7.8 Obesity and healthy weight
One of the priorities in the Joint Health and Wellbeing Strategy and for the Health
and Wellbeing Board is to build a borough where everyone is able to achieve and
maintain a healthy weight.
Tackling obesity requires a whole system approach across a wide range of issues
and partnerships; from planning roads, to promoting cycling, building houses which
have the space to cook and eat as a family; to working with local businesses to
provide healthy menu options, and workplace initiatives that support staff to improve
their health and increase activity levels. It also involves commissioning services to
support children, families, and adults who are overweight to reach their goal of
gaining a healthy weight and a healthy future. This strategy is about creating a
borough that supports local people to make healthy choices now, as well as creating
an environment which makes those choices easier and more accessible in the
future.
Carrying excess weight can have serious and long term impacts on health and
wellbeing. Like smoking or substance misuse, the routes into and out of obesity are
not straight forward for many people, and there is no simple solution. Excess weight
may increase the risk of coronary heart disease, hypertension, liver disease,
osteoarthritis, stroke, type 2 diabetes, and some cancers such as breast, colon,
endometrial and kidney cancer. People who are overweight or obese may also
experience mental health problems, stigmatisation and discrimination because of
their weight.
Obesity is a complex challenge at both a population and individual level, which
necessitates working across the entire social, environmental and cultural
environment to help individuals who have excess weight regain a healthy weight and
prevent individuals of a healthy weight gaining weight in the future. Preventing
people gaining excess weight is a societal challenge, similar to climate change. It
requires partnership between government, science, business and civil society.
The Government policy paper ‘Healthy Lives, Healthy People: A Call to Action on
Obesity in England’ (2011)1 sets out the national approach for tackling obesity,
building on the whole system approach described in the Foresight Report (2007)2.
The document reiterated the leadership role of local government in supporting
individuals to achieve and maintain a healthy weight through bringing together a
coalition of partners to tackle obesity locally, and this reflects the partnership
approach already in place in the borough.
1
HM Government (2011) Healthy Lives, Healthy People: A Call to Action on Obesity in England, London,
Department of Health https://www.gov.uk/government/publications/healthy-lives-healthy-people-a-call-to-actionon-obesity-in-england
2
Tackling Obesity: Future Choices - Foresight Report 2007
http://www.erpho.org.uk/viewResource.aspx?id=16891
The borough has historically faced significant challenges to tackling obesity in both
children and adults; these challenges continue. NICE guidance was published in
March 20153 ‘Maintaining a healthy weight and preventing excess weight gain
among adults and children this guideline makes recommendations on behaviours
that may help people maintain a healthy weight or prevent excess weight gain.
The recommendations aim to:

encourage people to make changes in line with existing advice

encourage people to develop physical activity and dietary habits that will help
them maintain a healthy weight and prevent excess weight gain

encourage people to monitor their own weight and associated behaviours

promote the clear communication of benefits of maintaining a healthy weight
and making gradual changes to physical activity and diet

