Overview of Healthy Weight
The health impact of obesity
Obesity is caused by a complex set of personal, social and environmental factors. Being overweight or obese can bring physical, social, emotional and psychosocial problems, which can lead to the onset of preventable long term illness, stigma, discrimination, increased risk of hospitalisation and reduced life expectancy.
This has a direct impact on the community. An overweight or obese population is less likely to be physically active, which can lead to reduced productivity. It can affect life opportunities and place an increased demand on social care, putting extra pressure on limited services and resources. Someone who is severely obese is three times more likely to need social care than someone who is a healthy weight, so the need for quality weight management services does not only impact individuals, but also affects public funds and the wider community.
Vision 2030
Sandwell has a much worse obesity problem than the national average, both amongst children and adults. Reducing the levels of obesity in Sandwell will be a big step towards achieving the council’s 2030 ambition of Sandwell being a ‘place where we live healthy lives and live them for longer’.
Excess weight in Sandwell
In 2017/18, 12.8% of Reception aged children in Sandwell are obese, compared to 9.5% for England. This rises to 28.2% of Year 6 aged children in Sandwell, compared to 20.1% nationally. Over 18s also fair badly, with almost a third of adults in Sandwell being obese compared to 23.3% in England.
The figures are far worse when we consider “excess weight” – those overweight or obese, with almost a quarter of children in Reception being overweight or obese, rising to over two-thirds of adults.
Children
The National Child Measurement Programme (NCMP) is an annual measure of the height and weight of school children which provides a detailed picture of the prevalence of child excess weight (overweight and obese) and obesity in children at reception age (4-5 year olds) and Year 6 (10-11 year olds).
In terms of excess weight (children who are overweight or obese), at Reception age, whilst Sandwell generally has a higher proportion of children who have excess weight, the West Midlands and England averages are not dissimilar. At age 10-11 (Year 6) however, the difference between Sandwell and the regional and national averages is more pronounced, and is the highest in the West Midlands conurbation area.
The difference between Sandwell and the West Midlands and England averages is much wider when considering obesity. There has been a steady increase in the level of obesity among Reception age children in Sandwell, and for Year 6 this rise has been going on for even longer. In 2017/18, the Sandwell figure now stands at more than 8 percentage points higher than England, and is the highest within the West Midlands conurbation area.
Children living in the most deprived areas of Sandwell are generally more likely to be obese than those living in the least deprived areas, although there does appear to be an anomaly to this for children of Reception age. For 2013/14 - 2017/18, there is an unexpectedly high proportion of obese children living in the least deprived quintile of Lower Super Output Areas (the LSOAs within the best 20% nationally on the Index of Multiple Deprivation). This is not currently replicated for Year 6 children, but further work may be needed to find out what is happening in these areas.
Black children are more likely to be obese than Asian or White children, at both Reception age and in Year 6.
For excess weight, it is possible to analyse local NCMP data.
Adults
The Active Lives Survey explores participation in leisure and recreational activities, including sport, physical activity and culture. The survey is led by Sport England in partnership with the Arts Council, Public Health England and Department for Transport.
Data is collected for two surveys, with the Active Lives Adult Survey focusing on people aged 16 and above, while Active Lives Children and Young People looks at the activity levels of children aged 5-16.
The Active Lives Survey shows that in 2016/17, over 70% of adults (over 18's) in Sandwell are classified as overweight or obese, compared with 61.3% nationally. In terms of obesity, almost a third of adults are obese in Sandwell, compared with 23.3% in England. Both of these figures are the worst in the West Midlands conurbation area.
Due to sample size, we are unable to access local data for particular population groups. However, data for England shows that adults have a greater chance of being overweight or obese if they are economically inactive, or disabled (70.2% of those with a disability suffer from excess weight compared with 59.6% of those who are able bodied).
Those in routine and manual occupations are also more likely to be overweight or obese - 66.3% compared with 60.6% of those in managerial and professional occupations in 2016/17. It is routine and manual occupations that are over-represented in Sandwell compared to the national average.
In terms of ethnicity, as with children it is Black adults who are more likely to be overweight or obese than other groups (69% of Black adults in England have excess weight in 2016/17), whilst Chinese groups have a much lower propensity (31.5%). Nationally, 62.3% of the White British population is overweight or obese.
JSNA Sections (click to expand)
Weight Management Services Pathway and service provision
In respect of the development of an integrated weight management services pathway, Public Health has commissioned, through a ‘core’ lifestyle services contract, a range of lifestyle interventions to prevent and treat overweight and obesity in individuals and families, in order to help them achieve and maintain a healthy weight. The service has been developed with a ‘person’ rather than ‘programme' focus and with an ethos to provide personalised lifestyle packages and interventions which are tailored around individual needs and requirements.
