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Tackling Childhood Obesity

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First 'whole system' NICE guidance, focussing on prevention as ... Minimise sedentary activities during play time. Provide regular opportunities for enjoyable ... – PowerPoint PPT presentation

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Title: Tackling Childhood Obesity


1
Tackling Childhood Obesity
  • Using the NICE guidance
  • North East Regional Conference
  • 3rd May 2007
  • Dr Ken Snider

2
The guidance
  • First whole system NICE guidance, focussing on
    prevention as well as treatment
  • Commissioned by DH and Welsh Assembly
  • Aims to
  • Stem the rising prevalence of obesity and
    associated diseases
  • Increase effectiveness of prevention
  • Improve the care provided to obese patients
  • Limited by scope to age two and above

3
Need for the guidance - 1
Overweight (between 85th 95th centiles)
Obese (above 95th centile)
Percent
Durham Dales
Easington
Sedgefield
Hartlepool
Middlesbrough
Redcar
Stockton
North East
England
Cleveland
SHA
4
Need for the guidance - 2
Obese (above 95th centile)
5
The shape of things to come?
6
Conditions associated with obesity
  • Children and teenagers
  • hypertension
  • hyperinsulinaemia
  • dyslipidaemia
  • type 2 diabetes
  • psychosocial dysfunction
  • exacerbation of existing conditions
  • orthopaedic problems
  • Adults
  • type 2 diabetes
  • coronary heart disease (CHD)
  • hypertension
  • various cancers
  • osteoarthritis

7
(No Transcript)
8
The guidance - format
  • Prevention comprehensive, whole system approach
  • Identification Body Mass Index (BMI)
  • Assessment algorithms
  • Management lifestyle, drugs, surgery as a last
    resort
  • Information for the public on prevention and
    treatment

9
Who the guidance is for non NHS
  • Education sector early years and schools
  • Employers
  • Local authorities and partners
  • Community safety
  • Streets and parks
  • Urban planning
  • Leisure services
  • Self help and community settings
  • The public

10
Who the guidance is for - NHS
  • PCTs managers and health professionals
  • Primary care including GPs, nurses
  • Secondary care - paediatrics, adult medicine,
    dietetics, clinical psychology, etc
  • Specialist obesity services incl. surgery

11
Monitoring implementation
  • Implementation in the NHS will be monitored by
    the Healthcare Commission
  • No absolute requirement for implementation in
    other sectors, but authoritative as production
    involved a wide range of stakeholders and content
    was consulted on widely

12
Recommendations for local authorities
  • Work with local partners to create and manage
    more safe spaces for incidental and planned
    physical activity
  • Address as a priority any concerns around safety,
    crime and inclusion
  • Provide facilities and schemes such as cycling
    and walking routes, cycle parking, area maps and
    safe play areas
  • Make streets cleaner and safer, through measures
    such as traffic calming, congestion charging,
    pedestrian crossings, cycle routes, lighting and
    walking schemes

13
Recommendations for local authorities ctd
  • All relevant workplace policies should support
    the local obesity strategy
  • Work with the local community to identify
    environmental barriers to eating healthily and
    being physically active
  • Ensure building designs encourage the use of
    stairs and walkways
  • Encourage local shops and caterers to promote
    healthy food and drink choices

14
Recommendations for early years settings
  • Minimise sedentary activities during play time
  • Provide regular opportunities for enjoyable
  • active play and structured physical activity
    sessions
  • Implement Department for Education and Skills,
    Food
  • Standards Agency and Caroline Walker Trust (see
  • www.cwt.org.uk) guidance on food procurement and
  • healthy catering
  • Involve parents and carers

15
Recommendations for schools
  • Head teachers and chairs of governors, in
    collaboration with parents and pupils, should
  • assess the whole school environment
  • ensure school policies help children to eat a
  • healthy diet, be physically active and maintain
    a healthy weight
  • use a whole-school approach to develop life-long
    healthy eating and physical activity
  • practices

16
Recommendations for schools - ctd
  • Ensure school policies and the schools
    environment encourage physical activity and a
    healthy diet
  • Teaching, support and catering staff should have
    training on how to implement healthy school
    policies
  • Establish links with health professionals

17
Recommendations for workplaces
  • Ensure policies encourage activity and healthy
    eating
  • Provide opportunities for staff to eat a healthy
    diet through promotion of healthy choices in
    restaurants, hospitality, vending machines and
    shops, in line with Food Standards Agency
    guidance

18
Self-help, commercial and community settings
should
  • help people decide on a realistic healthy target
    weight
  • focus on long-term lifestyle changes
  • address both diet and activity, and offer a
    variety of approaches
  • use a balanced, healthy-eating approach
  • offer practical, safe advice about being more
    active
  • include some behaviour-change techniques
  • recommend and/or provide ongoing support

19
Key recommendations for the NHS
  • Managers and health professionals in all primary
    care settings should
  • ensure that preventing and managing obesity is a
    priority, at both strategic and delivery levels
  • dedicate resources for action and training
  • consider endorsing self-help, commercial and
    community weight management programmes if they
    follow best practice

20
Implementation tools
  • Costing tools
  • costing report
  • costing template
  • Guide to useful resources
  • Audit criteria
  • Available from www.nice.org.uk/CG043

21
Costs of implementing the guidance
22
Potential savings
23
Key implementation issues
  • Engaging others to agree relative priority and to
    obtain commitment
  • Working in partnership to produce (or review) a
    local action plan and to agree priorities for
    early implementation
  • Agreeing and commissioning secondary and tertiary
    care service developments
  • Securing the resources
  • Providing training

24
Some Ps for discussion
25
Priorities
  • What relative priority should stopping the
    childhood obesity epidemic have?
  • What are the current costs in terms of morbidity,
    mortality, economic costs?
  • What would the benefits and savings be from
    effective implementation of the guidance?
  • What will be the costs of failure?

26
Prevention
  • We all know that lots is already being done
  • Whatever has been done up to now, it hasnt
    worked! (Prof. Peter Littlejohn)
  • Do we need a fresh approach?

27
What can we learn from fresh?
  • Determination and commitment
  • A regional priority
  • Resourced staff, premises, materials, etc
  • Effort from regional to local levels
  • Partnership working
  • What else?

28
People and passion
  • Changing the culture popular and organisational
  • Knowledge, attitudes, behaviour
  • Education, empowerment, environment
  • Not just a cosmetic issue obesity is more
    harmful than smoking, heavy drinking or poverty

29
Other ponderables
  • Partnerships gaining commitment . and
    investment
  • Primary care will this guidance help?
  • Performance and service development capacity
    and commissioning, training
  • Publicity using the media to change the culture
  • Probability of success - ?

30
What needs to be in place?
  • Agreement of relative priority at all levels by
    NHS and partners, with commitment and investment
    i.e. full engagement
  • Integrated regional and local action plans with
    agreed priorities, objectives and timescales
  • Dedicated resources for prevention, training,
    service development, etc
  • An audit cycle to monitor implementation and
    effectiveness
  • Surveillance and monitoring
  • Relevant research to inform further action

31
also
  • Commitment
  • Determination
  • Optimism
  • Guile
  • Hard work

32
Finally
33
What about the under twos?
  • the risk of obesity starts in the womb and grows
    in infancy

34
www.nice.org.uk/CG043
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