Download Childhood Obesity Nottingham City Joint Strategic Needs

Childhood Obesity
Nottingham City Joint Strategic Needs Assessment April 2010
Introduction
Obesity results from an ‘energy imbalance’ - in adults, obesity occurs from taking in more energy
than used. Getting the balance right in children is more complex as growth is only possible if energy
intake (food and drink) exceeds energy output (resting metabolic rate and activity). If there is more
than required for appropriate growth the excess energy will become excess fat. However, the
underlying causes of this energy imbalance which result in weight gain are complex. Behavioural,
psychological, social, cultural and environmental factors are thought to determine the increasing
prevalence of obesity seen throughout the world.
-
-
Obesity has been rising rapidly in children in England over the past 20 years (Ridler et al, 2009)
the proportion of children classified as obese nearly doubling for children aged 4-5 years and
increasing more than three fold for children aged 10-11 years (Ridler et al 2009).
Nottingham has above average rates of child obesity when compared to the East Midlands and
England and is ranked 127th out of 155 local NHS areas.
Obese children are at increased risk of psychosocial problems, including reduced self-esteem
and increased risk of depression and social isolation (Doak et al, 2006).
Obese children are at risk of becoming obese adults reducing life expectancy by an average of 9
years through a greatly increased risk of heart disease, cancer, diabetes and high blood
pressure (APHO, 2005).
Adult obesity, physical activity, diet and nutrition and paediatric nutrition (see pregnancy and
maternities) are considered elsewhere.
Key issues and gaps
-
The prevention of childhood obesity requires a broad multifaceted partnership approach as
outlined in the national strategy to tackle obesity Healthy Weight, Healthy Lives.
Obesity is strongly associated with deprivation. In Nottingham where 81% of children fall in the
first 3 deprivation deciles, this is a significant contributing factor.
The family environment has a strong influence on a child’s development, their eating and activity
habits, and predisposition to overweight. Nottingham has high rates of adult obesity increasing
the risk of child obesity.
Relatively higher rates of child obesity in the 10-11 years age group and falling rate in 4-5 years
age group suggest that work in primary school age children should be one of the areas to focus
attention locally.
There is a low uptake of targeted weight management services relative to need within the care
pathway.
Current capacity of targeted weight management services does not meet the identified need for
the 5 – 13 years age group.
Data analysis is required to understand local obesity prevalence amongst children with learning
disabilities and Looked After Children.
Evidence of effectiveness of interventions to tackle obesity is lacking and more research is
required to understand underlying causes. Interventions should therefore be rigorously
evaluated.
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Recommendations for consideration by commissioners
- The partnership should continue to invest more resources in prevention in line with guidance and
local targets to halt the rise in child obesity.
- Work across the partnership to get better information on the prevalence of obesity amongst
children with learning disabilities and Looked After Children.
- Ensure early identification and prevention of obesity through the Healthy Child Programme by
setting clear commissioning outcomes.
- Implement the breastfeeding strategy and commission services to implement the UNICEF Baby
Friendly Initiative.
- Develop a child nutrition strategy and ensure integrated nutrition interventions through Children’s
Centres, schools, and other community settings.
- Support implementation of the Physical Activity, PE and Sport Strategy for Children and Young
People to ensure more opportunities for physical activity, particularly family based interventions
and access to facilities in deprived areas.
- Develop a mechanism for recording progress towards the ambition of offering all children at least
five hours of PE and sport every week.
- Joint planning in the areas of the built environment, the natural environment, access to healthy
food and transport.
- Expand provision of targeted weight management interventions for the 5 – 13 year age group.
- Develop and implement a communication strategy to ensure effective implementation of the Care
Pathway to increase uptake of interventions.
- Conduct a Health Equity Audit of the Go4It weight management service to assess equitable
uptake of the service by disadvantaged and minority groups.
- Continue to build the capability of the wider children’s workforce to ensure those working at a
local level are clear about promoting the benefits of a healthy weight and feel confident in
sensitively raising the issue with those who are overweight or obese.
- Rigorously evaluate current interventions by including evaluation criteria from the Standard
Evaluation Framework for Weight Management Interventions, (National Obesity Observatory,
2009) in contracts, and through research to inform future impact modelling and commissioning.
- Conduct an assessment of new research around child obesity and re-evaluate the effectiveness
of interventions in light of new evidence base.