Locally, we have adopted a new approach to enabling and supporting sustainable behavioural change. A key component of this is the development of the behaviour change and maintenance pathways achieved through collaboration between key partners and Public Health. Sandwell Council have implemented a ‘Public Health Development Officers’ (PHDOs) delivery matrix. The PHDO officers have a remit to build integrated service pathways at neighbourhood level to address gaps in service provision and meet the needs of local people.
Building upon universal weight prevention, a wide provision of physical activity services is available to help individuals and families to increase their levels of physical activity.
Future
Pre-natal, pregnancy and post-natal services
Public Health is currently working to identify opportunities to develop new partnerships with key stakeholders including health professionals, particularly Midwives and Health Visitors, in addition to specialist services such as Sandwell and West Birmingham Hospital, Walsall Manor Hospital, Dudley’s Russell’s Hall Hospital in order to address the gap in pre-natal and post-natal services and to further develop the local integrated weight management services pathway.
Emerging evidence
The nation faces a major challenge to address the unhealthy lifestyle that pushes children and families towards over-consumption of processed food & sugary drinks and weight gain. As highlighted by the results from the National Child Measurement Programme (NCMP), the picture is worse in Sandwell, reflecting the general pattern that obesity rates increase in areas with increased levels of deprivation and lower levels of education and employment.
A number of underlying factors may contribute to any individual child becoming overweight and/or obese. For this reason the condition of ‘obesity’ has been described as ‘complex but not complicated’ and to tackle it comprehensively within the wider population requires a joined-up, systematic and long term approach. The local approach (described below) shows action areas currently being addressed within the remit of Public Health; acknowledging the need for closely coordinated activity across the ‘whole system’ to impact meaningfully upon the levels of child obesity.
Obesity is likely to persist from childhood, with most obese adolescents also being obese in adulthood. Children and young people very overweight are more likely to become obese adults, and have a higher risk of morbidity, disability and premature mortality in adulthood. Excess weight can be associated with conditions such as bone and joint problems, pre- diabetes, poor psychological and emotional health and many children and young people experience bullying linked to their weight. Children and young people with excess weight are more likely to have weight-related health issues, be absent from school due to illness and require additional health care support than children and young people of a healthy weight. Once established, obesity can be difficult to treat, so prevention and early intervention are very important.
Who is at risk and why?
Socio-economic status remains a strong indicator for excess weight in children. Typically, rates of obesity increase most in children from a lower socioeconomic background. This worsening of health inequality in relation to obesity is more marked in girls than boys. Other factors such as ethnicity can be correlated with excess weight in children. As shown previously on this page, children from Black And Minority Ethnic Groups (BAME) have higher levels of excess weight and obesity than their white counterparts.
The national government ambition is to achieve a sustained downward trend in the level of excess weight in children by 2020, targeting excess weight in 4-5 and 10-11 year old children and a downward trend in the level of excess weight in adults by 2020. Sandwell’s local mission is to reduce obesity by 0.5% year on year. (Foresight report, 2007)
Since 2015, the local approach to reducing excess weight in children and families has been underpinned by key documents such as the Food System Map (2015 LANCET Series), the Childhood Obesity Plan (2016 National Govt.) and the Whole Systems Approach to Obesity (Local Authority ‘Levers’) – Leeds Beckett University (2017).
Aligned to the National Childhood Obesity Plan (2016), Public Health and key partners are currently working together in 6 key areas to tackle obesity; particularly focusing on children & families in order to influence the trajectory of weight gain with age.
(i) Supporting local schools; who have received a doubling in their pupil premium from the national government’s sugar tax, through our learning community hubs attended by a wide range of school representatives and through school food projects (growing, tasting & cooking).
(ii) Locally adopting the government’s yearly target of 5% sugar reduction and we are working with school food providers to reduce sugar content in school foods and achieve 20% sugar reduction in school foods by 2020.
(iii) Supporting children to achieve their 60 minutes physical activity every day through active play opportunities, increasing school delivery capacity and supporting school participation in the ‘Daily Mile’.
(iv) Offering ‘family’ packages within our lifestyle services (physical activity, healthy eating and weight management) specifically for individuals to attend with their families.
(v) Beginning to work with local businesses to make healthier options available when eating out through promoting our ‘Eat Out Eat Well’ healthy catering award (aligned to national accreditation & standards).
(vi) Supporting national government initiatives, for example, the restrictions on food and drink advertising, producing clearer food labels and making healthy options more available in the public sector including hospitals.