Tackling obesity: the role Tackling obesity: the role of dietitians and local of dietitians and local

partnerspartners

ContentContent

The role of dietitiansThe role of dietitians The growing problem of obesityThe growing problem of obesity Local solutionsLocal solutions

What is a Dietitian…?What is a Dietitian…?

Dietitians translate the science of nutrition Dietitians translate the science of nutrition into practical information about foodinto practical information about food

Work with people to:Work with people to:-- Promote nutritional wellbeingPromote nutritional wellbeing-- Prevent food-related problemsPrevent food-related problems-- Treat diseaseTreat disease

Where do Dietitians work…?Where do Dietitians work…?

The NHSThe NHS

-- HospitalsHospitals

-- CommunityCommunity

-- CateringCatering

Industry, e.g. Supermarkets, Food ManufacturersIndustry, e.g. Supermarkets, Food Manufacturers

EducationEducation

ResearchResearch

FreelanceFreelance

Obesity & HealthObesity & Health

Obesity has tripled in past 20 years Obesity has tripled in past 20 years It is predicted that it could reduce average life-It is predicted that it could reduce average life-

span by 9 yearsspan by 9 years Linked to wide range of physical and psychosocial Linked to wide range of physical and psychosocial

problemsproblems >80% of adults with type 2 DM are overweight and >80% of adults with type 2 DM are overweight and

80% will die from CVD80% will die from CVD High costs to health services & wider economy High costs to health services & wider economy

e.g. at least £2.5billion per year in England e.g. at least £2.5billion per year in England

Obesity in ChildrenObesity in Children

Prevalence increasing Prevalence increasing from 9.9% children in from 9.9% children in 1995 to 13.7% in 1995 to 13.7% in 2003.2003.

27.7% children now 27.7% children now overweightoverweight

Children have lower Children have lower life expectancy than life expectancy than their parentstheir parents

Obesity in BirminghamObesity in Birmingham

Based on population of Based on population of 1 million.1 million.

495,000 overweight 495,000 overweight adultsadults

Of those 165,000 will Of those 165,000 will be obesebe obese

Plus 55,000 obese Plus 55,000 obese childrenchildren

Definition of obesityDefinition of obesity

Body mass index = Body mass index = weight (kg)weight (kg)

height (m)height (m)22

Healthy Weight Healthy Weight == 20-2520-25 Overweight Overweight == 25-3025-30 ObeseObese == over 30over 30

Factors leading to increases Factors leading to increases in obesityin obesity

ENERGY OUTENERGY IN

Physical act ivity Food digest ion

Rest ing metabo lism 7

Reductions in activityReductions in activity

Reduced occupational Reduced occupational activityactivity

Increased use of Increased use of labour saving deviceslabour saving devices

Security issuesSecurity issues

Calorie Usage - Changes over Calorie Usage - Changes over 50 years50 years

Per weekPer week 1950s 1950s 2000s2000s

Shopping on foot/car & supermarket 2400 275Shopping on foot/car & supermarket 2400 275 Washing clothes by hand/machine Washing clothes by hand/machine 1500 270 1500 270 Making a coal fire/gas fireMaking a coal fire/gas fire 1300 3 1300 3

Per hourPer hour Hand lawn mower/electric mowerHand lawn mower/electric mower 500 180 500 180 No power steering/with itNo power steering/with it 96 75 96 75

More time spent watching television More time spent watching television than spent in school classroomthan spent in school classroom

Six food adverts every 30 minutesSix food adverts every 30 minutes

77,000 food adverts age 1 to 1877,000 food adverts age 1 to 18

Marketing of high fat, high Marketing of high fat, high sugar snack foodssugar snack foods

© IACFO 2003

Advertising promotes a very distorted dietAdvertising promotes a very distorted diet

Young people using internet daily:Young people using internet daily:USA USA 85%85%

