Healthy Weight, Healthy Lives

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Healthy Weight, Healthy Lives

• Tackling obesity in England

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Obesity levels are too high, with significant
impact on individuals, the health service and
society as a whole

• By 2050, if trends continue, 60 of men and 50
  of women could be clinically obese (UK Foresight
  report)

• HEALTH IMPACT
• 58 type 2 diabetes
• 21 of heart disease
• 10 of non-smoking related cancers
• 9,000 premature deaths a year in England
• Can reduce life expectancy and quality of life
• COST
• National Health Service - 4.2bn
• Wider economy - 15.8bn
• Foresight estimates by 2050 costs to economy of
  50bn

Overweight obesity forecast trend 2007-2050
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Obesity in adults and children is too high and
forecast to rise, with huge costs to society..
Alternative slide option

• 2050
• Based on current trends 60 men, 50 women and
  25 children will be obese
• 9 in 10 adults will be overweight or obese if we
  carry on as we are
• Cost to the NHS forecasted to more than double
• Cost to the wider economy predicted to rise to
  50 billion per year

• NOW
• 60.8 of adults (aged 16) overweight or obese,
  of these 24 are obese
• 28.6 of children (aged 2-10) overweight or
  obese, of these 15.4 are obese
• Cost of overweight and obese individuals to NHS
  estimated to be 4.2 billion
• Cost to the wider economy is 16 billion

• ..and to the individual
• risk of diseases, such as cancer, heart disease
  or Type 2 diabetes
• risk of reduced life expectancy and quality of
  life

Sources The Health Survey for England 2007 and
Foresight
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Foresight developed a system map showing the
multiple determinants of obesity
Optional slide
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Foresight identified four factors driving this
trend and creating an obesogenic environment

• Genetics can increase the risk of obesity
• Early life experiences including breastfeeding
  can affect a childs risk of being overweight
  later

HUMAN BIOLOGY
CULTURE / INDIVIDUAL PSYCHOLOGY

• Difficult to break habituated unhealthy
  behaviours, especially when these are common to
  those around us
• Obesity and overweight are becoming normal

FOOD ENVIRONMENT

• Availability of convenient food has increased
  massively, which tends to be high in saturated
  fat, salt and sugar

PHYSICAL ENVIRONMENT

• Our lives have become increasingly sedentary.
  For example, the last two decades have seen a
  10 drop in children walking to school

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The Government has set out an ambitious strategy
Our ambition is to be the first major nation to
reverse the rising tide of obesity and overweight
in the population, by enabling everyone to
achieve and maintain a healthy weight. Our
initial focus will be on children By 2020, we
aim to reduce the proportion of overweight and
obese children to 2000 levels.

• In January 2008 the Government published Healthy
  Weight, Healthy Lives A Cross-Government
  Strategy for England
• 372 million is being committed over 3 years to
  implement the strategy
• In April 2009 Healthy Weight, Healthy Lives One
  Year On was published. It reviews progress on the
  strategy and sets out priorities for the future.

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The strategy sets out action in 5 themes, based
on the evidence provided by Foresight

• Children healthy growth and healthy weight
• early prevention of weight problems to avoid the
  conveyor-belt effect into adulthood
• Promoting healthier food choices
• reducing the consumption of foods that are high
  in fat, sugar and salt and increasing the
  consumption of fruit and vegetables
• Building physical activity into our lives
• getting people moving as a normal part of their
  day
• Creating incentives for better health
• increasing the understanding and value people
  place on the long-term impact of decisions
• Personalised advice and support
• complementing preventative care with treatment
  for those who already have weight problems

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Healthy Weight, Healthy Lives actions to date
include

• Launching Change4Life, a national movement to
  bring together community groups, health
  professionals, teachers, government departments,
  supermarkets, the media etc to help everyone to
  eat well, move more and live longer
• 30m matched investment in 9 Healthy Towns
• Sending NCMP results to parents and helping PCTs
  commission services for overweight and obese
  children
• Healthy Food Code of Practice covering our policy
  on food and health
• 65.9m in PCT allocations in 08/09 to support
  action on overweight and obesity
• Rises in breastfeeding rates and 3,000 Sure Start
  Centres providing healthy living advice and
  support in pregnancy and early childhood
• 97 of all schools participating in Healthy
  School programme and 3m children eating school
  dinners
• 34 reduction in childrens exposure to TV ads
  for unhealthy food drink
• 7m to encourage people to walk more and 42m for
  Cycling Towns
• 3,500 extra play areas across the country
• 80 of LAs signed up for Free Swimming for under
  16s and over 60s

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First signs that we are having an impact on
child obesity?

