Memorandum by the National Heart Forum
The National Heart Forum (NHF) welcomes the
opportunity to submit written evidence to the Health Committee
on this very important inquiry into obesity. We would like to
express our concerns over this epidemic, especially among children
and young people which, if not addressed now will lead to a further
epidemic of coronary heart disease, stroke, diabetes and some
cancers in 30, 40 and 50 years time.
Increasingly, obesity is being recognised as
a key risk factor for coronary heart disease (CHD). Being overweight
or obese is linked with several known CHD risk factors: the prevalence
of high blood pressure and diabetes is three times higher among
overweight people than among those of normal body weight, and
obesity is also associated with higher levels of total blood cholesterol1.
It is estimated that 5% of male and 6% of female CHD deaths are
attributable to obesity accounting for 6,500 deaths per annum
in the UK2.
2. THE NATIONAL
The NHF is the leading alliance of over 40 organisations
working to reduce the risk of CHD in the UK. Member organisations
represent the medical and health services, professional bodies,
consumer groups and voluntary organisations. Members also include
many individual experts in cardiovascular research. Government
departments have observer status. The purpose of the NHF is to
work with and through its members to reduce disability and death
from CHD. Our four main objectives are:
To provide a forum for members for the
exchange of information, ideas and initiatives on coronary heart
To identify and address areas of consensus
To develop policy based on evidence and
on the views of member organisations; and
To stimulate and promote effective action.
The NHF embraces professional, scientific and
policy opinion in current issues in CHD prevention. It co-ordinates
action to reduce heart disease risk through information, education,
research, policy development and advocacy.
Given the expertise and multidisciplinary background
of our membership, and its wealth of scientific and policy experience
in matters relating to obesity, the NHF is uniquely placed to
offer advice to the Select Committee. The secretariat and our
members would be delighted to provide oral evidence to the Committee
on any of the issues raised in this submission.
3. SUMMARY OF
The NHF believes that on the basis of current
evidence and technologies there is very limited scope to reverse
or "cure" obesity in individuals. However there are
potentially many effective public health policy interventions
that would probably have a very significant bearing on reducing
obesity at the population level. Hence we believe that the public
policy priority has to be to invest in the prevention of obesity,
and that this has to begin with the origins of obesity that usually
start in childhood.
There is no comprehensive government-backed
national strategy for preventing obesity in England, despite the
NAO report on obesity in 2001. 3
Obesity prevention requires a comprehensive
response across government and the private sector that fundamentally
reverses the dramatic and damaging social changes over the recent
decades in the nature of the UK's eating and activity culture.
Currently there appear to be many areas of conflicting
government policy that work against one other, eg the sponsorship
of physical activity and sport in schools by manufacturers of
confectionery, soft drinks and snack foods.
By preventing obesity the UK can at the same
time prevent and reduce the incidence of many linked and associated
avoidable chronic diseases such as coronary heart disease, stroke,
diabetes and some cancers. Together these chronic diseases are
the main causes of premature mortality and morbidity in the UK.
Despite the impact on society, the economy and the NHS there are
still no national strategies for the promotion of physical activity
and nutrition in England equivalent to the competent national
plans that have been recently developed in Scotland, Wales and
Northern Ireland. We would like in particular the Government to
take forward the excellent recommendations of the recent review
by the Cabinet office's Strategy UnitGame Plan4as
a national plan of action.
The size of the social and economic consequences
of the obesity epidemic mandate detailed examination. There is
currently very limited research investment into such analyses
and prevention. It would be seem appropriate to model the obesity
epidemic and the response merited by government within the new
Treasury review to be led by Derek Wanless.
The NHF is particularly concerned about the
marketing of foods to children high in fat, sugar and salt and
is currently consulting with its members on the most effective
and appropriate marketing controls. The NHF will be able to submit
further evidence on this to the HSC soon. We hope that the HSC
will take the opportunity of the review to ask the fast food,
confectionery, soft drinks and advertising industries to disclose
what they know about the impact of their marketing activities
on children's diets.
