Tackling Childhood Obesity in the Tri-Borough (TCOT) Programme Lynne Horn TCOT Programme Manager Tri-borough Public Health 1
Tackling Childhood Obesity in the
Tri-Borough
(TCOT) Programme
Lynne Horn TCOT Programme Manager
Tri-borough Public Health
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Context
• The level of childhood obesity is of
international, national and local concern.
• Obese children are at increased risk of
developing social, psychological and other
health problems.
• They are also more likely to become obese
adults with poor health outcomes.
• Childhood obesity costs the capital £7.1 million
a year and this could reach almost £111 million
each year if today’s children remain obese into
adulthood1
1 Greater London Authority (2011): Tipping the scales
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Estimated cost of children currently (2012) obese
becoming obese adults
Category H&F RBKC Westminster Tri-borough
Estimated number of children currently
obese 4-15 years old 4,000 3,000 4,000 11,000
Annual Direct Cost based on £31 per
obese children (2007 costings) £124,000 £93,000 £124,000 £341,000
Annual Cost Direct and Indirect if 79%
become obese adults based on £611
per annum ( 2007 costings)
£1,931,000 £1,567,000 £1,931,000 £5,428,000
Lifetime cost for 79% of all current
obese 4-15 year olds assuming they
live to 75
£112,726,000
£91,420,000
£112,726,000
£316,872,000
The cost of child obesity
“Today’s generation of obese children will cost London at least £111
million per year in healthcare costs and productivity losses, if they
come to enter the workforce as obese adults.”
Tipping the scales Childhood obesity in London April 2011 : GLA
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Trends in hospital admission in children
aged 5 to 19 years in England for obesity
Jones Nielsen JD et al. Plos One 2013 Jun 12;8(6):e65764
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Westminster Child Measurement Programme
Results, 2012-2013
Prevalence of underweight, healthy weight, overweight and obesity, 2012/13 RECEPTION
Prevalence of underweight, healthy weight, overweight and obesity, 2012/13 YEAR 6
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Trends in Weight Status of Children in
Westminster, 2006/07 – 2012/13
Prevalence of obesity over time RECEPTION Prevalence of obesity over time YEAR 6
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Numbers with excess weight by ward of residence Overweight or obese. Attending local state schools. Private schools not measured
Reception Year 6
Strong focus in areas of deprivation, due to (a) higher rates of excess weight and (b) higher numbers
of children in these areas (particularly those attending state schools)
Suggests targeted work may be effective at tackling issue
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Causes and predictors of Childhood Obesity
• Energy intake exceeds energy use over a sustained period of time
• Interventions focus on improving diet and increasing physical activity at individual, community and population level
•Many parents believe their child’s obesity is linked to metabolic problems rather than lifestyle
•The strongest predictor is parental obesity; only 3% of obese children have parents who are not obese
• Combination of genetic, epigenetic, social and environmental factors
•Children with one or two obese parents are more likely to become obese and remain obese into adulthood
•Breaking this generational cycle is key to prevent obesity in childhood
•Children find it harder to influence their environment or control their behaviour.
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Tackling childhood obesity – The evidence base
Parental support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities
Environments and cultural practices that support children
eating healthier foods and being active throughout each day A school curriculum that includes healthy eating, physical
activity and body image Increased school sessions for physical activity and the
development of movement skills throughout the week Improvements in nutritional quality of the food supply in
schools Support for teachers and other school staff to implement
health promotion strategies and activities (e.g. professional development, capacity building activities)
HOLISTIC:
- Whole family
- Whole school
- Whole
environment
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Holistic Approach to Childhood Obesity
•Multi-level: Preventing obesity and treating those already obese are necessary at the same time.
•Multi-stage: There are opportunities for intervention at key life stages from before birth until early adulthood and then again pregnancy.
•Multi-disciplinary: A range of stakeholders from different fields must work together. Health professionals can not deal with the issue alone.
Farley C: CHILDHOOD OBESITY: What can primary care do? September 2012
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Tackling child obesity – what needs to be in place
Visible and vocal political leadership
A vision shared by all parties
Commitment from senior leaders and
influential figures, with regular engagement
Priorities which are clear, shared, and
ambitious. These should stimulate debate
These things have
been in place in
successful child
obesity programmes
in Europe and the
USA:
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Swinburn et al. Lancet 2011; 378:804-14
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A framework to categorise obesity determinants
and solutions
Key findings from tri-borough childhood
obesity review
• Existing prevention services popular and well attended
• Inequitable provision
• Some services can be difficult to access
• Children’s workforce can lack confidence to raise the issue
• Need for co-ordinated action to create healthier environments
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Our vision –
Tackling Childhood Obesity in the Tri-borough
Parks & open
spaces
Education &
learning Health & healthcare Transport
Housing &
planning Leisure & culture
Concerns about
traffic, pollution and
safety on roads
and/or cycling routes
restricting active
travel and play
Urban environments
provide limited
opportunities for
children to understand
food origins and be
physically active while
commercial fast food is
easily accessible
Limited availability of safe
outdoor play facilities and
poor access to leisure
services contribute to
inactive lifestyles
Active travel is the
norm for children and
families, as a result of
better traffic flow, safe
walking routes, and
efforts to promote
cycling and tackle
pollution
Healthy choices are
made easier as there
are fewer fast food
shops, healthier
catering practices are
widespread, and new
housing developments
promote physical
activity
Accessible leisure
services, safe and
stimulating outdoor
environment and play
facilities enable children
and families to have fun
and be active
Perceptions of lack of
safety,
inadequate equipment
and/or supervision,
distance and safe
travel routes
contribute to parks
and open spaces
being under-used
Inconsistent provision of
healthy food in
education settings, lack
of confidence to raise
the issue with parents,
lack of cooking skills
and limited opportunities
for physical activity
during school
Difficulties accessing
weight prevention
services, inconsistent
messages about healthy
lifestyles, and the stigma
associated with obesity
Children and families
routinely use parks
and open spaces as
improved facilities,
lighting, and patrolling
increase perceptions
of safety and
accessibility
All schools provide and
promote healthy food
and physical activity at
every available
opportunity, and
engage parents in
activities to promote
healthy lifestyles
Weight prevention
services are easily
accessible to all that need
them, and children and
families receive consistent
messages about healthy
lifestyles to motivate
positive change
What barriers to a healthy lifestyle do children and families living in the tri-borough face in 2014?
