Background Reducing obesity is a Health and Wellbeing Board (HWBB) - - PowerPoint PPT Presentation

Developing our Approach to Obesity in

Gloucestershire

Hein Le Roux (GP) Sue Weaver (Public Health Manager)

Background

• Reducing obesity is a Health and Wellbeing Board (HWBB)

priority for improving health and wellbeing in Gloucestershire

• HWBB has been awarded a place on the national Systems

Leadership Programme

• ‘Place-based approach’ requiring a step change across a

whole system

• Includes opportunities for leadership development training and

an enabler (consultant with expertise in systems leadership)

• Break the intergenerational cycle of obesity in areas of urban

and rural deprivation.

Why is reducing obesity important?

• ‘Probably the most widespread threat to health and wellbeing in

the country’ (DH, 2011)

• Major risk factor for main causes of early death and ill-health:

diabetes, heart disease, stroke, cancers (e.g. breast, colon), chronic respiratory disease

• Dementia – emerging evidence of a link between obesity in

middle age and the development of dementia > 65 years

• Disability – obesity linked with four most prevalent disabling

conditions: arthritis, back pain, mental health problems and learning disabilities

Why is reducing obesity important?

• Obese children more likely to experience low self-esteem and

depression and almost all have been teased or bullied

• Child obesity is (weakly) associated with lower educational

attainment; adult obesity affects employment chances

• Obese employees take significantly more short- and long-term

sickness absence (average four more days per year)

• Obesity is a health inequalities issue affecting some of our most

vulnerable individuals and communities

• Strong association between obesity and deprivation – particularly

among women and children

Obesity – what’s the cost?

England

• Wider economy - £20bn (lost productivity, sickness, social care,

benefits)

• NHS - £5bn per year

Gloucestershire

• ? Costs to wider economy
• NHS Gloucestershire - estimated costs £149.1 million (NICE,

2010)

Government’s Ambition for Obesity

• By 2020 we aim to see:
• Sustained downward trend in levels of excess weight in children
• Downward trend in the level of excess weight among adults
• Narrow the gap in excess weight among children living in our most

and our least deprived neighbourhoods.

The size of the issue

• England now termed the ‘fat man of Europe’ – over a quarter of

adults obese and 1 in 3 children overweight or obese by age ten

• County obesity rates are similar to national averages
• Adults: 24.7% (24.4% England)
• 4-5 year olds 8.8% (9.4% England)
• 10-11 year olds 17.9% (19.2% England)
• Some signs of levels flattening off among 4-5 year olds
• Based on current trends over half children will be overweight or
• bese by 2020.

‘Wicked Issue’

Obesogenic Settings and Environments

What works in reducing obesity?

• Evidence of effectiveness for a range of interventions:
• Increasing walk- and cycle-ability of environment to help people build

physical activity into their daily lives

• Controlling local availability of / exposure to ‘HFSS’ foods
• School based programmes, targeting children and parents e.g. ↓

sugary drinks and screen time (KS2)

• Targeted individual or family based support to reduce weight.
• Gloucestershire have implemented a range of interventions across

the life course under Healthy Weight Strategies (2001; 2007-17)

Why is a different approach needed?

• Despite almost a decade of intervention - few signs of a decline in

child obesity levels

• By Year 10 > a quarter of children never do any physical activity
• utside school, only 16% eat ‘5 a day’, and > a third want information
• n how to lose weight (Gloucestershire OPS, 2012)
• Delivery of ambitions require a ‘new approach’ (DH, 2011; NICE,

2012)

• A system wide approach: integrated measures to tackle wider

determinants, with some targeted support for those at greatest risk (NICE, 2012)

Learning from one example

• EPODE (Europe) reduced excess weight among 7-9 year olds from

21.9% to 18.3% from 2000-2007

• Long-term approach (> 5 years)
• ‘Everybody’s business’ – multi-sector including private / public

partnerships

• Focus on families (children as intermediaries) in small geographical

areas

• ‘Bottom-up approach’ - sustained community engagement
• Local coordinators working on the ground to mobilise communities,

create connections, support community-led innovation.

Next steps: What might this approach involve?

• First step meeting with SLP Director 6th August 2013
• Propose strategic partnership (Chair: Cllr Dorcas Binns)
• Two pronged-approach:
• System change involving policy, contracts, harnessing contribution
• f existing programmes to deliver coherent obesity prevention

strategy for benefit of population as a whole

• ‘Deep dive’ within relatively small communities at increased risk,

based on sustained engagement , adopting a long term action learning approach.

Some food for thought

• How do we ensure senior level sign up across key organisations and

policy areas – including new partners e.g. business?

• How do we make the most of collective resource – is this an
• pportunity for pooling budgets
• How do we engage meaningfully with our communities?
• How do we help to shift social norms?