Developing a Shared Approach to Tackling Obesity in Birmingham

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Developing a Shared Approach to Tackling Obesity
in Birmingham

• Linda Hindle
• Consultant Dietitian in Obesity
• Birmingham East and North PCT
• Email linda.hindle_at_benpct.nhs.uk
• Tel [phone]

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Format

• About Birmingham
• Obesity Strategy, Care Pathway and Service
  Development local NHS collaboration
• Children and Young Peoples Nutrition Health
  Task Force
• Implementation
• Next steps

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About Birmingham

• Population of almost 1 million
• Multi racial Inner City deprivation
• Served by-
• 1 City Council
• 1. Leisure Services Provider
• 3 PCTS
• Regional Children's Hospital
• 4 Acute Trusts
• 1 Mental Health Trust

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Obesity Strategy Development
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NHS Obesity Strategy Development

• Background
• Stakeholders
• Timescale
• Birmingham Solihull Strategic Framework
  individualised to each PCT
• Care Pathways for Adults and Children

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A Strategy describes .

• Where we are now
• Where we want to be
• How we will get there

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Structure

• Background
• Policy Context
• Aims and Objectives
• Evidence
• Action Plans

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Strategic Aims

• To work in partnership, to develop a range of
  approaches, to prevent and reduce obesity in the
  population as a whole, with particular reference
  to children and at risk groups.
• To develop a coordinated approach to the
  management of people identified as being
  overweight or obese with particular emphasis on
  encouraging self-management principles

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Strategic Objectives

• To develop partnerships with key stakeholders to
  realise a shared goal of halting the rise in
  obesity in Birmingham and Solihull.
• To ensure that obesity is embedded within other
  lead strategies and plans and linkages between
  these are made implicit.
• To develop information systems for the collection
  and use of data relating to overweight and
  obesity

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Strategic Objective cont.

• To identify inequity in access to opportunities
  for prevention and treatment of overweight and
  obesity in local communities and to work with
  local people, communities, voluntary and private
  sector agencies and local services to address
  these inequities.
• To ensure a consistent and effective approach to
  the prevention of overweight and obesity and
  weight management within primary care and partner
  services, particularly for children.
• To work with partners to develop and implement an
  evidence based care pathway for the management
  and treatment of obesity.

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Delivery Strands
The delivery element of the strategy has been
divided into 5 strands   1. Baseline data and
Monitoring schools Primary care 2.
Prevention macro measures at population
level (diet and physical activity) community
approaches workplace schools whole
family 3. Management of Weight
Loss community workplace schools
primary care 4. Specialist
treatment primary and secondary care
drugs surgery 5. Long-term
maintenance community/environment
supportive Long-term support follow-up


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Adult Obesity Service Care Pathway
Level 4
Secondary Care Morbid Obesity Service
Level 3 Primary Care Specialist Obesity Service
Level 2 Community/Primary Care Weight Management
Services
Level 1 Early Intervention and Prevention
Front line Staff (NHS, Council, Vol. Sector),
Health Trainers, On-line advice
Exercise on Prescription, walking, cycling
programmes etc. Leisure Services
Food Skills Courses, Food Access projects
Smoking Cessation Service
Commercial slimming on prescription
Pharmacy services
Tobacco strategy
Physical Activity Strategy
Commercial slimming clubs
Food Strategy
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Childhood Obesity Service Pathway
Level 4 Secondary Care Morbid Obesity Service
Level 3 Specialist obesity service Watch It,
Input from dietician, child psychologist
Community Paediatrician
Level 2 First line weight management service
provided by School Nurse, Health Visitor
Level 1 Early Intervention and Prevention
Front line Staff (NHS, Council, Vol. Sector),
Health Trainers, On-line advice
Food Skills Courses, Food Growing Projects
Sports Clubs - Activity Programmes
Healthy Schools
Healthy Start (Sure Start, Childrens Centre,
Breast Feeding)
Physical Activity Strategy
Media campaigns/ signposting service
Food in Schools
Community groups
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Birmingham Children and Young Peoples Nutrition
and Health Task Force

• Review of childhood obesity within Birmingham
  initiated by Health Overview and Scrutiny
  Committee in July 2003
• Identify local factors contributing to obesity
  which could be avoided
• Map impact of national policies and local
  programmes
• Explore, from community perspective, barriers to
  maintaining normal body weight
• Explore services available

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Report produced May 2004Findings/conclusions

• Current measures to tackle obesity in Birmingham
  are failing
• No coherent pan Birmingham inter-agency approach
• Services are not well developed or accessed
• Poor surveillance monitoring childhood obesity
  prevalence
• Schools should be part of solution to tackle
  obesity, however schools are also part of the
  problem
• Importance of food poverty cannot be
  underestimated

