Diet and nutrition

Good nutrition has a key role to play both in the prevention and management of diet-related diseases such as cardiovascular disease (CVD), cancer, diabetes and obesity (World Health Organisation, 2003). Healthy eating during childhood and adolescence is vital as a means to ensure healthy growth and development and to set up a pattern of positive eating habits into adult life. The promotion of evidence-based healthy eating messages is fundamental. Alongside this, it is necessary to ensure that guidelines concerning a nutritionally adequate diet are implemented to help prevent diet-related deficiencies and malnutrition in vulnerable infants, children and adults.

In the UK, the poorer people are, the worse their diet, and the more diet-related diseases they suffer from. This is known as food poverty. Poor diet is a risk factor for the UKs major causes of death: cancer; coronary heart disease (CHD); and diabetes. It is only recently that the immense contribution it makes to poor health has been quantified: poor diet is related to 30% of life years lost in premature death and disability (De Rose et al, 1998).

Tackling food poverty is recognised as key to achieving government targets on reducing inequalities; reducing illness from cancer and CHD; and improving the health of children and older people. However, action needs to be more than health professionals giving advice to individuals. It must change the ‘food environment’ – that is, accessibility, affordability, culture – in which people live (O’Neil, 2005).

Poor diet is a major health risk. It contributes to:

  • almost 50% of CHD deaths
  • 33% of all cancer deaths
  • increased falls and fractures among older people
  • low birth weight and increased childhood illness and mortality
  • increased dental disease in children.

This topic is most closely linked to:

 

Last updated: 2016-05-04 10:17:49
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1. What are the key issues?

Breastfeeding rates are amongst the lowest in England and the gap between Middlesbrough and England is widening.

At all ages, the proportion of people who are overweight and obese is higher than England.  Only half of adults eat a healthy diet.

There is low uptake of vitamin supplements through the Healthy Start scheme.

People in vulnerable groups and those with low incomes are at increased risk of having malnutrition from diet-related illness.

There is inconsistent advice on optimal nutrition from professionals.

There are high rates of dental decay in children, which will be significantly influenced by diet.  There is a four-fold difference in decay rates between the best and worst wards.

 

Last updated: 04/05/16

2. What commissioning priorities are recommended?

2012/01
Commission evidence-based best practice to maximise breastfeeding initiation and continuation
.  Ensure appropriate support services are in place and that health professionals are appropriately trained to provide support and consistent advice throughout antenatal and postnatal periods. Minor amendment in wording from 2012, remains a priority.

2012/03
Continue to commission services to increase and maintain the uptake of the national Healthy Start initiative
, in particular vitamin supplements, to both professionals and the target audience. Minor amendment in wording from 2012, remains a priority.

The following commissioning priority is new for 2016

2016/01
Commission services to improve children’s diet during early years of life
alongside commissioned work to promote healthy weight.

Other key priorities that are not necessarily related to commissioning include:

2012/02
Promote healthy eating
, making use of national campaigns and brands, and develop joint working with key sectors, such as planning and transport departments, to ensure the potential for physical activity and healthy eating is maximised, including the use of health impact assessments to address the causes of poor diet. Remains a priority.

2012/05
Develop consistent and integrated strategies among all health and social care providers to detect, prevent and treat malnutrition
.  Make appropriate training available to staff in all settings so that they have a common basic knowledge of nutrition, skills to promote a nutritionally adequate diet and are able to appropriate screen for malnutrition. Remains a priority.

2012/06
Ensure that good quality and healthy food is provided
by working with local public sector service providers, such as schools, hospitals, and prisons. Remains a priority.

The following priorities are new for 2016:

2016/02
Support the delivery of cookery training, especially for priority groups
in line with the emerging evidence base.

2016/03
Support primary schools with a core public health offer to deliver key public health messages
to help staff, children and their families to live healthily, safely and responsibly.

 

Last updated: 03/05/16

3. Who is at risk and why?

Nationally, there have been positive changes in the diet of British people over 15 years (Scientific Advisory Committee on Nutrition, SACN, 2008).  However, the latest National Diet and Nutrition Survey shows that overall; the UK population is still consuming too much saturated fat, added sugars and salt, and not enough fruit, vegetables, oily fish and fibre (Public Health England, 2014).  Additionally, there are still several areas of concern.

Age
Infants, children and young people

Rates of breastfeeding have increased for all age groups nationally (Health & Social Care Information Centre, 2010).  Nationally young mothers have 50% lower breastfeeding initiation rates and are then less likely to continue breastfeeding compared to older mothers. In South Tees only one in five teenage mothers breastfeed, compared with 50% of mothers aged over 30 (Department of Health, 2013).

It is estimated that 30% of hospital admissions would be avoided for each additional month of full breastfeeding and that 100% of full breastfeeding among 4-month-old babies would avoid 56% of hospital admissions in babies who are younger than 1 year (UNICEF, 2012).

