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JSNA Chapter : Child Obesity

Section: Specific Condition
Next Review Date: 05/02/2015
Date Published: 05/02/2014

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Contents

  1. Introduction
  2. Who's at risk and why?
  3. The level of need in the population
  4. Current services in relation to need.
  5. Projected service use and outcomes in 3-5 years and 5-10 years.
  6. Evidence based (what works and what does not work)
  7. Unmet needs and service gaps
  8. Equality Impact Assessment
  9. Recommendations for Commissioning
  10. Recommendations for needs assessment work
  11. Key contacts
  12. Chapter References
  13. Signed off by


Introduction

Obesity is a major public health concern, reflecting escalating rates and the serious health and financial consequences it brings. Of particular concern is the rising trend in overweight and obesity rates in children and young people, with current estimates indicating that by 2050 nearly 25% of children in the UK will be obese and nearly 40% will be overweight (1)

Tackling obesity is a priority area for the Government as has been reported in 'Healthy Lives, Healthy People: A call to action on obesity in England’. This includes national ambitions relating to excess weight in children and recognises that excess weight (i.e. overweight and obesity) in children leads to excess weight in adults resulting in premature mortality and ill health. Within the Public Health Outcomes Framework there is an outcome relating to obesity in children which is measured as excess weight in 4–5 year olds and 10–11 year olds

It has been recognised that obesity cannot be effectively tackled by one discipline alone and the move of Public Health into local authorities on 1st April 2013 was seen as bringing about the development of co-ordinated action to tackle obesity across various departments, services and partner organisations. To support this action, partners from transport, planning and environment, leisure and culture, parks and green spaces, education and learning, health and social care, housing and workplaces are identified as necessary to tackle obesity.

Obesity results from an ‘energy imbalance’ in that more energy is taken in than expended. In children this is more complex than adults as children are also growing and need to ensure their requirements for growth are met. However, if energy intake in children (food and drink) exceeds energy output (resting metabolic rate and activity) and there is more energy than required for appropriate growth the excess energy will be stored as excess fat.

The underlying causes for this energy imbalance and resulting weight gain are complex and multi-factorial and include behavioural, psychological, social, cultural and environmental factors.

Childhood obesity is an increasing problem globally, nationally and at a local level. The number of overweight and obese children in Surrey can be estimated by applying national prevalence figures to the Surrey population available from the Health Survey for England (HSE). These survey figures (2) (table 1) are taken from a relatively small sample, so even at a national level they need to be interpreted with care and can only give some indication of the size of the problem in Surrey. Data on obesity prevalence in children is also available through the National Child Measurement Programme (NCMP) which measures the height and weight of around one million school children in England every year. Children are weighed and measured at 4–5 years of age (Reception year) and at 10–11 year of age (Year 6); of which, approximately 22,000 children from Surrey are included in the data. Using data from both the NCMP and the HSE provides a more detailed picture of the prevalence of childhood obesity in Surrey and the links to age, gender, ethnicity and deprivation.

Table 1: Estimated numbers of obese and overweight children in Surrey, 2011
 
HSE_Numbers_Chart.jpg
Source: HSE, 2011

The data from the HSE give some indication as to the size of the obesity problem in Surrey and show that an estimated one in four children in the county is either overweight or obese up to the age of 10 years with this rising to one in three in the 11 to 15 year olds.

This approximates to over 57,000 children in Surrey being either obese or overweight, of which 31,000 are estimated to be obese.

Obesity has been rising rapidly in children in England over the past 20 years with the proportion of children classified as obese nearly doubling for children aged 4-5 years and increasing more than threefold for children aged 10-11 years (3).

Findings from the NCMP show that Surrey has below average rates of child obesity when compared to the South East and England and was ranked 147th out of 151 PCTs ( Primary Care Trusts) in 2011/2012.

Surrey obesity rates from the NCMP in 2011/12 show that among 4–5 year olds (Reception year) 6.8% (9.5%) were obese and among 10–11 year olds (Year 6) 14.4% (19.2%) were obese (figures in brackets are for England).

The NCMP shows that childhood obesity is strongly linked to levels of deprivation and as the level of deprivation rises so does obesity prevalence (4)(16).

Further findings from the NCMP shows childhood obesity prevalence varies with ethnicity and is significantly higher than the national average for children in both school years in the ethnic groups: ‘Asian or Asian British', ‘Any Other Ethnic Group', ‘Black or Black British' and ‘Mixed' (4).

Obese children are known to be at increased risk of psychosocial problems, including reduced self-esteem and increased risk of depression and social isolation (5).

There is also an increased risk of becoming an obese adult leading to a reduced life expectancy of 9 years through a greatly increased risk of coronary heart disease, cancer, type 2 diabetes and high blood pressure (6).

Key issues and gaps

Surrey has below average rates of childhood obesity compared to the South East and England however, because of its relatively large population it does have a large number of both obese and overweight children.