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Recommendations

• Establish a task force to develop a city action
  plan
• PCTs ensure data on childhood obesity is
  collected and services for obese children are
  provided
• Guidance for schools on food, drink and activity
  in schools
• Training for school governors

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Task Force Membership

• City Council Councillors
• BCC Learning Culture
• BCC Transportation
• BCC Local Services
• BCC Communications
• PCTs
• Children's Hospital
• Parent Representative
• BBC West Midlands
• School Governor
• School Meal Providers
• Health Education Unit
• Community Care
• West Midlands, Cycling Walking Coalition
• Nursery Representative
• Leisure Services
• Peer Advocate Childrens rights

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Action Plan

• Children and young people are physically active
  for at least one hour a day
• A choice of sport and physical recreation
  activities is included in before and after
  school programmes
• All nurseries, Children's Centres and youth
  settings are healthy places for children and
  young people to play, learn and develop
• All children and young people have access to
  fresh healthy food and easy access to drinking
  water at school

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Action Plan cont.

• The NHS provides practical advice, support and
  accessible services for children, young people
  and parents who need help with weight management
• Parents and others who care for children and
  young people are educated and trained on how to
  choose, prepare and cook healthy food
• The number of supermarkets and fast food outlets
  that promote and provide healthy food is
  increased
• They influence and change catering practices at
  mass entertainments events and outlets in the
  city

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So What?
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Benefits of Care Pathway for Service Development

• Consensus on service needs
• Identifying gaps in service
• Staff groups and partner organisations can also
  identify where they can contribute

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Children
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Villa Vitality!

• Partnership between HOB tPCT, BEN PCT, Aston
  Villa, Healthy Education Unit and Schools. Up to
  160 children per week
• Interactive activities-
• Physical activity coaching
• classroom and computer based healthy eating
• Develop Radio Programme Villain Radio
• Healthy Lunch
• Teacher Pack

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Level 1 Rowing Machines in Schools

• Partnership programme with BCC Education Dept.,
  Concept 2 and HoB schools
• Aims to increase physical activity levels,
  providing alternative to competitive/ team based
  sport
• Each school can claim up to 5 machines
• Concept 2 provides an internet support package
  for schools includes training programmes, lesson
  plans, distance awards, tips and training on
  technique.

• I like rowing because its healthy and I can
  keep fit. Other than Basketball, its the only
  thing Im good at. I feel more confident because
  I can do it by myself. Michael Gardener, Year 9

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Level 1 Active Kids Initiative

• Training local teenagers to deliver physical
  activity and healthy eating messages to other
  kids Yr 5

• Those delivering attain coaching qualification
  and training by dietitian in return for
  commitment to project

• Reinforces the importance of being active and
  finding an activity the you enjoy!

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Level 1 Face Fruits

• Local mums trained to deliver
• 2.5hr interactive sessions in Schools aimed at
  increasing understanding of fruit veg, their
  benefits, how to eat them, portions and variety.
• Sessions explain why we should try and eat 5 a
  day
• Children's faces are painted with images of 3
  fruits (from the School Fruit and Vegetable
  Scheme)
• Certificates are taken home with a picture of the
  children and 3 key health messages

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Level 1 Schools Dietitian

• Works across HoB and BEN primary and secondary
  schools
• Interactive events (assemblies, classroom
  sessions, parent sessions) on BoGH, 5-a-Day,
  Sugar and Fat Content
• 1-to-1 meetings with Healthy Schools
  Co-ordinators in schools
• Supporting establishment of School Nurse Led
  Weight Management Programme
• School food policy development, breakfast club
  establishment, menu planning, tuckshop advice
  etc.

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Level 1 Food Net 4 Children

• Nutrition team working alongside under 5s staff
  (HVs, Linkworkers, Nursery Nurses, childrens
  centres)
• Responsible for training and support to deliver
  on healthy eating and obesity prevention e.g.
  breastfeeding, weaning, toddler nutrition
• Work with health education service to develop and
  implement early years healthy setting status

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Level 1 Growing Gains

• CSV environment scheme in schools that aims to
  increase
• The range/variety of fruit and veg consumed by
  children
• Increase pupil / parent knowledge healthy diet
  and how fruit and veg contributes to this.
• Childrens understanding of how fresh foods are
  produced and how eating fresh foods can
  positively affect health.
• Teacher and pupil involvement in initiatives
  aimed at encouraging healthy eating
• CSV environment will work alongside schools to
  create vegetable plot and deliver 18 sessions in
  schools

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Level 1 Training Playground Assistants

• Working with Healthy Schools Team to train
  playground assistants and midday supervisors in
  HoB
• Project aims to increase physical activity levels
  among primary school aged children

