Obesity

The prevalence of obesity in England is increasing at all ages; almost two-thirds of adults and one-third of children are either overweight or obese.  If present trends continue, 60% of men, 50% of women and 25% of children will be obese by 2050.

Overweight and obesity are major risk factors for disease and mortality including cardiovascular disease, cancer and disability during older age.   It contributes to a decrease in life expectancy.  Furthermore, obesity is associated with serious chronic conditions such as type 2 diabetes, hypertension, and hyperlipidaemia, which are major risk factors for cardiovascular disease (Health Survey for England, 2009).   Risk factors for some of these conditions start at a relatively low body mass index (BMI), and this will cause future health service costs to rise significantly.  In Middlesbrough alone, NHS costs of principal diseases related to obesity are estimated to be £47.5 million (Department of Health, 2010).

The rising trend in obesity is one of the biggest threats to the health of the population of Middlesbrough. The prevalence of obesity in Middlesbrough is significantly higher than the national average for both adults and children.  The trend of weight problems in children and young people is of particular concern because of evidence suggesting a ‘conveyor belt’ effect in which excess weight in childhood continues into adulthood (Department of Health, 2008). In addition to the increased health risks in later life, children and young people face immediate health and psychological consequences of obesity including increased risks for elevated blood pressure and type 2 diabetes, low self-esteem, anxiety and depression.

The causes of obesity are complex and relate to a wide variety of societal and behavioural factors which cannot be tackled in isolation. Social determinants have an important impact on the likelihood of becoming obese and they need to be addressed.

The inequalities, health risks and costs associated with obesity combine to make the prevention of obesity a major public health challenge.

This topic is linked with the following JSNA topics:

 

Last updated: 2015-12-24 13:28:02
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1. What are the key issues?

Overweight and obesity is influenced by a complex, multi-faceted system of determinants including environmental, physiological and behavioural factors (see Foresight obesity system map). Tackling obesity therefore requires a multi-agency, multi-faceted approach.

Obesity is one of the most common causes of preventable death in England and is associated with a plethora of increased health risks including type two diabetes, cardiovascular disease, some cancers, hypertension, stroke and increased risks during and after pregnancy. Risk factors for some of these diseases, notably type 2 diabetes and hypertension, start to increase at a relatively low BMI, particularly for some ethnic groups.

If a child or young person is obese there is a high likelihood they will become an obese adult. In addition to the increased risk for health problems in later life, children face immediate health and psychological consequences of obesity including increased risks for elevated blood pressure and type 2 diabetes, low self-esteem, anxiety and depression.

Both the child and adult rates of obesity in Middlesbrough continue to be significantly higher than the regional and national average. Moreover, the prevalence of child obesity doubles between ages 5 and 11 years, clearly demonstrating the need for interventions at an early age.

The increasing prevalence rates of overweight and obesity subsequently impactson demand for services and cost to the NHS and wider economy.  Costs to the NHS of the consequences of overweight and obesity are estimated at £5.1 billion per year; while it has been estimated that lost earnings attributable to obesity amounts up to £2.6 billion a year (Department of Health, 2011).  Within Middlesbrough, the annual cost to the NHS in 2010 was £47.5 million, predicting to rise to £50.8 million by 2015.

National data suggests that individuals of Asian origin, people with learning and physical disabilities and pregnant women have the greatest health risks due to obesity demonstrating a need to develop and provide targeted weight management services for these population sub-groups.

Nationally, the proportion of pregnant women who are obese has doubled over the last 19 years.  The incidence of maternal obesity is higher in Middlesbrough than the national average. Maternal obesity significantly increases the morbidity and mortality risks to the mother and infant, and is a significant burden on NHS resources.

There are significant gaps in Tier 2 and Tier 3 services for all sub-groups of the population.

 

Last updated: 23/12/15

2. What commissioning priorities are recommended?

2015/01
Commission weight management treatment services in line with population need
.

2015/02
Commission a range of interventions aimed at preventing unhealthy weight gain
.

2015/03
Commission pilot approaches to preventing/treating obesity in the under-fives
based on the best available science that will ultimately add to the evidence base.

2015/04
Work with colleagues across other commissioning functions (e.g. transport)
to maximise opportunities for obesity prevention and treatment.

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

2015/05
Adopt a whole council / whole system approach to obesity prevention and treatment
in line with the Foresight obesity system map and future Public Health England (PHE) commissioned whole systems obesity work.