4. THE NATIONAL
Young@heart is the National Heart Forum's major
policy initiative to tackle the causes of heart disease from its
beginnings in early life. The young@heart policy framework Towards
a generation free from coronary heart disease: policy action for
children and young people's health and well-being5 sets out a
series of recommendations to protect children from developing
heart diseaseand other chronic diseases like such as obesity,
stroke, diabetes and some cancersand to foster health as
well as life expectancy in their adult life. Recommendations include
those to develop comprehensive national strategies for improving
nutrition and increasing physical activity. They can be viewed
The young@heart recommendations are based on
a unique set of research and policy reviews6 providing clear evidence
for policy action. We refer to this evidence and the young@heart
policy recommendations in this written evidence.
5. CORONARY HEART
Even though death rates from CHD have been falling
since the early 1970s CHD is still the leading single killer in
the UKin 2001 it caused 120,000 deaths, 43,000 of these
were premature (before the age of 75). One in four men and one
in six women die from the disease. The UK has one of the highest
CHD rates in the European Union7.
However CHD is a largely preventable disease
due to its major modifiable risk factors of poor diet, sedentary
lifestyle, smoking and the impact of poverty. Indeed, targeted
primary prevention efforts in adults have been partly responsible
for the recent declines. If effective public health action was
implemented across all social groups deaths from CHD under the
age of 65 could be virtually eliminated.
5.1 Obesity as a risk factor for CHD and associated
Obesity is a recognised risk factor for CHD.
It is associated with numerous health problems including high
blood pressure (hypertension), raised blood cholesterol and type
2 diabetes, all of which directly contribute to an increased risk
In recent years, central (abdominal/visceral)
obesity has been identified as a risk factor for CHD independently
of body mass index (BMI), and simple waist measurement as well
as the waist-hip ratio is being promoted for use in risk assessment.
Central obesity refers to the predominant accumulation of fat
centrally in the abdomen rather than on the hips and elsewhere
on the body. Intentional weight loss has been shown to be beneficial
in terms of CHD and total mortality in overweight women in the
United States. In both the United States and the UK it has been
shown8 that the risk of cardiovascular mortality, heart attack
and diabetes, as well as the levels of a wide range of cardiovascular
risk factors, increase progressively from a BMI of about 20kg/m2.
The recent declines in CHD mortality rates are
not mirrored by CHD incidence rates, which appear to be rising7,
partly as a result of escalating obesity rates. Increasing obesity
rates will also lead to increases in stroke, cancer and diabetes;
with a double toll being taken by CHD for which obesity and diabetes
are both independent risk factors. The prevalence of diabetes
has increased by 65% in men and 25% in women since 1991. Diabetes
substantially increases the risk of CHD. Men with type 2 diabetes
have a two to fourfold greater annual risk of CHD, with an even
higher (three to fivefold) risk in women. Diabetes not only increases
the risk of CHD, but also magnifies the effect of other risk factors
for CHD such as raised cholesterol levels, raised blood pressure,
smoking and, of course, obesity.
Recent research by the World Health Organization
suggests that the cardiovascular burden due to raised BMI may
be greater than previously suggested. The World Health Report
20029 estimates that over 7% of all disease burden in developed
countries is caused by raised blood pressure, and that between
25-49% of CHD in developed countries is due to levels of BMI in
excess of the optimal range (19-25kg/m2).
6. TRENDS IN
In England about 47% of men and 33% of women
are overweight (a BMI of 25-30 kg/m2), and an additional 21% of
men and 24% of women are obese (a BMI of more than 30 kg/m2).
Overweight and obesity increase with age. About
36% of men and 34% of women aged 16-24 are overweight or obese
but 77% of men aged 55-64 and 71% of women aged 65-79 are overweight
Overweight and obesity are increasing rapidly.
The percentage of adults in England who are obese has more than
doubled since the mid 1980s. This increase in obesity is particularly
marked in men, among whom rates have tripled since the mid 1980s,
with men now as likely to be obese as women.
The prevalence of obesity increases with age
throughout childhood. In 1996, around 13% of eight year olds and
17% of 15 year olds in England were obese.
The high levels of overweight and obesity among
children are likely to exacerbate the trend towards overweight
and obesity in the adult population, since compared to thin children;
obese children have a high risk of becoming overweight adults.
Obesity is more common in adults employed in
manual occupations, particularly women. A quarter of women working
in unskilled manual occupations have a BMI of more than 30 kg/m2
compared to one in seven of those employed in a professional role.