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1) Who’s at risk and why?
- Obesity prevalence is influenced by age, gender, ethnicity and deprivation.
-
Prevalence of obesity almost doubles between the age of 4-5 years and 10-11 years (from
10.4% to 20% in boys and 8.8% to 16.6% in girls).
Figure 1: Prevalence of child obesity, overweight, healthy weight and underweight, 2007/08
School Year
Sex:
Obese
Overweight
Healthy Weight
Underweight
Reception
Boys
Girls
10.4%
8.8%
13.6%
12.3%
74.5%
77.9%
1.5%
1.0%
Year 6
Boys
20.0%
14.4%
64.5%
1.2%
Girls
16.6%
14.2%
67.6%
1.6%
Source: Ridler et al, 2009
-
Levels of overweight and obesity are higher in children in deprived populations (Figure 2). In
Nottingham where 81% of children fall in the first 3 deprivation deciles, this is a significant
contributing factor.
Figure 2: Prevalence of obesity in Year 6 children 2006/07 and 2007/08 by 2007 Index of Multiple
Deprivation decile
Source: Ridler et al, 2009
-
The National Child Measurement Programme 2007/08 found that children in the Bangladeshi,
Black African, Black Caribbean and Pakistani (except Year 6 girls) groups were significantly
more likely to be classified obese than individuals from the White British ethnic group (Ridler et
al, 2009). The above average proportion of people from African Caribbean and Pakistani
communities within Nottingham is also therefore likely to contribute to Nottingham's overall
higher rates of child obesity.
-
However it is important to note that the reasons for some of these differences are complex.
Deprivation is a confounding variable for ethnicity and that there are differential degrees of
deprivation between different ethnic groups, influencing the odds of being classified as
overweight & obese. Differences in stature between ethnic groups can also account for some
Nottingham City Joint Strategic Needs Assessment April 2010
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apparent ethnic differences. Controlling for height and development suggests that earlier
findings in which children from Black African and Black Caribbean ethnic groups had the
highest odds of being obese, were most likely to be due to physical characteristics related to
ethnicity, in particular height. (Ridler et al, 2009)
-
Only 3 percent of overweight or obese children have parents who are not overweight or obese
(Cross-Government Obesity Unit, 2008). The family environment has a strong influence on a
child’s development, their eating and activity habits, and predisposition to overweight (Finn et
al, 2002). Nottingham also has high rates of adult obesity increasing the risk of child obesity.
-
Children’s eating behaviours are influenced by the family food environment, including parental
food preferences and beliefs; children’s food exposure; role modelling; media exposure and
child/parent interactions around foods (Campbell et al, 2001). Similarly, children’s activity levels
are strongly influenced by, for example, parental decisions on car use and walking, family
television viewing habits, leisure time activities.
-
Inadequate diet (high intake of energy-dense foods) and low levels of physical activity increase
the risk of obesity. The Health Survey for England, 2007 found that among girls aged 2 to 15
years, 21% of girls in the low physical activity group were classed as obese compared to 15%
in the high activity group.
-
There are associations between certain geodemographic groups (groups defined by social,
economic and lifestyle factors) and child obesity. However, owing to the lack of transparency in
the way in which data is aggregated for these indicators it is uncertain how far these
differences are explained by the factors already mentioned. Such data can be used however
as a predictive tool to estimate postcode level risk. This is demonstrated by the ‘penetration
map’ produced by Experian which shows the percentage of Super Output Area above the
baseline level for Child Obesity.
-
Obesity is more common in people with learning disabilities than in the general population: It is
estimated that 24% of children with learning disabilities are obese (Kerr et al, 2006).
-
There is very little information about the physical health of looked after children and young
people despite evidence that they are at increased risk of ill health in adulthood. However
according to the Caroline Walker Trust, looked after children may have poor access to
adequate healthcare and health promotion information and highlight that their diets are a
particular cause for concern.
2) The level of need in the population
Published results from the National Child Measurement Programme undertaken during the 2008/9
academic year suggest that:
- In Reception (aged 4-5 years), 26% of boys and 23% of girls were overweight or obese;
- In Year 6 (aged 10-11 years) 38% of boys and 34% of girls were overweight or obese.
