Islington JSNA 2010/11 Healthy Eating

Transcription

1 Islington JSNA 2010/11 Healthy Eating

2 INTRODUCTION A well-balanced diet is important for good health and involves consuming a wide range of foods, including fruit and vegetables, starchy whole grains, dairy products and lean protein. Government recommendations suggest at least five portions of fruit and vegetables per person per day to reduce the risks of cancer, coronary heart disease and many other chronic diseases. Increased weight gain and a poor diet can have significant impacts on health. They are major risk factors for ill health, premature death and contribute to the development of a number of chronic diseases including cancer, liver disease, cardiovascular disease, type 2 diabetes, mental health problems and obesity. Obesity 1 has become increasingly common and has been described as the biggest single public health challenge of the 21 st century 1. The prevalence of obesity is expected to rise to almost nine in ten adults and two-thirds of children by The Department of Health estimates that by 2015, managing disease related to overweight and obesity is likely to cost about 74 million per year 2. Obesity contributes to about eleven percent of deaths in Islington 3. Food choices are influenced by many factors, including social class, community, culture and the environment. It is important to support healthy food choices wherever possible through a combination of interventions such as education, promotion of healthy options and creation of supportive environments. WHO ARE THE KEY GROUPS AFFECTED? The following groups are more likely to consume a diet high in saturated fat, high in sugar, and salt with low intakes of fruit, vegetables and dietary fibre: Low income families and individuals Children and young people BME communities, particularly Black African, Caribbean, and Bangladeshi People with mental health problems, physical or learning disabilities. 1 A condition that occurs when energy consumed outweighs energy expended

3 Kensington and Chelsea Camden Barnet City of Westminster Hammersmith and Fulham Hackney Harrow Haringey Brent Wandsworth Islington Richmond upon Thames Hounslow Enfield Ealing Croydon Lambeth Kingston upon Thames Southwark Merton Lewisham Hillingdon Redbridge Sutton Greenwich Newham Waltham Forest Bromley Bexley Havering Tower Hamlets Barking and Dagenham Percentage THE ISLINGTON PICTURE Key indicators that can illustrate healthy eating behaviours and impact upon associated outcomes are discussed below. This information helps us understand the challenges faced in Islington to address issues related to poor diet, weight gain and obesity risks in the local population. Fruit and vegetable consumption The adult population of Islington are more likely to consume at least five portions of fruit and vegetables than the adult population of England, but consume similar amounts to London (Figure 19.1). Within Islington, women are more likely to consume five portions of fruit and vegetables compared to men. Older adults (55 years plus) are less likely to consume five portions of fruit and vegetables per day compared to those aged between 16 and 54 years 4. Figure 19.1: Modelled estimates of percentage of adult population consuming five or more portions of fruit and vegetables daily, London Local Authorities, London and England averages, Modelled estimates of percentage of adult population consuming five or more portions of fruit and vegetables daily, London Local Authorities, London and England averages, London England London Local Authority Source: Modelled estimates based on the Health Survey for England , Health Profiles for England, available at

4 Breastfeeding rates Breastfeeding provides significant health benefits for both baby and mother. For the baby, benefits include protection against common childhood infections, including gastroenteritis, respiratory infections, otitis media and urinary tract infections, as well as diabetes mellitus. The longer-term benefits include lower blood pressure and protection against obesity. Exclusive breastfeeding for six months is associated with a 20% reduction in the relative risk of obesity in childhood. Within Islington, initiation rates of breastfeeding are higher than both the London and England averages. In general, breastfeeding rates tend to decrease between six and eight weeks (Table 19.1). However, the rates of breastfeeding, either exclusive or partially, in Islington at 6 to 8 weeks are higher than both the London and England averages. Both the rates of breastfeeding initiation and breastfeeding at 6-8 weeks in Islington have increased from 2008/09 to 2009/10. Table 19.1: Breastfeeding initiation and prevalence at six to eight weeks Islington, London and England, 2008/09 and 2009/10 Area Breastfeeding Initiation within 48 Hours Percentage Breastfeeding at 6-8 Weeks 2008/ / / /10 Islington 85.6% 88.6% 74.0% 75.2% London 83.8% 84.2% 72.0% 65.0% England 71.7% 72.7% 49.0% 45.2% Source: Department of Health, statistical release, Breastfeeding initiation and prevalence at 6 to 8 weeks, Q4 2009/10 Healthy Start Vitamins Uptake The Healthy Start Scheme is a statutory benefit scheme that provides a nutritional safety net for very low-income pregnant women and families with young children in a way that aims to encourage breastfeeding and healthy eating. Families are provided with vouchers which can be exchanged for formula milk, fresh milk, fresh and frozen fruit or vegetables. Within Islington 3010 families were eligible for the scheme in December 2010, with 85% taking up the scheme. Vitamin supplements are also available via the scheme for both mother and infant. Nationally, the uptake of Healthy Start vitamins is poor, with only 1.6% (Quarter 3, 2010/11) of families claiming vitamin drops for children, in London 1.1% families claimed vitamins in the same time period (Figure 19.2). The uptake of infant vitamins within Islington is higher than both London and England, with 5.2% families claiming children s vitamin

