promoting healthy weight, healthy lives for …...promoting healthy weight in children and families...

Children and young people’s strategic partnership Promoting Healthy Weight in Children and

Families group

Promoting healthy weight, healthy lives

for Lewisham children, young people

and their families

Strategy on childhood obesity

March 2010

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Contents

1. Policy context

1.1 Background

1.2 National policy

1.3 Local policy

2. Needs assessment

2.1 Key challenges to Lewisham

2.2 Estimating obesity prevalence

2.3 Referral to specialist weight management service

2.4 Eating and activity patterns of children in Lewisham

3. Rationale for strategy

4. Delivering action at a local level

5. Action plans

6. Equalities impact assessment

7. Governance

8. Appendix

9. References

Policy context summary.

1.1 Background

Obesity is a complex Public Health issue that is a growing threat to children’s health.

Childhood obesity is becoming an increasingly important issue in our local communities.

Data from the Health Survey for England 2007 showed that (nationally) 3 in 10 children are

either overweight or obese, and 1in 6 are obese. If current UK trends continue, one fifth of

boys and one third of girls will be obese (nationally) by 2020. In addition nearly a quarter of

English adults are obese with two thirds of men and over a half of women either overweight

or obese. 1

Obesity is increasingly linked to many serious health risks in both children and adults

including type-2 diabetes, cardiovascular problems, respiratory illnesses, joint and movement

problems and psychological disorders, such as depression, low self-esteem and disordered

eating. It is estimated that obesity reduces life expectancy by between 3-13 years. Children

who are obese are at an increased risk of becoming obese adults and they risk the early

appearance of obesity-related health problems normally associated with middle age. The

estimated annual cost to NHS Lewisham of diseases related to overweight and obesity is

£79.1 million for 2010.

Differences in the prevalence of obesity in children are seen with deprivation, ethnicity and

parental obesity. The prevalence of children at risk of obesity is higher in more deprived

areas, analysis of the London school measurement data2 revealed that the prevalence for

year 6 children was almost two-thirds higher in the deprived group, they also reported a

higher prevalence of obesity in children from Black ethnic minority groups. National data

show 22% of girls from the low income groups were obese compared to 9% in the highest

income group and children from Black ethnic minority groups and Pakistani boys were at

higher risk of obesity than the general population. Children from households where one or

both natural parents were classed as obese had much higher rates of obesity than children

from households where parents were classed as normal or underweight.

1.2 National Policy

A cross-Government strategy, led by the Department of Health and the DCSF: “Healthy

Weight, Healthy Lives: A Cross-Government strategy for England” was published in 2008. As

part of the Public-service agreement (PSA) on Child Health and Well-being the government

announced its ambition to be the first major country to reverse the rising tide of obesity and

overweight in the population by ensuring that all individuals are able to maintain a healthy

weight. The initial focus will be on children: by 2020 it aims to have reduced the proportion of

1 www.ic.nhs.uk Statistics on obesity, physical activity and diet: England, February 2009 2 www.lho.org.uk Weighty matters The London findings of the national child measurement programme May

2009

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overweight and obese children to 2000 levels. The strategy supports the creation of a healthy

society - from early years, to schools and food, from sport and physical activity to planning,

transport and the health service. It specifically focuses on five areas:

• The healthy growth and development of children

• Promoting healthier food choices

• Building physical activity into our lives

• Creating incentives for better health

• Personalised advice and support

In March 2010 the government published “Healthy Weight, Healthy Lives: Two Years On”,

this report reviews the progress on the delivery of Healthy Weight, Healthy Lives and

reinforces the priorities for future work to enable everyone in society to maintain a healthy

weight.

In recognition of the complexity of obesity there is increasing encouragement for the

partnership of the NHS, local authorities, schools, children and parents and other partners to

work together to tackle the issue from a holisitic perspective. To be successful every part of

society; individuals, communities and industry will need to recognise and address the

problem, the diagram below shows the role of the major sectors in tackling excess weight.

From: Healthy weight, healthy lives: a cross-government strategy for England 2008

The aim of the Healthy Weight, Healthy Lives strategy is one of promoting healthy weight for

the whole population, recognizing that individuals who are underweight will also need

support. The government’s initial focus is on tackling obesity and overweight in children. Any

strategy must ensure not just a multi agency approach but equally one which recognises that

tackling obesity and promoting healthy lifestyles in children can only be tackled in the context

of the whole family and society more broadly.

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Nationally the government has a number of programmes, some of which cut across services

and organizations, these include:

In early years:

• Healthy Child Programme

• Healthy Start Programme

• Start4ife

In schools:

• The Healthy Schools programme

• The Food in Schools programme

• The School Fruit and Vegetable scheme

• The Physical Education, School Sport and Club Links programme (PESSCL)

• Active travel and school travel plans

• Food promotion to children

Others:

• Healthy lives, brighter futures

• Be active, be healthy

• Healthy Child Programme for 5-19 year-olds

• Change4Life

1.3 Local policy

‘Shaping our future’ - Lewisham’s Sustainable Community strategy 2008-2020 is the

overarching plan for the borough. Its principles are:

• Reducing inequality- narrowing the gap in outcomes for citizens

• Delivering together efficiently, effectively and equitably – ensuring that all citizens

have appropriate access to and choice of high-quality local services

‘Shaping our future’ sets out the borough’s strategic priorities for the wider community, which

are:

• Ambitious and achieving – where people are inspired and supported to fulfil their

potential.

• Safer – where people feel safe and live free from crime, antisocial behaviour and

abuse.

• Empowered and responsible - where people are actively involved in their local area

and contribute to supportive communities.

• Clean, green and liveable – where people live in high quality housing and can care for

and enjoy their environment.

• Healthy, active and enjoyable – where people can actively participate in maintaining

and improving their health and well-being.

• Dynamic and prosperous – where people are part of vibrant communities and town

centres, well connected to London and beyond.

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The 2009-12 Children and Young People’s Plan (CYPP) underpins ‘Shaping Our Future’ –

and sets out how partnership agencies working with children, young people and their families

will support the delivery of the borough’s priorities. The Children and Young People’s plan

has identified four key areas for impact for the next three years.

These are:

• Early Intervention and support for families

• Raising aspirations and closing the gaps

• Reducing child poverty and its impact

• Strengthening the positive influence of young people

Reducing childhood obesity is a Lewisham children and young people’s strategic partnership

priority, both in the current and new (2009-2012) plans. Levels of obesity are measured

against national indicators within our Local area agreement with targets set for each as:

• NI 55 - By 2011 to ensure that childhood obesity reduces to 25% for Year 6

pupils, given that obesity levels are predicted to rise in 2009 for Year 6 pupils

(LAA local indicator).

• NI 56 - By 2011 to reduce childhood obesity to 11%, given that current levels are

predicted to rise in 2009, for Reception Year pupils (LAA target)

• NI 52 – Increase the % of pupils who take school lunches to 54% by March 2011

• Improve the take up of Free School Meals to 88% by Summer 2010.

