640

Healthy Weight Strategy;

Tackling Overweight and Obesity

2008/09 to 2013/14

A 5-year strategy to support the people served by

NHS North Staffordshire to achieve and maintain

a healthy weight









nd

Version 10 – 2 July 2009







1

2

Contents

Executive summary

Recommendations



Section 1 - Making the case for action Page 6

1.1 What causes overweight and obesity?

1.2 Why is overweight and obesity a problem?

1.3 What are the health risks of being overweight or obese?

1.4 What are the costs for treating overweight and obese people?

1.5 Who is most likely to be overweight or obese?

1.6 What does the local prevalence look like in the NHS North Staffordshire area?

1.7 How is overweight and obesity measured and defined?

1.8. What are the most effective ways of treating and preventing unhealthy weight gain

and obesity?



Section 2 - What is happening in NHS North Staffordshire to prevent and manage

overweight and obesity? Page 14

2.1 Policies and reports to tackle overweight and obesity?

2.2 Prevention of unhealthy weight gain in NHS North Staffordshire - What are we going

to do to make a difference?

2.3 What can Primary Care Contractors & Community Service Providers do to make a

difference?

2.4 What can Partner Agencies do to make a difference?

2.5 What can we do in partnership to support communities to maintain a healthy weight?

2.6 Management and treatment of overweight and obesity – what can we do to make a

difference?



Section 3 - Strategy recommendations Page 20

3.1Strategy concepts

3.2 Aim of strategy

3.3 Objectives

3.4 Proposed Care pathways

3.5 Action plan; Healthy Weight



Section 4 – References Page 34



Appendices



Appendix 1; Classification of Body Mass Index and Risk of Co-morbidities

Appendix 2; Potential Health Benefits of 10% weight reduction

Appendix 3; Adult Older People Care Pathway; Healthy Weight Care Pathway - Tier

Descriptions

Appendix 4; Children & Young People; Healthy Weight Care Pathway - Tier Descriptions









3

Executive summary



The Healthy Weight strategy has been developed to provide a coordinated

approach to address the local lifestyle risk factor of being overweight or obese. It

comprises of actions that need to be undertaken by NHS North Staffordshire to

prevent, manage and support obese and overweight children, young people,

adults and older people to achieve a healthy weight.



The Healthy Weight Strategy outlines current levels of overweight and obesity

amongst children, young people, adults and older people within the NHS North

Staffordshire area and our ambition to stop increases. .



The Strategy action plan outlines evidence based interventions and indicates the

context of the settings where they can be delivered to optimum effect.



Key recommendations



NHS North Staffordshire



 Link actions and interventions from this strategy where relevant to local

plans and care pathways.



 Work in partnership with other agencies and organisations to address

factors that may impact adversely on strategies that support people to

achieve and maintain a healthy weight.



 Ensure that partner organisations are provided with information about

how they can contribute to achieving the objectives of this strategy and

are provided with the skills and resources required for effective

implementation of the strategy.



 Be proactive and work with the local media to ensure that Healthy Weight

articles and messages are consistent, accurate and ensure that

appropriate messages are communicated to the local population.





Public Health / Health Improvement



 Provide leadership support and work with partner organisations to ensure

that an evidence-based approach is taken in developing weight

management services and where required commission training for staff.



 Target interventions to ward areas where the prevalence of overweight

and obesity is highest and where the economic and socio-economic

environment makes it harder for local people to reduce their weight and

maintain a healthy weight.





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 Undertake Equality Impact Assessment, and monitor access to local

weight management and physical activity services.



 Identify gaps, make investments and create innovative services that can

be delivered in a range of local settings by a diverse range of

organisations.



 Support Food in Schools via the National Healthy Schools Programme.



 Develop and support local activities and interventions to increase physical

activity across our population.



 Monitor the prevalence of overweight and obesity in the NHS North

Staffordshire area.



 Monitor the success of individual projects.









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Section 1 - Making the case for action



In the UK the epidemic of obesity is growing at an alarming rate and has

trebled since 1980 (DH, 2004 and NHS Health and Social Care Information

Centre 2005). In 2004, 22.7 percent of men and 23.8 percent of women were

obese and almost two-thirds of all adults - approximately 31 million were

either overweight or obese (NHS Health and Social Care Information Centre

2005).



Obesity amongst children is an increasing problem. In 2003 the prevalence of

obesity amongst children was 13.7 percent, with 27.7 percent recorded as

overweight. Furthermore increased childhood obesity may mean that today‟s

children have a shorter life expectancy than their parents (Jotangla et al

2005). Within indicator 3 of the Public Service Agreement Delivery Agreement

12 the government has outlined its vision to reduce current obesity levels

among children aged below 11 years back to 2000 levels by 2020. This is part

of a long-term national plan to tackle overweight and obesity throughout the

population (HM Govt, 2008).





1.1 What causes overweight and obesity?



Most evidence suggests that the main reason for the rising prevalence of

overweight and obesity is a combination of less active lifestyles, changes to

the types of food eaten and eating patterns (Department Health, 2004).



The reasons for these changes in diet and activity tiers are complex with

many differing factors playing a part. These include;



 Cultural and individual behaviour; changing family patterns of eating,

cooking and physical activity which are also influenced by knowledge,

attitude and behavioural influences.



 Food and environment; access to affordable local facilities for healthy food

such as local shops and markets.



 Built environment and a perception that the local community are unsafe;

poor access to exercise facilities, active travel and healthy eating places

and good quality safe play, leisure and sport facilities.



 Reduced tiers of occupational activity; changing work environments.



 Psychological factors; such as poor mental wellbeing.









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1.2 Why is overweight and obesity a problem?



Being overweight or obese can have a severe impact on an individual‟s

health, both are associated with an increasing risk of diabetes, cancer, heart

and liver disease. The risks of developing these conditions increase the more

overweight you become. In recent years Britain has become a nation where

being overweight is the norm (Foresight, 2007).



Childhood obesity is closely linked with early onset of preventable disease,

including diabetes. But the consequences of obesity in childhood go further

and include social stigma, discrimination and prejudice linked to low self-

image, and depression. Moreover, evidence suggests that overweight

children now have a 50 percent chance of being overweight adults. Children

of overweight parents have twice the risk of being overweight compared to

those with healthy weight parents (NAO, 2002).