5 Percentage drops. The percentage of maternal vitamin tablets claimed in Islington is one of the highest in England with 5.6% take up. Figure 19.2; Percentage Uptake of Healthy Start Vitamin Drops by Healthy Start beneficiaries by quarter; Islington, London and England, 2009/ /11 Percentage Uptake of Healthy Start Vitamin Drops by Healthy Start beneficiaries by quarter; Islington, London and England, 2009/ / Islington London England 5 0 Q1 2009/10 Q2 2009/10 Q3 2009/11 Q4 2009/10 Q1 2010/11 Q2 2010/11 Q3 2010/11 Source: Healthy Start Management information, Department of Health, February 2011 Key health areas influenced by some of the factors outlined above are the rates of childhood and adult obesity. CHILDHOOD OBESITY IN ISLINGTON The National Childhood Measurement Programme (NCMP) collects data annually on height and weight of Reception and Year 6 primary school children to determine the prevalence of obesity. The latest results for Islington indicate that obesity levels in Reception children have decreased from 12.6% in 2008/09 to 11.4% in 2009/10 (Table 19.2). The prevalence of obesity in Year 6 children increased from 21.4% to 24.8%, which is higher than both the London and England average (Table 19.3). Further data are required to indicate whether these results are part of a sustained trend. There is a strong relationship between deprivation and prevalence of childhood obesity, this is especially important for Islington due to the deprivation levels within the borough.

6 Table 19.2: Percentage of overweight and obesity amongst reception year children, 2007/ /10, Islington schools, London and England Year Islington London England Overweight 12.4% 12.0% 13.0% 2007/08 Obesity 10.4% 10.9% 14.3% Overweight 11.9% 12.4% 13.2% 2008/09 Obesity 12.6% 11.2% 9.6% Overweight 13.7% 12.7% 13.3% 2009/10 Obesity 11.4% 11.6% 9.8% Source: National Childhood Measurement Programme: 2009/10 Table 19.3: Percentage of overweight and obesity amongst year 6 children, 2007/ /10, Islington schools, London and England Year Islington London England Overweight 15.1% 14.7% 14.3% 2007/08 Obesity 24.1% 21.6% 18.3% Overweight 15.7% 14.7% 14.3% 2008/09 Obesity 21.4% 21.3% 18.3% Overweight 13.5% 15.1% 14.6% 2007/08 Obesity 24.8% 21.8% 18.7% Source: National Childhood Measurement Programme: 2009/10 ADULT OBESITY IN ISLINGTON The prevalence of obesity amongst Islington adults is estimated to be 18.8% (95% CI 17.1% to 20.6%), which is lower than both London and England (Figure 19.3) 5. Within Islington, adult obesity contributes to about one-in-ten deaths each year. Rates of adult obesity in Islington increase with age, although rates dip again in the older age groups (75 years old and above). The prevalence of obesity is higher in lower socioeconomic groups compared to higher groups. This trend is more exaggerated for women than men. Obesity also varies according to ethnic group, with higher rates in Black Caribbean men and women, and Black African and Bangladeshi women compared to the population as a whole. 6

