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Why promote a healthier weight in your professional practice?
Childhood obesity and excess weight are significant health issues for children and their families. There can be serious implications for a child’s physical and mental health, which can continue into adulthood. The number of children with an unhealthy and potentially dangerous weight is a national public health concern.
Healthcare professionals play an important role in supporting families to take action. Working alongside other professionals and public health teams, they can also influence the general population by delivering whole systems approaches to tackle excess weight, and reduce drivers of excess calorie intake and sedentary lifestyles.
Action across the child life course is essential to impact childhood obesity, and enable positive behaviour change around eating and activity. The focus should be on:
- preconception and pregnancy
- infancy and early childhood
- older childhood and adolescence
- transition into independent adulthood
Obesity is associated with poor psychological and emotional health, and many children experience bullying linked to their weight. Obese children are more likely to become obese adults and have a higher risk of morbidity, disability and premature mortality in adulthood.
Using National Child Measurement Programme data relating to primary school children, the NHS states that:
- more than 1 in 5 children are overweight or obese when they begin school, and 1 in 3 children are overweight or obese by the time they leave primary school
- obesity rates are highest in the most deprived 10% of the population, approximately twice that of the least deprived 10%
Obesity rates are higher in some ethnic minority groups of children (particularly among children from Black and Bangladeshi ethnicities, though this varies by age and sex of the child).
The main risk factors for children, in terms of the households they are born into and grow up in, include:
- maternal health: in 2014, 58% of women of childbearing age (16 to 44 years) in England were either overweight or obese1
- parental health: children who live in a family where at least one parent or carer is obese are more at risk of becoming obese themselves
- children who are obese are more likely to be obese in adulthood and thus increase the risk of obesity for their own children later in life
- poor diet and low levels of physical activity are the primary causal factors to excess weight
The amount of sugar that children consume on a daily basis is a major contributing factor to gaining weight. The National Diet and Nutrition Survey found that sugary drinks account for 30% of 4-to-10-year-olds’ daily sugar intake. Childrens’ consumption of added or processed sugars significantly exceeds the maximum recommended level.
Low levels of physical activity - and increased sedentary behaviours among children and young people - exacerbate the problems of poor diet and nutrition. Data from 2015 in England shows only 23% of boys and 20% of girls aged 5 to 15 achieve recommended levels of physical activity (excludes activity in schools).
HM Government Childhood Obesity: a Plan for Action
improving the nutritional content of the food and drink our children consume
strengthening the information available to parents about those products
changing the way that unhealthy food and sugary drinks are promoted
Core principles for healthcare professionals
Healthcare professionals and the wider public health workforce should:
- know the needs of individuals, communities and population and the services available
- think about the resources available in health and wellbeing systems
- understand specific activities which can prevent, protect, and promote
If you’re a front-line health professional:
- remember that a healthy weight is primarily achieved through improving dietary intake, portion control, and physical activity
- provide consistent evidence-based healthier weight, optimal nutrition and physical activity messages for parents, children and young people - this includes explaining the principles of the Eatwell Guide, and directing families to further information
- understand the specific activities and interventions which can support individuals and families to achieve and maintain a healthy weight. Use opportunistic moments to open up conversations around weight
- encourage parents to sign up for the Start4Life information service for children from 0 to 5 years; the service provides evidence-based information for parents on pregnancy and child health development from 0 to 5 years, including important messages on breastfeeding initiation and continuation and improved nutrition
- ensure you are familiar with the local obesity care pathway and aware of the services and support available in the local system - from the NHS, local authorities and voluntary and community sectors
- promote breastfeeding uptake and duration, timing of introduction of solid food, and responsive feeding practice
- think about how you as a professional are role modelling healthy behaviours - and how you can support your peers and colleagues with their own weight issues
- promote and support healthy home environments to families
In addition, it is important to:
- encourage schools to register with the Change4Life School Zone, to receive new teacher packs designed to help teach curriculum-linked PSHE topics, with flexible lesson plans and engaging videos
- encourage schools to work proactively with the National Child Measurement Programme so that it is an integral element of the whole school approach to healthy weight. Think about the role you can play in supporting children and young people who are identified as overweight or obese
- offer evidence-based advice to increase activity such as the What works in schools and colleges publication, as well as ideas for using the PE and Sport Premium
- use ideas and toolkits for your Change4life sports club
- support schools to adopt healthy eating policies
- support the development of school bullying policies so that they include obesity and weight issues as possible causes. Think about the role that school nurses and other professionals can play in supporting young people affected by bullying
- raise awareness amongst school and college staff to support positive emotional health and wellbeing
- have a conversation with a young person and about the support that is available locally to support both their mental health and weight issues and signpost to Rise Above
If you’re a team leader or manager:
In addition to the actions highlighted for frontline professional, team leaders or managers can support this work by:
- standardising the approach across the service - for example, ensuring the five mandated health visitor reviews are offered for every family, or by ensuring all clinics have the Eatwell Guide and physical activity infographics displayed on the wall in the waiting room
- think about how the service can support sharing appropriate data between health, education, social care and community organisations to target prevention activity and coordinate intervention
- think about how you as a team leader or manager are role modelling healthy behaviours, and how you can support your peers and colleagues with their own weight issues
If you’re a senior or strategic leader:
- inform local commissioners about local issues that either help or hinder work to reduce tackling excess weight in children
- support local commissioners and providers to involve children, young people and families in commissioning and designing services so they meet the needs of local people
- feed back to local commissioners and providers where services are working well, and where there are problems accessing support for overweight or obese children and their families
- prioritise Healthy workplaces to reduce sickness absence, lower staff turnover and boost productivity. It is important not just for businesses and staff, but for the economy as a whole
- promote a ‘sustainable, community-wide approach’ to prevent obesity. This involves a set of integrated services and actions delivered by the many organisations, community services and networks that make up the ‘local system’
The Baby Friendly Standard is a UNICEF initiative which aims to create breastfeeding friendly spaces to encourage and support breastfeeding, often supported by peer education and peer support networks.
