The whys and wherefores ofhealthy weight

Broxbourne Obesity Summit, 22 October 2013

Jim McManus

Director of Public Health

Key points

• Keeping a healthy weight is difficult

• We are failing as a Country and a County

• Broxbourne Significantly Worse than Herts

• There are multiple reasons why so many people struggle

• We need a multifaceted solution

• The Broxbourne pilot gives us perhaps our best chance at achieving this

• Many strands of scientific debate and argument

Health Profiles 2013 indicators

MeasureEng

Average Herts Broxb Watford

9 Obese children (Year 6) % 19.2 14.1 17.8 19.1

13 Increasing and higher risk drinking % 22.3 22.9 22.1 22.5

14 Healthy eating adults % 28.7 32.7 27.2 32.2

15 Physically active adults % 56.0 58.2 55.4 58.9

16 Obese adults % 24.2 21.4 26.4 17.3

26 Life expectancy - male years 78.9 80.2 80.8 79.2

27 Life expectancy - female years 82.9 83.8 85.1 82.5

30 Early deaths: heart disease & stroke per 100,000 60.9 51.8 53.6 58.7

Green: Significantly better than Hertfordshire average

Amber : Not significantly different from Hertfordshire average

Red: Significantly worse than Hertfordshire average

Health Profiles for England 2013

Broxbourne Wards

Reception Year (aged 4-5)

MSOA/ Ward Excess Weight Obese

Rosedale 45.7% 27.1%

Goffs Oak 44.6% 18.9%

Bury Green 39.4% 16.9%

Flamstead End 38.6% 15.7%

Wormley & Turnford 37.1% 18.1%

Year 6 (aged 10-11)

MSOA/ Ward  Excess Weight Obese

Wormley & Turnford 50.0% 24.2%

Flamstead End 44.7% 23.5%

Bury Green 41.2% 17.6%

Rosedale 40.4% 25.0%

Rye Park 38.1% 15.9%

Obesity is growing at an alarming rate, with a significant impact

UK Foresight report: By 2050, 60% of men and 50% of women could be clinically obese

Health Impacts

• Health impact of obesity:– 58% type-2 diabetes– 21% of heart disease– 10% of non-smoking related cancers– 9,000 premature deaths a year in England– Reduces life expectancy by, on average, 9 years.

• Costs of obesity:– National Health Service - £4.2bn– Wider economy - £15.8bn– Foresight estimate costs to economy of £50bn by 2050

The Science

• Biology – “hormonal” response to foods

• Medicine – treatment regimes of various levels

• Psychology – intra and interpersonal

• Built Environment – mitigates for being overweight

• Social Sciences – family and social influences, advertising

THERE IS NO ONE ANSWER – THE ISSUE IS BUILDING A WHOLE SYSTEM APPROACH

Multiple causesMultiple challenges

PhysicalActivityis not theanswer toObesity, but it is apart of ananswer

Active Living is Seen as Essential to Good Health, but it is ONE part, not the whole solution

Why maintaining a healthy weight is so complex1) Human biology - genetics plays a part but

does not pre-destine us to be obese

2) Culture/Individual psychology - it is difficult to break habituated unhealthy eating patterns, especially when common to those around us

3) The food environment - there has also been a huge increase in the quantity of quick convenience foods, which tend to be high in saturated fat, salt and sugar.

4) The physical environment - our lives have become increasingly sedentary. For example, the last 2 decades have seen a 10% drop in children walking to school

• Levels of public health action needed

• Social• Biological• Environmental• Behavioural• Legislative• Structural

Systems thinking on getting to healthy weight

The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!)

The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences)

The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)

Prevalence of obese children by parental obesity

it is particularly important to engage parents

0

5

10

15

20

25

30

No obese parents One parent obese Both parentsobese

% o

f O

be

se

Ch

ildre

n

Boys

Girls

Average BMI

Underweight

Healthy weight

Overweight

Obese

Average BMI

Underweight

Healthy weight

Overweight

Obese

Fewer overweight Fewer obese

Reduce average BMI

Fewer underweight

Maximise proportion at a healthy weight

Minimise proportion at an unhealthy

weight

a new approach is needed, focus on shifting weight distribution in the population

Make more people a healthy weight, not just fewer people obese

We all have a role to play

What we’re doing currently

• Children’s Centres promoting healthy weight in under-5s

• Healthy Schools Programme, with subsidy to encourage local schools to take part

• Exercise on Referral Scheme Pilot with Council leisure centres and 4 GP practices

• Weight Management pilot (WeightWatchers and Slimming World)

• PlayRangers active play sessions for children, targeted in locations where children most at risk

• HealthWalks programme

www.hertsdirect.org

Some Key Priorities for Broxbourne and Hertfordshire

1. Every child should start and grow up with a healthy weight

2. Our food environment should make healthy choices easy

3. Regular physical activity to maintaining healthy weight

4. Good education for all about what keeps us a healthy weight

5. Our physical environment needs to support maintaining a healthy weight

• Remember those levels of action? We need them all

• Social

• Biological

• Behavioural

• Environmental

• Legislative

• Structural