Source: NCMP - Solihull · Web viewThere has been recognition from the WHO that physical inactivity...

Health in Every System

Working Together to Get Solihull to Eat Well and Move More by 2021 through a Whole System Approach

Health in Every System


Contents Page

Page Page

1. Strategy on a page 3

2. Context 4

2.1 National 4

2.2 Local 5

2.3 A Complex Story 6

2.4 A Whole System Approach 8

2.5 Weight Management v Lifestyle Improvement 9

2.6 Issues around Healthy Weight 10

2.7 Priority Groups 12

2.8 Strategies and Policies 14

3. The Challenge in Solihull 15

3.1 Children 16

3.2 Adults 18

4. Likely Returns on Investment 22

5. Services and Assets 23

6. A Life Course Approach 27

7. Opportunities 31

7.1 Schools and Local Authority 31

7.2 NHS 35

7.3 Voluntary sector 36

7.4 Community 36

7.5 Local Businesses and Workplaces 36

8. Behaviour Change 37

8.1 Individual 37

8.2 Organisational and Population 37

9. Outcomes and Tactics 38

9.1 Priorities 38

9.2 What does success look like? 39

9.3 Action Plan 39

10. References 42

11. Glossary 46

12. Appendix 46


1. Strategy on a page

Vision

By working in partnership with a range of stakeholders we will enable the residents of Solihull to feel able to reach their health and wellbeing potential through a whole system approach that tackles poor nutrition and inactivity.

Priorities

Close the gap in health inequalities between the regeneration wards in the north and the affluent south of the borough

Close the gap in health behaviours and levels of obesity in children between the regeneration wards in the north and the affluent south of the borough

How

- Strong leadership

- Effective partnerships

- Asset based approach

- Meaningful community engagement

- Emphasis on prevention

- Integrated solutions covering the life course and tackling the whole system

- Evidence based, cost effective practice and encouragement of innovation

- Evaluation and reflection on practice

Outcomes

Increase in number of people meeting guidelines for being active Increase in number of people consuming 5 portions of fruit and vegetables a day Reduction in prevalence of diseases that are linked to poor diet and inactivity Reduction in health inequalities across the borough in particular the 10 year life

expectancy gap between the north and south of the borough Reduction in the inequality in childhood obesity and health related behaviours between

the regeneration wards in the North of Solihull and the affluent south of the borough Reduction in the predicted trajectory for the rise in overweight and obesity in Solihull

N.B. we are taking the view that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO 1948)

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2. Context

2.1 National

In England, the prevalence of obesity among adults (classified by Body Mass Index (BMI) measurements, see Glossary for definition) rose from 14.9% to 25.6% between 1993 and 2014. Although the rate of increase has slowed down since 2001, the trend is still upwards. The prevalence of overweight has remained broadly stable during this period at between 36–39 % (PHE 2016). The National Child Measurement Programme (NCMP) has also revealed that 28% of children aged between 2 and 15 are classified as overweight or obese (for a definition of BMI and its use in children see Glossary). GP records of children aged 2-15 from 1994 to 2003 showed that the odds of overweight and obesity increased by 8.1% per year compared with 0.4% from 2004 to 2013. This demonstrates that there has also been a sharp increase in childhood obesity and that to some extent the rate is stabilising (Van Jaarsveld and Gulliford 2015).

Sixty nine per cent of the population in England are not eating the minimum 5 pieces of fruit and vegetables a day (National Diet and Nutrition Survey 2011). Diet-related diseases such as type 2 diabetes are on the increase among the general population and even amongst children. The number of people diagnosed with diabetes in the UK has increased by more than 163,000 between 2012 and 2013 (Diabetes UK 2014). Overall, DEFRA estimates that sub-optimal diets cost the UK £20.5 billion annually (DEFRA 2010).

There is also a significant part of the population (66%) not meeting the minimum level of physical activity (HSE 2008) despite a plethora of initiatives and social media promotions to tackle this. There has been recognition from the WHO that physical inactivity is the 4th leading risk factor for global mortality and a key risk factor for non-communicable disease in particular CVD, type 2 diabetes and some cancers.

Preventable disease as a result of sedentary behaviour and unhealthy eating is on the increase in England and expected to continue to do so.

Figure1.Diabetes UK, 2011


Obesity has been associated with a number of conditions such as type 2 diabetes; stroke; some cancers; Coronary Heart Disease (CHD);Muscular-Skeletal problems; osteoarthritis; High Blood Pressure; Gall Bladder Disease and Gallstones; Gout; breathing problems; reproductive problems; poor mental wellbeing; high cholesterol; skin infections; gastric ulcers; constipation; poor oral health; fatigue and poor immunity, infertility, asthma, sleep apnoea, depression, osteoarthritis, hyperlipidaemia and back pain and maternal obesity has been linked to increased risk of congenital abnormalities.

A one per cent shift in the number of people in the UK putting on extra weight each year until 2035, could avoid around 77,000 cases of disease including 45,000 cases of type 2 diabetes in the year 2035 alone (Obesity Health Alliance 2016). A weight loss of even as little as 3% or more of your original body weight, and maintaining this for life, has been shown to significantly reduce your risk of obesity-related complications (NHS 2016). 5-10% weight loss will potentially bring significant health benefits for obese people with corresponding reductions in blood pressure, lipid profiles and blood sugars (Magkos, Faidon et al 2016). However these health benefits have also been attributed to improvements in lifestyle behaviours rather than the weight loss itself. Studies have shown the importance of fitness over weight status in predicting premature mortality (Sui et al 2007).

Research published in the Lancet (2015) shows that 40% of NHS resources are currently spent on illnesses and disease caused by potentially preventable lifestyle factors such as unhealthy eating habits, inactivity, obesity, alcohol and smoking. Diet is now the number one factor driving poor health, even ahead of smoking, causing 10.8% of illness in the UK compared with 10.7% caused by smoking (Fraser et al 2015).

There is a strong relationship between spatial planning and the wider determinants of health (Royal Town Planning Institute 2009). The planning system can shape the built environment and influence human behaviour and lifestyles. Planning can help to: improve access to healthy eating and active lifestyle choices and opportunities by allowing for initiatives such as urban growing it can also promote physical activity by encouraging active travel and improve access to open spaces, sports and recreation facilities (NHS London Healthy Urban Development Unit 2013). Healthy planning can make a healthy lifestyle the easier and most likely choice for the local population.

2.2 Local

Local councils are responsible for working with other organisations to improve the health of people living in their borough. This includes making sure that the right services are in place to meet the health needs of their local community such as services for people classed as overweight or obese. Solihull has a local Health and Wellbeing Board that is tasked with improving the health of the borough and brings together local organisations to help create an environment in which people can make healthier choices.

Solihull borough covers about 11,100 Hectares, more than two thirds of which are green belt and 50% is farmland. It has 1,300 acres of parks and open spaces and is home to around 200,000 people. Solihull is bordered by the mainly rural counties of Warwickshire and Worcestershire, and also by Britain’s second biggest city, Birmingham. Solihull has more than

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4,000 businesses and is the hub of an air, rail and road network which joins every part of the United Kingdom, Europe and the world (Solihull MBC 2008). This gives Solihull great potential with access to a wide range of both health promoting and health limiting opportunities.

However currently in Solihull just as nationally, people are becoming increasingly sedentary and diets are becoming more processed and levels of obesity are increasing. The increase in Solihull is predicted to continue and to be a major contributory factor in premature mortality, disability and health inequalities. There is a higher prevalence of poor diet, inactivity and obesity in the North of Solihull where there are also higher levels of deprivation, but, more importantly, if you live in the north of the borough your health is disproportionately affected by having a higher BMI as you are more likely to be affected by poor health outcomes associated with obesity.

2.3 A Complex Story

In this strategy, we recognise that there is evidence that people with a BMI in the normal range, can also experience poor health related to poor diet and inactivity, and that people with high BMI’s may be eating balanced diets and being very active. There is an epidemic of unhealthy behaviours, and an elevated BMI is the most obvious marker. We need to attack the root cause: the behaviours that are damaging to health.

Lifestyle related disease has been steadily increasing in the UK as a result of social, environmental and technological changes over the last three or four decades. This has led to an increasingly sedentary population where there are reduced opportunities and requirements to engage in physical activity and the population are exposed to sophisticated marketing and easy access to food that is energy dense and nutrient poor.

The new rise in social media especially with ever younger children accessing online content has given uncontrolled opportunities for advertising for global corporations people are bombarded with messages that can be perfectly targeted for specific audiences for maximum impact (American Psychological Association 2016 & BBC 2016)

There is a great deal of discourse around the multifactorial causes of poor diet and inactivity which can lead to obesity, including the Healthy Weight, Healthy Lives: A toolkit for developing local strategies (DH 2008). No intervention in isolation, however effective will be sufficient to create a population that eats a balanced diet and meets physical activity recommendations. Solutions need to be multifaceted, with initiatives across several sectors. Interventions that might have quite small effects when assessed in isolation may still constitute important components of an overall strategy (Gortmaker 2011).

Lifestyle choices and obesity are a consequence of numerous factors. They are a product of a complex system and involve genetics, diet, physical activity levels, the surrounding environment, social and cultural factors. The complexity of the system that supports the development of obesity and behaviours that lead to poor health outcomes were formulated into a systems map of obesity by Foresight in the report Tackling Obesities: Future Choices — Obesity, System Atlas 2007 (see figure 2).


Figure 2.

Certain individuals and communities have an increased risk. There is a higher prevalence of obesity in children and women living in deprived areas; those that belong to a certain ethnic minority i.e. women from black African groups, Caribbean, Pakistani, aged between 45 –74; people with a learning disability; women with a mental health issue. These demographics are also more likely to be eating a poor diet and be less active. There is significant overlap between the issues of obesity, poor nutrition and inactivity.

To tackle obesity, the Government Foresight report (2007) suggested a system-wide approach. This should address everything from the production and promotion of healthy diets, to the redesigning of the built environment to promote walking, together with wider cultural changes to shift societal values around food and activity.

Interventions should be universal including people at every age and regardless of risk factors (Linde and Jeffrey 2010). The Institute of Medicine developed a Systems Approach framework for obesity prevention in the US (Institute of Medicine 2010) proposing a comprehensive plan with integrated actions throughout society; a coordinated approach to communications; interventions across all demographics; use of diverse intervention combining initiatives focused on health promotion; the environment and addressing social norms. They recognise the need for long term plans and highlight that obesity must be considered alongside other societal challenges such as climate change and poverty reduction because of the common causes and solutions.

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This strategy aims to take a whole system approach to increasing and supporting health behaviours associated with obesity across the whole population. This is the most sustainable and effective way of improving the health of the whole population of Solihull.

2.4 A Whole System Approach

This strategy represents a shift in focus towards a more upstream or preventative approach to tackle the causes of poor health outcomes resulting from poor nutrition, excessive calorific intake and inactivity across all weights on the BMI spectrum from those classed as underweight to those classed as obese. This will pave the way for a downward trend in population level overweight and obesity and an increase in overall population health.

