Essay: Local Authority Strategy to Target Obesity 2015-2020

Obesity is a local, national, and international problem. Over the past 25 years obesity rates in England have increased by more than 50% and being overweight has become accepted as a norm for adults, with estimates that by 2050 half the population will be obese (Foresight, 2007). As a society the UK is less active than it once was, jobs are less physically active, cars are routinely relied upon even for short journeys, whilst easy access to cheaper, highly energy dense foods that are high in fat, sugar, salt and low in nutrients are consumed (Department of Health, 2008). Obesity contributes to premature mortality, increases the risk of diseases such as diabetes, cancer, and cardiovascular disease, and has a negative effect on life expectancy (HSCIC, 2014). The economic cost of treating obesity and its associated conditions has been estimated at a cost of ??5 billion a year to the NHS (Foresight, 2007). 67.2% of the adult population in Liverpool are overweight or obese compared with the average of 62.1% in England (HSCIC, 2014). The prevalence of obesity (including those overweight) in Year 6 aged children in the region is 39.1% compared to the average of 33.3% in England (Craig and Mindell, 2014). Liverpool has more obese children than any other English city (Food Active, 2014). It is estimated treating obesity costs the NHS in Liverpool ??163m a year (Department of Health, 2008). In 2004 the government established obesity as a key priority for public health through their Choosing Health: Making Healthier Choices Easier strategy but levels have steadily increased year on year since the priority status (Craig and Mindell, 2014). Instilling positive attitudes towards food and diet and physical activity can lead to beneficial effects on individual’s health and the health of the nation (Department of Health, 2008).
Strategy Aim
To improve the overall health of the city by halting the rise of obesity and overweight in adults and children within the local authority and beginning a reduction in prevalence by 2025.
Using the themes set out in the Governments Healthy Lives, Healthy People strategy this strategy will focus on promoting healthier food choices and building physical activity into everyday life (Department of Health, 2008). The target population will be children, young people and families. To halt the future of obesity we need to educate and empower our young people as to the benefits of physical activity and healthy eating.
Objectives
1. Create a local environment that promotes and supports healthy weight
a. Regulation of takeaways and fast food outlets
b. Community engagement programmes
2. To establish healthy eating and physical activity patterns among children and young people
a. Schools healthy eating programme
b. Promotion of active travel
This strategy will endeavour to involve both treatment and prevention of obesity as part of the long term plan to promote the benefits of a healthy lifestyle within the local authority. Using a multi-component approach, the strategy will attempt to engage with the local population and provide the foundation to make the healthy choice the easy choice and allow participants to maintain a healthy weight.
1. Create a local environment that promotes and supports healthy weight
The local authority is in the perfect position to change the local environment through policy change (Shepherd et al, 2006). A 2005 Cochrane review (Waters et al, 2011) concluded that when assembling a broad strategy to increase physical activity and improve diet, interventions that involve environmental change will be of importance. A tax on fatty or sugary types of food will likely increase the cost of living for families and make little difference to health objectives (Snowden, 2013). Instead this strategy will focus on engaging the community through the promotion of community schemes aimed at educating on the benefits of healthy diets and physical activity and the regulation of takeaways and fast food outlets within the authority.
a. Regulation of takeaways and fast food outlets
Takeaways and fast food outlets provide access to inexpensive, highly energy dense food, and take away the time constraint of cooking, but have a strong link with obesity. There are 553 takeaways and fast food outlets in Liverpool, the sixth highest across towns and cities in England (Food Active, 2014). The perceived poor quality of school meals and cheapness and easy access to fast food acts as a barrier for young people to eat healthier (Shepherd et al, 2006). Although the link between obesity and fast food takeaways is a matter of common sense, the evidence for policy reform is limited. Although a review by Papas et al (2007) found strong evidence that obesity is positively linked with close proximity and dense concentration of fast food outlets but important consideration must be given to the social and physical environments that individuals have no control over, which influence obesity.
Measures to regulate takeaways and fast food outlets:
‘ Reduce the clustering of outlets within residential areas or deprived areas deemed at risk
‘ Set ideal zones for takeaways such as town centre and non-residential areas
‘ Refuse new takeaways from opening within a 500 metre radius of schools, leisure centres and play grounds
‘ Work with current outlets near at-risk groups to restrict opening times e.g. closed during school end times
‘ Introduce an award scheme to encourage existing establishments to improve the health quality of the foods they offer
Boroughs in London have worked with takeaways and although they cannot yet show a link with a reduction in obesity it has had positive effects on school eating habits. Waltham Forest authority introduced a scheme refusing planning permission to new takeaways within 400 metres of schools and leisure centres, in conjunction with a scheme to improve school meals and saw childhood obesity levels in year 6 pupil’s drop to by 2% within 18 months (Waltham Forest, 2009; Barney and Goodchild, 2010).
b. Community engagement programmes
Shepherd et al (2006) found that support from family members is an important facilitator in young people eating healthily. Parents who have an understanding of the healthy options such as portion sizes and understanding food labels are more likely to prepare and provide their children with healthier foods (Waters et al, 2011). The initiation of a programme that provides dietary education and cookery classes with simple fun exercise activities would allow the whole family to engage in understanding the benefits of living a healthy life.
Walking is free and requires no special training which is great for people to engage in their local communities. Walking for Health schemes (Natural England, 2010) allow families to discover their local environment whilst benefiting their health. A Natural England commissioned (2010) study estimated that for every ??1 spent on a health walk scheme could save a PCT up to ??7 on medications and hospital admissions expenditure. A systematic review by Kassavou et al (2013) found promoting walking in groups to be an effective method of increasing physical activity.