Previous commissioning priorities:

2012/01
Establish a strong local partnership
with a variety of organisations to develop an informed and shared vision to prevent and manage obesity. This should build on the partnerships and outcomes achieved through the Healthy Towns Partnership. Remains a priority.

2012/02
Adopt a life course approach
to ensure health inequalities are addressed at all stages of the life course. Remains a priority.

2012/03
Review care pathways and the obesity service model
in line with evidence that suggests different BMI cut-off points for different ethnic groups should be considered as points for public health action, particularly for people of South Asian origin. Remains a priority.

2012/04
Create a balance of investment between prevention and treatment services
ensuring targeted support for people identified most at risk of overweight and obesity. Remains a priority.

2012/05
Promote joint working with planning and transport departments
to ensure that the potential for physical activity and healthy eating is maximised including the use of health impact assessments to address the obesogenic environment. Abandoned, replaced by 2015/04 and 2015/05.

2012/06
Increase capacity
across the different sectors to ensure every contact becomes a health improvement opportunity and to ensure increased capacity and capability in the workforce to support children, young people and adults to achieve and maintain a healthy weight. Abandoned, replaced by new priorities.

 

Last updated: 23/12/15

3. Who is at risk and why?

Age
The prevalence of overweight and obesity rises with age, in both men and women, from a relatively low level in the 16-24 age group to a peak at 65-74 (although obesity peaks slightly earlier in men).  Older adults (aged 75+) have a lower prevalence of obesity (National Obesity Observatory, 2010).

In children, the prevalence of obesity also increases with age. The National Child Measurement Programme (NCMP) shows obesity prevalence is significantly higher in Year 6 than in Reception classes.  The Health Survey for England 2012 (Health and Social Care Information Centre, 2014) shows that those aged 11-15 were more likely to be obese than those aged 2-10 years (19.1%/18.7% and 10.8%/10.3% for boys/girls respectively).

Gender
There is no current evidence suggesting gender plays a significant role in determining the prevalence of obesity in adults.  However, the NCMP shows that boys are significantly more likely to be obese than girls.

Ethnicity
Obesity prevalence varies substantially between ethnic groups for both adults and children (National Obesity Observatory, 2011a).  However, estimates of adult obesity prevalence by ethnic group seem to differ according to the measurement used (for example, BMI, waist-to-hip ratio and waist circumference).

For men, when using BMI, findings suggest that compared to the general population, obesity prevalence is lower in Bangladeshi and Chinese communities.  However, if using a different measurement such as raised waist-to-hip ratio, obesity prevalence is higher in Bangladeshi men.

For women, when using BMI, obesity prevalence appears to be higher in Black African, Black Caribbean and Pakistani women and lower in women from Chinese communities. When using raised waist-to-hip ratio, obesity prevalence is higher in Bangladeshi women.

Children from most minority ethnic groups have a higher prevalence of obesity than White British children, although the patterns are different for boys and girls and for different age groups. Among Reception age children, Black African boys and girls have the highest prevalence of obesity. In Year 6, Bangladeshi boys have the highest prevalence, whereas among girls, those from African and Other Black groups have the highest prevalence (National Obesity Observatory, 2011a).

There is continuing debate about the applicability of definitions of obesity between ethnic groups for adults and children. Since different ethnic groups have different physiological responses to fat storage, revised BMI thresholds and waist circumference measures have been recommended, particularly for South Asian populations who are at risk of chronic diseases and mortality at lower levels than European populations (National Institute of Health and Care Excellence, 2012).

Socioeconomic status
The distribution of overweight and obesity has a significant social gradient, with prevalence among people who are socially and economically deprived.  Adults and children in social class V (unskilled manual) have a higher prevalence of obesity than those in social class I (professional). The gap between the two is significant, and has widened since 1997 in both sexes (National Obesity Observatory, 2011b).

Familial factors
There is evidence that childhood obesity is higher in households where parents are classed as overweight or obese. The prevalence of obese children in households with overweight/obese adults was 24% for boys and 21% for girls. By comparison, rates of obesity for children in normal/underweight households were 11% for boys and 10% for girls (Health and Social Care Information Centre, 2012).

