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CAFAP

happy child with fruit
Teenagers
Western Australians
Health professionals
Researchers

Teenagers

f you are a teenager wanting to improve your health and happiness, or you know a teenager that might like some support to improve their health and happiness, you might like to start here.

Firstly, congratulate yourself for finding this webpage and for taking the first step towards better health. After this, it’s important to start with very small changes to your lifestyle. A tiny change that you can keep going with is better than a big change that you can’t do forever!

Consider what motivates you to change. For example, you might want to feel better about yourself or maybe you want to have more energy during the day. Knowing what motivates you can help you to stay on track and achieve your goals.

Set some small goals for change. Think about small changes that you can make over the next week. These might be related to the way you think, the food and drinks you consume, the activity you do or the times you spend being inactive.

Have a look at some of the ideas below that have been useful for other teenagers like you

Being more active

  • Active play in the park – like kicking a ball.
  • Walk or cycle to and from school
  • Cycle over to a friend’s place rather than get a lift in a car
  • Take the dog for a walk
  • Meet a friend for active play
  • Active play with parent or brother/sister
  • Do active chores like mowing lawn
  • Get a job delivering leaflets/newspapers
  • Join a dance/martial arts class

Being less inactive

  • Watch only my 1 or two favourite TV shows today (name shows)
  • Move the TV out of my bedroom into a family room.
  • Do an exercise station every ad break when watching TV
  • Move my computer out of my bedroom into a family room.
  • Walk over to talk with my friend rather than chatting on IM/Facebook
  • Limit my electronic game playing to non-school days.
  • Set an egg time to limit by electronic game play to 30 minutes today.
  • Replace sitting electronic game with active one like Move/Kinect

Eat more fruit/vegetables and less junk food

  • Have a healthy breakfast.
  • Eat a home cooked dinner (not fast food)
  • Help to cook dinner
  • Eat dinner with my family
  • Eat dinner at the table (away from TV)
  • Take a homemade lunch to school
  • Drink water instead of juice/soft drink
  • Have fruit for a snack/dessert
  • Have some vegies with my breakfast/lunch/dinner

“Personally it made me think that the benefits of being more active isn’t actually looking good, cuz at the start before I did CAFAP, that’s what I was thinking. But I realised that you don’t just do CAFAP, or any other activity, to look good. It’s like there’s a whole other way to look at it like being less tired or more energetic, more confident.”

“Doing little by little really does help a lot.”

“For me it was about doing exercise and eating healthy and knowing that I’m not the only one. Like there’s more people out there”

“Because of CAFAP I’ve now started to eat breakfast and I’ve found it so much easier to not think about food all day and to eat healthier at night.”

“Exercise, now I actually find it, not fun, but like more enjoyable than I did before”

Western Australians

In Western Australia, as of August 2014, the following services may be useful for teenagers wanting to improve their health and weight:

  • Speak to your GP or local doctor about what they can do to help
  • Your GP may be able to refer you to the CLASP program at Princess Margaret Hospital. CLASP (Changes in Lifestyle are Successful in Partnership) is an outpatient family based lifestyle education and weight management programme for children and adolescents with complicated and/or significant obesity. Phone: 9340 7546
  • The Better Health Program is a free healthy living program for kids above a healthy weight, running across the Perth Metropolitan region. This fun and interactive program helps children aged between 7 and 13 and their families, adopt a long-lasting healthy lifestyle.
  • Fuel Your Future is a program designed to help teenagers make good food choices. During the program teens aged 12-18 develop skills and confidence to make delicious, healthy, nourishing food.
  • Speak to your school health nurse
  • Speak to a dietitian. You can find a dietitian close to you on this website.

Health professionals

For health professionals potentially interested in providing services to overweight or obese adolescents, this section provides an overview of CAFAP as well as resources for facilitator training and program delivery.

WHAT

Curtin University’s Activity, Food and Attitudes Program, otherwise known as CAFAP, is a healthy lifestyle group program designed for adolescents aged 12-16 and their parents. The resources from CAFAP have been uploaded onto this website to be shared amongst health professionals working with adolescents.

WHY

CAFAP was established as there were very few programs available to help overweight adolescents take charge of their health and happiness.

WHY CAFAP IS SPECIAL

CAFAP has a strong grounding in Self-Determination Theory, which explains how to best support adolescents to develop intrinsic motivation to change their own lifestyle behaviours. The training associated with this can provide clinicians and parents with the fundamental skills to work effectively with adolescents. The strong use of Goal-Setting Theory also helps adolescents and parents to develop a clear plan about how to start changing their own behaviours. The nutrition and physical activity components are also especially designed for adolescent groups.

WHO

The program was designed to be run by a multi-disciplinary team consisting of 3 health professionals 1) Dietitian 2) Physiotherapist/exercise physiologist 3) Psychologist.

