Healthy weight in children (health and wellbeing needs in South Tyneside)

The World Health Organisation regards childhood obesity as one of the most serious global public health challenges for the 21st century. Obesity has a substantial impact on the health of children, both now and in the future.

There is no single effective solution for obesity. Tackling obesity requires a whole systems approach across the entire social, environmental and cultural environment and requires partnership between governments, science, business and communities.  

Work to promote a healthy weight in children in South Tyneside forms part of the Better Health and Wellbeing Strategy to ensure that every child has a good start in life, that prevention is promoted across the whole life course, and that health inequalities are reduced.

• In South Tyneside, National Child Measurement Programme (NCMP) data identified that in 2015 / 16, 25.6% (n=408) of Reception children measured as overweight or obese. 11.3% (n=180) of these Reception Children were obese, very slightly lower than in previous years. However, based on the average class size of 30 children, this still equates to approximately 5 and a half classes of obese children at the start of their school careers.
• NCMP data also identified that 38.1% (n=560) of Year 6 children measured as overweight or obese. 22% (n=323) were obese- a figure that is higher than previous years. This equates to just over 12 full classes of obese Year 6 children in the borough, the year before they go up into secondary school.
• NCMP data for all of England shows that in all areas there is a steady rise in obesity prevalence with increasing deprivation for both Reception and Year 6.
• Obesity does not affect communities equally - it is more common amongst people from deprived areas, older age groups, some black, minority ethnic  groups and people with disabilities.
• In terms of health overweight / obese children are more at risk of high cholesterol, high blood pressure, bone and joint problems, pre-diabetes and breathing difficulties.
• There is some evidence that mothers who breastfed provide their child with protection against, amongst other things, diabetes and excess weight in later life.
• There is also a growing body of evidence suggesting that overweight / obese children do not do as well academically-something OFSTED are currently interested in.
• Long term, obese children are more likely to become overweight / obese adults-which has its own risks
• Obese people are 9 times more likely to suffer from type II diabetes
• Obesity reduces life expectancy by an average of 3 years and severe obesity (BMI>40) reduces it by 8-10 years

• Monitor, implement and deliver the NCMP in conjunction with School Nurses. Share the NCMP data with stakeholders to maximise effectiveness 
• To provide a number of consistent obesity related messages targeted towards families  to promote healthy lifestyle behaviours   through a range of communication mediums
• To provide or promote education, awareness and training on childhood obesity to support schools and the community to increase knowledge and understanding
• Ensure the Local Authority sets the example by making healthy choices as easy as possible.

Childhood overweight and obesity affects some groups of our population more than others.

Deprivation

• There is a strong link between the prevalence of reception age overweight (including obesity) and deprivation. Those in the most deprived decile have a prevalence of 25.5 compared to those in the least deprived with a prevalence of 17.1.
• Fingertips: Obesity profile: National Child Measurement Programme
• The same inequalities exist between the prevalence of year 6 age overweight (including obesity) and deprivation.
• Fingertips: Obesity profile: National Child Measurement Programme

Sex

• In South Tyneside there is a variation in the prevalence of overweight (including obesity) reception age children when broken down by sex with males, with a prevalence of 22.6, more likely to be overweight than females who have a prevalence of 21.2.
• Fingertips: Obesity profile: National Child Measurement Programme
• This gender difference is still present when looking at year 6 age children with males having a prevalence of 34.9 and females 31.5.
• Fingertips: Obesity profile: National Child Measurement Programme

Ethnicity

• There is a substantial difference in the prevalence of childhood overweight and obesity amongst different ethnic groups in South Tyneside.  Black African children are the most likely to be classed as overweight with a prevalence of 44.8 compared to the least prevalent ethnicity, white and Asian, which has a prevalence of 29.4
• Fingertips: Obesity profile: National Child Measurement Programme

The National Child Measurement Programme (NCMP) provides the prevalence of 'underweight', 'healthy weight', 'overweight', 'obese' and 'overweight and obese combined' children, in Reception (aged 4 - 5 years) and Year 6 (aged 10 - 11 years).The following data is taken from the 15 / 16 dataset.

