Promoting healthy weight, healthy lives for …...Promoting Healthy Weight in Children and Families...
Transcript of Promoting healthy weight, healthy lives for …...Promoting Healthy Weight in Children and Families...
Children and young people’s strategic partnership Promoting Healthy Weight in Children and
Families group
Promoting healthy weight, healthy lives
for Lewisham children, young people
and their families
Strategy on childhood obesity
March 2010
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Contents
1. Policy context
1.1 Background
1.2 National policy
1.3 Local policy
2. Needs assessment
2.1 Key challenges to Lewisham
2.2 Estimating obesity prevalence
2.3 Referral to specialist weight management service
2.4 Eating and activity patterns of children in Lewisham
3. Rationale for strategy
4. Delivering action at a local level
5. Action plans
6. Equalities impact assessment
7. Governance
8. Appendix
9. References
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Policy context summary.
1.1 Background
Obesity is a complex Public Health issue that is a growing threat to children’s health.
Childhood obesity is becoming an increasingly important issue in our local communities.
Data from the Health Survey for England 2007 showed that (nationally) 3 in 10 children are
either overweight or obese, and 1in 6 are obese. If current UK trends continue, one fifth of
boys and one third of girls will be obese (nationally) by 2020. In addition nearly a quarter of
English adults are obese with two thirds of men and over a half of women either overweight
or obese. 1
Obesity is increasingly linked to many serious health risks in both children and adults
including type-2 diabetes, cardiovascular problems, respiratory illnesses, joint and movement
problems and psychological disorders, such as depression, low self-esteem and disordered
eating. It is estimated that obesity reduces life expectancy by between 3-13 years. Children
who are obese are at an increased risk of becoming obese adults and they risk the early
appearance of obesity-related health problems normally associated with middle age. The
estimated annual cost to NHS Lewisham of diseases related to overweight and obesity is
£79.1 million for 2010.
Differences in the prevalence of obesity in children are seen with deprivation, ethnicity and
parental obesity. The prevalence of children at risk of obesity is higher in more deprived
areas, analysis of the London school measurement data2 revealed that the prevalence for
year 6 children was almost two-thirds higher in the deprived group, they also reported a
higher prevalence of obesity in children from Black ethnic minority groups. National data
show 22% of girls from the low income groups were obese compared to 9% in the highest
income group and children from Black ethnic minority groups and Pakistani boys were at
higher risk of obesity than the general population. Children from households where one or
both natural parents were classed as obese had much higher rates of obesity than children
from households where parents were classed as normal or underweight.
1.2 National Policy
A cross-Government strategy, led by the Department of Health and the DCSF: “Healthy
Weight, Healthy Lives: A Cross-Government strategy for England” was published in 2008. As
part of the Public-service agreement (PSA) on Child Health and Well-being the government
announced its ambition to be the first major country to reverse the rising tide of obesity and
overweight in the population by ensuring that all individuals are able to maintain a healthy
weight. The initial focus will be on children: by 2020 it aims to have reduced the proportion of
1 www.ic.nhs.uk Statistics on obesity, physical activity and diet: England, February 2009 2 www.lho.org.uk Weighty matters The London findings of the national child measurement programme May
2009
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overweight and obese children to 2000 levels. The strategy supports the creation of a healthy
society - from early years, to schools and food, from sport and physical activity to planning,
transport and the health service. It specifically focuses on five areas:
• The healthy growth and development of children
• Promoting healthier food choices
• Building physical activity into our lives
• Creating incentives for better health
• Personalised advice and support
In March 2010 the government published “Healthy Weight, Healthy Lives: Two Years On”,
this report reviews the progress on the delivery of Healthy Weight, Healthy Lives and
reinforces the priorities for future work to enable everyone in society to maintain a healthy
weight.
In recognition of the complexity of obesity there is increasing encouragement for the
partnership of the NHS, local authorities, schools, children and parents and other partners to
work together to tackle the issue from a holisitic perspective. To be successful every part of
society; individuals, communities and industry will need to recognise and address the
problem, the diagram below shows the role of the major sectors in tackling excess weight.
From: Healthy weight, healthy lives: a cross-government strategy for England 2008
The aim of the Healthy Weight, Healthy Lives strategy is one of promoting healthy weight for
the whole population, recognizing that individuals who are underweight will also need
support. The government’s initial focus is on tackling obesity and overweight in children. Any
strategy must ensure not just a multi agency approach but equally one which recognises that
tackling obesity and promoting healthy lifestyles in children can only be tackled in the context
of the whole family and society more broadly.
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Nationally the government has a number of programmes, some of which cut across services
and organizations, these include:
In early years:
• Healthy Child Programme
• Healthy Start Programme
• Start4ife
In schools:
• The Healthy Schools programme
• The Food in Schools programme
• The School Fruit and Vegetable scheme
• The Physical Education, School Sport and Club Links programme (PESSCL)
• Active travel and school travel plans
• Food promotion to children
Others:
• Healthy lives, brighter futures
• Be active, be healthy
• Healthy Child Programme for 5-19 year-olds
• Change4Life
1.3 Local policy
‘Shaping our future’ - Lewisham’s Sustainable Community strategy 2008-2020 is the
overarching plan for the borough. Its principles are:
• Reducing inequality- narrowing the gap in outcomes for citizens
• Delivering together efficiently, effectively and equitably – ensuring that all citizens
have appropriate access to and choice of high-quality local services
‘Shaping our future’ sets out the borough’s strategic priorities for the wider community, which
are:
• Ambitious and achieving – where people are inspired and supported to fulfil their
potential.
• Safer – where people feel safe and live free from crime, antisocial behaviour and
abuse.
• Empowered and responsible - where people are actively involved in their local area
and contribute to supportive communities.
• Clean, green and liveable – where people live in high quality housing and can care for
and enjoy their environment.
• Healthy, active and enjoyable – where people can actively participate in maintaining
and improving their health and well-being.
• Dynamic and prosperous – where people are part of vibrant communities and town
centres, well connected to London and beyond.
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The 2009-12 Children and Young People’s Plan (CYPP) underpins ‘Shaping Our Future’ –
and sets out how partnership agencies working with children, young people and their families
will support the delivery of the borough’s priorities. The Children and Young People’s plan
has identified four key areas for impact for the next three years.
These are:
• Early Intervention and support for families
• Raising aspirations and closing the gaps
• Reducing child poverty and its impact
• Strengthening the positive influence of young people
Reducing childhood obesity is a Lewisham children and young people’s strategic partnership
priority, both in the current and new (2009-2012) plans. Levels of obesity are measured
against national indicators within our Local area agreement with targets set for each as:
• NI 55 - By 2011 to ensure that childhood obesity reduces to 25% for Year 6
pupils, given that obesity levels are predicted to rise in 2009 for Year 6 pupils
(LAA local indicator).
• NI 56 - By 2011 to reduce childhood obesity to 11%, given that current levels are
predicted to rise in 2009, for Reception Year pupils (LAA target)
• NI 52 – Increase the % of pupils who take school lunches to 54% by March 2011
• Improve the take up of Free School Meals to 88% by Summer 2010.
