Context 5 Findings 7 Recommendations 19 References 27

Contents Chair’s foreword 2 Glossary 3 Context 5 Findings 7 Recommendations 19 References 27 Appendix 1 – Scope of the review 28 Appendix 2 – Health & Older People Scrutiny Panel 29

terms of reference Appendix 3 – Methodology 31

First edition

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Chair’s foreword Obesity can be described as a worldwide epidemic, driven by cheap calorie dense foods and increasingly sedentary lifestyles. In Sandwell obesity contributes to life limiting illnesses such as heart disease, diabetes and some cancers. During this review we met with many professionals working directly or indirectly to tackle obesity to find out what more needs to be done. We also went on site visits to see innovative ways of tackling obesity for example projects at Salop Drive Market Gardens or the Adizones established in some of Sandwell’s parks. This review found that the causes of obesity are complex. Modern life has created circumstances where it is easier than ever before for an individual to become obese. If obesity is to be addressed all organisations, including the private sector, will have to work together to make Sandwell a place where people have access to healthy food, live in an environment that encourages physical activity and can get support losing weight if they need it. I hope this review contributes to achieving this. I would like to take this opportunity to thank everyone who has supported the work of the panel during this review. Councillor Mary Griffin Chair of the Health & Older People Scrutiny Panel

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Glossary BME Black and minority ethnic people or groups. Body Mass Index (BMI) Body mass index, a mathematical calculation used in assessing weight, taking into account height and weight. Commonly used to calculate if someone is overweight or underweight given their height. Cardio vascular disease Disease affecting the heart or blood vessels. Diabetes A condition where the amount of glucose in the blood is too high. Elected member A person elected to serve on the local council, often called a councillor. Midwife Led Unit Maternity units which are staffed and run by midwives, they aim to offer a homely rather than clinical environment. Musculoskeletal disorders Injuries and disorders of the muscles, nerves, spinal discs, cartilage, tendons, ligaments and joints. Obesity A medical condition whereby the body has too much fat stored. Obesogenic An environment that promotes obesity. Primary Care Trust (PCT) PCT’s are NHS organisations which have been set up throughout the country to provide, plan and fund health services for their local people. Primary care includes all those health services that people normally go to first when they need help – the family doctor (GP), optician, dentist or local pharmacist. Once the PCT has assessed the health needs of their local population, and following consultation it specifies what services are required to meet those needs. Then PCT’s commission (fund) agreements with hospitals and other NHS trusts and others to deliver those services, within the resources available to the PCT as well as providing some services itself.

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Sedentary Inactive and involving a lot of sitting and little physical movement, for example many modern workplaces could be described as sedentary as they require much sitting at desks.

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Context National Context Obesity is a major worldwide problem due to its link to a number of life limiting illnesses including cardiovascular disease, diabetes, musculoskeletal disorders and many cancers. Worldwide it is becoming a major public health challenge with the WHO predicting there will be 700 million obese people in the world by the year 2015. The World Health Organisation (WHO) defines adult obesity as a BMI of equal to, or higher than, 30. BMI is assessed by recording height and weight and this gives a guideline score which indicates whether someone is overweight, underweight or obese. BMI Definitions BMI Score BMI Definition 18.5 or lower underweight 18.5 – 24.9 normal/healthy weight 25 – 29.9 overweight 30 – 34.9 obese 40 and above morbidly obese Childhood obesity is slightly more complicated with BMI results being plotted against standard growth charts to calculate if a child is a healthy weight. In the UK, the levels of obesity have been rising in recent years to the extent that approximately a quarter of the national population is classed as obese according to the Health Survey for England. Adult obesity is mirrored amongst children and young people with the national child measurement programme highlighting high levels of obesity amongst children in year six (ages 10 and 11) of school. In response to these high rates of obesity and the impact upon public health the UK the government aims 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.’ (HM Government, Healthy Weight, Healthy Lives, 2008) In order to begin this reverse there have been a number of national