HOW

The program is designed to be run over eight weeks, with two sessions per week each running for 2 hours. In total there are 16x two hour sessions. Participants are involved in some adolescent-only or some parent-only sessions, and then some joint adolescent and parent sessions. The general format for the program was for adolescents to complete 1 hour of fun physical activity while parents complete one hour of parent-specific activity, with the second hour allocated for joint activities.

WHEN

CAFAP was implemented in 2012 and evaluated in 2013. Healthway provided the funding for the implementation and evaluation.

WHERE

CAFAP is designed to be run in the community. During 2012 it was implemented across Western Australia at community centres in Cockburn, Midland and Esperance.

WHAT HAPPENED

The results suggest modest improvements in healthy behaviours that may assist with long-term weight management, including increased levels of moderate physical activity and reduced sedentary time, improved fitness levels, increased strength, increased fruit and vegetable intake and decreased junk food intake, and improved quality of life.

WHERE TO NOW

The CAFAP resources have been made available for health professionals to use in their work with adolescents. The program is designed to be run by a team, and each of the sessions from different health disciplines complements and builds on the other sessions. Despite this, the program authors acknowledge that team based interventions may not always be possible, and hence would like to make the resources available for any health professionals working with adolescents.

Researchers

For researchers interested in the research conducted to support the development and evaluation of CAFAP, this section provides an overview of CAFAP and the published research.

Curtin University’s Activity, Food and Attitudes Program (CAFAP) was evaluated using a waitlist controlled clinical trial run in Western Australia between 2012-2013 with funding from Healthway. The program was developed from the Fitmatters program run at Princess Margaret Hospital and refined based on formative research.

The evaluation involved adolescents (n=69, 71% female, mean age 14.1 (SD 1.6) years) and parents completed an 8-week intervention followed by 12 months of telephone and text message support. Assessments were completed at baseline, before beginning the intervention, immediately following the intervention, and at 3-, 6-, and 12- months follow-up. The primary outcomes were physical activity and sedentary time assessed by accelerometers and servings of fruit, vegetables and junk food assessed by 3-day food records. Secondary outcomes included food behaviours; body composition, fitness and physical function; mental and social well-being (quality of life, mood and attitudes), and family functioning.

The published development and evaluation findings are:

Straker, L.M., Smith, K.L., Fenner, A.A., Kerr, D.A., McManus, A., Davis, M.C., Fielding, A.M., Olds, T.S., Hagger, M.S., Smith, A.J. and Abbott, R.A.(2012) Rationale, design and methods for a staggered-entry, waitlist controlled clinical trial of the impact of a community-based, family-centred, multidisciplinary program focussed on activity, food and attitude habits (Curtin University’s Activity, Food and Attitudes Program–CAFAP) among overweight adolescents. BMC Public Health, 12, 471. This paper describes the evaluation protocol for CAFAP. http://www.biomedcentral.com/1471-2458/12/471

Fenner, A.A., Straker, L.M., Davis, M.C. and Hagger, M.S. (2013) Theoretical underpinnings of a need-supportive intervention to address sustained healthy lifestyle changes in overweight and obese adolescents. Psychol Sport Exerc, 14, 819-829. This paper describes the use of self-determination theory and goal setting theory in the development and implementation of CAFAP. http://www.sciencedirect.com/science/article/pii/S1469029213000708

Smith, K., Straker, L., McManus, A. and Fenner, A. (2014) Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders. BMC Pediatr, 14, 53. This paper considers the barriers and enablers to recruitment, retention and maintenance in an intervention for overweight adolescents. http://www.ncbi.nlm.nih.gov/pubmed/24552207

Straker, L., Howie, E., Smith, K., Fenner, A., Kerr, D., Olds, T., Abbott, R. and Smith, A. (2014) The impact of Curtin University’s Activity, Food and Attitudes Program on physical activity, sedentary time and fruit, vegetable and junk food consumption among overweight and obese adolescents: A waitlist controlled trial. PLOS ONE, in press. This paper describes the primary outcomes from the evaluation of CAFAP.

Smith, K., Straker, L., Kerr, D., Smith, A. (2014) Overweight adolescents eat what? And when? Analysis of consumption patterns to guide dietary message development for intervention. Journal of Human Nutrition and Dietetics. This paper describes adolescent intake before participation in CAFAP. http://www.ncbi.nlm.nih.gov/pubmed/25157498

Smith, K.L., Kerr, D.A., Fenner, A.A. and Straker, L.M. (2014) Adolescents just do not know what they want: a qualitative study to describe obese adolescents’ experiences of text messaging to support behavior change maintenance post intervention. J Med Internet Res, 16, e103. This paper considers the use of text-messaging to support adolescents after they have completed CAFAP. http://www.jmir.org/2014/4/e103/

Papers regarding the nutrition, fitness, physical activity and mental health outcomes are currently in the review process and will be added when accepted for publication.

A detailed process evaluation of CAFAP is being undertaken and future papers will be published here.