The strategy advocates a system wide approach as recommended in the governments Foresight Report (2007), in order to reduce inequalities by tackling the wider social determinants of health and the current environment where eating an unbalanced diet and being inactive are the default options.

A Whole Systems Approach is the most appropriate strategy for tackling complex public health problems such as unhealthy lifestyles and obesity (as depicted by Foresight 2007). The approach needs to be developed around explicit recognition of the systems nature of the causes of unhealthy lifestyles. For example, for people to increase their level of physical activity, they need to have the opportunity to access physical activity such as a bike. Have the capability to ride a bike. There then needs to be a supportive culture and people need to feel that this activity can be carried out safely. At the same time the person needs to be motivated usually by believing the behaviour is going to be beneficial to themselves. In regards to food, people need to see the overall benefit of eating healthily, have access to affordable healthy food that is safe and culturally acceptable.

This strategy aims to incorporate the 10 core features of the Whole System Approach

1. Explicit recognition of the public health system Unhealthy lifestyle behaviours form part of a complex problem that interlinks across

the environment, culture etc.2. Capacity building

E.g. getting people in the community trained up to deliver classes and making use of assets

3. Encouragement of local creativity and /or innovation Help people in the community to find solutions

4. Developing working relationships E.g. developing working relationships and shared goals with the key stakeholders

such as planning 5. Community engagement

E.g. Getting feedback from the communities about what they want and facilitating programmes that are relevant to them

6. Enhancing communication E.g. ensuring that all parts of the system have open dialogue and understand each

other’s position and are working towards the same goals7. Policy and action is embedded


Embedding the system approach into stakeholder’s relevant strategies and policies and ensuring that these are realistic with people being held accountable and clear milestones.

8. Robustness and sustainability To ensure that the approach has its own momentum and the capacity to make

lasting change 9. Facilitative leadership

Commitment to steer the systems approach and lead on it and enable the approach to be developed by other stakeholders

10. Monitoring and evaluation Measuring the progress of the approach and how well aspects are delivering the

intentions

The Australian Assessing Cost Effectiveness (ACE) in Obesity and ACE Prevention studies demonstrated that preventative policy approaches that aim to make changes to the system that is supporting unhealthy lifestyle behaviours generally show greater cost effectiveness than health promotion or clinical interventions (Vos 2010; Carter 2009).

As has been seen with smoking; changing the environment to make healthy choices easier is necessary to support long-term behaviour change. To continue supporting individuals to change their eating and activity behaviours without addressing the obesogenic environment in which they live is futile. Thus working towards changing the environment needs to be at the centre of this strategy.

PHE are working with Leeds Beckett University to support a number of local authorities to implement a Whole System Approach to obesity. Solihull as an associate for the Leeds Beckett University study receives regular updates and will use their findings to inform the implementation of this strategy and action plan.

2.5 Weight Management V Lifestyle Improvement

Nationally, Local Authorities have focused on helping people to achieve a healthy weight through lifestyle interventions such as weight management programmes, but often people who are a healthy weight can also have poor diets and sedentary lives putting them at risk of lifestyle diseases, while people classed as obese can live healthier lifestyles and experience better health.

Traditionally we have diverted resources to people classed as overweight /obese with the interventions funded by the Local Authority on offer only able to provide support to 3.7% of the overweight population who are eligible. We need to refocus our resources to a more upstream approach, recognising that everyone is at risk from poor health as a result of inactivity and poor diet.

Life expectancy rose from 75.9 to 81.3 years between 1990 and 2013. But, over the same period, the total amount of time spent living in ill-health barely changed at all, as chronic diseases have taken grip. Death rates from diabetes fell by 56 per cent, but the number of years lost to disability and illness linked to the condition rose by 75 per cent over the same period.

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In Solihull 6.3% of the population have diagnosed diabetes but it is estimated that 7.7% actually have diabetes and 15% are estimated to have pre diabetes based on health checks data (Reid 2015). Combined this represents 22.7% of the population. Upstream Population Interventions that can impact upon the majority of the population would provide a better approach to help to prevent pre-diabetes developing into diabetes, and prevent more people from becoming at risk of developing diabetes. This is likely to help in reducing inequalities caused by harder to reach populations being unwilling to engage with individual interventions and reduces stigmatisation.

Approaches to reducing population weight until now have relied upon the more downstream approach of diet programs e.g. Weight Watchers, These programmes often change eating behaviour for a short time through diet, motivation and inspiring success stories, but these success stories are atypical. Whilst successful in the short term the programmes do little to permanently change the individuals’ long term weight and healthy relationship with food. The model is more likely to cause weight cycling this has been capitalised by commercial companies whose business models rely on repeat business, with most clients returning for an average of four programme cycles (e.g. Weight Watchers business plan 2001).

Traditional ways of dieting are less likely to improve health outcomes. Increasingly research is demonstrating that weight cycling is potentially more harmful for the body than maintaining a stable higher weight (Brown & Kuk 2015). The process of dieting itself is associated with greater rebound weight gain as it often sets up individuals on a starve-binge cycle (Pietilainen et al 2011). Keeping weight off and dieting is at odds with the body’s evolutionary goal to stay alive. Further, evidence suggests that the apparent health benefits of weight loss are not associated with the weight loss itself, but are more to do with the behaviours undertaken in order to achieve this – improved nutrition and an increase in physical activity (Tomiyama et al 2013) A growing body of evidence suggests that these behaviours have a greater positive impact on health outcomes than the weight loss.

There is also an increasing need to address the psychological aspects of overeating, poor diet and inactive habits long term looking towards more evidence based approaches such as Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) and other evidence based programmes that demonstrate long term health improvement.

2.6 Issues around Healthy Weight

Measuring Health

BMI is generally the measure used to identify whether someone is a healthy weight; however there is concern around the appropriateness of using BMI as a measure of how healthy an individual is. BMI is a measure of weight and height and does not directly measure adiposity, limiting its use for measuring levels of obesity and specifically the health of an individual.

Measuring the waist circumference or waist to hip ratio is another method of estimating the health risks associated with an increase in weight gain (intra-abdominal fat mass). This measure may be more appropriate for Asian communities in particular (See appendix for waist measurements as a predictor of health risk).


Researchers have shown that BMI may not be the best measurement for some people with disabilities. For example, BMI can underestimate the amount of fat in people with spinal cord injuries who may have less lean muscle mass or people with amputated or shorter limbs. This can mean that mean that better accuracy can be gained in measuring a person’s waist where extra fat may be on the body.

Obesity is not implicated in every form of diet-related disease many people with cholesterol-related disease are not classed as overweight and inactive thin people can also be at risk of non-communicable diseases.

Weight Stigma

A number of psychological issues surround the discussion around body size and need to be untangled. High weight is associated with low self-esteem and poor self-concept and body image. Around 60% of people considered obese have depression.

Studies have shown that people who are considered overweight/obese are frequently stigmatised in industrialised societies such as the UK, and they emphasise the importance of family and peer attitudes in producing psychological distress, this particularly affects overweight/obese children (Lobstein et al 2004). Parents own food issues can be passed on and create food issues (such as Binge Eating, Bulimia, Anorexia or body image) in children and affect the child’s subsequent relationship with food.

From a young age, parents have a huge impact on their children’s relationship with food, including seeing food as a reward (e.g. sweets and chocolates) and also seeing it as something negative (e.g. some vegetables). Seeking weight management treatment can make children feel that there is something wrong with them, triggering emotional problems (Braet et al 1997). This can have a massive impact on their learning and lead to both bullying and subsequently, internalisation of the bullying.

People come in a variety of shapes and sizes. Moving the focus away from individual weight will have other population-wide benefits. For example, previous public health interventions can foster an increase in weight stigma. Stigma in itself has been shown to increase the risk of heart disease, diabetes, hypertension, and mental health issues, independent of BMI. Obese persons experience a high degree of stress, and this stress could be what is driving some of the BMI-health association (Muennig 2008). We can reduce the burden of stigma and the associated health outcomes by promoting and accepting size diversity and focusing on population based health promotion messages.

Eating Disorders

The so called War on Obesity (regularly cited by the UK media) has seen some casualties including a rise in the development of eating disorders in ever younger children and in newer demographics (men and lower socio-economic status). Anorexia has the highest fatality rate of any mental health condition, and the impact of public health interventions on this outcome is often overlooked.

Figures from the Health and Social Care Information Centre have shown a rise of 8% in the number of hospital admissions for eating disorders in the 12 months to October 2013. Development of an eating disorder is extremely complex and doesn’t just include one factor but may be a whole host of reasons. One of these factors is the pressure of society which is

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affecting a wider range of individuals (PWC 2015). A report from BEAT in 2012 on the Cost of Eating Disorders estimated a total cost of £500million to the healthcare system for the treatment of eating disorders. This could be reduced by pushing early detection, treatment and prevention.

The SCOFF screening tool (see appendix) was developed to indicate a possible eating disorder. Dieting has been associated with the development of eating disorders (Haines & Neumark-Sztainer 2006) and it is essential that we monitor for possible negative impacts of any intervention.

2.7 Priority Groups

Reducing the prevalence of childhood obesity is a high priority in Solihull in particular the regeneration wards. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. It is essential to create environments where children can flourish and are facilitated to choose to be active and eat food that is nutritious.

Some groups of people in Solihull are at greater risk of developing poor diets and being inactive and as a consequence are highly likely to become overweight and suffer poorer health outcomes. There is a relationship between poor health outcomes and stigma and marginalisation, often experienced by these priority groups which create barriers to access to health. These groups will be a priority for the implementation of this strategy to reduce inequalities in health in Solihull.

Learning Disabilities

People with learning disabilities are much more likely to be underweight or overweight /obese than the general population (Emerson 2010). It has been suggested that over 60% of people with learning disabilities are classified as overweight or obese (Marshall 2003). Women, people with Down’s Syndrome, people of higher ability and people living in less restrictive environments are at increased risk of obesity (Melville 2007).

There are a variety of reasons why people with learning disabilities are more susceptible to obesity (BDA 2011) including:-

Increased dependence on others for food, drink and activity opportunities Reduced ability or opportunity to make informed choices Reduced skills and ability to understand and apply healthy messages Lower income and poorer budgeting skills Social isolation or exclusion

People with profound or multiple learning disabilities are totally dependent on carers who may not have the knowledge and skills to provide a balanced diet for clients (Melville 2009).

Mental health

Physical and mental health are closely linked – people with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier than other people – one of the


greatest health inequalities in England. Two thirds of these deaths are from avoidable physical illnesses, including heart disease and cancer (Mental Health Taskforce 2016).