UKUK 72%72%

ItalyItaly 55%55%

South KoreaSouth Korea 78%78%

ArgentinaArgentina 27%27%

Free music downloads, free ringtonesFree music downloads, free ringtones SMS texts to phones – bypasses parentsSMS texts to phones – bypasses parents

Beyond television…Beyond television…

Secular Trends in Portion SizeSecular Trends in Portion Size

Food intake per eating occasion (oz)

Salty snacksSoft drinks

Nielsen & Popkin. (2003)

0

5

10

15

25

20

0

0.5

1.0

2.0

1.5

1977-1978

1989-1991

1994-1998

1977-1978

1989-1991

1994-1998

Standard servings Standard servings 1955 and 20011955 and 2001

1955Fries 72gCoke 200ml

2001Fries 205gCoke 950ml

Remember nutritional health - diet also influences risk factors independently

Addressing the problemAddressing the problem

Needs to be tackled at all levelsNeeds to be tackled at all levels- Government- Government- Food Industry- Food Industry- Media- Media- Schools- Schools- Local Authorities- Local Authorities- Businesses- Businesses- NHS- NHS

Changing eating habits – Changing eating habits – advice for children and their advice for children and their

familiesfamilies Increase activity and reduce inactivity e.g. Increase activity and reduce inactivity e.g.

watching TVwatching TV Regular meals rather than grazingRegular meals rather than grazing Separate eating from other activitiesSeparate eating from other activities Encourage child to respond to hunger cuesEncourage child to respond to hunger cues Alternatives to food as rewardAlternatives to food as reward

Changing eating habits – Changing eating habits – advice for children and their advice for children and their

familiesfamilies Comfort with attention, hugs etc rather than Comfort with attention, hugs etc rather than

foodfood Keep foods to avoid out of the houseKeep foods to avoid out of the house Avoid classifying foods as good or badAvoid classifying foods as good or bad Be consistentBe consistent

Addressing obesity at Policy Addressing obesity at Policy LevelLevel

Choosing Health White PaperChoosing Health White Paper Public Service AgreementPublic Service Agreement

Halt the year on year rise in obesity in the under Halt the year on year rise in obesity in the under 11 yr olds by 201011 yr olds by 2010

City Council Overview and Scrutiny Review City Council Overview and Scrutiny Review – Childhood Nutrition– Childhood Nutrition

Elements of an obesity strategyElements of an obesity strategy

Prevention of obesityPrevention of obesity Management / treatment of obesityManagement / treatment of obesity Supporting weight maintenanceSupporting weight maintenance Support population to adopt a healthy diet Support population to adopt a healthy diet

and lifestyleand lifestyle

What is happening locallyWhat is happening locally

Development of Strategy and care pathwayDevelopment of Strategy and care pathway Development of specialist obesity service Development of specialist obesity service

for children – Lead by a Consultant in for children – Lead by a Consultant in ObesityObesity

Task force from scrutiny reviewTask force from scrutiny review Local services continueLocal services continue Training for health professionalsTraining for health professionals Roll out of pilot to monitor BMI in childrenRoll out of pilot to monitor BMI in children

How schools are contributingHow schools are contributing

healthier breakfast clubshealthier breakfast clubs healthier cookery clubshealthier cookery clubs healthier lunch boxeshealthier lunch boxes growing clubsgrowing clubs dining room environmentdining room environment

How schools are contributing 2How schools are contributing 2

water provisionwater provision healthier tuck shops healthier tuck shops healthy vending machines.healthy vending machines. School mealsSchool meals Healthy eating in the curriculumHealthy eating in the curriculum BMI measurement projectBMI measurement project

Food in schoolsFood in schools

www.foodinschools.orgwww.foodinschools.org Food in schools tool kitFood in schools tool kit

Consultant Dietician:Consultant Dietician:Linda HindleLinda Hindle

lliinda.hindle@easternbirminghampct.nhs.uknda.hindle@easternbirminghampct.nhs.uk

0121 44610250121 4461025