Healthy Weight, Healthy Lives Tackling obesity in England

Overweight & obesity forecast trend 2007-2050 Obesity levels are too high, with significant impact on individuals, the health service and society as a whole By 2050, if trends continue, 60% of men and 50% of women could be clinically obese (UK Foresight report) HEALTH IMPACT 58% type 2 diabetes 21% of heart disease 10% of non-smoking related cancers 9,000 premature deaths a year in England Can reduce life expectancy and quality of life COST National Health Service - £4.2bn Wider economy - £15.8bn Foresight estimates by 2050 costs to economy of £50bn Overweight & obesity forecast trend 2007-2050

Alternative slide option Obesity in adults and children is too high and forecast to rise, with huge costs to society.. Alternative slide option NOW 60.8% of adults (aged 16+) overweight or obese, of these 24% are obese 28.6% of children (aged 2-10) overweight or obese, of these 15.4% are obese Cost of overweight and obese individuals to NHS estimated to be £4.2 billion Cost to the wider economy is £16 billion 2050 Based on current trends 60% men, 50% women and 25% children will be obese 9 in 10 adults will be overweight or obese if we carry on as we are Cost to the NHS forecasted to more than double Cost to the wider economy predicted to rise to £50 billion per year ..and to the individual risk of diseases, such as cancer, heart disease or Type 2 diabetes risk of reduced life expectancy and quality of life Sources: The Health Survey for England 2007 and Foresight

Foresight developed a system map showing the multiple determinants of obesity Optional slide

CULTURE / INDIVIDUAL PSYCHOLOGY Foresight identified four factors driving this trend and creating an ‘obesogenic’ environment HUMAN BIOLOGY Genetics can increase the risk of obesity Early life experiences including breastfeeding can affect a child’s risk of being overweight later CULTURE / INDIVIDUAL PSYCHOLOGY Difficult to break habituated unhealthy behaviours, especially when these are common to those around us Obesity and overweight are becoming ‘normal’ FOOD ENVIRONMENT Availability of convenient food has increased massively, which tends to be high in saturated fat, salt and sugar PHYSICAL ENVIRONMENT Our lives have become increasingly sedentary. For example, the last two decades have seen a 10% drop in children walking to school

The Government has set out an ambitious strategy Our ambition is to be the first major nation to reverse the rising tide of obesity and overweight in the population, by enabling everyone to achieve and maintain a healthy weight. Our initial focus will be on children: By 2020, we aim to reduce the proportion of overweight and obese children to 2000 levels. In January 2008 the Government published Healthy Weight, Healthy Lives: A Cross-Government Strategy for England £372 million is being committed over 3 years to implement the strategy In April 2009 Healthy Weight, Healthy Lives: One Year On was published. It reviews progress on the strategy and sets out priorities for the future.

The strategy sets out action in 5 themes, based on the evidence provided by Foresight Children: healthy growth and healthy weight early prevention of weight problems to avoid the ‘conveyor-belt’ effect into adulthood Promoting healthier food choices reducing the consumption of foods that are high in fat, sugar and salt and increasing the consumption of fruit and vegetables Building physical activity into our lives getting people moving as a normal part of their day Creating incentives for better health increasing the understanding and value people place on the long-term impact of decisions Personalised advice and support complementing preventative care with treatment for those who already have weight problems

Healthy Weight, Healthy Lives actions to date include… Launching Change4Life, a national movement to bring together community groups, health professionals, teachers, government departments, supermarkets, the media etc to help everyone to “eat well, move more and live longer” £30m matched investment in 9 ‘Healthy Towns’ Sending NCMP results to parents and helping PCTs commission services for overweight and obese children Healthy Food Code of Practice covering our policy on food and health £65.9m in PCT allocations in 08/09 to support action on overweight and obesity Rises in breastfeeding rates and 3,000 Sure Start Centres providing healthy living advice and support in pregnancy and early childhood 97% of all schools participating in Healthy School programme and 3m children eating school dinners 34% reduction in children’s exposure to TV ads for ‘unhealthy’ food & drink £7m to encourage people to walk more and £42m for Cycling Towns 3,500 extra play areas across the country 80% of LAs signed up for Free Swimming for under 16s and over 60s