There is a bidirectional association between obesity and mental health (NOO 2011). Obese people have a 55% increased risk of developing depression over time, whereas people with depression have a 58% increased risk of becoming obese (Luppino 2010). There are a number of mechanisms that contribute towards the relationship between mental health and obesity these include social factors e.g. stigma, behavioural factors e.g. diet, Biological factors e.g. medication and psychological factors e.g. low self-esteem (NOO 2011).

People with physical disabilities

Obesity in people with physical disabilities is generally associated with reduced mobility. As obesity increases, mobility is further affected. Obesity is associated with the most prevalent disabling conditions in the UK including arthritis and back pain.

People with physical disabilities can find it more difficult to always eat healthy, control their weight, and be physically active. This might be due to:

A lack of healthy food choices. Difficulty with chewing or swallowing food, or with the taste or texture of foods. Medications that can contribute to weight gain, weight loss, and changes in appetite. Physical limitations that can reduce a person’s ability to exercise. Pain. A lack of energy. A lack of accessible environments (for example, sidewalks, parks, and exercise

equipment) that can enable exercise. A lack of resources (for example, money; transportation; and social support from

family, friends, neighbours, and community members).

http://www.noo.org.uk/uploads/doc/vid_18474_obesity_dis.pdf

Ethnic Minorities

There is no clear relationship between ethnicity and obesity prevalence in the UK and data sources are limited. Data from Health Survey for England (HSE 2004) suggests black African and Caribbean’s have the highest obesity levels. What is clear is that individuals of Asian origin, particularly South Asians have a greater risk of metabolic syndrome and its consequences at a lower BMI than other ethnic groups. For this reason obesity within the South Asian community is a concern.

Reception aged children from Indian and mixed ethnic groups have similar prevalence of obesity to white ethnic groups. Obesity prevalence among boys in reception is highest in the black African, Bangladeshi, and black other groups. For girls in reception obesity prevalence is highest among those from Black African, and Black other ethnic groups (HSCIC 2016).

Boys in Year 6 from all minority ethnic groups are more likely to be obese than white British boys, with boys of Bangladeshi ethnicity having the highest prevalence. For girls in Year 6, obesity prevalence is high for children from black Caribbean, black African and black other ethnic groups (HSCIC 2016).

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Older adults

Increasing age is associated with increasing prevalence of obesity. In Solihull 19.2% of the population are over 65 (n= 39,800). The aging process results in a loss of lean body mass. This can be masked in obese older adults by excess fat. The combination of reduced lean body mass and obesity can result in obese older adults becoming increasingly frail and immobile and at risk of falls. As activity levels decrease weight gain may exacerbate. Obesity can also mask malnutrition if the quality of the diet is poor.

Smokers and ex-smokers

Individuals who smoke often gain weight when they stop smoking as nicotine speeds up the metabolic rate and smoking has been cited as a method of weight control especially in young girls.

2.8 Strategies and Policies

There has been a plethora of strategies, policies and documents related to helping the UK to tackle obesity, poor diets and physical activity that have recently been published from national bodies and the government and these have been used to inform this strategy (See national policy context below).

The Healthy Weight Strategic Board have also been working with a variety of departments within the council looking for where our work streams complement and overlap one another to incorporate a number of other policies and strategies looking at how we can integrate other agendas for example we are working with Solihull Active building in the Physical Activity and Sports Strategy, Transport and Planning looking at active travel and education, Working with Parks and Open Spaces looking at tenders for ice cream vans and better utilisation of our parks and open spaces for being active.

National Policy Context

Obesity is linked to a large number of Long Term Conditions and is affected by a number of systems and there are an extensive list of guidance, reports, policies and strategies nationally that cite obesity related to its effects and prevention. We have listed a selection of key documents in the appendix. Including how we aim to utilise them through the implementation of the strategy.

Some prevention initiatives require intervention at National and International level such as food labelling or product re-formulation legislation and taxation. This strategy focuses on what is possible on a borough wide level and the implementation of national strategies where appropriate.

Linked Local Strategies and Policies

As part of our joined up approach we will be working with the authors of and teams responsible for the following strategies to support the implementation and will be utilising them


to enable us to take a whole system approach to putting health into every aspect of the lives of people that are living in the Solihull borough.

Solihull MBC Sustainable Modes of Travel Strategy 2013-2016 – This strategy looks at how we can increase levels of physical activity in the borough by increasing active transport.

Focus on Food - Solihull Food Strategy & Action Plan 2015 – 2017 – This strategy uses a whole system style approach and asset based approach to tackle the food system including improving access to healthy food to improve the diet of the population of Solihull.

Health and Wellbeing Strategy – The healthy weight strategy feeds into this strategy and the objectives are interrelated.

Joint Strategic Needs Assessment – This document has been used to inform the objectives of this strategy and the priority groups.

Making Every Contact Count in Solihull Strategy 2013–15 – This strategy forms part of the behaviour change approach for the Healthy Weight strategy and ensures that we are promoting the same messages.

A Community Sports Strategy for Solihull – This strategy provides a plan to get more people involved in sports as recreation in Solihull.

Green Spaces Strategy – This ensures that we maintain the green spaces in Solihull, essential to provide an environment that is health promoting

Physical Activity Strategy 2014 – 2020 – This strategy and its priorities feed into and compliments the priorities of this strategy. It aims to increase the levels of physical activity in Solihull and decrease inactivity.

Emotional Wellbeing and Mental Health Strategy – People with mental health issues are a key priority in this strategy

Behaviour change 2016 – We will be using this strategy to take a COM-BI approach to achieving the behaviour change objectives that will help us to meet the priorities of the strategy

Alcohol Strategy 2016 – There are some interrelated priorities between this strategy and the healthy weight strategy

Improving school readiness creating a better start for the West Midlands – School readiness is defined as; well-nourished and within normal weight for height, having motor control and balance for a range of physical activities. School improvement will be working with us to attain this for children in Solihull

Parenting Strategy 2016-19 – This strategy will look at enabling more parents to breastfeed for longer and helping children to reach their health and achievement potential

3 The challenge in Solihull

Solihull tracks either below or in line with the England average when it comes to prevalence of overweight and obesity. However the borough is divided with the regeneration areas in the North presenting lower prevalence of healthy lifestyle behaviours and higher prevalence of obesity both for children and adults and the affluent south presenting with higher levels of healthy lifestyle behaviours and much lower levels of both obesity and related chronic conditions.

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3.1 Children The 2014 Health Related Behaviour Questionnaire demonstrated that the number of children eating five portions of fruit and vegetables and the number of children meeting guidelines on physical activity are declining. Activity levels further decline as children move into adolescence, this is particularly true of girls (Year 10 girls report the lowest levels of exercise of any group).

For three out of the last four years Solihull has been significantly lower than the national average on obesity in reception year. In the last year, for which measurements are available, Solihull’s rate (19.1%) was the second lowest among our statistical neighbours.

Excess weight – Reception Year

Source: National Child Measurement Programme (NCMP) Source: NCMP

Excess weight – Year 6

Solihull’s prevalence of excess weight at year 6 continues at just below 30%. Again this is significantly lower than the national average and is similar to statistical neighbours.

Figure 46: Trend for excess weight in reception year (2014/15)

Figure 47: Excess weight in reception year (2014/15) – statistical neighbours

Figure 48: Trend for excess weight in year 6 (2014/15)

Figure 49: Excess weight in year 6 2014/15 – statistical neighbours


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

2012/13

2013/14

2014/150

10203040

Solihull England

Cheshire West and Chester

SOLIHULL

Stockport

ENGLAND

0 5 10 15 20 25 30 35proportion (%)

Source: NCMP Source: NCMP

Inequalities within Solihull

There is a strong relationship between deprivation and childhood obesity, such that nationally, obesity prevalence of the most deprived 10% of the population is approximately twice that of the least deprived 10% Data from Public Health England also shows that socioeconomic inequalities in obesity prevalence have widened over the years (2006-2014).

Source: NCMP Source: NCMP

The maps above highlight the extent to which there is inequality in excess weight in children across Solihull and demonstrates the link with socio-economic deprivation and excess weight. (NOTE: primary schools are indicated by purple pins on these maps).

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% pupils with excess weight11.5 -18.218.2 – 24.924.9 -31.631.6 – 38.338.3 - 45

Reception excess weight

% pupils with excess weight11 - 18.218.2 – 24.9 24.9 – 31.631.6 – 38.338.3 - 45

Year 6 excess weight by MSOA 2011-14

Key points

Solihull has less overweight and obese children than the England average: however childhood obesity is a nationwide phenomenon and rates show no sign of reducing.

The NCMP data in Solihull between 2009 and 2014 demonstrates that there is a significant upward increase in obesity prevalence in the regeneration areas and that a genuine gap between the regeneration wards and non-regeneration wards exists and is greater in year 6.

3.2 Adults

Solihull has a relatively old and rapidly ageing population. 43,300 people are aged 65+ (21% of population compared to England average of 18%). Excess weight tends to accumulate through the life course with the 55-65 age group being the most affected. The population in the north of the borough are younger and have higher levels of obesity. This means that the rates of obesity in the north are likely to increase as the population ages.

At the time of the 2011 Census, 24% of Solihull residents aged 65+ said that their day to day activities were limited a lot by a long term health problem or disability, (34% North Solihull), with this rising to 52% of those aged 85+ (60% North Solihull). Long term health problems and disability increase levels of inactivity often leading to increased levels of excess weight.

Adult obesity is modelled to be 24.9% with levels of excess weight reaching 64.4% (total of obesity plus overweight) this is similar to the National average (24.1% and 64.6% respectively), Solihull has a population of 206,700 and this means that 45,908 individuals are estimated to be obese. Distribution of obesity is uneven across the borough with those from deprived wards in the north most affected (see figure1).


Figure 1 Percentage of obese adults in Solihull (Source ONS)

This uneven distribution is also reflected in healthy lifestyle behaviours such as with the percentage of people eating 5 portions of fruit and vegetables a day. The percentage of people eating 5 portions of fruit and vegetables is as low as 17% in some wards in the north of the borough and as high as 38.7% in some wards in the south of the borough (see figure 2). This also highlights that the majority of people even in the more affluent wards are not meeting the governments recommended minimum dietary guidelines.

Figure 2 Percentage of Adults in Solihull eating 5 or more portions of fruit and vegetables 2006 - 2008 (source ONS)

Heart disease, stroke and cancer are the major causes of premature death; levels in Solihull all three have all been associated with lifestyle behaviours (particularly smoking, poor diet and lack of physical activity) and excess weight. The Health Impact of Physical Inactivity (HIPI)

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18-20.8%

20.8-24.7%

24.7-27.9%

27.9-30.8%

30.8-33.4%

estimated that of the 422 cases in 2010 of people that went to Emergency Hospital with CHD 47 would have been prevented if the population was more active.

As well as contending with higher rates of obesity, if you live in the north of the borough your health is disproportionately affected by having a higher BMI as you are more likely to be affected by poor health outcomes that are associated with obesity such as CHD (see figure 3). There is a life expectancy gap of up to 10 years between the most deprived and the most affluent wards.

