Karen Jackson
Public Health
2012
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Why HNA?- aim
Headlines from obesity HNA
Adults & children with learning disabilities
Revised obesity strategy ‘framework for
action’
Way forward for learning disabilities
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Tackling Obesity Strategy -2005-2010
Uses evidence – based interventions to produce a
framework for action -Halt the rise in obesity
Targeted
interventions
at the overweight
and obese
Targeted
interventions
Primary Prevention
through
at the lifestyle
overweight
encouraging healthy
and obese
Action on the obeseogenic environment
Primary
Prevention through
and health
inequalities
encouraging healthy lifestyle
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Monitoring via 6 monthly Task Group meetings and annual report to LSP, PCT
Board, LA Corporate Board and Cabinet
All areas contribute to demand management
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To inform refresh of Dudley’s obesity
strategy
Includes reviews of:
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national and local data –obesity & lifestyles
services and interventions currently in place
evidence on emerging interventions
stakeholder views,
progress of 2005-10 strategy
Makes recommendations,
Proposes a revised framework for action,
strategic objectives, monitoring and
outcomes measures
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
% Prevalence
Obesity Trends (BMI 30+)- Adults
35.0
30.0
25.0
20.0
England
15.0
Dudley
Linear (England)
10.0
Linear (Dudley)
5.0
0.0
Year
Prevalence of Obesity in Dudley- Adults
70%
60%
58%
54%
% obese
% prevalence
50%
% obese &
overweight
42%
40%
30%
21%
17%
20%
10%
9%
0%
1992
2004
2009
Year
51,317 People Obese
138,532 People Overweight and obese
England
Average:
•61% overweight
& obese
•24.5% obese
YEARLY RATES OF INCREASE
Obese:
Overweight:
Overweight & obese:
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2004
2009
0.7
0.3
1.0
0.8
0.0
0.8
All of current increase due to obese category
At current rates: 24.9% obese by 2016
Halt the rise by 2016- balance of 9400 less
people moving into the obese category
Obesity Trends- England :Children 2-15
40
Overweight
35
% Prevalence
30
Obese
25
Overweight including obese
20
15
Linear (Overweight)
10
Linear (Obese)
5
0
1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015
Year
Linear (Overweight including
obese)
Reception Year Obesity Prevalence
2006/07 2007/08 2008/09 2009/10 2010/11
(%)
(%)
(%)
(%)
(%)
Dudley
11.4%
11.4%
9%
10.2%
10.7%
% point av
yrly
change
-0.18
W.Mids
10.4%
10.0%
10.1%
10.5%
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+0.03
England
9.9%
9.6%
9.6%
9.8%
_
-0.03
Year 6 Obesity Prevalence
Dudley
W Mids
England
2006/07 2007/08 2008/09 2009/10 2010/11 % point av
(%)
(%)
(%)
(%)
(%)
yrly
change
23.4%
20.1%
21.0%
23.8%
22.4%
-0.25
19.1%
19.6%
19.8%
20.5%
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+0.47
17.5%
18.3%
18.3%
18.7%
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+0.4
Adults: Increase in physical activity-46% to 49% (2004 to 2009,)- but
more so in the least deprived than the most deprived areas. BME, women
and girls, older people and overweight and obese people - lower activity
levels.
Children: 70 % of year 5/6 year olds get enough exercise nationally,
which declines to 62% by years 8/10 - more so for girls Less children
cycle or walk to school than in previous years.
Adults:5 a day F&V intake -remained constant at 25.6% (2009), increased in deprived areas. Males, BME and deprived areas have a lower
5-day levels. 86.9% of the population eat a less than healthy diet
Children: 5 a day F&V intake -increased slightly for children since 2004.
Declines between school years 5/6 and 8/10. Children are consuming
high levels of fatty and sugary snacks on a daily basis.