• NI 57 – Increase the % of 5-16 year olds participating in at least 2 hours per week

of high quality sport to 91% by March 2011

• NI 53 – Increase the prevalence of breastfeeding at 6-8 weeks from birth to 66%

by Jan-Mar 2011

Consultations with children and young people through student councils have highlighted

obesity and healthy living to be a concern to children. They report that eating healthily is very

important and that we should make reducing childhood obesity a priority.

The Children and Young People’s plan for 2009 to 2012 has “the reduction of childhood

obesity” (BH4) as a key priority. The plan states that we will:

• Target resources and services to identified areas of the borough where need is

greatest.

• Work with families in Children’s Centres and schools to promote healthy eating

and physical activity.

• Build on Healthy Schools status and extended school services activity to promote

healthy weight and healthy activity and allow targeted support to children and

young people at risk of obesity.

• Increase the take up of school meals whilst delivering to the nationally set

nutritional standards.

• Work with School Sports Partnership and other sport and physical activity

providers to promote sport and physical activity to children and young people and

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their families.

• Promote national campaigns such as Change4life to Lewisham residents.

• Implement a care pathway for children with weight management issues.

• Commission age specific and targeted weight management programmes,

including programmes that support both children and their families to create

sustainable lifestyle changes.

• Ensure children are as healthy as possible at birth, including promotion of

breastfeeding and preparation towards Baby Friendly status across the borough.

The action plans of the Promoting healthy weight, healthy lives for Lewisham children, young

people and their families strategy expand on how the partnership will meet the above

objectives and provide detail and targets for these actions.

The Lewisham Healthy Weight, Healthy Lives strategy recognises that tackling the issue of

weight requires us to understand the multitude of influences on people’s lifestyles which

affect the access to and understanding of healthy and affordable diet and access and

encouragement to participate in physical activity. This fits within Lewisham’s early

intervention ethos and family support and parenting approaches, all of which underpin the

priorities in the Children and Young People’s plan 2009 -2012.

In order to effect change therefore the partnership expect a wide ranging approach which

includes collaboration with other areas of Lewisham policy including, but not restricted to:

Physical activity strategy

A Five year plan, to help bring together organizations which will work in partnership to

sustain sport and physical activity in Lewisham. The aims are;

• To increase participation in physical activity and

• To enable the Lewisham community to develop its potential in sport

• To develop an appropriate infrastructure of facilities.

Open space strategy Provides an overarching review of open space in the borough, its aims are;

• To protect open space in Lewisham from inappropriate development

• To enhance and improve the level of quality of open space in Lewisham

• To raise awareness of the social, economic and environmental benefits of sustainability

• To improve accessibility of open spaces to promote greater social inclusion

• To build on the role that open spaces offer in sustaining the health and well-being of residents

• To reduce the Fear of Crime in open spaces, making Lewisham a safer place

• To adopt the Open Spaces Strategy as Supplementary Planning Guidance.

Play and recreation strategy

Key principles

• Play should be freely chosen

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• Play facilities or activities provided are safe

• Play provision must be well planned in partnership with children and young people

• Play in whatever form in Lewisham must not discriminate

• Play will foster independence and healthy self esteem.

Food Strategy

The overall aim of the food strategy is to increase the health and welfare of Lewisham people

through improved access to nutritious and safe food from a more sustainable food chain.

The strategy consists of five sections:-

1. Food access

To reduce the physical, economic, social, cultural and educational barriers which prevent

people in Lewisham from accessing food, which will improve their health and well-being.

2. Food in schools

To increase the health and welfare of children in Lewisham schools through improved access

and awareness of a healthy diet, food safety and sustainable food.

3. Food, nutrition and health

To contribute to long term improvements in the diet and nutrition of people in Lewisham and

the reduction of nutrition related ill health and disease in the borough.

4. Food sustainability

To achieve a more sustainable food chain in Lewisham by improving the sustainability of

food transported, sold and consumed in the borough.

5. Food safety

To ensure the safety, composition and information provided about foods produced, imported,

sold and consumed in Lewisham, and to reduce the incidence of food poisoning.

Sustainable mode of travel strategy for schools

The objectives of this strategy are:

• To make cycling and walking safer and more attractive

• To increase bus use amongst the school population

• To reduce congestion around the school area

• To develop partnerships with schools, their communities and other organizations and

to promote the development of school travel plans

• To promote road user safety through education and training

• To promote the health benefits of walking and cycling

• To promote more sustainable travel choices by ensuring new educational

establishments are accessible by walking, cycling and public transport.

Regeneration and planning

Lewisham’s regeneration strategy is the vision for the future of the borough from 2008-2020

based on 3 themes, people, prosperity and place with 12 key objectives for the delivery.

People

• To celebrate Lewisham’s diverse community and strengthen cohesive communities

• Healthy communities- to reduce health inequalities and encourage healthy lifestyles

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• Young communities- to invest in children and young people

• Creative communities- to support and develop creativity in young people.

Prosperity

• Creative growth- encourage and support creative businesses

• Education and skills growth- to invest in education and skills

• Business enterprise and jobs growth- provide access to jobs and business support for

local people.

Place

• Evolving environment- ensure new development is to the highest standards of design

and sustainability

• Liveable environment- provide decent homes for all residents

• Protected and managed environment- protect and manage special areas of

Lewisham

• Accessible environment – provide accessible, convenient and safe transportation

networks

• Safe environment – reduce crime and improve community safety.

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2. Needs assessment

2.1 Key challenges for Lewisham

Lewisham is the third largest inner London borough in terms of population. The population of

Lewisham has a high proportion of young people, with nearly a fifth of the population under

15, estimated at 49,002 for 2009, of these 19,762 are children under 5 years (7.5% of the

population). The population is forecast to grow over the coming years.

The borough is the 15th most ethnically diverse local authority in England with over 170

different languages spoken, overall 40% of all Lewisham residents are of Black and minority

ethnic origin. It is projected that by 2020 the percentage of residents from Black and minority

ethnic groups will have increased to 44%. Lewisham has a high proportion of children and

young people from black and ethnic minority groups (59% of under 15), with the highest

ethnic groups being Black African (17.6%), Black Caribbean (13.8%) and Black Other

(13.2%) with under 15% from all other ethnic groups.

Lewisham has the highest proportion of lone parent families in London, with 17.8% of all

households’ lone parent families, this compares to 11.6% for Inner London and 7.2% for

England.

It is the 39th most deprived local authority in the country, 8 out of Lewisham’s 166 Super

Output areas are in the 10% most deprived and 64 are in the 20% most deprived in the

country.

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2.2 Estimating obesity prevalence for children in Lewisham

Currently there are two resources available to estimate the prevalence of childhood obesity;

1. Results from the National Child Measurement Programme (NCMP)

Data from the National Child Measurement Programme (NCMP) provides information on the

prevalence of obesity for children in Reception (aged 4–5 years) and Year 6 (aged 10–11

years) to assess overweight and obese levels. The national target for participation rate in the

national child measurement programme was exceeded in 2007/08 and 2008/09, which

means Lewisham now has 2 years robust data for the prevalence of childhood obesity for

both reception and year 6 children.