By 2016 we envisage that great strides will have been taken towards achieving our vision :
OUR VISION WORKING DRAFT 14
Our Solution – Tackling Childhood Obesity in
the Tri-borough Programme
This will be delivered through action and increasing opportunities in the following areas:
• Supporting a healthy start in life by supporting early years services to develop healthy lifestyle interventions
• Healthier preschools and schools by supporting a ‘whole school’ approach to healthy eating and physical activity
• Strengthening partnership working and integration across services and organisations to increase opportunities for children and their families to be active and eat healthily
• Utilisation of system levers to address the wider determinants of obesity and create local environments that better support healthy lifestyle choices
• Providing consistent messages to children and families about healthy lifestyles
• Maximising the use of existing services and assets within the community
• Increasing the involvement of community members in the design and delivery of healthy lifestyle initiatives
• Monitoring, evaluation and increased research to ensure we can evidence the difference our programme makes and contributing to the evidence base on ‘what works’ to tackle childhood obesity
The overall objective of the programme is:
To halt and reverse the rising trend in childhood obesity across the Tri-
borough area
Resulting in better informed families and more physically active children
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There are 3 components of the programme to
tackle childhood obesity in Tri-borough
Healthy Weight Services Environment Pilot
2.Whole council partnership to ensure that environment and facilities support newly learnt behaviours and identified
needs Communications ASC FCS Planning Leisure Housing Transport Parks Legal
1. Provision of comprehensive services accessed by children and
their families via recognised Pathways
Education Health Care
Voluntary Sector
3. Engaged communities tell us ‘what works’ for them
Local agencies work together to deliver solutions
Research, Evidence and Evaluation
Informs Supports
Retail Employers Private Providers NHS and other providers
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1. Provision of comprehensive services accessed
by children and their families
We are commissioning 2 lots of services
• Policy and Workforce Development; creating healthy weight promoting environments
Professional development and support to frontline staff to raise the issue with those at risk, support on policies development and environmental changes in relevant settings
• Obesity Prevention and Lifestyle; Weight Management Services
Universal tier 1 lifestyle parent and child obesity prevention services
Programmes on healthy eating, physical activity, behaviour management and formation of healthy habits for families with children aged 0 to 4
Tier 2 lifestyle child weight management services
To assist children and young people aged 5 - 18 years who are on/above the 91st BMI centile to reach and maintain a healthier weight.
Whole school obesity prevention programme for children
Practical fun, healthy eating activities and extra physical activity with each year group including engagement activities with parents. A selected number of schools in each borough will be worked with continuously over 3 years.
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2. Whole council partnership approach
EXTERNAL DIRECT
INTERNAL DIRECT
INTERNAL INDIRECT
EXTERNAL INDIRECT
Planning
Workforce
Housing
Licensing
CityWest Children’s
Centres
Wider
RSLs
Schools
Developer
s
Police
Fire
GPs Sports and
Leisure
Libraries
Public Health
services
Community
Assets
Royal Parks
Local
Retailers
Acute
sector
Unions
Council tax
Adult Social
Care
Children’s services
Further /
Higher
education
Adult
Education
Nurseries
Central Government
National retailers
Pharmacies
Health visiting
Parking
Transpor
t
NHS
England
Change
4 life
CCGs Dentists Supported
Housing
VCS
Healthwatch
GLA
Probation
/ Justice
Working collaboratively with all those involved in shaping the environments in which children live, learn and play across the Tri-borough to find ways to make
healthy choices the easy choices.
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3. Community based pilot project in RBKC
To support healthy eating and physical activity among children in all the
settings they live, learn and play
Key aims of the project
• Increase opportunities for children and their families to be active and eat healthily
• Create a local environment that better supports healthy lifestyle choices
• Ensure children and families receive consistent messages about healthy lifestyles
• Support partnership working and integration between local agencies
Key objectives of the project • Increase awareness and knowledge about healthy eating and physical activity • Increase self-efficacy and skills to achieve healthy lifestyles • Identify how to support and motivate key agencies and groups working with children and
families in the area to promote healthy lifestyles • Influence and challenge social norms about the perceptions on a healthy weight and healthy
lifestyle • Increase levels of physical activity and healthy eating • Achieve sustainable and maintained healthy lifestyle behaviour • Increase the proportion of children with a healthy weight in Golborne • Rigorous evaluation leading to strong evidence base for future application
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Initial ideas from the local community…..
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For more information contact:
Lynne Horn
Triborough Public Health
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