The diets of under-fives in the UK are too low in vitamins A and C, iron and zinc and, for some groups of children, vitamin D.  Children’s diets also contain too few fruits and vegetables, too much of the type of sugars that most contribute to tooth damage, and too much salt (Caroline Walker Trust, 2006).

Children are eating too many unhealthy snacks.  Nearly three in ten secondary school pupils are snacking on crisps, sweets or fizzy drinks three or more times a day (British Heart Foundation, 2011).

Children aged 11-18 years have low iron intake, predominantly among girls where 46% have a mean daily intake below the recommended amount. This has implications for growth and development, and an increased risk of iron deficiency anaemia (Whitton et al. 2011).

Dietary habits seem to be set at an early age and seldom improve spontaneously (Frémeaux et al, 2011).

Young adults aged 19-24 years
The Scientific Advisory Committee on Nutrition (2008) found that:

  • Almost all (98%) young adults in this age group consumed less than the minimum recommended intake of fruit and vegetables. Mean consumption was 1.6 portions per day.
  • The group exceeded the maximum recommendation of added sugar (11% of food energy) with mean intakes sugar at 16% food energy. The main source was soft drinks with the average intake being 8-9 cans each week.
  • Almost one-third of women in this age group have a low vitamin D status.
  • Over 40% of young women had an iron intake below the recommended level.
  • One-fifth of young men had a salt intake above 15g per day; the recommended maximum is 6g.

Adults aged 65 years and over living in institutions
There is evidence of low intake and status for a number of vitamins and minerals for older people living in institutions. In October 2007, the Food Standards Agency issued nutrient and food-based guidance for UK institutions. Malnutrition was found to affect more than 1 in 3 adults on admission to hospitals, more than 1 in 3 adults admitted to care homes in the previous 6 months, and 1 in 5 in adults on admission to mental health units in the UK (British Association for Parenteral and Enteral Nutrition, 2011). Most of those affected were in the high risk category. Malnutrition is common in all types of care homes and hospitals, all types of wards and diagnostic categories, and all ages.  According to the report, much of the malnutrition present in institutions originates in the community.

Gender
Almost one-third of women aged 19-24 have a low vitamin D status.

Over 40% of young women had an iron intake below the recommended level.

One-fifth of young men had a salt intake above 15g per day; the recommended maximum is 6g.

Some men, following divorce, consume a poor diet due to their lack of cooking skills (Eng et al. 2005).

Socioeconomic status
Women from disadvantaged groups have a poorer diet and are more likely either to be obese or to show low weight gain during pregnancy and their babies are more likely to have a low birth weight. Mothers from these groups are also less likely to take folic acid or other supplements before, during or after pregnancy (Food Standards Agency, 2009).

Mothers in low socioeconomic position continue to have a strong impact on patterns of infant feeding (Health and Social Care Information Centre, 2010). Incidence of breastfeeding remains higher amongst mothers in managerial and professional occupations. However across the UK as a whole, breastfeeding rates increased in all socioeconomic groups (Health and Social Care Information Centre, 2010).

Mothers in lower socioeconomic groups are more likely to introduce solid foods earlier than recommended and their children are at a greater risk of both ‘growth faltering’ (that is, they gain weight too slowly) in infancy and obesity in later childhood (Armstrong et al, 2003). In addition, average daily intakes of iron and calcium are significantly lower, and rates of dental caries are significantly higher among children from manual groups compared with those from non-manual groups (Gregory et al. 1995; Health and Social Care Information Centre, 2015).

About 39% of people from low income groups report that they worry about having enough food to eat before they receive money to buy more. Similarly, about one-third (36%) report that they cannot afford to eat balanced meals. Overall, one-fifth of adults in low income groups report reducing the size of, or skipping, meals. Five per cent report that, on occasion, they have not eaten for a whole day because they did not have enough money to buy food (Food Standards Agency, 2008).

People have adopted a wide range of strategies to try and manage shortfalls in household income, and using food banks is often the last resort (Lambie-Mumford et al. 2014; Perry et al. 2014). However, more people are using them to make ends meet and the evidence suggests that need is driving demand, not supply (Cooper, Purcell & Jackson, 2014). Research in West Cheshire suggests that 47% of referrals to food banks were the result of problems with social security benefits with a further 20% the result of low, insecure incomes and 11% due to debt (Spencer, Ogden & Battarbee, 2015).

Many areas of dietary concern for people in lower socioeconomic groups were similar to that of the general population (Scientific Advisory Committee on Nutrition, 2008); but the following were more marked:

  • Average consumption of fruit and vegetables was lower with the average daily intake being 2.5 for women, 2.4 for men, 2 for girls and 1.6 for boys.
  • Intakes of added sugar, especially amongst children and saturated fats were above current recommendations.
  • Intakes of dietary fibre fell below current recommendations.
  • Evidence of inadequate nutritional status for iron, folate and vitamin D.
  • A substantial proportion of men and women were overweight or obese.