Data for Lewisham shows that in 2007-08, 10.6% of Reception year children were at risk of

obesity as were 25.3% of Year 6 children. When at risk of overweight and obesity are

combined 25 % of Reception children and 40% of Year 6 children are affected.2 In Lewisham

in 2007/08 the proportion of children at risk of obesity in reception year was not significantly

different to London or the England average. In year 6 the proportion of children at risk of

obesity was significantly higher than the London and England average.

Table1.1 Results of Lewisham NCMP 2007/08 compared to London SHA and England results

School year Area Underweight

%

Overweight

%

Obese

%

Overweight

and Obese

%

Reception Lewisham 1.0 14.4 10.6 25.0

London 1.8 12.0 10.9 22.9

England 1.3 13.0 9.6 22.6

Year 6 Lewisham 1.2 14.7 25.3 40.0

London 1.8 14.7 21.6 36.3

England 1.4 14.3 18.3 32.6

Prevalence of obesity in both reception and year 6 in 2008/09 remain significantly above the

England average and are similar to our statistical neighbours. Prevalence of obesity in

2008/09 was lower in year 6 (22.1%) and higher in reception (12.0%) compared to the

previous year but these changes were not statistically significant. Currently there is

insufficient data to determine a trend in childhood obesity rates for Lewisham. When at risk of

overweight and obesity are combined 25.2 % of Reception children and 37.3% of Year 6

children in Lewisham are affected. It is for this reason that tackling obesity remains a key

priority in Lewisham.

2 Obesity is defined using the UK National Body Mass Index (BMI) classification, with obesity defined as a BMI

more than 95th centile and overweight as more than the 85

th centile of the UK 1990 reference chart for age and

gender

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Table1.2 Results of Lewisham NCMP 2008/09 compared to London SHA and England results

School year Area Underweight

%

Overweight

%

Obese

%

Overweight

and Obese

%

Reception Lewisham 0.7 13.2 12.0 25.2

London 1.3 12.4 11.2 23.6

England 1.0 13.2 9.6 22.8

Year 6 Lewisham 1.0 15.2 22.1 37.3

London 1.6 14.7 21.3 36.0

England 1.3 14.3 18.3 32.6

Analysis of the 2007/08 NCMP results for London2 revealed that for both reception and year

6 the prevalence of children at risk of obesity and overweight (but particularly obesity) tended

to be highest in the more deprived areas. Children from black ethnic minority groups in both

year groups were at significantly higher risk of obesity than other ethnic groups. The report

indicated that the differences between ethnic groups are likely to relate specifically to

physical characteristics such as height and that ethnicity may not be strongly linked with the

risk of obesity. This can have a potential confounding effect on the prevalence rates of

obesity. When Lewisham NCMP results for year 6 was compared to national data by

ethnicity, rates for Lewisham were higher than the England average for White, Black, Asian

and Mixed ethnic groups.

Year 6 Lewisham Black 28.2% White 23.9% Asian 28.7% Mixed 22.4%

England Black 26.4% White 17.3% Asian 21.5% Mixed 20.4%

No area in Lewisham is significantly different to the Lewisham average for children at risk of

obesity for any of the ethnic groups.

2. Obesity prevalence ready-reckoner (based on Health Survey for England 2006)

This resource uses the same definition for obesity as the NCMP and is used to estimate the

prevalence of obesity in children aged 1 to 15 years based on the population estimates for

the borough.

Extrapolating to Lewisham population this estimates that in 2009 there are in Lewisham:

• 8,573 children aged 1-15 years at risk of obesity which includes

• 2,595 children aged 1-4 years at risk of obesity

The ready-reckoner is based on national data and does not take into consideration ethnicity,

deprivation or location that might affect obesity prevalence, thus the estimates for Lewisham

are likely to be underestimated. Local factors that are likely to increase the prevalence of

obesity in Lewisham include;

• a high percentage of children from black and minority ethnic groups,

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• deprivation score significantly worse than the England average with 37.9% of people living in 20% most deprived areas of England.

Table 1.3 2009 estimate of number of children aged 1-15 years who are obese in Lewisham

Age

Male

Male

obese

Female

Female

obese

1 2,165 375 2,075 332

2 2,039 355 1,961 333

3 1,947 333 1,862 309

4 1,739 287 1,674 271

5 1,641 272 1,592 264

6 1,561 259 1,476 241

7 1,456 237 1,452 245

8 1,536 263 1,447 255

9 1,468 264 1,451 263

10 1,457 267 1,388 260

11 1,466 283 1,446 282

12 1,444 277 1,489 305

13 1,333 277 1,403 296

14 1,369 282 1,365 300

15 1,333 288 1,326 298

Subtotal 23,954 4,319 23,407 4,254

(Formulae for obesity based on the Health Survey for England 2006)

The number of young children in the borough is increasing year by year, with a projected

population growth in Lewisham between 2008-2014 particularly in 0-4 years (% compound

growth 8.4%) and 5-14 (% compound growth 4.6%) Incidence of obesity in children

increases with age, but due to the higher number of young children in Lewisham there are a

similar number of obese children for each age.

2.3 Referral to specialist weight management services

Of the estimated 8573 children aged 1-15 years at risk of obesity in Lewisham (2009 figures),

there will be a proportion with needs requiring support beyond that which can be provided by

general preventative measures, school nurses and general practitioners.

This group of children includes those who are extremely obese, or who have medical

conditions secondary to obesity or who have co-morbidities such as a physical or learning

disability or another underlying chronic disease or psychological problem. There may also be

a small minority of children who may have a medical condition causing their obesity such as

Prader Willi syndrome, Cushings and monogenic causes. Some of the community

programmes designed to manage obesity would have to exclude these children on the

grounds of their co-morbidity as they are unable to deal with their complex needs.

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These children make up the tip of the obesity triangle and although the numbers will be

comparatively small, their management remains an important part of the obesity care

pathway as it is these children who are most likely to suffer the adverse consequences of

their unhealthy weight and cause health care workers the most concern. Stakeholder

interviews identified the need for a specialist weight management service for children and the

proposed weight management care pathway for children (section 4) includes a specialist

service for children delivered by healthcare professionals with specialist knowledge of

childhood obesity.

Estimated demand for a specialist weight management service for children

The clinical definition of overweight and obesity in children recommended by NICE (2006) is:

Overweight: BMI more than 91st centile of the UK 1990 reference chart for sex and age.

Obesity: BMI more than 98th centile of the UK 1990 reference chart for sex and age.

Children on the 99.6th centile (3 standard deviations from the mean), are classed as very

obese.

From the 2007/08 Lewisham child measurement data on reception and year 6 pupils the

number of children who met the clinical definition of overweight and obesity are shown in the

table.