Maternal obesity
The proportion of pregnant women who are obese has doubled from 7.6% in 1989 to 15.6% in 2007 (Heselhurst et al, 2010). Maternal obesity presents a series of significant health risks to both mother and child during pregnancy and childbirth.  It is associated with an increased risk of serious adverse outcomes including miscarriage, foetal congenital abnormality, thromboembolism, gestational diabetes, pre-eclampsia, post-partum haemorrhage, stillbirth and neonatal death. There is also a higher caesarean section rate and lower breastfeeding rate in this group of women compared with women with a healthy BMI (Department of Health, 2008).

There is a significant relationship between maternal obesity and deprivation. Women who are obese are significantly more likely to be older in pregnancy and to live in areas of high deprivation, compared with women who are not obese (Centre for Maternal and Child Enquiries [CMACE], 2010).

There are also significant links with ethnicity.  The CMACE (2010) report found that women with BMI ≥35 from BME groups were three-and-a-half times more likely to have type 2 diabetes and 1.6 times more likely to have gestational diabetes than white women with BMI ≥35.

North East England research shows that 65% of overweight and obese pregnant women are physically active at 13 weeks gestation, although this decreases as the pregnancy progresses (McParlin et al, 2010).

Disability
There are associations between limiting longstanding illness and BMI. Combined data from the Health Surveys for England 2006-10 showed that 35.8% of adults with a limiting long-term illness or disability (LLTI) in England were obese compared to 22.9% without a LLTI (National Obesity Observatory, 2013a).

Obesity disproportionately affects people with a learning disability.  A report by the Sainsbury’s Centre for Mental Health (Samele et al. 2006) found that the rate of obesity among people with a learning disability was significantly different to those without such a disability (28.3% compared to 20.4%).

Children who have a limiting illness are more likely to be obese or overweight, particularly if they also have a learning disability. Combined data from the Health Surveys for England 2006-10 showed that children aged 2–15 years with a LLTI in England were approximately 35% more likely to be obese compared to those without a LLTI (National Obesity Observatory, 2014).

Mental health
The relationship between obesity and common mental health disorders is complex. Evidence suggests there are links between obesity and depression, although it is not clear which ways the influence flows.  A recent systematic review found that “obese persons had a 55% increased risk of developing depression over time, whereas depressed persons had a 58% increased risk of becoming obese”(Luppino et al. 2010).

Risks associated with obesity
Compared with a man of healthy weight, an obese man is:

  • five times more likely to develop type 2 diabetes;
  • three times more likely to develop cancer of the colon;and
  • over two-and-a-half times more likely to develop high blood pressure, a major risk factor for stroke and heart disease.

Compared with a woman of healthy weight, an obese woman is:

  • almost thirteen times more likely to develop type 2 diabetes;
  • four times more likely to develop high blood pressure; and
  • three or more times more likely to have a heart attack.

Increased risk for other diseases includes angina, gallbladder disease, liver disease, ovarian cancer, osteoarthritis and stroke. Risk factors for some of these diseases, notably type 2 diabetes and hypertension, start to increase at relatively low BMIs, particularly for those people from some ethnic groups, including South Asian people (Government Office for Science, 2007).

In addition to the increased risk for health problems in later life, obese children face immediate health and psychological consequences such as blood pressure, elevated risk of type 2 diabetes, low self-esteem and higher rates of anxiety and depression (Lobstein, 2011).

 

Last updated: 23/12/15

4. What is the level of need in the population

Adult obesity
As part of the Active People Survey, weight status in the adult population of Middlesbrough was measured. This suggested that 25.8% of the adult population is obese with a further 43.9% overweight (69.7% overweight or obese). These figures are higher than the national averages but not significantly. Middlesbrough generally has lower rates compared with similar areas and other North East local authorities.

Adult obesity, Middlesbrough, 2012-14

 

Learning disability
In Middlesbrough the rate of adults with a learning disability who are known to the local authority is 8.8 per 1,000 population. It has been suggested that approximately 49% of adults with a learning disability are overweight or obese (Bhaumik et al, 2008), whilst only 15% meet the Government physical activity recommendations (Finlayson, Turner and Granat, 2011).

Maternal obesity
In England, first trimester obesity (BMI>30kg/m2) has more than doubled from 7.6% to 15.6%, in 19 years, leading to an additional 47,500 women in England requiring high dependency care every year (Heslehurst et al. 2010). Data from James Cook University Hospital (JCUH) shows that the incidence of maternal obesity is higher than the national average and has been increasing in recent years.

