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Innovations and new initiatives to prevent obesity
NSW Health Innovation & Health Symposium – November 2015
Louise A BaurUniversity of Sydney: Discipline of Paediatrics & Child Health, Sydney Medical School, AND Sydney School of Public Health
The Children’s Hospital at Westmead, Sydney: Weight Management Services
Email: louise.baur@health.nsw.gov.au
• One of today’s most blatantly visible – yet most neglected – public health problems
• The public health equivalent of climate change
• The Millennium Disease
How others have described the problem of obesity
WHO; www.who.int/nut/obs.htm; Laing & Rayner, Obesity Reviews 2007; www.iotf.org
!!!!
With such a complex issue ……we can’t tackle it
by staying in our silos
With such a complex issue ……we can’t tackle it
by staying in our silos
Obesity and the chronic disease care pyramid
Primary prevention & health promotion
Level 170-80% of people with o’weight/obesity
Self-care & community based care
Obesity and the chronic disease care pyramid
Self-care supported by GPs, other 1o care, group programs
Primary prevention & health promotion
Level 170-80% of people with o’weight/obesity
Self-care & community based care
Level 2High risk patientsCare management
Obesity and the chronic disease care pyramid
Self-care supported by GPs, other 1o care, group programs
Multidisciplinary teams; specialist allied health; group programs
Primary prevention & health promotion
Level 170-80% of people with o’weight/obesity
Self-care & community based care
Level 2High risk patientsCare management
Level 3
Obesity and the chronic disease care pyramid
Complex patientsCase management
Self-care supported by GPs, other 1o care, group programs
Multidisciplinary teams; specialist allied health; group programs
Tertiary level facilities & special obesity clinics; specialist teams; keyworker case manages & joins up care
Primary prevention & health promotion
Level 170-80% of people with o’weight/obesity
Self-care & community based care
Level 2High risk patientsCare management
Level 3
But we tend to stay in our silos!
Complex patientsCase management
Self-care supported by GPs, other 1o care, group programs
Multidisciplinary teams; specialist allied health; group programs
Tertiary level facilities & special obesity clinics; specialist teams; keyworker case manages & joins up care
Primary prevention & health promotion
Silo 1 – Health promotion
Silo 2 – Primary careCommunity care
Silo 3 – Hospitals
What are some of the new, or newer, strategies in tackling obesity?
Tackling gestational weight gain:
→ Providing a Get Healthy Coaching Service to pregnant women
affected by obesity
Why gestational weight gain?
• A critical period when future health trajectories can be influenced
• Pregnant women are very open to health messages AND they are being seen – often frequently - by the health system!
• Excess weight in pregnancy → influences current & future maternal health AND offspring health
Trial of for women with gestational weight gain
• Trial underway using the Get Healthy platform
• Can we see a future when ….– all women in early pregnancy who are affected
by obesity are provided with a high quality, accessible intervention to help them avoid excess weight gain and have as healthy a pregnancy as possible?
– the Get Healthy Service is used successfully by many, many people – including young people (i.e. prior to pregnancy)?
Integrating anticipatory guidance about breastfeeding and healthy infant/
young child eating and activity into routine clinical service delivery
→ Universal and Targeted home visiting to mothers of new babies
Home visiting programs?
• Can be effective in improving social and health outcomes of disadvantaged parents and children
• What about weight, eating and activity outcomes?
• → The Healthy Beginnings Trialo south-western Sydneyo intervention from 3rd trimester to
child age 2yo 8 home visits by early childhood
nurse, developmentally staged
1Olds DL, et al. JAMA 1997, 278:673-643.
And, Healthy Beginnings led to …:
• significant reduction in body mass index at age 2 y → the first intervention to decrease child BMI in early childhood
• improvements in some child and mother eating and activity/TV behaviours • …. but the effect
didn’t persist beyond 2 y - when the home visits stopped
0.0
5.1
.15
.2.2
5y
blue/dash -- for control. red/solid -- for intervention. 18.2 -- equivalent to adult BMI 25.
BMI distributions of children at 2 years old by treatment
Wen LM et al. BMJ 2012; 344:e3732
Home visiting programs to prevent obesity?
• Trial being planned in Sydney LHD
• Can we see a future when ….– Anticipatory guidance – about breastfeeding,
healthy infant/child feeding & activity – is integrated into home visiting programs for targeted pregnant women/mothers of young babies?
• Are there other ways to support large numbers of women? What about phone coaching? The Get Healthy Service for new mothers?
On-line training of clinicians (nurses, allied health, doctors …) who see
children and adolescents - to monitor weight status, raise the issue of
obesity and provide initial and more detailed advice
→ Weight4KIDS training modules
Why the interest in training health professionals?
• Treatment services very limited, poorly co-ordinated, across NSW and Australia-wide
• Most health professionals are poorly trained in managing paediatric obesity and its complications
• → Development of Weight4KIDS: – a series of on-line training modules suitable for
all types of health professionals working with children, in any setting
– well-evaluated in metro and regional NSW settings
Upskilling of health professionals?
• Can we see a future when ….– All clinicians and health promotion staff are
able to access relevant training as needed and feel confident in:
• raising the issue of obesity • monitoring the problem• helping people find the support they need to
tackle the issue
Some last reflections
Of course we need many other strategies too! BUT …
• Let’s be as flexible and innovative as we can within our existing budgets
• How can we avoid being stuck in our different “craft silos” and comfort zones?
• Where does health promotion end and clinical service delivery begin? And vice versa?
• How can health promotion infiltrate/ embed itself - or be integrated - into routine clinical service delivery?
• How can health promotion be integrated across many other sectors?
Of course we need many other strategies too! BUT …
• Let’s be as flexible and innovative as we can within our existing budgets
• How can we avoid being stuck in our different “craft silos” and comfort zones?
• Where does health promotion end and clinical service delivery begin? And vice versa?
• How can health promotion infiltrate/ embed itself - or be integrated - into routine clinical service delivery?
• How can health promotion be integrated across many other sectors?
Thank you!
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