There is clear clinical evidence of what works to prevent and treat obesity at an individual level. However, the effectiveness of public health programmes aimed at addressing the population level factors underlying increasing levels of obesity around the social and economic environments which surround food consumption and physical activity is less clear.  
  
In Surrey both Surrey County Council and NHS organisations play a key role in co-ordinating and supporting the efforts of partner organisations from boroughs, districts, local communities, businesses, health providers and key individuals in implementing those services needed to prevent and treat obesity. Having previously had community based services available across the county there are now no weight management programmes available to families and children for those aged 5 to 17 years of age and only a limited service available for those aged under 5.

The Surrey Obesity Strategy  (2007) and the Childhood Obesity Needs Assessment carried out by NHS Surrey in 2008 identified that in order to tackle obesity in Surrey there needs to be interventions for both the prevention and treatment of obesity across the County.

From April 2013 local responsibility for the prevention and management of obesity transferred from PCTs to local authorities. Public Health now sits within the County Council and works with partner agencies to deliver the recommendations from the Obesity Strategy and the Childhood Obesity Needs Assessment. Both documents support both the prevention and management of obesity in line with Healthy Lives, Healthy People: A call to action on obesity in England (7) and NICE guidance (8). The Surrey Joint Health and Well-being Strategy also identifies tackling obesity through prevention and treatment as essential to delivering its identified priorities.

Key issues and gaps identified in the NHS Surrey Childhood Obesity Needs Assessment include the need to:

1. Improve and use effectively the childhood obesity data for Surrey, ensuring that commissioned services are put in place in those areas with a higher prevalence of childhood obesity and deprivation.

2. Identify and clarify the roles of stakeholders to provide an integrated approach to the prevention and management of childhood obesity. This to include development and implementation of an obesity care pathway across Surrey ensuring a consistent approach to the identification, assessment, treatment and referral of obese and overweight children and their families.

3. Develop a focus on young children and families whilst ensuring appropriate services are targeted at those identified as having higher and more challenging needs. This is to include provision of weight management programmes to support these family with initiatives encompassing the required elements of healthy eating, physical activity and behaviour change.

4. Promote healthier food choices (see JSNA Chapter: Diet and Lifestyle) ensuring all partner agencies work together to develop an environment that encourages a healthy lifestyle through the promotion of healthier food choices.

5. Build physical activity into children’s lives (see JSNA Chapter: Physical Activity) through developing a focus on physical activity and the environment with all partners and recognition of the need to create healthy environments and neighbourhoods in order to encourage children and their families to be more active in their daily lives.

6. Create incentives for better health with all partner agencies being exemplar organisations through developing health at work initiatives that include  
  • the promotion of healthy eating and physical activity
  • the location and design of their buildings and;
  • staff engagement programmes.

7. Provide personalised support for overweight and obese children including access to information on interventions, counselling and local facilities to address those risks which are modifiable (i.e. reducing time spent watching television, increasing the level of family physical activity and reducing consumption of dietary fats, carbohydrates and sweetened drinks).

8. All partners to monitor progress and evaluation of effectiveness of interventions.

9. Build local capabilities through providing training to stakeholders and commissioning appropriate resources including a directory of relevant services and resources available for families.


Recommendations for Commissioning

The Surrey NHS Childhood Obesity Needs Assessment (2008) and the Surrey NHS Obesity Strategy (2007) identified the services that need to be commissioned to address Childhood Obesity in Surrey. Alongside this, the Child Obesity National Support Team (CONST) produced a Strategic High Impact Changes document (9) which identifies the services needed to tackle childhood obesity. These resources have provided evidence and support for identifying those services that need to be commissioned to tackle obesity in Surrey. 


Services needed to be commissioned to include:

A range of specialist weight management services for treating obese and overweight children that meet the NICE guidance Managing overweight and obesity among children and young people (PH47) October 2013 and include 

    • Provision of HENRY (Health, Exercise and Nutrition for the Really Young) a programme that supports 0 to 5 year olds who are obese or at risk of obesity through healthy weaning practices and development of healthy eating habits in under 5s based on parenting (10). 

    • Delivery of family-based weight management programmes such as MEND (Mind, Exercise, Nutrition and Do it)      

   • Expansion of targeted weight management interventions for the 5 -17 year age group as due to MEND being age specific there are currently no identified weight management services for children to meet the needs of children between the ages of 5 and 7 and those over 14 years of age. 

    • Partner organisations supporting obese and overweight children identified as having higher needs, and to include looked after children, children attending pupil referral units, children with learning disabilities and children with physical disabilities. 

    • Investment in a Surrey-wide specialist service for obese children requiring a higher level of intervention due to complex psychological problems. There is currently an absence of service for these clients.