ensure messages are tailored to specific groups

ensure activities are integrated with the local strategic approach to obesity.
7.8.1 Childhood obesity
The National Child Measurement Programme (NCMP) measures children’s height
and weight in Reception and Year 6 classes in Primary School. The height and
weight measurements are then used to calculate the child’s body mass index (BMI)
and compared to growth charts to consider whether they are underweight, healthy
weight, overweight or obese compared to the average values for their gender and
age.
The 2013/14 NCMP measurements found show that there has been a slight increase
in levels of obesity and overweight children in Reception class (Fig 7.14). In Year 6
there was an increase in obesity prevalence, but the proportions that were
overweight fell (Fig 7.15). Barking and Dagenham had the ninth highest proportion of
overweight and obese children in Reception class (26.8%) and the third highest
proportion in Year 6 (42.2%) in England.
Provisional NCMP measurements for 2014/15 indicate that the prevalence of
children in reception year that are obese or overweight increased by 1%, from 26.6%
in 2013/14 to 27.6% in 2014/15. Conversely, the prevalence of overweight or obese
children in year 6 fell by 1.9%, from 42.4% in 2013/14 to 40.5% in 2014/15. National
and regional data for 2014/15 is not yet available, but in comparison with the
2013/14 national and regional rates, both of these results are significantly higher.
However, the results for children in year 6 may signal the reversal of the upward
trend in the prevalence of overweight and obese children seen previously (Fig 7.8.2).
These results are provisional and should therefore be interpreted with caution. So
for the purposes of this JSNA data up to 2013/14 has been used.
3
Maintaining a healthy weight and preventing excess weight gain among adults and children NG7
Figure 7.8.1: National Child Measurement Programme for Barking and Dagenham: Percentage
of children obese and overweight – Reception Year
Prevalence of Overweight and Obese Children in Barking and
Dagenham in Reception Year, 2008/09 to 2013/14
35%
% Overweight or Obese
30%
25%
20%
15%
10%
5%
0%
2008/09
2009/10
2010/11
2011/12
NCMP Year
2012/13
2013/14
Source: National Child Measurement Programme available via
http://www.hscic.gov.uk/catalogue/PUB09283
Figure 7.8.2: National Child Measurement Programme for Barking and Dagenham: % of
children obese and overweight – Year 6
Prevalence of Overweight and Obese Children in Barking &
Dagenham in Year 6, 2008/09 to 2013/14
50%
% Overweight or Obese
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
2008/09
2009/10
2010/11
2011/12
NCMP Year
Source: National Child Measurement Programme available via
http://www.hscic.gov.uk/catalogue/PUB09283
2012/13
2013/14
LBBD shows a similar trend to that of England and London with regard to the
prevalence of overweight in reception year (Fig 7.8.3a). There has been a slight
increase in overweight over the three years but not at significant levels. Prevalence
is similar across all statistical neighbours amongst reception year. Greenwich seems
to have been able to reduce prevalence amongst its year 6 pupils.
Amongst children in year 6 there has been a significant increase in the prevalence of
children that are overweight over the three years indicated. There has been an
upward trend in prevalence levels in London but this is not significant (Fig 7.8.3b).
LBBD obesity levels have remained at similar levels amongst reception year (Fig
7.8.3c) and at year 6 (Fig 7.8.3d).
The prevalence of excess weight has remained at similar levels for both reception
year (Fig 7.8.3 e) and year 6 (Fig 7.8.3f).
Figure 7.8.3 (a-f) prevalence (%) of overweight, obese and excess weight, reception year and
year-6, England, London, LBBD and its London Statistical Neighbouring Boroughs, 2011/122013/14
Overweight reception year
16.0%
14.0%
2011/12
2012/13
Overweight year-6
17.0%
2013/14
16.5%
12.0%
16.0%
10.0%
15.5%
8.0%
15.0%
6.0%
14.5%
4.0%
14.0%
2.0%
13.5%
0.0%
13.0%
2011/12
2011/12
2012/13
2013/14
30.0%
25.0%
30.0%
25.0%
5.0%
0.0%
2011/12
2012/13
2013/14
Excess weight-Year-6
50.0%
40.0%
30.0%
20.0%
0.0%
2013/14
10.0%
15.0%
5.0%
2012/13
15.0%
20.0%
10.0%
2011/12
20.0%
Excess weight-Reception year