Definitions

• Excess weight is defined as a BMI centile greater than or equal to the 85th centile
• Obese is defined as a BMI centile greater than or equal to the 95th centile

Reception

• 25.6% of the reception aged children that were weighed were recorded as having excess weight. 
• This was slightly higher than the 2014 / 15 rate of 25.2%, higher than the regional rate of 24.6%, and significantly higher the England's rate of 22.1%.
• There was a slight increase in the obesity rate in reception aged children, rising 0.2 percentage points to 11.3%.
• South Tyneside had the third highest reception aged obesity prevalence in the region, with only Sunderland and Middlesbrough having a higher rate. The obesity prevalence was higher than the regional rate of 10.7%, and significantly higher than the national rate of 9.3%.

Year 6

• 38.1% of Year 6 children that were weighed were recorded as having excess weight. 
• This was lower than the 2014 / 15 rate of 39.3%, higher than the regional rate of 37.0%, and significantly higher the England's rate of 34.2%.
• There was a decrease in the obesity rate in year 6 children, dropping 1 percentage points to 22.0%.
• South Tyneside's had the second lowest Year 6 obesity prevalence in Tyne and Wear.
• The obesity prevalence was lower than the regional rate of 22.4%, however it was still higher than the national rate of 19.8%.

Current Trajectory

• The CAF and HWB strategy includes an excess weight target:
• Reduce childhood excess weight in  South Tyneside from 25.2% to 22% in 4 - 5 year olds.
• Reduce childhood excess weight in  South Tyneside from 39.3% to 35.1% in 10 - 11 year olds by 2020

• Currently in South Tyneside we have no dedicated services to support children and their families who are overweight or obese. A recent Star workshop highlighted the fact that this was an issue with professionals who work with children. The stakeholders at the event felt that there needed to be a dedicated service to support overweight children and their families in South Tyneside
• The evidence base of childhood obesity interventions is somewhat limited and is discussed further in section 8.

Reception Progress

• To achieve the 2020 target of 22% excess weight among 4 - 5 year-olds there needs to be an average annual reduction of 0.64 percentage points from the 2014 / 15 result of 25.2%
• The increase in Reception age excess weight means we are now 1 percentage point above our expected rate.
• The gap is not statistically significant.

Year 6 Progress

• To achieve the 2020 target of 35.1% excess weight among 10 - 11 year-olds there needs to be an average annual reduction of 0.82 percentage points from the 2014 / 15 result of 39.3%.
• The reduction in Year 6 excess weight means we are now slightly below our expected rate.

The following is a list of some of the initiatives provided for schools and families by South Tyneside Council, with partners that may contribute to a reduction in obesity