Figure 3 Elective hospital admissions Chronic Heart Disease 2006-11 (Source ONS)

The prevalence of lifestyle related diseases such as type 2 diabetes is increasing (currently at 6.2%) at a faster rate than other life style related illnesses. The HIPI estimated that of the 8933 type 2 diabetes diagnosis in 2010, 1205 could have been prevented by increased levels of physical activity.

Figure 4: Disease Prevalence (Source: Quality and Outcomes Framework)


Solihull’s level of excess weight of 64.4 puts it towards the higher end when compared with our statistical neighbours. This means that we are below where we would be expected to be when looking at our demographics and level of affluence.

Figure 5: Excess Weight in Adults – Similar Statistical Neighbours (Source: Active People Survey2012-14 Sport England)

Solihull faces several challenges that can be considered barriers to residents enjoying healthy lifestyles. These include:

Limited access to essential services and public transport in rural areas Poor access in North Solihull for walking and cycling to local services, facilities. Physical, behavioural and perceptual barriers to more sustainable forms of transport

(which also have beneficial health and wellbeing impacts) such as walking, cycling and buses

Continued development pressure on the green belt and mature suburbs of south Solihull

A significant proportion of respondents to the borough wide Place Survey considered increasing activities for young people a priority in their local area

4 Likely Returns on Investment

Estimates suggest obesity cost the NHS £5.1 billion in 2006/07, including obesity medication, the increasing use of bariatric surgery and new equipment to accommodate larger people. This is more than the £3.3 billion attributed to smoking related ill health and £3.3 billion attributed to alcohol related ill health.

Diseases relating to overweight and obesity currently cost the NHS in Solihull around £66m each year. Including costs such as lost earnings due to premature mortality or sickness, as a result of obesity, the total cost to Solihull each year is expected to be over half a billion pounds (Foresight 2007).

Work in progress in PHE initially suggests that severely obese people are over 3 times more likely to need formal social care than those who are a healthy weight, resulting in increased risk of hospitalisation and associated health and social care costs. Social care requirements

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for very obese people are costly and include housing adaptations and carer provision and amounts to a further £352 million in extra hours of help (PHE 2016a).

Obesity is associated with a number of long term conditions that place a significant burden on the social care system (Kings Fund 2012) i.e.

Mental health problems Liver disease Type 2 diabetes, Cardiovascular disease, Muscular skeletal disease, Some cancers, Respiratory disease.

Employment and Productivity

Obesity can impact on the workplace. People classed as obese are frequently the victims of prejudice and discrimination. There is evidence that they are likely to take more short and long term sickness absence than workers of a healthy weight. For an organisation employing 1000 people, this could equate to more than £126,000 a year in lost productivity due to a range of issues including back problems and sleep apnoea (PHE 2016b).

Childhood obesity and Mental Health

There are conflicting views on the association between obesity and depression or low self-esteem in children. However, there is strong evidence to suggest that by adolescence, there is increased risk of low self-regard and impaired quality of life in obese individuals. Factors associated with mental health problems in obese children include lower levels of physical activity, low self esteem, body dissatisfaction, eating disorders and weight-based teasing. Recent findings from the Millennium Cohort Study suggest that childhood obesity may be associated with emotional and behavioural problems from a very young age, with obese boys at particular risk (PHE 2016c).

Attainment and Achievement

Some relationship has been found between obesity and lower educational attainment but a systematic review has found that this is mostly attributable to stigmatisation, bullying, low self-esteem and young people’s exclusion from opportunities for social interaction (Caird et al 2011).

5 Services and Assets

N.B. Clinical interventions aimed at people with severe obesity such as bariatric surgery are out of scope for this strategy. For more on this see the report Commissioning Proposal for Future Commissioning of Morbid Obesity Services (for Adults).

Solihull Childhood Programmes


Programme Primary aim Activities Age group ProviderSolihull Healthy Schools

Support and improve the health and wellbeing of all pupils and staff in Solihull schools

Whole school approach through the themes of Food Physical Activity, PSHE, Emotional Health and Wellbeing through: Environment, curriculum and policies

School age School led, supported by Public Health and Learning and Achievement

Eat Well Move More

Family weight management Education on healthy eating, physical activity and mental wellbeing

4-11y (?16y) with BMI>91 centile

Solihull Active Team

NCMP Mandatory, monitoring Measuring BMI 4/5, 10/11y School nurses

Food 4 Life To improve the diet of children

Catering, GardeningFeeding

School age Solihull Catering

Walk SmartIncrease the number of children walking to school

Targeted pedestrian training Year 2 Safe and Active Travel team

ScootabilityIncrease skills and awareness of courtesy to pedestrians when scooting to school

Scooter training Primary Safe and Active Travel team

BikeabilityIncrease cycling to school and recreation

Level 2 cycle trainingLevel 3 cycle training

Years 5,6Secondary

Safe and Active Travel team

Bike It

To increase number of children travelling to and from school by bike or walking

Physical activityActive travelTeach children to cycle

Primary Schools


On the MoveIncrease awareness of benefits of active travel

Workshops Year 6 Safe and Active Travel team

Modeshift Stars

increase levels of sustainable and active travel to improve the health and well-being of children and young people.

Physical acidityActive travel

School age Safe and Active Travel team

Frame Academy

Teach students how to repair and rebuild bicycles. Students keep the bike they to encourage active transport

Workshops Secondary school


GCSE Physical Education

Increase use of cycling as active transport

Delivery of modules in either road biking or mountain biking that contribute to the award of the GCSE in PE.

Secondary school


Cook ItTeach families to cook meals from scratch.

CookingDiet

Families in the North

Northern Star,

Eco Schools Allotments

Increase the number of schools that are growing food on site. Teach children about sustainability

GrowingSustainability

School Age Policy and Spatial Planning

Meriden Park Adventure playground

Increase opportunities for supervised outdoor play. Reduce inequalities through providing food.

Physical activityCookingMental wellbeing

Up to age 14 Youth Services

Holiday Kitchen

To provide food and activities during the summer holidays

Access to nutritious food Primary School

Ashram Housing

Parenting To enable parents/carers to Parenting Courses Pregnancy Barnardo’s

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be effective and engaged caregivers via access to advice, parenting education and peer support.

to 19 co-ordinate parenting courses through Solar

School Nurses

To improve the health and wellbeing of children and young people

Working across education and health, providing a link between school, home and the community.

Age 5 to 19. Heart of England NHS Foundation Trust

Health Visiting

Assess health needs of individuals, families and the wider community. Promote good health and prevent illness

Development checks and guidance and support for families with greater level of need.

Pregnancy to 5

Heart of England NHS Foundation Trust

Family Nurse Partnership

Provide health visiting for client families enabling; healthy pregnancy, Improved child health and development and mothers to plan futures and achieve aspirations.

Intense voluntary home visiting programme for first time young mums

Pregnant mums aged 19 and under to age 2


Healthy Start

FREE vitamins for EVERY pregnant and breastfeeding mum in Solihull and a national voucher scheme for money off fruit, vegetables, milk, infant formula milk and free vitamins for children in families on low income.

VouchersFree vitamins (Folic Acid, C and D) for all pregnant and breastfeeding mumsVitamins (A,C and D) for children in families on low income

Vitamins: Pregnancy to 12 monthVouchers: Pregnancy to child’s 4th birthday

Public Health

Infant Feeding Support Service

Support women to breastfeed for as long as they wish to and support parents in all aspects of infant feeding

Breastfeeding cafes, Specialist clinics, Peer Support, Breast pump loan, Online/mobile phone app support, training

Pregnancy to 12 months


Solihull Community Programmes

Programme Primary aim Activities ProviderSolihull Girls Can

Increase participation of girls in sports and PA

Promotional campaign Solihull Active

Business Travel Planning

Work with local employers to produce initiatives and promotions that encourage staff to use active transport

Create travel plans for businesses


Bike Hubs Teach residents to ride bikes, increase confidence and build skills

Range of cycling activities and free use of bikes.


Leisure services and activities

Increase participation of residents in being active.

Leisure Activities,Social media

Parkwood LeisureSolihull active

Health HubsIncrease opportunities for community to access health advice and signpost to services

Advice, Signposting You plus, Health Exchange, Libraries

Cookery Courses

Increase cooking skills in Solihull Practical Education Gateway family service

Weight Management

Enable people to make healthy lifestyle changes and reduce BMI

Education, and behaviour change techniques

Gateway family services, Man v fat

Health trainers Enable people to make healthy lifestyle changes

Education and behaviour change techniques

Health exchange

Doc Spot Support inactive people with Physical activity Parkwood Leisure


conditions to increase their level of activity

Social Prescribing

Support people to increase their levels of activity and reduce social isolation

Support and Behaviour change Health Exchange

Growing schemes

Increase physical activity, wellbeing and intake of fruit and vegetables

Food growing and wildlife gardens

Gro Organic and Warwickshire Wildlife Trust

Outdoor Gyms Increase access to physical activity opportunities

Physical activity Parks and Open Spaces

Cycle networks

Increase safe access to sustainable transport opportunities

Access to facilities Planning, Safe and Active Travel, Solihull Active, Parks and Open Spaces

Hot food take away support

Improve healthy options available in hot food takeaways

Access to healthy food Food safety

Parks and recreation

Increase access to physical activity opportunities

Access to opportunities to be active

Parks and Open spaces

Football pitches Increase access to physical activity opportunities


Parks and open spaces

Tennis Courts Increase access to physical activity opportunities



Basketball courts

Increase access to physical activity opportunities



Pitch and Putt Increase access to physical activity opportunities



Allotments Increase access to physical activity and food growing opportunities

Access to opportunities to be active and fresh food


NHS Health checks

Screening to prevent diabetes, heart disease, kidney disease, stroke and dementia

Screening Health Exchange

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Solihull Healthy Weight Services 2016


6. A Life Course Approach

Any action to tackle unhealthy lifestyle behaviours needs to take a life course approach. The evidence to date indicates a number of points in the life course where there may be specific opportunities to influence behaviour. These relate to critical periods of metabolic change (e.g. early life, pregnancy and menopause), times linked to spontaneous changes in behaviour (e.g. leaving home, or becoming a parent), or periods of significant shifts in attitudes (e.g. peer group influences, or diagnosis of ill health) (Foresight 2007).

Table Critical opportunities in the life course to influence behaviour

Pre-conception to conception

NICE (2008) guidance on improving the nutrition of pregnant and breastfeeding mothers and children estimates that up to 50% of pregnancies are likely to be unplanned, Promotion needs to start early. We need to promote the benefits of a healthy lifestyle to young women and

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those who are trying to conceive. Social marketing and education directed at promoting the importance of a healthy diet and being active for women who are – or who plan to become – pregnant are likely to have the greatest effect if delivered before conception and during the first 12 weeks.