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initiatives. For example the ‘change 4 life’ campaign has been developed as a brand for healthy eating and exercise targeted at families and children. There has also been much done nationally around promoting sport and physical activity in the build up to the London 2012 Olympics. In the private sector, many food producers have made well publicised efforts to make food healthier by lowering salt, sugar and fat content. A leading national supermarket also recently announced the removal of hydrogenated vegetable fats (associated with obesity and cardio vascular disease) from all of its own brand products. Despite an ambitious plan to reverse the tide of obesity nationally, and the efforts of national government and some private sector companies, levels of obesity have not yet started to reduce. However, the most recent statistics show that very recently obesity levels may have stopped rising and reached a plateau. Local Context The West Midlands was, during the course of this review, highlighted as the most obese place in Europe. Sandwell regularly ranks near the very top for levels of childhood obesity, has the lowest physical activity rates in the West Midlands and has the lowest fruit and vegetable consumption than all of its neighbours in the wider West Midlands, with the exception of Stoke. All these factors lead to greater levels of health inequalities in Sandwell, with obesity having a role to play in heart disease, some cancers and diabetes. Sandwell’s Child and Family Strategic Implementation Plan (which is updated quaterly) brings together physical activity, food policy and the urban environment in an attempt to tackle obesity. It is a whole family approach recognising that all agencies have to play their part in tackling obesity and improving the health of local people. In Sandwell there are lots of preventative services working to prevent people becoming overweight or obese, often by encouraging exercise or healthy eating. There are also weight loss initiatives, such as private sector slimming clubs or Sandwell PCTs Slimwell and Wellfit for people who need support in managing their weight. There are also drug treatments and surgical interventions to treat people who are extremely and persistently obese.

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Findings Healthy eating

Changes over time have led to people having easy access to a diet of cheap calorie dense food. This has contributed to the current high levels of obesity. Messages about healthy eating seem to be getting through to people. As part of the evidence gathering focus groups with students on Sandwell College’s ‘what next’ programme revealed that the young people knew about the health need to eat fruit and vegetables with them all quoting the ‘5 a day’ message. The focus groups highlighted that young people seem to know what food was healthy and what was not. Yet people are still not eating healthily so it seems there must be barriers to some of them doing so. Influencing people to make the healthier choices in terms of healthy eating or physical activity is crucial to tackling obesity. Lessons may be learned from the approach to smoking where health messages and other measures have influenced most people to make the choice not to smoke. Sandwell PCTs food policy team work to promote healthy eating and access to healthy food in Sandwell, and have a number of programmes to do this which are crucial in addressing obesity and preventing obesity including:

• Cookwell • Shop tours • Grow-well • Shopwell • Community cafes

Cookwell is a free six week course which aims to teach people how to cook simple, healthy yet appetising food. Giving people the knowledge and confidence to prepare healthy meals for themselves and their families can help end reliance on ‘fast food’ and ‘convenience’ foods. The work of Cookwell is particularly important in teaching skills around cooking to people who may not have been taught how to cook at school or by family members, and in dispelling myths around the cost and convenience of cooking healthy food. Cookwell sessions are also delivered in community groups and venues around the borough. Cookwell sessions targeted at young people who are about to become independent adults might help address a gap in cooking skills that exists

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for some young people and give them more confidence to cook healthy food for themselves and their families in the future. Colleges and sixth form centres are ideal venues to target young people who are about to become independent adults with some basic healthy cooking skills. Recommendation 1 The food policy team create a package involving Cookwell and other programmes to be targeted at school leavers

The food policy team also organise shop tours where health professionals take people on a one hour tour of a local supermarket showing them things such as how to buy healthy food cheaply and how to read food labels to assess nutritional content. This is done with full support of the supermarkets and is a good example of the private sector and PCT working together to tackle obesity. Grow-well and Ready Steady Grow are organised in conjunction with the Salop Drive Market Gardens in Oldbury. This project aims to give school children, sometimes along with parents, an awareness and appreciation of where healthy food comes from and the health benefits of eating fresh fruit and vegetables. Grow-well is one of the initiatives contained in the community agriculture strategy in Sandwell. The community agriculture strategy sets out a vision for expanding food growing in Sandwell, with the knock on benefits that fresh fruit and vegetables bring to obesity and general health and wellbeing. There are also other financial and environmental incentives to growing more food locally when globally oil and food commodity prices are rising. Salop Drive Market Gardens, and other locations in Sandwell, also play a valuable role in promoting healthy food amongst children and young people and giving local people the skills to grow their own fruit and vegetables.