1.3 What are the health risks of being overweight or obese?



Being overweight or obese is a key risk factor for a number of conditions

including coronary heart disease, stroke, some cancers and type 2 Diabetes

(see Table 1 - Health risks associated with increasing body mass Index). The

risk of developing type 2 diabetes is higher among people who are obese

compared with lean people. Coronary heart disease (which has a slightly

higher incidence among obese people) is more common among diabetic men

and more common among diabetic women. Stroke is also more common

among obese people (and also among those with diabetes) than in the

general population, as are many cancers, particularly endometrial and kidney

cancer, as well as osteoarthritis. Obesity is responsible for more than 9000

premature deaths per year in England.









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Table 1: Health risks associated with increasing Body Mass Index



Metabolic syndrome - 30% of middle-aged people in developed countries have features of

metabolic syndrome



−2

Type 2 diabetes - 90% of type 2 diabetics have a body mass index of > 23 kg m



Hypertension - 5 times higher risk in obese people

- 66% of hypertension is linked to excess weight

-2

- 85% of hypertension is associated with a body mass index > 25 kg m



Coronary artery - 3.6 risk of CAD for each unit change in body mass index

disease



Coronary artery - Dyslipidaemia progressively develops as body mass index increases from

−2

disease and stroke 21 kg m with rise in small particle low-density lipoprotein

- 70% of obese women with hypertension have left ventricular hypertrophy

- Obesity is a contributing factor to cardiac failure in >10% of patients

- Overweight/obesity plus hypertension is associated with increased risk of

ischaemic stroke



Respiratory effects - Neck circumference of > 43 cm in men and > 40.5 cm in women is

associated with obstructive sleep apnoea, daytime somnolence and

development of pulmonary hypertension



Cancers 10% of all cancer deaths among non-smokers are related to obesity (30% of

endometrial cancers).



Reproductive function - 6% of primary infertility in women is attributable to obesity

- Impotency and infertility are frequently associated with obesity in men



Osteoarthritis (OA) - Frequent association in the elderly with increasing body weight – risk of

disability attributable to OA equal to heart disease and greater to any other

medical disorder of the elderly



Liver and gall bladder - Overweight and obesity associated with non-alcoholic fatty liver disease and

disease non-alcoholic steatohepatitis. 40% of NASH patients are obese; 20% have

dyslipidaemia

- 3 x risk of gall bladder disease in women with a body mass index of >32 kg

−2 −2

m ; 7 x risk if body mass index of > 45 kg m









Source: Kopelman (2007)









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1.4 What are the costs for treating obese and overweight people?

Based on current trends it is estimated that by 2050 that amongst adults, 60

percent of males, and 50 percent of females could be obese. Amongst

children aged 6 to 10 years it is predicted that by 2050, 50 percent of boys will

be obese compared with 20 percent of girls within the same age (Foresight,

2007).



The cost of treating overweight and obesity and its consequences is

estimated to be between £1 billion and £1.8 billion per year. The cost of lost

productivity as a direct result of physical inactivity to the economy as a whole

is estimated at around £5.5 billion from sickness absence and £1 billion from

premature death of people of working age (Allender et al 2007). This indicates

that the total cost of treating obesity is approximately £8.3 billion per year.



Evidence suggests that the current increases in overweight and obesity is

linked to reductions in physical activity levels (National Heart 2007). Local

costs of treating physical inactivity for NHS North Staffordshire as a whole are

£3,768,920, and the total cost per hundred thousand of our population is

£1,852,887 (Allender et al 2007).









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1.5 Who is affected by overweight and obesity?



High-risk groups include children who have at least one obese parent,

people with physical or learning disabilities and people who have recently

stopped smoking. This is particularly relevant to the local population as

lower tiers of activity are reported in this population (Sport England, 2006)

and evidence suggests that this will significantly increase their risk of

developing Type 2 diabetes and Cardiovascular Disease.



In addition, the rate of overweight and obesity is increasing in school

children, which poses major risks for the health of the future adult

population. People in lower socio-economic groups, especially women are

more likely than the rest of the population to be overweight or obese.



Black and minority ethnic groups such as Black Caribbean and Pakistani

women are more at risk of becoming obese. Although Black and Minority

Ethnic groups make up only 3.2 percent (6,800 people) of NHS North

Staffordshire‟s population this needs to be acknowledged (ONS 2006).









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1.6 What does the local prevalence look like in the NHS North

Staffordshire area?



Table 2: Number of people aged 16 and over with Body Mass Index

recorded in the last 15 months (01.01.2007 to 31.03.2008)



NHS North Total Body Mass % Body Mass % of Body % of population

Staffordshire PBC population Index recorded Index ≥ 30 & population Mass

clusters recorded above Index ≥

25 to 29.9

Biddulph & 32,483 10,493 32.3% 3,131 9.6% 3,782 11.6%

Kidsgrove

Leek & 30,382 12,511 41.2% 3,770 12.4% 4,575 15.1%

Werrington

Moorlands Rural 24,963 7,833 31.4% 2,402 9.6% 2,893 1.6%

Newcastle North 48,124 17,345 36.0% 5,389 11.2% 5,796 12.0%

Newcastle South 40,018 11,432 28.6% 2,873 7.2% 3,745 9.4%

Total 175,970 59,614 33.9% 17,565 10.0% 20,791 11.8%



Table 3: Number of people aged 16 and over with Body Mass Index

recorded in the last 15 months (01.01.07 – 31.03.2008)





Body Body Body

Mass Mass Mass

Local Total Index Index % Index

Authority Population Recorded % population ≥ 30+ Population ≥25-29.9 % Population

Newcastle-

under-Lyme 102,920 33,903 32.9% 9,711 9.4% 11,403 11.1%

Staffordshire

Moorlands* 73,050 25,711 35.2% 7,854 10.8% 9,388 12.9%

Total 175,970 59,614 33.9% 17,565 10.0% 20,791 11.8%



*There are 3 wards in Staffordshire Moorlands District Council which are the responsibility of

Stoke-on-Trent PCT:

(Within these 3 wards, there is a single branch surgery of a Norton GP practice).

Therefore, the above data for Staffordshire Moorlands comprises only people registered

with a North Staffordshire GP.

Source: GP Practice - Health Informatics Service 2008



Table 4: Prevalence of underweight, healthy weight, overweight and obese

children (2007/2008)

NHS North Staffordshire Underweight Healthy Weight Overweight Obese

Reception (aged 4 to 5 years) 1.1% 72.8% 15.4% 10.7%

Year 6 (aged 10 to 11 years) 1.1% 65.5% 14.0% 19.4%





Source: Information Centre for Health & Social Care 2008









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1.7 How is overweight and obesity measured and defined?



1.7.1 Body mass index

The body mass index is a method of evaluating individual young people aged

16 years and above and adults to see if they are under or overweight. It

involves comparing their weight to their height by dividing the weight

measurement (expressed in kilograms) by the square of the height (expressed

in meters).