Table 1.4 Number of children identified as overweight or obese (based on clinical

definition 2007/08 NCMP)

Total pupil

numbers

91st – 97th

centile

overweight

98th -100th

centile

obese

>99.6th centile

Very obese

Reception 2625 248 222 80

Year 6 2522 328 520 165

Children with special needs

Limited information is available for this group of children in Lewisham. A small study on

children with severe physical and learning disabilities conducted by the community paediatric

team in 2004 revealed a problem with underweight and obesity in this client group.

2.4 Eating and activity patterns of children in Lewisham

Lewisham has commissioned a survey conducted by the Schools Health Education Unit

(SHEU) that includes self-reported information on the eating and activity patterns of children

biannually since 2004. The survey collects information on children in years 4 (ages 8-9), 6

(ages 10-11), 8 (ages 12-13) and 10 (ages 14-15). In 2008 a total of 2244 children

participated in the survey.

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Headline results for Lewisham school children in 2008 included

Primary schools

• 4% had nothing to eat or drink for breakfast on the day of the survey

• 6% ate no fruit or vegetables the day before the survey, 35% ate 5 or more portions (improvement between surveys)

• 60% ate fresh fruit, 46% vegetables, 23%crisps, 26% sweets and chocolates on most days

• 82% enjoyed physical activities

• 5% had low self esteem scores

SHEU reported that Lewisham children are more likely to make healthy food choices than the

wider national sample.

Secondary schools

• 25% of year 10 and 21% of year 8 girls had nothing to eat or drink for breakfast on the day of the survey

• 50% of year 8 girls said they would like to lose weight (increase from 2006)

• 33% of year 8 reported not eating a lunch on the day of the survey (increase from 2006)

• 39% ate fresh fruit, 40% vegetables, 15% chips, 23% crisps, 31% sweets and chocolates on most days

• Most common leisure activities after school on the day before the survey were watching TV and playing computer games

• 2% had low self esteem scores

SHEU reported that Lewisham children are more likely to say they had nothing for lunch than

the wider national sample.

Nationally the consumption of fruit and vegetables by children aged 5-15 years has

increased over recent years with 22% of boys and girls eating five or more portions of fruit

and vegetables a day in 2007. Children from lower income households were less likely to

reach the 5 a day recommendation.

School meals

The latest figures (December 2009) for the percentage of children eating school meals are;

• Primary pupils taking a school meal - 57%

• Secondary pupils taking a school meal - 30%

Uptake of free school meals

• Primary taking a free meal - 87%

• Secondary taking a free meal - 79%

Compared to national data the percentage of pupils who have school meals in Lewisham is

higher in primary schools (57% compared to 43% nationally) but lower in secondary schools

(30% compared to 37.6% nationally).

Healthy schools

As of March 2010

• 59 out of the 69 primary schools (86%) in the borough had achieved Healthy School status with another 10 actively working towards Healthy School status.

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• 12 out of 14 secondary schools (86%) had also achieved Healthy School status with another 2 actively working towards Healthy School status.

• Of the 87 schools in Lewisham 83% have achieved Healthy School status.

To fulfil the criteria for Healthy School status schools have to provide examples of qualitative

and quantitative impact/outcomes on the 4 core themes which include healthy eating and

physical activity. In December 2008 the Lewisham Healthy School team collected data from

self-validation forms completed by schools together with responses from a questionnaire

sent to schools to assess the impact of the National Healthy School Programme.

Results suggested;

• Increase in uptake of school meals (including free school meals)

• Quality of packed lunches has improved

• Children and young people choosing to eat more fruit and vegetables

• Healthier snacks eaten at school

• Children and young people have a more positive attitude to physical activity

• Number of children and young people missing lessons has decreased

• Range of physical activities at lunchtimes has increased

• Number walking to school has increased

• Number cycling to school has increased.

School sports survey

The 2008 survey revealed that 84% of pupils in Lewisham participated in at least 2 hours

high quality PE lessons and out of school activities which is comparable to national data.

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3. Rationale for strategy

The Healthy Weight, Healthy Lives strategy and action plans for Lewisham are based on;

• National Institute for Health and Clinical Excellence (NICE) clinical guideline 43

Obesity: guidance on the prevention, identification, assessment and management of

overweight and obesity in adults and children (2006)

• Foresight tackling obesities: future choices-project report (2007).

In simple terms obesity is caused by an imbalance between energy intake and energy

expenditure, where intake is greater then expenditure. The reasons for the recent worldwide

increase in obesity are complex; the individual’s biology, eating and activity habits are

influenced by external social and environmental factors where an abundance of food and

increased sedentary behaviour is common. Foresight identified 108 variables that directly or

indirectly influenced energy balance and produced the obesity system map with these

variables grouped into seven themes.

1 Biology

2 Individual psychology

3 Food consumption

4 Individual activity

5 Food production

6 Activity and environment

7 Societal influences

These variables are highly interconnected and the map below confirms the complexity of

obesity intervention. Foresight suggests that the approach that is needed to halt the

increasing prevalence of obesity will need to be long-term, broad and diverse with the focus

on promoting achievement of a healthy weight.

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Source: The Foresight, tackling obesities: future choices project report 2007

The strategy will encompass prevention and treatment of obesity for the whole population of

Lewisham as part of a long term plan to promote healthy lifestyles in the borough and to be

effective has where possible incorporated all seven themes into the strategy. It is planned

that the impact of any intervention will be strengthened by the range of policies in Lewisham

that will act as enablers and amplifiers and support such as;

• Sustainable community strategy

• The Lewisham Food Strategy

• Open Space Strategy

• Physical activity strategy

• Play and recreation strategy

• Sustainable mode of travel strategy for schools

• Regeneration and planning strategy.

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Fig 1 Role of enablers and amplifiers on the impact of interventions

Source: The Foresight, tackling obesities: future choices project report 2007

The NICE obesity guidelines provide the most current evidence addressing both the

prevention and treatment of obesity in adults and children. Its recommendations state that

the prevention of obesity should be a priority for all and provides recommendations for the

NHS, early years, schools, local authorities, employers and the public.

Its focus is on ways of improving diet and increasing physical activity with emphasis on how

the social and physical environments can be made healthier places.

Effective interventions should be multi-component, involve partnership working and provide a

targeted approach. Key priorities for implementation in Lewisham and examples of targets

are included in the following table.

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Table 1.5 Key priorities for implementation of NICE recommendations in Lewisham

Key priorities for implementation Target

Local authorities and their partners

in the community

Concerns about transport, safety and

services have a huge impact on

people’s ability to eat healthily and take

exercise.