Both men and women working in unskilled manual
occupations are over four times as likely as those in professional
employment to be classified as morbidly obese (a BMI over 40).
In both men and women, the prevalence of central
obesity is higher in people from manual social classes (IIIM,
IV and V) than from non-manual classes (I, II and IIINM). However,
as in general obesity, the social class patterning of central
obesity is most evident in women, where the prevalence of central
obesity gradually increases from 18% in social class I to 27%
in social class V.
Levels of general and central obesity vary with
ethnicity in both men and women in England. Compared with the
general population, levels of obesity are much lower in Pakistani,
Indian, Chinese, and, most markedly, Bangladeshi men, who are
three times less likely to be obese than men in the general population.
Despite low levels of general obesity, Pakistani, Indian and Bangladeshi
men, have relatively high levels of raised waist to hip ratio,
with 41% of Indian men classified as centrally obese compared
to 28% of men in the general population. Black Caribbean and Chinese
men are less likely to have a raised waist hip ratio.
Among women, obesity prevalence is high for
Black Caribbean and Pakistani women and low for Bangladeshi and
Chinese women. However, all female minority ethnic groups have
levels of central obesity well above that of the general female
population, with Black Caribbean and Pakistani women two times,
and Bangladeshi women over three times, as likely to have a raised
waist to hip ratio as women in general.
Data from national surveys of overweight and
obesity collected by Professor Boyd Swinburn and his colleagues
at Deakin University, Victoria, Australia (see ref 7) show that
the prevalence rates for overweight and obesity in the UK are
some of the highest in the world. For example the prevalence of
obesity is the eighth highest for men (out of 40 countries) and
the eleventh highest for women (out of 41 countries). While levels
of overweight and obesity are increasing in all countriesboth
developed and developingthe rate of recent increase in
the UK is particularly high.
7. ECONOMIC COSTS
The National Audit Office estimated the cost
of treating obesity and associated disease as £0.5 billion
to the NHS and as much as £2 billion to the wider economy3.
Broken down further, the direct healthcare costs
of CHD and diabetes have been estimated at £1.7 million and
£1.3 million, respectively, while the total costs of CHD
to the UK economy amount to £7,055 million per year7.
8. WHY THE
According to the National Audit Office the number
of obese people in England nearly doubled between 1980 and the
late 1990s3. This rise has been attributed to changing eating
habits and decreasing levels of physical activity. Speculation
that physical activity levels among children and adults have declined
during the latter half of the twentieth century has attracted
increased support over recent years, but there are no robust temporal
data to confirm this. There is, however, a growing body of evidence
that total mean energy intake has increasedbut this is
generally under-reported in surveys8.
The NHF strongly recommends that the Committee
is sensitive to the bias often placed on the role of physical
activity in the obesity debate. Given the clear links to the roles
of both diet and physical activity in obesity, we urge that the
Committee's recommendations for any approach to the obesity problem
must be closely linked to both national diet and national patterns
of physical activity.
9. DIETARY PATTERNS
A healthy, balanced diet has an extremely important
role to playtogether with physical activityin the
prevention of excessive weight gain from early life into adulthood.
It is also fundamental to effective obesity management, rather
than reliance on slimming products.
The features of our diet which must be addressed
to prevent overweight and obesity are: a) the type of foods we
eat and drink, particularly in terms of calorie-rich fat and sugar
content, and b) the quantities and frequency that we consume these
foods and drinks.
Although levels of consumption of food and nutrients
are difficult to assess, food consumption patterns have been tracked
in the UK for 50 years by the National Food Survey (NFS). This
is useful for giving an idea of general trends, but has only very
recently started to record food eaten outside the home, so for
the moment current data does not capture the impact of food eaten
in restaurants or fast food chains, or of snacking on the move.
Nevertheless, the NFS suggests that British adults derive around
38% of food energy from total fat and around 15% from saturated
fatsignificantly higher levels than government's COMA targets10.
The National Diet and Nutrition Survey 200211 suggests that on
average men and women consume less than three portions of fruit
and vegetables a day. Many people consume much less.
Over recent decades in the UK there have been
distinct changes in diet as more ready meals and processed foods
are available in the shops, and more and more people choose to
eat out or eat fast/take-away foods.
