Healthy weight, healthy lives - nationalarchives.gov.uk

257 Pages·2008·2.91 MB·English

© Crown copyright 2008
283780 xp xk Sept08 (xxx)
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HR/Workforce Commissioning
Management IM & T
Planning Finance
Clinical Social Care/Partnership Working
Document purpose Best Practice Guidance
Gateway reference 10224
title Healthy Weight, Healthy Lives:
A toolkit for developing local
strategies
author Dr Kerry Swanton for the
National Heart Forum/Cross-
Government Obesity Unit/Faculty
of Public Health
Publication date October 2008
target audience PCT CEs, Directors of PH, Directors
of Nursing, Local Authority CEs,
Directors of Children’s SSs
Circulation list SHA CEs
Description This toolkit is intended as a
resource to help those working
at a local level to plan and
coordinate comprehensive
strategies to prevent and manage
overweight and obesity.
Cross reference Healthy Weight, Healthy Lives:
A cross government strategy for
England; Healthy Weight, Healthy
Lives: Guidance for local areas
Superseded documents Lightening the Load: Tackling
overweight and obesity
action required N/A
timing N/A
Contact details National Heart Forum
Tavistock House South
Tavistock Square
London WC1H 9LG
www.heartforum.org.uk
Cross-Government Obesity Unit
Wellington House
133-155 Waterloo Road
London SE1 8UG
www.dh.gov.uk
Faculty of Public Health
4 St Andrews Place
London NW1 4LB
www.fph.org.uk
for recipient use
HealtHy weigHt, HealtHy lives:
a toolkit for developing
local strategies
Written by Dr Kerry Swanton

Consultant editor: Professor alan maryon-Davis FFPH FRCP FFSEM

Edited by Wordworks

Produced by the national Heart forum in association with the faculty of Public Health,
the Department of Health, the Department for Children, Schools and families and
foresight, Government offce for Science
Contents iii
Contents
foreword
1
executive summary 2