• NI 57 – Increase the % of 5-16 year olds participating in at least 2 hours per week
of high quality sport to 91% by March 2011
• NI 53 – Increase the prevalence of breastfeeding at 6-8 weeks from birth to 66%
by Jan-Mar 2011
Consultations with children and young people through student councils have highlighted
obesity and healthy living to be a concern to children. They report that eating healthily is very
important and that we should make reducing childhood obesity a priority.
The Children and Young People’s plan for 2009 to 2012 has “the reduction of childhood
obesity” (BH4) as a key priority. The plan states that we will:
• Target resources and services to identified areas of the borough where need is
greatest.
• Work with families in Children’s Centres and schools to promote healthy eating
and physical activity.
• Build on Healthy Schools status and extended school services activity to promote
healthy weight and healthy activity and allow targeted support to children and
young people at risk of obesity.
• Increase the take up of school meals whilst delivering to the nationally set
nutritional standards.
• Work with School Sports Partnership and other sport and physical activity
providers to promote sport and physical activity to children and young people and
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their families.
• Promote national campaigns such as Change4life to Lewisham residents.
• Implement a care pathway for children with weight management issues.
• Commission age specific and targeted weight management programmes,
including programmes that support both children and their families to create
sustainable lifestyle changes.
• Ensure children are as healthy as possible at birth, including promotion of
breastfeeding and preparation towards Baby Friendly status across the borough.
The action plans of the Promoting healthy weight, healthy lives for Lewisham children, young
people and their families strategy expand on how the partnership will meet the above
objectives and provide detail and targets for these actions.
The Lewisham Healthy Weight, Healthy Lives strategy recognises that tackling the issue of
weight requires us to understand the multitude of influences on people’s lifestyles which
affect the access to and understanding of healthy and affordable diet and access and
encouragement to participate in physical activity. This fits within Lewisham’s early
intervention ethos and family support and parenting approaches, all of which underpin the
priorities in the Children and Young People’s plan 2009 -2012.
In order to effect change therefore the partnership expect a wide ranging approach which
includes collaboration with other areas of Lewisham policy including, but not restricted to:
Physical activity strategy
A Five year plan, to help bring together organizations which will work in partnership to
sustain sport and physical activity in Lewisham. The aims are;
• To increase participation in physical activity and
• To enable the Lewisham community to develop its potential in sport
• To develop an appropriate infrastructure of facilities.
Open space strategy Provides an overarching review of open space in the borough, its aims are;
• To protect open space in Lewisham from inappropriate development
• To enhance and improve the level of quality of open space in Lewisham
• To raise awareness of the social, economic and environmental benefits of sustainability
• To improve accessibility of open spaces to promote greater social inclusion
• To build on the role that open spaces offer in sustaining the health and well-being of residents
• To reduce the Fear of Crime in open spaces, making Lewisham a safer place
• To adopt the Open Spaces Strategy as Supplementary Planning Guidance.
Play and recreation strategy
Key principles
• Play should be freely chosen
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• Play facilities or activities provided are safe
• Play provision must be well planned in partnership with children and young people
• Play in whatever form in Lewisham must not discriminate
• Play will foster independence and healthy self esteem.
Food Strategy
The overall aim of the food strategy is to increase the health and welfare of Lewisham people
through improved access to nutritious and safe food from a more sustainable food chain.
The strategy consists of five sections:-
1. Food access
To reduce the physical, economic, social, cultural and educational barriers which prevent
people in Lewisham from accessing food, which will improve their health and well-being.
2. Food in schools
To increase the health and welfare of children in Lewisham schools through improved access
and awareness of a healthy diet, food safety and sustainable food.
3. Food, nutrition and health
To contribute to long term improvements in the diet and nutrition of people in Lewisham and
the reduction of nutrition related ill health and disease in the borough.
4. Food sustainability
To achieve a more sustainable food chain in Lewisham by improving the sustainability of
food transported, sold and consumed in the borough.
5. Food safety
To ensure the safety, composition and information provided about foods produced, imported,
sold and consumed in Lewisham, and to reduce the incidence of food poisoning.
Sustainable mode of travel strategy for schools
The objectives of this strategy are:
• To make cycling and walking safer and more attractive
• To increase bus use amongst the school population
• To reduce congestion around the school area
• To develop partnerships with schools, their communities and other organizations and
to promote the development of school travel plans
• To promote road user safety through education and training
• To promote the health benefits of walking and cycling
• To promote more sustainable travel choices by ensuring new educational
establishments are accessible by walking, cycling and public transport.
Regeneration and planning
Lewisham’s regeneration strategy is the vision for the future of the borough from 2008-2020
based on 3 themes, people, prosperity and place with 12 key objectives for the delivery.
People
• To celebrate Lewisham’s diverse community and strengthen cohesive communities
• Healthy communities- to reduce health inequalities and encourage healthy lifestyles
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• Young communities- to invest in children and young people
• Creative communities- to support and develop creativity in young people.
Prosperity
• Creative growth- encourage and support creative businesses
• Education and skills growth- to invest in education and skills
• Business enterprise and jobs growth- provide access to jobs and business support for
local people.
Place
• Evolving environment- ensure new development is to the highest standards of design
and sustainability
• Liveable environment- provide decent homes for all residents
• Protected and managed environment- protect and manage special areas of
Lewisham
• Accessible environment – provide accessible, convenient and safe transportation
networks
• Safe environment – reduce crime and improve community safety.
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2. Needs assessment
2.1 Key challenges for Lewisham
Lewisham is the third largest inner London borough in terms of population. The population of
Lewisham has a high proportion of young people, with nearly a fifth of the population under
15, estimated at 49,002 for 2009, of these 19,762 are children under 5 years (7.5% of the
population). The population is forecast to grow over the coming years.
The borough is the 15th most ethnically diverse local authority in England with over 170
different languages spoken, overall 40% of all Lewisham residents are of Black and minority
ethnic origin. It is projected that by 2020 the percentage of residents from Black and minority
ethnic groups will have increased to 44%. Lewisham has a high proportion of children and
young people from black and ethnic minority groups (59% of under 15), with the highest
ethnic groups being Black African (17.6%), Black Caribbean (13.8%) and Black Other
(13.2%) with under 15% from all other ethnic groups.
Lewisham has the highest proportion of lone parent families in London, with 17.8% of all
households’ lone parent families, this compares to 11.6% for Inner London and 7.2% for
England.
It is the 39th most deprived local authority in the country, 8 out of Lewisham’s 166 Super
Output areas are in the 10% most deprived and 64 are in the 20% most deprived in the
country.
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2.2 Estimating obesity prevalence for children in Lewisham
Currently there are two resources available to estimate the prevalence of childhood obesity;
1. Results from the National Child Measurement Programme (NCMP)
Data from the National Child Measurement Programme (NCMP) provides information on the
prevalence of obesity for children in Reception (aged 4–5 years) and Year 6 (aged 10–11
years) to assess overweight and obese levels. The national target for participation rate in the
national child measurement programme was exceeded in 2007/08 and 2008/09, which
means Lewisham now has 2 years robust data for the prevalence of childhood obesity for
both reception and year 6 children.