Nottingham’s children have similar levels of obesity than the England average in Reception,
although levels are higher than the England rate in Year 6 where 22.6% of those measured were
obese. Data relating to 2008-09 is also available via he Information Centre website www.ic.nhs.uk
Latest data presented in Figure 3 shows that rates appear to be rising in Year 6 boys and falling in
reception year children. However, there are too few points to establish a trend and overlapping
confidence intervals indicate that the differences are too small to be confident that differences are
Nottingham City Joint Strategic Needs Assessment April 2010
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more than background random year on year change. 2006/7 and 2007/8 cohorts are not
comparable groups of schools. That said, relatively higher rates of child obesity in the 10-11 years
age group and falling rate in 4-5 years age group suggest that work in primary school age children
should be one of the areas on which to focus attention locally.
Figure 3: Proportion of children who are obese in Nottingham City schools reception year (aged 45 years) and year 6 pupils (aged 10-11 years)
Source: National Child Measurement Programme
The variability in rates at a smaller level is illustrated in Figure 4. Each point represents a school
and there are widely varying rates between schools. However, almost all schools fall within the
tramlines indicating a large proportion of the variation could be accounted for by small numbers
and differences due to chance year on year variation.
Figure 4: Funnel plot of percentage of Children Year 6 who are obese by school (2008/9 data)
Source: Local Child Measurement Programme Data
Nottingham City Joint Strategic Needs Assessment April 2010
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Benchmarking Nottingham against similar PCTs (ONS centres with industry B) shows Nottingham
to be worse than average position, but similar to its peer group. The estimated expected
percentage of children aged 10-11 years who are obese for Nottingham based on deprivation
national rates is 21.45%.
Table 1: Percentage of Obese Children Aged 10-11 Years: ONS Centres with Industry –B; 2008/9
Source: National Obesity Observatory e-Atlas
AREA
Sandwell
Barking and Dagenham
Wolverhampton
Manchester
Nottingham
Birmingham East & North
South Birmingham
Leicester
% Obese
24.59
24.22
23.52
22.64
22.56
20.75
19.79
17.78
Mosaic group F (people living in social housing with uncertain employment in deprived areas) has
been identified as having the highest index score for child obesity in the City. The top ten wards
with households in this group can be seen below:
Top Ten Wards
St Ann's
Bridge
Radford & Park
Arboretum
Bestwood
Mapperley
Dales
Berridge
Wollaton East & Lenton Abbey
Bulwell
% of Group F Households
60
51
30
24
18
18
16
14
13
12
Source: Nottingham City Council Children’s Services
There are approximately 42,000 children aged 2 - 15 years registered with a Nottingham City GP.
It is estimated (using the UK BMI 1990 BMI chart’s 91st and 98th centile cut offs and child
measurement programme data 07/08) that approximately 6000 children/families would potentially
benefit from targeted weight management services. Assuming that a minimum of 10% of these is
motivated and committed to change if offered the opportunity, sufficient capacity for at least 600
specialist programme places per annum needs to be provided via an obesity pathway.
Issues of Inequality
Mapping illustrates the extent to which obese children are concentrated in the more deprived City
areas. The wards with the highest proportion of obese children are: Aspley, Bilborough, Bulwell
Forest, St Ann’s, Arboretum, Mapperley, Lenton Abbey and Clifton (Figure 5). In terms of service
planning it is useful to examine which wards have the highest number of obese children. This
shows a similar, yet slightly different picture with the highest numbers in: Aspley, Bilborough,
Bulwell, Bulwell Forest, Bestwood, Berridge, Basford, St Ann’s, Dales and Clifton (Figure 6).
These are areas where estimates of adult obesity are also relatively high.
26.7% of children in Nottingham belong to ethnic groups other than White British. Given the rates
Nottingham City Joint Strategic Needs Assessment April 2010
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outlined above for different ethnic groups and the local ethnic mix about 1.75% of the overall rate
in Year 6 children (21.95%) is attributable to ethnic mix. Further local analysis is being undertaken
to understand how far the national picture is reflected locally. When socio-economic circumstances
and parental education is taken into account, ethnic differences may not be great. However,
cultural issues are important for management and prevention.