• Change 4 Life (C4L) is the new wellbeing programme  launched recently and includes a website where residents can self refer to gain advice on how they can take small steps to live healthier and longer lives. Information on a number of lifestyle issues including stopping smoking, cutting back on alcohol, tips for healthier eating, getting more exercise or where to get an NHS Health Check is available from the Change4Life South Tyneside Programme. Health Professionals including GPs are also able to refer people into the programme which is aimed at tackling health inequalities by taking a life course approach working with children, adults and families. 
• In order to build capacity, C4L also offers a training programmewhich is open to all C4L deliverers and is delivered by an external provider(s) commissioned by Public Health. Modules enable participants to develop skills in addressing the wellbeing needs of the local population in key Public Health areas across the life-course and include, among other things: Every Contact a Health Improvement Contact, NHS Health Checks, Health Eating, Emotional Health and Wellbeing and Children and Young People (incorporated into a life-course approach / model of delivery). Target participants include School Nurses, all school staff, Children Centre staff. Gaps in provision are also being looked at and the training will target those staff / localities first.
• The council's C4L team also provide other teams with their own healthy eating resources box along with training. All primary schools, Children's Centres, Sports Development staff , the Matrix, Family Support and School Nurses recently attended training on how to deliver session on healthy eating and were provided with lesson plans and a box of evidence based resources to do so. 
• Public Health has commissioned a Training Course on adult and childhood obesity to enable front line staff to identify and raise the issue with families. So far 74 staff have attended the four 3 day training sessions offered in 2015. Trained staff include teachers, social workers, sports development, family workers and outreach staff
• South Tyneside Council are committed to a number of Public Health England campaigns including those linked to Best Start in Life and Change4Life. A new Change4Life Schoolzone campaign is about to be launched and will potentially provide schools with readymade resources including lesson plans, power points, publicity materials.
• In April 2013, Local Authorities took on the statutory responsibility to deliver the National Child Measurement Programme, which is delivered in schools. Children in Reception (aged 4 - 5) and Year 6 (aged 10 - 11) have their heights and weights measured by School Nurses who are commissioned to deliver the programme. The programme provides Local Authorities with robust public health surveillance data on child weight status to aid planning and provides parents with feedback on their child's weight status. In 2013 / 14 there was a 97% uptake from all those eligible across the age ranges.
• 4 UPP (Understanding Parental Perceptions)is a project being carried out by Newcastle University in conjunction with the Local Authority. Parents of children measured via the NCMP in 2013 - 14 were asked to give consent to be contacted by the University for further questioning, should their child be measured as overweight or very overweight. The University are currently looking at the parental attitudes/beliefs and understanding of obesity, its causes and effects. The have produced a tool to use with parents that will help demystify some of the perceptions of what constitutes childhood obesity. It is intended that  this will  be widely available once clinical trials have taken place.
• In terms of support for families, currently all families are offered School Nurse (SN) support when they receive their NCMP results. A review of the service has recently taken place and future plans include increasing the public health role of the school nurse, which will include closer involvement in NCMP follow up. Currently, NCMP feedback letters to parents to inform them that School Nurses are able and available to offer individual advice and support to young people and their families on healthy diet and lifestyle issues. It is intended that in future, SNs will also signpost families to any Families Lifestyle Programmes on offer in South Tyneside, leisure services and other nutrition (eg cooking skills) and or physical activity opportunities in the borough.
• In addition School Nurses offer advice, and support at their drop- ins which are offered in all secondary schools and negotiated with the Head Teacher in primaries.
• The Healthy Schools Programme, is available to all schools and has physical activity, healthy eating and emotional health criteria included. Schools are asked to complete an audit of their relevant work and the 'distance travelled' in meeting the criteria. In 2014 - 15 the focus on obesity was increased in the next levels / Badges of the Healthy Schools Programme. Currently, any primary school that wishes to progress with the Badges must  focus firstly on the Healthy Weight Badge. They may also choose to work on another Badge of their choice, based on need if they wish to do more. Currently 8 primary schools are working on their Healthy Weight Badges and are focusing, for example on the school environment, a lunchtime charter, snack provision and rewards etc
• The Council's Sports Development team offer an extensive programme of physical activities to schools across the borough. After school clubs and holiday clubs are also provided at a small cost to parents. Staff have recently attended training on obesity in order to help them discuss the issue with children and their families, when appropriate
• As previously stated, an initiative has taken place that looked at the planning and numbers of hot food takeaways in South Tyneside as there is a correlation between the number of takeaways per ward and the levels of adult and childhood obesity. Work will take place looking at beliefs, attitudes and behaviours in relation to takeaways to inform future training and campaigns targeting families.
• All current training offered around nutrition includes a section about takeaways and will be amended accordingly
• In the past Free School Meal (FSM) entitlement has been used as a deprivation indicator, deprivation having a close link to obesity.  Local data  for 2013 - 14 does indicate that the higher the FSM entitlement, the higher the obesity levels in schools . In terms of uptake in South Tyneside, an average of 90% of those eligible, take up the offer. However, this fluctuates greatly across primary schools from between 80% to 98%. In 2015 - 16, schools with lower uptake will be targeted by the Education Catering team.
• In South Tyneside, the school meals are provided in such a way, that should a child wish, they could access their 5 a day in one sitting. All Catering Team Leaders have received training on promoting a healthy balanced meal to children which they practice at all sittings. 
• The Fitness Challenge was a project set up to get Year 4 pupils to be more active by engaging them in monitoring their individual/class team activity and it enabled competition against other schools in South Tyneside. The project ran for 10 weeks in the Summer Term and pupils were provided with an accelerometer and measured and recorded their steps / activity online each day. An evaluation report is underway and will include recommendations for a way forward
• There is clear evidence (Unicef) that that breastfeeding for the first six months has a number of health benefits to baby eg reduction in chest infections, gastroenteritis, ear infections, urinary infections, diabetes, allergies, sudden infant death syndrome (SIDS), childhood cancers and heart disease. There is the recognition that diabetes and heart disease are linked to adult obesity and that this link to obesity can be reduced by prolonged breastfeeding (Renfrew el at 2012).Long term health benefits to women include reduction of breast cancer, ovarian cancer and osteoporosis.  This correlates to the length of time women breastfeeding ie the longer breastfeeding continues the longer protection happens. In South Tyneside work is taking place to ensure implementation of the UNICEF Baby Friendly Initiative standards . Maternity staff, health visiting, neonatal unit and children's centres staff have all been offered and are taking up training implement these standards. There is also ongoing training of breast feeding peer supporters (women who have breastfed their own children and wish to support other women who chose to breastfeed). Breastfeeding support groups and infant feeding workshops are also held in the local Childrens' Centres across the borough. The above information is to be provided to schools and promoting breastfeeding as the preferred option has recently been written into the Healthy School Award criteria.
• The Hebburn Early Help pilot took place with high impact families and focused amongst other things, on healthy weight. An evaluation is currently being carried out by Durham University and future plans will be dependent on this.
• From a strategic point of view, Local Government Association (LGA) makes a number of recommendations for Local Authorities  to tackle the issue, many of which are addressed  via an  obesity action plan, which was the product of a Scrutiny review in 2013
• Since Scrutiny, South Tyneside Council have or are in the process of carrying out a number of Health Impact Assessments  on their regeneration programme, South Shields 365 eg on the relocation of Central Library to The Word, the new Library and Media Centre.  These assessments will ensure maximisation of the health benefits of such programmes and mitigate against any negative health effects.
• As recommended by the LGA, data included in this report will form part of a JSNA section on obesity in the future
• In addition, when tackling childhood obesity, the  LGA makes a number of other recommendations for councils, including promoting local leadership at all levels - such as local leadership through elected members, strategic leadership through the Health and Well-being Board and health leadership via Clinical Commissioning Groups, wider NHS partners and public health teams
• They also recommend commissioners (CCG and Council) listen to the views of children, young people, adults, families and communities and involve them in commissioning decisions and the design of health services and programmes.
• For Local Councils they advocate creating a network of community champions from the likes of teachers, pupils, school canteen staff and youth club leaders and getting schools on board. There is a wealth of opportunities from cooking lessons, gardening clubs and PE where the importance of preventing obesity can be incorporated in a fun way.

