OBESITY HNA

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OBESITY HNA

• Karen Jackson
• Public Health
• 2012

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AN OVERVIEW

• Why HNA?- aim
• Headlines from obesity HNA
• Adults children with learning disabilities
• Revised obesity strategy framework for action
• Way forward for learning disabilities

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THE CHANGING CONTEXT
-2005-2010
-Halt the rise in obesity
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OBESITY HNA What It Involved

• To inform refresh of Dudleys obesity strategy
• Includes reviews of
• national and local data obesity lifestyles
• services and interventions currently in place
• evidence on emerging interventions
• stakeholder views,
• progress of 2005-10 strategy
• Makes recommendations,
• Proposes a revised framework for action,
  strategic objectives, monitoring and outcomes
  measures

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THE OBESITY PICTURE FOR DUDLEY
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THE OBESITY PICTURE FOR DUDLEY
51,317 People Obese138,532 People Overweight
and obese
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THE OBESITY PICTURE FOR DUDLEY
YEARLY RATES OF INCREASE YEARLY RATES OF INCREASE YEARLY RATES OF INCREASE
2004 2009
Obese 0.7 0.8
Overweight 0.3 0.0
Overweight obese 1.0 0.8

• All of current increase due to obese category
• At current rates 24.9 obese by 2016
• Halt the rise by 2016- balance of 9400 less
  people moving into the obese category

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THE OBESITY PICTURE FOR DUDLEY
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THE OBESITY PICTURE FOR DUDLEY
Reception Year Obesity Prevalence
2006/07() 2007/08() 2008/09 () 2009/10 () 2010/11 () point av yrly change
Dudley 11.4 11.4 9 10.2 10.7 -0.18
W.Mids 10.4 10.0 10.1 10.5 _ 0.03
England 9.9 9.6 9.6 9.8 _ -0.03
Year 6 Obesity Prevalence
2006/07() 2007/08() 2008/09 () 2009/10 () 2010/11 () point av yrly change
Dudley 23.4 20.1 21.0 23.8 22.4 -0.25
W Mids 19.1 19.6 19.8 20.5 _ 0.47
England 17.5 18.3 18.3 18.7 _ 0.4
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DUDLEY HEALTHY LIFESTYLES

• Adults Increase in physical activity-46 to 49
  (2004 to 2009,)- but more so in the least
  deprived than the most deprived areas. BME, women
  and girls, older people and overweight and obese
  people - lower activity levels.
•  
• Children 70 of year 5/6 year olds get enough
  exercise nationally, which declines to 62 by
  years 8/10 - more so for girls Less children
  cycle or walk to school than in previous years.
•  
• Adults5 a day FV intake -remained constant at
  25.6 (2009), -increased in deprived areas.
  Males, BME and deprived areas have a lower 5-day
  levels. 86.9 of the population eat a less than
  healthy diet
• Children 5 a day FV intake -increased slightly
  for children since 2004. Declines between school
  years 5/6 and 8/10. Children are consuming high
  levels of fatty and sugary snacks on a daily
  basis.
• Breast feeding Initiation and duration rates
  are falling and lower than W.Mids and England .
  Year 8/10 children 2/3rds would not consider
  breast-feeding

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HEALTH NEEDS/RISK VARIES

• There are specific groups that are more at risk
  of developing obesity-
• Children from low income families
• Children from families where at least one parent
  is obese
• Looked after children
• Young parents- lt21
• Adults- unemployed or in routine/semi routine
  jobs
• Older people
• People of Asian origin
• Ethnic groups with higher than average prevalence
• People with physical and learning difficulties
• People with mental health conditions

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CONCLUSIONS GAPS

• Robust initiatives and services in place, but
  impact on public health outcomes not yet
  realised.
• Interventions - not yet at full implementation
• takes longer than 5 years for the impacts of
  public health programmes to come to fruition
• Some programmes have limited resources and are
  achieving only a small reach
• New action plan - build on these interventions
• 2005 obesity strategy delivery framework still
  valid to add life-course at-risk population
  groups

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REVISED STRATEGIC DELIVERY FRAMEWORK
Progressive universalism- universal and targeted
in each section
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RECOMMENDATIONS

• Tier 1 Tackling the Obeseogenic Environment
• Expand reach and impact of programmes increasing
  access to healthy food , active travel, urban
  design and planning
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• Tier 2 Lifestyles Attitudes, Knowledge and
  Skills
• Public health campaign to raise the publics
  consciousness
• Early years primary school age, breast-feeding
  healthy workplace programmes
•  
• Tier 3 Treatment Pathways for Adults and
  Children
• Increase referrals, Improve long-term weight loss
  outcomes

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SO WHAT ABOUT LEARNING DISABILITIES-why at higher
risk?

• Higher prevalence of overweight and obesity than
  the average population 1 in 3 obese V 1in 5
• Less than 10 of adults with learning
  disabilities in supported accommodation eat a
  balanced diet, sufficient intake of FV
• Carers generally have a poor knowledge about
  healthy diet
• 80 of adults with learning disabilities not
  taking enough exercise
• More likely than the general population to have
  avoidable, diet related ill health and a
  shortened life expectancy type 2 diabetes is
  double

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LEARNING DIFFICULTIES- local prevalence and risk?

• National prevalence rates 25/1000 with mild and
  moderate learning difficulties, 3-4/1000 with
  severe learning disabilities
• Locally
• ? 6023 adults- mild/moderate LD , 2008 obese
• ? 722-963 adults severed LD, 241-321 obese
• QOF data (Sept 2011) 53/54 practices
• 1250 adults mild/moderate severe LD
• 984 adults- on LD register (moderate/severe),
• 805 (81.8) also on obesity register
• 59 male, 41 female
• Obesity most prevalent for 35-54 year olds- as
  general population
• Schools Health Behaviour Data suggestion of less
  healthy lifestyle for children with LD

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WHAT DID THE SERVICE REVIEWS TELL US

• Environmental changes are universal and will
  benefit all- healthy towns, food for health award
• Many universal interventions will support people
  with learning difficulties (but need carer
  support or involvement, or need to be aimed at
  carers)
• Targeted services also in existence- for weight
  management
• Adults slimmers kitchen for LD,
• Children Seekers (ages 8 to 18 with LD)
• Data shortage
• Systematic measurement and referral of children
  with learning disabilities is patchy
• Outcomes from initiatives can be lower for LD
  clients

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SLIMMERS KITCHEN FOR LD
Referral Status Number Universal services
Total referrals 16
Did not attend (DNA) 1 6
Dropped out 1 6
Completed course 14 88
Weight loss 0-2.5 (completers) 8 57
Weight loss 2.5-4.9 4 29
Weight loss 5 1 7 27-55
No weight loss/gained 1 7
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SEEKERS- CHILDREN WITH LD
2009/10 Seekers (8-18 YRS) ALL PROGRAMMES
Accepted a place 8 261
Attended (rate ) 8 (100) 245 (67)
DNA rate 0 87 (33)
Completed (rate ) 6 (75) 145 (83)
Drop out rate 2 (25) 29 (17)
maintained or reduced BMI 1/8 (17) 84 (71)
reduced/maintained waist size 3(50) 67/80 (84)
Programmes 1 31
where monitoring data available
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FUTURE FOR LD

• Making reducing obesity a priority for all- at
  both strategic and delivery levels -
  implementation of the learning disability obesity
  charter
• Development and delivery of an obesity action
  plan for people with learning difficulties
• Monitoring data