Recent review
Catherine Clapham
RSPH [] would like to thank the conference sponsors Weightwatchers, The British Dietetic Association, National Heart Forum and Men’s Health Forum as well as all the speakers and the delegates who attended.
Tackling Obesity.
Starting the day was Dr Harry Rutter, Director of the National Obesity Observatory, who explained the difficulties involved in evidence and evaluation. Dr Rutter made the point that it is impossible to predict outcomes of an intervention so to maximise impact multiple programmes should be run concurrently. He made the point that when implementing new strategies we should learn from failures as well as successes because they both provide valuable information.
Dr Gillian Lang, deputy chief executive of the National Institute for Health and Clinical Excellence (NICE) spoke next about the information NICE produce. NICE aims to provide easily accessible, relevant information on a range of health topics including how to prevent and treat obesity. In the future the guidance will consider how local policy makers can work with different communities as to the causes of obesity associated with modern living. She said NICE and Public Health need to work together to encourage uptake of the most effective Public Health interventions.
Dr Susan Jebb from the Human Nutrition Research in Cambridge presented some recent research which had been conducted in adult weight management. It is estimated that every GP in the UK has 1000 patients who would benefit from weight loss. Trials have shown that intensive lifestyle interventions can deliver clinically important weight loss should the participant be motivated, however there is an approximate 50% drop out rate. There are not brief interventions or ‘quick fixes’ for obesity and it is often difficult for people to weight off once the programme has finished. She asked the question ‘should Primary Care refer people to commercial providers such as Weight Watchers or Slimming World’? Trials testing this (Such as the ‘Lighten Up’ trial by Birmingham University which featured in one of the workshops) have shown that people referred to a commercial programme lose on average twice as much weigh as those who just visit their GP and a third of those lose more than 10% of their body weight. She finished by making the point that we have to implement programmes that are effective and cost effective.
The next speaker was Professor Klim McPherson visiting Professor of Public Health Epidemiology at the University of Oxford, who examined the cost of obesity on the UK economy. Individuals with a BMI of 30 or more have medical costs of approximately 30% higher than their peers with BMIs of less than 25. Modelling software has been developed to anticipate the growth of obesity and calculate the resulting costs. What has also been calculated is that small changes in BMI have a noticeable impact on the economic burden; a reduction rate of 1% of BMI across the whole population would save the UK £3.10 billion by the year 2030.
For the first time the RSPH [] decided to run three parallel workshops, ‘Building local capacity to tackle child obesity – the Chalk model’, ‘The Lighten Up Weight Management Service’ and ‘Working Effectively with Men on Weight Issues’. Three main points from each session were brought to a discussion session.
The Chalk Model
1. Only people with the power to make decisions and implement changes should attend training.
2. There must be existing services which can help make the programme more effective.
3. Advertising and promotion must be pitched at the right level to the right people.
Lighten Up
1. Direct, focused marketing sent straight from the GP to everyone with a BMI over 30.
2. Supporting patients through out the programme, always someone to talk to in the call centre.
3. People respond well to things being free; vouchers, weighing scales and call centre.
Men’s Health
1. It is difficult to get men to be aware of their weight gain; it is much easier for women to gage weight gain through their clothes.
2. Once men get on weight loss programmes they do as well as women.
3. Men do well on programmes with a physical exercise element because of the competitive nature of this.
After the workshops Professor Chris Drinkwater from the NHS Alliance and HealthWORKS Newcastle spoke on the importance of dealing with obesity as a long term condition, emphasising the need to focus on ‘self help’ rather than relying on unsustainable medical interventions, drugs and surgery do not deal with the reasons why people are overweight. Rather than prescribing everyone the same medication, a variety of programmes tailored to a range people should be available. HealthWORKS Newcastle have developed many different teams which aim to help people help themselves, these are a Physical Activity team, Learning and Development team, a Food and Nutrition team, Volunteers and Community Health trainers. The Physical Activity team allows overweight people to exercise together in a special gym to prevent embarrassment, it is imperative that it is staffed by a very supportive and encouraging team. The Food and Nutrition team try to change the food people eat by re-educating them. They have healthy eating advice, practical cookery courses, weaning and breastfeeding programmes, an allotment group and men’s cooking sessions. What Professor Drinkwater concluded was that it is imperative that there are strong local links, with volunteers and trainers recruited from the local community. Commissioners needed to look at developing local assets, allow for long term maintenance incentives. It is also important to look at high drop out rates because this means the initiative is not working.
Dr John Middleton from UK Faculty of Public Health examined the role of the local authority in tackling obesity. Dr Middleton argues that there is currently inequality in the health services offered by councils and that it is often poorer areas that receive the worst services. All councils should offer the same services and these should be based around a ‘Learning Agenda’ and a ‘Social Care Agenda’. The Learning Agenda focuses on teaching skills to the whole community through projects in schools and the wider area. This should take place through cooking and healthy eating programmes on the school curriculum as well as readily available healthy, low fat and enjoyable school meals, community growing projects and food for life programmes. The Social Care Agenda focuses promoting physical activity for everyone, including those with disabilities and the mentally ill and looks at creating a positive environment by, amongst other things, creating safe walking routes, cleaning up the environment and ensuring effective street lighting.
