HEALTHY WEIGHT STRATEGY

Report by Fiona Clarke, Health Promotion Specialist – Food and Nutrition

The Board is asked to:
  • Endorse the strategy.
  • Note the key considerations and actions required to further develop multi-agency commitment to the strategy.
  • Note the need to scope and develop interventions, including those that are multi-agency with local authority partners, and meet the consequent requirements for funding.

1Background and Summary

Obesity is a complex issue which results from failure to maintain a neutral energy balance in a fast changing world. There are many influences on energy balance which can be broadly grouped into:

  • Physical – Built environment, transport
  • Psychosocial influences
  • Activity levels
  • Eating habits
  • Physiological factors

Psychosocial influences include the need for more time and convenience, the desire to reduce stress, availability of greater choice and the desire for short term rewards or compensations. The global market for food production and distribution is also important.

The Highland Healthy Weight strategy has been developed in response to calls for action on overweight and obesity from the World Health Organisation, the Scottish Government and in response to local need. There are a number of initiatives and plans which are already contributing to obesity prevention and treatment in Highland and Argyll and Bute Council area, including Argyll and Bute Food and Health Strategy, Food First (work with those on low incomes in Inverness), ‘Hungry for Success’ (improving food in schools). However, work undertaken over the past 18 months by a multi agency working group on healthy weight has identified some gaps. There are many opportunities for action, and until development of this strategy, there has been no local overview of policies, evidence, action and interventions to promote healthy weight. Over two thirds (66.2%) of the adult population in the Highland and Argyll and Bute Council area are overweight or obese, slightly higher than the national figure (65.4%). The Highland healthy weight strategy brings together the social, infrastructural and environmental factors that need to frame the planning and implementation of policies for obesity.

The Highland Joint Health Improvement Plan (2004-2007) called for the development of a Healthy Weight Strategy whilst recognising that work on obesity needs to be part of a wider food and health policy as well as making links to transport, the environment, different life stages and isolated communities.

The aim of this strategy is to promote healthy weight among the people of Highland and Argyll and Bute Council areas by working towards targets to improve diet and physical activity levels, as well as providing a framework for action on the environment in which people live and the treatment of overweight and obese individuals.

2Strategy Development

A multi agency steering group was convened to develop a co-ordinated approach to promoting healthy weight. The strategy presented here reflects the work of that group, includes feedback received from a multi agency consultation, and overview of current activity, a review of the evidence for effective action, a gap analysis and opportunities for further action.

Highland, like the rest of the UK, has a population where overweight has become usual, rather than unusual. Obesity is a consequence of abundance, convenience and underlying biology and thus the strategic aim of the strategy is to improve the health and well-being of the people of Argyll and Bute and Highland by working towards targets which improve diet and physical activity levels. This will involve changing behaviour, the environment and if at all possible biology.

The objectives drawn from these strategic aims of the Highland Healthy Weight Strategy are:

1.To develop and implement initiatives which will contribute to the Highland population maintaining a healthy weight.

2.To increase the number of people who consume a healthy diet that is consistent with the UK Dietary Reference Values.

3.To increase the number of people who are physically active in line with the recommendations in the Physical Activity Strategy.

4.To make the greatest gains in those population groups who have the highest burden of obesity and poorest health outcomes.

5.To create environments which promote and encourage healthy eating and physicalactivity.

6.To develop and implement a care pathway for overweight and obese individuals.

Considerations

It is unrealistic to expect any regional strategy to have an impact on rates of obesity and overweight because of limited impact on factors such as national and European agricultural policy, the marketing and advertising of food, as well as food pricing and taxation. The objectives in the strategy focus on challenging but achievable targets.

There is a dearth of evidence based interventions for both the prevention and treatment of obesity. The need for urgent action has to be balanced with the need for longitudinal data collection and proven clinical and environmental interventions. The strategy is based on the best available evidence and gives greater priority to primary care based interventions. There are gaps in the evidence in relation to the effectiveness of interventions and so it will be important to implement a range of activities and pilot interventions that will add to the evidence base.

Crucial requirements to developing the strategy and interventions at a range of levels are:

  • Commitment to the strategy by key Community Planning partners, including identifying leadership and governance arrangements within each organisation and through a multi agency strategy group. This needs to be carefully thought through.
  • A cross-cutting strategic approach involving implementation of evidence based interventions which are likely to have an impact on healthy weight in the Highland and Argyll and Bute populations.
  • Prioritisation of weight problems and a healthy weight perspective maintained when developing strategies and policies and considering funding choices. Plans should be ‘weight-proofed’, that is, take account of any impact or potential impact on the issue of healthy weight.
  • The involvement of both private and voluntary sector organisations.
  • Review of the membership and role of the healthy weight strategy group to ensure it is fit for purpose in delivering on this complex issue, including developing monitoring and evaluation of the strategy
  • Integration with other joint plans and processes, so that Community Health Partnerships (CHPs) produce local action plans.
  • Direct work in communities should be considered a key element of developments and built in to local action plans.