Analysis of three years’ worth of data (April 2010 to March 2013) found that, in the South Tees area, 48.9% of mothers had a BMI above 25 at booking and 21.6% had a BMI above 30. There is a threefold variation between wards in Middlesbrough.
 

Maternal obesity, Middlesbrough wards, 2010 to 2013

Maternal obesity is nearly twice as high in the most deprived quintile of LSOAs in South Tees compared with the least deprived.  In the South Tees area, nearly six in ten bookings (59%) are for mothers who live in the most deprived areas. In three years, there were 357 women with a recorded BMI>40 at booking, about 120 per year or one every third day.

Maternal obesity rates at booking increase with the age of the mother.  About one in eight teenage mothers are obese, half of the rate seen in mothers aged over 35.

Maternal obesity and age, South Tees, 2010-2013

Child obesity
The prevalence of obesity and overweight, as measured by the National Child Measurement Programme (NCMP), is higher than the national average. In Reception classes, Middlesbrough is higher than England but not significantly. However, for  Year 6, the rate of overweight and obese children is significantly higher than England.

NCMP spine chart, Middlesbrough, 2013/14

The North East has higher percentages of overweight and obese children in both reception and year 6 when compared against England. Compared to other local authorities regionally, Middlesbrough is ranked 7th out of 12 authorities for reception overweight and obese. However for year 6, Middlesbrough has a higher rate regionally ranking 5th for both overweight and obese pupils.

Nationally, there has been a steady increase in the prevalence of obesity in children aged 2-15 years between 1995 and 2004; the rate of increase has slowed since 2005, suggesting a flattening out of the previous upward trend (HSCIC, 2014).

Local trends show that obesity rates in reception age children, although fluctuating has fallen slightly over the 8 year period. The rate for Reception classes is similar to England, the North East and both Hull and Tameside (similar local authorities). However for year 6 children, the rates have increased locally and nationally, with Middlesbrough rates showing a sharp increase in 2012/13 before reducing slightly.  The Middlesbrough rate for Year 6 classes is significantly higher than England but similar to the North East and two similar local authorities.

Child obesity, Middlesbrough, 2006/07 to 2013/14

Obesity in 5-year-olds, Middlesbrough and benchmarks, 2013/14

Obesity in 11-year-olds, Middlesbrough and benchmarks, 2013/14

Obesity at ward level
The following two maps show rates of childhood obesity in each ward in Middlesbrough. For reception children, the highest rates of obesity tend to be found in more deprived wards, however some wards, such as Ladgate, have some of the highest rates and are some of the least deprived wards in the town.

Obesity in 5-year-olds, Middlesbrough wards, 2010/11 to 2012/13

Generally, obesity prevalence for children in year 6 tends to be higher in the more deprived wards in Middlesbrough compared to reception children. Rates are highest in Pallister and Ayresome where nearly one third of children are obese, whilst in the most affluent ward of Nunthorpe, only 10% of children are obese.

Obesity in 11-year-olds, Middlesbrough wards, 2010/11 to 2012/13

Evidence shows that the prevalence of child obesity is closely related to deprivation; the National Obesity Observatory (2013b) found that the prevalence of obesity of children living in the 10% poorest areas is nearly twice that of those living in the most affluent areas with a linear relationship in-between. The graphs below show the association between obesity and deprivation in Tees wards for children aged 5 and 11 years.  The strength of the relationship between obesity and deprivation appears stronger at age 11 than age 5.

Obesity and deprivation, 5-year-olds, Tees wards, 2010/11 to 2012/13

Obesity and deprivation, 11-year-olds, Tees wards, 2010/11 to 2012/13

 

Last updated: 23/12/15

5. What services are currently provided?

Adults

In Middlesbrough, a four tiered model has been developed:

  • Tier 1 – population wide basic intervention and prevention for adults with a BMI ≤ 25
  • Tier 2 – community weight management service for adults with a BMII ≥ 25 with no known significant co-morbidities
  • Tier 3 – specialist weight management service for adults with BMI ≥ 40 or ≥ 35 with significant co-morbidities
  • Tier 4 – Access to bariatric surgery
Tier 1 - Prevention

Listed below are some of the key interventions which contribute to the prevention of overweight and obesity. These are discussed in more detail in the Diet and nutrition and Physical inactivity topics.

Extra Life is a setting based initiative that supports the promotion of health and wellbeing within an organisation to improve work environments and boost the health and wellbeing of its people.

