Transcript Slide 1

Developing a Shared
Approach to Tackling
Obesity in Birmingham
Linda Hindle
Consultant Dietitian in Obesity
Birmingham East and North PCT
Email: [email protected]
Tel: 0121 446 1025
Format
About Birmingham
 Obesity Strategy, Care Pathway and
Service Development – local NHS
collaboration
 Children and Young People’s Nutrition &
Health Task Force
 Implementation
 Next steps
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About Birmingham
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Population of almost 1
million
Multi racial
Inner City deprivation
Served by:
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1 City Council
1. Leisure Services
Provider
3 PCTS
Regional Children's
Hospital
4 Acute Trusts
1 Mental Health
Trust
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Obesity Strategy Development
NHS
Birmingham City Council
Overview and Scrutiny
Committee - Health
Obesity strategy
group
Children and Young People’s
Nutrition and Health
Task Force
Strategy and
Care Pathway
Children's Nutrition
Action Plan
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NHS Obesity Strategy Development
Background
 Stakeholders
 Timescale
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 Birmingham
& Solihull Strategic
Framework individualised to each PCT
 Care
Pathways for Adults and Children
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A Strategy describes ……….
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Where we are now
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Where we want to be
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How we will get there
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Structure
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Background
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Policy Context
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Aims and Objectives
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Evidence
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Action Plans
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Strategic Aims
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To work in partnership, to develop a range of
approaches, to prevent and reduce obesity in
the population as a whole, with particular
reference to children and at risk groups.
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To develop a coordinated approach to the
management of people identified as being
overweight or obese with particular emphasis on
encouraging self-management principles
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Strategic Objectives
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To develop partnerships with key stakeholders to
realise a shared goal of halting the rise in obesity in
Birmingham and Solihull.
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To ensure that obesity is embedded within other lead
strategies and plans and linkages between these are
made implicit.
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To develop information systems for the collection
and use of data relating to overweight and obesity
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Strategic Objective cont.
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To identify inequity in access to opportunities for
prevention and treatment of overweight and obesity
in local communities and to work with local people,
communities, voluntary and private sector agencies
and local services to address these inequities.
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To ensure a consistent and effective approach to the
prevention of overweight and obesity and weight
management within primary care and partner
services, particularly for children.
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To work with partners to develop and implement an
evidence based care pathway for the management
and treatment of obesity.
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Delivery Strands
The delivery element of the strategy has been divided into 5 strands
1. Baseline data and Monitoring:
schools
Primary care
2. Prevention :
macro measures at population level
community approaches
workplace
schools
whole family
3. Management of Weight Loss:
community
workplace
schools
primary care
4. Specialist treatment:
primary and secondary care
– drugs & surgery
5. Long-term maintenance:
community/environment supportive
Long-term support & follow-up
(diet and physical activity)
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Adult Obesity Service
Care Pathway
Level 4
Secondary Care
Morbid Obesity
Service
Level 3
Primary Care Specialist
Obesity Service
Level 2
Community/Primary Care
Weight Management
Services
Level 1
Early Intervention and Prevention
Front line Staff (NHS, Council, Vol. Sector), Health Trainers, On-line
advice
Exercise on
Prescription, walking,
cycling programmes
etc. Leisure Services
Physical Activity
Strategy
Commercial
slimming clubs
Smoking Cessation Service
Pharmacy
services
Tobacco
strategy
Food Skills
Courses, Food
Access projects
Commercial
slimming on
prescription
Food
Strategy
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Childhood Obesity Service Pathway
Level 4
Secondary Care
Morbid Obesity
Service
Level 3
Specialist obesity service –
Watch It, Input from
dietician, child psychologist
& Community Paediatrician
Level 2
First line weight
management service
provided by School Nurse,
Health Visitor
Level 1
Early Intervention and Prevention
Front line Staff (NHS, Council, Vol. Sector), Health Trainers, On-line
advice
Sports Clubs Activity
Programmes
Healthy Schools
Food Skills
Courses, Food
Growing Projects
Healthy Start
Physical Activity
Strategy
Media campaigns/
signposting service
Food in
Schools
(Sure Start, Children’s
Centre, Breast Feeding)
Community
groups
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Birmingham Children and Young People’s
Nutrition and Health Task Force
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Review of childhood obesity within Birmingham
initiated by Health Overview and Scrutiny
Committee in July 2003
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Identify local factors contributing to obesity
which could be avoided
Map impact of national policies and local
programmes
Explore, from community perspective, barriers
to maintaining normal body weight
Explore services available
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Report produced May 2004
Findings/conclusions
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Current measures to tackle
obesity in Birmingham are failing
No coherent pan Birmingham
inter-agency approach
Services are not well developed or
accessed
Poor surveillance monitoring
childhood obesity prevalence
Schools should be part of solution
to tackle obesity, however schools
are also part of the problem
Importance of food poverty
cannot be underestimated
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Recommendations
Establish a task force to develop a city
action plan
 PCTs ensure data on childhood obesity is
collected and services for obese children
are provided
 Guidance for schools on food, drink and
activity in schools
 Training for school governors
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Task Force Membership
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City Council Councillors
BCC Learning & Culture
BCC Transportation
BCC Local Services
BCC Communications
PCTs
Children's Hospital
Parent Representative
BBC West Midlands
School Governor
School Meal Providers
Health Education Unit
Community Care
West Midlands, Cycling & Walking Coalition
Nursery Representative
Leisure Services
Peer Advocate – Children’s rights
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Action Plan
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Children and young people are
physically active for at least one
hour a day
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A choice of sport and physical
recreation activities is included in
‘before and after’ school
programmes
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All nurseries, Children's Centres and
youth settings are healthy places for
children and young people to play,
learn and develop
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All children and young people have
access to fresh healthy food and
easy access to drinking water at
school
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Action Plan cont.