First signs that we are having an impact on child obesity? Latest figures from the Health Survey for England give an early indication that the trend in obesity prevalence in children ‘may have begun to flatten out’ (NHS Information Centre) NCMP 2007/08 data supported this, showing no significant change in obesity rates between 06/07 and 07/08 at ages 4-5 or 10-11 However, it is still to early to tell if these results are part of a new trend The scale and complexity of the challenge means we cannot assume that the action already taken will be enough and it’s important to maintain momentum. Percentage of obese children 2-10 years old 7 9 11 13 15 17 19 21 23 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Action over the coming year Healthy Weight, Healthy Lives: One Year On (April 2009) builds on the 5 themes from Healthy Weight, Healthy Lives and demonstrates our commitment to maintaining the momentum in tackling unhealthy weight. We will continue our drive to reduce obesity by: helping people to make healthier choices; creating an environment that promotes healthy weight; ensuring effective services are available for those at risk; and strengthening the delivery system.

1. Helping people make healthier choices In the next 12 months, we plan to help change how people relate to and understand obesity by giving parents clear information about the importance of healthy weight and the tools to allow them to make healthier choices for themselves and their children. We will: inspire 200,000 families to change behaviour through Change4Life extend Change4Life to at-risk adults provide new content and tools through the NHS Choices website and NHS LifeChecks to support people in assessing and managing their own lifestyle, including maintaining a healthy weight examine how NCMP results may best be shared with health professionals to enable more proactive follow-up where required.

Engaging families with the National Child Measurement Programme Established in 2005, the NCMP weighs and measures children in Reception year (aged 4-5 years) and Year Six (aged 10-11) in schools. In 2007/08, almost 1 million children were measured, approximately 88% of those eligible. About half of all PCTs are now routinely feeding back the results to parents, as a means to engage them - we expect a rise in the number of PCTs feeding back in 2009/10. Many PCTs are using NCMP data to inform the provision of services to children and families, such as weight management programmes, and to target resources. With results letter parents receive Top Tips for Top Kids, a Change4Life resource

2. Creating an environment that promotes healthy weight It is vital that we continue to act in a wide range of settings to create a social environment that makes it easier for individuals and families to maintain a healthy weight. Children do more to support children in early years through a single set of evidence-based messages on healthy eating and active play use sample surveys and research to collect and track data on weight status of very young children continue to improve environment for school-age children Food choices raise public understanding of maintaining an appropriate energy balance see more fast food and other chain restaurants provide calorie labelling for consumers at the point of choice look to develop a voluntary set of principles to underpin all forms of promotion and marketing of food and drink to children continue to work in partnership with industry to reformulate foods by reducing levels of saturated fat, salt and sugar

2. Creating an environment that promotes healthy weight (continued) Physical Activity encourage local authorities to deliver active travel initiatives through the next round of transport plans set up an expert working group to look at sedentary behaviour, screen time and obesity and advise on messages to families evaluate work of Healthy Towns and ensure learning is shared commission robust evidence of how healthy living objectives are being delivered locally from a spatial perspective Incentives work to improve the health and wellbeing of public sector employees, starting with the NHS workforce support SMEs and non-FTSE companies in the private sector to adopt the Business HealthCheck Tool. look at results of subsidised gym pilots for young people and consider whether scheme should be rolled-out to other areas

3. Effective services for those at risk For those currently overweight or obese, we need to provide effective services that help them to achieve and maintain a healthier weight. Going forward, we will provide further support to local commissioners in this area, aligning with the World Class Commissioning agenda. We will: review and build upon the package of support for commissioning child weight management services that we have developed in partnership with PCT colleagues, which includes a commissioning toolkit and a framework of 'pre-qualified' training providers focus on supporting local commissioning of weight management services for adults begin the roll out of NHS Health Checks for all 40–74-year-olds, including an assessment of BMI and referral into weight management or exercise programme where necessary for health reasons ensure that primary care professionals are better equipped to play their part in providing advice and referral. Bullet 1 refers to Healthy Weight, Healthy Lives: Child weight management programme and training providers framework (March 09)