7 Barking and Dagenham Bexley Havering Newham Waltham Forest Sutton Brent Croydon Greenwich Enfield Hillingdon Lewisham Redbridge Haringey Bromley Southwark Hackney Hounslow Ealing Harrow Lambeth Islington Merton Barnet Kingston upon Thames Wandsworth Hammersmith and Fulham Richmond upon Thames Camden Tower Hamlets City of Westminster Kensington and Chelsea Percentage Figure 19.3: Modelled estimates of obesity prevalence in adults, London Local Authorities, London and England residents 16+, Modelled estimates of obesity prevalence in adults, London Local Authority England London Source: Modelled estimates based on the Health Survey for England , Health Profiles for England, available at MATERNAL OBESITY If a pregnant woman is obese, this will have a greater impact upon her health and that of her unborn children than the amount of weight gained during pregnancy. Both mother and child are at increased risk of complications during pregnancy and childbirth 7. Extra support in establishing breastfeeding may be required. The UK prevalence of women with a known BMI greater than 35 at any point in pregnancy, who give birth past 24 weeks of gestation, is 5% 8. This translates into about 38,000 maternities each year in the UK. Of the 22, 087 women who gave birth in London (March and April 2009), 3.6% had BMI greater than 35; Table 19.4 shows the classification of obesity and percentage of pregnant women in those groups. There is no local data about the prevalence of maternal obesity within Islington, but local estimates suggest that 100 pregnant women would have BMI greater than 35.

8 Table 19.4: Percentage Prevalence of Maternal Obesity in London, March and April 2009 Total Number of women giving birth BMI 35 BMI BMI BMI 50 London 22, % 2.2% 1.2% 0.1% Source: Centre for Maternal and Child Enquires. Maternal Obesity in the UK: findings from a national project SERVICES CURRENTLY PROVIDED IN ISLINGTON A broad range of interventions and activities are directed towards the prevention and management of diet-related diseases across Islington and are summarised in Table In addition, there are secondary and tertiary services available for those who are obese such as dietetic clinics and GP practice-based support programmes and bariatric surgery. Islington Council also provide a number of statutory services relating to food hygiene and food safety. The majority of services are multi-component with physical activity, single component programmes link in with physical activity services, which are highlighted in the physical activity chapter.

9 Table 19.5: Healthy eating related interventions and activities within Islington Intervention/Activity Description Target Group Prevention UNICEF Baby Friendly Initiative and breastfeeding peer support network Healthy Children Centres Programme MEND 2-4 Healthy Start Scheme Healthy Schools Programme National Child Measurement Programme To provide effective and adequate information and support for Islington mothers to enable them to initiate and maintain successful breastfeeding. The effectiveness of this information and support will be validated through achievement of UNICEF Baby Friendly accreditation, as well as local evaluation and meeting nationally and locally agreed targets. Healthy Weight Healthy Lives element of the programme aims to promote all aspects of healthy eating in all Children s Centres. An obesity prevention programme. Teaches families parenting skills and educates them about nutrition and play techniques. MEND 2-4 is delivered through children s centres. Provides free vitamins and food vouchers to families in receipt of benefits and for all teenage mothers. Incorporates healthy eating standards including whole school food policy. Educates the school community about food and healthy eating. Programme delivered by school health advisers in partnership with schools to gather information of height and weight of children in reception and Year 6. Informs local planning and service delivery 5 a day project Promotes healthy eating and 5 a day messages within Islington, to support and encourage Islington population to make healthier choices. Involves cook and eat sessions, teaching life skills, participating in local community events, training local people to become community nutrition advisers and running food safety courses. Islington Food Strategy Training and support to local health care professionals Partnership work between NHS Islington & Islington Council, education services and VCS organisations to implement a strategy focusing on food and health, food and the environment and food poverty, with a supporting action plan Obesity care pathways training and other obesity- related training. Pregnant women and mothers 0-5 years 2-4 years Pregnant women, families with children under 5 years Primary, secondary, special schools and pupil referral units Reception & Year 6 pupils Borough wide Borough wide Health care professionals