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The NHS provides practical advice,
support and accessible services for
children, young people and parents
who need help with weight
management
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Parents and others who care for
children and young people are
educated and trained on how to
choose, prepare and cook healthy food
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The number of supermarkets and fast
food outlets that promote and provide
healthy food is increased
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They influence and change catering
practices at mass entertainments
events and outlets in the city
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So What?
Benefits of Care Pathway for Service
Development
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Consensus on service needs
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Identifying gaps in service
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Staff groups and partner organisations can
also identify where they can contribute
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Children
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Villa Vitality!
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Partnership between HOB tPCT, BEN PCT, Aston
Villa, Healthy Education Unit and Schools. Up to
160 children per week
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Interactive activities: Physical activity coaching
 ‘classroom’ and computer based
healthy eating
 Develop Radio Programme – Villain
Radio
 Healthy Lunch
 Teacher Pack
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Level 1: Rowing Machines in
Schools
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Partnership programme with BCC
Education Dept., Concept 2 and
HoB schools
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Aims to increase physical activity
levels, providing alternative to
competitive/ team based sport
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Each school can claim up to 5
machines
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Concept 2 provides an internet
support package for schools:
includes training programmes,
lesson plans, distance awards, tips
and training on technique.
“I like rowing because it’s healthy and I
can keep fit. Other than Basketball, it’s
the only thing I’m good at. I feel more
confident because I can do it by
myself.” Michael Gardener, Year 9
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Level 1: Active Kids Initiative
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Training local teenagers to deliver physical activity
and healthy eating messages to other kids –Yr 5
• Those
delivering attain
coaching qualification and
training by dietitian in return
for commitment to project
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Reinforces the importance of being active and
finding an activity the you enjoy!
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Level 1: Face Fruits
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Local mums trained to deliver
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2.5hr interactive sessions in Schools aimed at
increasing understanding of fruit & veg, their
benefits, how to eat them, portions and variety.
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Sessions explain why we should try and eat 5 a
day
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Children's faces are painted with images of 3
fruits (from the School Fruit and Vegetable
Scheme)
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Certificates are taken home with a picture of the
children and 3 key health messages
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Level 1: Schools Dietitian
• Works
across HoB and BEN primary
and secondary schools
• Interactive events (assemblies,
classroom sessions, parent sessions)
on BoGH, 5-a-Day, Sugar and Fat
Content
•1-to-1 meetings with Healthy Schools
Co-ordinators in schools
•Supporting establishment of School
Nurse Led Weight Management
Programme
• School food policy development,
breakfast club establishment, menu
planning, tuckshop advice etc.
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Level 1: Food Net 4 Children
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Nutrition team working alongside under 5s staff (HVs,
Linkworkers, Nursery Nurses, children’s centres)
Responsible for training and support to deliver on healthy
eating and obesity prevention e.g. breastfeeding,
weaning, toddler nutrition
Work with health education service to develop and
implement early years healthy setting status
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Level 1: Growing Gains
CSV environment scheme in schools that
aims to increase:
The
range/variety of fruit and veg consumed by
children
Increase pupil / parent knowledge healthy diet
and how fruit and veg contributes to this.
Children’s understanding of how fresh foods are
produced and how eating fresh foods can positively
affect health.
