· Web view– Both primary prevention of people of normal weight and secondary prevention of those who may be overweight or obese and subsequently at risk of associated diseases and

National Public Health Service for Wales Tackling Obesity

Tackling Obesity in Wales: The Current Situation

Version: 1 Date: 12/07/07 Status: Final (updated 27/07/07)Author: Malcolm Ward & Sarah Aitken Page: 1 of 30


1 Tackling Obesity in Wales

The alarming and rapid rise in levels of overweight and obesity across much of the developed world has been well documented and publicised. The situation in Wales broadly parallels that in most other Western countries. Recognising the need for an effective response to the health threat posed by obesity, the Welsh Assembly Government along with the Department of Health in England jointly commissioned the National Institute for Health & Clinical Excellence (NICE) to conduct a systematic review of the evidence and to produce both clinical and public health guidance informed by the evidence. This process took almost 2 years and the final guidance on ‘the prevention, identification, assessment and management of overweight and obesity in adults and children’ was launched in December 2006 with a range of both clinical and public health recommendations.

In general, the approach taken to tackling obesity can be considered at two levels:

Prevention – Both primary prevention of people of normal weight and secondary prevention of those who may be overweight or obese and subsequently at risk of associated diseases and conditions.

Treatment – Covering both clinical and non-clinical treatment of obesity. Clinical treatments may include surgical, pharmacological and psychological interventions and should be informed by the clinical guidance produced by NICE. Non-clinical interventions would include lifestyle modifications addressing diet and physical activity.

As with all interventions there are resource and capacity implications with issues relating to specialist staff, impact on waiting lists, costs of drug therapies, access to services etc.

2 Present ActivityPresent NPHS agreed workplan activity for 2006/07 has been focused primarily on addressing the two lifestyle factors that influence overweight and obesity;

a) Physical Activity

b) Healthy Eating

There is also some, albeit limited activity, which has been developed locally to address the issue of obesity specifically, where applicable these are identified in the Appendices.

It should be noted that there are also a range of complementary activities conducted and/ or supported by the NPHS which are relevant to tackling the obesity agenda, including community food initiatives and healthy schools schemes.



2.1 Physical Activity

Promoting physical activity is a key function of all the local public health teams in Wales in providing support to Local Health Boards and their partners. Further support and advice for this local action is provided through an organisational network of physical activity leads. The NPHS also works closely with the Wales Centre for Health who co-ordinate the Physical Activity Network across Wales. The NPHS has also developed a ‘Framework for Action on Physical Activity’ which provides evidence based advice on interventions. This is further informed by Evidence Briefings compiled and updated by the NPHS Library and Knowledge Management Service. There is a national lead for Physical Activity within the organisation that works closely with national partners and supports local teams in addressing the physical activity agenda. Within most local public health teams, a named member of staff is identified to lead/co-ordinate this area of work (Appendix 2). This work includes support for the delivery of a range of physical activity projects and initiatives including the development of local physical activity strategies and action plans. Local Authorities have a key lead role in this agenda and in all areas will be a key or lead partner.

A recent audit of activity indicated that the following activities were being delivered or supported by local public health teams;

Local physical activity action plans were in place in 8 LHBs for Physical activity -

Bridgend, Caerphilly, Cardiff, Ceredigion, Neath, Pembrokeshire and Wrexham and

being developed in 11 LHBs – Anglesey, Carmarthenshire, Conwy, Denbighshire,

Flintshire, Gwynedd, Merthyr, Powys, Rhondda Cynon Taff , Torfaen and Vale of

Glamorgan. Healthy schools schemes were being supported by 12 counties/LHBs for

physical activity.

Numerous initiatives have been developed and supported in all groups and settings

including Dragon Sport, Physical Education and School Sport (PESS), Free

Swimming, Keep moving, GP Referral schemes, Cardiac Rehabilitation phase 4,

Walking the Way to Health (WW2H), Mentro Allan (Outdoor Activity), Leisure

Passes and ‘Choices’.

Physical activity is a key component of falls prevention work with older people. This

work includes the delivery of EXTEND to older people in Cardiff and Ceredigion,

Moving More Often in Merthyr and Walk About Flintshire which is a WAG funded

initiative.

19 LHBs reported the existence of a physical activity group/forumVersion: 1 Date: 12/07/07 Status: Final (updated 27/07/07)Author: Malcolm Ward & Sarah Aitken Page: 3 of 30


2.2 Nutrition

As with physical activity, nutrition provides a focus for a lot of support activity from local public health teams. There is a similar organisational network of leads (Appendix 3) supporting the delivery of a wide range of initiatives including the development of local Nutrition strategies and action plans. The NPHS also works closely with the Wales Centre for Health who co-ordinate the Nutrition Network for Wales. Similarly, the NPHS have developed a Framework for Action on Nutrition to inform the local action and again this is supported by an Evidence Briefing. As with physical activity there is an identified national lead for nutrition issues. The recent audit identified the range of nutrition activities being delivered locally as follows;

Local plans were in place in 10 LHBs – Blaenau Gwent, Caerphilly, Cardiff,

Ceredigion, Denbighshire, Neath, Newport, Powys, the Vale of Glamorgan and

Wrexham and were being developed in 7 - Anglesey, Carmarthenshire, Conwy,

Flintshire, Gwynedd, Pembrokeshire, and Rhondda Cynon Taff. Healthy schools

schemes for nutrition were being supported by majority of counties.