Data for Lewisham shows that in 2007-08, 10.6% of Reception year children were at risk of
obesity as were 25.3% of Year 6 children. When at risk of overweight and obesity are
combined 25 % of Reception children and 40% of Year 6 children are affected.2 In Lewisham
in 2007/08 the proportion of children at risk of obesity in reception year was not significantly
different to London or the England average. In year 6 the proportion of children at risk of
obesity was significantly higher than the London and England average.
Table1.1 Results of Lewisham NCMP 2007/08 compared to London SHA and England results
School year Area Underweight
%
Overweight
%
Obese
%
Overweight
and Obese
%
Reception Lewisham 1.0 14.4 10.6 25.0
London 1.8 12.0 10.9 22.9
England 1.3 13.0 9.6 22.6
Year 6 Lewisham 1.2 14.7 25.3 40.0
London 1.8 14.7 21.6 36.3
England 1.4 14.3 18.3 32.6
Prevalence of obesity in both reception and year 6 in 2008/09 remain significantly above the
England average and are similar to our statistical neighbours. Prevalence of obesity in
2008/09 was lower in year 6 (22.1%) and higher in reception (12.0%) compared to the
previous year but these changes were not statistically significant. Currently there is
insufficient data to determine a trend in childhood obesity rates for Lewisham. When at risk of
overweight and obesity are combined 25.2 % of Reception children and 37.3% of Year 6
children in Lewisham are affected. It is for this reason that tackling obesity remains a key
priority in Lewisham.
2 Obesity is defined using the UK National Body Mass Index (BMI) classification, with obesity defined as a BMI
more than 95th centile and overweight as more than the 85
th centile of the UK 1990 reference chart for age and
gender
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Table1.2 Results of Lewisham NCMP 2008/09 compared to London SHA and England results
School year Area Underweight
%
Overweight
%
Obese
%
Overweight
and Obese
%
Reception Lewisham 0.7 13.2 12.0 25.2
London 1.3 12.4 11.2 23.6
England 1.0 13.2 9.6 22.8
Year 6 Lewisham 1.0 15.2 22.1 37.3
London 1.6 14.7 21.3 36.0
England 1.3 14.3 18.3 32.6
Analysis of the 2007/08 NCMP results for London2 revealed that for both reception and year
6 the prevalence of children at risk of obesity and overweight (but particularly obesity) tended
to be highest in the more deprived areas. Children from black ethnic minority groups in both
year groups were at significantly higher risk of obesity than other ethnic groups. The report
indicated that the differences between ethnic groups are likely to relate specifically to
physical characteristics such as height and that ethnicity may not be strongly linked with the
risk of obesity. This can have a potential confounding effect on the prevalence rates of
obesity. When Lewisham NCMP results for year 6 was compared to national data by
ethnicity, rates for Lewisham were higher than the England average for White, Black, Asian
and Mixed ethnic groups.
Year 6 Lewisham Black 28.2% White 23.9% Asian 28.7% Mixed 22.4%
England Black 26.4% White 17.3% Asian 21.5% Mixed 20.4%
No area in Lewisham is significantly different to the Lewisham average for children at risk of
obesity for any of the ethnic groups.
2. Obesity prevalence ready-reckoner (based on Health Survey for England 2006)
This resource uses the same definition for obesity as the NCMP and is used to estimate the
prevalence of obesity in children aged 1 to 15 years based on the population estimates for
the borough.
Extrapolating to Lewisham population this estimates that in 2009 there are in Lewisham:
• 8,573 children aged 1-15 years at risk of obesity which includes
• 2,595 children aged 1-4 years at risk of obesity
The ready-reckoner is based on national data and does not take into consideration ethnicity,
deprivation or location that might affect obesity prevalence, thus the estimates for Lewisham
are likely to be underestimated. Local factors that are likely to increase the prevalence of
obesity in Lewisham include;
• a high percentage of children from black and minority ethnic groups,
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• deprivation score significantly worse than the England average with 37.9% of people living in 20% most deprived areas of England.
Table 1.3 2009 estimate of number of children aged 1-15 years who are obese in Lewisham
Age
Male
Male
obese
Female
Female
obese
1 2,165 375 2,075 332
2 2,039 355 1,961 333
3 1,947 333 1,862 309
4 1,739 287 1,674 271
5 1,641 272 1,592 264
6 1,561 259 1,476 241
7 1,456 237 1,452 245
8 1,536 263 1,447 255
9 1,468 264 1,451 263
10 1,457 267 1,388 260
11 1,466 283 1,446 282
12 1,444 277 1,489 305
13 1,333 277 1,403 296
14 1,369 282 1,365 300
15 1,333 288 1,326 298
Subtotal 23,954 4,319 23,407 4,254
(Formulae for obesity based on the Health Survey for England 2006)
The number of young children in the borough is increasing year by year, with a projected
population growth in Lewisham between 2008-2014 particularly in 0-4 years (% compound
growth 8.4%) and 5-14 (% compound growth 4.6%) Incidence of obesity in children
increases with age, but due to the higher number of young children in Lewisham there are a
similar number of obese children for each age.
2.3 Referral to specialist weight management services
Of the estimated 8573 children aged 1-15 years at risk of obesity in Lewisham (2009 figures),
there will be a proportion with needs requiring support beyond that which can be provided by
general preventative measures, school nurses and general practitioners.
This group of children includes those who are extremely obese, or who have medical
conditions secondary to obesity or who have co-morbidities such as a physical or learning
disability or another underlying chronic disease or psychological problem. There may also be
a small minority of children who may have a medical condition causing their obesity such as
Prader Willi syndrome, Cushings and monogenic causes. Some of the community
programmes designed to manage obesity would have to exclude these children on the
grounds of their co-morbidity as they are unable to deal with their complex needs.
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These children make up the tip of the obesity triangle and although the numbers will be
comparatively small, their management remains an important part of the obesity care
pathway as it is these children who are most likely to suffer the adverse consequences of
their unhealthy weight and cause health care workers the most concern. Stakeholder
interviews identified the need for a specialist weight management service for children and the
proposed weight management care pathway for children (section 4) includes a specialist
service for children delivered by healthcare professionals with specialist knowledge of
childhood obesity.
Estimated demand for a specialist weight management service for children
The clinical definition of overweight and obesity in children recommended by NICE (2006) is:
Overweight: BMI more than 91st centile of the UK 1990 reference chart for sex and age.
Obesity: BMI more than 98th centile of the UK 1990 reference chart for sex and age.
Children on the 99.6th centile (3 standard deviations from the mean), are classed as very
obese.
From the 2007/08 Lewisham child measurement data on reception and year 6 pupils the
number of children who met the clinical definition of overweight and obesity are shown in the
table.
