Adult Obesity (also see Childhood Obesity) Headlines raise awareness of the scale, complexity and evidence base in relation to this issue, including promotion of the Change4Life campaign contribute to the evidence base. The estimated cost to the NHS in Leeds of diseases related to overweight and obesity was 197.4 million in 2007 and 204.9 million by 2010. National costs are predicted to reach 6.5.billion by 2050 and pose the single biggest threat to the NHS. 1 Obesity is the second most important preventable cause of ill health and death after smoking. Why is this important? Being obese or overweight brings significant risks at a range of different points throughout life. The health risks for adults are stark. We know that, compared with a healthy weight man, an obese man is: five times more likely to develop type 2 diabetes three times more likely to develop cancer of the colon more than two and a half times more likely to develop high blood pressure a major risk factor for stroke and heart disease. An obese woman, compared with a healthy weight woman, is: almost thirteen times more likely to develop type 2 diabetes more than four times more likely to develop high blood pressure more than three times more likely to have a heart attack. 2 Story for Leeds Currently NHS Leeds objectives are to: improve the ability of the workforce to support families with obese children and adults provide opportunities for children and adults to become more active and eat more healthily offer weight management services to those in most need 1 Healthy Weight, Healthy Lives Toolkit. National Heart Forum, 2008. 2 Department of Health, 2011. Healthy Lives, Healthy People. A call to action on obesity in England. Leeds Lets Change NICE guidance recommends that brief interventions are implemented consistently by a wide range of staff. Ideally this includes primary and secondary care staff, community services, local authority and voluntary settings. NHS Leeds is committed to delivering Leeds Let s Change, a healthy living services programme which aims to implement a whole system approach to brief interventions in a variety of settings through the following: Embedding systematic procedures for referral and signposting to healthy living services and opportunities across sectors. Providing a brief interventions training programme to increase confidence and competence of staff in supporting behaviour change. This is how the regional Every Contact Counts programme is being delivered in Leeds. Delivering Healthy living training. To date, 228 frontline workers have been trained to deliver evidence based messages regarding food and physical activity. A website and phone number for Leeds Let s Change www.leedsletschange.co.uk. This will map all local service and healthy living opportunities and provide downloadable self care information. Promotion of Leeds Let s Change as a local brand to deliver Change4life messages. Piloting of Bodyline on referral (referral to leisure centre activities with a high level of discount) for people identified as at risk through the NHS Health Check. Adult weight management services NHS Leeds commissions weight management services delivered in the community from Leeds Community Healthcare Trust. The service provides tier 1 and 2 services as well as assessment for tier 3 specialist obesity surgery services. These services are available to people with a Body Mass Index (BMI) over 30 kg/m 2 or 27 kg/m 2 with co morbidities (other health conditions i.e. diabetes ). 1
The tier 1 service consists of a structured weight management programme combining diet, activity and behaviour change support 3 including a physical activity session that is delivered in 16 Leeds City Council leisure centres or community venues across the city. People can be referred to weight management in group sessions by their GP or they can self refer. The tier 2 and 3 service provides one to one sessions for people with complex co morbidities, who are using prescribed anti obesity medications to little effect or who may be a candidate for morbid obesity surgery assessment. 3 Sessions offer tailored advice and more intensive motivational interviewing, cognitive behavioural therapy and solution based approaches to behaviour change. The service is also developing work with obese pregnant women; initially this has involved providing training, resources and support to midwifery to provide an enhanced maternity pathway for women with a BMI over 40kg/m2. More support for postnatal obese women is in development. Morbid obesity surgery NHS Leeds and Leeds Teaching Hospitals Trust (LTHT) have made a significant contribution to Regional Specialist Commissioning Group (SCG) work to develop a commissioning policy and designation process for obesity surgery across the region. An assessment and triage system is in place through the community weight management service, which is working to criteria defined by the SCG. Patients are able to choose from a range of designated tier 3 surgical providers including LTHT, Spire, Bradford and York. Better food skills for adults (See also the Estimated Consumption of Fruit and Vegetables JSNA pack.) NHS Leeds commissions 60 four week cook4life courses from 11 third sector organisations in deprived areas across Leeds. The Ministry of Food Leeds has been established in Kirkgate Market in partnership with NHS Leeds, Leeds City Council, Zest Health for Life and the Jamie Oliver 3 NICE, 2006. NICE CG43. Obesity: Guidance on prevention, identification, assessment and management of overweight and obesity in adults and children. Foundation. The cooking centre aims to run 75 cooking programme a year to support adults and families to shop, prepare and cook healthy and tasty meals on a budget. Active Leeds: a healthy city (See also the Active Lifestyles JSNA pack. ) Raising levels of physical activity is fundamentally important to improving health and wellbeing, particularly for those who are defined as inactive that is, people who participate in less than one hour of physical activity per week. Taking the Lead, the strategy for sport and active recreation in Leeds 2006 2012, identified the following priorities: Increase