Breast feeding: Initiation and duration rates are falling and lower than
W.Mids and England . Year 8/10 children – 2/3rds would not consider
breast-feeding
There are specific groups that are more at risk of
developing obesity
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Children from low income families
Children from families where at least one parent is
obese
Looked after children
Young parents- <21
Adults- unemployed or in routine/semi routine jobs
Older people
People of Asian origin
Ethnic groups with higher than average prevalence
People with physical and learning difficulties
People with mental health conditions
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Robust initiatives and services in place, but
impact on public health outcomes not yet
realised.
◦ Interventions - not yet at full implementation
◦ takes longer than 5 years for the impacts of public
health programmes to come to fruition
◦ Some programmes have limited resources and are
achieving only a small ‘reach’
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New action plan - build on these interventions
2005 obesity strategy delivery framework still
valid –to add life-course & at-risk population
groups
Progressive universalism- universal and targeted in each section
Tier 1: Tackling the Obeseogenic Environment:
 Expand reach and impact of programmes increasing
access to healthy food , active travel, urban design
and planning
Tier 2: Lifestyles: Attitudes, Knowledge and Skills:
 Public health campaign to raise the public’s
consciousness
 Early years & primary school age, breast-feeding &
healthy workplace programmes
Tier 3: Treatment Pathways for Adults and Children:
 Increase referrals, Improve long-term weight loss
outcomes
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Higher prevalence of overweight and obesity than
the average population: 1 in 3 obese V 1in 5
Less than 10% of adults with learning disabilities
in supported accommodation eat a balanced diet,
& sufficient intake of F&V
Carers generally have a poor knowledge about
healthy diet
80% of adults with learning disabilities not taking
enough exercise
More likely than the general population to have
avoidable, diet related ill health and a shortened
life expectancy – type 2 diabetes is double
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National prevalence rates: 25/1000 with mild and moderate
learning difficulties, 3-4/1000 with severe learning
disabilities
Locally:
◦ Ω 6023 adults- mild/moderate LD , 2008 obese
◦ Ω 722-963 adults – severed LD, 241-321 obese
QOF data: (Sept 2011) 53/54 practices
◦ 1250 adults – mild/moderate & severe LD
◦ 984 adults- on LD register (moderate/severe),
805 (81.8%) also on obesity register
◦ 59% male, 41% female
◦ Obesity most prevalent for 35-54 year olds- as general
population
Schools Health Behaviour Data: suggestion of less healthy
lifestyle for children with LD
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Environmental changes are universal and will benefit
all- healthy towns, food for health award
Many universal interventions will support people with
learning difficulties (but need carer support or
involvement, or need to be aimed at carers)
Targeted services also in existence- for weight
management
◦ Adults: slimmer’s kitchen for LD,
◦ Children: Seekers (ages 8 to 18 with LD)
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Data shortage
Systematic measurement and referral of children with
learning disabilities is patchy
Outcomes from initiatives can be lower for LD clients:
Referral Status
Total referrals
Did not attend (DNA)
Dropped out
Completed course
Weight loss 0-2.5%
(completers)
Weight loss 2.5-4.9%
Weight loss 5%+
No weight loss/gained
Number
16
1
1
14
%
6%
6%
88%
8
4
1
1
57%
29%
7%
7%
% Universal
services
27%-55%
2009/10
Accepted a place
Attended (rate %)
Seekers (8-18 YRS)
8
8 (100%)
DNA rate %
ALL PROGRAMMES*
261
245 (67%)
0
87 (33%)
Completed (rate %)
6 (75%)
145 (83%)
Drop out rate%
2 (25%)
29 (17%)
1/8 (17%)
84 (71%)
3(50%)
67/80 (84%)
1
31
% maintained or
reduced BMI
% reduced/maintained
waist size
Programmes
* where monitoring data available
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Making reducing obesity a priority for all- at
both strategic and delivery levels implementation of the learning disability
obesity charter
Development and delivery of an obesity
action plan for people with learning
difficulties
Monitoring data