Table 1.4 Number of children identified as overweight or obese (based on clinical
definition 2007/08 NCMP)
Total pupil
numbers
91st – 97th
centile
overweight
98th -100th
centile
obese
>99.6th centile
Very obese
Reception 2625 248 222 80
Year 6 2522 328 520 165
Children with special needs
Limited information is available for this group of children in Lewisham. A small study on
children with severe physical and learning disabilities conducted by the community paediatric
team in 2004 revealed a problem with underweight and obesity in this client group.
2.4 Eating and activity patterns of children in Lewisham
Lewisham has commissioned a survey conducted by the Schools Health Education Unit
(SHEU) that includes self-reported information on the eating and activity patterns of children
biannually since 2004. The survey collects information on children in years 4 (ages 8-9), 6
(ages 10-11), 8 (ages 12-13) and 10 (ages 14-15). In 2008 a total of 2244 children
participated in the survey.
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Headline results for Lewisham school children in 2008 included
Primary schools
• 4% had nothing to eat or drink for breakfast on the day of the survey
• 6% ate no fruit or vegetables the day before the survey, 35% ate 5 or more portions (improvement between surveys)
• 60% ate fresh fruit, 46% vegetables, 23%crisps, 26% sweets and chocolates on most days
• 82% enjoyed physical activities
• 5% had low self esteem scores
SHEU reported that Lewisham children are more likely to make healthy food choices than the
wider national sample.
Secondary schools
• 25% of year 10 and 21% of year 8 girls had nothing to eat or drink for breakfast on the day of the survey
• 50% of year 8 girls said they would like to lose weight (increase from 2006)
• 33% of year 8 reported not eating a lunch on the day of the survey (increase from 2006)
• 39% ate fresh fruit, 40% vegetables, 15% chips, 23% crisps, 31% sweets and chocolates on most days
• Most common leisure activities after school on the day before the survey were watching TV and playing computer games
• 2% had low self esteem scores
SHEU reported that Lewisham children are more likely to say they had nothing for lunch than
the wider national sample.
Nationally the consumption of fruit and vegetables by children aged 5-15 years has
increased over recent years with 22% of boys and girls eating five or more portions of fruit
and vegetables a day in 2007. Children from lower income households were less likely to
reach the 5 a day recommendation.
School meals
The latest figures (December 2009) for the percentage of children eating school meals are;
• Primary pupils taking a school meal - 57%
• Secondary pupils taking a school meal - 30%
Uptake of free school meals
• Primary taking a free meal - 87%
• Secondary taking a free meal - 79%
Compared to national data the percentage of pupils who have school meals in Lewisham is
higher in primary schools (57% compared to 43% nationally) but lower in secondary schools
(30% compared to 37.6% nationally).
Healthy schools
As of March 2010
• 59 out of the 69 primary schools (86%) in the borough had achieved Healthy School status with another 10 actively working towards Healthy School status.
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• 12 out of 14 secondary schools (86%) had also achieved Healthy School status with another 2 actively working towards Healthy School status.
• Of the 87 schools in Lewisham 83% have achieved Healthy School status.
To fulfil the criteria for Healthy School status schools have to provide examples of qualitative
and quantitative impact/outcomes on the 4 core themes which include healthy eating and
physical activity. In December 2008 the Lewisham Healthy School team collected data from
self-validation forms completed by schools together with responses from a questionnaire
sent to schools to assess the impact of the National Healthy School Programme.
Results suggested;
• Increase in uptake of school meals (including free school meals)
• Quality of packed lunches has improved
• Children and young people choosing to eat more fruit and vegetables
• Healthier snacks eaten at school
• Children and young people have a more positive attitude to physical activity
• Number of children and young people missing lessons has decreased
• Range of physical activities at lunchtimes has increased
• Number walking to school has increased
• Number cycling to school has increased.
School sports survey
The 2008 survey revealed that 84% of pupils in Lewisham participated in at least 2 hours
high quality PE lessons and out of school activities which is comparable to national data.
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3. Rationale for strategy
The Healthy Weight, Healthy Lives strategy and action plans for Lewisham are based on;
• National Institute for Health and Clinical Excellence (NICE) clinical guideline 43
Obesity: guidance on the prevention, identification, assessment and management of
overweight and obesity in adults and children (2006)
• Foresight tackling obesities: future choices-project report (2007).
In simple terms obesity is caused by an imbalance between energy intake and energy
expenditure, where intake is greater then expenditure. The reasons for the recent worldwide
increase in obesity are complex; the individual’s biology, eating and activity habits are
influenced by external social and environmental factors where an abundance of food and
increased sedentary behaviour is common. Foresight identified 108 variables that directly or
indirectly influenced energy balance and produced the obesity system map with these
variables grouped into seven themes.
1 Biology
2 Individual psychology
3 Food consumption
4 Individual activity
5 Food production
6 Activity and environment
7 Societal influences
These variables are highly interconnected and the map below confirms the complexity of
obesity intervention. Foresight suggests that the approach that is needed to halt the
increasing prevalence of obesity will need to be long-term, broad and diverse with the focus
on promoting achievement of a healthy weight.
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Source: The Foresight, tackling obesities: future choices project report 2007
The strategy will encompass prevention and treatment of obesity for the whole population of
Lewisham as part of a long term plan to promote healthy lifestyles in the borough and to be
effective has where possible incorporated all seven themes into the strategy. It is planned
that the impact of any intervention will be strengthened by the range of policies in Lewisham
that will act as enablers and amplifiers and support such as;
• Sustainable community strategy
• The Lewisham Food Strategy
• Open Space Strategy
• Physical activity strategy
• Play and recreation strategy
• Sustainable mode of travel strategy for schools
• Regeneration and planning strategy.
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Fig 1 Role of enablers and amplifiers on the impact of interventions
Source: The Foresight, tackling obesities: future choices project report 2007
The NICE obesity guidelines provide the most current evidence addressing both the
prevention and treatment of obesity in adults and children. Its recommendations state that
the prevention of obesity should be a priority for all and provides recommendations for the
NHS, early years, schools, local authorities, employers and the public.
Its focus is on ways of improving diet and increasing physical activity with emphasis on how
the social and physical environments can be made healthier places.
Effective interventions should be multi-component, involve partnership working and provide a
targeted approach. Key priorities for implementation in Lewisham and examples of targets
are included in the following table.
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Table 1.5 Key priorities for implementation of NICE recommendations in Lewisham
Key priorities for implementation Target
Local authorities and their partners
in the community
Concerns about transport, safety and
services have a huge impact on
people’s ability to eat healthily and take
exercise.
Policy and planning
Encourage active travel
Promote and support physical activity
Promote healthy foods
Community programmes
Self help, commercial and community
programmes
Early years settings
Pre-school years are a key time for
shaping attitudes and behaviours
Improve physical activity levels
Provide healthy diet
Involve parents and carers
Schools
Helps children develop healthy
lifestyles, better achievement at school
School policies and school environment
Staff training
Links with relevant organizations and
professionals
Interventions
Workplaces
Create culture that supports healthy
eating and physical activity
Policies and working practice
Building design
Education and promotion
Public
Improves health and reduces risk of
some diseases
Reinforce messages on healthy eating
and activity
NHS
Ensure systems in place and dedicated
resources to implement local strategy
Implement obesity strategy
Prevention
Obesity care pathway
Source adapted from NICE guidelines on obesity 43
Preventative action to tackle overweight and obesity needs to take a lifelong approach.
