up-to-date with new materials and campaigns.

Children's weight: information for parents providing more support and advice on receiving their child's feedback letter, following their child's school height and weight check.

6.4 Resources to encourage healthy eating

School Food Plan training resource: a resource to help all school staff understand the importance of a good school food culture.

The Eatwell Guide image and Eatwell Guide booklet: a tool used to define government recommendations on eating healthily and achieving a balanced diet.

Let's Get Cooking and the Learning Network: an e-learning platform with 15 courses for schools and caterers related to improving food for children.

6.5 Resources to encourage physical activity

What works in schools and colleges to increase physical activity: a resource for head teachers, college principals, staff working in education settings, school nurses, directors of public health, county sports partnerships and wider partners. An overview of the evidence and local examples about what works in schools and colleges to increase levels of physical activity in children and young people.

Active Mile Briefings: provides information about the evidence on active mile initiatives, ideas for how to implement them and examples of practice.

School sport and activity action plan: a cross-government action plan to provide pupils with greater opportunity to access 60 minutes of sport and physical activity every day.

Active School Planner: a free-to-use interactive tool for schools to review and improve the physical activity offer to their pupils.

Change4Life Sports Clubs: can help contribute to all children getting at least 30 minutes of physical activity in every school day.

School Games: inspiring millions of young people across the country to take part in appropriate competitive school sport.

PE and sport premium for primary schools: how to invest in sport premium funding to increase physical activity levels.

School capital funding allocations: guidance on direct allocations of the Healthy Pupils Capital Fund to local authorities and multi-academy trusts.

Physical activity guidelines for 5 to 18-year-olds: Chief Medical Officer's physical activity guidelines infographic for 5 to 18-year-olds.

Physical activity in disabled children and disabled young people evidence review and physical activity infographic: Chief Medical Officer's guidelines on physical activity for disabled children and young people.

The Daily Mile: a simple and free initiative to encourage children to run, walk, jog for 15 minutes every day.

6.6 Resources to encourage emotional health and wellbeing

Relationships and sex education (RSE) and health education: DfE 's guidance (2019) on teaching relationships education, relationships and sex education (RSE) and health education became a statutory requirement for schools to implement from September 2020. It sets out expectations about what pupils should know by the end of primary and secondary school and includes content on mental wellbeing. It is supported by guidance on teaching about mental wellbeing.

Teaching about mental wellbeing: practical materials for primary and secondary schools to use to train staff about teaching mental wellbeing.

Better Health school zone: offers lesson plans for year 6 and key stages 3 and 4 to support the relationships, sex and health education curriculum and enable teachers to support the wellbeing of students.

Promoting children and young people's mental health and wellbeing: this guidance was refreshed in 2021 and published jointly by DfE and Public Health England. It sets out 8 principles of a whole school or college approach to promoting mental health and wellbeing. The learning outcomes for senior mental health lead training (PDF, 172KB) are aligned with these principles.

PSHE Association: the PSHE Association is the national body for PSHE education. Within the organisation's resource library are lesson plans and assessment tools to help teach on mental health and emotional wellbeing.

MindEd: MindEd is a free educational resource on children and young people's mental health for all adults. It includes content curated specifically for school settings including content designed to help schools promote wellbeing during the COVID-19 pandemic, for example Wellbeing for Education Return.

References

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National Child Measurement Programme 2022: information for schools

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Produced by the Office for Health Improvement and Disparities, part of the Department of Health and Social Care. The National Child Measurement Programme ( NCMP), also known as the School Height and Weight Checks, is a mandated annual programme delivered by local authorities, which involves measuring the height and weight of all school children in reception and year 6.

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Drop-in clinics with the school nurse that are optional and open to all students

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Drop-in clinics with the school nurse that are optional and open to all students

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Every pupil in the school has a well-being adult that they can request to speak to at any point. We also have 4 ELSAs in school as well as a FLW. In school all adults model speaking openly and sharing feelings and thoughts are celebrated rather than stigmatized.

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Increased pressure on boys to build muscle, students taking more supplements to increase body mass.
We have had a member of staff with a background in strength and conditioning give a talk to all of the sixth form on the risks of supplements and excessive exercise

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On the PSHE Association website we have guidance and lesson plans on mental health including eating disorders: 

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On the PSHE Association website we have guidance and lesson plans on mental health including eating disorders: 

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Mental health and emotional wellbeing pack

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Coram Campus, 41 Brunswick Square, London WC1N 1AZ. The PSHE Association is a registered charity and a company limited by guarantee. Charity number: 1127056 Company number: 6551975 © Copyright 2022 PSHE Association All Rights Reserved.

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We have a number of Units that allow us to explore the topic and provide advice

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Psychology in schools - free Parent/carer workshop programme.
Sign up here

https://www.eventbrite.co.uk/o/psychology-in-schools-team-nsft-32627846273

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psychology in schools team - nsft tickets

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Norfolk and Suffolk NHS Foundation Trust is committed to transformation to develop an integrated provision for children and young people's mental health and wellbeing. A key priority is to bring specialist mental health support into local communities through a different relationship between GPs, education, primary care and community services and specialist mental health/wellbeing services.