Tackling Childhood Obesity

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Tackling Childhood Obesity

• Using the NICE guidance
• North East Regional Conference
• 3rd May 2007
• Dr Ken Snider

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The guidance

• First whole system NICE guidance, focussing on
  prevention as well as treatment
• Commissioned by DH and Welsh Assembly
• Aims to
• Stem the rising prevalence of obesity and
  associated diseases
• Increase effectiveness of prevention
• Improve the care provided to obese patients
• Limited by scope to age two and above

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Need for the guidance - 1
Overweight (between 85th 95th centiles)
Obese (above 95th centile)
Percent
Durham Dales
Easington
Sedgefield
Hartlepool
Middlesbrough
Redcar
Stockton
North East
England
Cleveland
SHA
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Need for the guidance - 2
Obese (above 95th centile)
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The shape of things to come?
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Conditions associated with obesity

• Children and teenagers
• hypertension
• hyperinsulinaemia
• dyslipidaemia
• type 2 diabetes
• psychosocial dysfunction
• exacerbation of existing conditions
• orthopaedic problems

• Adults
• type 2 diabetes
• coronary heart disease (CHD)
• hypertension
• various cancers
• osteoarthritis

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The guidance - format

• Prevention comprehensive, whole system approach
• Identification Body Mass Index (BMI)
• Assessment algorithms
• Management lifestyle, drugs, surgery as a last
  resort
• Information for the public on prevention and
  treatment

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Who the guidance is for non NHS

• Education sector early years and schools
• Employers
• Local authorities and partners
• Community safety
• Streets and parks
• Urban planning
• Leisure services
• Self help and community settings
• The public

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Who the guidance is for - NHS

• PCTs managers and health professionals
• Primary care including GPs, nurses
• Secondary care - paediatrics, adult medicine,
  dietetics, clinical psychology, etc
• Specialist obesity services incl. surgery

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Monitoring implementation

• Implementation in the NHS will be monitored by
  the Healthcare Commission
• No absolute requirement for implementation in
  other sectors, but authoritative as production
  involved a wide range of stakeholders and content
  was consulted on widely

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Recommendations for local authorities

• Work with local partners to create and manage
  more safe spaces for incidental and planned
  physical activity
• Address as a priority any concerns around safety,
  crime and inclusion
• Provide facilities and schemes such as cycling
  and walking routes, cycle parking, area maps and
  safe play areas
• Make streets cleaner and safer, through measures
  such as traffic calming, congestion charging,
  pedestrian crossings, cycle routes, lighting and
  walking schemes

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Recommendations for local authorities ctd

• All relevant workplace policies should support
  the local obesity strategy
• Work with the local community to identify
  environmental barriers to eating healthily and
  being physically active
• Ensure building designs encourage the use of
  stairs and walkways
• Encourage local shops and caterers to promote
  healthy food and drink choices

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Recommendations for early years settings

• Minimise sedentary activities during play time
• Provide regular opportunities for enjoyable
• active play and structured physical activity
  sessions
• Implement Department for Education and Skills,
  Food
• Standards Agency and Caroline Walker Trust (see
• www.cwt.org.uk) guidance on food procurement and
• healthy catering
• Involve parents and carers

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Recommendations for schools

• Head teachers and chairs of governors, in
  collaboration with parents and pupils, should
• assess the whole school environment
• ensure school policies help children to eat a
• healthy diet, be physically active and maintain
  a healthy weight
• use a whole-school approach to develop life-long
  healthy eating and physical activity
• practices

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Recommendations for schools - ctd

• Ensure school policies and the schools
  environment encourage physical activity and a
  healthy diet
• Teaching, support and catering staff should have
  training on how to implement healthy school
  policies
• Establish links with health professionals

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Recommendations for workplaces

• Ensure policies encourage activity and healthy
  eating
• Provide opportunities for staff to eat a healthy
  diet through promotion of healthy choices in
  restaurants, hospitality, vending machines and
  shops, in line with Food Standards Agency
  guidance

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Self-help, commercial and community settings
should

• help people decide on a realistic healthy target
  weight
• focus on long-term lifestyle changes
• address both diet and activity, and offer a
  variety of approaches
• use a balanced, healthy-eating approach
• offer practical, safe advice about being more
  active
• include some behaviour-change techniques
• recommend and/or provide ongoing support

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Key recommendations for the NHS

• Managers and health professionals in all primary
  care settings should
• ensure that preventing and managing obesity is a
  priority, at both strategic and delivery levels
• dedicate resources for action and training
• consider endorsing self-help, commercial and
  community weight management programmes if they
  follow best practice

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Implementation tools

• Costing tools
• costing report
• costing template
• Guide to useful resources
• Audit criteria
• Available from www.nice.org.uk/CG043

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Costs of implementing the guidance
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Potential savings
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Key implementation issues

• Engaging others to agree relative priority and to
  obtain commitment
• Working in partnership to produce (or review) a
  local action plan and to agree priorities for
  early implementation
• Agreeing and commissioning secondary and tertiary
  care service developments
• Securing the resources
• Providing training

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Some Ps for discussion
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Priorities

• What relative priority should stopping the
  childhood obesity epidemic have?
• What are the current costs in terms of morbidity,
  mortality, economic costs?
• What would the benefits and savings be from
  effective implementation of the guidance?
• What will be the costs of failure?

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Prevention

• We all know that lots is already being done
• Whatever has been done up to now, it hasnt
  worked! (Prof. Peter Littlejohn)
• Do we need a fresh approach?

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What can we learn from fresh?

• Determination and commitment
• A regional priority
• Resourced staff, premises, materials, etc
• Effort from regional to local levels
• Partnership working
• What else?

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People and passion

• Changing the culture popular and organisational
• Knowledge, attitudes, behaviour
• Education, empowerment, environment
• Not just a cosmetic issue obesity is more
  harmful than smoking, heavy drinking or poverty

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Other ponderables

• Partnerships gaining commitment . and
  investment
• Primary care will this guidance help?
• Performance and service development capacity
  and commissioning, training
• Publicity using the media to change the culture
• Probability of success - ?

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What needs to be in place?

• Agreement of relative priority at all levels by
  NHS and partners, with commitment and investment
  i.e. full engagement
• Integrated regional and local action plans with
  agreed priorities, objectives and timescales
• Dedicated resources for prevention, training,
  service development, etc
• An audit cycle to monitor implementation and
  effectiveness
• Surveillance and monitoring
• Relevant research to inform further action

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also

• Commitment
• Determination
• Optimism
• Guile
• Hard work

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Finally
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What about the under twos?

• the risk of obesity starts in the womb and grows
  in infancy

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www.nice.org.uk/CG043