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(Helen Sneyd, Veronica Barry, Cllr Joanne Hadley, Cllr Mary Griffin and Adam Richardson at Salop Drive Market Garden) In some areas of Sandwell healthy food is harder to find than in other areas. The local shops do not routinely stock quality healthy food. In order to try and combat this the food policy team have been working with the private sector to increase availability of fresh fruit and vegetables in local shops. This scheme is called Shopwell and has had some success in encouraging small local businesses to stock fresh fruit and vegetables which are easily accessible to people who are unable to travel regularly to markets or supermarkets to buy their food. The food policy team also work alongside organisations in the community to create community cafes, which provide healthy food, based on the Eatwell plate, which shows the proportion of each food group that should be eaten for a balanced diet, at reasonable prices. There are a number of these cafes in community venues offering menus which are healthy and offer people an alternative to hot food takeaways or fast food restaurants if they want to ‘eat out’. This network of community cafes could be extended and built upon to include sites such as hospitals, leisure centres and council owned buildings thereby giving people better access to healthy food.

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Recommendation 2 The community cafes are better promoted and supported

Physical activity Physical activity prevents and tackles obesity by ‘burning off’ excess calories and fat, it also has a number of other health benefits including strengthening muscles and benefits to mental health. Sandwell historically has low levels of physical activity. In Sandwell the Physical Activity Board has been formed to bring together health, education, sport and leisure. Sandwell Leisure Trust report swimming in the borough is more popular than ever, for both swimming lessons and swimming for leisure. It is a way of keeping physically active and this should be built upon, as wider participation in swimming will have benefits to health and obesity. For people who are obese swimming can be a particularly good form of exercise as it utilises a wide variety of muscle groups and a lot of energy is used. However some people who are obese or overweight may feel self conscious swimming in regular classes, and this can put people off. Some obese people may prefer more private swimming sessions perhaps with more support from instructors to get the maximum benefit from a swimming session. In Oxford a scheme is running where obese people can be referred to specialist swimming classes if they want to use swimming as a way to lose weight. These sessions offer people the chance to swim to lose weight with other people who have the same goal of losing weight. Specific swimming sessions targeted at people who are overweight could appeal to some people, when other forms of exercise or swimming at mainstream times might not. Recommendation 3 Swimming sessions targeted at people who are overweight or obese be provided in Sandwell

Sandwell Leisure Trust also do outreach work to try and target people who may not naturally go to a gym or leisure centre. The Physical

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Activity Development Officers (PADOs) work with hard to reach groups, often in community venues. The PADO for Smethwick carries out targeted work with women from Black and Minority Ethnic (BME) communities to encourage them to be more active, with knock on benefits for obesity levels. Funding for the PADOs is time limited expiring in winter 2011, consideration needs to be given as to how that outreach work can be maintained and embedded into the Leisure Trust’s mainstream work programme. Recommendation 4 The outreach work of the Physical Activity Development Officers be maintained beyond 2011

The Physical Activity Referral Scheme in Sandwell, informally known as ‘exercise on prescription’ has been established to use the benefits of exercise as treatment for people with health problems, including those associated with obesity. GPs and other health professionals can refer people to this scheme where they receive an assessment by health and fitness advisors who advise on appropriate exercises and help individuals overcome barriers to exercise, for example by taking people on tours of gyms to demonstrate equipment and build confidence. In the questionnaire conducted for this review some people said when they stopped smoking they had put weight on as a result, using eating as a coping strategy for the stress that quitting smoking resulted in. Whilst there are links between stop smoking services and the physical activity referral scheme in place a routine referral, when someone wants to quit smoking, to physical activity could help people exercise as a way of coping with the stress of quitting smoking. Recommendation 5 People who are quitting smoking are routinely referred to the physical activity referral scheme

Cycling has big benefits to health and can help reduce obesity as well as contributing to lower carbon emissions and less traffic congestion. However, in the UK only between 1-2% of journeys are made by bicycle. This compares to a rate of 10% in Germany and nearly 30% in the Netherlands. People may be put off cycling in Sandwell by the hills, the

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amount of fast traffic and a lack of skills and confidence in cycling. The relief of the land in Sandwell cannot readily be addressed, however creating a more cycle friendly borough and equipping people with the skills to cycle safely are targets that can result in lower levels of obesity. Petrol price increases and an increase in the profile of cycling for sport with the Olympics in London next year are likely to encourage more people to cycle. An environment that is seen as safe and inviting to cyclists can further help encourage people to cycle as part of their daily routine. Despite recent improvements to the local cycle network in Sandwell there are still links to be made to achieve the goal of making it relatively easy to travel by bicycle. Recent changes to the management of certain roads in the borough, going from Highways Agency control to local authority control (for example the A4123 Wolverhampton Road), and the local sustainable transport fund bid led by Centro, offers potential opportunities to further extend the local cycle network. A fully integrated cycle network in Sandwell would encourage more people to cycle, and help develop a culture of cycling in Sandwell. Recommendation 6 A connected cycle network is established in Sandwell