Consumption of soft drinks has risen over the
years. Studies suggest that 28% of boys and 24% of girls aged
between two and 15 are drinking more than one soft sweetened drink
a day (excluding sugar-free or diet drinks) and 35% of boys and
29% of girls eat chips three or more times a week12.
Influences and trends
Dietary habits are determined by a variety of
factors including the family, society and culture in which we
They are also heavily influenced by what we
can afford and what food is readily available and accessible where
we live. Food poverty is associated with a diet high in cheap,
processed foods and low in fruits and vegetables. In the US, Mississippi
is the state with both the highest poverty rates and the highest
rates of obesity.
Marketing and advertising have a strong influence
on food choices, particularly among the young. There is a strong
association between products which are most heavily promoted and
those which are high in salt, fat and sugar including confectionery,
soft drinks and snacks. It is estimated that of a total advertising
spend of £600 million per year, only £26 million is
spent on advertising fruits and vegetables13.
We are eating more processed and pre-prepared
food than ever before. Levels of hidden fat, salt and sugar are
often high and difficult to monitor. The UK accounted for 42%
of all European sales of ready meals in 2002 (£1.4 billion).
We are cooking fewer meals from raw ingredients,
and are more likely not to learn how to cook at school since the
decline of practical cookery lessons.
High salt levels in many snack foods (crisps,
biscuits) and processed foods make us thirsty. Britons are drinking
increasing quantities of sugary, carbonated drinks.
The amount of food we need to eat is largely
determined by our energy requirements. If we are inactive, we
require less energy.
Portion size for many fast food meals, confectionery
items and soft drinks have increased in recent years. Pricing
strategies have kept the price of bumper size items relatively
low, making them "value for money".
A diet high in energy-dense foodsthose
with a relatively high calorific valuecan distort our natural
sense of satiety, making us likely to eat more food than we need
to meet our actual energy requirements.
Diet and weight gain
The dietary changes over recent years that may
to various extents be implicated in the rise in overweight and
Consuming more calories than our energy
requirementsa problem of over-eating for an inactive lifestyle;
Eating more snacks, crisps and sweets
Drinking more high-sugar soft drinks;
Eating more ready meals (which may contain
Consuming few fruit and vegetables (which,
if eaten, tend to displace more fattening food items);
Consuming more fast food which is typically
high in fat, such as cheese burgers, chips and chicken nuggets;
Snacking between mealtimes; and
Increasing alcohol consumption among
women in recent years.
Young@heart: children's diets
The status of children's diets in the UK is
a cause for serious concern. Data from the National Diet and Nutrition
Survey14 showed that 92% of children have intakes of saturated
fat which exceed the recommended level, and 83% have intake of
NME sugars which are high than the recommended level. Many young
people depend for a significant proportion of their total intake
of energy on three foodscrisps, cake and biscuitsat
the expense of more nutritious options.
The measurement of physical activity levels
is complicated. Both the frequency and the intensity are important
in terms of health benefits, and they are likely to be variable
over time. Capturing the required information in a simple questionnaire
for large-scale surveys is not straightforward and many different
physical activity rating scales have been developed, making comparisons
Physical activity questions have been included
regularly in the Health Survey for England since it began in 1991.
At that time the recommended level of physical activity for adults
was 20 minutes of vigorous activity, three times a week. The frequency-intensity
classifications were designed to estimate the extent to which
the population was achieving this goal. The emphasis then shifted
to the public health benefits of moderate exercise and it was
recommended that adults should do 30 minutes of moderate exercise
at least five days a week. The Health Survey questions were revised
for the 1997 and 1998 surveys to address the issue of accumulations
(to a total of 30 minutes) and to allow better estimation of the
amount of time spent participating in different activities.
Current activity levels and trends
It is generally thought that over the last 20
years, physical activity levels have declined in the UK. Since
1994 the proportion meeting the current recommended level of physical
activity has remained stable at 37% in men and increased slightly,
from 22% to 25% in women; but the proportion classified as sedentary
(less than one occasion of physical of thirty minutes a week)
has increased from 30% in 1994 to 35% in 1998 in men, and from
35% to 41% in women7. Levels of activity in the UK are below the
Compared with the general population, South
Asian and Chinese men and women are the least likely to participate
in physical activity. Black Caribbean men and women are most likely
to be active at the recommended level7.
