innovations and new initiatives to prevent obesity nsw health innovation & health symposium –...

Innovations and new initiatives to prevent obesity

NSW Health Innovation & Health Symposium – November 2015

Louise A BaurUniversity of Sydney: Discipline of Paediatrics & Child Health, Sydney Medical School, AND Sydney School of Public Health

The Children’s Hospital at Westmead, Sydney: Weight Management Services

Email: [email protected]

• One of today’s most blatantly visible – yet most neglected – public health problems

• The public health equivalent of climate change

• The Millennium Disease

How others have described the problem of obesity

WHO; www.who.int/nut/obs.htm; Laing & Rayner, Obesity Reviews 2007; www.iotf.org

http://www.who.int/nut/obs.htm

http://www.iotf.org/

With such a complex issue ……we can’t tackle it

by staying in our silos

Obesity and the chronic disease care pyramid

Primary prevention & health promotion

Level 170-80% of people with o’weight/obesity

Self-care & community based care


Self-care supported by GPs, other 1o care, group programs




Level 2High risk patientsCare management



Multidisciplinary teams; specialist allied health; group programs





Level 3


Complex patientsCase management



Tertiary level facilities & special obesity clinics; specialist teams; keyworker case manages & joins up care





Level 3

But we tend to stay in our silos!

Complex patientsCase management



Tertiary level facilities & special obesity clinics; specialist teams; keyworker case manages & joins up care


Silo 1 – Health promotion

Silo 2 – Primary careCommunity care

Silo 3 – Hospitals

What are some of the new, or newer, strategies in tackling obesity?

Tackling gestational weight gain:

→ Providing a Get Healthy Coaching Service to pregnant women

affected by obesity

Why gestational weight gain?

• A critical period when future health trajectories can be influenced

• Pregnant women are very open to health messages AND they are being seen – often frequently - by the health system!

• Excess weight in pregnancy → influences current & future maternal health AND offspring health

Trial of for women with gestational weight gain

• Trial underway using the Get Healthy platform

• Can we see a future when ….– all women in early pregnancy who are affected

by obesity are provided with a high quality, accessible intervention to help them avoid excess weight gain and have as healthy a pregnancy as possible?

– the Get Healthy Service is used successfully by many, many people – including young people (i.e. prior to pregnancy)?

Integrating anticipatory guidance about breastfeeding and healthy infant/

young child eating and activity into routine clinical service delivery

→ Universal and Targeted home visiting to mothers of new babies

Home visiting programs?

• Can be effective in improving social and health outcomes of disadvantaged parents and children

• What about weight, eating and activity outcomes?

• → The Healthy Beginnings Trialo south-western Sydneyo intervention from 3rd trimester to

child age 2yo 8 home visits by early childhood

nurse, developmentally staged

1Olds DL, et al. JAMA 1997, 278:673-643.

And, Healthy Beginnings led to …:

• significant reduction in body mass index at age 2 y → the first intervention to decrease child BMI in early childhood

• improvements in some child and mother eating and activity/TV behaviours • …. but the effect

didn’t persist beyond 2 y - when the home visits stopped

0.0

5.1

.15

.2.2

5y

blue/dash -- for control. red/solid -- for intervention. 18.2 -- equivalent to adult BMI 25.

BMI distributions of children at 2 years old by treatment

Wen LM et al. BMJ 2012; 344:e3732

Home visiting programs to prevent obesity?

• Trial being planned in Sydney LHD

• Can we see a future when ….– Anticipatory guidance – about breastfeeding,

healthy infant/child feeding & activity – is integrated into home visiting programs for targeted pregnant women/mothers of young babies?

• Are there other ways to support large numbers of women? What about phone coaching? The Get Healthy Service for new mothers?

On-line training of clinicians (nurses, allied health, doctors …) who see

children and adolescents - to monitor weight status, raise the issue of

obesity and provide initial and more detailed advice

→ Weight4KIDS training modules

Why the interest in training health professionals?

• Treatment services very limited, poorly co-ordinated, across NSW and Australia-wide

• Most health professionals are poorly trained in managing paediatric obesity and its complications

• → Development of Weight4KIDS: – a series of on-line training modules suitable for

all types of health professionals working with children, in any setting

– well-evaluated in metro and regional NSW settings

Upskilling of health professionals?

• Can we see a future when ….– All clinicians and health promotion staff are

able to access relevant training as needed and feel confident in:

• raising the issue of obesity • monitoring the problem• helping people find the support they need to

tackle the issue

Some last reflections

Of course we need many other strategies too! BUT …

• Let’s be as flexible and innovative as we can within our existing budgets

• How can we avoid being stuck in our different “craft silos” and comfort zones?

• Where does health promotion end and clinical service delivery begin? And vice versa?

• How can health promotion infiltrate/ embed itself - or be integrated - into routine clinical service delivery?

• How can health promotion be integrated across many other sectors?

Of course we need many other strategies too! BUT …

• Let’s be as flexible and innovative as we can within our existing budgets

• How can we avoid being stuck in our different “craft silos” and comfort zones?

• Where does health promotion end and clinical service delivery begin? And vice versa?

• How can health promotion infiltrate/ embed itself - or be integrated - into routine clinical service delivery?

• How can health promotion be integrated across many other sectors?

Thank you!

innovations and new initiatives to prevent obesity nsw health innovation & health symposium –...

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