BMI = Weight in Kg

(Height in m) 2



Table 5; Body Mass Index* & Risk of Co-morbidities**





Classification Body Mass Risk of co-morbidities

Index

(kg/m2)



Underweight 40.0 Very severe





Source: National Institute for Health and Clinical Excellence, 2006, 2 adapted

from World Health Organization, 2000



Note:



*Body mass index is not always a good reflection of body fatness. A very muscular

person might have a high body mass index when in fact their body fat is at a

healthy tier, as muscle weighs more than fat.



**Co-morbidities are the health risks associated with obesity, i.e. type 2

diabetes, hypertension (high blood pressure), stroke, coronary heart disease,

cancer, osteoarthritis and dyslipidaemia (imbalance of fatty substances in the

blood).







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1.7.2 Waist measurement



Waist measurements also provide a good obesity indicator. A report by the World

Health organisation suggests that increased risk is present when the waist

measurement exceeds 94cm (37 inches) for men or 80cm (32 inches) for women.

Research suggests that measuring the waist circumference and waist hip ratio is

also a reliable method of estimating the health risks associated with an increase in

weight gain (WHO, 1995, WHO, 2000 and WHO 2004).



1.7.3 Measuring children

Body mass index is a measure of overweight and obesity in children although it

changes substantially as the child grows. The clinical definition of overweight and

obesity in children is based on body mass index percentile charts for boys and girls

plotted at different ages from 2-16 years. The National Institute for Health and

Clinical Excellence recommends that tailored clinical intervention should be

considered for children with a body mass Index at or above the 91st centile,

depending on the needs of the individual child and family, and that an assessment

of co-morbidity should be considered for children with a body mass index at or

above the 98th centile.



1.8. What are the most effective ways of treating and preventing

overweight and obesity?

The National Institute for Health and Clinical Excellence Clinical Guideline – 43

Obesity outlines the evidence base for preventing, identifying, assessing and

managing overweight and obesity in adults and children;



 Self management support for parents.

 The role of Local Authorities and Community - based workers such as

childcare provider, schools and employers.

 Specialist Treatment Services provided in hospital and primary care

settings.









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Section 2 - What is happening in NHS North Staffordshire to prevent and

manage overweight and obesity?



2.1 Policies and reports to tackle overweight and obesity

A range of local, regional and national strategies and plans are in place to

support our commitment to tackling overweight and obesity, and to support and

enable our local population to maintain a Healthy Weight.









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Table 6: Policies and reports to tackle overweight and obesity

Lead organisation Policy / Plan Key focus



NHS North Staffordshire A Healthy Future To reduce childhood obesity through the

Within NHS North development of early intervention services to:

Staffordshire‟s Strategy –

“A Healthy Future – - Identify the number of our adult population

Staying Healthy” (NHS suffering from being overweight and obese.

North Staffordshire, 2007).

- Target resources in the right place at the right

time to reach the most appropriate people



- Collaborate with partners such as, South

Staffordshire PCT, NHS Stoke, NHS West

Midlands, Newcastle under Lyme BC and

Staffordshire Moorlands DC Local Strategic

Partnerships, Staffordshire County Council,

Staffordshire Children & Life Long Learning

Directorate, and the Third Sector



- Include and cross reference the Healthy Weight

strategy with the bookcase of documents that have

been produced and or in the process of production

with the Healthy Future strategy to support the

overall message that is being given by NHS North

Staffordshire.



Staffordshire Moorlands Local Strategic Partnership - Adults & older people, children, young people and

District Council – Sustainable families.

Communities – Health and

Wellbeing Plan. - Community Activity Network (CAN).



Children‟s Trust Board –

Children & Young Peoples - Health & Wellbeing of Children & Young people

Plan. including focus on childhood obesity.



Newcastle under Lyme Local Strategic Partnership - Adults & older people, children, young people

Borough Council – Sustainable and families.

Communities – Healthier

Communities Older People - Community Sport Activity Network (CSPAN).

Plan.



Children‟s Trust Board – - Health & Wellbeing of Children & Young people

Children & Young Peoples including focus on Childhood Obesity

Plan.



Staffordshire County Local Area Agreement - Multi partnership / agency Delivery Group for -

Council (LAA) 2008 to 2011 National Indicator 056; Childhood Obesity



Staffordshire Healthy - National Indicator 08 – Physical

Weight LAA Delivery activity

Group for; - National Indicator 110 – Young

- NI 055 - Children in people‟s participation in positive

Reception Year: activities

overweight and obesity



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levels.

- NI 056 - Children in Year

6: overweight and obesity

levels.





NHS West Midlands Investing for Health (NHS Investing for Health Project 2b: Commissioner

WM 2008) Collaboration on Upstream interventions such as

Childhood Obesity.



Department of Health Healthy Weights Healthier Strategy to tackle overweight and obesity.

Lives (DH 2008)



National Institute of Clinical The National Institute of Clinical guidance on evidence of effectiveness for

Excellence (NICE) Clinical Excellence Clinical identification, prevention, management and

Guideline - 43 Obesity treatment of overweight and obesity.

(NICE 2008)



Promoting physical activity, Public health guidance for all those who have a

active play and sport for direct or indirect role in – and responsibility for –

pre-school and school-age promoting physical activity for children and young

children and young people people aged up to 18 years old. This includes

in family, pre-school, those working in the NHS, education, local

school and community authorities and the wider public, private, voluntary

settings – National Public and community sectors, Family members such as

Health Guidance 17 (NICE parents, grandparents and other carers (including

2009). professional carers), children and young people

and other members of the public. CE public health



Workplace health The guidance is for employers and professionals in

promotion: how to small, medium and large organisations who have a

encourage employees to direct or indirect role in, and responsibility for,

be physically active improving health in the workplace. This includes

National Public Health those working in the NHS, local authorities and the

Guidance 13 (NICE 2008) wider public, voluntary, community and private

sectors, especially those working in human

resources or occupational health. It also focuses

on the needs of employees, trades union

representatives and members of the public. The

guidance complements and supports, but does not

replace, NICE guidance on physical activity and

the environment, workplace smoking and obesity.





2.2 Prevention of unhealthy weight gain in NHS North Staffordshire - What

are we going to do to make a difference?

In order to realise the significant health benefits possible from reducing the

prevalence of overweight and obesity NHS North Staffordshire‟s Healthy

Weight Strategy will lead the implementation of a number of initiatives to enable

effective monitoring of changes to this indicator. These initiatives will include;



 Talking to local people to find out what might help.



 Collection of baseline data in primary care and community settings.





