Tackling Childhood Obesity in the

Tri-Borough

(TCOT) Programme

Lynne Horn TCOT Programme Manager

Tri-borough Public Health

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Context

• The level of childhood obesity is of

international, national and local concern.

• Obese children are at increased risk of

developing social, psychological and other

health problems.

• They are also more likely to become obese

adults with poor health outcomes.

• Childhood obesity costs the capital £7.1 million

a year and this could reach almost £111 million

each year if today’s children remain obese into

adulthood1

1 Greater London Authority (2011): Tipping the scales

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Estimated cost of children currently (2012) obese

becoming obese adults

Category H&F RBKC Westminster Tri-borough

Estimated number of children currently

obese 4-15 years old 4,000 3,000 4,000 11,000

Annual Direct Cost based on £31 per

obese children (2007 costings) £124,000 £93,000 £124,000 £341,000

Annual Cost Direct and Indirect if 79%

become obese adults based on £611

per annum ( 2007 costings)

£1,931,000 £1,567,000 £1,931,000 £5,428,000

Lifetime cost for 79% of all current

obese 4-15 year olds assuming they

live to 75

£112,726,000

£91,420,000

£112,726,000

£316,872,000

The cost of child obesity

“Today’s generation of obese children will cost London at least £111

million per year in healthcare costs and productivity losses, if they

come to enter the workforce as obese adults.”

Tipping the scales Childhood obesity in London April 2011 : GLA

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Trends in hospital admission in children

aged 5 to 19 years in England for obesity

Jones Nielsen JD et al. Plos One 2013 Jun 12;8(6):e65764

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Westminster Child Measurement Programme

Results, 2012-2013

Prevalence of underweight, healthy weight, overweight and obesity, 2012/13 RECEPTION

Prevalence of underweight, healthy weight, overweight and obesity, 2012/13 YEAR 6

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Trends in Weight Status of Children in

Westminster, 2006/07 – 2012/13

Prevalence of obesity over time RECEPTION Prevalence of obesity over time YEAR 6

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Numbers with excess weight by ward of residence Overweight or obese. Attending local state schools. Private schools not measured

Reception Year 6

Strong focus in areas of deprivation, due to (a) higher rates of excess weight and (b) higher numbers

of children in these areas (particularly those attending state schools)

Suggests targeted work may be effective at tackling issue

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Causes and predictors of Childhood Obesity

• Energy intake exceeds energy use over a sustained period of time

• Interventions focus on improving diet and increasing physical activity at individual, community and population level

•Many parents believe their child’s obesity is linked to metabolic problems rather than lifestyle

•The strongest predictor is parental obesity; only 3% of obese children have parents who are not obese

• Combination of genetic, epigenetic, social and environmental factors

•Children with one or two obese parents are more likely to become obese and remain obese into adulthood

•Breaking this generational cycle is key to prevent obesity in childhood

•Children find it harder to influence their environment or control their behaviour.

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Tackling childhood obesity – The evidence base

Parental support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities

Environments and cultural practices that support children

eating healthier foods and being active throughout each day A school curriculum that includes healthy eating, physical

activity and body image Increased school sessions for physical activity and the

development of movement skills throughout the week Improvements in nutritional quality of the food supply in

schools Support for teachers and other school staff to implement

health promotion strategies and activities (e.g. professional development, capacity building activities)

HOLISTIC:

- Whole family

- Whole school

- Whole

environment

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Holistic Approach to Childhood Obesity

•Multi-level: Preventing obesity and treating those already obese are necessary at the same time.

•Multi-stage: There are opportunities for intervention at key life stages from before birth until early adulthood and then again pregnancy.

•Multi-disciplinary: A range of stakeholders from different fields must work together. Health professionals can not deal with the issue alone.

Farley C: CHILDHOOD OBESITY: What can primary care do? September 2012

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Tackling child obesity – what needs to be in place

Visible and vocal political leadership

A vision shared by all parties

Commitment from senior leaders and

influential figures, with regular engagement

Priorities which are clear, shared, and

ambitious. These should stimulate debate

These things have

been in place in

successful child

obesity programmes

in Europe and the

USA:

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Swinburn et al. Lancet 2011; 378:804-14

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A framework to categorise obesity determinants