The Road Safety Team work with schools to give confidence and teach safe cycling skills to children and young people. For adults, Sandwell PCT currently run an accredited (Bikeability) scheme to encourage adults to start cycling for leisure or for travel. With the establishment of GP consortia, but it is important that this function carries on within public health, as the benefits of cycling to public health are well established. Parks and green spaces provide a place to walk, cycle and play some parks in Sandwell now have dedicated exercise equipment installed. Through a partnership with sportswear company Adidas, two Adizones have been established in Victoria Park, Smethwick and Dartmouth Park, West Bromwich. The Adizones provide simple gym equipment that can be used in the parks by local people for free. Anecdotally it has proved popular with young people and South Asian women who may be less likely to access mainstream exercise in gyms and leisure centres. These opportunities to exercise could be made available and accessible for people at more outdoor locations across Sandwell.

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Recommendation 7 More Adizones or outdoor gyms be established in parks across Sandwell

Sandwell Stride is a Sandwell PCT programme which encourages walking as gentle exercise for people appealing to many people, who may not want to access other exercise. Results from the questionnaire showed walking to be a very popular way to keep fit, especially when people had other health issues. These health walks can burn up to 300 calories, as well as having other health and social benefits. Sandwell Healthy Urban Development Unit The Foresight Report was produced in 2007 and highlighted the importance the rising levels of obesity and the importance of tackling obesity. It defined the obesogenic environment as being ‘the sum of influences in the environment promoting obesity amongst individuals and the population’. Characteristics of an obesogenic environment include somewhere without easy access to affordable healthy food and somewhere which is not conducive to physical activity such as not being walking friendly. The obesogenic environment is a place where unhealthy options are easier than healthy options, for example where it is easier to drive for ten minutes through congested traffic than it is to cycle over busy motorway junction islands. Many parts of Sandwell could be classified as obesogenic, and in response to this the Sandwell healthy urban development unit (SHUDU) was formed. SHUDU brings together a partnership of a wide range of agencies who may not have a direct link to health, but have a role to play in influencing the wider determinants of health, such as transport planning. SHUDU has wide sign up from a range of agencies, however further input from Sandwell Leisure Trust for example could help integrate sport and physical activity into the design of urban spaces. The private sector has a role to play in tackling obesity, local involvement of the Black Country Chamber of Commerce, for example could also play an important part.

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Recommendation 8 Sandwell Leisure Trust, the Black Country Chamber of Commerce, the Local Enterprise Partnerships and relevant private sector organisations become involved with Sandwell Healthy Urban Development Unit

SHUDO make healthy options easier options for local people and also seeks to influence regional issues that might impact upon health and obesity in Sandwell, for example SHUDU was involved in the consultation around the local transport plan for the wider West Midlands. Hot food takeaways are a treat for many people and can be enjoyed as part of a healthy diet, however for some people in Sandwell hot food takeaways are eaten to excess with detriment health consequences. SHUDU has worked alongside existing takeaways in Sandwell to encourage them to adopt healthier cooking practices. Options are also being explored to use local authority planning processes to limit the number of new hot food takeaways opening, particularly in areas where there is already a high concentration. As a result of the review’s questionnaire carried out at a Slimming World class people said that they felt there were too many hot food takeaways in the borough, especially near schools. Barking and Dagenham London Borough Council have taken a proactive approach to hot food takeaways, through a supplementary planning document it has established exclusion zones for local takeaways. This means that places that are deemed saturated with hot food takeaways cannot have more open within those areas. This is an approach that would be beneficial, particularly in parts of the borough where there are already several hot food takeaways. Recommendation 9 Exclusion zones are created to limit the number of hot food takeaway restaurants in parts of the borough that are saturated with hot food takeaways

Childhood obesity Childhood obesity is on the rise. Nationally there is a focus upon childhood obesity in order to prevent obese children growing up to be obese adults. In Sandwell the whole family approach to obesity, includes