Obesity in pregnancy has been associated with increases in childhood obesity and infant mortality as well as impacting on the mother’s immediate (complications of pregnancy) and future health (see figure …). Obese pregnant women have a twofold risk of stillbirth (CEMACH dataset 2006 26% of stillbirths, mother BMI > 30) and a twofold increase in risk of neonatal death.

The majority of future parents do little or nothing to prepare for pregnancy. A high proportion of women have an unhealthy lifestyle before pregnancy, with poor diet, low levels of physical activity, smoking, excessive alcohol consumption etc. There is evidence that early signs of cardio metabolic risk in children are related to their mother’s nutrition in pregnancy and a healthy diet in the mother can have beneficial effects on childhood cardiovascular function. Inadequate food intake and low maternal weight are linked to low birth weight, as is micronutrient deficiency, especially of foliate.

There is evidence that maternal obesity is related to health inequalities, particularly socioeconomic deprivation, inequalities within minority ethnic groups and poor access to maternity services (Heslehurst et al 2007).

Women should know how important it is to enter a pregnancy already eating a healthy diet (e.g. eating fruit or vegetables at least three times each day), being physically active and in


good mental health and avoiding harmful substances (e.g. smoking in pregnancy, which is associated with obesity in childhood).

Potential parents frequently come into contact with services, e.g. buying a fertility or pregnancy test from a community pharmacy, attending a community contraceptive service for removal of a contraceptive device or implant, or visiting their GP or early pregnancy unit after miscarriage. These present ideal opportunities for pre-conception health interventions, such as giving simple written information, advice and supplies (e.g. folic acid and vitamin supplementation) or access to mobile health platforms to promote pre-conception health, but these are frequently missed. Further opportunities present after a baby is born such as baby checks for infants or pre-nursery children, when about one in five mothers are likely to be planning another pregnancy (Davies 2015).

Birth

The World Health Organization and the Department of Health recommend exclusive breastfeeding for the first six months of an infant’s life. Evidence suggests that mothers who breastfeed provide their child with protection against excess weight in later life (Horta et al 2007). For the mother, there is evidence to suggest that breastfeeding increases the likelihood of returning to their pre-pregnancy weight (Dewey et al 1993). We need to identify and work better with people at risk of not breastfeeding. NICE have provided a set of recommendations for health professionals on how to help parents and carers provide a healthy, balanced diet for babies and young children (NICE Q598 Maternal and Child Nutrition 2015).

Early years

Ensuring healthy growth and implanting healthy lifestyle behaviours from a young age is essential to prevent the development of lifestyle related illnesses later in life (DH 2008). The pre-school years are an ideal time to establish the foundation for a healthy lifestyle. Parents are primarily responsible for their child’s nutrition and activity during these years, but childcare providers including schools also play an important role. NICE and the Caroline Walker Trust provide guidelines for those providing food for children under 5 to encourage healthy eating from an early age (Crawley 2006).

Providing healthy, balanced and nutritious meals, controlling portion sizes and limiting snacking on foods high in fat and sugar in the early years can all help children to grow healthy bodies and develop healthy lifestyle habits. Childcare settings should also encourage regular opportunities for enjoyable active play and structured physical activity sessions, children must be supported in developing an understanding of the importance of physical activity (DCSF 2008).

Increasingly younger children are exposed to higher levels of screen time as games are designed and marketed for younger children, studies show that the more television infants and toddlers are exposed to, the more likely they are to be inactive and obese (Hancox &Poulton 2006) and have difficulty sleeping (Thompson & Christakis 2005).

School years

During their school years, children develop life-long patterns of behaviour that affect their ability to maintain health. Schools play an important role in this by providing opportunities for

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children to be active and to develop healthy eating habits. NICE recommends that schools assess the whole-school environment and ensure that the ethos of all school policies help children and young people to develop healthy lifestyles, eat a healthy diet and be physically active, in line with existing standards and guidance. This includes policies relating to building layout and recreational spaces, catering (including vending machines) and the food and drink children bring into school, the taught curriculum (including PE), school travel plans and provision for cycling, (NICE CG 43 2006). Schools are an important part of the health promoting system so investment to ensure that all schools provide a healthy environment is an essential strategy. It is also important to work with the whole family, not just the child especially younger children, who are mostly influenced by their parents and often do not make their own decisions about what they eat.

The PHE Change4Life Social Marketing programme has been very successful and is widely recognised. Solihull MBC makes use of the branding for Change4Life when designing media content particularly for this age group.

Young Adulthood 16 – 30

Young adults are at a significant risk of being overweight and obese as they transition to independence, working, marriage and parenthood which can all lead to weight gain (Musingarimi 2008). Focusing health promotion in this age group is essential as these are the future parents; their health and lifestyle behaviours will have an impact on their children.

48% of 16–24 year olds use fitness apps on a regular basis, with only 12% using the internet to search for healthy living information (HSCIC 2015). Interventions for this age group need to offer positive messages looking at increasing physical activity, improving diet and reducing sedentary time, as opposed to negative messaging about risk.

Middle Adulthood 30 – 50

Many women are now choosing to have babies later in life so much of the preconception to conception section applies here.

Currently 42% of adults in midlife (40 – 60) are living with at least one long-term health condition and the NHS spends a minimum of £11bn a year on treating preventable illnesses caused by the effects of diet, inactivity, smoking and drinking alcohol. The burden of these conditions and diseases does not fall evenly. Those from more deprived backgrounds have a lower life expectancy and spend more years in ill health than those from less deprived backgrounds. A lot of this is because they are more likely to demonstrate unhealthy behaviours in midlife (PHE 2016d).

Middle adulthood is also a critical time in the preventative reduction of risk factors. There is evidence to suggest that if weight gain is avoided in early adulthood the risk for CVD may be reduced. Within this age group the proportion of individuals who are obese or overweight increases significantly. Perception of risks of ill health as a result of being obese or overweight may be more realistic as ill health consequences are likely to be perceived as being proximal. In this life stage, individuals are likely to know colleagues or friends of their age who may undergo adverse health events such as heart attacks. A key life stage event in this age group is the end of dependent parenthood. This may result in more time to be physically active and opportunities for uptake of physical activity interventions may increase (Musingarimi 2008).


The PHE One You Social Marketing programme targets the 40 – 60 year old age group but has been effective at engaging many people over 18 and is widely recognised. Solihull MBC makes use of the branding for One You when designing media content particularly for this age group.

Later Life 50 and over

There are a growing number of older people who are overweight or obese. This is a result of more people reaching old age already overweight and the increase in the aging population. In old age, obesity is associated with increased morbidity which impacts on quality of life. It can exacerbate the age-related decline in physical function and lead to frailty.

Late in life many individuals are resigned to the fact that as one gets older ‘their metabolism slows down’ and so being obese/overweight is often perceived as being a part of the aging process. Retirement from paid employment is a key life transition people find they have more time to be physically active, but may need more support in order to do so. Physical activity is important in this age group as aging can lead to increased risk of falling. Exercise and a healthy diet, can lead to improvements in quality of life and also to improvements in vasomotor symptoms.

Treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing BMI and the concern that weight loss could have potential harmful effects in the older population. However, there is evidence that increasing physical activity and improving diet improves physical function, quality of life, and medical complications (Musingarimi, 2008),

For women in particular healthy behaviours such as eating healthily and participating in regular physical activity improves women’s experience of the menopause, The menopause is a time when women frequently seek advice from their doctors. It is also arguably an important opportunity to encourage positive health-related behaviours such as stress reduction, smoking cessation, dietary intake and increasing physical activity. Such changes might benefit women going through the menopause transition as well as offer prevention of longer-term health problems. Targeting women at 40 or 45 in preparation for the menopause has been advocated (Davies 2015),

7. Opportunities

To create a healthier environment in Solihull we must work at many levels to ensure the whole system is engaged including all sectors and partners and the community. This will allow us to find shared goals and work together to have a bigger impact on achieving these goals. We need to capitalise on the partners already engaged with us and seek out new partnerships that will further the work of this strategy.

7.1 Local Authority including Schools

A local review of Public Health commissioned Weight Management Services and initiatives in Solihull in 2012 recommended a number of specific actions including:-

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Mapping to identify actions, potential actions, commitment and resources across all relevant sectors, to build a system wide approach (we are now working with several sectors collaboratively exploring actions and initiatives to tackle obesity through the healthy weight steering group)

Obesity should be a standing agenda item on key topics: Planning, Transport, Housing, Financial Inclusion, Libraries, Education, Social Care, Leisure Services and Early Help.

Elected members and council leaders should raise the profile of healthy lifestyle promotion initiatives through informal meetings with local people and groups at formal ward meetings.

Re-design of the weight management services. Now complete. Local initiatives to include improved partnerships with schools, early year’s

settings, environmental health and others. We are currently working with the food safety team to deliver a healthier hot food takeaway project and with parks to develop a list of preferred healthier vendors for events. The Solihull Active team are working with leisure services to make changes to vending in leisure facilities

Local Authorities to be exemplars of good practice – Internal policies should reflect healthy weight objectives for staff e.g. appropriate travel plans and policies, and healthy eating opportunities. At the time of writing this Strategy, SMBC is near completion of achieving Commitment Level of the Workplace Wellbeing Charter.

o A supportive physical environment, although the council house provides showers and secure cycle parking more could be done to such as improvements to stairwells

o Recreational opportunities, the council promotes the 5 ways to wellbeing to staff through newsletters and yoga classes an annual pedometer challenge and reduced rates to use local leisure facilities.

Promoting everyday participation in physical activity such as brisk walking or active travel. Public Health have developed an Obesity Communication Plan for Solihull that forms part of the overall public health communication plan and have embedded the forthcoming PHE One You campaign within this.

There are further opportunities to create cross cutting integrated commissioning that supports the health of the whole borough.

Planning and Transport

This department is looking at how we can include promotion of a supportive built environment to encourage active travel such as cycling and walking, to encourage the use of parks and green spaces, and to encourage opportunities for active and unstructured play. NICE guidance PH8 (see appendix …) supports this work as it emphasises that environmental factors need to be tackled in order to make it easier for people to be active in their daily lives, ensuring that health and wellbeing are prioritised and integrated throughout the planning system, we need to protect land for food growing from inappropriate development, particularly the best and most versatile agricultural land, conduct health impact assessments to ensure that all parties think about proposed developments from a health perspective, and provide training and support to elected members and senior officers to secure strong leadership and commitment to health at all levels and in all policies.


Housing

This department is looking at how they can work with social landlords to implement the practical action plan led by the Design Council and the National Housing Federation that sets out ten priorities for change to provide more opportunities for people of all ages to be more active and enjoy the space outside their homes.

Provide essential housing adaptations and support in the homes of severely disabled people.

Work with other departments to ensure that obese people in social housing or in adapted homes have the opportunity to be physically active through home or community based physical activity programmes.

Improve availability of unstructured opportunities for physical activity, such as access to parks and open spaces and safe play areas.