and solutions

Key findings from tri-borough childhood

obesity review

• Existing prevention services popular and well attended

• Inequitable provision

• Some services can be difficult to access

• Children’s workforce can lack confidence to raise the issue

• Need for co-ordinated action to create healthier environments

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Our vision –

Tackling Childhood Obesity in the Tri-borough

Parks & open

spaces

Education &

learning Health & healthcare Transport

Housing &

planning Leisure & culture

Concerns about

traffic, pollution and

safety on roads

and/or cycling routes

restricting active

travel and play

Urban environments

provide limited

opportunities for

children to understand

food origins and be

physically active while

commercial fast food is

easily accessible

Limited availability of safe

outdoor play facilities and

poor access to leisure

services contribute to

inactive lifestyles

Active travel is the

norm for children and

families, as a result of

better traffic flow, safe

walking routes, and

efforts to promote

cycling and tackle

pollution

Healthy choices are

made easier as there

are fewer fast food

shops, healthier

catering practices are

widespread, and new

housing developments

promote physical

activity

Accessible leisure

services, safe and

stimulating outdoor

environment and play

facilities enable children

and families to have fun

and be active

Perceptions of lack of

safety,

inadequate equipment

and/or supervision,

distance and safe

travel routes

contribute to parks

and open spaces

being under-used

Inconsistent provision of

healthy food in

education settings, lack

of confidence to raise

the issue with parents,

lack of cooking skills

and limited opportunities

for physical activity

during school

Difficulties accessing

weight prevention

services, inconsistent

messages about healthy

lifestyles, and the stigma

associated with obesity

Children and families

routinely use parks

and open spaces as

improved facilities,

lighting, and patrolling

increase perceptions

of safety and

accessibility

All schools provide and

promote healthy food

and physical activity at

every available

opportunity, and

engage parents in

activities to promote

healthy lifestyles

Weight prevention

services are easily

accessible to all that need

them, and children and

families receive consistent

messages about healthy

lifestyles to motivate

positive change

What barriers to a healthy lifestyle do children and families living in the tri-borough face in 2014?

By 2016 we envisage that great strides will have been taken towards achieving our vision :

OUR VISION WORKING DRAFT 14

Our Solution – Tackling Childhood Obesity in

the Tri-borough Programme

This will be delivered through action and increasing opportunities in the following areas:

• Supporting a healthy start in life by supporting early years services to develop healthy lifestyle interventions

• Healthier preschools and schools by supporting a ‘whole school’ approach to healthy eating and physical activity

• Strengthening partnership working and integration across services and organisations to increase opportunities for children and their families to be active and eat healthily

• Utilisation of system levers to address the wider determinants of obesity and create local environments that better support healthy lifestyle choices

• Providing consistent messages to children and families about healthy lifestyles

• Maximising the use of existing services and assets within the community

• Increasing the involvement of community members in the design and delivery of healthy lifestyle initiatives

• Monitoring, evaluation and increased research to ensure we can evidence the difference our programme makes and contributing to the evidence base on ‘what works’ to tackle childhood obesity

The overall objective of the programme is:

To halt and reverse the rising trend in childhood obesity across the Tri-

borough area

Resulting in better informed families and more physically active children

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There are 3 components of the programme to

tackle childhood obesity in Tri-borough

Healthy Weight Services Environment Pilot

2.Whole council partnership to ensure that environment and facilities support newly learnt behaviours and identified

needs Communications ASC FCS Planning Leisure Housing Transport Parks Legal

1. Provision of comprehensive services accessed by children and

their families via recognised Pathways

Education Health Care

Voluntary Sector

3. Engaged communities tell us ‘what works’ for them

Local agencies work together to deliver solutions

Research, Evidence and Evaluation

Informs Supports

Retail Employers Private Providers NHS and other providers

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1. Provision of comprehensive services accessed

by children and their families

We are commissioning 2 lots of services

• Policy and Workforce Development; creating healthy weight promoting environments

Professional development and support to frontline staff to raise the issue with those at risk, support on policies development and environmental changes in relevant settings

• Obesity Prevention and Lifestyle; Weight Management Services

Universal tier 1 lifestyle parent and child obesity prevention services

Programmes on healthy eating, physical activity, behaviour management and formation of healthy habits for families with children aged 0 to 4

Tier 2 lifestyle child weight management services

To assist children and young people aged 5 - 18 years who are on/above the 91st BMI centile to reach and maintain a healthier weight.

Whole school obesity prevention programme for children

Practical fun, healthy eating activities and extra physical activity with each year group including engagement activities with parents. A selected number of schools in each borough will be worked with continuously over 3 years.

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2. Whole council partnership approach

EXTERNAL DIRECT

INTERNAL DIRECT

INTERNAL INDIRECT

EXTERNAL INDIRECT

Planning

Workforce

Housing

Licensing

CityWest Children’s

Centres

Wider

RSLs

Schools

Developer

s

Police

Fire

GPs Sports and

Leisure

Libraries

Public Health

services

Community

Assets

Royal Parks

Local

Retailers

Acute

sector

Unions

Council tax

Adult Social

Care

Children’s services

Further /

Higher

education

Adult

Education

Nurseries

Central Government

National retailers

Pharmacies

Health visiting

Parking

Transpor

t

NHS

England

Change

4 life

CCGs Dentists Supported

Housing

VCS

Healthwatch

GLA

Probation

/ Justice

Working collaboratively with all those involved in shaping the environments in which children live, learn and play across the Tri-borough to find ways to make

healthy choices the easy choices.

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3. Community based pilot project in RBKC

To support healthy eating and physical activity among children in all the

settings they live, learn and play

Key aims of the project

• Increase opportunities for children and their families to be active and eat healthily

• Create a local environment that better supports healthy lifestyle choices

• Ensure children and families receive consistent messages about healthy lifestyles

• Support partnership working and integration between local agencies

Key objectives of the project • Increase awareness and knowledge about healthy eating and physical activity • Increase self-efficacy and skills to achieve healthy lifestyles • Identify how to support and motivate key agencies and groups working with children and

families in the area to promote healthy lifestyles • Influence and challenge social norms about the perceptions on a healthy weight and healthy

lifestyle • Increase levels of physical activity and healthy eating • Achieve sustainable and maintained healthy lifestyle behaviour • Increase the proportion of children with a healthy weight in Golborne • Rigorous evaluation leading to strong evidence base for future application

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Initial ideas from the local community…..

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For more information contact:

Lynne Horn

lhorn@westminster.gov.uk

Triborough Public Health

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