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 Investment and commitment of resources that focus on prevention,

management, and treatment to tackle overweight and obesity.



 Development, implementation and evaluation of the Healthy Weight

action plans for both adults and children.



 Promotion of evidence based, consistent and uniform health messages

that coincide with the messages of strategies such as „A Healthy Future‟

and the Department of Health Social Marketing Campaign Change for

Life.



 Implementation and evaluation of examples of good practice.



 Development and implementation of pilot schemes.



 Adoption of a consistent approach, and showcase individual tier changes

to behaviours, and positive change over time.



 Enhancement of existing partnerships with the County and District

Councils to tackle environmental and social factors that impact on an

individuals‟ ability to make healthy dietary and activity choices.



 Participation in Partnership projects to create and enhance healthy

sustainable opportunities for local people to be active and to eat well.



 Supporting the principles of self-care and making healthier choices

easier.



 Integration of Healthy Weight prevention and management into as wide

a range of roles and organisations as possible.



2.3 What can Primary Care Contractors & Community Service Providers

do to make a difference?



 Identify record and screen and refer as appropriate overweight and

obese patients to evidence based services for treatment and support.



 Work in partnership with NHS North Staffordshire to build capacity and

competency to support local people to achieve and maintain a Healthy

Weight within primary care to ensure that secondary care services are

prioritised for those most at risk.



2.4 What can Partner Agencies do to make a difference?



 Ensure that Healthy Weight is integral to relevant strategies and policy

approaches such as those for environment, transport, education and

leisure.







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 Develop partnerships with NHS North Staffordshire and other agencies

to work together to tackle the factors that contribute to the increase in

obesity locally such as the environment, transport, education and leisure.









2.5 What can we do in partnership to support communities to maintain a

healthy weight?





2.5.1 Supporting adults and older people

We can work together to make the environments that adults and older

people use as part of their daily lives more health promoting. Examples

include improvements to the following environments;



 Access to healthy, affordable food and cooking skills;

- Provide healthier alternatives in workplace canteens, restaurants and

cafés.

- Develop adult education programmes that support the development of

cooking skills and raise awareness of the key components of healthy

eating.

- Develop and implement multi-faceted workplace-based interventions

including: nutrition guidelines, physical activity promotion, and reduction

in sedentary behaviour.



 Access to physical activity programmes;

- Promote modest increases in physical activity particularly walking, and

activities not dependent on leisure facilities such as gyms.

- Provide support to enable individuals to do 30 minutes of physical

activity 5 times per week.

- Adopt active transport and work travel plans; support for walking, cycle

and public transport to work.

- Enhance access to facilities for physical activity; corporate membership

for local leisure facilities and encourage Interventions that include

regular contact with physical activity specialists.

- Develop, support & implement social marketing and media campaigns;

incorporating multi-component community-wide strategies.



2.5.2 Supporting children, young people and families:



 Access to healthy and affordable food;

- Promote breast feeding during pregnancy and early years.

- Support early years / childcare providers to work to national nutritional

guidance standards and to apply for the Eat Well Staffordshire -

Nurturing Health accreditation award.

- Support and implement whole school approaches to healthy eating;

ensure that nutritional standards for school meals are met.

- Develop and implement multi-faceted school-based interventions

including: nutrition education, physical activity promotion, reduction in



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sedentary behaviour, teacher training, curricular material, and

modification of school meals and tuck shops are effective.



 Access to physical activity programmes;

- Community based programmes; to promote increases in activity so that

children and young people can take part in 60 minutes of physical

activity per day.

- Integrate regular activity into daily life.

- Work with schools: ensure school transport plans incorporate walking or

cycling to school schemes; Support the 5 hours per week standard of

Physical Education and school sport recommended by the Physical

Education and Sport Strategy for Young People.

- Reduce the amount of time spent on sedentary activity.



 Awareness raising:

- Develop mass media campaigns incorporating multi-component

community-wide strategies in line with Department Health Strategy.

- Implement school-based health promotion (classroom curriculum to

reduce television, videotape and video game use) may be effective in

preventing obesity.



2.6 Management and treatment of overweight and obesity – what can we

do to make a difference?

Obesity management needs to follow a multidisciplinary approach and

secondary care needs to be involved in the management of complex cases.

The NICE Clinical Guidance 43 suggests that the main steps of an effective

weight management protocol should include the following approaches:



2.6.1 Management of overweight and obese adults:

 Develop clear referral pathways to ensure appropriate access.

 Adopt a multi-disciplinary approach to ensure that medical, psychological

and dietetic treatments are integrated.

 Ensure pharmacological and surgical treatment options based on

National Institute of Clinical Guidance - 43 recommend that the following

approaches are adopted;



Step 1:

 Identify of individuals who are in need of risk factor and weight loss

management (at risk groups include those with diabetes, Cardiovascular

disease, hypertension, and / or hyperlipidaemia).

 Primary care based staff should create and maintain a register of obese

patients (Body mass index ≥ 30) and also overweight patients (body

mass index ≥ 25-29.9) who have other cardiovascular disease and or

risk factors for stroke risk.

 Collect baseline data to monitor changes in childhood obesity is also

required.



Step 2:

 Assess baseline overweight and /or obesity and risk factors in identified

individuals.





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Step 3:

 Risk factor management in identified individuals.



Step 4:

 Implement weight management programmes for identified individuals.

 Ensure weight management and advice is provided for all individuals

whose body mass index is over 25.

 Focus on modest weight loss (i.e. 5-10 percent weight loss) and

prevention of further weight gain rather than major weight loss or return

to ideal weight.

 Implement evidence based weight management programmes that are

culturally sensitive, matched to individual needs, circumstances and

willingness to change behaviour. Ideally such programmes would

comprise of the following:



- Trained support.

- Advice on diet and physical activity.

- Effective behaviour modification techniques (based on cognitive

behavioural therapy).

- Long-term follow up and support with frequent contact.

- Involvement of the whole family/household.

- Continued long term self-monitoring of exercise and eating habits.

- Consuming 500 calories less per day.



2.6.2 Management of children who are overweight or obese

Children are still growing and calorie restrictions are not recommended. Weight

management support for overweight and obese children should focus on

enabling children to maintain a healthy weight as their height increases, or for

modest controlled weight loss. Family based interventions comprising of

healthy eating, increased physical activity and reducing sedentary behaviours

have been found to be effective.



Section 3 - Strategy recommendations



3.1 Strategy concepts

A significant proportion of the people who live in the NHS North Staffordshire

area are overweight or obese. The causes are complex and these are

influenced by a number of factors including personal choice, education,

financial constraints, food supply and labelling, environment, transport, and

cultural background. Resources need to focus on population groups most at

risk and specific factors that partner organisations can influence.