Policy and planning

Encourage active travel

Promote and support physical activity

Promote healthy foods

Community programmes

Self help, commercial and community

programmes

Early years settings

Pre-school years are a key time for

shaping attitudes and behaviours

Improve physical activity levels

Provide healthy diet

Involve parents and carers

Schools

Helps children develop healthy

lifestyles, better achievement at school

School policies and school environment

Staff training

Links with relevant organizations and

professionals

Interventions

Workplaces

Create culture that supports healthy

eating and physical activity

Policies and working practice

Building design

Education and promotion

Public

Improves health and reduces risk of

some diseases

Reinforce messages on healthy eating

and activity

NHS

Ensure systems in place and dedicated

resources to implement local strategy

Implement obesity strategy

Prevention

Obesity care pathway

Source adapted from NICE guidelines on obesity 43

Preventative action to tackle overweight and obesity needs to take a lifelong approach.

Foresight identified specific points during the life course where opportunities to influence

behaviour exist, these are;

• periods of metabolic change (early life, pregnancy and menopause),

• times of spontaneous behaviour change (leaving home, becoming a parent)

• significant shifts in attitudes (peer group influences, diagnosis of ill health)

and the strategy will aim to target these specific points, further details are provided in the

following table.

22

Table 1.6 Critical opportunities in the life course to influence behaviour

The Healthy Weight, Healthy Lives: Consumer Insight Survey provides information on

families’ attitudes and behaviour in relation to diet and activity. Families with children aged

between 2 and 10 could be divided into six clusters:

Cluster 1. Lacking time, money and knowledge

Cluster 2. Lack the knowledge and parenting skills to improve their families lifestyle

Cluster 3. Affluent, overweight families who over-indulge in unhealthy foods

Cluster 4. Living healthily

Cluster 5. Strong parenting skills but need to make changes

Cluster 6. Plenty of exercise but too many bad foods

Clusters 1, 2, 3 and 5 were found to be most ‘at risk’ of developing obesity and these clusters

had the highest rates of adult and child obesity. These four clusters have been prioritised for

national action within the Change4Life social marketing campaign. This information will also

be used to inform local interventions to deliver effective targeted services. (A summary of the

key characteristics of each cluster and their location and distribution in Lewisham is provided

in appendix 1).

23

4. Delivering action at a local level

The Lewisham Healthy Weight, Healthy Lives strategy is linked in to the Children and Young

People’s plan and is a partnership strategy. The Promoting Healthy Weight in Children and

Families group is a multi-agency partnership group responsible for the delivery of the agreed

actions for reducing childhood obesity, and is a sub-group of the Children and Young

People’s Strategic Partnership Board.

The strategy on reducing childhood obesity is part of a long term plan to promote healthy

lifestyles for the whole population of Lewisham. Based on national and local guidance priority

areas for 2009-2011 are:

1. Children and young people

- families with children aged 2-11 years

- young people aged 12-18 years

2. Adults

3. Building physical activities into lifestyles

Action plans for 2009-2011 have been developed for priority 1, Children and young people

which are multi-component, involve partnership working and take a lifelong approach. The

action at a local level will be evidence based and focused around the five key themes

previously identified in section 1.

1. The healthy growth and development of children – early prevention of weight

problems to avoid the ‘conveyor-belt’ effect into adulthood

2. Promoting healthier food choices – reducing the consumption of foods high in fat and

sugar and salt and increasing consumption of fruit and vegetables

3. Building physical activity into our lives – getting people moving as a normal part of

their day

4. Creating incentives for better health – increasing the understanding and value people

place on the long-term impact of decisions

5. Personalised advice and support for individuals who already have weight problems –

complementing preventative care with treatment

The action plans for the universal services of promoting healthy weight for all children are

divided into 7 work streams as shown below and cover key themes 1 to 4.

24

Fig 2 Universal action plans

In addition local initiatives will apply the Department of Health national social marketing

Change4Life campaign to support behaviour change among families. The main message of

the campaign is ‘Eat well, move more, live longer’. The Change4Life logo will be added to

existing and new materials and Change4Life resources will be used to promote healthy

eating and physical activity with families in Lewisham so that the strategy aligns with the

national campaign.

To deliver the strategy it will be necessary to address the training needs of the workforce so

that all partners are aware of their roles in promoting the benefits of a healthy weight. There

is a need for both health and non-health professionals to be trained to deal sensitively with

the issue of overweight and obesity. A number of training programmes are available that

meet the needs of these different staff groups.

The proposed weight management care pathway for children includes prevention, treatment

and management of overweight and obesity for children who are already identified as

overweight or obese. This will be used as the basis for the development and commissioning

of services.

Universal

Promotion

of

Healthy

Weight

for all

Children

National Child Measurement Programme

and Data

Maternity

Early Years

Leisure / Sport / Environment

Lewisham Food Strategy

Workforce Training and Communication

Schools

Level 3

Specialist Weight

Management

Service

Specialist Weight Management Service

For children with a BMI above 98th centile

with co-morbidities or complex needs � Multicomponent interventions- address behaviour change,

barriers to weight loss, healthy eating and physical activity � Delivered by health care professionals with specialist

knowledge of childhood obesity � Family based approach � Referral to paediatrician for further assessment � For children who have already attended Level 3

services and need additional support regular and long term follow up by health care professionals with specialist knowledge of childhood obesity and option of medication or referral to tertiary care

Level 2

Community Based

Healthy Lifestyle and

Weight Management

Support

Community Based Healthy Lifestyle and

Weight Management Support

For children with a BMI above 91st centile � Address behaviour change, healthy eating and physical

activity � First line individual intervention by healthcare

professionals � Individual sessions with dietitian (under 8 years) � Family lifestyle improvement programmes delivered by

trained workers supported by health care professionals � Family based approach � Core programme of support to nominated schools by

‘healthy weight’ school nurse and advisor

Level 1

Brief Intervention

and

Prevention

Brief Intervention and Prevention

Population based approach for all children with

a BMI below 91st centile Universal services - promote healthy eating, increased physical activity and reduce sedentary behaviour, which include: � Early years settings - engage families in healthy lifestyles � Schools - Healthy Schools programme, whole school food

policies, school travel plans, school sports partnerships � Health promoting environment – green spaces, active travel � Training for frontline staff � Borough wide food and nutrition policies and resources to

support staff working with families � Signposting to community activities � Change4Life

Specialist obesity and community weight management services to be commissioned

Proposed weight management services for children-draft

Lewisham Healthy Weight, Healthy Lives Action plan 2009-2011

Priority areas for 2009-2011 based on national and local guidance are:

1. Children and Young people

- families with children aged 2-11 years - young people aged 12-18 years

2. Adults

3. Building physical activities into lifestyles

Priority 1 Children and young people

The action plans are divided into

- (a) promotion of healthy weight for all children (Universal) - (b) weight management services- targeted - (c) weight management services - specialist

Universal

Targeted

Specialist

Promoting Healthy Weight in Children and Families Task Group

Multiagency task group meets quarterly to discuss and formalise work around healthy weight, healthy lives in Lewisham.

All universal objectives in the action plans are agreed by the group which is responsible for the delivery of the agreed actions.