A range of services for the prevention of obesity and overweight in children through: 

    • Building the capability of the wider children’s workforce to ensure those working at a local level are clear about promoting the benefits of a healthy weight and feel confident in sensitively raising the issue with those who are overweight or obese. Multi-agency training should be commissioned that includes how to raise awareness of obesity with parents including raising awareness with parents who do not understand that their child is overweight/obese and the long-term associated health risks. 

    • Ensuring early identification and prevention of obesity through implementing the Healthy Child Programme. 

    • Implementation of the Breastfeeding Strategy and commissioning of services to implement the UNICEF Baby Friendly Initiative. 

    • Investment in obesity prevention programmes to enable families with children and young people to live healthier and more active lifestyles, especially those living in areas of deprivation and those on low incomes.

    • Ensuring services are in place to implement and support feedback from the NCMP ensuring parents and carers are supported through information and signposting to services as appropriate. 

    • Increasing awareness of healthy food choices through investment in health and wellbeing programmes in school and delivery through the Surrey Healthy Schools programme. 

    • Implementation of services to reduce the increasing number of overweight and obesity in mothers before, during and after pregnancy. Services to include specialist training, and dedicated nutrition and dietetics capacity time to support an increasing number of obese mothers and provision of a seamless service through referral to the HENRY programme. 

    • Continued rigorous evaluation of current interventions through including evaluation criteria from the Standard Evaluation Framework for Weight Management Interventions (12) in contracts to inform future impact modelling and commissioning.

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Who's at risk and why?

England has one of the highest rates of obesity in Europe with over 60% of adults and one third of 10 and 11 year olds being either overweight or obese. Although childhood obesity is prevalent in all communities in Surrey, some sectors of the population are more at risk of obesity and developing the associated health and psychological complications associated with obesity.

The National Child Measurement Programme (NCMP) which measures the height and weight of around one million school children in England every year (of which, approximately 22,000 are in Surrey) helps to provide a detailed picture of the prevalence of childhood obesity. The NCMP has collected data since 2006/07 and over this time has identified trends and influences on obesity in children. These influences include age, gender, deprivation and ethnicity.

NCMP data for England shows that obesity prevalence rises with age and is significantly higher in 10 -11 year olds (Year 6) than in 4 -5 year olds (Reception year) with boys being significantly more likely to be obese than girls in both age groups. By comparing the results over time it is seen that obesity in 10 -11 year olds (Year 6) has increased from 19.0% to 20.7% among boys and from 15.8% to 17.7% among girls from 2006/07 to 2011/12. Among 4 -5 year olds (Reception year) obesity fell from 10.7% to 9.9% among boys and has remained stable at 9.0% among girls.

In Surrey, the prevalence of obesity in boys and girls although lower than for England shows a similar trend with prevalence in year 6 being significantly higher than in year R. In 2011/12 obesity prevalence in 10-11 year olds was more than double that of 4-5 year olds (Reception year), that is 14.4% compared to 6.8%. In the last five years the obesity levels in 10 -11 year olds (Year 6) has gone from 14.1% in 2007/08 to 14.4% in 2011/12. Among 4 -5 year olds (Reception year) obesity has seen a slight fall going from 7.9% in 2007/08 to 6.8% in 20011/12.

It is too early to say if these findings show that obesity levels are starting to stabilise but these findings need to be treated cautiously as it is known that children who are overweight or obese are more likely to opt out of being measured leading to an under representation of obese children in the results from the NCMP and particularly in 10-11 year olds (Year 6).

Surrey trend data is presented in the graphs (figures 1 & 2)  for the boroughs and districts for the last five years and although obese children are more likely to opt out of the NCMP it can be clearly seen that obesity rates increase with age across the county thus re-enforcing the need for interventions to start at an early age.

Figure 1 & 2: Shows trend and numbers of obese 4-5 year olds (Reception year) for 2007/08, 2008/09, 2009/10, 2010/11 and 2011/12 by sex and borough/district 

NCMP_Numbers_gender 20072012.jpg
Source: NCMP 2007/12

Figure 3 & 4: shows trend and numbers of obese 10-11 year olds (Year 6 ) for 2007/08, 2008/09, 2009/10, 2010/11 and 2011/12 by sex and borough/district

NCMP_Numbers_gender_Year6_20072012.jpg
Source: NCMP 2007/12

National data shows that obesity prevalence is significantly higher in urban areas than in rural areas for both school years.

Analysis of the data from the NCMP (4) also shows a strong positive relationship between deprivation and obesity prevalence for children in Reception and Year 6, with increased socioeconomic deprivation measured by the 2010 Index of Multiple Deprivation (IMD) score (13). Obesity prevalence is also related to eligibility for Free School Meals (FSM), another useful measure for deprivation, with those children living in areas with higher rates of eligibility for FSM having significantly higher rates of obesity than those living in areas with low eligibility rates (14).

Further information on the epidemiology of childhood obesity can be found on the NOO website (17).