Figure 5: Number of obese children: 2006-2009
Figure 6: Proportion of obese children: 2006-2009
Source: Local Child Measurement Programme Data, NHS Nottingham City
Notable changes in need since JSNA April 09
Between the academic year 07-08 and 08-09 there has been little overall difference in the
percentage of overweight and obese children in both the Reception and Year 6 age groups. In
Reception the percentage has decreased from 26% to 25% and in Year 6 the percentage has
remained at 36%. The percentage of obese children in Reception has decreased from 13% to
10% and only a small increase (less than 1%) occurred in Year 6.
Whilst year-on-year variation makes it difficult to assess the significance of the apparent slowing of
the rise in child obesity, Nottingham still seems likely to meet its aspiration to halt the rise in child
obesity by 2010 (albeit at a slightly higher proportion than the agreed targets).
NCMP data from 2006-2009 has been combined which gives a more robust analysis of areas of
the City with the highest rates and number of obese children. Since the JSNA 2009, some
Nottingham City Joint Strategic Needs Assessment April 2010
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additional areas (Clifton, St Ann’s and Dales) have been identified as areas that would benefit from
additional services.
3) Current services in relation to need
A Strategic Obesity Group is in place to drive the strategy and action plan to support both the
prevention and management of obesity in line with Healthy Weight, Healthy Lives and NICE
guidance. Key elements of the strategy are:
A jointly developed plan and strategy for child obesity for the city of Nottingham with clear
indicators of success to support management of programme implementation by a strategic
partnership group.
A clear understanding of the size of the problem through a well conducted child
measurement program and analysis informing the Joint Strategic Needs Assessment.
A child nutrition programme to promote breast-feeding, uptake of Healthy Start and healthy
diet delivered through children's centres and schools through the School Food Action Group,
Healthy Schools and Healthy Children’s Centres work.
Promotion of physical activity as part of the schools' core offer to deliver the national
curriculum, Healthy Schools, extended schools, the Nottingham City Council Sport and
Physical Activity Strategy, the Nottingham Play Strategy, the Physical Activity, PE and Sport
Strategy for Children and Young people and implementation of school travel plans and
initiatives such as Active Schools and Active Families.
Environmental approaches to improve accessibility and safety of recreational areas through
the Breathing Space Strategy, Sport and Physical Activity Strategy, Nottingham Transport
Plan, the Play Strategy and improving access to healthy fruit and vegetables through the city
and county Food Initiatives Group.
A care pathway to route children with weight problems to targeted and family-based
initiatives developed in partnership.
Increased capacity and capability of the workforce with increased investment, the
development of support worker roles and provision of staff training.
Use of Change 4 Life social marketing research to promote effectiveness of interventions
and improve reach to target groups
Evaluation of key interventions to refine delivery and improve commissioning
The strategic group co-ordinates action required to meet the childhood obesity Local Area
Agreement (LAA) target. The Local Strategic Partnership is working to meet both the NI 56 (child
obesity) and NI57 (participation in PE and sport) LAA targets.
Nottingham City Joint Strategic Needs Assessment April 2010
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Preventing overweight and obesity: Universal Approaches
Much of the activity that will help to reduce child obesity at a population level is inherent within current
general provision and therefore not readily identifiable. However listed below are some key interventions
which contribute to the prevention of overweight and obesity:
The overarching aim of the Breastfeeding Strategy is to improve the health
Breastfeeding
and survival of infants and young children by promoting the initiation and
Strategy
continuation of breastfeeding.
The early identification and prevention of obesity is a key priority in the HCP.
Healthy Child
All families are given information and advice around breastfeeding, healthy
Programme (HCP)
weaning, healthy eating and active play.
Healthy Start is open to pregnant women and families with children under 4.
Healthy Start
Vouchers are provided to exchange for fresh fruit and vegetables as well as
milk and infant formula milk.
The group aims to promote and facilitate a whole school approach to healthy
School Food Action
eating, the prevention of childhood obesity and the promotion of good
Group
nutrition.
City Smiles consists of oral health messages to improve oral hygiene and
Oral Health
healthy eating practices.
Children’s Centres are supported to achieve best practice criteria within the 4
Healthy Children’s
core themes of Personal, Social and Emotional Development, Healthy
Centres
Eating, Physical Activity and Play and Emotional Health & Wellbeing.
This is an intervention which provides family physical activity sessions in city
Active Families
leisure centres and community settings offering a variety of activities suitable
for the whole family
School travel plans are a key aspect of the Sustainable School Travel
School Travel Plans
Strategy and aim to increase the number of pupils walking to school.
