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

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 Supporting people in Dorset to lead healthier lives

Cardiovascular Disease Life Course Social status / Lack of Diet: healthy eating, environment physical cholesterol, salt, alcohol (e.g. air activity quality) Angina / Smoking Maternal Heart Attack risk factors, Diabetes / / Stroke Obesity e.g. smoking High BP Birth Death parents childhood adults older age Active transport / access to open GP management Rehab and spaces of diabetes / BP social care Good Hospital antenatal Healthchecks care / GP care and follow up 4

Healthy eating, excess weight and children… 5

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Percentage Prevalence 10% 12% 14% 16% 18% 20% 22% 0% 2% 4% 6% 8% Prevalence of Obesity – year 6 (2007/8 to 2013/14) 18.31% 18.33% 18.70% England 19.04% 19.20% 18.92% 19.1% 14.40% 14.90% 14.00% Dorset 15.26% 15.38% 14.88% 15.2% 17.20% 15.17% 15.88% Bournemouth 17.06% 15.43% 17.34% 15.0% 15.42% 15.52% 13.55% Poole 15.03% 14.25% 14.65% 16.4% 2013/14 2012/13 2011/12 2010/11 2009/10 2008/09 2007/08 7

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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 9

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

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; 11 • Follow up at 12, 24 and 52 weeks.

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 12

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

What is the CCG Role? 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 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

What do we want to improve in Diabetes Care • 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 Supporting people in Dorset to lead healthier lives

What are some of the issues • 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 Supporting people in Dorset to lead healthier lives

What are some of the issues • Enter and exit secondary care services (hospital) • Secondary care delivered more locally • Stronger community / Multidisciplinary approach to care • Patient information more consistent Supporting people in Dorset to lead healthier lives

General Practice • 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 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 Supporting people in Dorset to lead healthier lives