Foresight identified specific points during the life course where opportunities to influence
behaviour exist, these are;
• periods of metabolic change (early life, pregnancy and menopause),
• times of spontaneous behaviour change (leaving home, becoming a parent)
• significant shifts in attitudes (peer group influences, diagnosis of ill health)
and the strategy will aim to target these specific points, further details are provided in the
following table.
22
Table 1.6 Critical opportunities in the life course to influence behaviour
The Healthy Weight, Healthy Lives: Consumer Insight Survey provides information on
families’ attitudes and behaviour in relation to diet and activity. Families with children aged
between 2 and 10 could be divided into six clusters:
Cluster 1. Lacking time, money and knowledge
Cluster 2. Lack the knowledge and parenting skills to improve their families lifestyle
Cluster 3. Affluent, overweight families who over-indulge in unhealthy foods
Cluster 4. Living healthily
Cluster 5. Strong parenting skills but need to make changes
Cluster 6. Plenty of exercise but too many bad foods
Clusters 1, 2, 3 and 5 were found to be most ‘at risk’ of developing obesity and these clusters
had the highest rates of adult and child obesity. These four clusters have been prioritised for
national action within the Change4Life social marketing campaign. This information will also
be used to inform local interventions to deliver effective targeted services. (A summary of the
key characteristics of each cluster and their location and distribution in Lewisham is provided
in appendix 1).
23
4. Delivering action at a local level
The Lewisham Healthy Weight, Healthy Lives strategy is linked in to the Children and Young
People’s plan and is a partnership strategy. The Promoting Healthy Weight in Children and
Families group is a multi-agency partnership group responsible for the delivery of the agreed
actions for reducing childhood obesity, and is a sub-group of the Children and Young
People’s Strategic Partnership Board.
The strategy on reducing childhood obesity is part of a long term plan to promote healthy
lifestyles for the whole population of Lewisham. Based on national and local guidance priority
areas for 2009-2011 are:
1. Children and young people
- families with children aged 2-11 years
- young people aged 12-18 years
2. Adults
3. Building physical activities into lifestyles
Action plans for 2009-2011 have been developed for priority 1, Children and young people
which are multi-component, involve partnership working and take a lifelong approach. The
action at a local level will be evidence based and focused around the five key themes
previously identified in section 1.
1. The healthy growth and development of children – early prevention of weight
problems to avoid the ‘conveyor-belt’ effect into adulthood
2. Promoting healthier food choices – reducing the consumption of foods high in fat and
sugar and salt and increasing consumption of fruit and vegetables
3. Building physical activity into our lives – getting people moving as a normal part of
their day
4. Creating incentives for better health – increasing the understanding and value people
place on the long-term impact of decisions
5. Personalised advice and support for individuals who already have weight problems –
complementing preventative care with treatment
The action plans for the universal services of promoting healthy weight for all children are
divided into 7 work streams as shown below and cover key themes 1 to 4.
24
Fig 2 Universal action plans
In addition local initiatives will apply the Department of Health national social marketing
Change4Life campaign to support behaviour change among families. The main message of
the campaign is ‘Eat well, move more, live longer’. The Change4Life logo will be added to
existing and new materials and Change4Life resources will be used to promote healthy
eating and physical activity with families in Lewisham so that the strategy aligns with the
national campaign.
To deliver the strategy it will be necessary to address the training needs of the workforce so
that all partners are aware of their roles in promoting the benefits of a healthy weight. There
is a need for both health and non-health professionals to be trained to deal sensitively with
the issue of overweight and obesity. A number of training programmes are available that
meet the needs of these different staff groups.
The proposed weight management care pathway for children includes prevention, treatment
and management of overweight and obesity for children who are already identified as
overweight or obese. This will be used as the basis for the development and commissioning
of services.
Universal
Promotion
of
Healthy
Weight
for all
Children
National Child Measurement Programme
and Data
Maternity
Early Years
Leisure / Sport / Environment
Lewisham Food Strategy
Workforce Training and Communication
Schools
Level 3
Specialist Weight
Management
Service
Specialist Weight Management Service
For children with a BMI above 98th centile
with co-morbidities or complex needs � Multicomponent interventions- address behaviour change,
barriers to weight loss, healthy eating and physical activity � Delivered by health care professionals with specialist
knowledge of childhood obesity � Family based approach � Referral to paediatrician for further assessment � For children who have already attended Level 3
services and need additional support regular and long term follow up by health care professionals with specialist knowledge of childhood obesity and option of medication or referral to tertiary care
Level 2
Community Based
Healthy Lifestyle and
Weight Management
Support
Community Based Healthy Lifestyle and
Weight Management Support
For children with a BMI above 91st centile � Address behaviour change, healthy eating and physical
activity � First line individual intervention by healthcare
professionals � Individual sessions with dietitian (under 8 years) � Family lifestyle improvement programmes delivered by
trained workers supported by health care professionals � Family based approach � Core programme of support to nominated schools by
‘healthy weight’ school nurse and advisor
Level 1
Brief Intervention
and
Prevention
Brief Intervention and Prevention
Population based approach for all children with
a BMI below 91st centile Universal services - promote healthy eating, increased physical activity and reduce sedentary behaviour, which include: � Early years settings - engage families in healthy lifestyles � Schools - Healthy Schools programme, whole school food
policies, school travel plans, school sports partnerships � Health promoting environment – green spaces, active travel � Training for frontline staff � Borough wide food and nutrition policies and resources to
support staff working with families � Signposting to community activities � Change4Life
Specialist obesity and community weight management services to be commissioned
Proposed weight management services for children-draft
Lewisham Healthy Weight, Healthy Lives Action plan 2009-2011
Priority areas for 2009-2011 based on national and local guidance are:
1. Children and Young people
- families with children aged 2-11 years - young people aged 12-18 years
2. Adults
3. Building physical activities into lifestyles
Priority 1 Children and young people
The action plans are divided into
- (a) promotion of healthy weight for all children (Universal) - (b) weight management services- targeted - (c) weight management services - specialist
Universal
Targeted
Specialist
Promoting Healthy Weight in Children and Families Task Group
Multiagency task group meets quarterly to discuss and formalise work around healthy weight, healthy lives in Lewisham.
All universal objectives in the action plans are agreed by the group which is responsible for the delivery of the agreed actions.