Map 1: Indices of Multiple Deprivation 2010, by MSOA

Child Obesity Map 1.JPG
Source: IMD 2010 


Map 2: Percentage of obese 4 - 5 year olds (Reception year), 2009/12 by IMD 2010 by MSOA

NCMP_Receptions_2009-2012_840px.jpg
Source: NCMP 2009/12


Map 3: Percentage of obese 10 -11 year olds (year 6), 2009/12  by IMD 2010, by MSOA

NCMP_Year 6_2009-2012_equal count.jpg
Source: NCMP 2009/12

Childhood obesity prevalence also varies by occupation-based social class, with children in households where the main income earner works in a professional occupation having lower rates of obesity than those where the main income earner is in a manual occupation (15).

The National Obesity Observatory contains additional data tables at Local Authority (LA) and Middle Super Outcome Area (MSOA). The e-atlas for local authorities is also available at the NCMP Local Authority Profile.

The NCMP also reveals substantial variation in childhood obesity prevalence between ethnic groups with children from most minority ethnic groups having a higher prevalence of obesity than White British children, although the patterns are different for boys and girls and for different age groups. Among 4 -5 year olds (Reception year) Black African, Black Other and Bangladeshi boys and Black African and Black Other ethnic groups girls have the highest prevalence of obesity and in 10 -11 year olds (Year 6) Bangladeshi, Asian Other, and Pakistani ethnicities in boys have the highest prevalence, whereas among girls, those from African and Other Black groups have the highest prevalence.  The NOO contains additional information on childhood obesity and ethnicity.

Figure 5: Prevalence of obesity by ethnic group, Reception year , 2011/12

NOO_Reception_Ethnicity_20112012.jpg
Source: NOO, 2012



Figure 6: Prevalence of obesity by ethnic group, Year 6, 2011/12

NOO_Year 6_Ethnicity_20112012.jpg
Source: NOO, 2012 


Table 2: National figures for ethnic categories for children who are either overweight or obese 2011/12

LoN_Ethnicity_Table.jpg
Source: NCMP, 2011/12

By comparing Surrey County Council to similar local authorities (table 3 and figures 7 and 8) it can be seen that Surrey has a slightly lower obesity prevalence in both age groups. Looking at the geographical distribution of childhood obesity in England within the NCMP (2011/12) dataset (18) shows that Southwark PCT has the highest prevalence of obesity 28.3% for 10 -11 year olds (Year 6) and Newcastle PCT has the highest prevalence 14.5% for 4 -5 year olds (Reception year).The South Central has the lowest prevalence for 10 -11 year olds (Year 6) at 16.3%, while the South East Coast has the lowest prevalence for 4 -5 year olds (Reception year) at 8.1%. Table 4 and figures 9 and 10 show the prevalence of overweight children varies less by area, especially in the older age group (year 6).


Table 3: Prevalence of obese children compared with similar local authorities, 2007/12
 
Comparison PCT trend Obese_Table_201213.JPG
Source: NCMP 2012


Figure 7 & 8: Prevalence of obese children with 95% confidence intervals compared with similar local authorities

Comparison PCT trend Obese_201213.JPG
Source: NCMP trend data, 2007/12


Table 4: Prevalence of overweight children compared with similar local authorities, 2007/12

Comparison PCT trend Overweight_Table_201213.JPG
Source: NCMP, 2012


Figure 9 & 10: Prevalence of overweight children with 95% confidence intervals compared with similar local authorities

Comparison PCT trend Overweight_201213.JPG
Source: NCMP trend data 2007/12
 

Further information on the epidemiology of childhood obesity can be found on the NOO website.

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The level of need in the population

The number of overweight and obese children in Surrey can be estimated by applying national prevalence figures available from the Health Survey for England (HSE) to the Surrey population. These survey figures (2) (table 5) are taken from a relatively small sample, so even at a national level they need to be interpreted with care and can only give some indication of the size of the problem in Surrey. Data on obesity prevalence in children is also available through the National Child Measurement Programme (NCMP) which measures the height and weight of around one million school children in England every year. Children are weighed and measured at 4–5 years of age (Reception year) and at 10–11 years of age (Year 6) of which approximately 22,000 children from Surrey are included in the data.

The HSE data shows that obesity prevalence in 2 to 15 year olds has risen from 11.1% to 16.6% among boys, and from 12.2% to 15.9% among girls, between 1995 and 2011. The prevalence of overweight among children aged 2 to 15 has remained steady over the same period, suggesting that the size of the shift from the healthy weight range to overweight among children is similar to the shift from overweight to obese.

Based on these figures it is estimated that over 57,000 children in Surrey are either obese or overweight. The prevalence and estimated numbers are presented in table 5. 