Senior and strategic leaders can support these interventions by:
- building community capacity to enable local families to promote healthy eating and physical activity through children centre group work or peer to peer programmes
- working with the community to facilitate active lifestyles; examples include youth clubs, safe neighbourhoods, StreetPlay and outdoor play
As a health professional there are a range of reasons why it makes sense to measure your impact and demonstrate the value of your contribution.
This could be about sharing what has worked well, in order to benefit your colleagues and local people or to help you with your professional development.
The Everyday Interactions Measuring Impact Toolkit provides a quick, straightforward and easy way for health care professionals (HCPs) to record and measure their public health impact in a uniform and comparable way.
The childhood obesity impact pathway is recommended for healthcare professionals and the wider public health workforce to record and measure actions undertaken as part of routine care which impact on childhood obesity.
Understanding local needs
Child obesity data from the National Child Measurement Programme (NCMP) 2006 and 2007 to 2016 and 2017 is now available in the online tool NCMP Local Authority Child Data Profile.
The NCMP tool:
- provides local authority level child data (underweight, healthy weight, obese, excess weight, overweight including obese) for reception (aged 4 to 5 years) and Year 6 (aged 10 to 11 years)
- presents trend data (including inequalities data) and enables easy comparison of local authority data, allowing users to compare regional neighbours and local authorities with similar characteristics
At a population level, the following outcome measures can help build a picture of the obesity-related risk factors in the population:
- Department of Health and Local Government Association’s guide for school readiness
- the Early Years High Impact Area 4 which sets out the key components on healthy weight and nutrition for professionals and commissioners
- Breastfeeding initiation: percentage of mothers who have initiated breastfeeding within the first 48 hours
- Breastfeeding prevalence at 6 to 8 weeks: percentage of all infants who are partially or totally breastfeed at the 6 to 8-week check
- child health profiles: these provide a snapshot of child health and wellbeing for each local authority in England using key health indicators, which enables comparison locally, regionally and nationally
The Obesity Intelligence Knowledge hub website provides wide-ranging authoritative information on data, evaluation, and evidence related to weight status and its determinants.
You can also find out more by visiting Public Health England’s data and analysis tools related to obesity.
Advice for patients and the public
- NHS weight loss plan is a free 12-week diet and exercise plan
- NHS.UK website offers tips for healthy eating
- The Eatwell Guide shows the proportions in which different types of foods are needed to have a well-balanced and healthy diet
- OneYou provides tools, support, and encouragement across the breadth of lifestyle factors to help adults aged 40 to 60 years improve their health, every step of the way
- 5-a-day gives advice and recommendations about the benefits of eating 5 portions of fruits and vegetables a day
- Use the Healthy weight calculator to check your body mass index (BMI) and find out if you are a healthy weight
- Start4Life offers help and advice during pregnancy, birth and parenthood
- Change4Life is an England and Wales campaign offering advice on making healthy choices and reducing sugar
Professional resources and tools to promote healthier weight
These resources for promoting healthier weight are intended to support health and care professionals to be consistent and provide a core set of evidence-based healthier weight, nutrition and physical activity messages throughout the life course.
They consist of a set of infographics for use in practice, a set of slides to be used as a training tool and a child obesity animation.
The Our Healthy Year resources help school nursing teams to explain NCMP, and engage parents using classroom activities, practical tips and educational tools.
The Let’s Talk About Weight for adults and Let’s talk about weight resource for children and families support health and care professionals to have conversations about weight, and refer patients into weight management services.
The National child measurement programme (NCMP) operational guidance advises local commissioners and providers on running the NCMP.
Guidance on healthier and more sustainable catering.
UK physical activity guidelines - advice from the Chief Medical Officer on how much physical activity people should be doing.
Health Education England e-learning programme for practitioners in the NHS, and local authorities working in weight management. Healthcare professionals and the wider workforce can strengthen their knowledge by accessing a range of e-learning modules for free.
Some examples include:
- Health Promotion in Pregnancy: Obesity
- Obesity Prevention in Children
- Obese Toddlers and Infants
- Key Child Public Health and Mental health Issues for 5 to 12 years - Understanding and Tackling Obesity
Promoting healthy weight in children, young people and families, a resource to support local authorities, NHS commissioners and providers, voluntary and community sector organisations to take action to reduce obesity.
The resource is made up of briefings and practice examples to promote healthy weight for children, young people and families as part of a whole systems approach.
The briefing helps to:
- make the case for taking action to reduce obesity
- provide examples of actions that can be taken
- provide key documents that form the evidence base and other useful resources