14. HEALTHY EATING INTRODUCTION

Transcription

1 14. HEALTHY EATING 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. 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 and mental health problems. Obesity 1 has become increasingly common and has been described as the biggest single public health challenge of the 21 st century (1). It is predicted that obesity will rise to almost nine in ten adults and two-thirds of children by 2050 (2). Food choices are influenced by many factors, including social class and community culture and 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 of high saturated fat, high sugar, and salt with low intake 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 1

2 THE ISLINGTON PICTURE Fruit and vegetable consumption Fruit and vegetable consumption in Islington is similar to levels for England and London. Data from the Health Survey for England 2006 highlights the differences in fruit and vegetable consumption in Islington, according to sex, socio-economic status and age. For example, women are more likely than men to consume five portions of fruit and vegetables per day (Figure 14.1). The intermediate socio-economic groups are more likely to consume more than five portions of fruit and vegetables every day (Figure 14.2) and older Islington adults are less likely to consume five or more portions of fruit and vegetables compared to those in younger age groups (Figure 14.3). 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. Figure 14.1: Consumption of fruit and vegetable portions by sex, Islington, Male Female Percentage t 0 <1 1 or 2 3 or 4 >5 Number of portions consumed Source: Health Survey for England 2006: London Boost 2

3 Figure 14.2: Consumption of fruit and vegetable portions by socio-economic group, Islington, Mangerial & higher Intermediate Routine & manual Percentage <1 1 or 2 3 or 4 5 or more Number of portions consumed Source: Health Survey for England, 2006: London Boost Figure 14.3: Consumption of fruit and vegetable portions by age, Islington, Percentage <1 1 or 2 3 or 4 5 or more Number of portions consumed Source: Health Survey for England, 2006: London Boost 3

4 Childhood obesity in Islington The National Childhood Measurement Programme annually collects data on height and weight of reception and Year 6 primary school children. The latest results for Islington indicate a rise in obesity levels amongst reception year children from 10.4% in 2007/08 to 12.6% in 2008/09 (Table 14.1). The prevalence of obesity in Year 6 children dropped from 24.1% to 21.4%, comparable to levels in London but higher than the England average (Table 14.2). 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. Table 14.1: Prevalence of overweight and obesity amongst year reception children, Islington, London and England, 2008/09 Percentage Overweight Obese Islington London England Source: National Childhood Measurement Programme: 2008/09 Table 14.2: Prevalence of overweight and obesity amongst year 6 children, Islington, London and England, 2008/09 Percentage Overweight Obese Islington London England Source: National Childhood Measurement Programme: 2008/09 Adult obesity in Islington The prevalence of obesity amongst Islington adults is estimated to be 10% (confidence interval 5.1% to 14.9%), which is lower than London (16.5%). The estimated prevalence of overweight adults in Islington is 32.8%, similar to London at 34.3% (3). Rates of adult obesity 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 (4). This trend is more exaggerated for women than men. Obesity also varies according to ethnic group, with higher rates in 4

5 Black Caribbean men and women, and Black African and Bangladeshi women compared to the population as a whole (5). NHS Islington estimates that in 2015, managing diseases related to overweight and obesity is likely to cost approximately 73.6 million (Table 14.3). Table 14.3: Estimated annual costs to the NHS of diseases related to overweight and obesity (BMI 25kg/m² or more) and obesity alone (BMI 30kg/m² or more), Islington Islington PCT Estimated annual costs to NHS of diseases related to overweight and obesity million Estimated annual costs to NHS of diseases related to obesity million Source: Healthy weight, healthy lives: A toolkit for developing local strategies 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 the England averages. In general, breastfeeding rates tend to decrease between six and eight weeks (Table 14.4). Table 14.4: Percentage of women breastfeeding at initiation (within 48 hours) and at 6-8 weeks, Islington, London and England, 2008/09 Percentage Breastfeeding initiation Breastfeeding at 6 8 weeks within 48 hours Islington London England Source: Islington 2008/09: Child health records 5

6 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. Islington Council also provide a number of statutory services relating to food hygiene and food safety. Table 14.5: Healthy eating related interventions and activities within Islington Intervention/Activity Description Target Group Prevention Healthy Children Centres Programme Mini-MEND Social marketing young people and obese pregnant women Islington Food Strategy 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 targeting families who are at risk. Teaches families parenting skills and educates them about nutrition and play techniques. Mini-MEND is delivered through children s centres. Two projects underway developing interventions to increase healthy eating and levels of physical activity amongst secondary school children and their families and to promote healthy weight amongst pregnant mothers in Islington. Partnership work between NHS Islington & Islington Council, education services and VCS organisations to develop a strategy focusing on food and health, food and the environment and food poverty, with a supporting action plan 5 a day project To promote healthy eating and the 5 a day message in Islington, and to support and encourage people to make healthier choices. Involves running cook and eat sessions for Islington residents, teaching life skills to residents, participating in local community events, training local people to become community nutrition advisers and running food safety courses. Healthy Start Scheme Workplace initiatives Provides free vitamins and food vouchers to families in receipt of benefits and for all teenage mothers, Workfit a programme to promote health and wellbeing amongst NHS Islington employees and partner organisation Health Champions aims to identify and train 0-5 years 2-4 years years Pregnant women Borough wide Borough wide Pregnant women, families with children under 5 years Public Sector employees; PCT and partner 6