(a) Promotion of healthy weight for all children (Universal)

a.1 NCMP/Data Action Outcomes Timescale Leads

1

Complete weighing and measuring

of eligible Reception and Year 6

children in schools

To meet minimum participation rate of

eligible pupils set by DoH (85% 2008/09)

During school

year

HW school nurse

2 Uploading of data to Dept Of

Health that meets quality

guidelines

Accurate data for analysis By deadline set

by DoH

HW school nurse

3 Parental feedback for all children of

individual results

Letters provided to Reception and year 6

children

6 weeks after

individual

measurements

HW school nurse

4 Develop guide for parents based

on Change 4 Life brand to

accompany NCMP letter

Families aware of local initiatives to

encourage healthy lifestyles

Sent with NCMP

letter

HW school

nurse/HW schools

advisor/HW strategy

manager/LBL sport

and leisure

service/Health

improvement Team

5 Feedback to school of individual

results and comparison to England

average

Letter provided to all primary school, and

input at headteacher forum

By end of school

year

HW strategy

manager/ PCT/LA

6 Analysis of data by PCT and

produce report of PCT analysis

PCT to begin analysis of data

Report of NCMP data at PCT level

Data available

Dec

Report ready

March

PCT Information

analyst

7 Produce user friendly version of

NCMP data

Brief report available to relevant partners Brief version

available by April

Information analyst/

HW strategy

manager

8 NCMP action plans/targeted

schools for the next school year

Agree plan based on recommendations of

report

Annually in June Public health/ HW

school nurse/ HW

schools advisor

9 Produce dashboard of datasets to

help monitor progress of healthy

weight strategy

Dashboard to be produced quarterly and

provided to PHWCF group

Quarterly reports PCT/LA Information

analyst

10 Mapping of NCMP data e.g.healthy

schools, extended services, PE

and school sports

Annual report to inform potential

relationships with healthy weight agenda

Annual report in

April

PCT Information

analyst

11 Audit data on obesity prevalence in

pregnancy

Determine service requirement for weight

management in pregnancy

March 2010 Midwives/HWHL

strategy manager

a.2 Maternity

Action Outcomes Timescale Leads

1

Promoting healthy weight gain

during pregnancy at ante natal

visits

Improved outcomes for mother and baby

(NICE guidelines )

Ongoing Midwives/Consultant

Midwife PCT

2 Promote access to Children’s

Centres during pregnancy

Increased number of families registering

with children’s centres

Ongoing Midwives /Health

Improvement Team

3 Recruiting breast feeding advisor

for community

Recruit October 2009

Plan to exceed target prevalence of breast

feeding at 6-8 weeks of 66%

Increase number of breastfeeding cafes

and peer support programme

Until March

2011

Public health/

Midwives/

Children’s centres

4 Promote healthy start scheme at

booking

Increased uptake of healthy start vitamin

supplementation in pregnancy and

improved diet

Ongoing Midwives

a.3 Early years Action Outcomes Timescale Leads

1a

b

c

d

e

Children’s centres-nutrition

Delivery of healthy eating sessions

to children and families by dietitian

Contribute to a reduction in obesity levels

for Reception year

Ongoing to April

2011

CC dietitian


Provide training to children’s

centres staff on nutrition by dietitian

Promote healthy growth and weight in

children under 5

Ongoing to April

2011

CC dietitian


Delivery of healthy eating activities

(area 3) for families and children by

nutritionist


children and families

Ongoing to April

2011

Nutritionist


Develop nutrition policy for children

centre premises

Promote good practice around healthy

eating in children centre premises

By March 2010 Dietitian, nutritionist,

oral health


Provision of cookery

courses/training for families

Improve skills and nutrition knowledge of

parents/carers

Start January

2010

CC dietitian

2 Children’s centres- physical activity

Improved play areas for children

Allotments/growing plots

Promote outdoor play for young children

Ongoing CC

3 Commissioned programmes to

deliver activity and healthy eating

sessions e.g.Changing shapes


children under 5 and their families

Provide structured activity sessions

Ongoing CC/Teachsport

4 Recruit infant nutrition lead Recruit

October 2009

Achieve Baby Friendly Initiative

accreditation leading to improved infant

nutrition

Stage 1- March

2011

Stage 2 – March

2012

HWHL strategy

manager

5 Increase awareness of Healthy

Start scheme

Improved diet and increased uptake of

healthy start vitamins to women during

breastfeeding and children under 5

January 2010 Infant Nutrition

Project Manager

6 Report of data collection- weight

and height as part of Child Health

Promotion Programme (CHPP)

Actual number of children weighed and

measured at 8months, 2yrs and 3 ½yrs.

Data to help inform commissioning of

weight management service for under 5

September 2009 HV manager/HWHL

strategy manager

7 Health visitors as part of CHPP

Information on weaning, encourage

healthy eating and active lifestyle


children under 5 and their families

Ongoing HVT

8 Evaluate all sessions

commissioned to improve physical

activity or diet

Ensure delivery of effective evidence

based sessions to children and families

Ongoing LBL/CC managers

9 All nutrition messages to be based

on Department of Health guidance

and aligned to Change 4 Life

Ensure consistent nutrition messages

delivered to families

Ongoing HWHL strategy

manager/CC

managers/Health

Improvement Team

10 Review of Nutrition in the under 5’s

guidelines

Updated guidelines produced in

conjunction with Lambeth+ Southwark

Review date

January 2010

HWHL strategy

manager

11 Guidelines to be produced on

physical activity in early years

settings

Systematic adoption, implementation and

monitoring of guidelines

September 2010 LBL/Health

Improvement Team

a.4 Schools Action Outcomes Timescale Leads

1

Healthy Schools:

Support all schools to achieve

National Healthy School Status

(April 09 Baseline = 66% with

NHSS)

100% of schools achieved NHSS

91% of pupils participate in a minimum of 2

hours of high quality PE and sport per

week

100 % of schools with a School Food

Policy and a Physical Activity Policy

By March 2011

HS Programme

2 Healthy Schools:

Support schools with NHSS to

work towards Enhanced National

Healthy School Status (ENHSS)

34% of schools will have gained ENHSS

Outcomes for universal and targeted

provision will have been identified by

individual schools depending upon needs

of pupils

By January 2011 HS Programme

3 Support all schools to provide a

minimum of 2 hours per week of

high quality PE and sport to all its

pupils, in or outside the curriculum

Increased number of schools providing

minimum of 2 hours a week from the

baseline of 42%

By March 2011 School Sport

Partnership leads

(via sport and leisure

service and knights

academy)

4 Deliver centralised and school-

based training for school staff on

promoting healthy weight

100% schools operate whole school

strategies on promoting healthy weight

Staff have greater knowledge and skills in

promoting healthy lifestyles

Reduction in obesity in Reception and year

6 pupils

Until March 2011

HW schools advisor

5 Provision of targeted programmes

to children

Increased access to families for advice

regarding healthy lifestyle. Provision of

health drop-in at primary and secondary

schools.

