Healthy weight

• Ensure that all tiers of the service model can be provided across Kent
• To ensure that people are identified early on in the Care Pathway and enabled to access local services
• Ensure that services are integrated into the Children’s Care Pathway
• Ensure that there is more investment in primary prevention intervention and that additional investment is targeted
• Ensure these services are integrated into other primary prevention services

Obesity is a multifaceted condition with no single cause. Contributing factors include genetic pre-disposition; metabolic; and neural factors all of which are influenced by an individual’s physical activity; behaviour; lifestyle; eating habits; and socio-cultural factors. As such there are many reasons why an individual may become obese, but it is generally thought that current prevalence is due to people’s latent biological susceptibility, interacting with a sedentary lifestyle and increased availability of foods (Foresight 2007).

Body Mass Index (BMI) the commonly used measure to classify weight (NICE 2006). BMI is defined as the weight in kilograms divided by the square of the height in meters.

Although obesity is not generally thought of as a disease, it is a risk factor for a range of serious diseases and the risks increase with increasing body weight. The risks also are compounded by other risk factors such as smoking, giving an even higher level of risk. In public health terms, the greatest burden of disease arises from obesity-related morbidity. Table 5 below gives details of the health problems associated with obesity.  

Note: All relative risk estimates are approximate. The relative risk indicates the risk measured against that of a non-obese person of the same age and sex. For example an obese person is 2-3 times more likely to suffer from hypertension than a non-obese person.

Overall there is a strong relationship between obesity and disability and disease. This is also demonstrated by increasing mortality rates with increasing body weight.

Adult obesity  

It is estimated that appoximately 28.%% of the Kent population is obese (354,022)¹.  Using the Healthy Weight Healthy Lives Obesity Prevalence Tool² Table 1 shows the rates of obesity in adults. 

Table 1 Adults (≥16): Estimated number of obese adults in Kent 

Intervention at a primary prevention will help to reduce the number of people that fall into the next BMI category. 

Table 2 Classification of Weight 

There are more people who are just overweight than are currently classed as ‘obese’. The two categories together make up around 50% of the Kent population.

Targeting people in the 25-30 BMI categories needs to be considered on a population basis simply because of the numbers. This strategy would also have a beneficial effect on the next generation if parents can be encouraged to be more active.

Figure 1

Source:  Health Profiles 2010 APHO and Department of Health

Figure 1 shows obesity by Local Authority areas.  This demonstrates clearly that areas of highest deprivation have greater numbers of obese people.  However, it is of concern that for an affluent area such as Kent only three areas have a level of obesity below the national average. Whilst obesity is linked to deprivation and this needs particular attention, it is also a whole population problem.

Figure 2: Correlation between obesity and deprivation in Kent³

Figure 2 shows obesity rates and deprivation scores for Kent in that wards with higher deprivation have higher levels of overweight and obesity.  The correlation between the two is statistically significant, so that in general, obesity tends to be more prevalent in the lower socio-economic and lower income groups.

Obesity is an element of health inequality; there are social differences in the prevalence of obesity and associated causes of mortality and morbidity.  Deprivation is associated with a cluster of health problems including higher levels of overweight and obesity, physical inactivity, smoking, poor blood pressure control, and other factors that effect physical health.  It is also integral tolower educational attainment, lack of employment opportunities, poor housing status, poor access to services, referral differences of practitioners and poor compliance with disease management.

In a recent document published by the South East Coast policy support unit⁴ the following level of need (Table 6) has been identified which sets out prevalence, cost and the potential number of people that would benefit from Bariatric surgery (Tier 4) This proportion of the population represents the top of the pyramid as set out in Fig 3. (section xx). As the model suggests, the number of people that would benefit from the other tiers, 1, 2 and 3 would be exponentially greater. 

Source: NHS The Information Centre (QMAS database - 2009/10 data as at end of July 2010)

  
Source: Foresight – Tackling Obesity: Future Choices – Modeling Future Trends in Obesity and the Impact on Health, 2006. Analysed by DH to local level using national resource allocation formula

Source: South East Coast Specialised Commissioning Group

[1] ONS Mid-2010 Population Estimates 

[2] Using Healthy Weight Healthy Lives Toolkit – formulae based on Health Survey for England 2006 www.fph.org.uk 

[3] Health and Social care Information Centre (2004 IMD) ONS Synthetic Data  

[4] South East Coast Primary Care Trusts’ Policy Review and Recommendation Process Bariatric surgery for obesity and related comorbidities Final Report April 2011

Service Model East Kent

Improving the population’s diet is addressed using both a clinical approach and a health improvement approach. These services are currently commissioned through Kent Community Services in East Kent.

The Department of Clinical Dietetics and Healthier Living Services offers services where registered dietitians translate scientific information about food into practical dietary advice. Dietitians also advise about food related problems and treat disease and ill health. Dietitians work closely with, and accept referrals from:

• General Practitioners and Consultants
• All Registered Nurses
• Other Healthcare Professionals such as Speech and Language Therapists
• Health Promotion
• East Kent Exercise on Referral Scheme
• Self-referral must be accompanied by a medical history from GP

The Diabesity team is part of the Department of Clinical Dietetics and Healthier Living Services Kent Community Services. This service provides a high quality diabetes and obesity dietetic service for people of all ages and their carers across Kent. The Diabesity Team offers dietetic advice for diabetes, obesity and weight management to people of all ages and their carers.