(a) Promotion of healthy weight for all children (Universal)
a.1 NCMP/Data Action Outcomes Timescale Leads
1
Complete weighing and measuring
of eligible Reception and Year 6
children in schools
To meet minimum participation rate of
eligible pupils set by DoH (85% 2008/09)
During school
year
HW school nurse
2 Uploading of data to Dept Of
Health that meets quality
guidelines
Accurate data for analysis By deadline set
by DoH
HW school nurse
3 Parental feedback for all children of
individual results
Letters provided to Reception and year 6
children
6 weeks after
individual
measurements
HW school nurse
4 Develop guide for parents based
on Change 4 Life brand to
accompany NCMP letter
Families aware of local initiatives to
encourage healthy lifestyles
Sent with NCMP
letter
HW school
nurse/HW schools
advisor/HW strategy
manager/LBL sport
and leisure
service/Health
improvement Team
5 Feedback to school of individual
results and comparison to England
average
Letter provided to all primary school, and
input at headteacher forum
By end of school
year
HW strategy
manager/ PCT/LA
6 Analysis of data by PCT and
produce report of PCT analysis
PCT to begin analysis of data
Report of NCMP data at PCT level
Data available
Dec
Report ready
March
PCT Information
analyst
7 Produce user friendly version of
NCMP data
Brief report available to relevant partners Brief version
available by April
Information analyst/
HW strategy
manager
8 NCMP action plans/targeted
schools for the next school year
Agree plan based on recommendations of
report
Annually in June Public health/ HW
school nurse/ HW
schools advisor
9 Produce dashboard of datasets to
help monitor progress of healthy
weight strategy
Dashboard to be produced quarterly and
provided to PHWCF group
Quarterly reports PCT/LA Information
analyst
10 Mapping of NCMP data e.g.healthy
schools, extended services, PE
and school sports
Annual report to inform potential
relationships with healthy weight agenda
Annual report in
April
PCT Information
analyst
11 Audit data on obesity prevalence in
pregnancy
Determine service requirement for weight
management in pregnancy
March 2010 Midwives/HWHL
strategy manager
a.2 Maternity
Action Outcomes Timescale Leads
1
Promoting healthy weight gain
during pregnancy at ante natal
visits
Improved outcomes for mother and baby
(NICE guidelines )
Ongoing Midwives/Consultant
Midwife PCT
2 Promote access to Children’s
Centres during pregnancy
Increased number of families registering
with children’s centres
Ongoing Midwives /Health
Improvement Team
3 Recruiting breast feeding advisor
for community
Recruit October 2009
Plan to exceed target prevalence of breast
feeding at 6-8 weeks of 66%
Increase number of breastfeeding cafes
and peer support programme
Until March
2011
Public health/
Midwives/
Children’s centres
4 Promote healthy start scheme at
booking
Increased uptake of healthy start vitamin
supplementation in pregnancy and
improved diet
Ongoing Midwives
a.3 Early years Action Outcomes Timescale Leads
1a
b
c
d
e
Children’s centres-nutrition
Delivery of healthy eating sessions
to children and families by dietitian
Contribute to a reduction in obesity levels
for Reception year
Ongoing to April
2011
CC dietitian
Children’s centres-nutrition
Provide training to children’s
centres staff on nutrition by dietitian
Promote healthy growth and weight in
children under 5
Ongoing to April
2011
CC dietitian
Children’s centres-nutrition
Delivery of healthy eating activities
(area 3) for families and children by
nutritionist
Promote healthy growth and weight in
children and families
Ongoing to April
2011
Nutritionist
Children’s centres-nutrition
Develop nutrition policy for children
centre premises
Promote good practice around healthy
eating in children centre premises
By March 2010 Dietitian, nutritionist,
oral health
Children’s centres-nutrition
Provision of cookery
courses/training for families
Improve skills and nutrition knowledge of
parents/carers
Start January
2010
CC dietitian
2 Children’s centres- physical activity
Improved play areas for children
Allotments/growing plots
Promote outdoor play for young children
Ongoing CC
3 Commissioned programmes to
deliver activity and healthy eating
sessions e.g.Changing shapes
Promote healthy growth and weight in
children under 5 and their families
Provide structured activity sessions
Ongoing CC/Teachsport
4 Recruit infant nutrition lead Recruit
October 2009
Achieve Baby Friendly Initiative
accreditation leading to improved infant
nutrition
Stage 1- March
2011
Stage 2 – March
2012
HWHL strategy
manager
5 Increase awareness of Healthy
Start scheme
Improved diet and increased uptake of
healthy start vitamins to women during
breastfeeding and children under 5
January 2010 Infant Nutrition
Project Manager
6 Report of data collection- weight
and height as part of Child Health
Promotion Programme (CHPP)
Actual number of children weighed and
measured at 8months, 2yrs and 3 ½yrs.
Data to help inform commissioning of
weight management service for under 5
September 2009 HV manager/HWHL
strategy manager
7 Health visitors as part of CHPP
Information on weaning, encourage
healthy eating and active lifestyle
Promote healthy growth and weight in
children under 5 and their families
Ongoing HVT
8 Evaluate all sessions
commissioned to improve physical
activity or diet
Ensure delivery of effective evidence
based sessions to children and families
Ongoing LBL/CC managers
9 All nutrition messages to be based
on Department of Health guidance
and aligned to Change 4 Life
Ensure consistent nutrition messages
delivered to families
Ongoing HWHL strategy
manager/CC
managers/Health
Improvement Team
10 Review of Nutrition in the under 5’s
guidelines
Updated guidelines produced in
conjunction with Lambeth+ Southwark
Review date
January 2010
HWHL strategy
manager
11 Guidelines to be produced on
physical activity in early years
settings
Systematic adoption, implementation and
monitoring of guidelines
September 2010 LBL/Health
Improvement Team
a.4 Schools Action Outcomes Timescale Leads
1
Healthy Schools:
Support all schools to achieve
National Healthy School Status
(April 09 Baseline = 66% with
NHSS)
100% of schools achieved NHSS
91% of pupils participate in a minimum of 2
hours of high quality PE and sport per
week
100 % of schools with a School Food
Policy and a Physical Activity Policy
By March 2011
HS Programme
2 Healthy Schools:
Support schools with NHSS to
work towards Enhanced National
Healthy School Status (ENHSS)
34% of schools will have gained ENHSS
Outcomes for universal and targeted
provision will have been identified by
individual schools depending upon needs
of pupils
By January 2011 HS Programme
3 Support all schools to provide a
minimum of 2 hours per week of
high quality PE and sport to all its
pupils, in or outside the curriculum
Increased number of schools providing
minimum of 2 hours a week from the
baseline of 42%
By March 2011 School Sport
Partnership leads
(via sport and leisure
service and knights
academy)
4 Deliver centralised and school-
based training for school staff on
promoting healthy weight
100% schools operate whole school
strategies on promoting healthy weight
Staff have greater knowledge and skills in
promoting healthy lifestyles
Reduction in obesity in Reception and year
6 pupils
Until March 2011
HW schools advisor
5 Provision of targeted programmes
to children
Increased access to families for advice
regarding healthy lifestyle. Provision of
health drop-in at primary and secondary
schools.
