1. David Herne Public Health Specialist Chorley & South Ribble PCT

2. Purpose of this session - to promote an understanding of the wider determinants of health and specifically how they underpin patterns of obesity and - to consider what actions would contribute to a reduction in obesity rates.

3. Obesity is a problem But if you need any convincing look at the picture in America………………

4. Obesity Trends* Among U.S. Adults BRFSS, 1985 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

5. Obesity Trends* Among U.S. Adults BRFSS, 1986 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

6. Obesity Trends* Among U.S. Adults BRFSS, 1987 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

7. Obesity Trends* Among U.S. Adults BRFSS, 1988 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

8. Obesity Trends* Among U.S. Adults BRFSS, 1989 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

9. Obesity Trends* Among U.S. Adults BRFSS, 1990 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

10. Obesity Trends* Among U.S. Adults BRFSS, 1991 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

11. Obesity Trends* Among U.S. Adults BRFSS, 1992 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

12. Obesity Trends* Among U.S. Adults BRFSS, 1993 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

13. Obesity Trends* Among U.S. Adults BRFSS, 1994 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

14. Obesity Trends* Among U.S. Adults BRFSS, 1995 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

15. Obesity Trends* Among U.S. Adults BRFSS, 1996 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

16. Obesity Trends* Among U.S. Adults BRFSS, 1997 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

17. Obesity Trends* Among U.S. Adults BRFSS, 1998 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

18. Obesity Trends* Among U.S. Adults BRFSS, 1999 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

19. Obesity Trends* Among U.S. Adults BRFSS, 2000 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

20. Obesity Trends* Among U.S. Adults BRFSS, 2001 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

21. What is Obesity Body Mass Index (BMI) is a measure comparing weight to height and is often used as an indicator of body fat for adults. Obesity is usually defined as a body mass index (BMI) of 30 or above. BMI classification: Source: Tackling Obesity in England. Report by the Comptroller and Auditor General HC 220. National Audit Office, 2001. London: The Stationery BMIClassification Less than 20Underweight Over 20 but under 25Healthy Over 25 but under 30Overweight Over 30Obese

22. Why is obesity a problem ? - the costs In 1998 on conservative estimates, obesity treatment cost the NHS £0.5billion 1.5% of the total NHS expenditure in that year The bulk of this cost is attributable to treating the consequences of obesity £2billion was attributable to wider societal impacts such as sickness time off etc Over 18 million sick days and 6% of all deaths are attributed to obesity each year (compared to about 10% due to smoking)

23. An obese person loses approximately 9 years of life If the prevalence of obesity continues to rise at the present rate until 2010, costs would increase by £1billion to around £3.6billion

24. Obesity in Young Children Little change in overweight or obesity from 1974 to 1984. From 1984 to 1994 overweight increased from 5.4% to 9.0% in English boys 9.3% to 13.5% for English girls. The prevalence of obesity increased correspondingly, reaching 1.7% boys and 2.6% girls Now 10% of 6 year olds are classified as obese

25. Among 3 to 4 year old English Children 60% increase in the prevalence of being overweight and 70% increase in the prevalence of obesity Increases in obesity in surprisingly young children. Furthermore, more than 60% of overweight children have at least one additional risk factor for cardiovascular disease, such as raised blood pressure, hyperlipidaemia, or hyperinsulinaemia More than 20% have two or more risk factors.

26. Type 2 diabetes, which was previously rare in children and adolescents, now accounts for over 30% of new cases in some parts of the United States; Most cases of type 2 diabetes in children and adolescents are attributable to obesity. Sources BMJ2001;322:313-4 NWPHO 2002 BMJ 2001;322:24-6

27. Task 1 In pairs consider ….. why are children getting fat?

29. Task 2 In pairs consider What can schools alone do to address this broad agenda which underpins the Obesity epidemic? What more can they do if they work in partnership, and who else would they need to work with?

30. Public health is about… Surveillance & assessment of population health and well being Promoting and protecting population health and well being Developing health programmes & services and working to reduce health inequalities eg the LHSP

31. Public health is about… Developing & implementing policies and strategies Taking a strategic lead in collaborative working Working with and for communities Developing high quality in our work & routinely evaluating its effectiveness Carrying out research and development

32. Obesity was just an example…. The public health approach applies for many topic and setting areas