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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 ... – PowerPoint PPT presentation

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Title: Developing a Shared Approach to Tackling Obesity in Birmingham


1
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 0121 446 1025

2
Format
  • About Birmingham
  • Obesity Strategy, Care Pathway and Service
    Development local NHS collaboration
  • Children and Young Peoples Nutrition Health
    Task Force
  • Implementation
  • Next steps

3
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

4
Obesity Strategy Development
5
NHS Obesity Strategy Development
  • Background
  • Stakeholders
  • Timescale
  • Birmingham Solihull Strategic Framework
    individualised to each PCT
  • Care Pathways for Adults and Children

6
A Strategy describes .
  • Where we are now
  • Where we want to be
  • How we will get there

7
Structure
  • Background
  • Policy Context
  • Aims and Objectives
  • Evidence
  • Action Plans

8
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

9
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

10
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.

11
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


12
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
13
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
14
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

15
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

16
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

17
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

18
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

19
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

20
So What?
21
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

22
Children
23
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

24
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

25
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!

26
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

27
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.

28
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

29
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

30
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

31
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

32
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

33
Level 3 Watch-It Programme
  • Watch IT
  • MEND
  • Paediatric Dietetic Service

34
Level 4 Specialist Obesity Service
  • Level 4 service currently being devised by
    Consultant Endocrinologist, Childrens Hospital

35
ADULTS
36
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
37
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

38
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
39
Level 1 Stair Climbing
  • Workplace initiative to improve activity levels
    and incorporate as part of daily routine

40
Level 1 Healthy Lifestyles Grant Programme
  • Grant programme aimed at developing community
    based initiatives to prevent and tackle obesity

41
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.
42
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.


43
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.
44
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)
45
Next Step
  • Combined obesity strategy for Birmingham

46
Thank-You
  • Linda Hindle
  • Consultant Dietitian in Obesity
  • Birmingham East and North PCT
  • Tel0121446 1025
  • Email linda.hindle_at_benpct.nhs.uk
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