Start January
2010
HW School nurse
6a
b
c
d
e
f
School meals – new contract
Delivery of meals that meet nutrient
standards
Increase uptake of school meals to 54%
March 2010
LBL
School meals- eligibility for free
school meals
Increase uptake of FSM to 88%
Summer 2010 LBL
Develop strategic approach to
implementing and monitoring of
food in schools standards in all
schools
School meals working group to report to
PHWCG group
Quarterly update LBL/PCT
Named lead to co-ordinate data
collection process for school meals
to School Food Trust
School meals data to be provided to
School Food Trust
ongoing LBL/PCT
Co-ordinate borough wide
approach to monitoring of packed
lunches and breaktime snacks
Increased number of children eating
healthy packed lunches and breaktime
snacks
September 2009
and ongoing
HW school advisor
Evaluate existing initiatives around
healthy packed lunches and
disseminate good practice
Increased number of children eating
healthy packed lunches
September 2009
and ongoing
HW school advisor
7 School sports partnership
All schools to participate in school
sports partnership
91% of children and young people
participating in PE and school sports
(increase to 92%)
By March 2011
By March 2012
School sport
partnership
managers
8 Develop overarching strategic
approach to school sports
partnership
Maximise impact of programmes ongoing SSP Managers via
PESSYP Steering
group; LBL sport and
leisure service
9 Strengthen link between School
sports partnership and Healthy
Schools
More children more active ongoing SSP Managers via
PESSYP Steering
group; LBL sport and
leisure service
10 Promotion of sustainable school
travel-e.g. walking buses, walk
once a week (WOW), cycle
training,
100% of schools to have school travel plan
Aim to reduce proportion of car use for
travel to school by 1% per annum
2010 HS/LBL/health
Improvement Team
11a
b
c
Extended schools
Improved access to sport activities
Summer uni activities to include
schools with high levels of children
at risk of obesity
100% of schools to be extended schools
Increase number of young people
accessing summer programmes
March 2011 Extended services
board
Extended schools
Breakfast clubs- breakfast clubs to
offer healthy food choice that meet
government food-based standards.
Explore providing free breakfasts to
children in receipt of free school
meals
Increase provision of breakfast clubs
operating in schools from baseline of 80%
(February 2009)
More children have a healthy start to the
day
ongoing Extended services
board
Extended schools
Potential to engage with families to
promote healthy living through wide
range of activities provided by
extended services
Increased number of after school clubs
promoting range of physical activities.
Increased number of children including
those at risk of overweight and obesity
more active and adopting healthy eating
ongoing Extended services
board, LBL sport and
leisure services
a.5 Leisure/sport/Environment Action Outcomes Timescale Leads
1
Provide free swimming to children
under 16
Increased participation in sport by children
and families
Until March 2011
LBL Sport & Leisure
services
2 Offer more programmes aimed at
families and children 8-19 years
Increased participation in dance
based/other physical activity by children
and families (linking with point 3)
Ongoing LBL Sport & Leisure
Services/Public
Health
3 Commissioned programmes
during school holiday e.g. play in
the park
Increased participation in physical activities
by children aged 0-8
Ongoing CC
4 Evaluate all sessions
commissioned to improve physical
activity or diet
Ensure delivery of effective evidence based
sessions to children and families
Ongoing LBL/Public Health
5 Promotion of Change 4 Life brand
recognition in Lewisham
Adopt Change 4 Life to promote local
projects and programmes
Ongoing LBL Sport and
Leisure/Public Health
6 Improve communication to parents
on range of activities available to
young people
Increased proportion of children and young
people who have access to 5 hours cultural
activities per week
Ongoing Family Information
Service/LBL cultural
services
7 Build data set of activities for
young people – Plings (places to
go, things to do)
Proportion of young people who have
participated in positive youth activities will
rise to 78%
March 2010 LA
8 Improve the quality of outdoor play
facilities
Increase number of children and young
people who are satisfied with parks and
play areas from baseline of 54%
Ongoing LBL Parks Service
9 Clarify role and responsibilities
within Community Sports and
Physical Activity Network
Clear role around physical activity, sport
and leisure and PE
By March 2011 LBL Sport & Leisure
Services/Public
Health
10 Healthy weight to be included
within core strategy of Local
Development Framework
Built and natural environment supports
health agenda
By March 2011 Consultant in Public
Health
11 Investigate service specifications
around food provision in parks
Promote healthy lifestyles By August 2010 LBL Parks service
12 Formalise relationship between
PCT and LA planning
Health perspective incorporated into large
scale developments
ongoing Director of Public
Health
a.6 Lewisham Food strategy Action Outcomes Timescale Leads
1
Food access
Develop training opportunities for
local people in food and nutrition.
Develop food co-op model or
other models to increase access
to healthy food
Improved health outcomes for the
population
March 2009-April
2010
Health improvement
team/voluntary sector
2 Food, nutrition and health
Development of healthy weight
strategy
Contribute to reduction in childhood obesity End April 2010 HWHL strategy
manager
3 Food in schools
Provide all schools with support
on healthy eating
Evaluating and monitoring school
meals
Nutrition to be incorporated into
extended schools activities
Learning from SHEU survey incorporated in
advice to schools
Increased number of schools taking part in
school catering forum
Setting up more food related initiatives in
schools
Ongoing LBL/ HS/school
caterers
4 Food sustainability
Support retail and consumption of local
food
Ongoing LBL/voluntary sector
Increase access to allotments and
community gardens
60 new community gardens by 2012.
Increased access to fresh fruit and
vegetables
5 Deliver the action plan for food
safety within the borough
Promote food safety
Ongoing LBL
a.7 Workforce training and communications
Action Outcomes Timescale Leads
1
Develop comprehensive workforce
strategy- joint training programme
Workforce training to be included in
childhood obesity care pathway
start March 2010
and ongoing
HWHL strategy
manager
2 Mandatory training for early years
staff and community staff
Improved awareness of obesity prevention
measures
March 2011 Associate director
CYP services
3 Develop overarching policy
around staff wellbeing
March 2011 PCT/LA Training
Depts
4 Develop joint communications
plan
Co-ordinated and pro-active approach to
public health agenda
ongoing Lewisham
Communications
Group
5 All staff aware of Change 4 Life
campaign
Apply Change 4 Life to local initiatives Ongoing PCT/LA
Communications
(b) Weight management services for children –targeted
b.1 Current services Action Outcomes Timescale Leads
1
MEND to be commissioned for 1
year, facilitated by Teachsport
Recruitment of MEND co-ordinator
Improved participation and retention of
families in programme
March 2009-
October 2010
LBL/teachsport
2 To deliver minimum 4 MEND
programmes focusing delivery on
the 8 schools with highest
proportion of children at risk of
obesity
Minimum of 12 children to attend each
MEND programme
End October
2010
LBL/teachsport
3 Input of data for each programme
(as specified by MEND) to MEND
central
Accurate record of effectiveness of
programme and final evaluation of MEND.