7 organisations Public Health Nutritionist Healthy Schools Programme National Child Measurement Programme Baby friendly initiative and breastfeeding peer support network Training and support to local health care professionals Treatment MEND (Mind, Exercise, Nutrition, Do it!) Stepping stones Dietetics service Planning, development, delivery and evaluation of healthy eating programmes and initiatives across a wide range of settings. Supporting development of food and healthy eating policies. Planning and organising diverse activities and programmes, coordinating and organising multi-agency groups to manage public health promotion interventions and initiatives at a locality level. 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 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. Obesity care pathways training and other obesityrelated training. 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. Community-based weight management interventions for overweight and obese individuals focusing on weight loss and maintaining a healthy weight. 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 Whole borough Primary, secondary, special schools and pupil referral units Reception & Year 6 pupils Pregnant women and mothers Health care professionals 7-11 years overweight/ obese Overweight/ obese adults 7

8 NATIONAL DRIVERS FOR SERVICE PROVISION National Institute for Health and Clinical Excellence (NICE) guidance on obesity (6) identified some key factors that influence a person s ability to maintain a healthy weight. Such factors are important when planning and delivering interventions. These 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. A comprehensive review of evidence on healthy eating identified five main themes highlighted in the Government s 2008 healthy eating strategy, Healthy Weight: Healthy Lives (2). The themes are: 1. Children: healthy growth and healthy weight. 2. Promoting healthier food choices. 3. Building physical activity into our lives. 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 (2). 8

9 Table 14.6: 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 (7). 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 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 (8). 9

10 OPPORTUNITIES FOR DEVELOPMENT The implementation of a borough-wide food strategy and action plan will strengthen current healthy eating services and activities however we recognise that there are many opportunities for further development (outlined below). 1. Healthy Start vitamin tablets should be made available for pregnant women either to purchase or obtain via the Healthy Start scheme in health centres or pharmacies. 2. Training for those working directly with families, such as Early Years and Children Centre staff, with respect to healthy eating. 3. 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. 4. A scoping exercise to identify healthy eating peer education initiatives in BME communities should be undertaken. 5. 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. 6. A scoping exercise to identify beliefs, knowledge, attitudes and preferences of local population groups on food and healthy eating should be undertaken. 7. Interventions to reduce the numbers of children and young people who regularly eat from fast food outlets should be identified and prioritised. 8. 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 2008 JSNA. A number of interventions have been implemented to address obesity including MEND and New Start. An Islington Food Strategy has 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. 10

11 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. 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. Review the provision of promotional material from infant or follow-on formula companies across the borough. Children s Centres to implement the Healthy Children s Centre Programme, in particular the Healthy Weight: Healthy Lives criteria. Promoting healthier food choices Implement and monitor the Islington Food Strategy and accompanying action plan. Increase the number of food premises in Islington complying with the healthy eating award scheme. Develop incentives to encourage fast food outlets to increase provision of healthy alternatives. Use social marketing techniques to understand more about the factors that influence local people s diet, in particular vulnerable groups. This will ensure policy, advice and planned interventions meet the needs of different groups and are culturally appropriate. Integrate oral health messages into healthy eating promotion ensuring consistency of messages across services. Support community-based healthy eating projects. Creating incentives for better health Support workplaces to develop healthy and sustainable food policies. 11

12 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. 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. Promoting healthier food choices Ensure Healthy Start maternal vitamin supplements are available for Healthy Start recipients and those able to purchase them. 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. REFERENCE LIST (1) International Obesity Task Force and the European Association for the Study of Obesity. Obesity in Europe: the case for action. September (2) Department of Health. Healthy Weight, Healthy Lives: A Cross-Government Strategy for England, Cross-Government Obesity Unit (3) Information Centre for Health and Social Care. Health Survey for England 2006: London Boost

13 (4) Information Centre for Health and Social Care. Health Survey for England (5) Sport England. Active People Survey (6)National Institute for Health and Clinical Excellence. CG43 Obesity: full guidance, section 6- health economics: evidence statements and reviews (7) National Institute for Health and Clinical Excellence. PH11 Maternal and Child Nutrition. London; 2008 (8) Stockley L. Review of dietary intervention models for black and minority ethnic groups. Food Standards Agency Wales. May Available at FURTHER INFORMATION Islington Health Inequalities strategy Islington Food Strategy Healthy Weight, Healthy Lives m 13