Economic

This department is working with us to encourage businesses to consider health for their employees including looking at working towards the Workplace Wellbeing Strategy and also to support social enterprises and community interest companies in Solihull.

Community Library

Community libraries are an important resource for many people within communities for information and signposting to local opportunities and support services. The library services have developed two health hub libraries and they are working to extend these initiatives across the libraries in the borough. Many of the libraries hold regular health events and work with us to invite partners and health services.

Social Care

Social Care services intervene with some of the most vulnerable people in our society who can be experiencing high levels of social exclusion and isolation. Social Care services are able to work with partners to embed physical activity and healthy eating support and opportunities within existing social care pathways and care plans and a range of settings.

Social Care services are key in providing necessary adaptations and carer support for severely obese people to help improve their quality of life and enable them to achieve their health potential.


Work together to improve the provision of high quality, local, accessible and safe green space in line with recommendations by organisations including The Design Council.

Improve the aesthetics of green space, alongside appropriate safety and crime prevention initiatives to encourage people to use their local green space.

Promote and encourage the use of existing green spaces. Develop what is on offer in green spaces such as outdoor gyms, community gardens

and other healthy activities being delivered in parks

Leisure Services

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Improve access to and facilities for structured leisure programmes and other exercise and physical activity schemes.

Improve availability of unstructured opportunities for physical activity, such as access to parks and open spaces and safe play areas for children and young people.

Ensure all opportunities are accessible to people with limited mobility, including those who are obese.

Promote the value and benefits (health and otherwise) of an active lifestyle.

Engage

The Early Help programme in Solihull is delivered by Engage, they bring together a package of services and interventions and work with some of the most vulnerable and difficult to engage families in the borough that are more likely to be less active and less likely to be eating a balanced diet. They work with parents, children and young people with the potential to intervene early and help people to establish healthy habits and build resilience.

We need to work with Engage to consider opportunities to enable parents and young people to engage in being active and consuming a nutritious diet through their three teams; Direct Work, Community Capacity and Community Development.

Schools and Education

Education around healthy lifestyles is part of the statutory curriculum in schools and many schools work with parents to ensure that these messages also go home. The local Eat Well Move More programme is delivered by Solihull active and is a targeted service to reduce the inequality in obesity rates between schools in the north and south of the borough.

Eighty five per cent of the schools in our borough have maintained their Solihull Healthy School status which means they are taking a whole school approach to health, and the Quality Assurance Group meet termly. Twenty five per cent of the schools will attain enhanced healthy school status in 2016. We need to capitalise on work in schools to look at ways we can improve school environments to promote healthy lifestyles. We could encourage schools to use the school food plan and the Eat Better, Do Better programme. The school plan contains a series of actions, each of which is the responsibility of a named person or organisation, outlining what needs to happen to transform what children eat at school, and how they learn about food.

We will continue to support and capitalise on the centrally funded reception, year 1 and year 2 universal free school meals to promote balanced and nutritious meals for children. Solihull school catering has attained the Silver Food for Life Partnership (FFLP) standard in Catering. Three schools in Solihull are silver or bronze FFLP schools. We could capitalise on the catering award by working with schools to increase the number of schools working towards a whole system quality standard that improves children’s wellbeing and self-esteem through physical activity and healthy eating.

Cycle training is an important life skill. We need to work with schools to extend opportunities to get as many children as possible to get their Bikeability and Scootability awards and to use active transport to get to school. We need to look at local authority wide promotions such as walk to school week.


Work is currently in process to map existing practice around food initiatives in schools to identify gaps and areas of excellence to develop appropriate support.

7.2 NHS and General Practice

The NHS has three distinct roles in improving diet and activity levels in the population:

Supporting patients and populations to change behaviour through brief advice and referral and creating environments that support and promote behaviour change. Healthcare professionals play an important and highly cost-effective role in providing brief advice on physical activity in primary care. NICE have developed recommendations to support practitioners in delivering effective interventions to increase physical activity (NICE CG43, see appendix…)

We are currently working with the CCG to increase the use of social prescribing and PA as a prescription and Solihull and Birmingham are piloting the NHS England national diabetes prevention initiative referring adults at high risk of diabetes to lifestyle change programmes. Local authorities, in partnership with general practice, already undertake health checks and offer high risk individuals referral to behaviour change programmes. There is good evidence to support these interventions, more work may need to be done around helping practitioners to talk to patients in appropriate ways.

The Quality Outcomes Framework (QOF) incentivises general practitioners to note obese patients on a register; however there no monitoring of how the register links to lifestyle interventions and the uptake or outcome of these interventions. The system needs to facilitate a change in the mind set of health professionals. Solihull is currently working with Heart of England Foundations trust to train up staff to become MECC health champions.

Becoming an employer that enables health behaviour for their staff through the working environment and initiatives by improve the quality of food outlets on the hospital site; implementing reasonable working schedules, regular meal break times and initiatives that promote active travel to work.

Becoming advocates to drive local change through partnership with the Health and Wellbeing board and other independent bodies to influence change (Nuffield Trust 2015)

7.3 Voluntary Sector

Sustain supports the voluntary and community sector in Solihull through promoting opportunities for funding and training to engage volunteers. We could utilise this opportunity to

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provide training around health and also work with voluntary organisations to seek funding for health programmes. Frontline staff could be trained to deliver MECC sessions with the community.

Health Exchange delver the Social Prescribing programme in Solihull, which supports residents to engage with activities in the community including voluntary opportunities and services to improve their health and wellbeing.

7.4 Community

We need to increase community engagement by showing a willingness to share ‘power’ as appropriate between statutory and community organisations. In particular co-production, which involves firstly listening to the community, helping them make more informed decisions about what they believe would be effective at tackling unhealthy lifestyles in their area or for their community, and adequately equip and enable the community to sustainably pursue this themselves. We need a sound knowledge of community needs, including use of messages that resonate and reduce barriers and embrace an assets based approach. We need to develop Community Health Champions trained in MECC and better use of local social media and create social movements that resonate with the community and engage them with perusing their health potential.

We can also facilitate the creation of small scale community interventions such as community gardens looking at what has worked well with the Victory Gardens project in Chelmsley wood which is a community garden which is now being utilised by the local community. There is guidance from NICE around community wide action to prevent obesity (NICE PH42 2012, see appendix...).

7.5 Local Business and Workplaces

The workplace often has an impact on a person’s ability to carry out healthy lifestyle activities directly, by providing healthy eating choices and opportunities for physical activity (such as the option to use stairs instead of lifts, staff gym, cycle parking and shower facilities). Indirectly, the workplace can impact through the overall culture of the organisation (e.g. through policies and incentive schemes). Taking action to improve healthy lifestyle opportunities may result in significant benefit for employers (reduced staff sickness and increased productivity) as well as employees (improved health and wellbeing). NICE NG13 2016 (see appendix…) sets out recommendations for workplaces.

There are many opportunities in businesses and workplaces that we can utilise including better working with the Local Economic Partnerships, businesses that are signed up to or wish to sign up to the responsibility deal and working with the chamber of commerce to look at health and incentivise people to work towards initiatives such as the Workplace wellbeing charter (see appendix…).

We are promoting the Workplace Wellbeing Charter to businesses in Solihull and currently working with Jaguar Land Rover. The Workplace Wellbeing Charter is an adaptive programme that can be used by large and smaller businesses.


We are providing training for hot food takeaways as part of a pilot to help hot food takeaways to provide healthier takeaways and promote what they are offering.

8. Behaviour Change

In order to work optimally, actions outlined within this strategy should be informed by the SMBC Behaviour Change Strategy and corresponding tool kit. The toolkit will be largely administered by a suitably qualified Behaviour Change expert working within the Public Health Department.

Programmes for both population and individuals will be based upon a clear understanding and involvement of the populations of interest and co-produced where appropriate. Programmes and initiatives will be evaluated robustly, with longer term outcomes e.g. 1 year+ used as the basis of intervention success. Using a standardised evaluation framework such as the Medical Research Council

The wider public health workforce working directly with clients will be trained in MECC, Brief Interventions and receive further training in communication skills (as appropriate) utilising behaviour change competency frameworks.

8.1 Individual

The commissioned Weight Management Programmes that commenced October 2015, will be scrutinised for their consistency with NICE Behaviour Change Guidance (see appendix …) and overseen by a Health Psychology Service which will oversee and ensure service provision is consistent with NICE Guidance, is manualised and achieves service fidelity. Staff working with clients directly will be expected to develop the appropriate level of behaviour change expertise.

We are currently looking at the wider public health workforce that are working directly with clients and are ensuring that they are trained in MECC and communication skills.

8.2 Organisational/Community and Population

We need to increase our partnership work with individuals, communities, organisations and populations to plan interventions and programmes to change health-related behaviour, utilising the relevant behaviour change models and tools available from the Solihull Behaviour Change Strategy Tool Kit. We will need to effectively build on community assets, self-regulation and self-efficacy.

As we are taking a whole system approach to tackle the obesogenic environment we will be taking a behaviour analysis approach based around the COM B model utilising the behaviour change wheel to ensure the most suitable interventions are designed to address the change required.

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9. Outcomes and Tactics

We have set out a long term action plan that will enable us to meet the vision of the Health In Every System approach to Working Together to get Solihull to Eat Well and Move More by 2021 through a Whole System Approach.

Vision

By working in partnership with a range of stakeholders we will enable the residents of Solihull to feel able to reach their health and wellbeing potential through a whole system approach that tackles poor nutrition and inactivity.

9.1 Priorities

Close the gap in health inequalities between the regeneration wards in the north and the affluent south of the borough

Close the gap in health behaviours and levels of obesity in children between the regeneration wards in the north and the affluent south of the borough

We will use the Behaviour Change Strategy to inform priority actions and these priorities will be implemented in the following ways

How

- Strong leadership with cross departmental buy in and action- Actively seek out effective partnerships within the system that will enable us to

maximise the potential for health gain in our borough facilitating bottom up solutions, and collaborative learning

- Utilise, develop and seek out assets using an asset based approach- Meaningfully engage with the community to ensure that our work is well received,

meets their needs and empowers them to take action and develop initiatives- An emphasis on preventative approaches such as school based health and

wellbeing and improvement- Create and deliver a coherent integrated blend of solutions that cover the life

course and tackle the whole system including social, environmental and behavioural factors to enable healthier lifestyle behaviours.

- Seek out evidence based, cost effective practice and encourage innovation to maximise health outcomes utilising NICE recommended tools

- Evaluate and reflect on practice and allow this to develop initiatives

9.2 What does success look like?

School communities thrive within an environment where health is promoted and supported through a whole school approach

Children and families report feeling enabled to enact health behaviours and form healthy habits

Access to healthier food choices will be improved and promoted


People in the borough feel enabled to fit being active into their lives including both recreation and active travel.