Next steps:

A number of stakeholders have been involved in the development of this strategy and have taken part in the consultation. The current draft reflects responses to the consultation and the endorsement of the strategy which will be further developed by Highland and Argyll and Bute Councils.

In NHS Highland, timetabled, costed action plans will be derived from this strategy in collaboration with the CHPs and the Specialist Service Unit. These plans will build on rather than duplicate existing work, such as the Argyll and Bute Food & Health Action Plan, and will be part of the Community Health Partnership’s Health Improvement Plans with the expectation that implementation will begin in 20008/09 subject to the lead in time required for redesign and resourcing. It is also anticipated that further joint work will be undertaken between the NHS and its local authority partners as the nature and scope of the work is clarified and formally agreed. Joint working at a strategic planning level in particular needs to be strengthened. This will mean inclusion in the Argyll and Bute and Highland Joint Health Improvement Plans.

Initial outputs will be:

  • A tool kit for practitioners – a practical resource containing patient pathways, examples of good practice, resources and signposting for all elements of the strategy.
  • A performance framework – for monitoring the implementation and effectiveness of the strategy.
  • Guidance for CHPs and other stakeholders on the development to local delivery plans.

For health service interventions, accountability will be through the existing NHS process of performance review of delivery through the CHPs and the Specialist Services Unit. It would seem sensible to use existing systems of accountability for partnership working for any collaborative work with partner local authorities but this requires further discussion.

3Contribution to Board Objectives

The Healthy Weight strategy will contribute to:

HEAT target H0.4T - 50% of all adults accumulating 30 minutes per day of physical activity on 5 or more days per week

New LDP targets

H1: reduce mortality from Coronary Heart Diseased among the under 75s in deprived areas

H3: achieve agreed completion rates for child health weight intervention programme by 2010/11.

As part of one of the 5 cross- Government strategic objectives:

The increasing burden of disease, disability and premature death due to rising levels of overweight and obesity in children and adults is stemmed.

4Governance Implications

  • Staff Governance – this strategy is for everyone who lives and works in Highland and Argyll and Bute, including all staff of NHS Highland, and thus has implications for staff as individuals and for their interactions with others.
  • Patient and Public Involvement – Public engagement will be developed further; it is anticipated that the Equality and Diversity Impact Assessment will highlight various elements of the strategy for patient and public involvement such as the patient pathway; aspects of community development; working in education etc. The strategy will be published and made available in a variety of different formats.
  • Clinical Governance - the patient care pathway will be based on the best available evidence and will require a change in interventions with patients, communities’ and referral procedures.
  • Financial Impact – it is unrealistic to implement this strategy with no dedicated funds. This strategy will require specific investment. Proposals for specific initiatives have or are being developed eg: Secondary care service for the treatment of obesity; development of community food work, and the North of Scotland anticipatory care proposal. Implementation of key elements within the strategy will depend on the availability of financial resource.
  • There is a need to consider governance implications for other partner organisations. The Single Outcome Agreement (SOA) will be key to this, as Council service plans will be expected to demonstrate a link to outcomes in the SOA. This will be linked to the electronic performance management system which Argyll & Bute Council is developing. Council budget will be linked to the process and the Council will be expected to demonstrate service delivery in relation to the outcomes, indicators, targets within the SOA. The Scottish Government will be expecting Community Planning Partners to be involved in the SOA process from 2009.

5Impact Assessment

An impact assessment will be completed in February 2008.

Fiona Clarke

Health Promotion Specialist – Food and Nutrition

Public Health

25 January 2008

1

Draft Highland Healthy Weight Strategy

January 2008

Working with you to make Highland the healthy place to be

Contents

Contents

Healthy Weight Strategy in Highland - why weight?

Executive Summary

1.Introduction

1.2National and International Context

1.3Local context

1.4 Developing a Healthy Weight Strategy

1.5Aims and Objectives

2. Overweight and Obesity

2.1Definition

2.2Incidence

2.3Consequences

3.The Highland Framework

3.1Principles

3.2Process

The influences that affect weight

Mapping of current activity in Highland

3.3Key Findings from the Mapping Exercise

4.Opportunities for Action

4.1Cross-cutting themes (tree branches)

4.2Maternal and Child Health

4.3Childcare, Preschool and Schools

4.4Neighbourhoods and Communities

4.5Work Place

4.6Managing Healthy Weight

4.7Lifestyle and Emotional Health

4.8Deprivation

4.9Media, Marketing and Food Supply

4.10Evaluation

5.Monitoring

6.Conclusions

7.Reference

Appendix 1: National Strategies which have an impact on Healthy Weight

Appendix 2: Local Strategies which have an impact on Healthy Weight

Appendix 3: Membership of the Healthy Weight Steering Group

Appendix 4: Mapping Exercise - Initiatives relating to healthy weight in Highland

Description of Initiatives

Appendix 5: Mapping Exercise - Ages and Stages – Initiatives relating to healthy weight in children

Description of Initiatives

Healthy Weight Strategy in Highland- why weight?