Between 2000/2001 and 2008-2001 there was a reduction in daily salt intake across the UK population; however, the socioeconomic gradient in dietary salt intake remained constant between both surveys. Consumption was highest in Scotland but the regional differences were not statistically significant (Ji & Cappuccio, 2014).

Ethnicity
People from South Asian and African-Caribbean communities tend to have a greater prevalence of vitamin D deficiency, which is thought in part to be due to darker skin tone (Scientific Advisory Committee on Nutrition, 2008).

Compared with white Europeans, South Asian children reported a higher mean intake of total energy, total fat, polyunsaturated fat and protein whilst carbohydrate (particularly sugars), vitamins C and D, calcium and iron were lower. These differences were larger for Bangladeshi children (Donin et al. 2010).

Compared with white Europeans, Black African and Black Caribbean children had lower intakes of total and saturated fat, fibre, vitamin D and calcium (Donin et al. 2010).

Vulnerable groups

Learning disabilities
People with a learning disability have a greater prevalence of health problems. It is well established that they are nutritionally vulnerable. Historically, many people with a learning disability lived in long-stay hospitals where many nutritional problems occur. These problems can include the following; underweight (this leads to less resistance to infections and less resistance to pressure sores); overweight; constipation; dehydration and specific nutrient deficiencies. The main other issue cited is the higher prevalence of obesity and underweight in this population (The Caroline Walker Trust, 2007).

People suffering mental ill health
Self-neglect and disorganised lifestyles may be a symptom of mental health needs and may result in malnutrition. The 2007 National Nutrition Screening Week found 19% of adults admitted to mental health units were ‘malnourished’. Poor nutrition has been associated with a number of mental illnesses such as depression (Dipnall et al, 2015).

Depression increases the risk of mortality by 50% and doubles the risk of coronary heart disease in adults. People with schizophrenia or bipolar disorder have higher rates of obesity, abnormal lipid levels and diabetes. They are also less likely to benefit from public health programmes and mainstream screening (Department of Health, 2011).

Emerging concerns
There is increasing concern about the consumption of energy drinks in adolescents and young adults (particularly males), especially in terms of sugar content, impact on behaviour including increased risk taking and substance misuse and adverse effects affecting the cardiovascular and neurological systems (Ali et al. 2015; Sanchis-Gomar et al. 2015). A survey by the European Food Safety Authority (2013) found that 21% of UK adults were high chronic consumers of energy drinks (European average 12%), with an equivalent figure of 19% in adolescents (European average 12%).  The average consumption for adolescents in the UK was 3.1 litres per month, the highest in Europe (average 2.1 litres). Concerns over behaviour have led some schools to ban them whilst others have gone further by encouraging local shops not to sell them to students. However, robust evidence in relation to behaviour is sparse or non-existent.

 

Last updated: 03/05/16

4. What is the level of need in the population?

Healthy Eating Behaviour
Public Health England reports a low level of healthy eating adults in Middlesbrough.  In 2014, in Middlesbrough only half of adults are eating the recommended 5 portions of fruit and vegetables a day which, although is the second lowest in the North East, is not significantly different from the England rate of 53.5%.

five-a-day fruit and veg, North East local authorities, 2014


Comparisons with local authorities within the same deprivation decile show that Middlesbrough has a higher rate than many of the other local authorities.

Five-a-day fruit and veg, Middlesbrough and benchmark LAs, 2014

Social groups of the population that consume fewer than 2 portions of fruit per day are listed in the following table. Mosaic groups H, L, M and O make up 54% of the Middlesbrough population and have the lowest proportions of consumption. These groups consume significantly less fruit and vegetables than the national average of 36.2%

Population consuming less than 2 portions of fruit per day by Mosaic Group, Middlesbrough

Less than 2-a-day frut and veg, Middlesbrough populations and Mosaic group

Deprivation         
Middlesbrough is ranked the 6th most deprived local authority nationally and has the highest proportion of neighbourhoods (LSOAs) among the most deprived 10% in England of all local authorities (Indices of Deprivation, 2015).  Those living in the most deprived areas may face additional barriers to accessing and consuming a healthy diet.

Breastfeeding                                                          
Breastfeeding initiation in Middlesbrough is significantly lower than England and the gap between Middlesbrough and the North East average is widening.  Less than half of mothers in Middlesbrough initiate breastfeeding, the rate has barely changed since 2006/07.  In 2014/15, Middlesbrough had the lowest breastfeeding initiation rate (47.2%) of all local authority areas in England.
Breastfeeding intiation trend, Middlesbrough, 2004/05 to 2014/15

By the time babies in Middlesbrough are six to eight weeks old, only around one in four are being breastfed, about half the proportion seen in England as a whole.  In 2014/15, Middlesbrough had the fourth lowest breastfeeding rate at 6-8 weeks of all local authority areas in England.

