Health Improvement Partnership
Title of Paper
Healthy Weight
Strategic Lead
Julia Burrows
Report Contact
Alison Moore
Action Required by the
Partnership
1.0 Purpose of the Report
To increase levels of knowledge and awareness of current healthy weight agenda,
identify gaps and areas for action.
2.0 Background / Context
The number of obese people in England has been rising sharply for the best part of 20
years. Today one in four adults are obese, according to the Health Survey for
England, compared to less than 15 per cent in 1993. By 2050 these figures are
predicted to have more than doubled (LGA 2012). The 2011/12 NCMP prevalence
figures show the substantial changes that have occurred in children’s BMI over the
past two decades – with the proportion of children classified as obese nearly doubling
for children in Reception and increasing more than threefold for Year 6 since baseline
in 1990 (NHS Information Centre 2011).
2.1 Causes: Unhealthy diets and low levels of physical activity, as well as more subtle
causes, including societal influences, individual psychology and the environment
around us, which could often make it hard to make healthy choices (Foresight 2007).
Studies have shown that obesity reduces life expectancy by an average of three
years, while morbid obesity reduces it by eight years – the same effect as a lifetime of
smoking. This is because being obese can increase the risk of developing a range of
diseases and health problems; cancer, heart disease, stroke, type 2 diabetes, and
musculoskeletal problems. The resulting NHS costs attributable to overweight and
obesity are projected to reach £9.7 billion by 2050, with wider costs to society
estimated to reach £49.9 billion per year (Foresight 2007).
On 1st April 2013 public health became the responsibility of local government creating
opportunities to tackle the wider determinants of obesity and reduce health inequalities
in local communities, especially the poorest. The public health outcomes framework
identifies two specific indicators in relation to healthy weight; excess weight in adults
and excess weight in 4-5 and 10-11 year olds. Plus a number of key contributable
indicators; proportion of inactive adults, diet, breastfeeding, take up of NHS Health
Check, falls in over 65’s, utilisation of green space for exercise.
The work of the healthy weight team will also contribute to the over arching objective
of reducing the numbers of people living with preventable ill health and dying
prematurely, while reducing the gap between communities, namely mortality from
cardiovascular disease and cancer.
2.2 Prevalence: Adult obesity in Bradford is currently 25.6% (Health Survey for
England, 2008), which is significantly higher than the National Average of 24.2%.
Childhood obesity is 10.4% in Reception and 21.7% in Year 6 (NHS IC 2012), both
above the national average. Plus it must be pointed out that the national average is
extremely high, this means almost a third of 10-11 year olds and over a fifth of 4-5
year olds were overweight or obese.
2.3 Addressing overweight and obesity in the population:
To achieve a reduction in obesity and overweight in Bradford’s population the work
needs to be done at a number of different levels; environment, organisational, and
influencing personal choice.
The Local Authority commissions and delivers prevention initiatives and commissions
and provides community lifestyle weight management programmes and an exercise
referral scheme thought its public health function. These programmes are generally
defined as Tier 1 and Tier 2. Specialist, multidisciplinary obesity services are
generally defined as Tier 3 services, and we do not have these currently in Bradford.
Bariatric surgery is a Tier 4 service that is commissioned by NHS England. The
diagram below sets out proposed definitions of these tiers:
CLINICAL CARE COMPONENTS
COMMISSIONED SERVICES
2.4 Current work programme:
 Responsible for delivering the National Child Measurement Programme (NCMP)
locally. Measuring the height and weight of children in Reception and Year 6 and
the central return of that data is mandatory.
 Currently commission the School Nursing Service to deliver the NCMP and followup families
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Develop a locally tailored strategy for healthy weight – ensuring it is a priority at
strategic and delivery levels and external partners such as local employers,
schools, VCS organisations and the NHS are working together to integrate support
and provide preventative services.
Access to support by developing pathways from primary care to secondary care
and into sustainable community support
Currently have a partnership agreement for the delivery of adult healthy weight
courses that run in the community, provide training, resources and support.
Commission a voucher scheme for primary care for Weight Watchers
Making Every Contact Count – deliver a two-hour briefing session to groups of
front-line staff enabling them to raise lifestyle issues, assess readiness to change
and signpost to local lifestyle support services
Children’s Healthy Weight courses (2-4, 5-11 and 12+) are in development and
being piloted.
Every Baby Matters Strategy – actions around breastfeeding and child food
poverty
Commission an Infant Feeding Co-ordinator
School Nursing Service commissioned the Healthy Child Programme
Commission evidence based Food Dudes Programme in Special schools
Partnership agreement for the delivery of Walkshire – school based walking
programme
The Exercise Referral Scheme for Bradford – Bradford Encouraging Exercise
Programme (BEEP) increases access to specialist physical activity advice and
signposting to appropriate opportunities across the district.
Responsible for delivering the NHS Health Check locally. A cardiovascular
screening programme for 40-74 years measuring height, weight, blood pressure,
cholesterol, risk factor questions and blood glucose (if necessary) and the central
return of that data is mandatory. The national model indicates referral and
signposting to stop smoking services, exercise referral and community weight
management.
Good Food Bradford – Food Strategy and Food Network, Good Food Award,
Ministry of Food work
Highway to Health/Tour de France
Cross department working (eg environmental health, transport and planning) both
within the council and across West Yorkshire to assess health impacts of their
policies and strategies and to use opportunities to shape them to promote physical
activity and healthier lifestyles
3.0 Report Issues
 Public Health currently commissions VCS organisations to deliver a range of health
improvement activities – a review of this work is currently underway
 The lack of a specialist obesity service (tier 3) in Bradford. NHS England (the
commissioner of bariatric surgery) has specified that patients need to have been
through a Tier 3 service in order to be eligible for surgery. This means that unless
they have a very high Body Mass Index (>50kg/m2), patients in Bradford can not
currently access bariatric surgery. Work is ongoing between Public Health, the
Clinical Commissioning Groups and NHS England to address this problem, which
is an issues at local and national level.
4.0 Proposed Outcome / impact measurement
Establish effective partnership working to maximise impact and ensure a co-ordinated
approach. Commission for health outcomes by developing meaningful performance
measures for providers and appropriate reporting mechanisms.
5.0 Contribution of Health Improvement Partnership
Public Health Healthy Weight supports and contributes to addressing a number of
health inequalities and co-ordinates effort towards tackling the issue of obesity
6.0 Recommendations
Address gaps in services:
 Healthy Weight Pathway for adults and children, including addressing the issues
regarding a lack of Tier 3 service and access to bariatric surgery by all
commissioning organisations
 Work with partners
 Physical Activity opportunities with appropriate support for pregnant women
 Comprehensive delivery of a children’s lifestyle weight management service
 Physical activity pathways for secondary care
 Workplace health improvement initiatives
 Stronger links needed with Adult Services
For more information please contact Alison Moore Senior Public Health Manager
Bradford MDC alison.moore@bradford.gov.uk