35.0%
2013/14
Obese year-6
Obese reception year
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
2012/13
10.0%
0.0%
2011/12
2012/13
2013/14
Using data from the NCMP, it is possible to calculate three year rolling averages at
ward level which allow us to gain a better understanding of the patterns of obesity
across the borough. These highlighted that although there is variation across the
borough, every ward faces challenges in tackling childhood obesity, as every ward is
above the national average in both Reception and Year 6.
Table 7.8.1: Obesity – Three year rolling averages Barking and Dagenham wards 2011/12-13/14
Ward
2011/12-13/14
% Obese in Reception
2011/12-13/14
% Obese in Year Six
Abbey
13.3%
24.7%
Alibon
10.0%
26.0%
Becontree
12.3%
29.3%
Chadwell Heath
12.8%
24.6%
Eastbrook
12.6%
21.6%
Eastbury
11.5%
26.5%
Gascoigne
16.2%
29.0%
Goresbrook
16.2%
25.2%
Heath
15.0%
26.0%
Longbridge
11.4%
24.9%
Mayesbrook
12.6%
24.3%
Parsloes
14.8%
26.5%
River
17.2%
30.2%
Thames
15.6%
27.0%
Valence
12.2%
24.6%
Village
12.9%
27.9%
Whalebone
12.8%
22.8%
Source: Health and Social Care Information Centre – National Child Measurement Programme
The wards with the highest levels of reception aged children who are obese or
overweight are Gascoigne, Thames, Mayesbrook and River (see Figure 7.8.4).
Figure 7.8.4 Ward level rates of excess weight 2011/12-2013/14, and schools location across
Barking and Dagenham. Reception Year
The wards with the highest levels of year six children who are obese or overweight
are Becontree and River. River has the highest percentage in both reception and
year six (Figure 7.8.5).
Figure 7.8.5 Ward level rates of excess weight (obese/overweight) 2011/12-2013/14, and
schools location across Barking and Dagenham, and schools location across Barking and
Dagenham. Year 6 children
7.8.2 Adult obesity
There is no national measurement programme for weight trends at a population level
in adults, so the information on patterns of obesity in adults is drawn from a range of
different sources.
General practices report the overall prevalence of adults over the age of 16 years
who have a BMI of over 30 (obese) through the QOF framework.
Figure 7.8.6: Prevalence of obesity recorded on GP practice database (% of adults over 16yrs)
25%
2012/13
Percentage
20%
2013/14
England
15%
10%
0%
F82001
F82678
F82003
F82634
F82677
F82038
F82642
F82680
Y01280
F82665
F82621
Y02575
F82012
F82015
F82668
F82629
F82005
F82042
F82676
F82017
F82625
F82004
F82023
F82660
F82604
F82018
Y01795
Y01719
F82647
F82679
F82025
Y02583
F82051
F82040
F82650
F82661
F82612
F82034
F82027
F86040
5%
Practice Code
Source: The network of Public Health Observatories
4
The 2008/09 adult modelling suggested that 21.9% of adults in the borough are
obese, which was substantially higher than the prevalence recorded through QOF of
13.6% (Ref: NHS Comparators).
Although the overall PHOF prevalence trend has been downwards since 2009/10,
(Fig 7.8.6) it remains higher than the average in other outer north-east London
boroughs and compared to London.
Barking and Dagenham has a significantly higher prevalence of overweight and
obese adults when compared with London and is similar to that of England (Figure
7.8.7)
4
The network of Public Health Observatories and NHS Comparators, ‘Prevalence of obesity recorded
on GP practice database’ [online] available from: http://www.apho.org.uk/PracProf/Profile.aspx
Figure 7.8.7: Prevalence of overweight and obese adults in Barking and Dagenham and
neighbouring boroughs, Mid January 2012 to Mid January 2013
Percentage overweight or obese, %
75
70
65
60
55
50
45
Lewisham
Barking and
Dagenham
Greenwich
London
England
Source: Public Health Outcome Framework 2.12
Analysis of the prevalence of healthy weight in different groups of patients registered
with cardiovascular disease, diabetes and hypertension on GP databases found
some variation between disease groups. Obesity was highest amongst people with
high blood pressure (hypertension) and lowest amongst diabetics (Fig 7.8.8).
Figure 7.8.8: Body Mass Index Distribution in patients registered with diabetes, hypertension
or coronary heart disease (CHD) on GP database (April 2015)
CHD
Hypertension
24%
38%
38%
Diabetes
18%
19%
35%
35%
46%
Source: Health Analytics, https://ha.barkingdagenham.nhs.uk