Start January

2010

HW School nurse

6a

b

c

d

e

f

School meals – new contract

Delivery of meals that meet nutrient

standards

Increase uptake of school meals to 54%

March 2010

LBL

School meals- eligibility for free

school meals

Increase uptake of FSM to 88%

Summer 2010 LBL

Develop strategic approach to

implementing and monitoring of

food in schools standards in all

schools

School meals working group to report to

PHWCG group

Quarterly update LBL/PCT

Named lead to co-ordinate data

collection process for school meals

to School Food Trust

School meals data to be provided to

School Food Trust

ongoing LBL/PCT

Co-ordinate borough wide

approach to monitoring of packed

lunches and breaktime snacks

Increased number of children eating

healthy packed lunches and breaktime

snacks

September 2009

and ongoing

HW school advisor

Evaluate existing initiatives around

healthy packed lunches and

disseminate good practice

Increased number of children eating

healthy packed lunches

September 2009

and ongoing

HW school advisor

7 School sports partnership

All schools to participate in school

sports partnership

91% of children and young people

participating in PE and school sports

(increase to 92%)

By March 2011

By March 2012

School sport

partnership

managers

8 Develop overarching strategic

approach to school sports

partnership

Maximise impact of programmes ongoing SSP Managers via

PESSYP Steering

group; LBL sport and

leisure service

9 Strengthen link between School

sports partnership and Healthy

Schools

More children more active ongoing SSP Managers via

PESSYP Steering

group; LBL sport and

leisure service

10 Promotion of sustainable school

travel-e.g. walking buses, walk

once a week (WOW), cycle

training,

100% of schools to have school travel plan

Aim to reduce proportion of car use for

travel to school by 1% per annum

2010 HS/LBL/health

Improvement Team

11a

b

c

Extended schools

Improved access to sport activities

Summer uni activities to include

schools with high levels of children

at risk of obesity

100% of schools to be extended schools

Increase number of young people

accessing summer programmes

March 2011 Extended services

board

Extended schools

Breakfast clubs- breakfast clubs to

offer healthy food choice that meet

government food-based standards.

Explore providing free breakfasts to

children in receipt of free school

meals

Increase provision of breakfast clubs

operating in schools from baseline of 80%

(February 2009)

More children have a healthy start to the

day

ongoing Extended services

board

Extended schools

Potential to engage with families to

promote healthy living through wide

range of activities provided by

extended services

Increased number of after school clubs

promoting range of physical activities.

Increased number of children including

those at risk of overweight and obesity

more active and adopting healthy eating

ongoing Extended services

board, LBL sport and

leisure services

a.5 Leisure/sport/Environment Action Outcomes Timescale Leads

1

Provide free swimming to children

under 16

Increased participation in sport by children

and families

Until March 2011

LBL Sport & Leisure

services

2 Offer more programmes aimed at

families and children 8-19 years

Increased participation in dance

based/other physical activity by children

and families (linking with point 3)

Ongoing LBL Sport & Leisure

Services/Public

Health

3 Commissioned programmes

during school holiday e.g. play in

the park

Increased participation in physical activities

by children aged 0-8

Ongoing CC

4 Evaluate all sessions

commissioned to improve physical

activity or diet

Ensure delivery of effective evidence based

sessions to children and families

Ongoing LBL/Public Health

5 Promotion of Change 4 Life brand

recognition in Lewisham

Adopt Change 4 Life to promote local

projects and programmes

Ongoing LBL Sport and

Leisure/Public Health

6 Improve communication to parents

on range of activities available to

young people

Increased proportion of children and young

people who have access to 5 hours cultural

activities per week

Ongoing Family Information

Service/LBL cultural

services

7 Build data set of activities for

young people – Plings (places to

go, things to do)

Proportion of young people who have

participated in positive youth activities will

rise to 78%

March 2010 LA

8 Improve the quality of outdoor play

facilities

Increase number of children and young

people who are satisfied with parks and

play areas from baseline of 54%

Ongoing LBL Parks Service

9 Clarify role and responsibilities

within Community Sports and

Physical Activity Network

Clear role around physical activity, sport

and leisure and PE

By March 2011 LBL Sport & Leisure

Services/Public

Health

10 Healthy weight to be included

within core strategy of Local

Development Framework

Built and natural environment supports

health agenda

By March 2011 Consultant in Public

Health

11 Investigate service specifications

around food provision in parks

Promote healthy lifestyles By August 2010 LBL Parks service

12 Formalise relationship between

PCT and LA planning

Health perspective incorporated into large

scale developments

ongoing Director of Public

Health

a.6 Lewisham Food strategy Action Outcomes Timescale Leads

1

Food access

Develop training opportunities for

local people in food and nutrition.

Develop food co-op model or

other models to increase access

to healthy food

Improved health outcomes for the

population

March 2009-April

2010

Health improvement

team/voluntary sector

2 Food, nutrition and health

Development of healthy weight

strategy

Contribute to reduction in childhood obesity End April 2010 HWHL strategy

manager

3 Food in schools

Provide all schools with support

on healthy eating

Evaluating and monitoring school

meals

Nutrition to be incorporated into

extended schools activities

Learning from SHEU survey incorporated in

advice to schools

Increased number of schools taking part in

school catering forum

Setting up more food related initiatives in

schools

Ongoing LBL/ HS/school

caterers

4 Food sustainability

Support retail and consumption of local

food

Ongoing LBL/voluntary sector

Increase access to allotments and

community gardens

60 new community gardens by 2012.

Increased access to fresh fruit and

vegetables

5 Deliver the action plan for food

safety within the borough

Promote food safety

Ongoing LBL

a.7 Workforce training and communications


1

Develop comprehensive workforce

strategy- joint training programme

Workforce training to be included in

childhood obesity care pathway

start March 2010

and ongoing

HWHL strategy

manager

2 Mandatory training for early years

staff and community staff

Improved awareness of obesity prevention

measures

March 2011 Associate director

CYP services

3 Develop overarching policy

around staff wellbeing

March 2011 PCT/LA Training

Depts

4 Develop joint communications

plan

Co-ordinated and pro-active approach to

public health agenda

ongoing Lewisham

Communications

Group

5 All staff aware of Change 4 Life

campaign

Apply Change 4 Life to local initiatives Ongoing PCT/LA

Communications

(b) Weight management services for children –targeted

b.1 Current services Action Outcomes Timescale Leads

1

MEND to be commissioned for 1

year, facilitated by Teachsport

Recruitment of MEND co-ordinator

Improved participation and retention of

families in programme

March 2009-

October 2010

LBL/teachsport

2 To deliver minimum 4 MEND

programmes focusing delivery on

the 8 schools with highest

proportion of children at risk of

obesity

Minimum of 12 children to attend each

MEND programme

End October

2010

LBL/teachsport

3 Input of data for each programme

(as specified by MEND) to MEND

central

Accurate record of effectiveness of

programme and final evaluation of MEND.