Breastfeeding at 6-8 weeks trend, Middlesbrough, 2009/10 to 2014/15

Breastfeeding rates vary considerably within Middlesbrough.  The lowest breastfeeding initiation rates, where fewer than one-third of mothers initiated breastfeeding, are found in the east of Middlesbrough.  No wards have three-quarters of mothers initiate breastfeeding, and only Nunthorpe ward has more than two-thirds of mothers initiating breastfeeding (Source: South Tees Hospitals NHS Foundation Trust / Tees Valley Public Health Shared Service).
Middlesbrough breastfeeding initiation by ward, 2010-13


Healthy Start
During 2014/15, in Middlesbrough there were 886 interactions where Healthy Start Vitamins were given out. The majority (450; 51%) were for children aged 6 months to 4 years, whilst 292 (33%) were given to women prenatally and 97 (11%) for women postnatally. Only 47 (5%) were given out for children aged over 1 month and under 6 months who were breastfed.

National data indicates that uptake of the Healthy Start scheme is progressing well in Middlesbrough, with 89% of those eligible taking part.  However, the uptake of vitamin supplements remains low in comparison to those that are eligible to benefit, with only:

  • 1.2% of those eligible accessing women’s vitamins tablets;
  • 0.3% of those eligible accessing children’s vitamin drops.

Low uptake is concerning as Healthy Start Vitamins can reduce the risk of health problems associated with vitamin deficiencies such as rickets and spina bifida. Clearly, the vitamin supplement element of the Healthy Start scheme in Middlesbrough is being underutilised and presents an opportunity for further improvement.

Oral health
Poor oral health is a good indicator of poor nutrition. Families living in deprived areas tend to have diets containing high levels of sugar which can have an adverse effect on oral health and weight. Middlesbrough has the highest rate in the North East of children with decayed, missing or filled teeth with a rate of 41.5 compared to 27.9 nationally. There are significant dental health inequalities between wards with those in the most deprived wards having the worst oral health. Further information can be found in the oral health topic.

School meals
School meals in Middlesbrough meet the Food Based and Nutrient Based Standards for school lunches set by the Government.  In 2014, free school meal up take all schools in Middlesbrough (31.5%) was higher than both the regional (20.2%) and the England (16.3%) rate.

Free school meal uptake, Middlesbrough and North East LAs, possibly 2014

Underweight Adults and Children
The National Child Measurement Programme showed that 0.89% of reception children and 0.83% of year 6 children were defined as underweight, for the 2014/15 academic year. This is in line with the England average of 0.96% and 1.42% respectively, and a fraction of those identified as overweight or very overweight.

The Active People Survey for 2012-14 showed that, in Middlesbrough, 1.8% of adults were underweight, higher than both the regional prevalence of 1.0% and the national prevalence of 1.2%.

Malnutrition in Elderly Care
In 2015, of the 9 care homes in Middlesbrough that participate in Focus on Undernutrition, Malnutrition Universal Screening Tool (MUST) scores over a 6 month period have shown that 89.3% of residents have remained the same or have improved scores.

 

Last updated: 03/05/16

5. What services are currently provided?

Primary care
One-to-one consultations on nutrition and dietary advice are available within primary care.  General practices also carry out brief interventions, particularly as part of the Tees Healthy Heart Check programme to improve lifestyle behaviour, including dietary habits.

Antenatal care
Community midwifery services provide antenatal advice on dietary intake and supplements including folic acid and vitamin D.

Secondary care
South Tees Hospitals NHS Foundation Trust Nutrition and Dietetic Department provides clinical dietetic services for a wide variety of diet-related medical conditions. These include diabetes, coeliac disease, food allergies and intolerance, faltered growth, cardiac rehabilitation sessions, irritable bowel syndrome and nutritional support amongst a number of other services.

Mental health and learning disabilities
Tees, Esk and Wear Valleys NHS Foundation Trust cover a wide range of mental health, learning disability and substance misuse services. The dietetic team are implementing two pathways of care for malnutrition and weight management.

In-patient food provision is monitored to ensure that menus provided for in-patient settings meet the nutritional guidelines and needs of the client group. Healthy options are promoted using a traffic light food labelling system together with the provision of health promotion education groups and sessions for people with learning disabilities.

Care settings
To address issues of malnutrition in care settings, Malnutrition Universal Screening Tool (MUST) training is provided for primary care hospitals and community nursing staff in Middlesbrough.   The increases staff awareness of the importance of nutrition and screening for malnutrition.  Staff are trained to undertake an individual MUST screening of patients and provide food fortification advice and guidance on how to manage malnutrition in each care setting in line with NICE Guidance CG32.

