Lambeth Specialist Healthy Weight Project Vanessa Impey- Paediatrician Deborah Thompson- Specialist Dietitian

Prevalence of obesity by Local Authority Year 6 children (age 10-11 years) resident in London, NCMP 2009/10 Low prevalence High prevalence Child obesity: BMI ≥ 95th centile of the UK90 growth reference © NOO 2011 This slide shows an example of obesity prevalence mapped at LA level – extracted directly from the e-Atlas. In Lambeth this equates to: http://www.noo.org.uk/visualisation/eatlas

Childrens Weight:Lambeth Context NCMP data - Levels of obesity (2010/11) Reception - 11.6% Year 6 - 24% Consistently above average for London and England for both age groups.

Lambeth Specialist Healthy Weight Project Aims for a change in how we deliver a healthy weight service A whole system or integrated approach Systemic Family Therapy principles and practice Families as resourceful 5

Principles and practice - examples working with the whole family in mind non judgmental wider contextual and social factors - communities and cultures reaching out - bridging hospital and clinic multi disciplinary and multi agency - joined up working between health, family, activity and diet team learning - what are our beliefs and experiences relating to health and diet? 6

The process of our work Working as part of the Lambeth Healthy Weight Care Pathway Initial referral Two initial home visits / appointments Full assessment including health checks Plan and set up goals Weekly sessions until three month review 3 month review includes height/weight checks along with some re-evaluations Appointment frequency to be assessed at this point Until 6 month review

Physical Activities - aims Encourage and support families to make changes to current activity levels. Identify local community sessions activity sessions for families. Promote the long term benefits of regular physical activity. Assess children's cardiovascular responses to exercise over project time frame.

Dietetic Therapy Aim of dietetic therapy: To assess nutritional status To identify the main dietary causes of weight- gain To provide nutritional education To support family with making dietary changes Use Eatwell plate as a basis for dietary guidance/ comparisons Work on increasing fruit and vegetables

Paediatric input Full health and medical check Screening out underlying causes Looking at the impact of obesity on the child Blood tests taken

Family Therapy input The team works under a systemic umbrella. Connecting medical, physical, dietetic and emotional/psychological/, mental health issues Family patterns and underlying issues can be worked with Experiences of health and health care professionals Seeing weight issues as having a ‘logic’ within a family.

Case Examples include: Working with the impact of: parental mental health issues parental experiences of violence learning difficulties bereavement significant child mental health issues

Success and challenges appointment attendance improved engaging with families where other services don’t higher referral of children with special needs referrals to other services including adult community services referrals of families which appear to fall between gaps success in dietetics, physical health and parenting strategies all identified in quarterly reports families referred for medical investigations as necessary which wouldn’t have been picked up elsewhere identified children with vitamin deficiencies Changes in personnel

Making connnections : Social services were contacted and asked to cascade down Links were made with consultants at St Thomas’s Increased links with paediatricians at the Mary Sheridan Centre Links were made with dieticians in Lambeth (Community) and at St Thomas Links have been made with GP surgeries at Clapham Common , Mawby Clinic Gracefield Gardens and meetings arranged to discuss the project in more detail Team members are taking in project posters to schools when they visit The team gave out fliers at Gracefield Gardens Anniversary day and made some links with other health professionals

Referrals to the service: how you can work with us Identify families where children are aged between 4-12 with a BMI of over 98. Where there are psychosocial issues or other complexities Where families may have tried a Tier 2 service. If not, would that be helpful now : Ready Steady Go instead? Families must agree to a referral

Any Questions