Quarterly report to PHWCF group
End October
2010
LBL/teachsport
4 School nurse health drop in to
continue at secondary schools
and investigate services offered
by HWHL nurse
Increased access and support Ongoing HWHL School nurse
b.2 Development of local obesity care pathway for children and young people – targeted and specialist
Action Outcomes Timescale Leads
1
Estimate prevalence of obesity in
Lewisham using NCMP, HSE data
Identified prevalence of obesity in children
for all age groups up to 15 years
May 2009 HWHL strategy
manager
2 Conduct local needs assessment Identify distribution of age, ethnicity and
deprivation to target effective interventions
May 2009 HWHL strategy
manager
3 Map relevant local initiatives Updated local initiatives that promote
healthy eating and physical activity to
support care pathway
August 2009 HWHL strategy
manager
4 Establish sub-group to develop
multi-agency taskforce
Enable effective delivery of strategy November 2009 HWHL strategy
manager
5 Conduct literature and local
evidence review on prevention and
management of childhood obesity
Identify evidence based interventions for
under 5, children and young people in
different community settings
September 2009 HWHL strategy
manager
6 Review current service provision Identify gaps in service September 2009 HWHL strategy
manager
7 Arrange forum groups with parents
and young people on weight
management services
Identify appropriate services for community By July 2010 HWHL strategy
manager/young
Mayor
8 Investigate introduction of junior
exercise on referral programme
Incorporated into care pathway December 2010 Lewisham sport and
leisure
9 Feed results from mapping
exercises and literature review in
to care pathway
Develop care pathway for children 0-4. 5-
11 and 12-18
September 2010 HWHL strategy
manager
10 Commission appropriate services October 2010 HWHL strategy
manager
11 Application of Standard evaluation
framework to all local weight
SEF to be used for all weight management
programmes in Lewisham
December 2009 PCT/LA
commissioners
management programmes
12 Mandatory training for frontline
staff around behaviour change
Resources identified and training to be
offered to 100 key personnel and 500 front
line staff
by March 2011 HWHL strategy
manager
12 Maternal obesity management,
defined care pathway for
management of maternal
overweight and obesity
Improved health outcomes to mother and
babies
August 2010 HWHL strategy
manager
13 Commission maternal obesity
strategy
March 2011 HWHL strategy
manager
Priority 2 Adults (a) Development of adult weight management care pathway
Action Outcomes Timescale Leads
1
Estimate prevalence of obesity
in Lewisham using national and
QOF data, incorporating local
factors e.g. ethnicity
Identify prevalence of adult obesity in
Lewisham for different population
groups
June 2009 HWHL strategy
manager
2 Conduct local needs
assessment
Identify distribution of age, ethnicity
and deprivation to target effective
interventions
September 2009 HWHL strategy
manager
3 Identify and engage relevant
partner organisations to develop
a multi-agency obesity taskforce
Enable effective delivery of obesity
strategy
February 2010 PCT/LA
4 Map relevant local initiatives Updated local initiatives that promote
healthy eating and physical activity to
support care pathway
May 2010 HWHL strategy
manager/Health
Improvement Team
5 Map weight management
initiatives across the borough
Updated local initiatives to support
care pathway for targeted weight
management services
October 2009 HWHL strategy
manager
6 Review current service provision
for targeted/specialist services;
e.g. dietetic services, exercise
on referral, commercial groups
Identify gaps in service for targeted
and specialist weight management
services and ensure equitable access
borough wide
December 2009 HWHL strategy
manager
7 Develop morbid obesity dietetic
service
Provide specialist dietetic service to
adults with BMI more than 40 (or BMI
more than 35 +2 co-morbidities) in
Lewisham
Begin April 2009 GSTT
8 Develop adult weight
management care pathway
Provide tiered weight management
service
June 2010 HWHL strategy
manager/Health
Improvement
Team/LBL sport and
leisure
9 Identify services to be
commissioned
2009/2010 HWHL strategy
manager/Health
Improvement Team
10 Secure funding Align services with Health checks 2010/2011 PCT/LA
Priority 3 Building physical activity into lifestyles
Action Outcomes Timescale Leads
1
Develop physical activity
strategy for Lewisham
Increased number of people more
active
Begin February 2010 Health Improvement
Team
2 Develop Lewisham sports plan Increased number of people more
active
June 2010 LBL sports and
Leisure
2 Investment to improve sports
facilities e.g. Wavelengths
Leisure Centre
Increased number of people more
active
Ongoing LBL
3 Promote physical activity to
target groups e.g. women,
families, disabled adults e.g.
CIF time to get active
programme, NI8 sport ac+ve
programme
Increased access to physical activity
sessions
Ongoing LBL/Leisure services
4 Link physical activity
programmes with change 4 life
e.g. walk 4 life, swim 4 life
Increased number of people more
active more often
Ongoing LBL/PCT
5 To increase number of walking Increased number of people more Ongoing PCT
groups borough wide active more often
6 Environment conducive to
activity, walking, cycling etc
Increased number of people more
active more often
Ongoing LA
7 Develop a sustainable travel
infrastructure
-promote walking and cycling by
improving street environment
and number of cycle lanes
More people walking, cycling on a
regular basis
ongoing LA
5. Equalities Impact Assessment
The outline, screening grid and action plans are included in appendix 2
1 Governance
The multi-agency partnership working group (Promoting Healthy Weight in Children and
Families Group) is charged with delivering the Children and Young People Plan priority
‘Reducing Childhood Obesity’ through Lewisham’s Healthy Weight, Healthy Lives Strategy.
The CYP Joint Commissioning Group monitors the performance of the delivery of this priority
and is due to review progress on this priority at its meeting on 2nd Nov 2009. The CYPJCG
maintains a robust focus on performance management and will ‘call-in’ priorities where
progress is not on track. Each year the CYP Partnership produces an annual review of the
CYPP which monitors the implementation of the key areas for impact and progress in
delivering the ECM priorities.
Lewisham Healthy Lives, Healthy Weight Strategy - accountability structure
Children and Young Peolple’s Strategic Partnership Board
Children and Young People’s Joint Commissioning Group
Healthy Lives, Healthy Weight Group
Lewisham Strategic Partnership
Appendix I
Summary of Cluster Characteristics Source: Healthy Weight, Healthy Lives: Consumer Insight Summary
46
Location and distribution of clusters 1 to 6 in Lewisham
References
1. Statistics on obesity, physical activity and diet: England, February 2009 www.ic.nhs.uk
2. Weighty matters The London findings of the national child measurement programme
May 2009 www.lho.org.uk
3. Healthy Weight, Healthy Lives: a toolkit for developing local strategies. Department of
Health and National Heart Forum 2008
4. National Institute for health and Clinical Excellence (NICE) 2006. Obesity: the
prevention, identification, assessment and management of overweight and obesity in
adults and children. London www.nice.org.uk/guidance/CG43
5. Foresight Tackling obesities: Future choices- project report 2nd ed 2007.
www.foresight.gov.uk
6. Healthy Weight, Healthy Lives; A cross government strategy for England. Dept of
Health. 2008
7. It’s Everybody’s Business. Lewisham Children and Young People Plan 2009-2012.
www.lewisham.gov.uk
8. Healthy Weight, Healthy lives: Consumer Insight Summary. Department of Health
2008