An intervention delivered in primary schools to promote physical activity,
Active Schools
consisting of football and indoor rowing coaching, teacher mentoring and
education in healthy lifestyles.
Schools are supported to achieve best practice criteria within the 4 core
Healthy Schools
themes of PSHE, Healthy Eating, Physical Activity and Emotional Health and
Wellbeing in order to achieve National Healthy School Status.
A strategic framework to enable “All children in the City of Nottingham to
Nottingham Play
access a wide range of appropriate, freely chosen, self directed play
Strategy
opportunities”.
The strategy seeks to inspire all children and young people to lead more
Physical Activity, PE
active, healthier and successful lives, through lifelong participation and
& Sport Strategy for
achievement in physical activity, physical education and sport.
Children and Young
People
A local stakeholder group has been formed which coordinates local activity to
Change4Life
increase the impact and relevance of the Change4Life campaign to front line
staff and families.
The Strategy sets out proposals for the strengthening of local community
Breathing Spaces
engagement in the management and improvement of open and green space
Strategy
to achieve better quality, sustainable open and green spaces that are
accessible and inviting to use.
This piece of work is exploring the possibility of restricting the siting of new
Planning
fast food / hot takeaways premises near schools and other places where
children and young people congregate.
Nottingham City Joint Strategic Needs Assessment April 2010
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Interventions/services for children and young people who are overweight and obese
(using 91st & 98th centile cut offs)
Age
Estimat
Estimated
Services in relation to need
group
ed
number
2-4
years
1680
(1200
overweight
& 480
obese)
number
eligible for
intervention 1
120 eligible
for Level 1
intervention
(see care
pathway)
*100 eligible
for Level 2
intervention
*This includes
obese children
plus a proportion
of overweight
children who
have had
unsuccessful
Level 1
intervention
5 - 13
years
5900
(4100
overweight
& 1800
obese)
410 eligible
for Level 1
intervention
*380 eligible
for Level 2
intervention
*This includes
obese children
plus a proportion
of overweight
children who
have had
unsuccessful
Level 1
intervention)
Healthy Child Programme (Level 1)
 Families of overweight children receive brief intervention and
intensive support including signposting to local healthy living
opportunities by health visitors, Family Nurse Practitioners, GPs
and practice nurses.
 There is capacity for all eligible families.
Active Families (Level 2)
 An intervention which provides family physical activity sessions
in city leisure centres and community settings.
 Families with an overweight or obese child aged 2-4yrs can be
referred by a health professional and receive 10 free Active
Families sessions.
 Brief intervention around healthy eating is given in addition to
the referral.
 There is capacity for all eligible families.
Brief Intervention (Level 1)
 Overweight children/families receive brief intervention and
intensive support including signposting to local health living
opportunities by school nurses, GPs and practice nurses. There
is capacity for all eligible families through the School Nursing
Service (Healthy Child Programme, 5-19 years).
Go4It! (Level 2)
 Go4It is an evidence based targeted weight management
service which encourages children and families to establish and
maintain healthy lifestyles by promoting and educating them in
skills and knowledge around nutrition, physical activity and
behaviour change. Service consists of 24 sessions over a 12
week period.

Running at 3 sites (in areas with high child obesity rates). There
is capacity for 135 children/families per year.
Academic Year
2005-2006
2006-2007
2007-2008
2008-2009

Total No. attending
46
82
40
74
Of the 74 who attended Go4It in 2008/09, 16% children
attending had a disability, 42% were from BME communities and
Nottingham City Joint Strategic Needs Assessment April 2010
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14 15
years
1800
(1200
overweight
& 600
obese)
120 eligible
for Level 1
intervention
*120 eligible
for Level 2
intervention
*This includes
obese children
plus a proportion
of overweight
children who
have had
unsuccessful
Level 1
intervention)
Brief Intervention (Level 1)

Overweight young people receive brief intervention and
intensive support including signposting to local health living
opportunities by school nurses, GPs and practice nurses.

There is capacity for all eligible families through the School
Nursing Service (Healthy Child Programme, 5 – 19 years).
Slimming World (Level 2)

Slimming World has been commissioned to provide weight
management services for adults in Nottingham City and this
extends to young people aged 14-15 who will be offered the
children’s package. Children must be accompanied by their
parent / guardian. A voucher is given to the child/parent who
attends the group in the same manner as a paying customer.
