Memorandum by Amanda Avery (OB 111)
OF SPECIFIC
INTEREST TO
THE HEALTH
SELECT COMMITTEE
Seconded to work in Public Health in 1999 for
a 12-month period, specifically to produce a local obesity strategy
based not just on evidence of good practice at global level but
also to "map" examples of good local practice. After
publication the remit then to assist with feeding the strategy
into the Local Modernisation Agenda.
The document included two "pyramids",
summarising strategies to address both the prevention and the
management of obesity at a local level (attached).
One of the opportunities suggested with respect
to weight management was the consideration of working with the
commercial slimming sector, to endeavour to replicate smoking
cessation services but without the same level of funding. Following
wide consultation a successful feasibility study was set up and
is now available in report form.
The local obesity strategy is currently being
up-dated but the basic framework remains the same with myself
having contributed to large sections of the new document and an
active member of the small working group endeavouring to "launch"
the strategy and to feed it into the NSF for Diabetes.
Currently also very active in the five-a-day
programme at local level, sitting on the local steering group
to support the local co-ordinator. Have also assisted in emphasising
the preventative aspects of the NSF for CHD at Local Implementation
team level. Often feel quite unique in that apart from working
at strategic level, I also retain a clinical workload (three sessions/week).
Other great passion is infant feeding and for
the past 10 years have chaired the Under Fives Nutrition group
across Southern Derbyshire overseeing the publication of three
editions of a local Infant Feeding Policy and implementing an
accompanying training programme. A subsequent development was
a very successful "Change to Cup" campaign and together
with a fellow community dietitian developed resources which are
now available nationally. Feel very strongly that we need to "get
it right from the start" with our nutrition messages.
Have also been an active member of the British
Dietetic Association's Food First Planning group (1999-2003),
contributing to both the Give me five and Weight wise programmes,
including writing the research background for the first Weight
wise materials.
Currently a member of the Association for the
Study of Obesity and the Community Nutrition Group of the British
Dietetic Association.
BRIEF RESPONSES
TO THE
COMMITTEE'S
TERMS OF
REFERENCES
Health implications of obesity—feel that
currently both the economic and social costs are grossly underestimated.
Drug budgets could be considerably reduced if
obesity was better addressed. Unfortunately it is quite difficult
to transfer monies from a PCT's Prescribing budget to help fund
other initiatives to address obesity. All the emphasis is currently
on guidance as to how to use drugs but not on guidance as to how
to prevent their use in the first instance.
The cost of mental health problems associated
with a person feeling uncomfortable about their body shape is
rarely recognised.
Trends in obesity—certainly as a health
practitioner we are seeing people referred to us in their 30s/40s
for type 2 diabetes and hypertension, both related to the person
referred having a high BMI. This is considerably younger than
when I first practised and I do not feel it is all due to better
screening.
Locally data mirrors national data with females
from the lower social groups having a higher incidence of obesity.
Causes and what can be done; definitely both
due to changes in our diet and to people becoming less active.
With respect to diet, particularly due to young
people grazing on foods with a high energy density and veering
away from a more "traditional" diet. Hence if action
is not taken swiftly the situation is only going to get worse.
Over recent years there has also been an increase
in the energy derived from soft drinks. Ideally the siting of
vending machines selling soft drinks in our senior schools should
be banned. Instead there should be better availability of cool
water for pupils. It is immoral that senior schools are dependent
on such vending machines to boost their revenue. Whilst we have
national nutrition guidelines for primary school meals in this
country there are currently no guidelines for the foods served
in senior schools. Good nutrition should be seen as going hand
in hand with the overall educational remit of our schools. Whilst
the National Fruit in schools scheme is to be applauded it only
applies to four-six year olds. Ideally it would be admirable if
this could be extended to the older age-groups.
The "Healthystart" initiative is to
be welcomed but only if it is adequately "policed" and
resources are available to provide the accompanying support suggested.
The advertising of foods with a high fat and
sugar content during peak children's television viewing should
be banned.
The access and availability of healthy foods
to all population groups is still an important issue and there
remains this false concept that to eat healthier foods it is going
to be more expensive.
Despite the government's guidance that there
should be a minimum of two hours activity time within the school
week it would seem to be the first thing that drops off the school
timetable if there are other more "pressing" requirements
on the school's time in meeting the wider curriculum needs. How
is the minimum requirement of two hours monitored and are headteachers
fully aware of the many health benefits of exercise.
School playing fields still continue to be sold
off for housing developments and large houses continue to be built
with very small gardens. "No ball game" signs are a
feature of these new housing developments.
Parents could be given more of a responsibility
for assisting with the provision of the required exercise time
within the primary school curriculum—but as with any volunteer
scheme they should be given some kind of recognition.
RECOMMENDATIONS
Currently resources are too limited and obesity
for the last five years, although on the NHS and PCT agenda, has
not made it quite high enough up the priority list for action
to be taken. Prevention has always been the poor relation to issues
such as waiting times and expensive secondary interventions. Prevention
is relatively cheap but has the power to save money in the long-term.
There needs to be a radical overhaul as to best to use resources
effectively with greater emphasis on prevention using sustainable
approaches.
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