Food4Health – supports food businesses to meet consumer demands for healthy food and enable their customers to make more informed healthier food choices.  Healthy cooking skills provide advice and guidance on healthy eating together with community-based practical cooking skills training.

Change4Life – the Change4Life brand and messages have been incorporated into local programmes and services such as sport and leisure services, cooking programmes, walking and cycling programmes and allotment programmes.

Active travel – promoting uptake of walking and cycling (see Physical inactivity topic for more information)

Sport and Leisure Services - see the physical inactivity topic for further information.

Healthy Cooking – Middlesbrough Environment City provides cooking skills training in the community to raise awareness of the benefits of a healthy diet, improve confidence in cooking at home and encourage people to use local and seasonal produce to provide tasty, healthy and cost effective meals.

Tier 2 – Targeted interventions

Community weight management services – on the 31st March 2015, the main tier two weight management service was decommissioned. During 2015/16 a review of tier two weight management services is being conducted alongside other interventions, with a view to commissioning a new service from the 1st April 2016 that will better fit population needs. During this period, other services are available (e.g. exercise on referral, commercial services, internet based interventions) although some of these incur a charge on the individual.

Forensic Mental Health and Learning Disability Dietetic Service – weight management programmes are delivered to people with mental illness or learning disabilities who are detained on the forensic units.  These groups are delivered by specialist dieticians and technical instructors.

Tier 3 – Specialist Interventions

Specialist weight management service – commissioned by South Tees Clinical Commissioning Group, this provides a specialist weight management service delivered by a multi-disciplinary team for people with a BMI ≥ 40 or ≥ 35 with significant co-morbidities.  The service is patient-centred and offers a variety of treatment options including psychological support, dietetic support and physical activity support.

Maternal obesity healthy lifestyle clinic – aims to provide support for lifestyle changes related to healthy eating and physical activity during pregnancy.  The clinic is targeted at obese pregnant women who have a BMI ≥ 40 with no co-morbidities and is delivered by a midwife and dietitian.

Tier 4 – Bariatric surgery

This service is commissioned by NHS England Area Team for the North East for patients with a BMI ≥ 40 or between 35 and 40 and other significant disease (for example, type two diabetes or high blood pressure) or to be considered as a first-line option for adults with a BMI ≥ 50.  Bariatric surgery is delivered at James Cook University Hospital in Middlesbrough, North Tees University Hospital in Stockton-on-Tees and City Hospital Sunderland.

Children

In Middlesbrough, a three tiered model has been developed:

  • Tier 1 - universal/prevention services for children and young people with BMI ≤ 91st centile;
  • Tier 2 - community weight management services for children and young people with BMI ≥ 91st – 98th centile;
  • Tier 3 – specialist intervention for children and young people with BMI ≥ 99.6th centile currently carried out on an individual basis through existing secondary care contracts.
Tier 1 – Prevention

Listed below are some of the key interventions which contribute to the prevention of overweight and obesity in children and young people. These are discussed in more detail in the Diet and nutrition and Physical inactivity topics.

Baby friendly initiative – this accredits acute and community settings that have implemented best practice for breastfeeding through implementation of baby friendly standards. James Cook University Hospitals Maternity Services were awarded the UNICEF stage 3 accreditation in January 2015.

Children’s centres - promotion of healthy eating from birth onwards through programmes such as weaning advice and breastfeeding support, basic cooking skills programmes and community growing schemes.

Early Years Settings - most nurseries in Middlesbrough have achieved a Food4Health award in recognition of work on nutritional standards. There will be further work to support the nurseries in 2012/13 through the development of a Food4Health: Early Years element, specifically for children under five.

Healthy child programme – the early identification and prevention of obesity is a key priority.  All families are given advice about breastfeeding, healthy weaning, healthy eating and active play. For 5-19 year olds, emphasis is on school delivery, via ‘school health teams’ who will offer support to parents and carers.

Healthy school meals – see Diet and nutrition topic  for more information.

Hearty-BEATS – working with primary schools to promote heart health and healthy lifestyles within the school setting and with pupils families. Hearty-BEATS offers a wide variety of activities including healthy food within the school setting and at home, cooking skills, urban farming, physical activity, smoking awareness and health checks for family members.

School travel plans – All schools in Middlesbrough have a school travel plan in place.

Active travel – promoting uptake of walking and cycling (see Physical inactivity topic for more information).