This strategy outlines key settings for action and target groups within these. It

offers practical solutions to ensure that access to physical activity and healthy

food is easier for all of NHS North Staffordshire. This is particularly important

for children and young people and other at population groups who are unable to

take full responsibility for their food and physical activity choices.



Factors that impact on the prevention of overweight and obesity are in the

hands of policy makers, Government, food and leisure industries. Examples



20

include working hours, maternity leave, house prices (all of which impact on

commuting time), employment, local transport policies, the built environment,

availability of leisure and good quality play facilities, green spaces, workplace

and school catering, provision of food in local shops, and extension of food

labelling to takeaway food.









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3.2 Aim of strategy

To increase the proportion of NHS North Staffordshire residents who maintain a

healthy weight throughout their lives. At present the majority of our data comes

through the National Child Measurement programme and our GP Practice

Registers. Recording of body mass index in primary care is not always done in

a consistent manner, so we need to ensure that we increase coverage rates so

that we can collect more data to provide us with a true baseline.



It is recommended that GP Practice Registers are used to set a baseline so

that we can monitor changes against this. If our strategy aims are fully met by

2014 we will aim to see: Fewer adults with a body mass index in excess of 25,

lower Body Mass in adults, less children with a body mass index in excess of

the 98th percentile and overall a reduction in the incidence of overweight and

obesity i.e. fewer new cases per year. We also aim to slow down the rise in the

incidence of overweight and obesity amongst adults and slow down the annual

rise in the numbers of children with a Body Mass Index in excess of the 98th

percentile.



3.3 Objectives

To develop partnerships with key stakeholders to realise a shared goal of

halting the rise in obesity in the NHS North Staffordshire area and in particular

reduction of obesity levels amongst children in line with Public Service

Agreement - Delivery Agreement 12, back down to year 2000 levels (HM Govt,

2008).



 Ensure that obesity is embedded within other lead strategies and plans

and linkages between these are made implicit.



 Create information systems for the collection and use of data relating to

overweight and obesity.



 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, public and private sector agencies and

local services to address these inequities.



 Adopt a consistent and effective approach to the prevention of

overweight and obesity and weight management within primary care and

partner services, particularly for children.



 Work with partners to develop and implement an evidence-based care

pathway for the management and treatment of obesity.









22

Source; Adapted from Birmingham & Solihull Obesity Strategic Framework (2005)









23

Source; Adapted from Birmingham & Solihull Obesity Strategic Framework (2005)









24

3.5 Action plan; Healthy weight – Adults, Older People, Children, and Young People







Action Outcome Monitoring Responsibility Partners Resource / Timeline for

financial completion

implications

90% patients As part of Quality Primary Care NHS NS Local 2009/10 –

Enhance Body aged 15-75 outcome Commissioning Enhancement ongoing

Mass Index with body framework Lead Scheme

Registers in mass

primary care recorded in

last 15 months



National Child 90% year 6 School Nurse NHS North NHS NS 2009/10 –

Measurement children Admin Team & Staffordshire NHS NS Provider Arm – Children Choosing Health ongoing

Programme Public Health Public Health & Families Team Investment Plan

Directorate –

Health

Improvement Team

Work with

Staffordshire All schools Healthy Schools Healthy Schools Staffordshire County Council Staffordshire 2009/10 -

County Councils achieving Standards Lead – SCC Staffordshire Children & Life Long County Council ongoing

Healthy Schools Healthy Learning Directorate

Lead to ensure all Schools

schools become standards

Healthy Schools

and maintain

healthy school

status.

NHS North

Develop school All children School Nurse Care Staffordshire NHS North Staffordshire Provider NHS NS – 2009/10 -

based initiatives have Programme Public Health arm - Children & Families Team Choosing Health ongoing

to promote opportunity to School Sports Directorate – Staffordshire Moorlands DC Investment Plan

physical activity access 3 hours Partnership / Health Community Activity Network

and healthy of good quality Public Health – Improvement Team Newcastle under Lyme



25

eating. Physical Health Community Sports Activity

Education and Improvement Network

3 hours school Staffordshire Moorlands SSP

sport and Newcastle under Lyme SSP

community Staffordshire County Council

physical Children and Lifelong Learning

activity Directorate

opportunities





.

Health Trainer Health trainers NHS North NHS North Staffordshire Moorlands DC & NHS NS – 2009/10 -

role to have access to Staffordshire Staffordshire Newcastle under Lyme BC Choosing Health ongoing

incorporate appropriate Public Health Public Health Investment Plan

awareness skills and tools Directorate – Directorate –

raising and goal to raise obesity Health Health

setting in relation as an issue Improvement Improvement Team

to obesity. and support Team

individuals to

set goals for

weight loss



Promote To deliver an NHS NS Business NHS North UHNS Maternity Unit Included in HIMP 2009/10 -

breastfeeding. increase Plan Vital Signs Staffordshire Choosing Health ongoing

in Public Health NHS North Staffordshire Provider Investment Plan

breastfeeding Staffordshire Directorate – Arm - Health visiting service

initiation and County Council – Health

continuation Local Area Improvement Team Eat Well in Staffordshire

rates at 6-8 Agreement Partnership

weeks,

focusing on NHS West

women from Midlands Health

disadvantaged Improvement

groups Monitoring Report



Develop a Promotion of NHS North NHS North Schools Included in HIMP 2009/10 -



26

community based and Staffordshire Vital Staffordshire Choosing Health ongoing

nutrition implementation Signs Staffordshire Public Health Nursery Schools Investment Plan

programme. cooking skills County Council – Directorate –

and local Local Area Health Local Community groups including

awards to Agreement – Improvement Team day centres, community cafes and

support youth clubs

national Staffordshire Independent / Third Sector

standards e.g. Healthy Weight Staffordshire County Council

Eat Well Delivery Group Children & Lifelong Learning

Staffordshire; NI56 Directorate

Nurturing

Health Award.

Initiatives to

improve

access to

healthy foods



Rebrand, Go 5 Exercise Vital Signs – NHS NHS North Leisure services – Staffordshire Included in the 2009/10 -

enhance & Referral North Staffordshire Staffordshire Moorlands DC, & Newcastle Choosing Health ongoing

expand the Go 5 Scheme to be Public Health under Lyme BC Investment Plan

– Exercise accessible by Staffordshire Directorate –

Referral all of whom County Council Health

Programme - in would benefit Local Area Improvement Team

line with British from increased Agreement – NI 08

Heart Foundation activity Delivery Group

Guidance to be

published in

January 2009.

