Outcome: Childhood Obesity Leads: Natalie Field & Inge Shepherd & John Twigger
A Executive Summary
In 2007/08, 10.3% of reception age children were obese rising to 19.5% for Year 6 children (10-11 year olds). Nationally 18.3% of year 6 children
were obese. This does not include the percentage of children who are overweight.
The national target (Vital Signs) indicator is to increase the percentage of reception year children with height and weight recorded from 86.0%
coverage in 2007/08 to 91.5% by 2010/11 and the percentage of year 6 children from 84.0% coverage in 2007/08 to 88.3% by 2010/11 (see B4 and
B12). This is the process indicator. The key actions are to reduce levels of obesity. The rate of rise in childhood obesity is to be reduced by 50%
(est. 15,000-20,000 children) by 2010. The target excludes overweight children who would represent an additional 16% (est. 15,000 children) of all
Obesity is more prevalent in specific communities within our population e.g. Pakistani, Black African communities and people with
There has been some previous work which has been limited to working in schools on primary prevention e.g. Healthy Schools Programme.
Tackling this problem is complex and no developed country has yet succeeded in reversing the trend. Due to the scale of this problem
this is a multi-faceted, multi agency programme of work that will require additional investment and require more sophisticated modelling
and evaluation of the impact for each intervention.
New short term work includes:
Prevention: Includes encouragement of breastfeeding as evidence states that breast fed babies are less likely to be obese. Physical
activity, food and health advice to parents in early years settings e.g. childrens centres. A school nurse to support the national childhood
measurement programme and healthy weight interventions in a school setting e.g. physical activity, behavioural change and nutritional
advice sessions for children at risk of being overweight (these sessions are with their parents) and developing a programme for roll out
across the school nursing service. This links very closely with the healthy schools programme. Also, development of programmes aimed at
increasing physical activity.
Treatment: To provide an obesity treatment programme through 1 clinic at Bristol Childrens Hospital and 2 clinics out in the community (behaviour
modification). Providing the MEND programme which is a 12 week targeted programme for children and their families (see delivery plan C).
Long term work is part of wider healthy weight and physical activity programmes and work is:
Prevention: Bristol is the first city to implement the UNICEF Breastfeeding Baby Friendly Initiative in the community which are standards to ensure the
quality and consistency of advice from health visitors, etc; provide peer support, which is evidence based, in the 8 wards with the lowest
breastfeeding rates i.e. mothers with significant breastfeeding experience supporting breastfeeding mothers; expanding the interventions (similar to
the healthy schools programme) in early years settings (childrens centres) around healthy weight and physical activity e.g. cooking groups, provision
of healthy food, active travel plans; healthy schools programme - implementing nutritional guidelines; increasing the number and range of physical
activities interventions e.g. 'Bike It', 'Heels and Wheels'; Healthy Kids programme - healthy lifestyle interventions including physical activity and
Treatment: Implementing the childhood obesity care pathway - training our workforce including primary care and establishment of 4 new clinics in the
community (see delivery plan C).
Total new investment 2009/10-2012/13 = £400,000 (see delivery plan D).
Partnership arrangements: Partnership arrangements with the council are crucial. Links to the Health and Wellbeing group, sub group of
the Strategic Partnership (see delivery plan E).
B1 Brief description of health outcome:
Prevalence of obesity in Year 6 and Reception primary school age children. Good practice is that PCTs show in their plans a rate of increase in
prevalence of childhood obesity that is lower than the current national trend, as they work towards the new ambition of returning, nationally, to 2000
levels of childhood obesity by 2020. The rate of rise in childhood obesity to be reduced by 50% by 2010.
B2 Please state the rationale for choosing this health outcome:
In Bristol, approximately 1 in 5 (20%) Year 6 children and 1 in 10 (10%) Reception year children are obese, which is a four fold and two fold increase
respectively against the initial 5% who exceeded the 95th percentile from the 1990 baseline (1990 UK Growth Reference Charts). Obesity is a key
factor in short and long term health, in particular fatty liver and Type 2 Diabetes. Obesity in childhood usually leads to obesity in adulthood. Obesity is
more prevalent in specific communities within our population e.g. Pakistani, Black African communities and people with learning difficulties, which links
with the PCT's equality agenda.