The initiatives in place include community based adult weight loss groups, specialist

obesity clinics, pilot pharmacy weigh-in, community family based childhood obesity

programme and healthy school meals/vending machines and water coolers. There were

various community food volunteer programmes and partnership projects e.g. through

leisure services, Sure start initiatives such as Eat Right Smile Bright project.

Food matters project (funded by Big Lottery Fund) was implemented in Cardiff.

Weight management classes, healthy hearts and fit4fun courses have been delivered in

Caerphilly. Community fit club and Food solutions project, funded through WAGs

Older People strategy has lead to implementation of more initiatives in Conwy.

Nutrition working groups were in place in 15 counties.



2.3 Obesity Specific Projects

The recent audit has identified 7 LHB/LA areas as having specific activities related to obesity including;

Merthyr – The Slimswim programme, Hearthealth & Lifestyles Course

Carmarthenshire - Obesity Toolkit for Primary Care professionals

Caerphilly – Fit4Fun

Conwy – Obesity Forum

Denbighshire – Obesity Strategy

Flintshire – ‘Lighten Up, Tighten Up’

Rhondda Cynon Taff – Childhood Obesity programme

All of these activities receive NPHS support although some are led by key stakeholder partners e.g. ‘Lighten Up Tighten Up’ project in Wrexham which is led by the dieticians in Wrexham Maelor NHS Trust.

At the UK level, a useful toolkit has been developed by Faculty of Public Health, British Heart Foundation and Department of Health. This is available on the following link:

http://www.fph.org.uk/resources/AtoZ/toolkit_obesity/default.asp

3 Commercial Slimming ClubsFollowing reports of alliances between some commercial slimming organisations and PCT’s in England, it was felt that the NPHS should establish its position in relation to these developments based on the existing evidence base. The NPHS has produced a ‘Position Statement’ (Appendix 1) which has been circulated and is now available from the NPHS website. This occurred prior to the NICE recommendations but is broadly in line with those guidelines.


http://www.fph.org.uk/resources/AtoZ/toolkit_obesity/default.asp


4 Planned Future Developments4.1 2007/08 Workplan Priorities

Tackling Obesity has been identified as a key public health priority by NPHS and as such it represents a key area of work to be developed by the new Health Improvement Domain during 2007/08. In particular a key focus on tackling childhood obesity is required.

The NPHS is committed to supporting its stakeholders to further develop the agenda to tackle obesity in Wales. Through its proposed workplan the NPHS is already committed to continuing to develop and support both physical activity and nutrition initiatives across a range of settings including national programmes such as Mentro Allan, the national Exercise Referral programme, the community OCN nutrition training initiative, the Healthy Schools Network, the Corporate Health Standard and others.

In addition NPHS will continue to support local partners, (through local public health team workplans) in the delivery of evidence-based programmes across primary and secondary care, schools, communities and workplaces. Given that obesity is the result of an imbalance between energy input through eating and energy output through physical activity, it is crucial that any actions taken to address the prevention and management of obesity incorporate activities that focus on these contributory factors. To optimise the impact of these actions on obesity they need to be co-ordinated and complementary ensuring a synergistic effect. However, whilst this should help strengthen the primary prevention aspect of obesity management, there will continue to be an imperative to support the secondary prevention and treatment agendas.

4.2 Strategic Synergy

Strategically the physical activity and nutrition leads have been working closely with their counterparts in WAG on identifying a cohesive approach to obesity, principally by ensuring complementarity between local physical activity and nutrition action plans that identify those actions that specifically address obesity. Work is also being undertaken with partners to develop guidance for LAs & LHBs on how to join such planned actions. In line with these developments, WAG with their partners, are presently endeavouring to integrate the national networks for physical activity and nutrition, at least at the virtual level, to ensure that obesity does get addressed by a complementary approach across the differing disciplines.

Given the broad social, economic and economic factors that shape the so-called ‘obesogenic environment’ it is also important to ensure synergy with supporting strategies including Community Plans, Environmental, Transport, Education, Catering, Health Social Care & Wellbeing and other local and national strategies.

4.3 Secondary Prevention

NPHS is already engaged in a number of local initiatives to address weight management for people who are overweight and obese. With the WAG national exercise referral programme launched at the end of 2006, ‘people with overweight or obesity’ are among the patients who can be referred into this programme and experience from the several referral projects that are already operating suggests that there will be many who will be identified and supported in this way.



4.4 Treatment

As indicated there are a few local initiatives supported by the NPHS that are specifically focussed on helping overweight and obese individuals to lose weight through dietary and physical activity lifestyle changes. As for surgical interventions the NPHS provided professional advice and support to Health Commission Wales on the development of a policy on bariatric surgery (Appendix 4) that is available on request from HCW prior to it being placed on their website. Pharmacological interventions should be guided by the NICE recommendations.