Increase the number of businesses in Solihull achieving a minimum of commitment level in the Workplace Wellbeing Charter

Lifestyle changes are supported with everyone able to access appropriate information on healthy lifestyles.

A move towards measuring wellbeing, good nutrition and physical activity as a measure of good health.

The following measurable outcomes will be used to monitor the success of the implementation of the strategy.

Outcomes

Increase in number of people meeting guidelines for being active Increase in number of people consuming 5 portions of fruit and vegetables a day Reduction in prevalence of diseases that are linked to poor diet and inactivity Reduction in health inequalities across the borough in particular the 10 year life

expectancy gap between the north and south of the borough Reduction in the inequality in childhood obesity and health related behaviours between

the regeneration wards in the north and the affluent south of the borough Reduction in the predicted trajectory for the rise in overweight and obesity in Solihull

9.3 Action Plan

In 2012 a comprehensive review of weight management and obesity prevention in Solihull was undertaken and a set of recommendations were developed based on a whole system approach for an integrated strategy to tackle obesity in Solihull. Some of these recommendations have since been implemented however some are still relevant and outstanding. The following action plan has been developed as a result of this report, a number of key local and national documents and the input of the Healthy Weight Strategic Group which represents a number of key stakeholders/partners in the borough.

Area of Work and timescale to deliver visible results

Primary Prevention

Stopping people becoming overweight or obese

Secondary Prevention

Stopping overweight and obesity getting worse and building healthy weight

Tertiary Prevention

Managing obesity especially long term

PlanningTimescale 2-10 years

Ensure our council is in a position to comply with any new national planning guidelines around location of hot food takeaways

Healthy and well-designed places and spaces which encourages increased activity and healthier food choices – health impact assessments undertaken for all major planning decisions to optimise health opportunities

Continue to explore opportunities to utilise unused public space for recreation or food growing

39

opportunities

TransportTimescale 1-2 years

Integrated transport planning with public transport, walking and cycling at heart

Engage with the community in assessing walkability of neighbourhoods

Regulatory and Licencing ServicesTimescale 1-3 years

Continue to develop healthy catering support/awards in conjunction with the food safety team– which identify premises offering healthy choices and help businesses to market healthier choices

Include nutrition and inactivity prevention as part of inspections of care homes, early years settings, children’s homes and other LA regulated premises

Use Local Government (Miscellaneous Provisions) Act 1982 and work with head teachers to restrict mobile food vendors from operating near schools

Local TaxationTimescale 1-3 years

Work with the business rates team to explore the potential to introduce penalties and incentives relating to the provision of healthy choices through business rates

Explore the potential to support the upcoming National sugar taxation on soft drinks

EnvironmentTimescale 2-10 years

Ensure the environment is safe and supportive for physical activity

Optimise links between obesity prevention agenda and climate change agenda.

Make better use of green space to encourage physical activity

Early yearsTimescale 2-10 years

Provide environments within early year’s settings which promote healthy eating and physical activity for children and families.

Engage families in national campaigns and local nutrition and physical activity programmes

EducationTimescale 2-10 years

Promote uptake of Solihull Healthy Schools and maintenance. Increase the uptake of schools engaged with the Enhanced Healthy Schools model. This will enable a whole school approach to nutrition and health.

Disseminate and promote the use of Solihull Health and Wellbeing website with links to resources, guidance and support for schools and other professionals working with young people. Continue to utilise social media

Good foundational health education training in schools

Promote 5 ways to wellbeing in schools to integrate messages

Undertake NCMP to monitor trends Lobby for healthier environments around schools Support engagement of the wider community in

lifestyle improvement initiatives through co-production

Engage families in national campaigns and local nutrition and physical activity programmes

Social CareTimescale 2-5 years

Nutrition and health standards in care services Identification and referral of people with difficulties

particularly those in vulnerable groups Care pathways to ensure early identification and

care for those with Mental Health issues

Integrated care pathway covering all agencies


Make Every Contact Count Plus to be embedded into social and home care services

LSP/HWBTimescale 2-5 years

Capitalise on links between obesity prevention and climate change; poverty reduction; congestion; crime etc.

Ensure healthy food service policies in all public sector venues

Promote and support businesses to achieve the Workplace Wellbeing Charter commitment level.

Work with employers on fit for work programmes

Leisure and SportTimescale 1-5 years

Getting people more active as a routine part of their week

Increase use of parks and green spaces – actively promote events, improve perception of safety

Provide healthy catering and healthier options in vending machines and events

Provide opportunities for physical activity for those who feel excluded from mainstream activities as a result of disabilities, self-esteem.

Communications MediaTimescale 1-3 years

Coordination, networking and communications engaging service providers, partners and stakeholders and aligning with national campaigns such as the One You and Change4Life campaigns

Positive messaging about creating a healthy borough and engaging the whole community

Coordinated healthy lifestyle campaigns using a range of communication tools to further reach

Voluntary sector Mobilise communities to demand a healthier

environment and feel connected within their communities

Increase volunteer opportunities and uptake Engage communities in healthy lifestyle

opportunities in promoting, getting involved in healthy activities and organising them

Support engagement in programmes that improve diet and increase physical activity of at risk populations

Private sector Consider impact on health in terms of food supply,

workforce, built environment, advertising, creation of social norms, desires and perceptions

Implement workplace health improvement schemes for employees

Encourage workplaces to take on the Workplace Wellbeing Charter and achieve commitment level

Engage businesses with the Make Every Contact Count programme, partnerships with leisure centres and health checks

Implement fit for work programmes

Primary CareTimescale 1-3 years

Brief interventions Promotion of

breastfeeding Linking with healthy

living pharmacy roll out and using it as a tool to reach hard to reach populations with health messages and referral into services

Regular health checks, screening those at risk including children

Interventions across the life course

Improved access to services that enable people to be more active and improve their diets

Integrated care pathway covering all agencies,

Secondary Screening and Screening Integrated care

41

CareTimescale 1-3 years

pathway for inpatients and outpatients

Brief advice and Making Every Contact Count

Nutrition and healthy eating standards

Support the roll out of the pre-diabetes programme

Look at how we can create a health promoting environment in Secondary care

Brief advice Treatment

protocol, behavioural pathway, exercise on referral

Improved access to services that enable people to be more active and improve their diets

pathway covering all agencies

Behavioural pathway when coming out of secondary care

These actions will be owned by members of the Healthy Weight Strategic Group who will be responsible for reporting on and monitoring their progress, evaluating and updating as new actions are required to achieve the strategy outcomes. Work programmes will be assessed for value for money and cost effectiveness.

10. References

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CarterR, MoodieM, MarkwickA, et al. Assessing cost-effectiveness in obesity (ACE-obesity): an overview of the ACE approach, economic methods and cost results. BMC Public Health2009; 9: 419

Crawley H. 2006, Eating well for under-5s in child care. Practical and nutritional guidelines. St. Austell: Caroline Walker Trust;

Davies, S.C, 2015. “Annual Report of the Chief Medical Officer, 2014, The Health of the 51%:Women” London: Department of Health


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Dewey KG, Heinig MJ, Nommsen LA. Maternal weightloss patterns during prolonged lactation. American Journal of Clinical Nutrition. 1993; 58(2): 162166.

DH 2008, Cross Government Obesity Unit, Department of Health, Department for Children, Schools and Families. Healthy weight, healthy lives: Guidance for local areas. London: Department of Health; 2008.

Emerson E, Baines S. (2010) Health Inequalities and People with learning disabilities in the UK: 2010. Improving Health and Lives: Learning Disabilities Observatory. http://www.improvinghealthandlives.org.uk/uploads/doc/vid_7479_IHaL2010-3HealthInequality2010.pdf (accessed 19.11.12).

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Fraser et al, 2015. Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013, The Lancet, 386 (10010) , pp. 2257-2274. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00195-6/fulltext

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Gortmaker SL, Swinburn BA, Levy D, Carter R, Mabry PL, Finegood DT, Huang T, Marsh T, Moodie ML. Changing the future of obesity: science, policy, and action. Lancet. 2011:378(9793);838-847

Haines, J. & Neumark-Sztainer D (2006). Prevention of obesity and eating disorders: a consideration of shared risk factors. Health Education Research, 21(6):770–782. [http://her.oxfordjournals.org/content/21/6/770.long ]

Hancox RJ, Poulton R. (2006) Watching television is associated with childhood obesity: but is it clinically important? International Journal of Obesity (1):171-175.

HSCIC 2016, Health and Social Care Information Centre, http://www.hscic.gov.uk/ncmp.

HSCIC, 2015 Focus on the health and care of young people June 2015

Health Survey for England (2006) Volume 1 Cardiovascular Disease and Risk Factors in Adults. The Information Centre. Published 2008. www.ic.nhs.uk/pubs/HSE06CVDabdriskfactors

Heslehurst N, Ellis LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD, 2007. Trends in maternal obesity incidence rate, demographic predictors, and health inequalities in 36,821 women over a 15 year period. British Journal of Obstetrics and Gynaecology. 2007; 114: 187194.

Horta B, Bahl R, Marines J, Victoria C. 2007, Evidence on the long term effects of breastfeeding: Systematic reviews and meta-analysis. Geneva: World Health Organization;

Institute of Medicine. Bridging the evidence gap in obesity prevention: a framework to inform decision making. Washington, DC: The National Academy Press, 2010

Jansen W, Brug J (2006) Parents often do not recognize overweight in their child, regardless of their socio-demographic background. European Journal of Public Health 16 (6) 645-7.

Jolly, K. et al (2011) Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trialBMJ2011;343:d6500doi: 10.1136/bmj.d6500

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Kings Fund, 2012, Transforming the delivery of health and social care

Linde JA, Jeffrey RW. Population approaches to obesity prevention. In: Crawford D, Jeffrey RW, Ball K, Brug J. eds Obesity Epidemiology, pp208 -221. Oxford University Press, New York.

Lobstein T, Baur L, Uauy R. ,2004, Obesity in children and young people: a crisis in public health. Report to the WHO by the International Association for the Study of Obesity. Obesity Reviews. 2004; 5(Suppl. 1): 485.

Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, et al.Overweight, obesity, and depression: a systematic review and meta-analysis ofLongitudinal studies. Archives of General Psychiatry 2010;67(3):220-9.

Magkos, Faidon et al, 2016, Effects of Moderate and Subsequent Progressive Weight Loss on Metabolic Function and Adipose Tissue Biology in Humans with Obesity. Cell Metabolism , Volume 23 , Issue 4 , 591 – 601 April 2016.

Markowitz S, Friedman MA, Arent SM. Understanding the relation betweenobesity and depression: Causal mechanisms and implications for treatment.Clinical Psychology: Science and Practice 2008;15(1):1-20.

Marshall D. et al (2003) Obesity in people with intellectual disabilities: the impact of nurse-led screenings and health promotion activities. Journal of Advanced Nursing, 41, 2 147-153

Melville C, Hamilton S, Miller S, Boyle S, Robinson N, Pert C, et al. Carer Knowledge and Perceptions of Healthy Lifestyles for Adults with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities 2009;22:298-306.