10 Intervention/Activity Description Target Group Treatment MEND (Mind, Exercise, Nutrition, Do it!) Practical, fun learning about healthy eating with behaviour modification techniques to boost selfconfidence, and fun games that stimulate the active enjoyment of physical activity. Whole family approach years overweight/ obese NEW start Multi-component weight management programme for young people aged between years years overweight/ obese Dietetics service Schools dietician provides professional development for school staff on range of issues including development of whole school food policies Dietetic clinics provided by NHS Islington Dietetic team, includes a range of services such as dietary assessment and individual clinical advice NATIONAL DRIVERS FOR SERVICE PROVISION National Institute for Health and Clinical Excellence (NICE) guidance on obesity 9 identified some key factors that influence a person s ability to maintain a healthy weight. Such factors are important when planning and delivering interventions. They include: Individual readiness to make changes Barriers to lifestyle change, including knowledge, socio-economic factors, environmental factors, personal tastes, views of family and community members, low levels of fitness and disabilities, low self-esteem and lack of assertiveness NICE guidelines on cardiovascular disease stress that everyone should move towards eating a balanced diet, not only to manage or prevent overweight and obesity but to prevent other long term conditions and diseases 10. A comprehensive review of evidence on healthy eating identified five main themes highlighted in the Government s 2008 obesity strategy Healthy Weight: Healthy Lives. The themes are: 1. Children: healthy growth and healthy weight. 2. Promoting healthier food choices. 3. Building physical activity into our lives.

11 4. Creating incentives for better health. 5. Personalised advice and support. For each theme the desirable behaviour outcomes are highlighted in Table Interventions provided should aim to address these outcomes. Table 19.6: Healthy eating behaviour change outcomes to prevent and manage overweight and obesity Children: healthy growth and healthy weight As many mothers as possible breastfeeding for up to six months Families knowledgeable about healthy weaning and feeding of their young children All children growing up with a healthy weight by eating well (e.g. 5 a day) Parents have the knowledge and confidence to ensure that their children eat healthily Promoting healthier food choices More families signing up to the healthy start scheme Less consumption of high fat, sugar and salt foods, especially by children More healthy options in convenience stores, school canteens, vending machines, at non-food retailers Creating incentives for better health More workplaces that promote healthy eating with the public sector acting as an exemplar Personalised advice and support Everyone able to access appropriate advice and information on healthy weight Increasing access to appropriate support and services for overweight and obese individuals Local staff/ practitioners understanding their role and empowered to fulfil it Source: Healthy weight: healthy lives: A Cross-Government Strategy for England. Cross- Government Obesity Unit NICE also provides recommendations on service provision related to maternal and child nutrition. 11 These recommendations include breastfeeding policy and programmes, promotion of the Healthy Start Scheme and training and professional developments. The Food Standards Agency (FSA) in Wales conducted a comprehensive review of dietary intervention models for BME groups. They recommended that interventions need to be tailored to different ethnic groups addressing cultural acceptability and recognition of different

12 health behaviours. Also a wide variety of activities should be undertaken to re-enforce changes in knowledge, behaviour and attitudes. Community development and peer education including evaluation appear to be successful approaches and should be explored further OPPORTUNITIES FOR DEVELOPMENT The implementation of a borough-wide food strategy and action plan strengthens current healthy eating services and activities. However there are many opportunities for further development (outlined below). 1. Healthy Start vitamin tablets should continue to be made available for all women and children either to purchase or obtain via the Healthy Start Scheme in health centres. 2. Training for those working directly with families and the key groups identified with respect to healthy eating. 3. Training programme established for health professionals on managing obesity, how to raise the issue of weight sensitively and positively, and basic behaviour change knowledge skills and competencies. 4. A review of local provision and supply of promotional materials from formula companies is necessary to comply with NICE guidance. NICE recommends that such material should not be readily available. 5. A scoping exercise to identify healthy eating peer education initiatives in BME communities should be undertaken. 6. Work should commence with businesses, such as local shops and food outlets, regarding the provision of healthy foods and lessons can be learnt from national pilots such as the Change 4 Life campaign. 7. A scoping exercise to identify beliefs, knowledge, attitudes and preferences of local population groups on food and healthy eating should be undertaken. 8. Interventions to reduce the numbers of children and young people who regularly eat from fast food outlets should be identified and prioritised. 9. A systematic approach to commissioning and evaluating weight management and healthy eating interventions should be developed. PROGRESS SINCE LAST YEAR S JSNA Good progress has been made on the recommendations made in the 2009/10 JSNA. A number of interventions have been implemented to address obesity in children and young people including preventative interventions delivered via early years and school setting as well as MEND and NEW Start. Healthy eating interventions have included the 5 a day project and community weight management programme. An Islington Food Strategy has

