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© Crown copyright 2008 283780 xp xk Sept08 (xxx) Produced by COI for the Department of Health. If you require further copies of this title visit: www.orderline.dh.gov.uk and quote: 283780/Healthy weight, healthy lives: A toolkit for developing local strategies or write to: DH Publications Orderline PO Box 777 HEALTHY WEIGHT, HEALTHY LIVES: London SE1 6XH Email: DH InformatIon reaDer BoX Policy Estates 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Weight, Healthy Lives: A cross government strategy for England; Healthy Weight, Healthy Lives: Guidance for local areas Superseded documents Lightening the Load: Tackling overweight and obesity action required N/A timing N/A Contact details National Heart Forum Tavistock House South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

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