4.5 Strategic Management by Domain

The recent change to management by Domain provides opportunities to ensure that appropriate links are made between the Health Improvement and Health and Social Care Quality priorities and workstreams. During 2007/08 this will enable NPHS to enhance its support to LHBs and stakeholders to address issues such as obesity which span the care pathway . This should facilitate action to be taken to implement the NICE guidelines e.g.

‘To take evidence based action in relation to obesity prevention, management and treatment so as to stem the rising prevalence of obesity and diseases associated with it and increase the effectiveness of interventions to prevent overweight and obesity’.



Appendix 1


Briefing Paper – Commercial

Slimming Clubs seeking

partnership arrangements with the NPHS


1. Introduction

Hospital Trusts and Local Health Boards are being approached by leading commercial slimming clubs with offers to help establish ‘Slimming on Referral’ schemes.

This document, prepared by the NPHS Wider Determinants and Inequalities Resource Team, provides guidance to public health directors responding to such approaches.

2. Obesity

There has been an exponential increase in obesity in Wales, the UK, Europe and across the world.

The prevalence of obesity in the UK has almost tripled since 1980. The National Audit Office reported the following trends in 2001:

o Obesity in the population increases with ageo People in lower socio-economic groups have an increased risk of obesityo There is a higher prevalence of obesity in some ethnic groups.

Obesity and overweight are the result of an accumulation of excess fat. The fundamental reason for excess weight is an imbalance of energy expenditure versus intake.

The health implications of obesity include Type 2 diabetes, hypertension, cardiovascular disease and osteo-arthritis. There are also serious financial consequences for the National Health Service and for the economy from obesity and overweight.

3. Tackling Obesity

Prevention is the best policy in terms of managing obesity and overweight. Clearly, however, there is also a need to support those who already have the problem.

Obesity is not an easy problem to tackle, even though modest weight loss confers significant health benefits. The aim of the treatment of overweight in adults is a focus on reducing the sedentary behaviour and achieving dietary change in combination.

As noted by the ‘All Party Parliamentary Group on Obesity 2003’, there is no single solution to weight management and treatment approaches. The NHS and health professionals do not have a monopoly on treating and managing obesity. It is essential that a multi-disciplinary and evidence based approach is undertaken.

As with most lifestyle health issues, obesity is a complex one within the nutrition and physical activity agendas. It is subject to many influences.

The National Institute for Health and Clinical Excellence (NICE) are presently reviewing all the evidence and are expected to produce guidelines on obesity and overweight late in 2006.



3.1 Slimming ClubsCommercial slimming clubs have increasingly been developing and formalising their links with community, acute sector and public health organisations.

Anecdotal evidence suggests favourable results with some clients finding the group support and weigh-ins helpful, but it should be noted that those clients who self select themselves into such commercial clubs may well not reflect the type of people who are obese and overweight . There are also concerns that the evident short term benefits for a few are outweighed by the long-term detriment to many who become engaged in the cyclical or ‘yo-yo’ dieting phenomenon, thus exacerbating the problem.

There are also issues relating to inequity with the not insubstantial costs of regular attendance been felt most keenly by those least able to afford them, and those who are also most at risk of overweight and obesity.

There has been little research on the efficacy of commercial slimming clubs. A recent American systematic review by Tsai and Wadden (2005) confirms the lack of robust and systemised research.

3.2 Recommendations

1. In the absence of evidence to support the effectiveness of services provided by commercial slimming clubs, the NPHS recommends that they should not be supported with formal referral schemes.

2. Where services or projects are planned to address the issue of overweight and obesity in the community, robust and comprehensive evaluation must be factored into the design process.

3. A wide-ranging and comprehensive range of actions targeted at key points across the life course and involving education, marketing, service provision, equality of access, cultural influence and many other factors needs to be addressed through the development of appropriate, local cross-cutting strategies and action plans.

4. Investment in community and school/pre-school nutrition and physical activity initiatives are likely to provide more effective long-term benefits in reducing obesity and overweight in the population than sponsorship of commercial slimming clubs.

3.3 References

All Party Parliamentary Group on Obesity (2003) The Medical Management of Obesity: State Funded Opportunism? Available online: www.nationalobesityforum.org.uk/

National Audit Office (2001) Tackling Obesity in England. The Stationary Office: London

Tsai, A.G. and Wadden, T.A. (2005) Systematic Review: an evaluation of major commercial weight loss programs in the United States. 142 (1) 56-66


http://www.nationalobesityforum.org.uk/


Appendix 2 – NPHS Physical Activity Leads

Team Contact Details PA Action Plan Local PA Forum/Group

Local PA Projects (Lead or supported by LPHT)

Obesity Specific

Anglesey & Gwynedd

[email protected]

01286 674204In Development Yes

Exercise. Referral (L) Cardiac. Phase IV (L) WWtH

Mentro Allan

X

Blaenau Gwent [email protected] No Yes Active Living Project Mentro Allan

Exercise Referral

Childhood Obesity Programme

Adult weight management programme

[email protected]

01656 754465Yes Yes

WW2H Mentro Allan Moving More Often (L)

PA and Nutrition sessions with older people (L)