B3 Brief description of indicator:
Tier 2 Vital Sign - VSB09 - (2 targets (1) Reception Year children and (2) Year 6 children). Percentage of children with height and weight recorded
should increase year-on-year and is expected. Measurements of height and weight for Year 6 children for 2009/10 will take place in autumn 2009 and
spring 2010 and for Reception age children in the summer of 2010.
B4 Vital Signs Submission:
04a0c151-218d-48f4-b361-b1053df8faec.xls 1 7/4/2011
B5 Definition of Obesity:
Childhood obesity is defined as having Body Mass Index greater than the 95th percentile (vs 1990 baseline). Overweight is defined as having a BMI
greater than or equal to the 85th percentile but less than the 95th percentile. Healthy weight is defined as having a BMI lower than the 85th percentile
for their age and sex. Obesity in children is identified differently to adults, identification is based on growth charts, depending upon the age of the child.
Current growth charts do not accurately reflect the growth patterns of certain BME groups, and therefore in areas with high BME groups there is a
danger of over estimating the levels of obesity.
B6 Causation Analysis and Evidence Base
The causes of childhood obesity are complex and multifaceted but result in an excess of calorie intake relative to calorie expenditure. The evidence
base is largely limited to observational data, but Bristol's Healthy Weight Strategy has been designed in line with NICE guidance 2006 and the Faculty
of Public Health 'Lightening the load' toolkit.
B7 Summary of Strategy:
Bristol has three inter-related strategies that tackle overweight and obesity as listed below. The combined strategies are known as Bristol’s Healthy
Weight strategy. Each strategy has its own action plan that is reviewed every two years.
• Weight Management Strategy 2007 - 2012 (focuses on treatment of overweight and obesity)
• Food & Health Strategy 2007 - 2012 (focuses on prevention of overweight and obesity and wider nutritional issues)
• Physical Activity Strategy 2005 - 2010 (focuses on prevention of overweight and obesity).
All the three strategies have Children and Young People as a key population group. The National Support Team for Childhood Obesity reviewed
Bristol's Healthy Weight strategies in March 2008. Their feedback was extremely positive and in particular they noted the robust strategies and action
plans were in place. They identified many examples of good and exemplar practice.
B8 Demonstrate the links to the Joint Strategic Needs Assessment (JSNA):
The Joint Strategic Health Needs Assessment (JSHNA) 2008 for Bristol identifies reducing childhood obesity as a key priority.
B8 Data from national data set (available to assessment panel):
Figure 1 shows levels of Year 6 childhood obesity for Bristol PCT, the SHA average and Cluster PCT average for 2007/08.
Vital Sign VSB09 - Childhood obesity
Obesity in 10-11 yr olds (2007/08)
National upper quartile
National low er quartile
Bristol PCT Cluster Average SHA Average
PCT and com parators
B9 Data source:
Information Centre for Health and Social Care – National Child Measurement Programme (NCMP)
B10 Is the national data robust? How have we come to this conclusion?
Year 6 2006/07 data was not robust due to low coverage (44%), Reception was robust and coverage was 89%. 2007/08 data for both is be robust
(see coverage below). The Year 6 low coverage in 2006/07 was due to the process being an opt-in method and a large proportion of higher BMI
children did not opt-in, thus skewing the results and underestimating the true level of obesity. Measurement has now changed to an opt-out consent
policy and this is reflected in a much higher coverage for year 6 in 2007/08. For Year 6 the 2007/08 data has been used as the baseline due to the
unreliability of Year 6 data in 2006/07, whereas for Reception year 2006/07 data is being used for the baseline.
B11 Please state current performance against target outcome:
Figure 1: Reception Year Obesity Prevalence
% of children measured that were
2006/07 2007/08 2008/09 2009/10 2010/11
Figures 1&2 show the increasing prevalence of obesity amongst Bristol's children between 2006/07 and 2007/08 (in blue). The
Vital Signs targets for 2008/09-2010/11 are shown in pink. The apparent increase of obesity in Year 6 children is misleading
because of the known inaccuracy of the 2006/07 data.