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children. The Marmot Review into health inequalities ‘Fair Society, Healthy Lives’ identified the importance of early interventions to prevent health inequalities persisting into adulthood, it clearly highlighted the need for interventions as early as the pre-natal stage. Evidence elsewhere echoes this in terms of obesity with the key age for intervention to prevent obesity stated as the first two years of a child’s life. At this early stage of a life, patterns can be set which result in obesity in later life. Sandwell FABtots works with very young children and their parents to try to prevent and address childhood obesity, often within children’s centres. They work with parents at the pregnancy stage until the children reach five years of age. The programme consists of educating parents about breast feeding, healthy eating, how to wean their infants in a healthy way and the importance of active play. Accessing pre-natal parents has been difficult for FABtots in the past, stronger links with the new Midwife Led Unit being built in Smethwick, and existing maternity services at City Hospital need to be established. This would also help pregnant women access other support services if they are obese. Maternal obesity can have a big health impact on a newborn child. The Sandwell Joint Strategic Needs Assessment published in February 2011 highlights the need for more work to be done in relation to maternal obesity, an increasing issue in Sandwell. Recommendation 10 FABtots establish links with maternity services at City Hospital and the new Midwife Led Unit

An increasing number of children at school reception age are overweight or obese. FABtots are currently designing a weight loss programme for children aged three to five years old called FABtots plus. Healthy schools The Healthy Schools Programme was established in 1999 as a joint initiative between the Department of Health and the Department for Children, Schools and Families, with the aim of a whole child and whole school approach to health. The Programme has developed initiatives to tackle childhood obesity including work around school meals and packed

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lunches, breakfasts at schools and more physical activity at break times. National evidence shows that the school environment is good for pupils’ health, with the highest obesity levels reported in September after the six week school holidays. However national changes to the way schools are run have changed the role of the Healthy Schools Programme. It is important that the good work carried out by Healthy Schools is continued. By promoting the successes of Healthy Schools, particularly around tackling obesity, to schools many Healthy Schools initiatives might be continued by increasingly autonomous schools. Recommendation 11 The Healthy Schools Programme publicise some of their successes around obesity and promote this to schools

Weight management and ‘slimming clubs’ Once people become overweight or obese many attend slimming clubs to receive advice, support and motivation in losing weight. There are a number of commercial slimming providers in Sandwell including Weight Watchers and Slimming World. There is also Sandwell PCT’s Slimwell programme which was created in line with NICE guidance. Slimwell is a 20 week rolling programme with a payment of £1 per week (which is considerably less then many commercial slimming clubs). A typical Slimwell session consists of:

• Physical exercise • Weigh in • Talk about particular foods or issues e.g. alcohol, hunger and

cravings • Goal setting

To build on the early success of Slimwell, Wellfit was developed by Sandwell PCT in 2010 to tackle the high levels of childhood obesity in the borough. It is targeted at children aged six to thirteen and often takes place through schools. There is however a gap in provision for teenagers who want to attend weight management. A bespoke weight management programme for teenagers could be more appealing than attending adults slimming sessions or the child focussed sessions of Wellfit. Such a programme could also focus on issues specific to teenagers such as puberty or coping with exam stress.

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Recommendation 12 The feasibility and benefits of providing of teenage weight management be explored

Response to Slimwell is positive with 88% of completers recording a reduced BMI. Once someone has completed the Slimwell programme they can continue to attend the sessions to prevent relapse if they wish. However longer term, after the 20 week programme is completed there is less information about success of the programme in instilling long term behaviour change. As Wellfit is a relatively new programme long term evaluation is not feasible at the moment. It would be beneficial to set in place routine monitoring and evaluation of the Slimwell and Wellfit programmes in order to establish the long term benefits of such programmes. Recommendation 13 Long term monitoring and evaluation of Slimwell and Wellfit is carried out to assess long term success of these programmes

Severe and morbid obesity Morbid obesity is defined as having a BMI of over 50 and means that the obesity will have a significant life limiting effect. A specialist weight management clinic is run in Sandwell from Sandwell Hospital, Neptune Health Park in Tipton and Rowley Regis Hospital for people who are severely or morbidly obese. People who come to these clinics have usually exhausted all other dietary and slimming options. These clinics look at the reasons for overeating and can refer to psychological support, specialist exercise and specialist diets. Other options for those who are severely obese are medical (using drugs) and surgical (bariatric surgery including stomach bypasses, jaw wiring, stomach balloons and gastric bands) options. The drug that is often prescribed for severe obesity is Orlistat which combines with fat and prevents absorption and this seems to have some success when combined with a low fat diet. Surgical options for treatment of obesity are known as bariatric surgery,