4. Strengthening delivery We need to ensure that we have a delivery system that prioritises tackling obesity and has the capability to do so. There is growing momentum and commitment towards tackling obesity locally and regionally. We want to continue to support the delivery chain. We will: provide £69 million to local areas within PCT allocations in 2009/10 to combat overweight and obesity encourage local authorities to use their power to promote or improve the economic, social or environmental wellbeing of their area commission an evaluation of the role of the regulatory environment in promoting and encouraging physical activity and healthy food choices develop a new Obesity Improvement Programme, to strengthen local capabilities to both prevent and treat overweight and obesity (planned for summer 2009) Obesity Improvement Programme - will include a one-stop-shop for sharing best practice, bespoke training to improve capability in the worst-affected areas, and benchmarking data on the extent and effectiveness of local weight management services;

Helping local areas promote healthy weight We have provided a range of support and guidance including: Child Obesity National Support Teams who visit local areas and provide intensive support a toolkit for developing local strategies guidance on commissioning weight management services for children and young people a directory of obesity training providers The new Obesity Improvement Programme will provide: a one-stop shop website providing best practice and a forum for sharing information and data training support to build capability of the delivery chain a national weight management monitoring system to track availability of local weight management services. To accompany the Strategy, “Healthy Weight, Healthy Lives: Guidance for Local Areas” was published on 19 March 2008. This document provides Primary Care Trusts (PCTs) and Local Authorities (LAs), in conjunction with their third and private sector partners, with guidance on what they can do to promote healthy weight and tackle obesity. The guidance document sets out a framework, along with indicators of success that local areas might use to deliver their child obesity goals as part of the NHS Operating Framework and Local Area Agreements.

Change4Life – supporting families to maintain a healthy weight We have allocated £75 million to launch a 3 year social marketing campaign called Change4Life. An extensive 18 month research programme helped us understand families with children under the age of 11 and their attitudes and behaviours in relation to food and physical activity. The Change4Life advertising campaign launched in January 2009. The message to the public is Eat Well, Move More, Live Longer. The Change4Life website (www.nhs.uk/change4life), helpline and direct marketing programme will provide ongoing help, advice and support. We will create more opportunities for activity and healthy eating through building on our Change4Life partnerships across all sectors. Some statistics so far 68% of mothers have heard of Change4Life and 79% of mothers said the adverts made them think of their children’s long-term health (Mar 09) over 250,000 ‘How are the kids?’ surveys have been completed over 90 signed commercial partners including Co-op, Kellogg's and ITV. It reframes the issue of obesity, moving it away from being about appearance or size, to being about the serious health consequences of having a poor diet and being sedentary.

Change4Life activity phases 2009 Phase one Phase two Phase three Phase four Phase five Role of marketing Reframing the issue of obesity Personalising the issue Rooting behaviours Inspiring people to change Supporting people as they change Sample marketing materials Desired out-take This isn’t about how my children look; it’s about diabetes, cancer and heart disease This isn’t about bad parents or very fat children – it’s about my children I know what to do to reduce my family’s risk I know people like me are changing their lives so I believe it’s possible I can see the difference this is making

We remain committed to building the evidence base on tackling obesity Commissioning research Chief scientific advisers set out a framework to guide next steps - 'Healthy Weight, Healthy Lives: A cross-government research and surveillance plan for England' (Dec 08). Continue to prioritise areas for investigation, and boost research on obesity, diet, physical activity and environmental influences. Learning through evaluation Continue to evaluate key policy activities e.g. evaluation of Healthy Towns and Change4life on behaviour and health outcomes. Work across government to identify additional policy areas and natural experiments where the impact on obesity and its causes can be assessed and evaluated. 2nd bullet more info: We will continue to work with research funders to prioritise areas for investigation and enhance use of cross-funder collaborations to boost research on obesity, diet, physical activity and environmental influences Supporting infrastructure and coordination National Obesity Observatory is established and working to act as a first point-of-call for information on obesity, its determinants and interventions. The HWHL expert group continues to support policy development.

Conclusion (to be amended audience depending) In Healthy Weight, Healthy Lives: A cross-government strategy for England, we issued a call to action to tackle the most significant public and personal health challenge facing us today, and we will continue to take that forward through the commitments in the One Year On report. Over the last year, we have worked together across society to tackle obesity, but this public health epidemic needs sustained action if we are to realise our ambition of everyone being able to maintain a healthier weight. www.dh.gov.uk/healthyweight