This consists of a 12- week local Slimming World group.
 59 of the city’s 62 GP practices have signed up to the scheme.
 Nine young people have been referred and accessed the
service since implementation in May 2009 until December 2009,
all aged between 17-19 years.
 There is capacity for all eligible young people.
In summary, we estimate we need sufficient capacity for approximately 600 children/families to
receive a targeted weight management service. Current capacity is for 355 families. PCT funding
will increase in 2010 to provide Go4It at two additional sites which will increase capacity to 445.
Work is in progress to ensure children from priority groups are engaged in the programme.
Go 4 It! is currently operating at Harvey Hadden Sports Complex, Bilborough, The Vine
Community Centre, Bobbersmill/Radford, and Southglade Leisure Centre, Bestwood. The service
will be expanded into Clifton and Sneinton in 2010 to reflect the higher need of the population in
these areas.
Specialist Services
Overweight children who have co-morbidities or complex needs are referred for Paediatrician
assessment and management. Present services meet demand but further work may be required to
ensure appropriate uptake and referral is taking place in the future.
Notable changes since JSNA April 09
-
Implementation of Active Schools intervention.
-
Obesity care pathway for children aged 2-16 years has been developed as well as supporting
documentation/guidance and an adapted version of the pathway for the wider children’s
workforce is in development.
-
A Directory of Healthy Living Opportunities for Children has been developed to support
signposting of overweight children to local physical activity and healthy eating opportunities.
-
Development of a Physical Activity, PE and Sport Strategy for Children and Young People.
-
Development and implementation of Active Families intervention.
-
National Child Measurement Programme - proactive feedback of results was piloted in two
schools, where parents of overweight and obese children were contacted by school nurses and
offered a one- one consultation. A larger pilot will take place in 2010 including a robust
evaluation of the impact of this approach.
Nottingham City Joint Strategic Needs Assessment April 2010
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-
In partnership with NHS Nottinghamshire County the recruitment of an infant feeding coordinator to work towards achieving UNICEF Baby Friendly accreditation across local maternity
services is currently being processed.
-
Department of Health funding has been awarded to recruit a breastfeeding coordinator to
implement Baby Friendly across community health services.
4) Projected service use and outcomes in 3-5 years and 5-10 years
In 2007/08, 21.9% of Year 6 children in Nottingham were obese. As the levels of obesity are
predicted to continue to increase in the near future, halting the year on year rise is a challenging,
complex and long term issue.
Too few data points (4 years) are known to reliably set trends. The projected local trend (Figure 1)
is therefore based on the current national trend, which estimates child obesity at both Reception
and Year 6 rising at a yearly rate of 0.5% points (Department of Health, 2008).
Figure 1: Rates, trends and targets for child obesity in Nottingham
% of children who are obese
30
25
20
15
10
5
0
Actual Prevalence (Yr 6)
2005/06
2006/07
2007/08
2008/09
20.2
20.1
21.9
22.6
21
Projected Trend (Yr 6)
LAA/Local Operational Plan Target (Yr 6)
England Rate (Yr 6 )
Actual Prevalence (Reception)
12.5
2010/11
2011/12
2012/13
21.5
22.0
22.5
23.0
23.5
20
20
20
15.5
16
17.5
18.3
18.3
12.5
12.8
10
13.5
14
14.5
15
12
12
12
Projected Trend (Reception)
LAA/Local Operational Plan Target
(Reception)
England Rate (Reception)
2009/10
9.9
9.6
9.6
However, the National Heart Forum (Brown et al, 2009) found evidence that the rate of increase in
childhood obesity may be starting to slow. Its figures suggest that by 2020 the proportion of boys
aged 2-11 who will be overweight or obese will be 30% - not 42% as previously predicted. For girls
of the same age the revised prediction is now 27% - down from 48%. The revised predictions also
indicate a big drop in the number of overweight and obese young people aged 12-19. The National
Heart Forum based its latest predictions on data collected for the Health Survey for England
between 2000 and 2007. Previous estimates were based on data collected for the same survey
between 1993 and 2004. Based on population projections, these revised predictions suggest that
there will be approximately 5935 obese 2-19 year olds living in Nottingham by 2020.