04a0c151-218d-48f4-b361-b1053df8faec.xls 2 7/4/2011
B12 Do we know the current rate of improvement? If so, please provide details:
The table below shows Bristol’s National Child Measurement Programme results (the proportion of children weighed & measured and levels of
childhood obesity. In 2007/08 nearly one out of five Year 6 children was obese. In 2006/07 nearly one out of ten Reception age children was obese.
Reception % obese 9.7% 10.3%
% coverage 89% 86.0%
Year 6 % obese 15.2% 19.5%
% coverage 44% 84.0%
* Year 6 2006/07 prevalence unreliable due to low coverage
B13 Include benchmarking data where available - comparison with SHA - ONS comparison - 'cluster' comparable cities:
Figures 3 & 4 shows the percentage of Reception age and Year 6 children who were obese in 2006/07 for some core cities and
for England as a whole.
Figure 3: In 2007/08 Bristol had lower levels of obesity among Reception age children compared to the core cities of Manchester
and Liverpool but higher levels than Sheffield and Leeds. Figure 4: In 2007/08, Bristol had lower levels of obesity among
Reception age children compared to the core cities of Manchester and Liverpool but higher levels than Sheffield and Leeds.
Figure 3: 2007/08 Reception Year Prevalence - Core Cities Figure 4: 2007/08 Year 6 Prevalence - Core Cities
% of children measured that were obese
% of children measured that were obese
B14 Is there an LAA, PCT Strategic Ambition or SHA stretch target? If so, please provide details:
PCT Strategic Ambition - SA28 - The rate of rise in childhood obesity to be reduced by 50% by 2010 (based on trajectory ref: Health Survey for
England (1995 to 2004)). The importance of childhood obesity has been recognised within Bristol’s LAA for 2008 – 2010 inclusive. The agreed
indicator is the level of obesity among Reception age children. There is a breastfeeding stretched target included in the LAA: To increase
breastfeeding initiation and continuation rates city-wide concentrating on the eight wards with the lowest levels. To achieve initiation rates of 80.8% by
31 March 2008 (from 72.5% at the year ending 31 March 2006). To achieve continuation rates at 6 to 8 weeks of 53.6% by March 2010 (from 48.5%
B15 Are there any links to other WCC health outcomes? If so, please provide details:
04a0c151-218d-48f4-b361-b1053df8faec.xls 3 7/4/2011
C Delivery Plan Actions & Indicators
Please state the main actions to be undertaken in order to improve health outcomes:
At the present time there is not enough evidence to indicate what impact each action will have on obese children. Therefore, these are process indicators that we will be
evaluating. However, all the actions come from the evidence base of NICE and the national support team recommendations.
No Actions Delivery Date Indicators/Data Collection Evidence Base
Specify the units of activity and exactly what outcome this will When will the What data/indicators will be collected/used to Why will the action be carried out?
lead to. action be carried demonstrate success?
PREVENTION: Children Centre Public Health Work Programme
1 Finalise consultation and production of childhood Mar-09 Guidelines in place and dissemination Current inconsistency of nutritional advice to
nutrition guidelines for pre-conception, conception & implementation plan developed. parents. Evidence shows that establishing good
and children 0-5 years. dietary behaviour at a young age prevents obesity.
Aim that all Children's Centres and Health Visitors
are giving quality consistent advice.
2 Develop proposal to secure recurring funding Nov-09 Proposal submitted into OPP. As above.
through the OPP to develop cooking skills/nutrition
training and Healthy Weight programmes e.g.
HENRI in Children's Centres.
3 Nutrition training for early years practitioners Mar-09 Number of staff trained and each As above. Evaluation from the training courses
including Children Centre staff will have been setting or cluster will appoint a healthy showed that prior to training there were a varying
delivered. eating champion. A minimum of 1 degree of knowledge around nutrition, healthy
member of staff per Children's Centre eating recommendations for 0-5s and healthy
will complete training. start.