Develop and Increased NHS North

implement a participation in Vital Signs – NHS Staffordshire Leisure services – Staffordshire Included in the 2009/10 -

range of physical activity North Staffordshire Public Health Moorlands DC, & Newcastle Choosing Health ongoing

activity programmes Directorate – under Lyme BC Investment Plan

programmes to by adults and Staffordshire Health Newcastle under Lyme Local

motivate and older people, County Council Improvement Team Strategic Partnership

support adults particularly Local Area Staffordshire Moorlands Local

and older people those who live Agreement – NI 08 Strategic Partnership





27

to keep active in priority Delivery Group Voluntary Sector

e.g. walking wards, and

programmes, those with an

pedometer increased risk

scheme, and of cardio

gardening / vascular

allotment disease and /

schemes. or other long

term conditions

Support Health

Workplace NHS NS to Health Improvement Independent / third Sector Included in HIMP 2009/10 -

Settings to promote staff Improvement Team, Public Provider Choosing Health ongoing

develop healthy health & well Team, Public Health Directorate Staffordshire Moorlands DC & Investment Plan

eating, and being. Health Directorate Newcastle under Lyme BC

promote physical Healthy Eat Well in Staffordshire

activity and workplace Partnership

improved access initiatives to be Staffordshire County Council

to public transport rolled out Newcastle under Lyme Strategic

for employees. promoted to Partnership

Promote healthy local Staffordshire Moorlands Strategic

eating and employers Partnership

physical activity

in the workplace

(Develop Healthy

Workplace plan).





Pharmacy weight Target those NHS North Health Local Pharmacists x 14 Staying Healthy 2009/10 -

management & with body Staffordshire Vital Improvement Unichem Investment Plan ongoing

cardiovascular mass index Signs Team, Public

disease >/= 30 with Health Directorate

Screening another risk

Service. factor for

cardiovascular

disease

Staying Healthy



28

Specialist Stop Information on NHS North Roy Castle Independent Provider Investment Plan 2008/09 -

Smoking Service preventing Staffordshire – Foundation Primary Care Contractors and Choosing ongoing

to provide weight gain Business Plan – Specialist Stop Health

evidence based given to all Vital signs / LAA NI Smoking service Investment Plans

brief advice on quitters 123

preventing weight

gain and sign

post where

appropriate.







Support and Provision of NHS North NHS North NHS North Staffordshire Public Choosing Health 2009/10 -

enable primary one to one Staffordshire Staffordshire Health Directorate – Health Investment Plan ongoing

care providers to motivational Public Health Public Health Improvement Team

support support and Directorate – Directorate –

overweight and advise. Health Health

obese patients to Improvement Improvement Team

achieve a healthy Team

weight.



Commission Apply NICE NHS North NHS North Weight watchers, slimming world, Choosing Health 2008/09 –ongoing

commercial and Criteria for Staffordshire Staffordshire & Nutracheck Investment Plans

voluntary assessing Public Health Public Health

slimming groups Slimming Directorate – Directorate –

based on NICE group assess Health Health

criteria. services before Improvement Improvement Team

commissioning Team

NHS North NHS North

Develop a Disseminate to Staffordshire Staffordshire Primary Care Contractors – GPs, Choosing Health 2008/09 -

directory/Care Clinicians to Public Health Public Health Pharmacies Investment Plans ongoing

pathway of improve Directorate – Directorate –

physical activity patient choice Health Health

and weight and signpost Improvement Improvement Team

management Team

services and



29

establish links

with Lifestyle Risk

Management

Services.

NHS North NHS North

Train health 60 staff trained Staffordshire Staffordshire NHS NS Provider Arm – Children WMPHG 2008/09 -

professionals and to provide Public Health Public Health &families Team ongoing

others to support weight Directorate – Directorate –

people to lose management Health Health WM PHG & Obesity Strategy

weight. interventions. Improvement Improvement Team Group

Wide spread Team

awareness

training

NHS North

Develop weight Pilot Health equity audit Staffordshire Nutrition & Cooking Skills Service Choosing Health 2009/10 -

management programmes Public Health Provider – Independent / Third Investment Plan ongoing

programmes developed by Directorate – Sector Provider

targeted to Nutrition & Health

communities Cooking Skills Improvement Team

most in need. Service

Provider





NHS North

Develop capacity Training Staffordshire School Nurse Choosing Health 2009/10 -

of school nurse accessed by Staffordshire Public Health Health Visitor Investment Plan ongoing

and health staff. County wide Local Directorate –

visiting services Care Area Agreement Health

to support programmes NI56 Delivery Improvement Team

overweight developed and Group

children and their implemented

families.

NHS North NHS North 2009/10 -

Pharmacists to Physical Staffordshire Staffordshire Public Health Directorate – Health Choosing Health ongoing

promote weight Activity & Public Health Public Health Improvement Team Investment Plan

management Weight Mgmt - Directorate – Directorate –

services to Health Health Health



30

patients receiving Promotion Improvement Improvement Team

prescriptions for campaign Team

diabetes or implemented

hypertension. as part of core

contract

NHS North 2009/10 -

Pharmacy weight Target those NHS North Staffordshire Local Pharmacists x 15 Staying Healthy ongoing

management & with body Staffordshire Public Health Unichem Investment Plan

Cardiovascular mass index Public Health Directorate –

Disease >/= 30 with Directorate – Health

Screening another risk Health Improvement Team

Service. factor for Improvement

cardiovascular Team

disease

NHS North 2009/10 -

Define and Care pathway NHS North Staffordshire UHNS – Dietetics / Nutrition Team Choosing Health ongoing

implement the agreed Staffordshire Public Health Leisure Services Investment Plan

care pathway for disseminated Public Health Directorate –

adult obesity and Directorate – Health

including referral implemented Health Improvement Team

criteria for Improvement

secondary care. Team







2009/10 -

Define and Care pathway SCC wide – Public Health SCC wide – Healthy Weight Choosing Health ongoing

implement a agreed Healthy Weight Directorate Health Delivery Group for LAA – NI56 / Investment Plan

childhood obesity disseminated Delivery Group for Improvement Team NI5

care pathway and LAA – NI56 / NI55 NHS NS Provider Arm Children &

including referral implemented Families Team

criteria to

secondary care.

2009/10 -

Develop and Age Health Public Health Staffordshire Moorlands DC Choosing Health ongoing

implement appropriate Improvement Directorate – Newcastle under Lyme BC Investment Plan



31

community based weight Team, Public Health Other voluntary, community, – National must

weight management Health Directorate Improvement Team private sector providers do - funding

management for children & Childhood

programmes. young people Obesity

based on nice

guidance

2009/10 -

Implement NICE Audit current SCC wide – Public Health – PBC Clusters N/A ongoing

guidance for the practice and Healthy Weight Health

prescribing of take action as Delivery Group for Improvement Team

anti-obesity appropriate LAA – NI56 / NI55

medication.