Table 5: Estimated numbers of obese and overweight children in Surrey, 2011
 
HSE_Numbers_Chart.jpg
Source: HSE, 2011

The HSE numbers indicate that there are slightly higher numbers of boys than girls who are either obese or overweight. 

In 2011/12, the NCMP data for Surrey showed that 6.8% of 4-5 year olds (Reception year) were obese and a further 11.6% were overweight and 14.4% of 10 -11 year olds (Year 6) were obese and a further 13.8% were overweight. Based on these figures just over one in four (28.2%) of 10-11 year olds (year 6) were either overweight or obese, and nearly one in five (18.4%) of 4-5 year olds were either overweight or obese in these school years in 2011/12. 

NCMP data for 2011/12 on both the numbers and percentages of obese and overweight children in both Reception year and Year 6 is presented for each borough and district in table 6.


Table 6: NCMP 2011/2012 results for obese and overweight by borough/district

LA_Numbers_Percentages_2012.jpg
Source: NCMP 2011/12


Figure 11 & 12: NCMP 2011/2012 results by borough/district showing the prevalence of obese and overweight for Reception year and Year 6 with 95% confidence intervals

Child Obesity pop Fig1.JPG
Source: NCMP 2011/12 


Figure 13 &14: HSE 2011results for Surrey showing the estimated number of obese and overweight children by gender 

   HSE Prevalence_Gender 2011.jpg
Source: HSE, 2011 

National findings shows strong link between deprivation and obesity levels. There is a link between obesity and certain ethnic groups and although ethnicity data has been collected in Surrey for the NCMP it has not been possible to do any analysis of the data due to the small numbers.

Key findings from Surrey are: 

  • Although Surrey has a slightly lower prevalence of obese children than neighbouring local authorities there are relatively large numbers of obese and overweight children in the county due to the larger population
  • Surrey follows the national trends with those areas identified as being more deprived having a higher incidence of obesity
  • Obesity prevalence doubles from year R to Year 6 showing that interventions to prevent and treat obesity need to be targeted at the under 5’s and school-aged children
  • Both age groups show that boys are more likely to be obese than girls. 

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Current services in relation to need.

This section outlines current provision across Surrey.

The Childhood Obesity Needs Assessment (2008) describes in detail the current services in the County for the prevention and treatment of obesity in children. Further details of the key services and interventions which contribute to the prevention and treatment of overweight and obesity are included in JSNA chapters on diet & lifestyle, physical activity, and diabetes.

It has been recognised that obesity cannot be effectively tackled by one discipline alone and the move of Public Health into local authorities on 1st April 2013 brought about the development of co-ordinated action to tackle obesity across various departments, services and partner organisations. To support this action partners from transport, planning and environment, leisure and culture, parks and green spaces, education and learning, health and social care, housing and workplaces are included. The National Obesity Observatory (NOO) has produced guidance on the role of local authorities in tackling obesity.

The prevention and treatment of childhood obesity is delivered through agencies who are either involved in providing individual dietary advice to children and their families or in undertaking population based public health obesity initiatives. Partnership working is essential in delivering both obesity prevention and treatment services and in developing an environment that enables people to make healthy lifestyle choices through reducing their food intake and increasing their physical activity. Such initiatives must ensure involvement of a wide range of partners working together to ensure these are targeted at those children and their families who are at greatest risk of obesity. 

Current services for obesity in Surrey is delivered in partnership with key partners and stakeholders that includes:

  • Surrey County Council and the 11 Boroughs and Districts in Surrey
  • Clinical Commissioning Groups (CCGs)
  • Surrey community provider health services
  • NHS trusts within Surrey
  • Primary Care
  • Pharmacies
  • Public and patient representatives
  • Voluntary organisations
  • Education - nurseries, schools, colleges and further education
  • Commercial sector including work places.

Support is also available from Change4Life, a national social marketing programme which targets children and families who are either obese or at risk of obesity.

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Projected service use and outcomes in 3-5 years and 5-10 years.

National data from the National Child Measurement Programme (NCMP) shows that in England in 2011/12, obesity among 4–5 year olds (Reception year) was 9.5% and among 10–11 year olds (Year 6) was 19.2%. These figures have remained broadly similar over the last three years. For Surrey in 2011/12, obesity among 4–5 year olds (Reception year) was 6.8% and among 10–11 year olds (Year 6) was 14.4% which (see figures 7 and 8) shows that over the last 5 years there has been a slight decrease among 4–5 year olds (Reception year) and a levelling out of the rate of obesity among 10–11 year olds (Year 6). However, these findings need to be treated with caution as they provide too few data points (five years) to reliably set trends and need to be monitored closely over the next 3-5 years.

At a national level NOO have looked at the changes in children’s body mass index (BMI) between 2006/07 and 2011/12. This report presents the analysis of data from the first six years of the National Child Measurement Programme (NCMP) describing the changes that have taken place across survey years in the BMI of children aged 4–5 and 10–11 years attending state maintained schools in England. 
 