Caerphilly [email protected] Y Y Physical Activity Network (L) GP Referral (L) Moving More Often (L) Healthy Hearts Extend

Fit 4 Fun (Childhood Obesity)

[email protected]

Y Y

document.docmalcolm.ward Page 11 06/05/2023

mailto:[email protected]









Obesity Specific

(01443) 811399

WW2H (healthy Hearts) Sustrans – Cycling Project HLC – Exercise Classes Cardiac Rehabilitation Cycling & Walking Network

Mentro Allan (x2)

Cardiff [email protected] Yes Yes Walk for Health, Extend, Mentro Allan,

Active Life Cardiff Development of strategy and action plan

(L)

Health improvement programmes – Dr Bike, community allotments, etc (L)

x

[email protected] In Development Link to Local

Authority Leisure

Forum and HSC WB

group

Obesity, CHD, Diabetes Toolkits for Primary Care (incorporate PA element) (L)

Workplace health (developing) (L) Early Years Physical Activity project -

Top Tots Healthy Schools Scheme – PA

initiatives, Class moves etc Local Authority and Sports Council

programmes Vitality GP Referral Cardiac Rehab phase 3 and 4 WW2H Health and Well Being Project (Over 0s

Obesity Toolkit for Primary Care professionals (incorporates physical activity element)









Obesity Specific

age in community first areas)

Walk and swim programme –over 50s

Ceredigion [email protected] Yes Yes WW2H Exercise for life (GP referral) Cardiac Rehab phase 3 & 4 Extend Moving More Often Top tots

Community Chest

Conwy and Denbighshire

[email protected] Development Yes

Mentro Allan, Conwy Children’s Active programme, Walk you way to health

Establishment of the Conwy Obesity Forum and the Denbighshire Obesity Strategy

Flintshire In Development Yes Mentro Allan Cardiac Health Steering Gp. Walkabout Ex Referral

Older Persons PA Steering Gp.

“Lighten up, Tighten up” is a community based weight loss project. This is led on by the dieticians at Wrexham Maelor








Obesity Specific

[email protected]

01685 358564 In Development

(Due out April 07)

Yes

WW2H Heartlinks (Ex Ref) Mentro Allan Active Living Forum

Slimswim Hearthealth &

Lifestyles Course

[email protected]

01600 710040

No No

HA/HSCWB grouping

Walking for Health Age Concern HL project/O. People Comm. First initiative ‘WORTH IT’. Ex. Ref. Children’s Gym project

‘Reach’ Leisure pass

X

Neath Port Talbot

[email protected]

01792 326516

In Development

Y

WW2H Mentro Allan

Ex. Referral

[email protected]

Decision taken not to develop

yet another strategy. Most

information planned via

Healthy Living

Y Mentro Allan WW2H GP Ex Referral (being developed.)

New project being developed under a Health Challenge Newport banner. The `Going for Gold’ Project is to target lifestyle issues. Joint NPHS/LA

x










Obesity Specific

Group.

[email protected] Yes Yes

Inequalities in Health CHD Project Healthy Lifestyle Project WW2H GP Exercise Referral

BLF Cardiac Rehab Project

x

Powys [email protected] In Development Yes WW2H Cardiac Rehab/Exercise Referral Powys Physical Activity Strategy Group

Mentro Allan

Obesity specific programme from 1/4/07

RCTIn Development Yes

GP Exercise Referral Scheme, WW2H, Heart Health Programme. Active Living Strategy/partnership,

Activ8 Scheme, Cardiac Rehab,

Moving More Often, Mentro Allan

Childhood Obesity. This programme provides evidence based family intervention to address overweight and obesity in children

SwanseaCindy Marsh

Tel 01792 784858In Development No A partnership physical activity action

plan is in development under the wider Climbing Higher Strategy









Obesity Specific

POSITIVE STEPS phase four exercise referral scheme managed and led by the LPHT was evaluated at year 3 and is now being extended as part of the WAG national pilot and part of the randomised control trial.

Local PA Campaign WW2H Green Gym Cardiac Rehab Forums Mentro Allan

Active Travel Plan Pilot Project

Torfaen [email protected] In Development Yes Exercise for Life (Ex Ref) Long term conditions groups: diabetes,

COPD, CHD, CHF. Mentro Allan WW2H JXL (younger persons weight

management through the Ex Ref) Pontypool Pacers (voluntary CHD rehab

exercise group)

PACT (Physical Activity Collaboration Torfaen)

x

Vale of Glamorgan

[email protected] D Y Active for Life (inc ex ref) Moving More Often








Obesity Specific

EXTEND

Walking for health

[email protected]

01978 264632Y Y Establishing

Obesity group to take responsibility of moving forward with NICE Obesity Guidelines.