Section a

overweight and obesity: the public health problem 7

What are ‘overweight’ and ‘obesity’? 8

Prevalence and trends of overweight and obesity 9

The health risks of overweight and obesity 22

The health benefts of losing excess weight 28

The economic costs of overweight and obesity 29

Causes of overweight and obesity 30

Section B

tackling overweight and obesity 33

Government action on overweight and obesity 35

Children: healthy growth and healthy weight 37

Promoting healthier food choices 40

Building physical activity into our lives 43

Creating incentives for better health 46

Personalised support for overweight and obese individuals 47

Section C

Developing a local overweight and obesity strategy 53

Understanding the problem in your area and setting local goals 58

Local leadership 61

Choosing interventions 63

Monitoring and evaluation 68

Building local capabilities 70

Tools for healthcare professionals 72

Section D

resources for commissioners 75

Tool D1 Commissioning for health and wellbeing: a checklist 79

Tool D2 Obesity prevalence ready-reckoner 91

Tool D3 Estimating the local cost of obesity 95

Tool D4 Identifying priority groups 101

Tool D5 Setting local goals 105

Tool D6 Local leadership 109

Tool D7 What success looks like – changing behaviour 117

Tool D8 Choosing interventions 119

Tool D9 Targeting behaviours 133

Tool D10 Communicating with target groups – key messages 139

Tool D11 Guide to the procurement process 145

Tool D12 Commissioning weight management services for children,

young people and families 151

Tool D13 Commissioning social marketing 155

Tool D14 Monitoring and evaluation: a framework 159

Tool D15 Useful resources 171
iv Healthy Weight, Healthy Lives: A toolkit for developing local strategies
Section e
resources for healthcare professionals 191
Tool E1 Clinical care pathways 195
Tool E2 Early identifcation of patients 201
Tool E3 Measurement and assessment of overweight and obesity – ADULTS 203
Tool E4 Measurement and assessment of overweight and obesity – CHILDREN 211
Tool E5 Raising the issue of weight – Department of Health advice 217
Tool E6 Raising the issue of weight – perceptions of overweight healthcare
professionals and overweight people 221
Tool E7 Leafets and booklets for patients 225
Tool E8 FAQs on childhood obesity 227
Tool E9 The National Child Measurement Programme (NCMP) 231
references 233
acronyms 243
Index 245
acknowledgements 248
List of figures
Figure 1 Prevalence of overweight and obesity among adults, by age and sex,
England, 2006 11
Figure 2 Future trends in obesity among adults, 2004-2050 14
Figure 3 Prevalence of overweight and obesity among children aged 2–15,
by age and sex, England, 2006 17
Figure 4 Obesity trends among children aged 2-15, England, by sex, 1995-2006 20
Figure 5 Future trends in obesity among children and young people aged under
20 years, 2004-2050 21
Figure 6 Estimated future NHS costs of elevated Body Mass Index, 2007-2050 29
Figure 7 The eatwell plate 41
Figure 8 A ‘road map’ for developing a local overweight and obesity strategy 56
List of tables
Table 1 Prevalence of obesity and central obesity among adults aged 16
and over living in England, by ethnic group, 2003/2004 12
Table 2 Prevalence of obesity among children aged 2-15 living in England,
by ethnic group, 2004 18
Table 3 Relative risks of health problems associated with obesity 22
Table 4 The benefts of a 10kg weight loss 28
Table 5 Future costs of elevated Body Mass Index 29
Table 6 Critical opportunities in the life course to infuence behaviour 36
Table 7 Standard population dietary recommendations 40
Table 8 Physical activity government recommendations 43
Table 9 Clinical guidance for managing overweight and obesity in adults,
children and young people 48
Contents v
this toolkit is intended as a resource to help those working at local
level to plan, coordinate and implement comprehensive strategies to
prevent and manage overweight and obesity. It focuses on multi-sector
partnership approaches. although specifcally tailored for england,
much of the information and guidance in the toolkit applies equally
to Scotland, Wales and northern Ireland.
this toolkit and updates can be downloaded from
www.heartforum.org.uk or www.fph.org.uk or www.dh.gov.uk.
these websites provide up-to-date information about developments
in the area of overweight and obesity.
Foreword 1
foreword
We are all aware from media reports that overweight and obesity are on the increase. In England
almost two-thirds of adults and a third of children are either overweight or obese. Future trends
provided by the Government Offce for Science’s Foresight make it clear that without effective
action this could rise to almost nine in ten adults and two-thirds of children being overweight or
obese by 2050.
This is why tackling overweight and obesity is a national government priority. The national obesity
strategy, Healthy Weight, Healthy Lives: A cross-government strategy for England,1 set out the
frst steps to meeting the challenge of excess weight in the population with a new ambition: to be
the frst major country to reverse the rising tide of obesity and overweight in the population by
ensuring that everyone is able to 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.
However, this ambition will only be met if the whole of society is engaged. Primary care trusts and
local authorities will need to play a key role in empowering their communities to succeed in
tackling the obesity epidemic. The Government has already provided local areas with guidance on
what they can do to promote healthy weight and tackle obesity. Healthy Weight, Healthy Lives:
Guidance for local areas2 sets out a framework that primary care trusts and local authorities can
use to develop local plans. This toolkit, Healthy Weight, Healthy Lives: A toolkit for developing
local strategies, will provide more detailed support for local areas and will help you to consider the
best approaches to tackling overweight and obesity in your local area, taking into account the
specifc needs of your local population and the socioeconomic and psychological experiences they
may face.
This is a fast-moving arena. That is why we are committed to ensuring that local areas are kept up
to date with the latest developments by regular online updates. We hope that the toolkit will help
you to develop the most appropriate and successful strategy for the needs of your community.
Let’s make England the frst country to successfully curb the obesity epidemic.
Sir Liam Donaldson Professor Klim mcPherson Professor alan maryon-Davis
Chief Medical Offcer Chair President
National Heart Forum Faculty of Public Health
2 Healthy Weight, Healthy Lives: A toolkit for developing local strategies
executive summary
Nearly a quarter of people in England are obese.3 Unless we take effective action, it has been
estimated that about one-third of adults and one-ffth of children aged 2-10 years will be obese
by 2010,4 and nearly 60% of the UK population could be obese by 2050.5 This could mean a
doubling in the direct healthcare costs of overweight and obesity, with the wider costs to society
and business reaching £49.9 billion by 2050.5
The rapid increase in levels of overweight and obesity cannot be attributed to genetic changes as
it has occurred in too short a time period. This means that the growing health problems are likely
to be caused by behavioural and environmental changes in our society. Added to this, overweight
and obesity are health inequalities issues, with people from the lowest socioeconomic groups
most at risk.
This toolkit has been designed to follow on from Healthy Weight, Healthy Lives: Guidance for
local areas2 and to provide further support for developing a local strategy to tackle overweight
and obesity. It is primarily aimed at commissioners of public health services in both
primary care trusts and local authorities. The document is not compulsory but is intended to
help local multi-agency teams – including public health, health promotion and primary care
professionals, and strategic planners in both the NHS and local government in England – to
develop and implement strategies and action plans to tackle the year-on-year rise of overweight
and obesity through prevention and management.
The toolkit provides a comprehensive collection of information and tools to assist with delivering
current national and local policies. It purposefully does not provide detailed information about
care and treatment of overweight and obesity, but rather offers signposts to well established and
comprehensive material covered elsewhere. The toolkit complements the National Institute for
Health and Clinical Excellence (NICE) clinical guideline Obesity: The prevention, identifcation,
assessment and management of overweight and obesity in adults and children,6 the Foresight
programme Tackling obesities: Future choices,5 and the Government’s obesity strategy, Healthy
Weight, Healthy Lives: A cross-government strategy for England.1 It supersedes Lightening the
Load: Tackling overweight and obesity. A toolkit for developing local strategies to tackle
overweight and obesity in children and adults.7
The toolkit is designed to equip local action teams with useful information and tools to meet and
address the challenge of tackling overweight and obesity. It has fve sections:
Section A Overweight and obesity: the public health
problem
This section focuses on the public health case for developing a local overweight and obesity
strategy. It discusses the terms overweight and obesity; provides data on the prevalence and
trends of overweight and obesity in children and adults; discusses the health risks of excess
weight and the health benefts of losing excess weight; gives current and predicted future direct
and indirect costs of overweight and obesity; and fnally examines the causes of overweight and
obesity as detailed by Foresight.5