• Latest figures from the Health Survey for England
  give an early indication that the trend in
  obesity prevalence in children may have begun
  to flatten out (NHS Information Centre)
• NCMP 2007/08 data supported this, showing no
  significant change in obesity rates between 06/07
  and 07/08 at ages 4-5 or 10-11
• However, it is still to early to tell if these
  results are part of a new trend
• The scale and complexity of the challenge means
  we cannot assume that the action already taken
  will be enough and its important to maintain
  momentum.

Percentage of obese children 2-10 years old
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Action over the coming year

• Healthy Weight, Healthy Lives One Year On (April
  2009) builds on the 5 themes from Healthy
  Weight, Healthy Lives and demonstrates our
  commitment to maintaining the momentum in
  tackling unhealthy weight.
• We will continue our drive to reduce obesity by

• helping people to make healthier choices
• creating an environment that promotes healthy
  weight
• ensuring effective services are available for
  those at risk and
• strengthening the delivery system.

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1. Helping people make healthier choices
In the next 12 months, we plan to help change how
people relate to and understand obesity by giving
parents clear information about the importance of
healthy weight and the tools to allow them to
make healthier choices for themselves and their
children.

• We will
• inspire 200,000 families to change behaviour
  through Change4Life
• extend Change4Life to at-risk adults
• provide new content and tools through the NHS
  Choices website and NHS LifeChecks to support
  people in assessing and managing their own
  lifestyle, including maintaining a healthy weight
• examine how NCMP results may best be shared with
  health professionals to enable more proactive
  follow-up where required.

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Engaging families with the National Child
Measurement Programme

• Established in 2005, the NCMP weighs and measures
  children in Reception year (aged 4-5 years) and
  Year Six (aged 10-11) in schools.
• In 2007/08, almost 1 million children were
  measured, approximately 88 of those eligible.

• About half of all PCTs are now routinely feeding
  back the results to parents, as a means to engage
  them - we expect a rise in the number of PCTs
  feeding back in 2009/10.
• Many PCTs are using NCMP data to inform the
  provision of services to children and families,
  such as weight management programmes, and to
  target resources.

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2. Creating an environment that promotes healthy
weight
It is vital that we continue to act in a wide
range of settings to create a social environment
that makes it easier for individuals and families
to maintain a healthy weight.

• do more to support children in early years
  through a single set of evidence-based messages
  on healthy eating and active play
• use sample surveys and research to collect and
  track data on weight status of very young
  children
• continue to improve environment for school-age
  children

• raise public understanding of maintaining an
  appropriate energy balance
• see more fast food and other chain restaurants
  provide calorie labelling for consumers at the
  point of choice
• look to develop a voluntary set of principles to
  underpin all forms of promotion and marketing of
  food and drink to children
• continue to work in partnership with industry to
  reformulate foods by reducing levels of saturated
  fat, salt and sugar

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2. Creating an environment that promotes healthy
weight (continued)

• encourage local authorities to deliver active
  travel initiatives through the next round of
  transport plans
• set up an expert working group to look at
  sedentary behaviour, screen time and obesity and
  advise on messages to families
• evaluate work of Healthy Towns and ensure
  learning is shared
• commission robust evidence of how healthy living
  objectives are being delivered locally from a
  spatial perspective

• work to improve the health and wellbeing of
  public sector employees, starting with the NHS
  workforce
• support SMEs and non-FTSE companies in the
  private sector to adopt the Business HealthCheck
  Tool.
• look at results of subsidised gym pilots for
  young people and consider whether scheme should
  be rolled-out to other areas

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3. Effective services for those at risk
For those currently overweight or obese, we need
to provide effective services that help them to
achieve and maintain a healthier weight. Going
forward, we will provide further support to local
commissioners in this area, aligning with the
World Class Commissioning agenda.