Nottingham City Joint Strategic Needs Assessment April 2010
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Nottingham
2020 Population
Projection
Obesity Rate based on
National Health Forum
Projections
Projected Number Obese
in 2020
2- 11 year population
32,560
13%
4233
12-19 year population
28,360
6%
1702
TOTAL
5935
These projections however, are based on national modelling so it can be assumed that this is an
underrepresentation of the projected number of obese children in Nottingham due to high levels of
deprivation in the city. They also do not take account of the effect of interventions to reduce child
obesity.
See page 1 of the Childhood Obesity factsheet for more information
5) Evidence of what works
National Institute for Health and Clinical Excellence. Obesity: the prevention, identification,
assessment and management of overweight and obesity in adults and children. 2006.
Department of Health (2008) Healthy Weight, Healthy Lives - A Cross Government Strategy for
England
Department of Health (2008) Healthy Weight Healthy Lives – a Toolkit for developing local
strategies.
Foresight Report (2007) Tackling Obesities: Future Choices – Project Report
It is very difficult to estimate cost effectiveness as effect of interventions are usually indirectly
related to outcome and are difficult to measure over long-term scales. However, given the high
costs of managing obesity and related health conditions and the high and rising prevalence it is
likely that the return on investment is high. At present a small fraction of expenditure is on
prevention when compared with dealing with consequences of obesity.
6) User Views
Evaluation of Go 4 It! and Active Schools shows positive user feedback and further research of the
outcomes of the programme are planned.
The work carried out by the PCT as a part of Our NHS Our Future highlights childhood obesity as
a priority issue as expressed via the public engagement event forums. Partners are working
collaboratively to take account of local views and address concerns. Further work is planned to
engage school governing bodies with the results of the Child Measurement Programme.
7) Equality Impact Assessments
Issues raised by Equality Impact Assessment
National and local data suggests a higher rate of obesity amongst children from Black and Minority
Ethnic groups, particularly Black African, Black Caribbean and Asian groups. In 2008/09, 42% of
families accessing the Go 4 It! programme were from Black and Minority Ethnic Groups.
An Equality Impact Assessment of the Child Obesity Strategy will be conducted in 2010.
Nottingham City Joint Strategic Needs Assessment April 2010
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8) Unmet needs and service gaps
- There is a short-term need to continue to expand provision of universal and targeted
interventions in order to reduce long-term need for health services to tackle the complications of
child and adult obesity.
- Services are located to provide access to disadvantaged communities but uptake on basis of
need needs to be confirmed.
- Some schools are reluctant to participate in the child measurement programme. This is being
addressed by the development of a ‘school health forum’ in conjunction with head teachers,
schools and the Local Authority in the 2009/10 school year
- Go4 It! programme is established in 3 areas but at present uptake is low and the minimum
estimated required capacity is not provided.
- Opportunities for physical activity, particularly for families and young women who are prenatal
could be increased.
- There is a need to increase capacity and capability ensuring all staff working with children and
families are trained to sensitively raise the issue of weight and offer appropriate support in line
with the care pathway.
- Evidence of effectiveness of interventions to tackle obesity is lacking and more research is
required to understand underlying causes and what works.
9) Recommendations for consideration by commissioners
- The partnership should continue to invest more resources in prevention in line with guidance
and local targets to halt the rise in child obesity.
- Work across the partnership to get better information on the prevalence of obesity amongst
children with learning disabilities and Looked After Children.
- Ensure early identification and prevention of obesity through the Healthy Child Programme by
setting clear commissioning outcomes.
- Implement the breastfeeding strategy and commission services to implement the UNICEF Baby
Friendly Initiative.
- Develop a child nutrition strategy and ensure integrated nutrition interventions through
Children’s Centres, schools, and other community settings.
- Support implementation of the Physical Activity, PE and Sport Strategy for Children and Young
People to ensure more opportunities for physical activity, particularly family based interventions
and access to facilities in deprived areas.
- Develop a mechanism for recording progress towards the ambition of offering all children at
least five hours of PE and sport every week.
- Joint planning in the areas of the built environment, the natural environment, access to healthy
food and transport.
- Expand provision of targeted weight management interventions for the 5 – 13 year age group.
- Develop and implement a communication strategy to ensure effective implementation of the
Care Pathway to increase uptake of interventions.
- Conduct a Health Equity Audit of the Go4It weight management service to assess equitable
uptake of the service by disadvantaged and minority groups.