Focus on Undernutrition in Care Homes
Focus on Undernutrition provides nutrition training and support for care home staff in elderly care homes to implement Malnutrition Universal Screening Tool (‘MUST’). The MUST aims to identify undernutrition and promotes treatment through a ‘food first’ approach and appropriate use of prescribed nutritional supplements.

Breastfeeding support
Antenatal and postnatal breastfeeding support sessions are provided by maternity services.  Following discharge from the midwifery service, locality health visiting teams and children’s centres support mothers further with breastfeeding and infant feeding.

Healthy Start
Healthy Start is a statutory scheme which aims to improve the health of pregnant women and families on benefit or low incomes.  Vouchers are provided to exchange for fresh fruit and vegetables as well as milk and infant formula milk.  Vitamin supplements are also provided.  Healthy Start targets pregnant women and families with children under four years old. Those on low incomes and all pregnant women under the age of 18 are eligible for free vitamins.

Weaning
Health Visiting services and Sure Start Children’s Centres provide advice on introducing solid foods. This can be during specified health drop-ins or in group situations, which supports parents by providing safe and practical advice.

Type 2 diabetes targeted programmes
There are two targeted programmes in Middlesbrough that aim to prevent the development of type 2 diabetes through increased physical activity and a healthy diet.  The first programme targets those aged 25 years or over who are identified at high risk of developing type 2 diabetes.

New Life, New You 2 is a pilot project offering people identified as having type 2 diabetes, a physical activity and healthy eating programme to support them to manage their condition and reduce the risk of complications occurring.

Community settings
Middlesbrough Environment City (MEC) is working within a range of community settings across Middlesbrough to support the setting to be able to provide their service users access to healthy cooking skills and physical activity. Working alongside staff and volunteers training programmes and support packages are agreed and then provided by MEC’s healthy cooking team to enable staff and volunteers within the setting to deliver healthy eating and cooking sessions to their service users. The model is being evaluated by Teesside University to establish its effectiveness as a mechanism for up scaling the delivery of high quality healthy eating programmes across Middlesbrough. The programme has a holistic approach and supports the setting to explore additional progression opportunities such as providing service users with opportunities to engage in urban farming, walking for health and cycling, all sustained within the setting by the training and support of staff and volunteers.

Slow cooker project
This project is specifically aimed at families living in Middlesbrough who are facing financial hardship and are delivered in partnership with the Foodbank.  The project provides participants with the knowledge and skills to prepare and cook low cost healthy meals using a slow cooker. The benefits of using a slow cooker, including the energy savings compared to using a conventional cooker, are illustrated. Upon completion of the sessions participants receive a bag of store cupboard ingredients, a slow cooker and a slow cooking recipe book.

Community cooking sessions
Middlesbrough Council’s Food4Health: Healthy Cooking Skills programme provides advice and guidance on healthy eating along with community-based practical cooking skills training.  Emphasis is placed on enabling people who work or volunteer with community groups to learn how to make healthy food and pass on their knowledge and skills in communities across Middlesbrough.

Workplace initiatives
Middlesbrough Council’s Food4Health: Healthy Eating Awards recognises and awards those food businesses that offer healthier food to their customers.

The North East Better Health at Work Award encourages employers in the North East to progressively consider how they can improve the health of their workforce. In Middlesbrough, the partnership between Middlesbrough Council, other north east local authorities and the TUC has enabled the award to be developed and introduced to local businesses. Now in its 7th year, implementing and promoting healthy eating is an integral part of the scheme including the development of a healthy eating policy and social considerations about local food procurement.

Urban farming / growing schemes
Over that last five years, Middlesbrough Environment City has been undertaking a community engagement programme to encourage more people to grow their own produce.  This has included the creation of community allotment sites within local communities and the development of a training site at Town Farm Allotments in East Middlesbrough.  MEC provides both accredited and unaccredited training in food growing to provide residents with the knowledge and skills to grow their own food. This work has been funded by the Big Lottery Fund and Middlesbrough Council Public Health.

Middlesbrough Environment City co-ordinates the Town Meal, an event to promote and share home grown food. The meal is a free celebration of the growing projects that take place throughout Middlesbrough and the produce is used to cook a meal to feed thousands.

Children's Centres in Middlesbrough provide a community garden group which encourages families to grow their own fruit and vegetables and eat healthier foods.  The programme specifically targets fathers and male carers.

Albert Park community growing
This project aims to develop the horticultural skills of participants who are able to grow and harvest produce to share with their families, friends and community. It also aims to increase understanding of cultural differences and behaviours to support integration and reduce isolation within communities. The project is also supported by a 10 week English language course (ESOL) in horticulture.

Food Action Plan
Middlesbrough’s Food Action Plan was revised in 2015.  Led by Middlesbrough Environment City, the plan includes six themes to promote healthy and sustainable food in Middlesbrough: Health and Nutrition; Local and Sustainable Food; Reducing Food Waste; Fairness in the Food Chain and Tackling Food Poverty; Education and Skills; and Building a Strong Local Food Economy.  There is also a Food Charter for businesses and a Food Pledge for local residents.