Sport and Leisure Services -  see Physical inactivity topic for more information.

Green Space – Middlesbrough Council manages parks and open spaces. See Physical inactivity topic for more information.

 

Tier 2 – Targeted interventions

Community weight management service – A service that provides community, family-based weight management programme for children and young people with a BMI≥91st and up to 98th centile with no significant co-morbidities who are aged 5 to 17 years. The multidisciplinary programme incorporates practical education in nutrition and diet, increasing physical activity, family involvement and behavioural modification.

 

Tier 3 – Specialist intervention

There is currently no weight management service at Tier 3.  Any specialist intervention is currently carried out on an individual basis through existing secondary care contracts.

 

Last updated: 23/12/15

6. What is the projected level of need?

Obesity prevalence is forecast to rise for both adults and children.  The trend has been upward for decades and suggests that by 2030, 41-48% of men and 35-43% of women could be obese. The most recent data suggests that the rise in obesity is levelling off.  However, more than one-quarter of adults are already obese and there is a serious and growing burden of obesity-related ill-health.

The Foresight report suggests an increase in the prevalence of obesity among people aged under 20 to around 15% by 2025.  The proportion of boys having a healthy BMI will be 45% while for girls only 30% will be in the healthy weight category (Government Office for Science , 2007).

Percentage of children predicted to be obese by age and sex, England, 2004 and 2025

Gender

Age

2004

2025

Boys

6-10

10%

21%

11-15

5%

11%

All under 20

8%

15%

Girls

6-10

10%

14%

11-15

11%

22%

All under 20

10%

15%

Source: Foresight report

 

For children, there is evidence from the last three to four years of HSE data that the increase in child obesity is slowing. This is also evident from the local NCMP data. Forecasts to 2020 show encouraging signs that the rising trend may be levelling out, suggesting that htere will be considerably lower proportions of overweight and obese children and young people than had previously been estimated. While it is encouraging that the trend in child obesity is levelling off and may reduce in the future, current prevalence of obesity and overweight remains high.

Forecasts for overweight and obesity in children and young people in 2020, England

Gender

Age

Overweight

Obese

Foresight forecast

McPherson forecast

Foresight forecast

McPherson forecast

Boys

2-11

22%

17%

20%

13%

12-19

25%

18%

19%

6%

Girls

2-11

34%

17%

14%

10%

12-19

35%

29%

30%

9%

 

Social class
There is no evidence that social class differences in the prevalence of obesity in the future will increase beyond those that already exist. However, obesity prevalence among social class I women (aged 20-60) is forecast to be only 15% by 2050, in contrast to 62% forecast for women in social class V.

Ethnicity
HSE samples are relatively small for some ethnic groups and so extrapolations should be treated with particular caution.  The projections suggest only very slight increases in the prevalence of obesity among Indian men and women.  However, obesity trends among black African women and Pakistani men and women are similar to that of the white population, with levels forecast to rise markedly.


 

Last updated: 24/12/15

7. What needs might be unmet?

There is inadequate capacity building within the workforce to ensure frontline staff are trained to raise the issue of weight and offer appropriate interventions and support.

There is a lack of preventive services particularly focusing on a life course approach.

Targeted weight management service provision is required for those identified at risk in adult and child populations (i.e. BME communities; learning disabilities; maternal obesity; men; under 5s; areas of high deprivation; specialist weight management support and for people with mental health needs).

Connection of weight management pathways and services is required with stronger links to be made with Map of Medicine and CCG’s to ensure a co-ordinated approach.

If current prevalence trends continue, demand for weight management services will outstrip capacity.

  • There is inadequate training to build workforce capacity and capability to ensure frontline staff are trained to raise the issue of weight and offer appropriate interventions and support.
  • There is a lack of preventive services for those identified at risk of overweight and obesity, particularly focusing on a lifecourse approach. Alongside this, there is limited support for children, young people and families at Tier 2 and Tier 3.
  • Targeted weight management service provision is required for those identified at risk in adult and child populations (i.e. BME communities; learning disabilities; maternal obesity; men; under 5s; areas of high deprivation; specialist weight management support and for people with mental health needs).
  • Connection of weight management pathways and services is required and stronger links to be made with Map of Medicine and NHS South Tees Clinical Commissioning Group (CCG) to ensure a co-ordinated approach.