- Continue to build the capability of the wider children’s workforce to ensure those working at a
local level are clear about promoting the benefits of a healthy weight and feel confident in
sensitively raising the issue with those who are overweight or obese.
- Rigorously evaluate current interventions by including evaluation criteria from the Standard
Evaluation Framework for Weight Management Interventions, (National Obesity Observatory,
2009) in contracts, and through research to inform future impact modelling and commissioning.
Nottingham City Joint Strategic Needs Assessment April 2010
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- Conduct an assessment of new research around child obesity and re-evaluate the effectiveness
of interventions in light of new evidence base.
Notable changes since JSNA April 09
The following recommendations have been removed because they have been, or are in the
process of being implemented:
- Further development of the child obesity strategy should make use of data in gaining
engagement of independent agencies such as schools to implement interventions outlined in
the Children and Young People’s Plan (CYPP).
- Multiple approaches (as outlined in the CYPP) are required and therefore there should be a
greater focus on local partnership action through a City-based child obesity working group that
is a part of the local strategic partnership structure.
- Family based interventions need to be developed alongside the adult obesity strategy to tackle
the intergenerational aspect of obesity
10) Further needs assessment required
- Bring together data on a range of obesity indicators and provide at a locality level where
possible and share with all partners.
- Carry out further data collation and analysis to understand the trends and patterns of child
obesity and also to understand the uptake of services in relation to need with a particular focus
on children with learning disabilities and Looked After Children.
- Identify reasons for high drop out rates and non attendance to the Go4It programme.
- Conduct an analysis of the child obesity data and the PE, school sports and club links survey
(PESSCL) data by school, and provide to schools to inform commissioning decisions.
Key contacts
Dr. Peter Cansfield, Consultant in Public Health, NHS Nottingham City ,
[email protected]
Sarah Diggle, Public Health Development Manager, NHS Nottingham City,
[email protected]
Susan Twemlow, Head of Service Commissioning Children and Families, Nottingham City
Council, [email protected]
References:
APHO (2005). Indications of Public Health in the English Regions 3: Lifestyle and its impact on health.
http://www.apho.org.uk/apho/publications/sepho_CMO3Lifestyle_220205.pdf
Birch L, Davison K. (2001). Family environmental factors influencing the developing behavioural
controls of food intake and childhood overweight. Paediatric Clinics of North America , 48:893–907
Brown M., Marsh T., McPherson K., Byatt T. (2009). Obesity: Recent Trends in Children Aged 2-11y
and 12-19y. Analysis from the Health Survey for England 1993 – 2007. National Heart Forum
Campbell K, Crawford D (2001). Family food environments as determinants of preschool aged
children’s eating behaviours: implications for obesity prevention policy. A review. Australian Journal of
Nutrition and Dietetic, 58:19–25.
Caroline Walker Trust (2001). Eating well for looked after children: nutritional and practical guidelines.
London: Caroline Walker Trust.
Nottingham City Joint Strategic Needs Assessment April 2010
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Cross-Government Obesity Unit (2008) Healthy Weight, Healthy Lives: A Cross-Government Strategy
for
England.
London:
DH/DCSF
(available
at
www.dh.gov.uk/en/
Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082378).
Department of Health (2008). How to set and Monitor Goals for Child Obesity: Guidance for PCTs and
Local Authorities.
Doak, et al. The prevention of overweight and obesity in children and adolescents. Obesity Reviews
2006; 7:111-136.
Finn K, Johannsen N, Specker B (2002). Factors associated with physical activity in preschool
children. Journal of Paediatrics, 140:81–5.
Kerr MR, Felice D (2006). Paper based on data also included in an unpublished study for the
Disability Rights Commission: Equal Treatment – closing the gap. London: Disability Rights
Commission.
McPherson K, Marsh T, Brown M (2007) Foresight Tackling Obesity:-Future Choices- Modelling
Future Trends in Obesity and their impact on Health. Government Office for Science
National Institute for Health and Clinical Excellence (2006), Obesity: the prevention, identification,
assessment and management of overweight and obesity in adults and children.
Ridler C, Townsend N, Dinsdale H, Mulhall C, Rutter H (2009); National Child Measurement
Programme: Detailed Analysis of the 2007/08 National Dataset; HM Gov London
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