NHS North

Provide access to Follow NICE Provider Staffordshire Public Walsall NHS Trust and Heart of NHS NS 2009/10 -

bariatric surgery. guidance for Management Health Directorate NHS England Foundation Trust ongoing

referrals. Commissioning – Health

Develop local and Redesign Improvement Team

referral criteria & Commissioning

and Redesign.



Provide age In line with Health Public Health UHNS NHS NS 2009/10 -

specific specialist NICE Improvement Directorate – ongoing

obesity services Guidance Team - Public Health

for children, and Health Directorate Improvement Team

young people.

Staffordshire

Health Weight

Group









32

33

4. References



Allender S et al. (2007).„The burden of physical activity-related ill health in the

UK‟, Journal of Epidemiology and Community Health 61: 344–348; Ossa D

and Hutton J (2002) The economic burden of physical inactivity in England.

London: MEDTAP International



Birmingham and Solihull (2005). Obesity Strategic Framework.



Department for Education and Skills and Department of Health (2004). Every

Child Matters: change for Children Programme.



Department of Health (2000). National Service Framework for Coronary Heart

Disease.



Department of Health (2004). Choosing Health: Making Healthier Choices

Easier (Public Health White Paper). London DH.



Department of Health (2004). National Service Framework for Children, Young

People and Maternity Services.



Department of Health (2005). Choosing a better diet. London DH.



Department of Health (2005). Choosing Activity. London DH.



Department of Health (2007). Definitions of Obesity. DH Website.



Department of Health Central Office of Information (2006), Your weight, your

health, London DH.



Department of Health NHS Health and Social Care Information Centre (2005).



Department of Health (2008). Healthy Weight, Healthy lives A Cross

Government strategy for England. London DH.



Department of Health (2009). Be active, be healthy: a plan for getting the

nation moving. London DH.



Faculty of Public Health (2005). A toolkit for developing a local strategy to

tackle overweight and obesity in adults and children. Consultation document.



Foresight (2007).Tackling Obesities; Future Choices.



Health Development Agency (2004). Evidence for the Effective prevention and

treatment of obesity.



Health Survey for England (2004). Updating of trend tables. London: NHS

Health and Social Care Information Centre.



House of Commons, Health Select Committee (May 2004), Obesity; Third

Report of Session 2003–04 Volume I.



34

Heart of Birmingham Teaching PCT (2006). Obesity Strategic Framework.



HM Government (2008), PSA Delivery Agreement 12: Improve the health and

wellbeing of children and young people.



HM Treasury (2007). Pre-Budget Report and Comprehensive Spending

Review



Jebb, S., Steer, T. (2004) .Tackling the weight of the Nation.



Jotangia D, Moody A, Stamatakis E, Wardle H (2005). Obesity among children

under 11. London: National Centre for Social Research, Department of

Epidemiology and Public Health at the Royal Free and University College

Medical School.



Kopelman P (2007). Health risks associated with overweight and obesity.

Obesity reviews 8 (Suppl. 1), 13–17.



National Audit Office (2001). Tackling Obesity in England. The Stationery

Office.



National Heart Forum in association with the Faculty of Public Health and the

Department of Health (2007) Lightening the Load; Tackling Overweight and

Obesity. A toolkit for developing local strategies to tackle

overweight and obesity in children and adults

National Obesity Forum website (2008). Potential Health Benefits of 10 percent

weight reduction.



National Office for Statistics (2002). Health survey for England – the health of

children and young people 2002. London: The Stationery Office.



NHS North Staffordshire (2007). A Healthy Future Strategy.



NHS North Staffordshire (2008). Annual Report of the Director of Public Health

2007/08.



NHS Tayside (2005). The Weighting Game; Tayside Healthy Weight Strategy.



National Institute for Clinical Excellence (2001). Guidance on the use of

Orlistat for the treatment of obesity in adults.



National Institute for Clinical Excellence (2001). Guidance on the use of

Sibutrimine for the treatment of obesity in adults.



National Institute for Clinical Excellence (2002). Guidance on the use of

surgery to aid weight reduction for people with morbid obesity.



National Institute for Clinical Excellence (2006). Obesity: the prevention,

identification, assessment and management of overweight and obesity in

adults and children. Clinical Guidance 43.



National Institute for Clinical Excellence (2008). Workplace health promotion:

35

how to encourage employees to be physically active. Public Health Guidance

13.





National Institute for Clinical Excellence (2009).Promoting physical activity,

active play and sport for pre-school and school-age children and young people

in family, pre-school, school and community settings. Public Health Guidance

19.





National Service Framework for Diabetes: Delivery Strategy, 2002.



Scottish Intercollegiate Guidelines Network (SIGN) 1996 Obesity in Scotland.

Integrating prevention with weight management. A national clinical guideline

recommended for use in Scotland by the Scottish Intercollegiate Guidelines

Network. Edinburgh: SIGN



Scottish Intercollegiate Guidelines Network (SIGN) Management of obesity in

children and young people. A National clinical guideline. SIGN Report No. 69,

2003, Edinburgh, Royal College of Physicians.



Sport England (2006) Active People Survey









36

Appendix 1



Body mass index definitions





Classification Body mass index (kg/m2)

Principal cut-off points



Underweight less than 18.50



Severe thinness less than 16.00



Moderate thinness 16.00 - 16.99



Mild thinness 17.00 - 18.49



NORMAL RANGE – HEALTHY WEIGHT 18.50 - 24.99



Overweight greater than or equal to 25.00



Pre-obese 25.00 - 29.99



Obese greater than or equal to 30.00



Obese class I 30.00 - 34.99



Obese class II 35.00 - 39.99



Obese class III greater than or equal to 40.00





Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004









37

38

Appendix 2



Potential Health Benefits of 10% weight reduction (taken from National Obesity

Forum website 2008)

Risk Benefit



Mortality >20% decrease in total mortality

>30% decrease in diabetes related deaths

>40% decrease in obesity related cancers





Hypertension Fall in 10% mmhg systolic

Fall in 20% mmhg diastolic





Lipids 10% decrease in total cholesterol

15% decrease in LDL cholesterol

30% decrease in triglycerides

8% increase in HDL cholesterol





Diabetes 30 - 50% fall in fasting glucose

50% fall in risk of diabetes developing

15% decrease in HbA1c





Adapted from Jung 1997.