According to Health Survey for England (HSE) figures show obesity prevalence amongst 2–10 year olds rose from 10.1% in 1995 to 13.9% in 2011. However, there are growing indications that this previous upwards trend in child obesity may now be flattening out although it is still too early to be certain that this represents a long-term change in the trend, particularly for older boys. Future HSE data will confirm whether this is a persistent pattern, or just a short-term change in a long-term upwards trend.

Further information on trend data on children’s weight can be found on the NOO website.


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Evidence based (what works and what does not work)

There is an extensive evidence base on interventions to tackle childhood obesity.

Local interventions have also provided evidence of effectiveness of local public health obesity, physical activity and nutrition initiatives and include:

MEND - Evaluation of children and families who attended MEND programmes
HENRY - Evaluation of HENRY pilot run in priority places in Surrey

There is also evaluation of these interventions at a national level 
HENRY: development, pilot and long-term evaluation of a programme to help practitioners work more effectively with parents of babies and pre-school children to prevent childhood obesity.
Rudolf MCJ, Hunt C, George J, Hajibagheri K, Blair M
Published Child 2010 

Training community practitioners to work more effectively with parents to prevent childhood obesity: the impact of HENRY upon Children’s Centres and their staff.
Willis TA, Potrata B, Hunt C, Rudolf MCJ
Published Journal Human Nutrition and Dietetics 2012, 25(5), 460-468 

HENRY: Long Term Impact of a Programme to Prevent Childhood Obesity
Brown R, Willis TA, Hunt C, Rudolf MCJ
Yorkshire & Humber Academic Presentation day 

Let’s Get Healthy with HENRY: National evaluation report – summary
Willis TA 

Evaluation of the 'Tackling Childhood Obesity with HENRY' e-course designed for professionals working in childcare and health settings
Rudolf MCJ, Hunt C, George J, Clarkson J
2008 

Combating child obesity: impact of HENRY on parenting and family lifestyle
Willis TA, George J, Hunt C, Roberts KPJ, Evans CEL, Brown RE and Rudolf MCJ
Published Pediatric Obesity 2013 

Preventing child obesity: a long-term evaluation of the HENRY approach
Brown RE, Willis TA, Aspinall N, Hunt C, George J, Rudolf MCJ
Published Community Practitioner 2013

Further examples of local initiatives to support the treatment and prevention of childhood obesity can be found in the Diet and lifestyle JSNA chapter.

The National Obesity Observatory provides a single point of contact for wide-ranging authoritative information on data, evaluation and evidence related to weight status and its determinants. It also has a wide range of reports and links to these and includes detailed evidence on the treatment and prevention of childhood obesity.

Key Documents

The Foresight Tackling obesity report (Foresight, 2007) provides recommendations for the population wide approach for addressing obesity. 

Reducing Obesity and Improving Diet (March 2013) provides details of current policy on helping people make healthier choices. 

NICE Guidance (2006) Obesity guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children provides population and community level interventions.

NICE Guidance (2013) Managing overweight and obesity among children and young people (PH47)

Department of Health (2011)  Healthy lives, healthy people: a call to action on obesity in England.   

National Obesity Observatory (2009) Treating childhood obesity through lifestyle change interventions. A briefing paper for commissioners  -aims to support commissioners by providing a brief guide to current best available evidence on effective treatment interventions for children and young people who are overweight or obese. 

National Obesity Observatory (2009) Preventing childhood obesity through lifestyle change interventions. A briefing paper for commissioners - aims to support commissioners by providing a brief guide to current best available evidence on effective obesity prevention interventions for children and young people.

Department. of Health (2011) Strategic High Impact Changes. The Childhood Obesity National Support Team (CONST) captured the learning and evidence from 44 area visits and translated their findings actions for addressing obesity in local areas. 

Social and economic inequalities in diet and physical activity
This briefing paper describes social and economic inequalities associated with two of the key determinants of obesity - diet and physical activity. The paper also explores possible explanations for these inequalities. 

Obesity and the environment: increasing physical activity and active travel
This report summarises the importance of action on obesity with a specific focus on active travel, and outlines the regulatory and policy approaches that can be taken. 

Obesity and the environment: regulating the growth of fast food outlets
This report summarises the importance of action on obesity with a specific focus on fast food takeaways, and outlines the regulatory and other approaches that can be taken at local level.


What works in combating childhood obesity: 

An anthology of the literature on effective whole-system approaches 
http://www.c4eo.org.uk/themes/files/childhood-obesity-anthology-may2011.pdf

A range of evaluation reports have been collated by the National Obesity Observatory and are available on  http://www.noo.org.uk/core/eval_reports.