Appendix 2 - NPHS Nutrition Leads across Wales – March 2007

LHB Area/NPHS contact

personNutrition/Obesity Related Activity Programmes

Sian Davies / Aled Hughes01286 672451

Currently working towards developing a physical activity and a nutrition action plan, both of which will clearly have an impact on Obesity

Themes around 'energy consumption versus energy expended' are common throughout all aspects of Physical Activity and Nutrition related activity across agencies and in the various settings

Alliance sub-groups are answerable to Anglesey Health Alliance. Areas of work include a range of exercise and nutrition projects with children and schools, adults and older people. Funding to maintain these projects derives from Children and Young People's Partnerships, HSCWB Partnerships, Inequalities and BLF funds as well as Alliance monies

It is anticipated that a mapping exercise will be undertaken to enable the coordination of activity pertaining to nutrition. This will enable the identification of any gaps within the field of nutrition, which will in turn result in the development of




proposed action plans which contribute to the development of the obesity agenda Blaenau GwentPost not yet filled01495 356718Bridgend/ Ann Davies01656754400

To be provided





CaerphillyMererid Bowley (+Jenny Jones) 01443 811405

A number of activities regarding obesity have taken place in local schools under the Healthy School Scheme, namely:1. Water in schools2. Training for fruit tuck shops3. Working with school caterers on nutritional content of school menus

Activity underway with respect to the OCN Training in Community Food and Nutrition Skills programme. This course has been produced by dieticians in Wales, and delivered to local partners progressing the nutrition agenda

A Gold Standard Healthy Snack Award has been developed. This award is applicable to childcare groups. The award encourages the consumption of fruit and vegetables by children

Links are under development with the Local Authority, namely, the School Catering and Leisure departments. It is anticipated that these links will ensure the improvement of vending provision as advocated by “Appetite for Life” (WAG)

Caerphilly GP Referral Scheme is a 12 week programme where GPs can refer patients who have one or more risk factors major CHD risk factor (primary prevention) to an exercise specialist. The programme received funding from the WAG Inequalities in Health Fund in 2004 until 2008

Childhood obesity (fit4fun). This 12 week group programme is designed to help and support overweight and obese children aged between 11 and 13 years and their families who are resident within Caerphilly county borough. A team of health professionals, including a dietician, psychologist and exercise specialist have developed a comprehensive teaching programme which is delivered to the children and their families. The programme received 3 years funding (£75,000) from the WAG Food & Fitness Grants in 2004 to set up and evaluate this initiative. Programme funding is due to end March 2007 work is underway to identify alternative funding

The following Working Groups are in place and address the area of obesity / nutrition:1. Nutrition Sub Group of Health Alliance2. Catering Nutrition Standards Group comprising, school catering/education/healthy schools/dietician – NPHS3. Healthy Snack Group, multi agency to progress the Gold Standard Snack Award.4. Physical Activity Sub Group of the Health Alliance5. Leisure Vending Group, has representation from procurement, leisure, education, council catering and

dietician NPHS





CardiffJudith John (on secondment) – Susan Toner02920 556034

1. Reduce the impact of poor nutritional status on health and well being (2006/07 – 2008/09)The LPHT in partnership with Cardiff & Vale NHS Trust Community Dieticians will focus on: providing public health advice to the Cardiff Food and Health Strategy Group providing public health advice and support to, and delivering on key actions of, the Cardiff Food and Health Action

Plan supporting the building of capacity by training and developing health literacy and personal skills supporting strategic and operational initiatives that increase access to affordable fruit and vegetables providing public health advice in the development of local food and health policies building capacity of the community nutrition service to deliver public health initiatives2. Reduce the impact of low levels of physical activity on health and well being (2006/07 – 2008/09)The LPHT, in partnership with the local authority and other organisations, will focus on: providing public health advice and support to the Cardiff Health and Active Lifestyles Steering Group (a task group of

the Health Alliance) and the Mentro Allan Steering Group incorporating physical activity action into identified health improvement programmes and negotiating access to leisure

and community facilities for vulnerable groupsCarmarthenshireCaroline Nichols & Liz Newberry Davies01554744468

LPHT and Trust have actively been involved with the Paediatric Interest Obesity Group. Activities have included the mapping of initiatives, in particular around programmes concerning children and young people. This mapping exercise is used as a resource for signposting all sectors and partners

LPHT implemented multi agency working group to develop obesity toolkit for primary care professionals – Adult obesity toolkit. Elements of prevention / treatment / management

No Frameworks / Strategies in place/developed Held a Food & Fitness Conference (2005) which addressed Physical Activity and Nutrition, in particular Obesity. This

conference was aimed at all groups and settings. Following on from this conference the LPHT undertook a local mapping exercise as to activities which addressed obesity

Nutrition Strategy for Schools – Healthy Schools coordinator and LPHT involved in the development of this strategy Nutrition for Older People currently being developed Nutrition Strategy for Under 5’s currently being developed

LHB Area/NPHS contact Nutrition/Obesity Related Activity Programmes



person

CeredigionHelen Jones01570 424105

To be provided

ConwyFiona Cunnah01492 536586

The following priorities have been agreed by the Board: That the Board accept a recommendation to develop a strategic plan with the ambition to:1. to improve diet and exercise in all Conwy residents in order to prevent obesity2. to ensure health services in Conwy help overweight and obese people to reduce weight healthily alongside

appropriate NHS resources that a multi-agency/multi-disciplinary Obesity Forum is established to enable this strategy

DenbighshireFiona Cunnah The Denbighshire Obesity Strategy was presented to the Board July 26 th 2006. This strategy describes actions

necessary to halt the rise in obesity. The aims of the strategy are as follows: Stem the rising prevalence of obesity and attendant rise in the prevalence of diseases associated with obesity. Improve the care provided to adults and children with obesity, particular in primary care. Increase the effectiveness of interventions to prevent excess weight gain, overweight and obesity.