Quarterly report to PHWCF group

End October

2010

LBL/teachsport

4 School nurse health drop in to

continue at secondary schools

and investigate services offered

by HWHL nurse

Increased access and support Ongoing HWHL School nurse

b.2 Development of local obesity care pathway for children and young people – targeted and specialist


1

Estimate prevalence of obesity in

Lewisham using NCMP, HSE data

Identified prevalence of obesity in children

for all age groups up to 15 years

May 2009 HWHL strategy

manager

2 Conduct local needs assessment Identify distribution of age, ethnicity and

deprivation to target effective interventions


manager

3 Map relevant local initiatives Updated local initiatives that promote

healthy eating and physical activity to

support care pathway

August 2009 HWHL strategy

manager

4 Establish sub-group to develop

multi-agency taskforce

Enable effective delivery of strategy November 2009 HWHL strategy

manager

5 Conduct literature and local

evidence review on prevention and

management of childhood obesity

Identify evidence based interventions for

under 5, children and young people in

different community settings

September 2009 HWHL strategy

manager

6 Review current service provision Identify gaps in service September 2009 HWHL strategy

manager

7 Arrange forum groups with parents

and young people on weight

management services

Identify appropriate services for community By July 2010 HWHL strategy

manager/young

Mayor

8 Investigate introduction of junior

exercise on referral programme

Incorporated into care pathway December 2010 Lewisham sport and

leisure

9 Feed results from mapping

exercises and literature review in

to care pathway

Develop care pathway for children 0-4. 5-

11 and 12-18


manager

10 Commission appropriate services October 2010 HWHL strategy

manager

11 Application of Standard evaluation

framework to all local weight

SEF to be used for all weight management

programmes in Lewisham

December 2009 PCT/LA

commissioners

management programmes

12 Mandatory training for frontline

staff around behaviour change

Resources identified and training to be

offered to 100 key personnel and 500 front

line staff

by March 2011 HWHL strategy

manager

12 Maternal obesity management,

defined care pathway for

management of maternal

overweight and obesity

Improved health outcomes to mother and

babies

August 2010 HWHL strategy

manager

13 Commission maternal obesity

strategy

March 2011 HWHL strategy

manager

Priority 2 Adults (a) Development of adult weight management care pathway


1

Estimate prevalence of obesity

in Lewisham using national and

QOF data, incorporating local

factors e.g. ethnicity

Identify prevalence of adult obesity in

Lewisham for different population

groups

June 2009 HWHL strategy

manager

2 Conduct local needs

assessment

Identify distribution of age, ethnicity

and deprivation to target effective

interventions


manager

3 Identify and engage relevant

partner organisations to develop

a multi-agency obesity taskforce

Enable effective delivery of obesity

strategy

February 2010 PCT/LA

4 Map relevant local initiatives Updated local initiatives that promote

healthy eating and physical activity to

support care pathway


manager/Health

Improvement Team

5 Map weight management

initiatives across the borough

Updated local initiatives to support

care pathway for targeted weight

management services

October 2009 HWHL strategy

manager

6 Review current service provision

for targeted/specialist services;

e.g. dietetic services, exercise

on referral, commercial groups

Identify gaps in service for targeted

and specialist weight management

services and ensure equitable access

borough wide

December 2009 HWHL strategy

manager

7 Develop morbid obesity dietetic

service

Provide specialist dietetic service to

adults with BMI more than 40 (or BMI

more than 35 +2 co-morbidities) in

Lewisham

Begin April 2009 GSTT

8 Develop adult weight

management care pathway

Provide tiered weight management

service

June 2010 HWHL strategy

manager/Health

Improvement

Team/LBL sport and

leisure

9 Identify services to be

commissioned

2009/2010 HWHL strategy

manager/Health

Improvement Team

10 Secure funding Align services with Health checks 2010/2011 PCT/LA

Priority 3 Building physical activity into lifestyles


1

Develop physical activity

strategy for Lewisham

Increased number of people more

active

Begin February 2010 Health Improvement

Team

2 Develop Lewisham sports plan Increased number of people more

active

June 2010 LBL sports and

Leisure

2 Investment to improve sports

facilities e.g. Wavelengths

Leisure Centre


active

Ongoing LBL

3 Promote physical activity to

target groups e.g. women,

families, disabled adults e.g.

CIF time to get active

programme, NI8 sport ac+ve

programme

Increased access to physical activity

sessions

Ongoing LBL/Leisure services

4 Link physical activity

programmes with change 4 life

e.g. walk 4 life, swim 4 life


active more often

Ongoing LBL/PCT

5 To increase number of walking Increased number of people more Ongoing PCT

groups borough wide active more often

6 Environment conducive to

activity, walking, cycling etc


active more often

Ongoing LA

7 Develop a sustainable travel

infrastructure

-promote walking and cycling by

improving street environment

and number of cycle lanes

More people walking, cycling on a

regular basis

ongoing LA

5. Equalities Impact Assessment

The outline, screening grid and action plans are included in appendix 2

1 Governance

The multi-agency partnership working group (Promoting Healthy Weight in Children and

Families Group) is charged with delivering the Children and Young People Plan priority

‘Reducing Childhood Obesity’ through Lewisham’s Healthy Weight, Healthy Lives Strategy.

The CYP Joint Commissioning Group monitors the performance of the delivery of this priority

and is due to review progress on this priority at its meeting on 2nd Nov 2009. The CYPJCG

maintains a robust focus on performance management and will ‘call-in’ priorities where

progress is not on track. Each year the CYP Partnership produces an annual review of the

CYPP which monitors the implementation of the key areas for impact and progress in

delivering the ECM priorities.

Lewisham Healthy Lives, Healthy Weight Strategy - accountability structure

Children and Young Peolple’s Strategic Partnership Board

Children and Young People’s Joint Commissioning Group

Healthy Lives, Healthy Weight Group

Lewisham Strategic Partnership

Appendix I

Summary of Cluster Characteristics Source: Healthy Weight, Healthy Lives: Consumer Insight Summary

46

Location and distribution of clusters 1 to 6 in Lewisham

References

1. Statistics on obesity, physical activity and diet: England, February 2009 www.ic.nhs.uk

2. Weighty matters The London findings of the national child measurement programme

May 2009 www.lho.org.uk

3. Healthy Weight, Healthy Lives: a toolkit for developing local strategies. Department of

Health and National Heart Forum 2008

4. National Institute for health and Clinical Excellence (NICE) 2006. Obesity: the

prevention, identification, assessment and management of overweight and obesity in

adults and children. London www.nice.org.uk/guidance/CG43

5. Foresight Tackling obesities: Future choices- project report 2nd ed 2007.

www.foresight.gov.uk

6. Healthy Weight, Healthy Lives; A cross government strategy for England. Dept of

Health. 2008

7. It’s Everybody’s Business. Lewisham Children and Young People Plan 2009-2012.

www.lewisham.gov.uk

8. Healthy Weight, Healthy lives: Consumer Insight Summary. Department of Health

2008

promoting healthy weight, healthy lives for …...promoting healthy weight in children and families...

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