Why is it an issue?
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Body mass index (BMI), a measurement calculated from weight and height, defines people as overweight (overweight) if their BMI is between 25 and 30 kg/m2, and obese when it is greater than 30 kg/m2.
Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnoea, certain types of cancer, depression and osteoarthritis. Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders and some medications.
The first years of life are a critical period for the development of food and flavour preferences, the ability to self-control food intake, the transmission of cultural and familial beliefs about food and eating, and the susceptibility to overweight and obesity later in life. Overweight in infancy or childhood tends to increase the risk of obesity as an adult.
What’s the local picture and how do we compare?
How do we compare?
What do things look like locally?
- Prevalence of overweight and obesity has increased steadily over the last few decades, with the result that locally an estimated 28.5 % of adults are obese against 24.2% nationally (Wakefield Health Profile, 2011; modelled estimate using Health Survey for England 2006-2007 revised).
- Information from GPs records shows that less than one third of all adults aged over 20 in Wakefield district have a normal Body Mass Index (BMI). However it is recognised that this data may not be reflective of the overall practice population. Problems with being overweight or obese are more common among people in middle age and there is a strong correlation between obesity and deprivation (State of the District, 2010; S1 Obesity Analysis, 2010; Lifestyle Survey – Obesity & Diet Analysis, 2009). Childhood obesity does not always share a direct correlation with deprivation (HI Gap Analysis, 2010).
- Comparing these figures with those reported by the Health Survey for England 2008 (HSE, 2008) Wakefield District compares poorly Nationally, Regionally and at Spearhead level. Worryingly for Wakefield District, lower prevalence in the Normal and Overweight BMI status categories is offset by higher prevalence in the Obese and the Morbidly Obese BMI status categories (S1 Obesity Analysis, 2010).
- Those who are in households with low levels of income, including those receiving housing benefit, council tax benefit and income support have higher levels of obesity (Lifestyle Survey – Obesity & Diet Analysis, 2009).
- Levels of obesity (As measured by the National Child Measurement Programme) in children & young people in Wakefield are similar to national and regional averages (CJSNA, 2010).
What’s the trend and what can we predict?
- The level of childhood obesity in the Priority Neighbourhoods is increasing, compared to a regional downward trend. In Year 6, the level of obesity in the Priority Neighbourhoods is falling quicker than across the rest of the district (HI Gap Analysis, 2010).
- The overall rate of child obesity is falling in both Reception and Year 6, although there are some data quality concerns over early periods (HI Gap Analysis, 2010).
- Adult obesity (as defined by QOF) has continued to rise, with over 10.5% of our population now on the disease register, placing us at the 84th percentile (QOF, 2010).
- Total population in Wakefield aged 65 and over with a BMI of 30 or more is expected to rise from 14,200 to 21,300 by 2030, assuming obesity rates in the Health Survey for England remain static (POPPI, 2010).
- The Foresight Report makes clear that obesity is a major public health concern – one that is expected to continue to rise in both profile and its collective effect on health and social care burden.
What are we doing and what can be done differently?
What are we doing?
- A new Wakefield Adult Weight Management Service is being commissioned to commence in January 2012. The service incorporates delivery of community weight management programmes as well as interventions for more complex patients, from a multi disciplinary team including Dietetic, Consultant, Physiotherapy, Psychology input as appropriate. Exercise on Referral programmes will also be incorporated into the service.
- Reviewing the issues and barriers that contribute towards maternal obesity and developing actions to address these.
- The Three Areas Project involving approximately with the 30 projects for all ages involved, all brought together under the Three Areas Project. By working closely together – with key aim to encourage people to move more, eat well and live longer through innovative schemes based on various themes like: increasing activity, growing and eating healthy food and developing strong communities.
- Made headway in developing and delivering weight management programmes for specific groups including Learning Disability groups, South Asian community and men as part of a Waist Management programme delivered in conjunction with local rugby clubs
- Childhood Obesity is managed in a number of ways; commissioning programmes to deal with the screening, prevention, treatment and management of children with weight issues:
- Screening: The school nursing team is commissioned weigh and measure Reception and Year 6 children during the school year. This is a national initiative known as The National Child Measurement Programme and its aim is to inform local planning and delivery of services for children. The measurement gathers population-level surveillance data to allow analysis of trends in growth patterns and obesity. The NCMP also helps to increase public and professional understanding of weight issues in children and is a useful vehicle for engaging with children and families about healthy lifestyles and weight issues.
- Prevention: The prevention of childhood obesity is widespread and is embedded into the school curriculum, and the activities of the Sport and Active Lifestyles team at Wakefield Council. More specifically a number of programmes are commissioned by NHS Wakefield. These projects include, Kick It – delivered in partnership with the three professional rugby league teams in schools, successfully promoting increased participation in out of school physical activity and participation in the Community Sports Leader’s Award. The Three Areas Projects (TAP) mentioned previously have had a significant focus on obesity prevention in children and have included education, growing, cooking and activity programmes. The community Food and Health team work in children’s’ centres, schools and in the community to promote healthier lifestyles and food choices. The school nursing team also works within the school setting to promote healthy weight and the PCT commissions Little Angels to support and promote breastfeeding in the district. The Connect3 team also deliver prevention sessions to families with children under five focusing on families working together to be physically active and eat a healthier diet.
- Management and treatment: The Mid Yorkshire Hospitals NHS Trust is commissioned to deliver a multi disciplinary weight management service to children aged under 19. The Connect3 programme delivers multi component and age appropriate support to overweight and obese children and their families; a 4-7 year old programme for the youngsters, the main family programme for children 8+ and C3 ‘Fit4Teenz’ for teenagers. Following their participation in the programme children can participate in follow on maintenance physical activity programmes (known as Connect3 Active), which are run in partnership with a number of different providers
What can be done differently?
- Improving BMI monitoring in GP practices, to encourage this to be recorded if all patients and not just of patients that are likely to be overweight or obese.
- To evaluate and deliver sustainable weight management interventions that meets the needs of specific vulnerable groups.
- Ensure that the information flow between provider and commissioner, i.e. NCMP, is appropriate and effective to make sure local planning is also equally effective