To establish a steering group to co-ordinate the development of a business case to implement the recommendations as identified in the draft NICE guidance document

FlintshireKim Burkhill01352 803273

Obesity is a priority in the Flintshire LPHT workplan 07/08. LPHT have worked in partnership with partners to develop the local food and fitness action plan, “Food for Health,

Active for Life”. Within the LHB the obesity agenda is linking in with the diabetes agenda There are no specific care pathways or focused primary care initiatives at present apart from GPs being encouraged

to keep a register as part of QoF “Lighten up, Tighten up” is a community based weight loss project. This is led on by the dieticians at Wrexham

Maelor The following initiatives “Kickstart” GP Exercise Referral Scheme and “Walkabout Flintshire” both link up with the

obesity agendaLHB Area

/NPHS contact Nutrition/Obesity Related Activity Programmes



person

GwyneddSian Davies / Aled Hughes

At the time of writing there is no dedicated, specific Obesity strategy in place. Neither are there any specific programs or interventions that are badged as an Obesity project

Alliance sub-groups are answerable to Gwynedd Health Alliance. Areas of work include a range of exercise and nutrition projects with children and schools, adults and older people. Funding to maintain these projects derives from Children and Young People's Partnerships, HSCWB Partnerships, Inequalities and BLF funds as well as Alliance monies

It is anticipated that a mapping exercise will be undertaken to enable the coordination of activity pertaining to nutrition. This will enable the identification of any gaps within the field of nutrition, which will in turn result in the development of proposed action plans which contribute to the development of the obesity agenda

Methyr TydfilMargaret Munkley01685 358560

As part of the HSC&WB Action Plan the LPHT are currently developing a Nutrition Strategy. This draft strategy is due to be consulted upon April 2007

Draft Local Physical Activity Strategy is currently out to consultation Identification of target groups for activity has been informed by the Food & Well Being Model School Nutrition Action Group - currently focusing on food in schools. The group have recently undertaken a menu

analysis. It is anticipated that findings obtained from the menu analysis will be incorporated into an Action Plan, which will be used to inform the School Nutrition Action Group

Healthy Schools Scheme – work is currently ongoing with respect to nutrition. Food & Fitness grant monies have been used to purchase Cooking Packs. These have been distributed to all schools within the Healthy Schools Scheme. In addition “Hungry for Nutrition” training packs have been distributed to those schools participating in the Healthy Schools Scheme – a total of 22 schools have received training around Key Stages 1 & 2

School Nutrition Action Group – this group have focused on healthy cooking skills and lunch box leaflets School Health Nurses – currently working on resources to be used with children in schools

MonmouthshireCaroline Watts01600 710040

Work underway within school setting - this addresses healthy meals and training for catering staff In the north of the county Food Cooperative Development is currently taking place





Neath Port Talbot(Jacquie Charles) 01792 326516

Projects aim to increase fruit and vegetable consumption intake among the general population and priority groups. This is achieved via the following:

1. 5 a day message2. Implementation of the “Confidence to Cook Basic Skills Class”3. Nutrition training4. Work has also been carried out with local Health Visitors, GPs and Businesses such as Corus. This programme of

activity has resulted in the development and implementation of a “Healthy Options Award Scheme”. This is run in partnership with Local Environmental Services

LPHT has linked in with Communities First areas, thus enabling the development and establishment of a number of local community food coops

Target groups with respect to the areas of nutrition / obesity have included young people, older age groups, black and ethnic minority groups, travellers and those with learning difficulties

Nutrition Port Talbot Nutrition and Health Action Plan 2006 – 2015 currently in place. This Action Plan was developed to address a number of challenges through supporting the local population to information pertaining to nutrition and improvement of their diet

NewportAngela Brain 01633 261430

To be provided

PembrokeshireLynne Perry 01437 771232

Penbrokeshire are not specifically focusing on obesity, rather they are addressing nutrition Number of strategies in place which focus on nutrition. They are:1. Early Years Setting – Summer 2006. Monitoring processes are now in place2. School and School Site Leisure Centres – March 20053. Out of School Hours Setting Strategy – Summer 20064. Currently developing Older People Strategy5. Planning Youth Strategy Local Public Health Team have led on the development of Strategies 1 – 3 Development of Strategy 4 is currently being led by Health and Well Being Manager All schools have Food and Fitness Policies in place. In addition the LPHT are currently working with schools to

develop an over-aching Food and Fitness Policy





PowysSarah Hope01874 712738

Powys Local Public Health Team, are currently developing their workplans. One of 6 areas of work to be included on the workplan includes that of Obesity. This will include Food/Nutrition/Physical Activity. It is anticipated that activity pertaining to obesity as outlined in the workplan will commence as of April 1st 2007