47%
Figure 7.8.9: Total number of referrals to Active Life and numbers referred and starting Weight
Watchers between Dec 2011 and Dec 2012.
Source: LBBD leisure and Weight Watcher Monthly Activity Data
Both Weight Watchers and Healthy Adults are achieving commissioned activity and
outcome targets focused on creating sustained reduction greater than 5% in
individual BMI. Although further work is needed to encourage participation from men
and ethnic minorities, benchmarking suggests these are similar challenges to other
programmes nationally.
Preventing obesity and promoting a healthy weight
Obesity is a complex challenge at a population, and at an individual level, which
requires a whole system approach working across the entire social, environmental
and cultural environment to help individuals who have excess weight regain a
healthy weight and prevent individuals gaining weight in future. Preventing people
gaining excess weight is a societal challenge, similar to climate change. It requires
partnership between government, science, business and civil society.
The government document ‘Healthy Lives, Healthy People: A Call to Action on
Obesity in England’ (2011) sets out the national approach for tackling obesity,
building on the whole system approach described in the Foresight report (2007) (Fig
7.8.10). In considering the issues related to obesity and promoting a healthy weight
we have to look at the evidence of need for physical activity and healthy eating, but
also keeping in mind early nutrition including breastfeeding.
Fig 7.8.10: Foresight Systems Map 2007
7.8.3 Physical activity
Children and young people’s physical activity
There are currently no national measures on children’s physical activity outside of
school settings. The last published data on participation in the national
recommended minimum of physical education in schools in 2009/10 showed a
significant improvement in Barking and Dagenham and closed the gap between the
borough and the London and England average (Table 7.9.2). The borough also
improved against the performance of statistical neighbouring boroughs.
Table 7.9.2: Percentage of school children who participate in at least 3 hours of high quality PE
and school sport within and beyond the curriculum, outer north east London boroughs,
London and England, 2009/10
Area Name
2008/09
2009/10
England
49.6%
55.1%
London
49.3%
55.2%
Barking and Dagenham
45.3%
54.3%
Greenwich
51.4%
57.5%
Haringey
41.3%
59.2%
Hackney
40%
42.9%
Source: Annual Survey of School Sport Partnerships, via APHO health
profiles. http://www.apho.org.uk/resource/view.aspx?RID=105001
Recommendations for Commissioners
Commissioners need to work in partnership to ensure the promotion of public health
interventions such as breastfeeding, healthy child nutrition, and physical activity are
embedded in relevant contracts to address the challenges of healthy weight in
children and adults. It becomes increasingly apparent that a family based approach
to healthy weight and obesity is crucial.
NHS Barking and Dagenham Clinical Commissioning Group and LBBD
commissioners will need to input into the newly formed Obesity Alliance, to develop
the obesity and healthy weight strategy, review pathways and support for weight
management interventions to address the growing demand for healthy lifestyle
services.
LBBD commissioners will need to work with the newly formed leisure trust, sports
clubs and education to improve the uptake of sport and physical activity, building on
the legacy of the 2012 Olympics games.
LBBD needs to develop clear communications for the borough on the benefits of
maintaining a healthy weight. These should include 'non health' benefits as well as
improvements to health. For example:

The enjoyment gained from shared, social physical activities.

The reduced risk of developing diseases associated with excess weight such as
coronary heart disease, hypertension, liver disease, osteoarthritis, stroke, type 2
diabetes and some cancers.

Improved mental wellbeing.

Reduced breathless, improved fitness and other benefits from increased physical
activity that are independent of weight.

Lower blood cholesterol, improved oral health and other benefits from improved
dietary habits that are independent of weight.