 

Last updated: 03/05/16

6. What is the projected level of need?

Breastfeeding at 6-8 weeks is forecast to decrease, based on historical data, thus widening the gap between Middlesbrough and England.

Middlesbrough breastfeeding 6-8 weeks projection to 2017/18

Other emerging nutritional deficiencies may also increase locally, such as vitamin D deficiency particularly as Middlesbrough has a growing BME population, and with the elderly population predicted to increase, the prevalence of malnutrition may also increase subsequently impacting on local NHS services and health costs.

 

Last updated: 03/05/16

7. What needs might be unmet?

Breastfeeding
Most children born in Middlesbrough do not receive the best nutrition from birth.  By age 6-8 weeks, only one in four infants receives breastmilk and three-quarters receive sub-optimal nutrition.

Children’s Centres are currently not UNICEF ‘Baby Friendly’ accredited.

Interventions for families, such as antenatal classes, breastfeeding support groups and weaning groups, are underutilised by those least likely to follow national advice.

Healthy Start
As the Healthy Start scheme is significantly underutilised for vitamin supplements there is a need to ensure a co-ordinated approach to raise awareness of the scheme, particularly in relation to the vitamin element, both with health professionals and families.

Vulnerable adults and children
Increased support and education for adults who move from a care setting to independent living and those already in supported living is needed as often they lack the resources and knowledge to purchase and eat a balanced diet, particularly for those adults with learning disabilities and mental ill health.

Black and minority ethnic groups
There is a need for targeted healthy eating and weight management services for the BME population.

Training and capacity building
There is a need for capacity and capability building in Middlesbrough for frontline staff to ensure every contact maximises the health improvement opportunity, and to ensure consistent nutrition advice and support, particularly for those who care for vulnerable children and adults.

There is no consistent approach to educational needs and standards of practice for nutritional care and support in care settings, particularly linked to malnutrition.

Demand for cooking skills development and practical advice on healthy eating is high, but meeting this demand is subject to available staffing resources, funding and facilities.

Food poverty
It is likely that people living in deprived areas may face additional barriers to a healthy diet putting them at greater risk of diet-related disease such as obesity, type two diabetes, cardiovascular disease (CVD) and poor oral health.

 

Last updated: 03/05/16

8. What evidence is there for effective intervention?

National Institute for Health and Care Excellence (NICE)

NICE (2006). Behaviour Change at Population, Community and Individual Levels (PH6).

NICE (2006). Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition (CG32).

NICE (2008). Maternal and Child Nutrition (PH11).

NICE (2010). Prevention of Cardiovascular Disease at Population Level (PH25).

NICE (2010). Weight Management Before, During and After Pregnancy (PH27).

NICE (2011). Food Allergy in Children and Young People: Diagnosis and Assessment of Food Allergy in Children and Young People in Primary Care and Community Settings (CG116).

NICE (2011). Preventing Type 2 Diabetes: Population and Community-Level Interventions (PH35).

NICE (2013). Managing Overweight and Obesity among Children and Young People: Lifestyle Weight Management Services (PH47).

NICE (2014). Behaviour Change: Individual Approaches (PH49).

NICE (2014). Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease (CG181).

NICE (2014). Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults (CG189).

NICE (2014). Overweight and Obese Adults - Lifestyle Weight Management (PH53).

NICE (2014). Quality Standard for Nutrition Support in Adults (QS24).

 

National Strategy

Department of Health (2011). Healthy Lives, Healthy People: A Call to Action on Obesity in England.

 

Other evidence

Jolly K, Ingram L, Khan KS. et al. (2012). Systematic review of peer support for breastfeeding continuation: meta-regression analysis of the effect of setting, intensity, and timing.

Kaunonen M, Hannula L. & Tarkka MT. (2012). A systematic review of peer support interventions for breastfeeding.

Knai C, Pomerleau J, Lock K. & McKee M. (2006). Getting children to eat more fruit and vegetables: A systematic review.

Government Office for Science (2007) Tackling Obesities: Future Choices.

Lara J, Hobbs N, Moynihan PJ. et al. (2014). Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials.

McGill R, Anwar E, Orton L. et al. (2015). Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact.

Moran VH, Morgan H, Rothnie K. et al. (2015). Incentives to promote breastfeeding: A systematic review.

National Obesity Observatory – for a wide variety of publications and information related to obesity

Pomerleau J, Lock K, Knai C. & McKee M. (2005). Interventions designed to increase adult fruit and vegetable intake can be effective: A systematic review of the literature.

Renfrew MJ, McCormick FM, Wade A. et al. (2012). Support for healthy breastfeeding mothers with healthy term babies.