PREVENTION: Breastfeeding 2008/09
4 A stretched target to increase breastfeeding Started Apr 08. Breastfeeding rates at initiation and 6-8 UNICEF BFI standards recommended by NICE
initiation and continuation rates is included in the Certificate of weeks. Guidelines for Postnatal Care(2006), NICE
Bristol LAA. commitment to Results of on-going BFI in house audit. Guidelines for Maternal and Child Nutrition (DH
Bristol is implementing UNICEF Breastfeeding be achieved by Evaluation of the BFI project by Bristol 2008), Scientific Advisory Committee on Nutrition
Baby Friendly Initiative (BFI) in the community (see Sep 08 and University (SACN 2008).
briefing paper for details of the initiative and the Stage One
relationship to obesity). There is evidence of accreditation by
improved initiation rates in hospital, but not of Oct 08.
widespread coverage of BFI in the community. We
are likely to be the first PCT to achieve this. Project
will be completed Dec 09 and will be maintained
through audit and training thereafter. Project is
being evaluated by Bristol University to add to the
5 Funding proposal developed to secure recurring Nov-08 Funding secured to develop robust In a few areas there are voluntary breastfeeding
funding through OPP for breastfeeding peer support peer support service. peer supporters associated with local
service targeting the wards with the lowest breastfeeding support groups. These peer
breastfeeding rates. schemes are on a small scale and they rely
virtually entirely on volunteers. Only a small
proportion of breastfeeding women can attend
such groups. UNICEF BFI standards
recommended by NICE Guidelines for Postnatal
Care(2006), NICE Guidelines for Maternal and
Child Nutrition (DH 2008), Scientific Advisory
Committee on Nutrition (SACN 2008).
6 Breastfeeding Welcome scheme, working with Mar-09 Number of establishments signed up to NICE maternal and child nutrition guidelines
NCT, breastfeeding groups, peer supporters, the scheme. (NICE March 08), Baby Friendly in the Community
council and local establishments to increase the Phase One of the project will be guidelines (BFI March 08), D of H Health
welcome for breastfeeding mothers in the wider internally evaluated and will monitor Inequalities progress and next steps (DH June
community - so far around 100 establishments are breastfeeding rates. 08). Paid peer supporters in Lancashire have
breastfeeding friendly. Phase two of the project will be been shown to increase breastfeeding
A breastfeeding peer support project to support externally evaluated using qualitative continuation rates (29% in 3yrs at 6-8 weeks and
mothers to breastfeed in the 8 wards with the lowest methods and breastfeeding rates. 100% exclusive breastfeeding rates at 6 months by
rates, will run from Oct 08-09. Bristol PCT is of health visitors will have completed BFI 21%). An action research project is concurrently
working in partnership with Barnardo's who have training. being carried out to explore parents and staff
employed the peer support co-ordinator. Aim of the views of breastfeeding support within 3 Children's
project is to strengthen peer support for Centres.
breastfeeding in local breastfeeding groups to help
more mothers to breastfeed for longer. Peer
supporters will have breastfed, live locally and will
have undertaken peer supporter training.
Funding needed for second phase of project which
will build on work of the PS Co-ordinator and also
employ paid local peer supporters to offer an
enhanced service to mothers in 3-4 of the wards.
Paid peer supporters will have enhanced training.
This part of the project will be externally evaluated.
If successful, phase three of the project will
focus on rolling out this project to the 7 areas
with the lowest rates.
PREVENTION: Healthy Schools Programme/Healthy Kids 2008/09
7 Continuation of the Cooking from Scratch By Feb 09 Evaluation forms will inform evidence Work in progress to be completed.
Programme - Key worker. base.
04a0c151-218d-48f4-b361-b1053df8faec.xls 4 7/4/2011
8 Healthy Schools Programme/Healthy Kids (see By Mar 09 Project plans from each of the 25 To support schools to build on 41 criteria using
briefing paper for description of impact on obesity) - schools involved will be submitted and local partnerships to facilitate behaviour change
91% of Bristol Schools have achieved minimum monitored at 6 monthly intervals (funding for those children and families with higher health
evidence standards. The ‘Transforming Food in subject to delivery/progress) to need therefore tackling health inequalities.
Schools Project’ has led to improvements in the demonstrate progress towards health
quality of school meals. behaviour change relating to PSA12 and
To recruit 25 schools to deliver Healthy Schools Priorities VSB09 and EX39 and 40.
