Obesity and excess weight are significant health issues for adults across the life course and into old age. Carrying excess weight can have significant implications for an individual’s physical and mental health. Figure 56 below predicts that obesity in people aged 65+ in Bexley will continue to rise. Obesity is associated with a range of long term health conditions including CVD, Cancer, diabetes and hypertension.
Figure 56: Obesity in people aged 65+ and over, projected to 2035
Source: POPPI, Crown Copyright 2016
What are we doing about it?
During 2018, Bexley is developing a new 5-year Obesity Strategy and Action Plan, which seeks to build on the achievements of our 2014 strategy, ‘Healthy Choices, Healthy Weight – An Obesity Plan for Children and Adults in Bexley’. The new strategy seeks to create a local environment that supports everyone to have a healthy weight in an attempt to halt the rise of excess weight in the borough and ultimately decrease rates of obesity in children and adults in Bexley. Table 15 summarises many of the things we are currently doing to help tackle obesity and sets out potential additional opportunities to influence this.
Table 15: Whole system interventions (not an exhaustive list)
|Interventions||What we currently do||What we could do in addition|
|Placed based||· Creating accessible safe green spaces and parks
· Promotion of Healthy Catering Commitment to businesses
· Promote active travel
· Boroughwide UNICEF Baby Friendly Accreditation
|· Mandating the Healthier Catering Commitment for all new food provision in the borough
· Restrictions on opening of new food outlets near schools and public transport hubs
· Designing Health into new developments including new housing
· Applying Healthy High Streets Principles in all developments
· Ensuring Active Travel is factored into all new developments
· Utilisation of licensing in promoting healthier environments
· Restricting the advertising of unhealthy food and drink in locations within the council’s control.
|Community based & Settings based||· Promotion of the Sugar Smart campaign
· Promotion of safe green and blue spaces for sport and leisure activities
· Play Streets – pilot
· Bike-ability courses
· Food growing initiatives
· Love Food Hate Waste & TriFocal project
· Engaging Libraries Project
· Bexley Walk to School Campaign with Kent Messenger – funded for 2017
· Active Travel Plan workshops
|· Roll out the provision of Play Streets across the borough
· Implementation of health charters in colleges, universities and workplaces
· Maintain work on Active Travel Plans in schools
· Health Promoting Libraries
· Healthy Schools
· Food offer in council buildings and all council contracts
· Co-ordination of Food Growing Initiatives and tailored support for schools
|Individual based||· NHS Health Checks Programme
· National Child Measurement Programme
· Weight Management Programme
· NHS Diabetes Prevention Programme
· Mental Health Services
· Exercise Referral Programme
· Time to Change Programme
· “Raising the Issue of Weight” training
· Volunteering & provision of programmes in the third sector
· Social Prescribing Programme
|· Weight management advice/dietary intervention prior to pregnancy, during and for breastfeeding and weaning.
· Tiered weight management pathway
· Better understand the role of genetics and early adiposity rebound
· Better understand the psychology of eating behaviours, adopting a multi-disciplinary approach to weight management
· Cookery Classes
· Co-ordinated approach to Early Years obesity prevention work
What works and best practice?
NICE Guideline on Obesity Prevention outlines how the NHS, local authorities, early years’ settings, schools and workplaces can increase physical activity levels and make dietary improvements among their target populations.
A ‘whole-systems approach’ to tackling obesity: Previous research indicates that we can only make significant in-roads into tackling obesity and improving quality of life by taking a whole systems approach. This requires looking at obesity as a wider societal issue, where population level interventions are available to help the majority while also providing the targeted treatment required by individuals at different levels of need. Leadership and coordinating action across multiple sectors – including health, social care, education, leisure, planning, housing, transport, business and the voluntary and community sector – is also critical to success. Engaging local groups and communities enables them to play a significant role in shaping and delivering the agenda, leading to more effective, local-owned and more sustainable solutions.
Public Health England have published guidance and resources to help front-line health and care staff use their trusted relationships with patients, families and communities to promote the benefits of achieving and maintaining a healthy weight. This includes links to NICE guidelines and online training resources to help healthcare professionals stay up-to-date on the latest evidence base.
Everyday interactions: In 2017, the Royal Society for Public Health published a report and toolkit that focusses on the public health impact of four of the key healthcare professions within the wider workforce: nurses and midwives, dentists, allied health professionals and pharmacists. The aim is to support healthcare professionals in the prevention and health improvement interventions that they do as part of routine clinical practice. Although the toolkit may have wider application, it can be used to support these healthcare professionals to record and measure their public health impact. The toolkit includes impact pathways covering ten public health priorities that healthcare professionals can help to support, including adult obesity and physical activity.
Role of Pharmacies: The Five Year Forward View recognises the key role of pharmacy, highlighting that there should be far greater use of pharmacists in the prevention of ill health, support for healthy living, and promotion of self-care for long term conditions. In 2017, Public Health England published a report looking at the potential opportunities that could be delivered by pharmacy teams in the primary and community sectors. This includes the development of Healthy Living Pharmacies (HLP) through the HLP quality mark.
 Making obesity everybody’s business: A whole systems approach to obesity, Local Government Association, 13 Dec 2017
 Everyday interactions – Measuring the public health impact of healthcare professionals, Royal Society for Public Health, June 2017
What are the gaps?
An Early Thoughts Paper, from our Public Health Team to the Bexley Health and Wellbeing Board in February 2018, recognised that most public health intervention programmes have had limited success in tackling the rising prevalence of obesity to date. This is attributed to the narrow scope of such programmes, which were aimed at addressing some specific determinants of excess weight but not the whole environment where people live and their community’s social norms surrounding food, eating, and lifestyle – all of which strongly influence what, when, and how much food is consumed.
The paper recommends that we should seek to build on previous work but shift the focus of future strategy to look at obesity as a wider societal issue, where population level interventions are available to help the majority, whilst also providing the targeted treatment required by individuals at different levels of need.
- Develop and implement a new 5-year Obesity Strategy that continues to ensure there are treatment services at individual level but also includes more ambitious plans to improve the health of Bexley residents at a population level, across the life-course and in different settings.
- Healthcare professionals should provide information, advice and support around healthy lifestyles and, where appropriate, refer to weight management services as part of routine daily contact with individuals.