Story M, Kaphingst KM, Robinson-O’Brien R & Glanz K. (2008). Creating healthy food and eating environments: Policy and environmental approaches.

Townsend N, Murphy S. & Moore L. (2011). The more schools do to promote healthy eating, the healthier the dietary choices by students.

 

Last updated: 04/05/16

9. What do people say?

There is a lack of local consultation and data on what people say about diet and nutrition-related issues. However local stakeholders have been consulted on the topic, including voluntary sector, primary care, early year providers, Nutrition and Dietetics, lifestyle providers, people with learning disabilities and older people care providers and their comments have been included throughout.

Breastfeeding
The former North East Strategic Health Authority (SHA) commissioned research with mothers on reasons for their infant feeding choices. The most common reasons for planning to use infant formula were:

  • Participants did not like the idea of breastfeeding;
  • Other people can feed the baby;
  • Inconvenient due to mother’s lifestyle;
  • Previous children were fed with infant formula;
  • Participants had breastfed previous children and didn’t like it.

The most common reason for planning to breastfeed was that ‘breastfeeding is best for health of the baby’.

During audit preparation prior to the UNICEF Baby Friendly Initiative, both women who were bottle feeding, but had initiated breastfeeding and women who were breastfeeding asked for local breastfeeding support groups as they had seen these on the television.

Women and families value the support that is provided by peer groups. This was identified in the final recommendations of the Public Health North East social marketing benchmarking research.

Women also highlight that embarrassment is a large part of choosing not to breastfeed and not knowing where would be “safe” to breastfeed when in public.

 

Last updated: 03/05/16

10. What additional needs assessment is required?

Further insight into the poor uptake, awareness and promotion of Healthy Start Vitamins, particularly in relation to vitamin D intake in the BME community.

Further insight into the availability of fast food take-away shops and shops selling affordable, healthy food in Middlesbrough particularly in relation to schools and wards (food mapping).

An analysis of training needs for those working in healthcare settings and for frontline staff.

Needs analysis to determine the level of breastfeeding services that might be required locally and to calculate the cost of commissioning breastfeeding services by:

  • identifying indicative local service requirements;
  • reviewing current commissioned activity;
  • identifying future change in capacity required; and
  • modelling future commissioning intentions and associated costs.

Develop a better understanding of local beliefs and attitudes to diet and nutrition and use this insight to commission culturally appropriate interventions aimed at improving diet and nutrition in target populations.

 

Last updated: 03/05/16

Key Contact

Name: Jo Bielby

Job Title: Health Improvement Specialist

e-mail: Joanna_Bielby@middlesbrough.gov.uk

phone: 01642 728060

 

References

National strategies and plans

Department of Health (2004). National Service Framework for Children, Young People and Maternity Services: Maternity Services.

Department of Health (2004). Infant Feeding Recommendation.

Department of Health (2011). Healthy Lives, Healthy People: A Call to Action.

NHS England (2015) Guidance – Commissioning Excellent Nutrition and Hydration.

Scientific Advisory Committee on Nutrition (2015). Carbohydrates and Health.

 

Local strategies and plans

Public Health North East (2012). North East Infant Feeding Weaning and Nutrition Guidelines.

 

Other references

Ali F, Rehman H, Babayan Z, et al. (2015). Energy drinks and their adverse health effects: a systematic review of the current evidence.

Armstrong J, Dorosty AR, Reilly JJ et al. (2003) Coexistence of social inequalities in undernutrition and obesity in pre‑school children.

British Association for Parenteral and Enteral Nutrition (2011). Nutrition Screening Survey in the UK in 2010.

British Heart Foundation (2011). The Real Five-a-Day? UK Kids Feast on Chocolate, Energy Drinks and Crisps.

Caroline Walker Trust (2006). Eating Well for Under 5’s in Childcare – Practical and Nutritional Guidelines.

Caroline Walker Trust (2007). Eating Well: Children and Adults with Learning Disabilities.

Cooper N, Purcell S & Jackson R. (2014). Below the Breadline: The Relentless Rise of Food Poverty in Britain.

Department of Health (2011). No Health Without Mental Health: A Cross-Government Mental Health    Outcomes Strategy for People of All Ages.

DeRose L, Messer E. & Millman S. (1998). Who's Hungry? And how do we know? Food Shortage, Poverty, and Deprivation.  New York: United Nations University Press.

Dipnall JF, Pasco JA, Meyer D. et al. (2015). The association between dietary patterns, diabetes and depression.

Donin AS, Nightingale CM, Owen CG. et al (2010). Nutritional composition of the diets of South Asian, black African-Caribbean and white European children in the United Kingdom: The Child Heart and Health Study in England (CHASE).

Eng PM, Kawachi I, Fitzmaurice G & Rimm EB. (2005). Effects of marital transitions on changes in dietary and other health behaviours in US male health professionals.