Teacher and pupil involvement in initiatives aimed
at encouraging healthy eating
CSV environment will work alongside schools to
create vegetable plot and deliver 18 sessions in
schools
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Level 1: Training Playground
Assistants
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Working with Healthy
Schools Team to train
playground assistants and
midday supervisors in HoB
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Project aims to increase
physical activity levels
among primary school
aged children
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Level 2: School Nurse Led Weight
Management Programme
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Developed by Dietetic service
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6 session programme
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Detailed session plans with worksheets, food
diaries etc and comprehensive list of resources
for each session
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Can be delivered on an individual or group
basis
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Coventry University also working in partnership
to develop SN-led weight management
programme for Primary School children
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Level 2: Children’s Gym
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Gym at Aston Villa (NRF
funded) for 8-16 yr olds
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Exercise on referral scheme
for kids
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Open access for HoB
residents
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Usage for HoB schools
during the day
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Level 3: Watch-It
Programme
Watch IT
 MEND
 Paediatric Dietetic Service
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Level 4: Specialist Obesity Service
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Level 4 service currently being devised by
Consultant Endocrinologist, Children’s
Hospital
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ADULTS
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Level 1: Size Down
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6 week self-referral course delivered by FHAs in
community venues
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Based on pre-prepared session plans
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Weighing optional each week but need 2
measures for evaluation
SIZE DOWN
PROGRAMME
Week 1
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Week
Week
Week
2
3
4
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Week
Week
5
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Getting started
Looking at personal challenges so
that you can change your lifestyle
Making those changes!
Using physical activity to help you
become more active
Understanding fats and sugars in
your food
Learning to read food labels
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Planning your meals
Making
your
favorite
healthier
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Planning for your future
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LOSE WEIGHT FOR GOOD WITH
Learn how to choose and eat
healthier foods
foods
A NEW FREE WEIGHT LOSS GROUP
COMING TO A VENUE NEAR YOU
TAKE THE CHANCE TO GET FREE HELP,
SUPPORT AND ADVICE ON HOW TO LOSE
WEIGHT AND KEEP IT OFF!!
GROUPS ARE RUN BY FULLY TRAINED NHS
PROFESSIONALS
………………………………………………………………
I would like to be contacted about the new weight loss
groups:
Name:__________________________________
Address:_______________________________________
______________________________________________
__
Contact No:
_____________________________________
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Level 1: Cook and Tastes
Consist of:
•Practical Cooking sessions led by Food Health
Advisor (HOB 0.6 wte)
•Programme of 5 sessions or one-offs/taster sessions
•Participants cook healthy dishes, discussion & education,
looking at salt, sugar & fat, increasing fruit and veg in meals
Benefits:
•Addresses lack of knowledge and skills, food culture, lack of
access, and financial constraints
•Evaluation shows increase in fruit and veg intake (average
1.7 portions), and in cooking confidence
•Groups make comments showing wide ranging benefits e.g.
reducing fat, sugar and salt, increasing fruit, veg, CHO and
fibre, losing weight, understanding labels, taking up exercise
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Examples of Level 1 Service cont.
Walk 2000
Way marked 2 Km walking routes
in parks and open spaces to encourage people
to become more active. Can be used with or
without Walk Leaders.
Routes and Maps on
www.birmingham.gov.uk/walk2000
Commercial Weight Management Groups
Weight Management Groups such as Weight
Watchers and Slimming World provide an
effective method of supporting weight loss.
These have been audited by the PCT to
ensure they meet criteria in the NICE
guidance for obesity
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Level 1: Stair Climbing
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Workplace initiative to
improve activity levels
and incorporate as
part of daily routine
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Level 1: Healthy Lifestyles Grant
Programme
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Grant programme aimed
at developing
community based
initiatives to prevent
and tackle obesity
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Examples of Level 2 Services
Practice Based Weight Management Clinics
Training and resources are being provided
to enable Practice Nurses to run effective
Weight Management Interventions within
surgeries
Dietetic Service
Opt-in by patient to a 45 minute
assessment and up to 5-6 follow ups (can
be groups), 1-2 months apart. Consists of
behavioral/ lifestyle/ complex issues and
advice on undertaking physical activity.
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Examples of Level 2 Services
EXERCISE ON PRESCRIPTION
Exercise on Prescription BEN GPs
refer patients who would benefit from
increased activity levels to local
leisure and fitness facilities. A leisure
services health and fitness
professional works with the patient to
develop a personalised activity plan.
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Example of Level 3 Services
Specialist Obesity Service
Service to treat people with morbid obesity
within a Primary Care setting. Run by a multi
– professional team including a GP, Specialist
Dietitian and Cognitive Behavioural
Psychologist, the service aims to be able to
provide a more intensive approach than
would generally be possible in Primary Care.
Suitable for patients with morbid obesity for
whom interventions in Primary Care have
been unsuccessful. This service will ensure
that all options have been tried before
someone is considered for bariatric surgery.
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Examples of Level 4 Services
Surgery
Bariatric Surgery for certain
cases and preferably where
patients have been through all
levels of the care pathway.
(Heartlands, Walsall Manor)
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Next Step
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Combined obesity strategy for Birmingham
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Thank-You
Linda Hindle
Consultant Dietitian in Obesity
Birmingham East and North PCT
Tel:0121446 1025
Email: [email protected]