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gastric banding is one of the more popular methods as it is a simpler procedure as well as being reversible. Gastric banding also has immediate benefits for diabetes through improved insulin control. However bariatric surgery usually costs approximately £10,000 per individual and as with any surgery there are dangers to the individual. Total food replacement diets, such as the Cambridge Diet replace food that would normally be eaten with very low calorie foodstuffs, typically in the form of milkshakes and muesli bars. These foodstuffs are nutritionally balanced but force the body to start burning fat for energy and consequently an individual loses weight. This often results in weight loss for people who are severely obese, however there are costs associated in buying the food replacement milkshakes and muesli bars. In Sandwell these diets are not commissioned for patients, despite being cheaper than bariatric surgery, and being commissioned by neighbouring PCTs. Recommendation 14 Total food replacement diets be explored to be potentially commissioned for obese patients in Sandwell

It is widely acknowledged that there a multitude of complex and interlinked factors which influence obesity. If the increasing levels of obesity in Sandwell is to be reversed all organisations including NHS organisations, the council, local employers, and the private sector must all play their part.

Recommendations - Tackling Obesity in Sandwell, April 2011 Based on the evidence received, the Health & Older People Scrutiny Panel makes the following recommendations, which are stated in relationship to the order of presentation of findings in this report and not in order of priority: Timescales are illustrative and therefore open to discussion. Ref Recommendation Lead agency Date Intended outcome 1

The food policy team create a package involving Cookwell and other programmes to be targeted at school leavers

Sandwell PCT

March 2012

To teach school leavers skills around healthy eating so that they have the knowledge, confidence and skills to make healthy choices around the food they eat.

2

The community cafes are better promoted and supported

Sandwell PCT

August 2011

Community cafes are routinely known about, and through their example people learn about healthy eating.

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Recommendations - Tackling Obesity in Sandwell, April 2011 Ref Recommendation Lead agency Date Intended outcome 3

Swimming sessions targeted at people who are overweight or obese be provided in Sandwell

Sandwell Leisure Trust Cabinet Member for Leisure Services

August 2011

To provide overweight and obese people with a more private swimming environment where they may feel less self conscious and therefore more motivated.

4

The outreach work of the Physical Activity Development Officers be maintained beyond 2011


January 2012

To continue to tackle obesity by providing physical activity opportunities for ‘harder to reach’ groups.

5

People who are quitting smoking are routinely referred to the physical activity referral scheme

Sandwell PCT

August 2011

To support people who are quitting smoking to take up exercise and physical activity and prevent them from putting on weight after quitting smoking.

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A connected cycle network is established in Sandwell

Sandwell PCT Cabinet Member for Jobs & Economy

March 2012

To encourage cycling in the borough by making cycling more accessible and safe for people as a means of transport.

7

More Adizones or outdoor gyms be established in parks across Sandwell


March 2012

To provide free outdoor exercise for people across Sandwell who may not want to access mainstream gyms or leisure centres.

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Sandwell Leisure Trust, the Black Country Chamber of Commerce, the Local Enterprise Partnerships and relevant private sector organisations become involved with Sandwell Healthy Urban Development Unit

Sandwell PCT

October 2011

A greater range of partners becoming involved and committed to making Sandwell a less obesogenic environment.

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Exclusion zones are created to limit the number of hot food takeaway restaurants in parts of the borough that are saturated with hot food takeaways

Cabinet member for Jobs & Economy

October 2011

To prevent the saturation of certain areas with hot food takeaways, and the knock on implications such saturation has on obesity.

10

FABtots establish links with maternity services at City Hospital and the new Midwife Led Unit

Sandwell PCT

December 2011

FABtots offering very early advice and support around obesity prevention at the pre and post natal stage, and that maternity services are aware of, and signpost to, FABtots.

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The Healthy Schools Programme publicise some of their successes around obesity and promote this to schools

Cabinet Member for Children & Families

June 2011

To showcase the successes of the Healthy Schools Programme so schools learn lessons around obesity.

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The feasibility and benefits of providing of teenage weight management be explored

Sandwell PCT

September 2011

The provision of bespoke weight management for the teenage age group.

13

Long term monitoring and evaluation of Slimwell and Wellfit is carried out to assess long term success of these programmes

Sandwell PCT

September 2011

An evidence base for the success of these programmes in reducing obesity in the long term so that future commissioning arrangements have evidence of what works.