For further information on the use of the NCMP including interpretation of the data, NOO has produced a number of resources. Links to download all the analysis reports published by NOO on the NCMP are available at: www.noo.org.uk/NCMP/National_report

These include: 

Changes in children’s body mass index between 2006/07 and 20011/12 

Variation in children’s BMI by month of measurement 

Guidance for analysis

A simple guide to classifying body mass index in children 

Standard Evaluation Framework for weight management interventions 

PowerPoint slide set presenting analysis on childhood obesity 

Data factsheets 

Changes in children’s body mass index between 2006/07 and 2010/11  uses the ONS Area Classification to explore child obesity prevalence (using National Child Measurement Programme data) by geographic population sub-groups that are based on socio demographic characteristics (Office for National Statistics Area Classification). The analysis highlights health inequalities that exist between different population groups and identifies the likely level of obesity within local neighbourhoods and populations.

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Unmet needs and service gaps

The Surrey Childhood Obesity Needs Assessment (December 2008) identified the unmet needs and service gaps for children and their families in Surrey. These gaps identified by nearly one hundred stakeholders have been summarised below
 
Starting interventions early with child and family through

  • Providing education in antenatal classes on risks from obesity, promoting breastfeeding and help with weaning
  • Promoting parent education including parenting skills and behaviour management, developing cooking skills to include healthy eating, portion size, raising awareness of available and appropriate activities, raising awareness of risks of obesity
  • Identifying and recognition of weight problems in children
  • Starting education early, preschool, with children and making it fun
  • Raising emotional wellbeing of families and children through programmes such as HENRY

Promoting healthier food choices through

  • Cooking and healthy eating education in schools as part of life skills
  • Increasing awareness of healthy eating in schools including school and packed lunches.
  • Having access to local healthy food, fresh fruit and vegetables
  • Promoting help for low income families such as higher benefits or “voucher” schemes

Building physical activity into lives through

  • Improving opportunities for physical activity that is affordable and local available safe play areas
  • Having activities for all – some of which are not competitive and ensure activities are age, gender and culturally appropriate (e.g. single sex swimming) and some specifically for children with disabilities
  • Encouraging walking and cycling to school through safe routes
  • Improving parks and playing fields and encouraging their use
  • Supporting after school sports including cubs and scouts groups
  • Promoting activities and include personalities as positive role models.

Personalising support for overweight and obese children through

  • Providing holistic and multifaceted approach in treatment and prevention of obese children involving society, school, home, environment, transport
  • Having local coordinated multidisciplinary services that follow NICE guidelines
  • Recognising that different approaches are needed and meet the needs of the individual
  • Having family based interventions, in groups and in the home that have a combined approach to improving self esteem, diet and exercise such as MEND and ensuring availability across Surrey

Currently there is no agreed local weight management pathway and services vary across Surrey with current services not meeting the needs of groups at high risk.

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Equality Impact Assessment

No Equality Impact Assessment (EIA) has been conducted for the overall strategic approach for childhood obesity. However an equality analysis (19) has been conducted for the Department of Health for the Healthy lives, healthy people: a call to action on obesity in England (7) which has evidence of need and potential differential impact relevant to the local approaches for addressing obesity.

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Recommendations for Commissioning

There is a need to invest in a range of specialist weight management services for treating obese and overweight children that meet the NICE guidance Managing overweight and obesity among children and young people (PH47) October 2013 (20) and to include:

Specialist weight management services

  • Support 0 to 5 year olds who are obese or at risk of obesity through commissioning the delivery of HENRY (Healthy Exercise and Nutrition for the Really Young) programme that promotes healthy weaning practices and development of healthy eating habits in under 5s through parenting (10) 
  • Commission the delivery of a family weight management programme such as MEND (Mind, Exercise, Nutrition and Do it) programme in all districts and boroughs (11) 
  • Expand provision of targeted weight management interventions for the 5 -17 year age group as due to MEND being age specific there are no identified weight management services to meet the needs of children between the ages of 5 and 7 and those over 14 years of age
  • Work in partnership to ensure programmes are in place to support obese children and are meeting the needs of particular groups of children and young people, for example: looked after children, children attending pupil referral units, children with learning disabilities and children with physical disabilities
  • Invest in a Surrey-wide specialist service for obese children requiring a higher level of intervention due to complex psychological problems. There is currently an absence of service for these clients, unless they are known to the eating disorder service. It is recommended that a scheme such as the Traffic Light (Great Ormond Street) is explored.