Plus programme focusing on vulnerable children in
areas of high health need; to support local and city
wide health priorities. Provide first payment
9 Funding proposal developed to secure recurring Nov-08 Funding to be secured to develop the Evaluation of the pilot Healthy Kids Programme
funding through OPP for expanding the Healthy Kids Healthy Kids Programme to 21 schools shows positive behaviour change among the
Lifestyle Programme. in 2009/10 (with a high proportion of children participating.
children claiming free school meals).
10 95% of Bristol schools to hold Healthy Schools By Mar 09 National Healthy Schools Database Healthy School Programme is a universal health
status. Audit Tool. promotion programme which has four aims: To
To provide training and support to schools to Attendance records for training. support children and young people in developing
achieve or revalidate Healthy Schools Status - All school to have a development plan healthy behaviours (including physical activity &
maintaining 100% participation and at least 95% in place PSA12 and NI 52,55,56,57,198. healthy eating), to help raise the achievement of
achieving status. children and young people, to help reduce health
inequalities and to help promote social inclusion.
11 Achieve standards for 'Food other than Lunch' in By March 09 95% of schools to achieve standards. School food contributes significant proportion of
primary and secondary schools. Bristol City Council Client Unit daily macro and micro nutrient intake, ensuring the
monitoring visits. standards are adhered to will ensure that these
meet and do not exceed current recommendations
for children and young people.
12 Achieve the nutrient based standards target, By Sep 08/By Menus with supporting nutritional Current inconsistency in school meals across City,
compulsory in all primary schools. Mar 09 analysis from all school meal providers, Standards will ensure that 33% or RNIs for various
Implement a healthy lifestyles programme for Bristol City Council Client Unit school nutrients are provided and that maximum levels
children and young people targeting schools with based monitoring, School Food Trust for those nutrients known to be detrimental when
the highest number of children overweight at research, school based monitoring by in excess
reception and/or year 6. staff and pupils.
Identification of first 15 target schools
and base line data taken National
Weighing and Measuring Programme to
the target group via a series of lunchtime
and after school session, involving the
parent/carers where appropriate.
PSA12 and NI55,56,57,198.
13 Appoint a public health school nurse to work By Jan 09 To support schools and children's Early pilot studies and research evidence
specifically on healthy weight and to link closely centres to write and implement a whole suggests that children who have attended a
with Bristol Healthy Schools Programme. school/centre Food Policy covering Healthy Lifestyles Programme; building on whole
Appoint Healthy Eating Coordinator for Children education and training to promote school approach to developing healthier lifestyles,
and Young People as part of Healthy Schools healthier eating in line with the Eat Well involving parents and carers, has resulted in
Team. Plate and to ensure food served meets improved self-esteem, willingness to participate in
the National Schools Foods Standards. physical activity and a better knowledge of the eat
To support schools to implement well plate.
Healthy School Programme plans.
PREVENTION: Active Bristol - Physical Activity Strategy and Active Travel 2008/09
14 Start implementation of 'Bike It' (see briefing By Oct 08 2 Bike It officers will be appointed to Bike It is an intervention developed by the cycling
paper for details) in Bristol schools. start working with 24 Bristol schools by charity, Sustrans, which has shown to significantly
end of October 2008. increase cycling to school.
15 Appoint active travel officer to work with Children's By Jan 09 To be agreed with BCC.
PREVENTION: Childhood Obesity Care Pathway - Development of Treatment Services 2008/09
16 Funding proposal to be developed for further By Oct 08 Funding secured to support the Tier 2 Healthy Weight Services Bristol’s Mind,
funding beyond Apr 09 for the 12 week Bristol’s ongoing work of the MEND programme Exercise, Nutrition and Do It! (MEND) programme
Mind, Exercise, Nutrition and Do It! (MEND) and/or children's healthy weight is coordinated by BCC Culture Leisure and Sport.
programme. programme based on similar model. The programme enables overweight children (7-13
yrs) and their families access to fun, effective and
practical lifestyle solutions to achieving a healthy
weight. Each programme lasts for 12 wks and
includes sessions on healthy eating and physical
activity as well as behaviour change advice.