Young@heart: children and physical activity
Again, levels of physical activity in children
are difficult to measure; no regular, nationally representative
cross-sectional surveys are conducted that measure physical activity
levels among children and young people. Surveys that have been
conducted suggest that children are active, and young people are
fairly active. Recent research indicates that there is no evidence
that computer games and TV have replaced more active leisure pursuits14.
However we do know that walking and cycling
to school have decreased16. In 1985-86 59% of children aged five
to 16 years walked to school compared with 48% in 1997-99. The
number of children transported to school by car increased from
16% to 30% over this period. Children in primary school very rarely
cycle to school. The number of secondary school children cycling
to school has fallen from 6% to 2% between 1985-86 and 1997-9916.
The reasons for the decline are most likely to be parental concerns
about safety, perceived time constraints so parents don't walk
or cycle with their children, possible increases in distances
travelled to schools and children carrying more equipment to and
We also know that time for physical education
in the curriculum has been eroded in recent years. However, there
is a new commitment from the Prime Minister that every child will
have two hours of high quality physical education per week and
there are several government initiatives in train to meet this
11. LEVERS AND
11a. Action by the food industry
Improving quality of ready meals and processed foods
Food manufacturers could work towards healthier
ingredients in prepared foods, increasing the amount of fruit
or vegetables and significantly reducing the quantities of sugar,
salt and fat.
Retailers could review their pricing policies
that currently place the highest profit marginsand therefore
higher priceson fruit and vegetables.
The food industry and retailers could take a
responsible position on labelling so that:
Fat, sugar and salt content is easily
The contribution of the food items toward
daily recommended intakes of salt, fat, sugar and calories, is
made explicitthis is especially important with growing
The appropriate frequency of consumption
for fast food and snack food items is indicated (McDonald's in
France has made moves to promote a "once a week" message).
The food industry should take a more responsible
approach to portion size and pricing policies so that unhealthily
large meals, high in fat, salt and sugar are not "cheaper".
Access to supermarkets
Large retailers could provide free transport
to take customers to and from greenfield site supermarkets to
improve access to healthier foods.
11b. Schools/local education authorities/DfES
Schools have an important role to play in helping
children maintain a healthy weight both in terms of diet and physical
activity. Providing children with healthy meals, educating them
about nutrition and cooking, and protecting them from marketing
activities of food manufacturers in the school environment should
be taken seriously nationally and locally.
The National Healthy Schools Standard offers
an excellent framework for schools and communities to co-ordinate
activities and practices.
National and local initiatives to raise parents'
awareness of entitlement to free school meals are needed.
DfES/FSA review of nutritional standards (England)
should be developmental and there should be a government commitment
to strengthen the standards if necessary, depending on the outcome
of the review.
Schools/LEAs must recognise that vending machines
encourage unhealthy eating and drinking and conflict with a whole
school approach to healthy eating. They should be removed from
schools or replaced with healthy vending options (serving fruit
juice or milk).
Chilled, fresh water should be freely available
to all schoolchildren throughout the day.
Schools/caterers should introduce pricing policies
for school lunches that offer discounts on healthier food choices.
Where there is an identified need, breakfast
clubs should be encouraged, offering healthy, sustaining meals
at the start of the day.
Lessons in life skills and parentingwhich
should emphasise nutrition and breastfeeding, cooking and practical
food skillsshould be introduced as statutory elements of
the Personal, Social and Health Education (PSHE) and Citizenship
curricula at all key stages.
Children should be taught to become critical
consumers with a good understanding of food advertising, promotion
There should be an independent accreditation
system for providers of educational materials from all sources
(but particularly those featuring food or branded food products),
to help teachers assess the quality, reliability and impartiality
of their content.
Health promoting school policies
DfES should look at developing a meaningful
policy for schools on ethical sponsorship arrangements between
schools and industry; one which recognises that arrangements with
fast food, snack, confectionery and soft drink manufacturers conflicts
with healthy eating policies.
NBthe HSC should be aware of the fact
that schools applying to be specialist schools in Physical Education
or any other subject are required to raise £50,000 in sponsorship.
