Healthy Eating, Obesity and Diabetes in Dorset Health and Wellbeing - - PowerPoint PPT Presentation

Supporting people in Dorset to lead healthier lives

Healthy Eating, Obesity and Diabetes in Dorset Health and Wellbeing Board – June 2015

Supporting people in Dorset to lead healthier lives

Addressing the mortality gap

Supporting people in Dorset to lead healthier lives

ill health is not inevitable

• Risks can be reduced of developing
• Dementia
• Disability – diabetes, cancer etc
• Frailty
• How – adopting healthier lifestyles

Cardiovascular Disease Life Course

Birth childhood adults

• lder age

parents Death Social status / environment (e.g. air quality) Diet: healthy eating, cholesterol, salt, alcohol Lack of physical activity Smoking Obesity Diabetes / High BP Maternal risk factors, e.g. smoking Angina / Heart Attack / Stroke

Good antenatal care

Hospital / GP care Healthchecks and follow up

Active transport / access to open spaces

GP management

• f diabetes / BP

Rehab and social care

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Healthy eating, excess weight and children…

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Prevalence of Obesity – year 6 (2007/8 to 2013/14)

18.31% 14.40% 17.20% 15.42% 18.33% 14.90% 15.17% 15.52% 18.70% 14.00% 15.88% 13.55% 19.04% 15.26% 17.06% 15.03% 19.20% 15.38% 15.43% 14.25% 18.92% 14.88% 17.34% 14.65% 19.1% 15.2% 15.0% 16.4% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 22% England Dorset Bournemouth Poole Percentage Prevalence

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

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What is effective in preventing obesity in children?

• Majority of interventions in schools
• Lack of studies with preschool children
• Cochrane Review found 55 interventions showed 0.2-0.3kg

weight change

• Lack of evidence of evidence of what works in the long-

term

• Few studies describe costs of scaling up interventions
• Lack of societal policy interventions or research

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Source: 2015 Health Profiles, Public Health England (Active Peoples Survey 2012).

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Responding to adult obesity

LiveWell Dorset:

• Brief interventions and ongoing support for individuals

delivered by a team of Wellness Advisors and Coaches;

• Four pathways: weight management, physical activity, alcohol

and smoking;

• Weight management pathway includes the option of referring

eligible people onto a 12-week weight management intervention (Healthy Choices);

• Physical activity pathway includes brief intervention and

signposting people to local physical activity opportunities;

• Follow up at 12, 24 and 52 weeks.

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The wider role local authorities can play?

• Transport
• Planning and environment
• Leisure and culture
• Parks and green spaces
• Education and learning
• Health and social care
• Housing
• Workplaces

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Supporting people in Dorset to lead healthier lives

Evidence base – Healthy Eating

• 30% of adults meet “5 a day” recommendations;
• Only 16% of boys and 20% of girls meet “5 a day”

recommendations;

• England’s young people consume the most sugary soft drinks in

Europe (40% of 11 to 15 years drink them at least daily);

• Of adults that drink, it is estimated that nearly 10% of their daily

calorie intake comes from alcohol;

• Diet-related diseases accounted for 13% of all EU healthcare

costs in 2009;

• The Trussell Trust (largest UK provider of food banks) reported a

163% increase in the use of emergency food banks in 2014.

Supporting people in Dorset to lead healthier lives

Evidence base – Healthy Eating

• New alcohol licenses consider local health needs and existing

licenses;

• Enforcing minimum unit pricing, preventing illegal alcohol sales;
• Reduce availability of food that contributes to an unhealthy diet –

reduce/limit fast food outlets near schools and workplaces, controls on the sale of ‘street food’;

• Availability of fresh food and vegetables;
• Skilled professionals to deliver behaviour change programmes.

Easier access to a healthier diet

Supporting people in Dorset to lead healthier lives

Help people adopt healthier lifestyles Prevention

• Health checks – find people at risk and support them to consider

more health lifestyles

Delay onset

• Identifying risks and supporting people to manage these risks

Delay and Prevent Complications

• Supporting people with diabetes living more healthy lifestyles
• Working with hospital colleagues when people need more specialist

care

What is the CCG Role?

Supporting people in Dorset to lead healthier lives

General Practice

• What works - Secondary prevention
• Holistic approach to disease management
• Using opportunities to influence lifestyle
• Short consultations do not help this

Main issue is how to shift from managing disease to prevention

Supporting people in Dorset to lead healthier lives

Risk of disease if you have diabetes compared to general population

Dorset Risk England Risk

Stroke

42.2% 34.3%

Heart Attack

61.0% 55.4%

Heart Failure

85.3% 73.7%

Major Amputation

349.1% 221.8%

Primary care is best placed to manage CVD risk.

Supporting people in Dorset to lead healthier lives

• Better appropriate control BP, HbA1c, cholesterol
• Care closer to home, cut the travel
• Improve skills and confidence in primary care
• New model of care in Dorset

Primary Care Led Secondary Care Supported

• Find our diabetics – thought to be 12,000 people
• Spend money for maximum return of investment
• Sustainable services to meet projected doubling in

Type 2 diabetics

What do we want to improve in Diabetes Care

Supporting people in Dorset to lead healthier lives

• 5 community diabetes nursing services – services too small and

fragmented

• Podiatry access is too long for people with foot ulcers, and people

at risk of ulcers are not seen in specialist clinics

• Dietetics services and the education programmes need to expand
• Less outpatients in a hospital- different types of consultations

What are some of the issues

Supporting people in Dorset to lead healthier lives

• Enter and exit secondary care services (hospital)
• Secondary care delivered more locally
• Stronger community / Multidisciplinary approach to care
• Patient information more consistent

What are some of the issues

Supporting people in Dorset to lead healthier lives

• Need more practice nurse time as diabetes numbers grow:
• more skilled and collaborative working across practices
• use information to target patients more
• more confident
• stronger links with community matrons, heart failure specialist

nurses

• Foot care - improvements in foot examination
• Support people to manage their diabetes risks in a more holistic

way

General Practice

Supporting people in Dorset to lead healthier lives

Bariatric Surgery – Where does this fit?

• Requires considerable changes to lifestyle for ever
• Everyone should go through a more intensive weight

management programme – called Tier 3 service

• Referrals to Dorset services very low

Supporting people in Dorset to lead healthier lives

Workshop – Key discussion points

Children and young people:

• Need to recognise the problem; sense of identity
• Habits may need to be broken
• Key age for development between 2 and 4 years
• Long-term approach (and funding) needed
• Relationships that already exist need to be maximised

Supporting people in Dorset to lead healthier lives

Workshop – Key discussion points

Adults:

• Need to create an environment where we promote successful

strategies and measures

• Communication of the key messages is crucial – ‘advertise’

healthy living

• Messages need to be consistent – and can be hard to deliver

Supporting people in Dorset to lead healthier lives

Workshop – Key discussion points

Healthy eating and sustainable food:

• Building community capacity and funding projects is key
• Involve partner agencies to drive home messages about food

content and quality (e.g. Trading Standards)

• Food education such as helping families with cookery skills has

valuable role

• Much is known about needs and problem areas, but not where

activities and projects are: there is a need for mapping