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Level 2 School Nurse Led Weight Management
Programme

• Developed by Dietetic service
• 6 session programme
• Detailed session plans with worksheets, food
  diaries etc and comprehensive list of resources
  for each session
• Can be delivered on an individual or group basis
• Coventry University also working in partnership
  to develop SN-led weight management programme for
  Primary School children

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Level 2 Childrens Gym

• Gym at Aston Villa (NRF funded) for 8-16 yr olds
• Exercise on referral scheme for kids
• Open access for HoB residents
• Usage for HoB schools during the day

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Level 3 Watch-It Programme

• Watch IT
• MEND
• Paediatric Dietetic Service

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Level 4 Specialist Obesity Service

• Level 4 service currently being devised by
  Consultant Endocrinologist, Childrens Hospital

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ADULTS
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Level 1 Size Down

• 6 week self-referral course delivered by FHAs in
  community venues
• Based on pre-prepared session plans
• Weighing optional each week but need 2 measures
  for evaluation

LOSE WEIGHT FOR GOOD WITH A NEW FREE WEIGHT
LOSS GROUP COMING TO A VENUE NEAR YOU TAKE THE
CHANCE TO GET FREE HELP, SUPPORT AND ADVICE ON
HOW TO LOSE WEIGHT AND KEEP IT OFF!! GROUPS ARE
RUN BY FULLY TRAINED NHS PROFESSIONALS
I would like to be contacted about
the new weight loss groups Name_________________
_________________ Address________________________
__________________________________________________
_____________ Contact No ________________________
_____________
SIZE DOWN
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Level 1 Cook and Tastes

• Consist of
• Practical Cooking sessions led by Food Health
• Advisor (HOB 0.6 wte)
• Programme of 5 sessions or one-offs/taster
  sessions
• Participants cook healthy dishes, discussion
  education, looking at salt, sugar fat,
  increasing fruit and veg in meals
• Benefits
• Addresses lack of knowledge and skills, food
  culture, lack of access, and financial
  constraints
• Evaluation shows increase in fruit and veg intake
  (average 1.7 portions), and in cooking confidence
• Groups make comments showing wide ranging
  benefits e.g. reducing fat, sugar and salt,
  increasing fruit, veg, CHO and fibre, losing
  weight, understanding labels, taking up exercise

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Examples of Level 1 Service cont.
Walk 2000 Walk 2000
Way marked 2 Km walking routes in parks and open spaces to encourage people to become more active. Can be used with or without Walk Leaders. Routes and Maps on www.birmingham.gov.uk/walk2000
Commercial Weight Management Groups Commercial Weight Management Groups
Weight Management Groups such as Weight Watchers and Slimming World provide an effective method of supporting weight loss. These have been audited by the PCT to ensure they meet criteria in the NICE guidance for obesity
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Level 1 Stair Climbing

• Workplace initiative to improve activity levels
  and incorporate as part of daily routine

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Level 1 Healthy Lifestyles Grant Programme

• Grant programme aimed at developing community
  based initiatives to prevent and tackle obesity

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Examples of Level 2 Services
Practice Based Weight Management Clinics Practice Based Weight Management Clinics
Training and resources are being provided to enable Practice Nurses to run effective Weight Management Interventions within surgeries


Dietetic Service Dietetic Service
Opt-in by patient to a 45 minute assessment and up to 5-6 follow ups (can be groups), 1-2 months apart. Consists of behavioral/ lifestyle/ complex issues and advice on undertaking physical activity.
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Examples of Level 2 Services
EXERCISE ON PRESCRIPTION EXERCISE ON PRESCRIPTION
Exercise on Prescription BEN GPs refer patients who would benefit from increased activity levels to local leisure and fitness facilities. A leisure services health and fitness professional works with the patient to develop a personalised activity plan.


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Example of Level 3 Services
Specialist Obesity Service Specialist Obesity Service
Service to treat people with morbid obesity within a Primary Care setting. Run by a multi professional team including a GP, Specialist Dietitian and Cognitive Behavioural Psychologist, the service aims to be able to provide a more intensive approach than would generally be possible in Primary Care. Suitable for patients with morbid obesity for whom interventions in Primary Care have been unsuccessful. This service will ensure that all options have been tried before someone is considered for bariatric surgery.
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Examples of Level 4 Services
Surgery Surgery
Bariatric Surgery for certain cases and preferably where patients have been through all levels of the care pathway. (Heartlands, Walsall Manor)
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Next Step

• Combined obesity strategy for Birmingham

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Thank-You

• Linda Hindle
• Consultant Dietitian in Obesity
• Birmingham East and North PCT
• Tel[phone]
• Email linda.hindle_at_benpct.nhs.uk