Clearly, this stipulation threatens the ethos of the health promoting
11c. Local government/SEU/ODPM/DEFRA
Food access, availability and affordability
Local access to shops should be improved through
measures like: mobile shopping facilities; free or subsidised
transport schemes for consumers to and from shops; and telephone
and internet ordering and home delivery.
Local retail strategies and local retail forums
should be supported by local authorities by encouraging and supporting
further community-based initiatives. These could include food
co-operatives, local farmers markets, fruit and vegetable box
schemes and food coupon schemes which offer discounts on fruit
Policies to promote healthy lifestyles should
include discounting schemes for purchase of fruit and vegetables,
and encourage healthy forms of transport to access shops like
cycling and walking.
11d. Department for Culture, Media and Sport
Food advertising to children
There is a huge volume of advertising for foods
high in salt, fat and sugar during children's television programming.
There is widespread support from public health, education and
consumer groups for restrictions on this type of advertising,
particularly to very young (pre-school) children.
DCMS should review the current (voluntary) regulatory
framework and pursue either voluntary or (more probably) statutory
measures to restrict food advertising.
11e. Department of Health/cross government
Food and health action plan
The Department of Health should be given resources
to develop the food and health action plan which forms part of
DEFRA's food and farming strategy. In the development of the plan
the DH should involve a stronger representation of public health
and civil society organisations in the process.
Children and food marketing
There is a need for an ethical marketing framework
to address food marketing to children which would cover a range
of issues such as TV advertising (see above) and sponsorship in
schools. It could be linked to relevant strategies such as the
national service framework for children, the children and young
people's strategy, the food and health action plan, the food in
schools programme (DH/DfES), the diabetes and CHD national service
frameworks and the health inequalities agenda.
11f. Food Standards Agency
The Food Standards Agency should have a more
explicit role to provide advice on obesity prevention, rather
than just the generic healthy eating remit it currently has. This
new role could include: public understanding of nutrition, better
food labelling and warnings, and dietary monitoring.
12. LEVERS AND
12a. Cross-government action
The Government should make public its intention
to implement the recommendations set out in the Strategy Unit's
report Game Plan4 as a national physical activity strategy for
Game Plan includes a target that 70% of the
population should be active by 2020. This is from a starting point
of 30% and it is estimated that to reach the target would require
100,000 people per month to become physically active. This is
a challenging but not unrealistic target that requires cross-government
commitment, resources and innovation. The NHF is looking at a
programme of work to generate some of the ideas needed to meet
this target and will be happy to share these with the HSC in due
National campaigns, such as the DfT campaigns
encouraging alternatives to the car, are effective for awareness
raising, reinforcing lifestyle changes, and supporting community
and individual interventions.
Mass media campaigns that promote active lifestyles
should be implemented.
12b. Department of Health
There should be an annual survey to measure
physical activity levels among children, young people and adults.
The Health Survey for England could provide this vehicle but at
present the emphasis of the survey changes year on year which
prevents any thorough analysis of temporal trends.
12c. Department for Transport
DfT should issue their long-promised walking
strategy for consultation as soon as possible and be held to account
for its delivery.
DfT should be urged to demonstrate clear leadership
on the issue of car use. The health of the population has for
too long come second place to the health of the car industry,
with little concern given to the implementation of transport policies
and initiatives to reduce congestion and pollution, reduce traffic
speeds and increase safety, all of which would encourage cycling
DfT should be obliged to make use of both health
impact assessments and environmental impact assessments when considering
the transport implications of planning applications. Methodology
for conducting a health impact assessment of a transport policy
has been developed by the Transport and Health Study Group of
the Faculty of Public Health Medicine and was applied by the Dept
for Regional Development in Northern Ireland to their draft regional
transportation strategy. Further details are available from the
DRD website: http://www.drdni.gov.uk/rts/pdffiles/finalpdfs/Healthimpact.pdf
Home Zones should be rolled out nationally,
following completion of the government-backed pilots, of which
there are currently 14. http://www.homezonenews.org.uk/html/whatahz.htm
12d. Office of the Deputy Prime Minister
Observational studies show an increase in habitual
physical activity associated with positive environmental changes
in the community eg cycle paths, well-lit streets, easier access
to recreational facilities.
Town planning guidance should explicitly include
consideration of measures to encourage physical activity, including
facilities for walking and cycling
12e. Local authorities
Alternatives to the car
Cost and availability of car parking is an important
influence on the decision to commute by car, therefore increasing
costs, reducing availability and providing incentives all encourage
a shift to alternative forms of transport.