Funding for 21 programmes from Feb 07 to Apr 09
has been secured from the Big Lottery Wellbeing
fund with dietetic support being funded by Bristol
PCT. In 2007/08 107 children received support
through the scheme and mean BMI change was -
0.73 with a mean weekly increase in physical
activity of 4.3 hours and a drop in sedentary
activities of 4.7 hours a week. Recruitment from
ethnic minorities is good, with an average of 39%
from various ethnic origins largely due to the
location of the programme in central Bristol.
17 Funding proposal to be developed for expansion By Oct 08 Funding secured to expand the A consultant led childhood obesity clinic has been
of community childhood obesity clinics dependent ongoing work of community childhood running in Bristol for 8 years. In Apr 08 2
on evaluation of existing services. obesity clinics. community childhood obesity clinics started in
Model dependant on outcome of Knowle West and Horfield as part of a feasibility
feasibility study in Bristol. study funded by the DH. These will continue for 18
months. Referrals are accepted from GPs and
school nurses. It is envisaged that results of the
evaluation will inform future service provision. The
clinics currently run in only these 2 areas of Bristol
but there may be opportunities to expand the
service, depending on the outcomes and funding
(i.e. weight loss and patient satisfaction).
04a0c151-218d-48f4-b361-b1053df8faec.xls 5 7/4/2011
18 Development of childhood healthy weight care By Mar 09 Childhood Healthy Weight Care
pathway for consultation. Pathway produced, agreed and staff
trained in its use.
PREVENTION: Children Centre Public Health Work Programme 2009/10
19 Recruit a dietician as an Early Years healthy Apr-09 Co-ordinator in post. Currently healthy eating advice is sought from
eating co-ordinator/advisor/trainer to work across various agencies, a dedicated post will ensure a
PCT & Local Authority. whole settings approach to food policy. Uptake of
Healthy Start is low.
PREVENTION: Breastfeeding 2009/10
20 Achieve BFI Level 3 accreditation. By Oct 09 Bristol PCT will have achieved full BFI Bristol will be the first city in England to achieve
accreditation by October 2009. UNICEF BFI status if this target is achieved.
21 Establishment of a Bristol-wide Peer Scheme to Phase one by 1,000 new mothers in the most
support mothers to breastfeed in the 10 wards with Oct 09. Second disadvantaged wards of Bristol will
the lowest rates. phase (pilot) receive breastfeeding peer support.
Oct 09-Apr 11
22 Expansion of the Breastfeeding Welcome Here Ongoing and All 28 libraries and 6 museums will
Scheme. focused around participate in the scheme.
Week in May
PREVENTION: Food and Health Strategy 2009/10
23 Expansion of the Cooking from Scratch Mar-10 Statistics on numbers and age groups To increase fruit & vegetable consumption.
Programme. Continue to develop and expand the will be collected, follow up evaluation will
Cooking from Scratch project to include other gauge success.
community food initiatives.
24 Cooking skills training for parents in Children’s Mar-10 Develop cooking skills / nutrition
Centres. The aim is to improve the nutritional status training for parents in 6 children's
of children under 5 by equipping parents with centres.
practical cooking skills.
25 Development of Food Cooperatives to improve Mar-10 Number of food cooperatives in Bristol.
access in disadvantaged areas to healthy food (in Number of people accessing fruit &
particular fruit and vegetables). vegetables through schemes.
Establish a food cooperative in North and Inner Evaluation to be commissioned.
city Bristol and expand the existing food cooperative Monitored annually through Bristol
in South Bristol. Quality of Life Survey for fruit &
PREVENTION: Healthy Schools Programme/Healthy Kids 2009/10
26 Achieve the nutrient based standards target, 2009 Menus with supporting nutritional Current inconsistency in school meals across City.
compulsory in all secondary schools. analysis from all school meal providers, Standards will ensure that 33% of RNIs for various
Bristol City Council Client Unit nutrients are provided and that there are maximum
monitoring, School Food Trust research, levels for those nutrients known to be detrimental
school based monitoring by staff and when in excess.
27 To develop the Healthy Kids Programme in 21 Dependent of Dependent on securing recurring OPP See 19.
Bristol schools. funding. If funding. Programme will be implemented
secured by in 21 schools.