 

Prevention through universal and targeted approaches

  • Build the capability of the wider children’s workforce to ensure those working at a local level are clear about promoting the benefits of a healthy weight and feel confident in sensitively raising the issue with those who are overweight or obese. Multi-agency training should be commissioned that includes how to raise awareness of obesity with parents including raising awareness with parents who do not understand that their child is overweight/obese and the long-term associated health risks.
  • Ensure early identification and prevention of obesity through the Healthy Child Programme by setting clear commissioning outcomes.
  • Implement the Breastfeeding Strategy and commission services to implement the UNICEF Baby Friendly Initiative.
  • Invest in obesity prevention programmes to enable families with children and young people to live healthier and more active lifestyles, especially those living in areas of deprivation  and those on low incomes
  • Ensure services in place to implement and support feedback from the NCMP ensuring parents and carers are supported through information and signposting to services as appropriate.
  • Increase awareness of healthy food choices through investment in health and wellbeing programmes in school and delivery through the Surrey Healthy Schools programme and the School Food Plan initiatives.
  • Implementation of services to reduce the increasing number of overweight and obese mothers before, during and after pregnancy, Services to include specialist training, dedicated nutrition and dietetics capacity and provision of a seamless service through referral to the HENRY programme.
  • Continue to rigorously evaluate current interventions by including evaluation criteria from the Standard Evaluation Framework for Weight Management Interventions(12) in contracts, and through research to inform future impact modelling and commissioning. 

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Recommendations for needs assessment work

  • Improve and use effectively the data on a range of obesity indicators for Surrey following guidance from the NCMP and use this to provide meaningful data at a local level where possible.
  • Carry out further data collation and analysis to understand the trends and patterns of child obesity and also to understand the uptake of services in relation to need with a particular focus on children with higher needs including those with more complex needs including:
  • children and young people with learning disabilities
  • those excluded from main stream schools
  • looked after children and
  • those identified at high risk of obesity.
  • Conduct analysis of the child obesity data at a local level alongside appropriate indicators linked to childhood obesity and use to inform commissioning decisions.

 


 

Key contacts

Julie Nelson, Obesity Programme Manager, NHS Surrey - julie.nelson@surreycc.gov.uk

Lynne Sawyer, Public Health Analyst, NHS Surrey - lynne.sawyer@surreycc.gov.uk



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Chapter References

  1. McPherson K, Marsh T, Brown M (2007) Foresight Tackling Obesity:-Future Choices- Modelling Future Trends in Obesity and their impact on Health. Government Office for Science.
  2. Statistics on obesity, physical activity and diet: England, 2011, The Health and Social Care Information Centre.
  3. Ridler C, Townsend N, Dinsdale H, Mulhall C, Rutter H (2009); National Child Measurement Programme: Detailed Analysis of the 2007/08 National Dataset; HM Gov London.
  4. National Child Measurement Programme: England, changes in children’s BMI 2006/7 to 2010/11 February 2013
  5. Health risks of child obesity (NOO), http://www.noo.org.uk/NOO_about_obesity/obesity_and_health/health_risk_child
  6. Tackling Obesity in England, The National Audit Office (2001) http://www.nao.org.uk/publications/0001/tackling_obesity_in_england.aspx
  7. Department. of Health (DH) (2011). Healthy lives, healthy people: a call to action on obesity in England.
    http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_130401
  8. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children, NICE Obesity Guidance,2006
  9. Strategic High Impact Changes, Childhood Obesity National Support Team, DH March 2011 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_126105.pdf
  10. Henry Programme  http://www.henry.org.uk
  11. Mend Programme  http://www.mendprogramme.org/
  12. Standard Evaluation Framework for Weight Management Interventions, (National Obesity Observatory, 2009)  http://www.noo.org.uk/core/SEF  
  13. IMD 2010,  http://www.communities.gov.uk/publications/corporate/statistics/indices2010
  14. School meal take up data http://www.noo.org.uk/data_sources/Nutrition/school_meal_takeup
  15. NOO data briefing (October 2010) Child Obesity and Socioeconomic Status http://www.noo.org.uk/uploads/doc/vid_7930_Child%20Socioeco%20Data%20Briefing%20October%202010.pdf
  16. PHE - Inequalities in child obesity  https://www.noo.org.uk/uploads/doc/vid_18988_PHEconf_Poster_NCMPinequalities_v2.pdf
  17. Child obesity and socioeconomic status. 2012. NOO. Available from: http://www.noo.org.uk/uploads/doc/vid_16967_ChildSocioeconSep2012.pdf 
  18. National Child Measurement Programme - England, 2011-2012 school year. Available from: http://www.hscic.gov.uk/searchcatalogue?q=title%3A%22national+child+measurement+programme%22&area=&size=10&sort=Relevance
  19. Equality analysis: a call to action on obesity in England. DH. 2011. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213721/dh_130511.pdf
  20. Managing overweight and obesity among children and young people: lifestyle weight management services (PH47). NICE. 2013. Available from: http://publications.nice.org.uk/managing-overweight-and-obesity-among-children-and-young-people-lifestyle-weight-management-ph47

 


 

Signed off by

Maggie Simkins, Obesity Programme Manager, NHS Surrey - maggie.simkins@surreycc.gov.uk

If you have any comments/feedback please send it to jsnafeedback@surreycc.gov.uk


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Updated: 05 February 2014 | Owner: Lynne Sawyer
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