Melville C, Hamilton S, Hankey C, Miller S, Boyle S. The prevalence and determinants of obesity in adults with intellectual disabilities.Obesity Reviews 2007;8:223-30.

Mental Health Taskforce, 2016, The five year forward view for mental health

Muennig P, 2008, The body politic: the relationship between stigma and obesity-associated disease BMC Public Health. 2008; 8: 128. Published online 2008 April 21. doi: 10.1186/1471-2458-8-128

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Scarborough P, Bhatnagar P, Wickramasinghe KK, et al. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006–07 NHS costs. J Public Health (Oxf) 2011;33:527–35. doi:10.1093/pubmed/fdr033

Scottish Intercollegiate Guidelines Network (2010).Management of Obesity Guideline 115.www.sign.ac.uk

Sui X, LaMonte MJ, Laditka JN, et al. 2007, Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults. JAMA. 2007;298(21):2507-2516. doi:10.1001/jama.298.21.2507.

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Van Jaarsveld CHM, Gulliford MC. Childhood obesity trends from primary care electronic health records in England between 1994 and 2013: population-based cohort study. Archives of Disease in Childhood. Published online January 29 2015

VosT, CarterR, BarendregtJ, et al. (2010)Assessing Cost-Effectiveness in Prevention http://www.sph.uq.edu.au/docs/BODCE/ACE-P/ACE-Prevention_final_report.pdf. (accessed April 18, 2011).

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11. Glossary

Obesity is defined in terms of Body Mass Index (BMI) which is a measure of body fat based on height and weight, see table 1.

Table 1: Classification of Body Mass Index and Risk of Co-morbidities (WHO 1998)

Classification

BMI (kg/m2)

BMI (kg/m2) Asian origin 11

Risk of co-morbidities

Underweight <18.5 18.5 Low (but risk of other clinical problems increased)

Normal range

18.5-24.9 18.5-22.9 Average

Overweight 25.0-29.9 23-27.4 Increased risk

Obese Class I

30.0-34.9 27.5 – 32.4 Moderate

Obese Class II

35.0-39.9 32.5-37.4 Severe

Obese Class III

>40.0 37.5 Morbid obesity

Obesity in children and adolescents is normally defined in clinical practice as a sex and age specific BMI at or above the 98th percentile based on 1990 BMI percentile classification charts (91th centile for overweight). When population data is collected children are defined as obese if their BMI is >95th percentile of the reference curve for age.

12. Appendix

Table 2: Waist measurements as a predictor of health risk adapted from WHO 2008

Men Asian men Women Asian women

Waist circumference

Increased risk ≥ 94cm ≥ 80cm


Substantially increased risk

≥102cm ≥ 90cm ≥ 88cm ≥ 80cm

Waist to hip ratio

Increased risk ≥ 1.0 ≥ 0.87

SCOFF questionnaire:

Do you ever make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone in a three month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?

A score of two or more positive answers is a positive screen.

(BEAT 2016)

National policies, strategies and guidance used to inform this strategy.

Document How it relates to obesity Impact on strategyPoliciesActive Travel briefing for local authorities (16/5/16)

Highlights the link between active travel, road transport and health. It demonstrates how we can build active travel into everyday life for a range of benefits for health, wellbeing, the environment and the economy.

The strategy involves working with planners and public health to build health into planning.

Healthy weight, healthy futures: Local government action to tackle childhood obesity (17/3/16)

A series of case studies showing what local authorities are doing to curb obesity

The strategy involves looking for innovative, effective practice and incorporating relevant practice into our work.

Building the foundations - tackling obesity through planning and development (29/2/16)

identifies a series of themes and more specific elements within planning that help to create healthy-weight environments


Healthier and more sustainable catering 2014

Catering guidance that offers practical advice on how to make catering affordable, healthier and more sustainable.

The strategy looks at how we can improve food provision through the workplace wellbeing programme, awards and partnership within the public sector

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http://www.local.gov.uk/web/guest/publications/-/journal_content/56/10180/7716564/PUBLICATION






http://www.noo.org.uk/news.php?nid=2827

http://www.noo.org.uk/news.php?nid=2827

Obesity and the environment briefing: regulating the growth of fast food outlets 2014

Addresses the opportunities to limit the number of fast food takeaways (especially near schools) and ways to make fast food offers healthier.

As part of the strategy we will work with planning to reduce the impact of fast food outlets as part of an obesogenic environment

Moving More, Living More: Olympic and Paralympic Games legacy 2014

Promoting physical activity to have a more physically active nation as part of the legacy from the London 2012 Olympic and Paralympic Games.

The strategy is working in synergy with the Physical Activity Strategy 2014 – 2020 of which this is a core goal.

PHE and Association of Directors of Public Health survey findings: tackling obesity 2014

Recommendations for reducing obesity in local communities


Obesity and the environment briefing: increasing physical activity and active travel 2013

Recommendations on creating environments where people are more likely to walk or cycle for short journeys and outlines the regulatory and policy approaches that can be taken.


Living Well for Longer: a Call to Action to Reduce Avoidable Premature Mortality 2013

A call to action on reducing premature mortality, for the 5 biggest killer diseases: cancer, stroke, heart, liver and respiratory disease. The first 4 of which are related to obesity.


Public Health England marketing strategy: 2014 to 2017From: PHELast updated:15 July 2015,

Describes how PHE will use marketing to support the objectives of its business plan and England’s public health system.

The strategy will use social marketing as part of the behaviour change package.

Strategic high impact changes: childhood obesity 2011

A summary of local views on good practice


Healthy Lives, Healthy People: our strategy for public health in England - 2010

Plans for whole of society to reduce obesityEncourages a range of partners, including government and business

This strategy takes a whole system approach looking at involve as many organisations and communities as possible to achieve the goals.

The public health white paper 2010

Government's plans for transforming public health in England

Has been used to inform the strategy

PSA delivery agreement 12: Improve the health and wellbeing of children and young people 2007

Commitment to improve the physical, mental and emotionalhealth and wellbeing of children and young people from conception to adulthood

This has been considered when setting targets and priorities


Sugar reduction: from evidence into action 2015

A report that details a review of the evidence on interventions to help the nation reduce their sugar consumption.


What works in schools and colleges to increase physical activity 2015

A summary of evidence The strategy involves looking for innovative, effective practice and incorporating relevant practice into our work.

Public Health Outcomes Framework updated 2016

-increased healthy life expectancy-reduced differences in life expectancy-healthy life expectancy between communities

These have been considered when setting targets and priorities

2010 to 2015 government policy: obesity and healthy eating 2015

Although now out of date there has not been an updated version yet


NHS 5 Year plan 2015 Sets out what the NHS intends to do for the next 5 years includes plans to reduce obesity


PHE (2014) From evidence into action: opportunities to protect and improve the nation’s health

PHE has identified tackling obesity in children and adults as one of seven priority areas

Document How it relates to obesity Impact on strategyGuidanceNICE Weight Management: Lifestyle services for overweight or obese adults (PH53) 2014

Recommendations for lifestyle services

Informs any commissioned lifestyle services

NICE Workplace health: management practices(NG13) March 2016

Recommendations on how to improve the health and wellbeing of employees, with a focus on organisational culture and the role of line managers.

We are working to increase the number of healthy employers in Solihull borough

NICE Preventing obesity and helping people to manage their weight (LGB9) 2013

Recommendations to prevent obesity


NICE Obesity in adults prevention and lifestyle weight management programmes (Q5111) 2016


Has been used to inform the strategy and informs any commissioned lifestyle services

NICE Obesity in children and young people prevention and lifestyle weight management programmes (Q594) 2015

Recommendations for lifestyle services and prevention


NICE BMI thresholds for intervening to prevent ill health


Has been used to inform the strategy and informs any

49

among black, Asian, and other minority ethnic groups (LGB13) 2014

commissioned lifestyle services

NICE BMI preventing ill health and premature death in black, Asian, and other minority ethnic groups (PH46)



NICE Weight Management before during and after pregnancy (PH27) 2010


Has been used to inform the strategy and informs any future commissioned lifestyle services

NICE Preventing excess weight gain (NG7) 2015



NICE Obesity Identification, assessment and management (CG189) 2014


Informs any commissioned lifestyle services

NICE Obesity Prevention (CG43) 2006

Recommendations to prevent, identify, assess and manage obesity in adults and children


NICE Maternal and child nutrition (Q598) 2015



NICE Nutrition support in adults (Q524) 2012



NICE Cardiovascular disease prevention (PH25) 2010

Recommendations to prevent CVD which is connected to obesity


NICE Type 2 diabetes prevention: population and community-level interventions (PH35) 2011

Recommendations to prevent type 2 diabetes which is connected to obesity


NICE Type 2 diabetes: prevention in people at high risk (PH38) 2012

Recommendations to prevent type 2 diabetes which is connected to obesity


Behaviour Change – Individual Approaches. NICE 2014 (PH49)

Recommendations for implementing behaviour change


NICE Behaviour Change – General Approaches. NICE 2007 (PH6)

Recommendations for implementing behaviour change


NICE Obesity / Communities document [PH42] 2012

This guidance aims to support effective, sustainable and community-wide action to prevent obesity.

As part of the strategy there are plans todevelop a sustainable, community-wide approach to obesity involving the community coordinate local actioninvolve local businesses and social enterprises operating in the local area.


NICE Physical Activity and the environment (PH 8) 2008.

Environmental factors need to be tackled in order to make it easier for people to be active in their daily lives.

Work is being done to reunite health with planning. We have taken an upstream focus emphasising the need to make changes to the environment to support health

NICE Health inequalities and population health (LGB4) 2012

Recommendations for local authorities and partnerorganisations on population health and health inequalities.

Relates to the whole system approach.

Workplace wellbeing charter Workplaces are able to work towards different levels for this award which includes ensuring physical activity and good food are promoted and meets certain standards

Will be used to engage with local businesses to create more healthy workplaces in the borough and allow us t make changes on a wider range of systems that impact on obesity.

The Eatwell Guide is a pictorial representation of the recommended balance of food groups in the diet. It aims to encourage people to choose the right balance and variety of foods to help them obtain the nutrients needed to stay healthy i.e.

• include plenty of fruit and vegetables –at least 5 portions a day of a variety of different types

• include meals based on starchy foods (including high-fibre varieties where possible)

• include moderate amounts of milk and dairy products – choosing low-fat options where possible

• include moderate amounts of foods that are good sources of protein

• low in foods that are high in fat, esp. saturated fat, high in sugar and high in salt.

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Physical Activity Benefits for Adults and Older Adults

Source: NCMP - Solihull · Web viewThere has been recognition from the WHO that physical inactivity...

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Transcript of Source: NCMP - Solihull · Web viewThere has been recognition from the WHO that physical inactivity...