• We will
• review and build upon the package of support for
  commissioning child weight management services
  that we have developed in partnership with PCT
  colleagues, which includes a commissioning
  toolkit and a framework of 'pre-qualified'
  training providers
• focus on supporting local commissioning of weight
  management services for adults
• begin the roll out of NHS Health Checks for all
  4074-year-olds, including an assessment of BMI
  and referral into weight management or exercise
  programme where necessary for health reasons
• ensure that primary care professionals are better
  equipped to play their part in providing advice
  and referral.

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4. Strengthening delivery
We need to ensure that we have a delivery system
that prioritises tackling obesity and has the
capability to do so. There is growing momentum
and commitment towards tackling obesity locally
and regionally. We want to continue to support
the delivery chain.

• We will
• provide 69 million to local areas within PCT
  allocations in 2009/10 to combat overweight and
  obesity
• encourage local authorities to use their power to
  promote or improve the economic, social or
  environmental wellbeing of their area
• commission an evaluation of the role of the
  regulatory environment in promoting and
  encouraging physical activity and healthy food
  choices
• develop a new Obesity Improvement Programme, to
  strengthen local capabilities to both prevent and
  treat overweight and obesity (planned for summer
  2009)

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Helping local areas promote healthy weight
We have provided a range of support and guidance
including

• Child Obesity National Support Teams who visit
  local areas and provide intensive support
• a toolkit for developing local strategies
• guidance on commissioning weight management
  services for children and young people
• a directory of obesity training providers

• The new Obesity Improvement Programme will
  provide
• a one-stop shop website providing best practice
  and a forum for sharing information and data
• training support to build capability of the
  delivery chain
• a national weight management monitoring system to
  track availability of local weight management
  services.

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Change4Life supporting families to maintain a
healthy weight

• We have allocated 75 million to launch a 3 year
  social marketing campaign called Change4Life.
• An extensive 18 month research programme helped
  us understand families with children under the
  age of 11 and their attitudes and behaviours in
  relation to food and physical activity.
• The Change4Life advertising campaign launched in
  January 2009. The message to the public is Eat
  Well, Move More, Live Longer.
• The Change4Life website (www.nhs.uk/change4life),
  helpline and direct marketing programme will
  provide ongoing help, advice and support.
• We will create more opportunities for activity
  and healthy eating through building on our
  Change4Life partnerships across all sectors.
• Some statistics so far
• 68 of mothers have heard of Change4Life and 79
  of mothers said the adverts made them think of
  their childrens long-term health (Mar 09)
• over 250,000 How are the kids? surveys have
  been completed
• over 90 signed commercial partners including
  Co-op, Kellogg's and ITV.

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Change4Life activity phases 2009
Phase two
Phase three
Phase four
Phase five
Phase one
Role of marketing
Reframing the issue of obesity
Personalising the issue
Rooting behaviours
Inspiring people to change
Supporting people as they change
Sample marketing materials
Desired out-take
This isnt about how my children look its about
diabetes, cancer and heart disease
This isnt about bad parents or very fat children
its about my children
I know what to do to reduce my familys risk
I know people like me are changing their lives so
I believe its possible
I can see the difference this is making
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We remain committed to building the evidence base
on tackling obesity

• Commissioning research
• Chief scientific advisers set out a framework to
  guide next steps - 'Healthy Weight, Healthy
  Lives A cross-government research and
  surveillance plan for England' (Dec 08).
• Continue to prioritise areas for investigation,
  and boost research on obesity, diet, physical
  activity and environmental influences.

• Learning through evaluation
• Continue to evaluate key policy activities e.g.
  evaluation of Healthy Towns and Change4life on
  behaviour and health outcomes.
• Work across government to identify additional
  policy areas and natural experiments where the
  impact on obesity and its causes can be assessed
  and evaluated.

• Supporting infrastructure and coordination
• National Obesity Observatory is established and
  working to act as a first point-of-call for
  information on obesity, its determinants and
  interventions.
• The HWHL expert group continues to support policy
  development.

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Conclusion (to be amended audience depending)

• In Healthy Weight, Healthy Lives A
  cross-government strategy for England, we issued
  a call to action to tackle the most significant
  public and personal health challenge facing us
  today, and we will continue to take that forward
  through the commitments in the One Year On report.

Over the last year, we have worked together
across society to tackle obesity, but this public
health epidemic needs sustained action if we are
to realise our ambition of everyone being able to
maintain a healthier weight. www.dh.gov.uk/health
yweight