13 been developed and progress has been made towards achieving UNICEF Baby Friendly Accreditation. Children s obesity care pathways have been implemented and the National Childhood Measurement Programme continues to be rolled out annually. RECOMMENDATIONS Achieving healthy eating across Islington requires collaboration and coordination across all agencies. Interventions should be at the universal or population level as well as being targeted at particular groups. Interventions should be sensitive to cultural and ethnic needs, and therefore tailored to the target population. All interventions should be thoroughly evaluated to measure the effectiveness, cost effectiveness and sustainability of the intervention should also be evaluated. Universal interventions Children: healthy growth & healthy weight Promote the Healthy Start Scheme. Support the implementation of UNICEF Baby Friendly Initiative within the community and local hospitals. Support Children s Centres to implement the Healthy Children s Centre Programme, in particular the Healthy Weight: Healthy Lives criteria. Ensure school policies and the whole school environment encourages a healthy diet. Promoting healthier food choices Implement and monitor the Islington Food Strategy and accompanying action plan. Work with the LA and local industry to develop incentives to encourage fast food outlets to increase provision of healthy alternatives. Conduct research to understand more about the factors that influence local people s diet, in particular vulnerable groups to better meet the needs of different groups and that are culturally appropriate. Integrate oral health messages into healthy eating promotion ensuring consistency of messages across services. Support community-based healthy eating projects and ensure the eight key healthy eating messages and the eatwell plate are promoted by trained frontline staff. Creating incentives for better health Support workplaces to develop healthy and sustainable food policies.

14 Personalised advice and support Ensure obesity care pathways are in place for all age groups and are implemented and evaluated accordingly. Commission weight management support for overweight and obese individuals. Support pregnant women with a booking BMI 30 should receive appropriate specialist advice and support antenatally and postnatally regarding the benefits, initiation and maintenance of breastfeeding Ensure health professionals, health care assistants and support workers have the skills to advise on the health benefits of weight management and the risks of being overweight or obese before, during and after pregnancy or after successive pregnancies. Targeted interventions Children: healthy growth & healthy weight Target breastfeeding initiatives to groups and local communities with lower levels of breastfeeding. Target schools and local communities using local data such as childhood obesity and segmentation data and provide training and support regarding healthy eating. Health professionals should offer specific dietary advice in preparation for pregnancy, advising that a healthy diet will benefit both women and the unborn child. Promoting healthier food choices The local findings of the young people s social marketing scoping should be disseminated and used across all partner agencies to inform strategic development and operational delivery. Review and implement peer education initiatives within BME communities. Support those on low income, vulnerable and BME groups to increase consumption of fruit and vegetables. Personalised advice and support Ensure that services reflect the local population profile in areas of high deprivation and include disabled people. All weight management programmes must be multi-component, integrating behaviour change, healthy eating and physical activity. Health professionals should advise, encourage and help women with a BMI greater than 30 to reduce weight before becoming pregnant. Women with a BMI greater than 30 postnatally should be offered a structured weight management programme

15 FURTHER INFORMATION Islington Health Inequalities strategy Islington Food Strategy Healthy Weight, Healthy Lives 1 International Obesity Task Force and the European Association for the Study of Obesity. Obesity in Europe: the case for action. September Department of Health. Healthy weight, healthy lives: A toolkit for developing local strategies NHS Islington and London Borough of Islington. Annual Public Health Report Understanding the gap: improving life expectancy in Islington. November Health Survey for England, 2006: London Boost 5 Modelled estimates based on the Health Survey for England , Health Profiles for England, available at 6 Information Centre for Health and Social Care. Health Survey for England 2006: London Boost National Institute for Health and Clinical Excellence. PH27 Dietary Interventions and physical activity interventions for weight management before, during and after pregnancy. July Centre for Maternal and Child Enquires. Maternal Obesity in the UK: findings from a national project National Institute for Health and Clinical Excellence. CG43 Obesity: full guidance, section 6- health economics: evidence statements and reviews National Institute for Health and Clinical Excellence. PH25 Prevention of cardiovascular disease National Institute for Health and Clinical Excellence. PH11 Maternal and Child Nutrition. London; Stockley L. Review of dietary intervention models for black and minority ethnic groups. Food Standards Agency Wales. May Available at