participation levels across all sections of the community Ensure equality of opportunity and narrow the participation gap in sport and active recreation between different sectors and groups within the community Ensure increased awareness of the opportunities and benefits of sport and active recreation Ensure that the health benefits of sport and active recreation are recognised and developed NHS Leeds commissions a number of physical activity interventions from Leeds City Council A bodyline on referral scheme offering access to leisure services with a high level of discount for people identified at high risk of cardiovascular disease through NHS Healthcheck. Physical activity interventions are part of the clinical pathways for people who are under the care of weight management services, cardiac rehabilitation services and community mental health teams. Where is this causing the greatest concern? Figure 1 below shows the prevalence of obesity in Middle Super Output Areas (MSOA) grouped by level of deprivation. This has risen slightly overall in the past two years. There have been some rises and falls but overall there has been a slight upward trend. There is a link between obesity prevalence and deprivation. Prevalence is lowest in the least deprived 2
quintile (the most affluent fifth of Leeds MSOAs) and highest in the most deprived quintile (the poorest fifth of Leeds MSOAs). The other three quintiles fall between these two in approximate order of deprivation (though the third and forth quintiles are very similar and have crossed over during the two years). Figure 2 shows that the MSOA with the lowest obesity prevalence in Leeds is South Headingley. The confidence intervals show that this is significantly lower than all the other MSOAs at the 95% confidence level. The difference between the top 10 and bottom 10 MSOAs in terms of obesity prevalence is approximately 15%. The MSOA with the highest obesity prevalence is Middleton and Westwoods. This MSOA is not significantly higher than the next six lower MSOAs. Figure 3 shows that age standardised obesity rates in the MSOA deprivation quintiles follow a similar pattern to the prevalence with the highest rate in the most deprived quintile and the lowest rate in the least deprived quintile. Again the other three quintiles fall between these two in order of deprivation with the third quintile almost exactly the same as Leeds overall. Figure 4 shows that the MSOA with the lowest obesity rate is West Park and Weetwood. However, this is not significantly lower than any of the other lowest 10 MSOAs except: Horsforth, New Road Side; Stanhopes and Rawdon South; and Hawksworth Village, Tranmere Park. The difference between the top 10 and bottom 10 MSOAs in terms of obesity rates is approximately 12,000 per 100,000 population. The MSOA with the highest obesity rate is Middleton and Westwards. However, this MSOA is not significantly higher than any MSOAs in the highest 10 except for Belle Isle North and Gipton North. 3
Figure 1 Figure 2 4
Figure 3 Figure 4 5
Views of local people * * An initial selection of surveys and focus group outputs were gathered to enable inclusion of public opinion data within the JSNA. Please note as this is only an initial selection it is not a comprehensive data set and therefore may not be representative of the whole population of Leeds. This part of the data set is under development for future versions of the Joint Strategic Needs Assessment. Please note that this section directly reproduces text from the quoted documents. Leeds City Council Residents Survey 2009 Residents of Leeds were asked within the Residents Survey about Health and Wellbeing Services. Evidence suggests that despite many respondents feeling uninformed by the council about healthy living services, helping them lead healthy lives is not an area they feel the council should be prioritising. Just over two fifths of respondents (45%) thought that the council kept respondents informed about healthy living services (e.g. stopping smoking, weight management, alcohol support) ; slightly more than felt it kept them uninformed (39%). Preventing long term health conditions Universal routine collection and recording of weight and BMI status in GP Practice would help us to gain a more reliable estimate of obesity prevalence for adults in Leeds, and improve patient care. Monitoring unintentional changes in weight can prompt action to support individuals to lose weight after minimal weight gain (rather than waiting until BMI is over 30kg/m 2 ) and would be a more preventative approach. It would also be useful in detecting unintentional weight loss so that action could be taken at an earlier stage to identify disease related malnutrition. Continue to invest in weight management services to support people to manage their weight to both prevent and manage long term conditions. Continue to training and support programmes to increase the skills of the wider workforce who support obese adults and children, such as Leeds Let s Change, Every Contact Counts and HENRY. Helping people lead healthy lives was seen as a relatively low priority for the council (Q3a), chosen as a high priority by 40% of respondents which placed it 10th on a list of 13 priorities. In fact, more than 1 in 10 (11%) thought this should be a low priority for the council and only 2% chose this as the single most important priority for the council. Considerations for the future Keeping people healthy Work with Leeds City Council to ensure that Council Departments use existing levers and powers so that the built environment helps people to choose active lifestyles and healthy food, particularly in deprived areas of the city. Continue to develop a menu of interventions and opportunities that promote physical activity and healthier eating in localities. This includes increasing leisure service provision in deprived areas,, strengthening and promotion of walking opportunities across Leeds and the roll out of the Ministry of Food cooking skills programme. Continue to embed the Leeds Lets Change systematic approach and Health is Everybody s Business programmes across health organisations and Leeds City Council. 6