1. Innovations and new initiatives to prevent obesity NSW Health Innovation & Health Symposium – November 2015 Louise A Baur University of Sydney: Discipline of Paediatrics & Child Health, Sydney Medical School, AND Sydney School of Public Health The Children’s Hospital at Westmead, Sydney: Weight Management Services Email: louise.baur@health.nsw.gov.au

2. One of today’s most blatantly visible – yet most neglected – public health problems The public health equivalent of climate change The Millennium Disease How others have described the problem of obesity WHO; www.who.int/nut/obs.htm; Laing & Rayner, Obesity Reviews 2007; www.iotf.orgwww.who.int/nut/obs.htmwww.iotf.org

3. !!!!

4. With such a complex issue …… we can’t tackle it by staying in our silos

6. Obesity and the chronic disease care pyramid Primary prevention & health promotion

7. Level 1 70-80% of people with o’weight/obesity Self-care & community based care Obesity and the chronic disease care pyramid Self-care supported by GPs, other 1 o care, group programs Primary prevention & health promotion

8. Level 1 70-80% of people with o’weight/obesity Self-care & community based care Level 2 High risk patients Care management Obesity and the chronic disease care pyramid Self-care supported by GPs, other 1 o care, group programs Multidisciplinary teams; specialist allied health; group programs Primary prevention & health promotion

9. Level 1 70-80% of people with o’weight/obesity Self-care & community based care Level 2 High risk patients Care management Level 3 Obesity and the chronic disease care pyramid Complex patients Case management Self-care supported by GPs, other 1 o care, group programs Multidisciplinary teams; specialist allied health; group programs Tertiary level facilities & special obesity clinics; specialist teams; key worker case manages & joins up care Primary prevention & health promotion

10. Level 1 70-80% of people with o’weight/obesity Self-care & community based care Level 2 High risk patients Care management Level 3 But we tend to stay in our silos! Complex patients Case management Self-care supported by GPs, other 1 o care, group programs Multidisciplinary teams; specialist allied health; group programs Tertiary level facilities & special obesity clinics; specialist teams; key worker case manages & joins up care Primary prevention & health promotion Silo 1 – Health promotion Silo 2 – Primary care Community care Silo 3 – Hospitals

11. What are some of the new, or newer, strategies in tackling obesity?

12. Tackling gestational weight gain: → Providing a Get Healthy Coaching Service to pregnant women affected by obesity

13. Why gestational weight gain? A critical period when future health trajectories can be influenced Pregnant women are very open to health messages AND they are being seen – often frequently - by the health system! Excess weight in pregnancy → influences current & future maternal health AND offspring health

14. Trial of for women with gestational weight gain Trial underway using the Get Healthy platform Can we see a future when …. –all women in early pregnancy who are affected by obesity are provided with a high quality, accessible intervention to help them avoid excess weight gain and have as healthy a pregnancy as possible? –the Get Healthy Service is used successfully by many, many people – including young people (i.e. prior to pregnancy)?

15. Integrating anticipatory guidance about breastfeeding and healthy infant/ young child eating and activity into routine clinical service delivery → Universal and Targeted home visiting to mothers of new babies

16. Home visiting programs? Can be effective in improving social and health outcomes of disadvantaged parents and children What about weight, eating and activity outcomes? → The Healthy Beginnings Trial o south-western Sydney o intervention from 3 rd trimester to child age 2y o 8 home visits by early childhood nurse, developmentally staged 1 Olds DL, et al. JAMA 1997, 278:673-643.

17. And, Healthy Beginnings led to …: significant reduction in body mass index at age 2 y → the first intervention to decrease child BMI in early childhood improvements in some child and mother eating and activity/TV behaviours …. but the effect didn’t persist beyond 2 y - when the home visits stopped Wen LM et al. BMJ 2012; 344:e3732

18. Home visiting programs to prevent obesity? Trial being planned in Sydney LHD Can we see a future when …. –Anticipatory guidance – about breastfeeding, healthy infant/child feeding & activity – is integrated into home visiting programs for targeted pregnant women/mothers of young babies? Are there other ways to support large numbers of women? What about phone coaching? The Get Healthy Service for new mothers?

19. On-line training of clinicians (nurses, allied health, doctors …) who see children and adolescents - to monitor weight status, raise the issue of obesity and provide initial and more detailed advice → Weight4KIDS training modules

20. Why the interest in training health professionals? Treatment services very limited, poorly co- ordinated, across NSW and Australia-wide Most health professionals are poorly trained in managing paediatric obesity and its complications → Development of Weight4KIDS: –a series of on-line training modules suitable for all types of health professionals working with children, in any setting –well-evaluated in metro and regional NSW settings

25. Upskilling of health professionals? Can we see a future when …. –All clinicians and health promotion staff are able to access relevant training as needed and feel confident in: raising the issue of obesity monitoring the problem helping people find the support they need to tackle the issue

26. Some last reflections

28. Of course we need many other strategies too! BUT … Let’s be as flexible and innovative as we can within our existing budgets How can we avoid being stuck in our different “craft silos” and comfort zones? Where does health promotion end and clinical service delivery begin? And vice versa? How can health promotion infiltrate/ embed itself - or be integrated - into routine clinical service delivery? How can health promotion be integrated across many other sectors?

29. Of course we need many other strategies too! BUT … Let’s be as flexible and innovative as we can within our existing budgets How can we avoid being stuck in our different “craft silos” and comfort zones? Where does health promotion end and clinical service delivery begin? And vice versa? How can health promotion infiltrate/ embed itself - or be integrated - into routine clinical service delivery? How can health promotion be integrated across many other sectors? Thank you!