Powys Food & Nutrition Strategy has been in place since 2003 Draft Physical Activity Strategy in place Workplan concerning obesity currently under development Physical Activity and Nutrition currently being dealt with as part of the Inequalities in Health Fund. Target areas

include: Ystradgynlais and Machynlleth Further work is underway in Ystradgynlais regarding Food and Nutrition. Activity is funded via the Big Lottery Fund

Rhondda Cynon TaffLynne Hughes 01443 744900

A number of local projects are in place which relate specifically to nutrition. They are as follows:1. Community Food. This project initiates and supports Community Food projects identified within the community. 6

Community Food Projects are now in place2. Retail and Catering. The aim of this programme of activity is to develop an intervention which promotes the

availability of healthier food choices in retail and catering outlets. Developed Healthy Options Award for Food Retailers in partnership with FSA

3. Early Years Project. This programme supports the parents and carers of young children through the provision of healthier food options. Development of teaching pack in progress for health professionals

4. Looked After Children Programme. This initiative enables children in public care to make healthier food choices. Steering group established. Workshops piloted with LAC. Training programme planned for After Care Team

5. Whole School Food Project. The aims of this project are to ensure the promotion and uptake of the whole school approach to Food and Health. Toolkit produced on CD Rom, including audit tool of current food provision in the school, advice on writing and implementing a whole school food and nutrition policy, advice on how to form a School Nutrition Action Group, lesson plans, and guidance on healthy lunchboxes

6. Childhood Obesity. This programme provides evidence based family intervention to address overweight and obesity in children

7. PALS. The objectives of this programme are the implementation and evaluation of the PALS scheme and Cardiac Rehab

8. Healthy Schools Scheme. There are currently 90 schools participating in the Healthy Schools Scheme In addition specialist public health advice and support is provided through the Health Alliance and its relevant sub-

groups. Active Living Partnership established and draft strategy in place. Food for Living and Food for Life Group now established



Nutrition/Obesity Related Activity ProgrammesSwansea

Cindy Marsh

Tel 01792 784858

Whilst at the time of writing there is no dedicated, specific obesity strategy in place in Swansea specific programmes and interventions under Swansea HSCWB prevention priorities action plans have begun to address the obesity prevention agenda.Activities outlined below are being coordinated, led and/or delivered by the LPHT:Swansea Healthy Schools Scheme (SHSS)

Development, coordination and launch of ‘A Food and Health Strategy for Swansea Schools 2007 -2013’. The LPHT has developed in partnership with Swansea NHS Trust a Healthy Eating in School training resource

for Health Visitors with schools as part of their remit. Cymru Cooks Initiative will be delivered in partnership with ContinYou and funded by WAG to encourage schools

to set up after school cookery activities. WAG Food and Fitness scheme supported by LPHT has all Healthy Schools across Swansea currently working

on Physical Activity and Nutrition as part of their award. 67 schools in Swansea are currently participating in the Free Breakfast Scheme Initiative.

Swansea Food Connections (SFC) BLF funded project from Jul 2004 – Jun 2007 managed and led by LPHT: Enabled partnership working on the food access agenda through a multidisciplinary steering group. Established Community Food Activities to help improve access, availability and affordability to healthy food

choices in the most deprived communities by:o 6 Food Co-operatives set up in different communities across Swanseao 2 Local Produce Markets set up

Built individual and community capacity by improving skills and knowledge about food and nutrition by:o Delivered 9 cookery activities across various communitieso Delivered 2 OCN Accredited Nutrition Training programmes to people in the communityo Organised delivery of 6 Food Hygiene Training courses training 50 people in the community

Provided opportunities to network and share best practice locally by:o Food for Thought Networking Evento Food Co-op Networking Days o Visit to Community Food Enterprise in Newham, London

Sustainable Outcomes from SFC into the future include 24 community tutors trained through the Accredited Nutrition Training some of which are delivering cookery



activities to disseminate key nutritional messages. The How to… A Guide to Community Food Activities is a step by step guide to growing, buying, cooking and

eating activities. Development of further partnership food and health proposals for funding identified priorities in communities.

Other Nutrition related activities supported by the LPHT: Swansea NHS Trust Dieticians have secured funding to deliver Nutrition Training to organisations who work with

children and young people across the area. Swansea Community Farm deliver a variety of schemes and activities such as ‘ Grow with Us’ , ‘Healthy Living

Days’ and ‘ Themed Local Produce Markets’ which aim to increase skills, knowledge and access to healthy food to variety of target populations (those with learning difficulties, mental health problems, children and their parents and adults).

6 Food Co-operatives set up in Swansea are supported by the Rural Regeneration Unit. They meet regularly on an informal basis to network and share ideas to help sustain activity.