28 To provide training and support to schools to By Mar 10 National Healthy Schools Database See 7.
achieve or revalidate Healthy Schools Status - Audit Tool.
maintaining 100% participation and at least 95% Attendance records for training.
achieving status. School Development Plans PSA12 and
To complete Healthy Schools Plus projects with NI 52,55,56,57,198.
first wave 25 schools demonstrating healthier Project plans from each school
behaviours for vulnerable children in areas of high involved will be monitored at 6 monthly
health need; to support local and citywide health intervals (funding subject to
priorities. second and final payments made - £1250 delivery/progress) to demonstrate
/project. progress towards health behaviour
To recruit second wave of 25 schools to Healthy change relating to PSA12 and Priorities
Schools Plus Programme. Healthy Eating VSB09 and EX39 and 40.
coordinator for Children and Young People as part Second wave of schools will repeat
of Healthy Schools Team. process.
To support schools and Children's
Centres to write and implement a whole
school/centre Food Policy covering
education and training to promote
healthier eating in line with the Eat Well
Plate and to ensure food served meets
the National Schools Food Standards.
To support schools to implement
Healthy School Programme plans.
PREVENTION: Active Bristol - Physical Activity Strategy and Active Travel 2009/10
29 25% of phase 1 and 2 Children Centres will have Mar-10
a travel plan in place.
30 Implement 'Bike It' in selected Bristol schools (8 Jul-10 Bike It to be implemented in 8
additional schools). additional schools.
TREATMENT: Childhood Obesity Care Pathway - Development of Treatment Services 2009/10
31 Implementation of childhood healthy weight care Start Dec 09 Childhood Healthy Weight Care Children weighed and measured as part of the
pathway. Pathway produced, agreed and GPs, National Child Measurement Programme need
Practice Nurses and School Nurses options for referral. Existing and possible
trained in its use. treatment options require identifying and mapping
in the form of a care pathway and referral criteria
developed in order to prioritise patients for
04a0c151-218d-48f4-b361-b1053df8faec.xls 6 7/4/2011
32 Deliver 18 healthy weight programmes: 9 Mar-10 18 programmes delivered. Each
programmes for 5-8 years and 9 programmes for an programme is for 12 children a with one
older age group (9-13 years). Assuming funding parent.
secured through OPP.
33 Four new childhood obesity clinics will be Start Nov 09 12 families will be seen per week.
established in the community. Fully Once set up this would consist of approx
established Mar 6 new patients and 6 follow up per week
10 per clinic.
34 Development of a new obesity prevention 01/03/2010 Deliver a Healthy Weight programme
programme for children aged 2-4 years and their Dependent on in 10 out of 24 Children's Centres.
families . E.g. HENRI programme. OPP funding
PREVENTION: Children Centre Public Health Work Programme 2010/11
35 Cooking skills training for parents in Children’s 01/03/2011 Develop a weekly programme of Indications are that parents/carers would welcome
Centres. The aim is to improve the nutritional status Dependent on cooking skills / nutrition training in 8 support around dietary behaviour change.
of children under 5 by equipping parents with OPP funding additional children centres (16 childrens
practical cooking skills. centres in total for 2010/11).
PREVENTION: Breastfeeding 2010/11
36 Maintenance of UNICEF Breastfeeding Friendly Reassessment BFI status will be maintained in the
status in the community and in acute trusts. within 2 years hospital and community.
2010 100% of health visitors will be BFI
37 Expansion of Peer Supporter scheme & evaluation Mar-11 2,100 out of 5,800 new mothers will
from year 1. receive breastfeeding peer support.
38 Expansion of Breastfeeding Welcome Here Mar-11 An additional 20 cafes will become
Scheme. involved in the scheme.
PREVENTION: Food and Health Strategy 2010/11
39 Mainstream Cooking from Scratch project by Mar-11 Funding secured to develop robust Difficulty in hiring suitable kitchens determines
funding a mobile cooking kitchen. Dependent on peer support service. where courses can be delivered.
40 Expand the number of Healthy Weight Mar-11 Deliver Healthy Weight programmes in
Programmes being delivered in Children's Centres. an additional 10 children's centres.