The potential negative consequences of weight loss:



 Rapid weight loss increases risk of developing gallstones

 Loss of bone mineral density has been associated with being underweight









39

Appendix – 3

Adults and Older People; Healthy Weight Care Pathway – Tier Descriptions



Tier Description Target Group Commissioning

Stream



1. Universal The aim of this tier is to ensure the availability of and to promote  All Body Mass Index

Prevention (includes a range of services for people who wish to maintain a healthy over 25 Self funding by

Baseline Data weight without the need for them to access the NHS via their  Body Mass Index over patient or voluntary

Collection and GP. Some of these services may be provided by the 23 for Asian people sector.

Monitoring). commercial sector. NHS funded services will be developed and  Waist circumference over Funding for some

positioned to reflect health inequalities. Examples of services 94cm men, 90 cm Asian elements from

include; men and 80 cm all public health /

 Commercial slimming groups women HIMP especially to

 Community food worker run weight management groups  Advertised / self referral reduce health

and food skills groups  Promoted via primary inequalities.

 Pharmacy led advice and support care to target population

 Leisure services – physical activity programmes

 Voluntary services input

 Health trainers

 On-line support

 Health promotion activities



This tier is aimed at those identified as „at risk‟ as a result of

2. Targeted Prevention their weight (through screening). Individuals who are „ready to  Body Mass Index over Staying Healthy /

change‟ will be supported by a trained individual (dietician, 30 (27.5 for Asians) Choosing Health

nurse, GP, pharmacist, exercise specialist) to develop a care  Body Mass Index over Investment Plan

plan to lose 5-10% weight. The content of the care plan will be 27 with existing co-

negotiated with the individual and could comprise any of the morbidities (23 for Asians

elements included in self care plus access to one or several of with co-morbidities)

the following:  Waist circ over 102cm

 Weight management groups or clinics run by trained men and 88cm women

individuals such as dieticians. These will include a  Advertised to patients /

behavioural approach. patients targeted through

 Exercise on prescription screening



40

 Slimming on referral schemes – in specified areas only

 Pharmacology using nice guidance, and anti-obesity

medication should not be used in isolation*



3. Community This tier is intended for those who have tried several  Body Mass Index over 40 Staying Healthy

Healthy Weight interventions to lose weight without success or those with (over 37.5 for Asians) Investment Plan

Management Services complex emotional relationships with food. This service  Body Mass Index over

provides more intensive and frequent support than previous 35 with co-morbidities

interventions and acts as a gateway to secondary care ensuring (over 32.5 for Asians)

that secondary care services are used appropriately.  Emotional eating

 Detailed assessment  Previous attempts to lose

 Multi disciplinary team weight

 Frequent appointments / support available

 Check that all options tried e.g. pharmacology, Cognitive

Behavioural Therapy techniques, alternative diet

approaches

 Medical support available

 Assessment against referral criteria for bariatric surgery





4. Specialist  Assessment for surgery  Body Mass Index over 40 NHS North

Secondary care  Psychological assessment for readiness for surgery (over 37.5 for Asians) Staffordshire

Obesity Service  Pre-surgery weight loss  Body Mass Index over 35

 Prep for post surgery with co-morbidities (over

32.5 for Asians)

 Been through tier 3

 Meet NHS North

Staffordshire

Prioritisation - referral

Criteria for surgery









41

42

Appendix 4

Children & Young People; Healthy Weight Care Pathway Tier Descriptions





Tier Description Target Group Investment Stream





Tier 1 - Prevention/Self Care The aim of this tier is to ensure the availability of All children Self funded by patient or

and promote a range of services for children voluntary sector.

/families who wish to maintain/manage their Advertised/self referral

weight without them needing to access the NHS Funding for some elements from

via their G.P. or School Nurse. NHS funded Part of school life public sector such as NHS NS –

services will be developed and positioned to Public Health / Health

reflect health inequalities. Examples of services Improvement Team - Choosing

include; Health Investment Plan.



- Universal provision - Physical Education and

Physical activity provided by schools and the

School Sports Partnership work under the

PESSYP strategy

- Leisure services – general sessions and those

targeted at overweight children Sports Clubs

and facilities

- Food in Schools Scheme

- Healthy Schools Initiative



Tier 2 – Targeted Triple P Obesity Reduction Body Mass Index over the 91st NHS NS – Public Health / Health

interventions centile Improvement Team - Choosing

Health Investment Plan.

Identified by School Nurse or

GP as a result of concern Staffordshire Moorlands DC &

expressed by teacher, parent Newcastle under Lyme BC

child. Leisure Services



Tier 3 – Primary Care This tier is aimed at those children identified as Body Mass Index over 98th NHS NS – Public Health / Health

Specialist Obesity Services at risk as a result of their weight. Individuals centile Improvement Team - Choosing



1

who are ready to change will be supported to Health Investment Plan.

develop a plan to maintain weight (as height Previous attempts at tier 2

continues to increase). Care plans will be possible co-morbidities, referral

developed involving child and parent – generally from School Nurse, G.P. or

by the School Nurse. other Health Professional or

self referral if meet criteria

The care plan could include:

 Weight management groups run by Commitment to participate in

School Nurse the Programme demonstrated

 1:1 from School Nurse

 Leisure Services – targeted to

overweight children (FIT programme)

 Based on department of health care

pathway for children and Young People

(DH, 2006 - Appendix B: Children and

Young People Care Pathway (Primary

Care)).



This tier is intended for those who are obese

and have tried interventions to lose weight

without success. This group will include, but not

be exclusive to, children assessed by a

Paediatrician (possibly at tier 4) and found to

have lifestyle related obesity rather than any

medical cause.



Services within this tier will also support children

with disabilities who are unable to effectively

access and use tier 1 and 2 services.



This service could include:



 The MEND and the mini MEND

Programme – for children aged 7-13

years.

 1:1 with Paediatric Community Dietician



2

– for children under 8 years

 Child Psychologist

 Paediatrician assessment

 Triple P Obesity Reduction







Tier 4 – Tertiary Care This tier is intended for those who are obese Meet NCH criteria for referral NHS North Staffordshire

Specialist Obesity Services and have tried interventions to lose weight

without success. This group will include, but not Referral by paediatrician or GP

be exclusive to, children assessed by a to obesity assessment clinic

Paediatrician (possibly at tier 4) and found to and/or specialities

have lifestyle related obesity rather than any

medical cause.



Treatment for medical causes of obesity –

endocrine, syndromes

Treatment of co-morbidities

Pharmacology

Dietetic and child psychology input



Bariatric surgery or pharmacological treatment

as medically indicated.









3