Fiscal and tax incentives should be introduced
to encourage a switch from cars to bicycles, walking and public
transport. These should target the individual and employers.
Workplace physical activity programmes can enhance
fitness, reduce absenteeism, increase productivity, and reduce
employers' health care costs.
Local authorities should encourage employers
to offer workplace facilities or financial incentives such as
corporate memberships to their employees.
Provision of local leisure services
Accessibility, convenience and safety of facilities
in the community influence physical activity levels. Provision
of accessible facilities plus low prices may also reduce social
class difference in participation.
Local authorities should be encouraged through
national target setting to map their local facilities and ensure
that these are serving their whole community.
Local pricing policies should be introduced
for local facilities, including subsidised access.
PE in the curriculum
Activity levels during childhood influence adult
activity habits. Physical education in the school curriculum has
been eroded over recent years, but there has been renewed commitment
from the Government that every child will have two hours of PE
per week (although this does not have to be in the curriculum
A minimum time for physical activity should
be set in the school curriculum. There are calls for this to be
as much as one hour per day
The HSC may be interested in the preliminary
findings of the Qualifications and Curriculum Authority research
into structured school play time. They have found that structured/active
play at break times benefits behaviour in the classroom and academic
achievement, thus providing a win-win situationmore active
children and improved school attainment (see pages 10 and 11 of
The NHF believes that structured play is of
fundamental value to children and should be mainstreamed in schools.
The National Healthy School Standard and OFSTED are existing mechanisms
through which structured play could be delivered and monitored.
Extra-curricular activities and suitable community
facilities are important for physical activity participation.
Use of existing community settings such as schools is effective.
Schools sport facilities including fields and
pools, should be made available for wider community use, outside
Safe routes to school
The HSC should encourage the Safe Routes to
School work to continue, and recommend that local policies consider:
banning cars within a certain distance
of schools (this in itself would improve safety).
increasing cycle storage capacity in
schools (and quality of it) to encourage more children to cycle.
13. ACTION TO
13a. Department of Health
Increase local accountability
Joint public health targets should be set between
PCTs and local government to facilitate joint working and the
pooling of budgets in the delivery of interventions to promote
the population's health.
Physical activity targets and indicators should
be included in the development of the next national priorities
and targets document. Experience indicates that local delivery
is driven by targets and star ratings and therefore more prevention
measures need to be included in this assessment process if obesity
is to be tackled effectively at the local level.
The HSC should critically examine the proposed
GP contract as it is not certain that there will be any onus on
GPs to prevent and tackle obesity through lifestyle interventions.
NHS lifestyle clinics
Weight reduction and lifestyle changes require
a systematic approach involving trained healthcare professionals
and adequate time. The same rigour that is applied to smoking
cessation should be applied to dealing with obesity.
The Department of Health should reconsider their
decision not to include standards on obesity/lifestyle clinics
in the National Service Frameworks for CHD or diabetes. This could
have offered people who were overweight or with suspected insulin
resistance, high blood pressure, or high cholesterol a 30-minute
consultation with a trained healthcare professional to give advice
on losing weight and lifestyle changes to prevent onset of obesity,
type 2 diabetes and CHD. Lifestyle advice has been made a requirement
by NICE prior to the prescribing of drugs to treat high cholesterol
or obesity, yet there is no current capacity in the NHS to provide
advice of the quality and quantity required in order to be effective.
13b. HM Treasury
We believe that the new Treasury review announced
in the April budget statementto be led by Derek Wanlessshould
systematically examine the case for investment in the prevention
of non-communicable diseases through health promotion and population-wide
initiatives. Modelling should be used to demonstrate that such
investment will reduce the incidence of non-communicable and largely
preventable diseases such as obesity and CHD in the future, and
thus present long-term savings to the NHS spending to treat largely
There should be greater investment in research.
Areas that should be investigated include:
effective ways to improve diets and increase
links between childhood experience (exposure
to tobacco in the womb, breastfeeding, birth weight) and risk
of obesity, by analysing existing cohort data. This is to look
at whether people can be "programmed" at a very early
age to be susceptible to weight-gain.
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