Executive Summary

Will be added once the strategy is approved by stakeholders.

1.Introduction

This is a draft strategy, awaiting final approval from the Highland Council and Argyll and Bute Council.

This strategy is for everyone living and working in Highland, Argyll and Bute. The number of overweight and obese people living in the area has risen alarmingly in recent years and this has serious implications for the lives of individuals, the health systems and also the local economy.

In Scotland, over 60% of the adult population are overweight or obese, one in every five children is in the unhealthy weight range, and levels are predicted to increase. This is often described as an ‘obesity epidemic’ and the majority of the population are under pressure.

Interventions which aim to promote a healthy weight often focus on food and/or activity, yet no matter how individually sensitive, Healthy Eating and Physical Activity promotion will not work as long as our environment encourages us to eat high calorie foods, and reduces our opportunities to be physically active during our daily lives. Some people call this an ‘obesogenic’ environment.

However, even though obesity has dramatically increased over the past 25 years, evidence for effective interventions and prevention strategies, is limited. What we do know is that action is needed at many levels, and this strategy acknowledges the need for action at a European and National level as well as locally. The prevention and treatment of obesity will be influenced by for instance, taxation policies, social welfare benefit reform, European Unionagricultural policy, changing community environments, and increasing the availability of affordable healthy food.

What we need is a broader system change. We need to shift community norms and resources so that a healthy lifestyle is affordable, acceptable, and easier to achieve than it is today, for all members of society. Clearly, system change requires many organisations to act, thus the development of this strategy has been with the involvement of many agencies, working in partnership to examine current activity; the evidence for effective action; roles and responsibilities, and outline opportunities for action. The strategy aims to take an environmental view of the influences on weight which extend beyond individual responsibilities. Whilst the consequences of living in an environment which promotes over consumption of food and sedentary behaviour are not easy to overcome there are strategies that can help.This strategy aims to provide guidance for a co-ordinated, consistent, and comprehensive approach to promoting healthy weight in Highland.

1.2National and InternationalContext

Strategic and policy guidance is essential for this work to be successful. The Scottish Government has tasked NHS Boards with reducing the prevalence of obesity in the adult population and has identified obesity as one of the five cross-Government themes. In support of this,Health Scotland commissioned a review of obesity policies in 14 developed countries to inform Scottish efforts (Crombie et al, 2005). The review concluded that current policymaking is largely formative and at the exploratory stage with no more than a ‘laundry list’ of recommendations with no commitment to action; and no fiscal or legislative support; and that strategic approaches targeting macro-level environmental change were notably missing.The authors concluded that ‘the problems posed by obesity completely overshadow the efforts being made to tackle them.’ A discussion paper and report with a stakeholder conference followed this review and a National Strategy for Healthy Weight inScotland is awaited.

In recent years the Executive has shown great commitment to health improvement, and there are a number of important and relevant policy drivers which have had a major influence on health improvement throughout Scotland and which should contribute to a coherent approach to healthy weight (Appendix 1).

Internationally, the World Health Organisation has developed calls to action on overweight, as for the first time the proportion of the population that is overweight exceeds those that are underweight. (WHO: Obesity Prevention 2002).

1.3Local context

The national drive to improve health has been picked up locally and there are already many initiatives and plans which will be contributing to obesity prevention and treatment in Highland, Argyll and Bute (Appendix 2). Joint Health Improvement Plans have been developed in both areas and set out a jointly agreed strategic framework for improving health as part of the Community Plan. The Highland JHIP (2004 - 2007) called for the development of a Healthy Weight Strategy whilst recognising that work on obesity needs to be part of a wider food and health policy and make links to transport, different life stages and isolated communities.

1.4 Developing a Healthy Weight Strategy

A Healthy Weight steering group proposed a co-ordinated approach to promoting healthy weight. Group membership included representatives from all key stakeholders including public health, education, transport and the built environment, primary and secondary health care, recreation, sport and environmental sustainability sectors. (Appendix3)

The strategy presented here reflects the feedback received from consultations, an overview of current activity, a review of the evidence for effective action, a gaps analysis and outlines opportunities for further action.

1.5Aims and Objectives

The aim of the Highland Healthy Weight Strategy is:

  • to improve the health and wellbeing of the people of Highland, Argyll and Bute by working towards targets which improve diet and physical activity levels.

The objectives of the Highland Healthy Weight Strategy are:

1.To develop and implement initiatives which will contribute to the Highland population maintaining a healthy weight.