41 Continue to expand the food cooperatives in North Mar-11 Increase in numbers of people
and inner city Bristol. accessing schemes.
PREVENTION: Active Bristol - Physical Activity Strategy and Active Travel 2010/11
42 50% of phase 1 and 2 Children Centres will have By Mar 11 12 Children's Centres will have a travel
a travel plan in place. plan in place.
TREATMENT: Childhood Obesity Care Pathway - Development of Treatment Services 2010/11
43 Implementation of childhood healthy weight care By Mar 2011 Childhood obesity clinics and MEND
pathway. Dependent on securing recurring OPP programme well established. 50% of
funding. families with an overweight/obese child
will be offered a healthy weight
44 Continue to run 4 community childhood obesity Mar-11 Assuming clinics are operational for 46
clinics and Bristol Children's Hospital clinic. weeks of the year, a total of 276 new
patients and 276 follow-up patients
would be seen per clinic per year.
45 Expand Healthy Weight programme (MEND). 36 Mar-11 18 programmes for 5-8 years and 18
programmes to be delivered: 18 programmes for 5- programmes for 9-13 years.
8 years and 18 programmes for 9-13 years.
D Total Investment
D1 Please provide details of the total new investment between 2009/10-2012/13:
D2 Please include comments if funding is subject to Operational Planning Process (OPP) approval:
Weight Management Treatment Initiatives: Recurring funding required 2009/10 = £540,000 Additional recurring funding 2010/11 = £106,000
Breastfeeding: Recurring funding required 2009/10 = £201,600 Additional recurring funding required 2010/11 = £122,000
Food and Health Strategy: Recurring funding required 2009/10 = £857,140 Additional recurring funding required 2010/11 = £464,000 Additional funding required
2010/11 = £475,000
Active Bristol: Recurring funding required 2009/10 = £525,000 Additional recurring funding required 2010/11 = £270,000 Additional recurring 2011/12 = £240,000.
Please note: The Food & Health Strategy and Active Bristol costs could be proportioned between the CVD Delivery Plan and Childhood Obesity Delivery
Costs for Childhood Obesity Delivery Plan only:
Food & Health Strategy: 2009/10 = £401,000 Additional recurring funding required 2010/11 = £304,000 Additional recurring costs 2011/12 = £350,000
Active Bristol: 2009/10 = £125,000 Additional recurring funding required 2010/11 = £55,000 Additional recurring costs 2011/12 = £62,500
E Partnership Arrangements
E1 Which organisations will help us deliver this plan? If key posts are part of another organisation please provide details:
An ‘obesogenic’ environment has developed in this country over many years. This environment must change if significant progress is to be made in tackling the
obesity problem. Achieving significant change depends on highly effective collaboration between stakeholders.
The existing stakeholders in the above strategies are primarily Bristol PCT, acute trusts and some departments of Bristol City Council.
To be effective in addressing childhood obesity, a much wider range of stakeholder participation is required.
Stakeholders should include local authorities, town planning, public transport, education, leisure services, acute NHS trusts, primary care, businesses, employers,
food producers, food retailers, media, hospitality industry underpinned by support from national government.
Partnership arrangements with the council are crucial. The Health and Wellbeing Delivery group, sub group of the Bristol Strategic Partnership, was responsible for
performance management of Bristol's healthy weight strategies and Active Bristol. The Health and Wellbeing Delivery Group has recently been disbanded and there
will be no further meetings. The Health and Wellbeing Partnership Board is to be formed shortly, and will take over the HWDG's role.
04a0c151-218d-48f4-b361-b1053df8faec.xls 7 7/4/2011
Triangle of Tiers
Figure 1: Hierarchy of the Childhood Obesity Care Pathway
Hospital Obesity Clinic
Community Childhood Obesity Clinics
1. Group sessions for overweight children (Exercise, nutrition,
behavioural intervention) / School Nurse Brief Interventions
Or 2. School Nurse Support
(self referral, GP / practice nurse / school nurse / health visitor)
e.g. Healthy Schools Programme, Children Centre Work Programme
04a0c151-218d-48f4-b361-b1053df8faec.xls 8 7/4/2011