TorfaenTeresa Filipponi01495 332307

The Nutrition forum (TAFH - Torfaen Action on Food for Health), recently established, is currently carrying out a mapping exercise for the borough

Activity underway includes: 1. Healthy eating schemes encompassing budgeting, meal planning, shopping, preparation, cooking and healthy

eating2. Weaning parties – this entails the provision of training aimed at parents to enable them to become Healthy

Eating Supporters 3. Promotion of OCN 2 Training "Community Food & Nutrition Skills". This is aimed at Health care professionals4. Supported the establishment of the “Fruit and Vegetable Box Scheme”5. Currently establishing new fruit and vegetables cooperatives in community first areas and schools

Groups being targeted by the LPHT include, both Sure Start families and Community First areas Focus in nutrition / obesity based activity is very much preventative Lead agents include; NPHS, LHB, Sure Start, voluntary Organisations Nutrition Strategy Action Plan due August 2007 (Needs Assessment Carried out Nov 2006)

Vale of Glamorgan Carol Maher02920 350600

To be provided

WrexhamSylvia Rickard01978 264632

Current action is contributing to a reduction in obesity amongst the local population. Mapping all local activity pertaining to obesity NICE Obesity Guidelines (2006) have been used to inform the LHB commissioning process Establishing Obesity group to take responsibility of moving forward with NICE Obesity Guidelines. Anticipated that



this will be implemented into the planning cycle this year. This will enable the Local Authority to identify appropriate departments to aid the development of obesity related service plans

Physical Activity and Nutrition working groups in place Further areas for expansion include the development of public health guidelines with respect to obesity. These will be

informed by the NICE Obesity Guidelines



Appendix 4

Eligibility criteria for NHS funded surgery to aid weight reduction for people with morbid obesity (bariatric surgery)

1. Introduction

1.1 People are defined as having morbid obesity if they have a body mass index (BMI) either equal to or greater than 40 kg/m², or between 35kg/m² and 40 kg/m² in the presence of significant co-morbid conditions that could be improved by weight loss. The term ‘morbid obesity’ obscures the heterogeneity of the people who make up this broad ranging group. In short, the needs of an individual with a BMI of 40 kg/m² and no co-morbidities are different to those of a person with a BMI of 35 kg/m² and multiple co-morbidities.

1.2 The eligibility criteria set out below attempts to reflect the differing needs of people defined as being morbidly obese. The differing needs of people with morbid obesity should be taken account of as it is relevant to the clinical management and outcomes of such people. The criteria also attempts to maintain fidelity to the NICE guidance on surgery to aid weight reduction for people who are morbidly obese, whilst also taking account of local circumstances.

2. Core criteria

2.1 Surgery will only be considered as a treatment option for people with morbid obesity providing all of the following criteria are fulfilled:

the individual is considered to morbidly obese according to the definition in 1.1 above.

the individual has been receiving intensive weight management in a specialised hospital obesity clinic or a community-based equivalent, if such a service is available in the area in which they are registered with a GP.

the individual is aged 18 years or over. there is evidence that all appropriate and available non-surgical measures

have been adequately tried but have failed to maintain weight loss, this may include commercially provided weight loss support programmes.



there are no specific clinical or psychological contraindications to this type of surgery.

the individual is generally fit for anaesthesia and surgery. the individual should understands the need for long-term follow-up.

2.2 Surgery will only be offered if:

the above criteria are met to the satisfaction of the patient’s GP and/or NHS weight management service, HCW(SS) and the provider of the surgery.

the person with morbid obesity has discussed in detail with the clinician responsible for their treatment (that is, the hospital specialist and/or bariatric surgeon) the potential benefits and longer-term implications of surgery, as well as the associated risks, including complications and postoperative mortality.

the patient has realistic expectations of the outcomes of surgery, and understands that long term commitment and compliance is required.

the patient understands that cosmetic plastic procedures to remove excess skin folds may not be funded by HCW(SS).

the provider of the service has undertaken a comprehensive, multi-disciplinary assessment of the individual.

arrangements have been made for appropriate healthcare professionals to provide pre-operative and postoperative counselling and support to the individual.

2.3 Priority for surgery will be given to people with:

A significant primary clinical condition, which is amenable to treatment if obesity is modified by surgery. NB this may be covered by the co-morbidity criterion (see below) but could also include other factors for example congenital conditions.

AND/OR

A BMI of 50 or greater in the presence of a serious co-morbidity which may be amenable to treatment if obesity is modified by surgery, these conditions include:

- uncontrolled type II diabetes- severe obstructive sleep apnoea: where CPAP is likely to be

required post bariatric surgery- Pickwickian syndrome- obesity related heart failure- clinically unmanageable hypertension- severe coronary artery disease: where a planned intervention

is not indicated unless patient loses weight.



- obesity related pulmonary hypertension- other co-morbid conditions which have been agreed by

HCW(SS) as exceptional, on an individual patient basis

AND/OR

A condition which requires surgery at the same time as bariatric surgery (e.g. hernia repair, cholecystectomy or severe gall bladder disease) which needs surgery or complex technological intervention as soon as possible after bariatric surgery.

2.4 HCW(SS) will consider requests for obese patients who fall outside these criteria to be offered surgery in exceptional circumstances.

2.5 The choice of surgical intervention should be made jointly by the individual and the clinician after considering the best available evidence, the facilities and the equipment available, and the experience of the surgeon who will perform the operation. This should ensure that any procedures are undertaken with the informed consent of the individual.


Documents

· Web view– Both primary prevention of people of normal weight and secondary prevention of those who may be overweight or obese and subsequently at risk of associated diseases and