 

Last updated: 24/12/15

8. What evidence is there for effective intervention?

Unhealthy weight gain is a complex issue that likely requires a complex response to prevent or treat. No country, region or locality in the developed world has made a demonstrable and sustained impact on rates of obesity and overweight. The evidence base continues to improve, but there is no intervention or range of interventions currently identified that can be prescribed to effect a population level change.

NICE Guidelines

Obesity: the Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children (CG43)

Weight Management Before, During and After Pregnancy (PH27)

Obesity: Working with Local Communities (PH42)

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

Behaviour Change: Individual Approaches (PH49)

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

Overweight and Obese Adults - Lifestyle Weight Management (PH53)

 

Department of Health

Strategic High Impact Changes: Childhood Obesity

Healthy Lives, Healthy People: A call to action

 

Other documents

Arterburn DE and Courcoulas AP (2014). Bariatric surgery for obesity and metabolic conditions in adults.

Bambra CL, Hillier FC, Cairns JM, Kasim A, Moore HJ, Summerbell CD. (2015). How Effective are Interventions at Reducing Socioeconomic Inequalities in Obesity among Children and Adults? Two Systematic Reviews.

Centre for Maternal and Child Enquiries (2010). Maternal Obesity in the UK: Findings from a National Project.

Dombrowski SU, Knittle K, Avenell A, Araújo-Soares V. and Sniehotta FF (2014). Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials.

Gardner, B., Wardle, J., Poston, L. and Croker, H. (2011). Changing diet and physical activity to reduce gestational weight gain: A meta-analysis.

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

Jolly K, Lewis A, Beach J, et al. (2011). Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten Up randomised controlled trial.

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

Waters E, de Silva-Sanigorski A, Burford BJ, et al. (2011). Interventions for preventing obesity in children.

 

Last updated: 24/12/15

9. What do people say?

Community weight management services
Weight management service user satisfaction surveys 2010/11:

  • 100% of service users rated the Tier 2 child weight management programme as good or above.
  • 100% of service users rated the Tier 2 adult weight management programme as good or above.
  • Tier 3 adult weight management: 94% of users rated the service as excellent with a further 6% rating it as good (64 service users across Middlesbrough, Redcar & Cleveland and Stockton-On-Tees, April 2012–March 2013).

Prior to the development of a service specification for the re-procurement of a Teeswide children and young people’s weight management service, current and potential service users were asked their views on how they thought the service should be delivered in their communities. Although this was a small sample, these views helped shape the service specification including preferred venue options, times of service delivery and service model.  This process will be repeated for future weight management procurements.

Maternal obesity services
The Consultation and Relational Empathy measure (Mercer et al. 2004) has been used to evaluate women’s views of the midwifery care within the healthy lifestyle service; overall  the women identified they had excellent care.

An evaluation by Teesside University of the South Tees Hospitals NHS Foundation Trust antenatal, intrapartum and postnatal clinical pathways for obese pregnant women identified that women who have attended the healthy lifestyle clinic have been positive about the increased level of support they received and appreciated the extra time they had with the health care professional to discuss issues when compared with routine appointments. Comments from the focus group held within the maternity service also identified positive experiences when they attended the healthy lifestyle clinic.

 

Last updated: 24/12/15

10. What additional needs assessment is required?

There is a recognition that more needs to be done to obtain the views of current and potential service users, and the public about obesity services and the obesogenic environment.

Local data and evidence is needed on the prevalence of child obesity for people with learning disabilities and BME populations, and their service needs.

Development of measures of adult obesity to provide data at a local level including ethnicity, gender, and socioeconomic status.

Further work is required to assess the needs of children, young people and families at Tiers 2 and 3 and develop appropriate services.

 

Last updated: 24/12/15

Key Contact

Name: Joanna Bielby

Job Title: Health Improvement Specialist – Nutrition and Obesity

e-mail: Joanna_Bielby@middlesbrough.gov.uk

phone: 01642 728060

 

References

Local strategies and plans

NHS  Tees Integrated Strategic and Operational Plan 2011-2014

NHS Tees Weight Management Services Strategic Review and Development Plan 2010

 

National strategies and plans

Department of Health (Childhood Obesity National Support Team,  2011). Strategic high impact changes: childhood obesity.

Department of Health (2011).  Healthy Lives, Healthy People: A call to action on obesity in England.

Department of Health, (2008). Healthy Weight, Healthy Lives: A Cross-Government Strategy for England.

 

Other references

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