1. Tackling obesity: the role of dietitians and local partners

2. Content The role of dietitians The growing problem of obesity
Local solutions

3. What is a Dietitian…?
Dietitians translate the science of nutrition into practical information about food
Work with people to: - Promote nutritional wellbeing - Prevent food-related problems - Treat disease
The British Society of Dieticians define the role as – FIRST LINE ON SLIDE

4. Where do Dietitians work…?
The NHS - Hospitals - Community - Catering
Industry, e.g. Supermarkets, Food Manufacturers
Education
Research
Freelance

5. Obesity & Health Obesity has tripled in past 20 years
It is predicted that it could reduce average life-span by 9 years
Linked to wide range of physical and psychosocial problems
>80% of adults with type 2 DM are overweight and 80% will die from CVD
High costs to health services & wider economy e.g. at least £2.5billion per year in England
DM = diabetes

6. Obesity in Children
Prevalence increasing from 9.9% children in 1995 to 13.7% in 2003.
27.7% children now overweight
Children have lower life expectancy than their parents
For the first time we see a teenage generation which may not live as long as their parents due to the increase in obesity. Rates of obesity on childhood are rising much faster than in the general population

7. Obesity in Birmingham Based on population of 1 million.
495,000 overweight adults
Of those 165,000 will be obese
Plus 55,000 obese children
Using national statistics and recent studies we can extrapolate the expected impact that this will have on people in Birmingham

8. Definition of obesity Body mass index = weight (kg) height (m)2
Healthy Weight = 20-25
Overweight = 25-30
Obese = over 30

9. Factors leading to increases in obesity

10. E N R G Y O U T I P h y s i c a l t v F o d g e n m b 7
In order t maintain weight we need to balance the amount of energy (FOOD/ DRINK) we take in against the energy (exercise/ activity) we undertake in a day

11. Reductions in activity
Reduced occupational activity
Increased use of labour saving devices
Security issues
Modern life means that activity levels have dropped. Natural physiology is such that our bodies store food in case we are not able to find any food in the near future. Driving from place to place. Sitting down at work instead of chasing our dinner across the prairie and keeping our children indoors because it is not safe for them on the street reduces the amount of activity children are taking

12. Calorie Usage - Changes over 50 years
Per week s s
Shopping on foot/car & supermarket
Washing clothes by hand/machine
Making a coal fire/gas fire
Per hour
Hand lawn mower/electric mower
No power steering/with it
Examples of just how much less energy we are using today as opposed to the lives of our grandparents when they were our age

13. Marketing of high fat, high sugar snack foods
More time spent watching television than spent in school classroom
Six food adverts every 30 minutes
77,000 food adverts age 1 to 18
TV, websites and advertising hoardings are giving us poor messages about food.
FINAL POINT – if you take this number of adverts and multiply them by 18 we will see approximately 77,000 food adverts by the time we reach adulthood. Many people learn best from visual images, so we are learning the ‘balanced diet’ advertisers want us to learn and not the one that research tells us is the right one

14. Advertising promotes a very distorted diet
© IACFO 2003

15. Beyond television… Young people using internet daily:
USA %
UK 72%
Italy 55%
South Korea 78%
Argentina 27%
Free music downloads, free ringtones
SMS texts to phones – bypasses parents
Advertisers are using other sources of advertising too – young people are known to spend time on the internet and have mobile phones, advertisers are moving to these mediums to promote the products

16. Secular Trends in Portion Size
Food intake per eating occasion (oz) 25
2.0
Soft drinks
Salty snacks 20
1.5 15
1.0 10
It isn’t just the sorts of food which we eat that has been changing in the last 30 years we can see that portion size has increased too
0.5 5
Nielsen & Popkin. (2003)

17. Standard servings 1955 and 2001 1955 2001 Fries 72g Fries 205g
Coke 200ml
2001
Fries 205g
Coke 950ml
The trend is getting quite alarming…

18. A well balanced meal should be made up of a variety of food and the recommended proportions are shown on this image – startchy carbohydrates should be complex carbohydrates such as whole grain pasta, bread or rice
Remember nutritional health - diet also influences risk factors independently

19. Addressing the problem
Needs to be tackled at all levels - Government - Food Industry - Media - Schools - Local Authorities - Businesses - NHS
Locally health services are looking to work in conjunction with other services to promote good food messages and encourage healthy eating

20. Changing eating habits – advice for children and their families
Increase activity and reduce inactivity e.g. watching TV
Regular meals rather than grazing
Separate eating from other activities
Encourage child to respond to hunger cues
Alternatives to food as reward
Increasing activity is an important part of the message about improving healthy.
Regular meals are also important , habits such as eating whilst watching TV are bad habits, attention is not paid to th emeal being eaten and therefore we are more likely to eat too much.
Learning about your body and knowing when it wants food and when it wants drink or just comfort is important. It is also important to ‘hearing’ when your body has had enough.
Parents and schools need to offer rewards that are not about food. Food is not a reward it is a necessity of life

21. Changing eating habits – advice for children and their families
Comfort with attention, hugs etc rather than food
Keep foods to avoid out of the house
Avoid classifying foods as good or bad
Be consistent
As parents or child carers we should:-

22. Addressing obesity at Policy Level
Choosing Health White Paper
Public Service Agreement
Halt the year on year rise in obesity in the under 11 yr olds by 2010
City Council Overview and Scrutiny Review – Childhood Nutrition
In Birmingham local action is being taken across the city

23. Elements of an obesity strategy
Prevention of obesity
Management / treatment of obesity
Supporting weight maintenance
Support population to adopt a healthy diet and lifestyle
The ways this strategy is being put into action is:-

24. What is happening locally
Development of Strategy and care pathway
Development of specialist obesity service for children – Lead by a Consultant in Obesity
Task force from scrutiny review
Local services continue
Training for health professionals
Roll out of pilot to monitor BMI in children

25. How schools are contributing
healthier breakfast clubs
healthier cookery clubs
healthier lunch boxes
growing clubs
dining room environment

26. How schools are contributing 2
water provision
healthier tuck shops
healthy vending machines.
School meals
Healthy eating in the curriculum
BMI measurement project

27. Food in schools
Food in schools tool kit

28. Consultant Dietician: Linda Hindle
For more information across the city contact:-