European Food Safety Authority (2013). Gathering Consumption Data on Specific Consumer Groups of Energy Drinks.

Food Standards Agency (2008). Low Income Diet and Nutrition Survey.

Food Standard Agency, (2009). Annual Report of the Chief Scientist 2008/09.

Frémeaux AE, Hosking J, Metcalf BS. et al. (2011). Consistency of children's dietary choices: annual repeat measures from 5 to 13 years.

Gregory J, Collins D, Davies P et al. (1995). National Diet and Nutrition Survey: Children aged 1½ to 4½ Years. Volume 1: Report of the Diet and Nutrition Survey.

Health & Social Care Information Centre (2010). Infant Feeding Survey 2010.

Health & Social Care Information Centre (2015). Child Dental Health Survey 2013, England, Wales and Northern Ireland.

Herbert K, Plugge E, Foster C & Doll H. (2012). Prevalence of risk factors for non-communicable diseases in prison populations worldwide: A systematic review.

Ji C & Cappuccio FP. (2014). Socioeconomic inequality in salt intake in Britain 10 years after a national salt reduction programme.

Jolly K, Ingram L, Khan KS. et al. (2012). Systematic review of peer support for breastfeeding continuation: meta-regression analysis of the effect of setting, intensity, and timing.

Kaunonen M, Hannula L. & Tarkka MT. (2012). A systematic review of peer support interventions for breastfeeding.

Knai C, Pomerleau J, Lock K. & McKee M. (2006). Getting children to eat more fruit and vegetables: A systematic review.

Lambie-Mumford H, Crossley D, Jensen E, et al. (2014). Household Food Security in the UK: A Review of Food Aid.

Lara J, Hobbs N, Moynihan PJ. et al. (2014). Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials.

McGill R, Anwar E, Orton L. et al. (2015). Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact.

Moran VH, Morgan H, Rothnie K. et al. (2015). Incentives to promote breastfeeding: A systematic review.

NICE (2006). Behaviour Change at Population, Community and Individual Levels (PH6).

NICE (2006). Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition (CG32) .

NICE (2008). Maternal and Child Nutrition (PH11).

NICE (2010). Prevention of Cardiovascular Disease at Population Level (PH25).

NICE (2010). Weight Management Before, During and After Pregnancy (PH27).

NICE (2011). Food Allergy in Children and Young People: Diagnosis and Assessment of Food Allergy in Children and Young People in Primary Care and Community Settings (CG116).

NICE (2011). Preventing Type 2 Diabetes: Population and Community-Level Interventions (PH35).

NICE (2013). Managing Overweight and Obesity among Children and Young People: Lifestyle Weight Management Services (PH47).

NICE (2014). Behaviour Change: Individual Approaches (PH49).

NICE (2014). Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease (CG181).

NICE (2014). Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults (CG189).

NICE (2014). Overweight and Obese Adults - Lifestyle Weight Management (PH53).

NICE (2014). Quality Standard for Nutrition Support in Adults (QS24).

ONS (2011). Fertility assumptions: 2010-based national population projections.

O'Neill M, (2005). Putting Food Access on the Radar.

Perry J, Williams M, Sefton T. & Haddad M. (2014). Emergency Use Only: Understanding and Reducing the Use of Food Banks in the UK.

Pomerleau J, Lock K, Knai C. & McKee M. (2005). Interventions designed to increase adult fruit and vegetable intake can be effective: A systematic review of the literature.

Public Health England (2014). National Diet and Nutrition Survey: Results from Years 1 to 4 (combined) of the Rolling Programme for 2008 and 2009 to 2011 and 2012.

Renfrew MJ, McCormick FM, Wade A. et al. (2012). Support for healthy breastfeeding mothers with healthy term babies.

Sanchis-Gomar F, Pareja-Galeano H, Cervellin G, et al. (2015). Energy drink overconsumption in adolescents: implications for arrhythmias and other cardiovascular events.

Scientific Advisory Committee on Nutrition (2008). The Nutritional Wellbeing of the British Population.

Spencer A, Ogden C & Battarbee L. (2015). #cheshirehunger - Understanding Emergency Food Provision in West Cheshire.

Story M, Kaphingst KM, Robinson-O’Brien R & Glanz K. (2008). Creating healthy food and eating environments: Policy and environmental approaches.

Townsend N, Murphy S. & Moore L. (2011). The more schools do to promote healthy eating, the healthier the dietary choices by students.

UNICEF (2012). Preventing Disease and Saving Resources: The Potential Contribution of Increasing Breastfeeding Rates in the UK.

Whitton C, Nicholson SK, Roberts C. et al (2011). National Diet and Nutrition Survey: UK food consumption and nutrient intakes from the first year of the rolling programme and comparisons with previous surveys.

World Health Organisation (2003). Diet, Nutrition and the Prevention of Chronic Diseases.