These behavioural approaches allow individuals and families to see the benefits they can make to their health by making lifestyle changes (Naidoo and Wills, 2009). Although public campaigns will increase people’s awareness of the need to eat and act healthily, there is less evidence to support a sustainment in a change in habit, so any educational approach will run as a supplement to other approaches (Naidoo and Willis, 2009). A strategy that initially considers a medical approach through bariatric surgery is not enabling its population to educate and benefit itself.
2. To establish healthy eating and physical activity patterns among children and young people
a. Schools healthy eating programme
Schools provide the perfect environment to educate children and young people on the benefits of a healthy balanced diet. Evidence shows that improving nutritional quality of school meals and increasing fruit and vegetable intake is an effective method of improving dietary intake (Shepherd et al, 2006). A study by Warren et al (2003) evaluated a programme using nutritional education and physical activities aimed at preventing obesity in children. Though the programme ran for 14 months no significant changes to the rate of obesity could be seen, but the study did show that these approaches had a significant improvement on the children’s nutritional knowledge and produced a significant increase in their fruit and vegetable intake.
All schools should adopt a school wide healthy eating policy where all food and drink served on the premises is in accordance with the government’s compulsory food standards and through co-ordination with student bodies initiate a healthy snack policy through the use of healthy tuck shops and vending machines (Dimbleby and Vincent, 2013). The provision of free school meals to children under the age of seven through free school meals and the School Food Plan ensures that children will receive at least one healthy, nutritional meal a day (Dimbleby and Vincent, 2013).
All four to six year old children in primary schools in the authority will receive a free portion of fruit or vegetable each school day through the School Fruit and Vegetable Scheme, enabling each pupil to eat at least one of their recommended five a day. A study by Knai et al (2006) showed that for children to consume more fruit and vegetables nutritional education should be combined with greater access to fruit and vegetables in school settings, which the School fruit and vegetable scheme provides. An analysis of schemes providing fruit and Vegetable to school children by de Sa and Lock (2007) showed that children receiving fruit and vegetables in school had a significantly increased daily intake than children who did not. There was no significant change in fruit and vegetables consumption once the children grew out of the programme, but this could be due to economic or personal reasons on their parent’s behalf, so universal provision is considered a positive (Wells and Nelson, 2005).
b. Promotion of active travel
Regular physical activity has multiple benefits. It increases life expectancy and reduces mortality whilst helping manage body weight and reduce obesity and has benefits for mental wellbeing too (Natural England, 2010). Active travel seeks to integrate exercise, such as walking and cycling, into the everyday lives of people, through designated walking routes and cycle paths, whilst supporting the environment by reducing congestion, carbon dioxide emissions and air pollution (Cavill and Rutter, 2013).
Traffic involved in the school run considerably contributes to congestion and has a major impact on the environment through CO2 emission pollution. School travel plans aim to reduce the number of journeys made by car thus encouraging walking and cycling to school and increasing physical activity for both parents and children. Active transport can make an important contribution in increasing the proportion of children who meet the recommendations for physical activity (Cavill and Rutter, 2013). Newson et al (2010) examined thirty case studies of school travel plans. Apart from the main benefit of improving the fitness and alertness of the pupils, travel plans help young people explore and familiarise themselves with their local environment, whilst building relationships between parents, schools and their local community. As well as reducing the congestion on local roads, benefits of travel plans include improving children’s road safety awareness and education through cycling and pedestrian training (Cavill and Rutter, 2013). School travel plans can be a complex system to set up and require the support of schools and parents, and will fail if engagement is not there.
Costs
Obesity comes with a huge cost, not only to the NHS but also to the country’s economy, with the total cost estimated at ??50 billion by 2050 (Foresight, 2007). Tackling obesity is an important public health issue so no cost should be spared especially to reap long term benefits. National obesity programmes can cost the government ??100 million a year, but many are cost effective and reduce health expenditure on chronic diseases (OECD, 2013). Many national initiatives will have funding available. A lot of these initiatives though are not tried and tested methods and may take a long time to produce health benefits so will be less cost effective (OECD, 2013).
Through the regulation of planning permission and restrictions on takeaways and fast food outlets moving into vacant stores, the local authority could lose revenue through the loss of rental income and taxes. This authority will work with local voluntary organisations to provide community education programmes and with local private sector businesses to sponsor initiatives to maintain the programmes for longer periods of time. At this time financial incentives to reward weight loss initiatives will not be considered. A systematic review by Paul-Ebhohimhen and Avenell (2007) found no significant outcome from the use of financial incentives to encourage weight loss at 12 or 18 months after initiation.
Evaluation
In meeting the aim of improving the overall health of the city by halting the rise of obesity and overweight in adults and children within the local authority and beginning a reduction in prevalence by 2025, we will keep a focus on
‘ Increasing the proportion of people eating healthily
‘ Increasing the proportion of people engaging with the recommended physical activity advice
Indicators
1. Create a local environment that promotes and supports healthy weight
a. Regulation of takeaways and fast food outlets
i. No new openings of takeaways and fast food outlets within a 500 metre radius of schools
ii. Allow up to a 5% increase in the number of fast food outlets city wide by 2025
b. Community engagement programmes
i. Observe the number of people taking part in local active schemes and using leisure centre facilities
ii. Monitor adult and child physical activity levels through local and national surveys
2. To establish healthy eating and physical activity patterns among children and young people
a. Schools healthy eating programme
i. Observe the levels of childhood obesity in the local area using data from the National Child Measurement Programme
ii. Monitor the uptake of the School Food Plan Programme
b. Promotion of active travel
i. All schools in authority to have school travel plans by 2020