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Total food replacement diets be explored to be potentially commissioned for obese patients in Sandwell

Sandwell PCT

September 2011

That individuals have the option of total food replacement diets to try to manage their weight, and reduce the need for surgery.

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That all of the findings of this review are given careful consideration and taken into account when making decisions in relation to tackling obesity in Sandwell

Sandwell Council Sandwell PCT Sandwell Leisure Trust

To ensure that all of the findings and learning of the review are considered in future developments in this area of work.

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A detailed action plan be created outlining how the recommendations and findings of this review are to be taken forward by the relevant partner(s). And that progress against this action plan is reported to relevant Cabinet Member(s), officer(s), partner(s) and scrutiny every six months until such time as the recommendations and findings have been addressed

Sandwell Council Sandwell PCT Sandwell Leisure Trust

To ensure progress in the implementation of the recommendations as agreed by Cabinet and the council’s partners.

References Public Health Annual Report 2009/2010, Sandwell PCT Saturation Point: Addressing the Health Impacts of Hot Food Takeaways, London Borough of Barking & Dagenham, August 2009. The Foresight Report: Tackling Obesities: Future Choices, Government Office for Science, October 2007 Data from the National Obesity Observatory www.noo.org.uk National Institute for Clinical Excellence (NICE), Quick Reference Guide Obesity, December 2006 Growing Healthy Communities: A Community Agriculture Strategy for Sandwell 2008 – 2012, Minutes and reports of the Health & Older People Scrutiny Panel

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Appendix 1

Scope of the review

Project title Tackling Obesity in Sandwell

What issue did this review address?

How obesity amongst children, adults and families can be prevented and treated.

Lead members Health & Older People Scrutiny Panel Councillor Mary Griffin (chair) Councillor Pat Davies (vice-chair)

Officer group Adam Richardson – Scrutiny Unit Adam Hadley – Scrutiny Unit Gordon Andrews – Obesity Strategic Lead Mary Fairfield – Choosing Health Manager

Aim and scope of the project

The aim of this review is to consider what is in place in Sandwell to tackle obesity levels, and what could be improved.

Specific outcomes required

A set of recommendations that will identify what organisations in Sandwell need to do to tackle obesity levels in the borough.

Independent advisors Member of Slimming World Weight Concern

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Appendix 2

Health & Older People Scrutiny Panel terms of reference 2010/2011 The terms of reference for the Health & Older People Scrutiny Panel state: ‘ … the Health & Older People Scrutiny Panel shall:-

(1) under the direction of the Scrutiny Management Board, undertake reviews which include matters which fall within the terms of reference of this Panel and any other Scrutiny Panel

(2) as set out in the Scrutiny procedure rules, scrutinise

recommendations, consider referrals under the Call for Action and Pre-Decision Scrutiny (Call in) processes and review and advise on the council’s policies and practices in respect of, and upon such terms as are set out below: - to have the powers of overview and scrutiny in relation

to health authority and associated matters - health partnership working - services for older and vulnerable adults - voluntary sector liaison funding and support

Principles The review was undertaken in line with the following principles within which scrutiny strives to operate:

• inclusive • non adversarial • evidence based as opposed to anecdotal • factual and unbiased • open and transparent

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Membership Elected Members Cllr Mary Griffin (chair) Cllr Pat Davies (vice-chair) Cllr Bill Archer (from 18 May 2010 to 30 November 2010) Cllr Liz Bowler (from 30 November 2010) Cllr Malcolm Bridges Cllr Elizabeth Giles Cllr Joanne Hadley

Cllr Sadie Smith

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Appendix 3

Methodology In undertaking this review the panel was supported by the scrutiny unit. The following presentations were received and considered by panel members from:

• Sandwell Obesity Strategic Lead • Sandwell PCT Food Policy Team • Sandwell PCT weight management services • Sandwell Leisure Trust • Sandwell Food Network • The Healthy Schools Programme • Sandwell Healthy Urban Development Unit • Weight management clinics at Sandwell Hospital • The Physical Activity Referral Scheme

The following visits were carried out to gather evidence:

• Site visit to Salop Drive Market Gardens • Visit to the Adizone in Victoria Park, Smethwick • Sandwell Stride Health Walk • Westminster Forum Conference ‘Obesity – time for a new

Approach?’

• An independent advisor from Slimming World • An independent advisor from Weight Concern • Questionnaires at Slimming World

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Documents

Context 5 Findings 7 Recommendations 19 References 27