Diabesity Dietitians provide dietetic advice and support for:

• Safe and healthy weight loss and weight management
• Children, young people and adults with newly diagnosed diabetes
• Improving diabetes control
• Dietary issues when starting insulin therapy
• Preconception dietary advice for women with diabetes who wish to become pregnant (available through antenatal clinics at each acute site)
• Insulin pump therapy
• Improving blood lipids (cholesterol) and blood pressure
• Cardiac (heart) health 

The Health Improvement Team also provides additional programmes listed below which support behaviour change with respect to increasing activity and improving diets.

·         The Exercise Referral Scheme

·         The Weight Management Scheme

·         Mind, Exercise, Nutrition… Do IT! MEND 7-13

·         Mind, Exercise, Nutrition… Do IT! MEND 2-4

·         Healthwalks

·         Bitesize Nutrition Training

·         Food Champion Training

Service Model West Kent

In West Kent health improvement programmes are not as well linked to NHS Dietetics services, which are mainly provided by the Acute Trusts.  The majority of community services that provide weight management as part of the Prevention Strategy to reduce prevalence are provided by local authorities, although there is a requirement for the nutritional aspects to be provided.  The services provided must meet the 2006 NICE guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. There are three essential elements of the Service Level Agreement which are summarised below:

1.  Family Weight Management Programmes in all localities (50 families per year)

• enabling families to change behaviour to achieve increased physical activity and improved nutritional intake;

• helping children or young people to develop a positive body image and build self-esteem;

• encouraging parents to role-model desired behaviours;

• and encouraging parents of overweight or obese children to lose weight if they are themselves overweight or obese

2.  Adult weight management programmes in all localities (targets based on prevalence) to be evaluated using the Standard Evaluation Framework 

• The programme will create a supportive environment that helps overweight or obese adults make sustained behavioural changes to achieve:

• increased physical activity and reduction in sedentary behaviour;

• improved eating behaviour and quality of the diet, and reduced energy intake;

• improved emotional well-being.

• The service should allow for personalised goal-setting in each of these areas.

3.      Providing Support for Change for Life each locality will have:

• A sustainable social marketing programme to support delivery of healthy lifestyles messages and their adoption

• Support at the local level to the defined programmes and activities organised to influence healthier food choices and adoption of an active lifestyle

• Measures in place to assess impact on all age all cause morbidity and mortality  through reduction in rates of overweight and obesity  

In addition holistic Community Development programmes are provided as part of the Healthy Living Centre agreements in all localities.

Service Model

Kent is developing the service model as set out on Figure 3.  The model offers four tiers of service which range from a population approach to maintaining and achieving a Health Weight to surgical procedures to achieve dramatic weight loss for those patients with higher BMI’s.

Figure 3  Weight management care pathway for adults

Life-stage Approach

Maintained weight reduction is the aim for people who are already overweight and who are showing signs of weight related conditions.  However, the reduction of unhealthy weight needs a whole system life stage approach.  The components of the programme are contained in the National Strategy and reflected in the West Kent Healthy Weight Strategy. 

• Ante-natal programme
• Breastfeeding and Weaning
• Early Years Interventions
• Healthy Schools
• National Child Measurement and Intervention Programme
• Social Marketing (Change4Life)
• Increased Physical Activity (Including  Let’s Get Moving in Primary Care)
• Adult Weight Management Programmes
• Specialised Tier 3 & 4 service 

The health benefits of losing excess weight

Weight loss in overweight and obese individuals can improve physical, psychological and social health. There is good evidence to suggest that a moderate weight loss of 5-10% of body weight in obese individuals is associated with important health benefits, particularly in a reduction in blood pressure and a reduced risk of developing type 2 diabetes and coronary heart disease. Table 4 shows the results of losing 10kg.

In relation to reduction in co-morbidities, the Diabetes Prevention Program in the US has shown that, among individuals with impaired glucose tolerance, a 5-7% decrease in initial weight reduces the risk of developing type 2 diabetes by 58%. It is important to recognise that, for very obese people, such changes will not necessarily bring them out of the at-risk category, but there are nevertheless worthwhile health gains. A continuous

programme of weight reduction should be maintained to help continue to reduce the risks.

The benefits of a 10kg weight loss can bring about the results shown in Table 4 below.

Table 4: The benefits of a 10kg weight loss ⁹

9 Lightening the load: Tackling overweight and the public health burden,2007

• Ensure that all tiers of the service model can be provided across Kent
• To ensure that people are identified early on in the Care Pathway and enabled to access local services
• Ensure that services are integrated into the Children’s Care Pathway
• Ensure that there is more investment in primary prevention intervention and that additional investment is targeted
• Ensure these services are integrated into other primary prevention services