• It is widely accepted that no commissioned interventions will be enough to tackle the current childhood obesity issue and that a whole systems approach is required to reverse the trends of childhood obesity. Interventions however may play a role in that whole systems approach.
• Evidence behind interventions is limited in terms of data quality so must be treat with caution. A Cochrane review of 64 RCT's demonstrated that combined behavioural lifestyle interventions, aimed at children and their families, compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents.
• A similar Cochrane review looked at 20 RCT's that delivered parent only interventions. The review found that Parent-only interventions had similar effects compared with parent-child interventions and compared with those with minimal contact controls.
• The evidence base for these types of interventions is steadily growing however at present, as discussed by Cochrane, the quality of the evidence is low with loss to follow up being a particular issue.

In 2015 NICE published a quality standard that covers a range of approaches at a population level to prevent children and young people aged under 18 years from becoming overweight or obese. It includes interventions for lifestyle weight management. These statements are particularly relevant to local authorities, NHS organisations, schools and providers of lifestyle weight management programmes. The list of quality standards is as follows

• Statement 1. Children and young people, and their parents or carers, using vending machines in local authority and NHS venues can buy healthy food and drink options.
• Statement 2. Children and young people, and their parents or carers, see details of nutritional information on menus at local authority and NHS venues.
• Statement 3. Children and young people, and their parents or carers, see healthy food and drink choices displayed prominently in local authority and NHS venues.
• Statement 4. Children and young people, and their parents or carers, have access to a publicly available up‑to‑date list of local lifestyle weight management programmes.
• Statement 5. Children and young people identified as being overweight or obese, and their parents or carers as appropriate, are given information about local lifestyle weight management programmes.
• Statement 6. Family members or carers of children and young people are invited to attend lifestyle weight management programmes, regardless of their weight.
• Statement 7. Children and young people, and their parents or carers, can access data on attendance, outcomes and the views of participants and staff from lifestyle weight management programmes.
• Statement 8. (placeholder) Reducing sedentary behaviour.

The full guidance can be found here.

The government recently published the childhood obesity strategy, 'a plan for action' in which it sets out the recommended steps that will be taken at a national level to start to reduce the prevalence of childhood obesity. The plan includes the following key points               

• · Introducing a soft drinks levy
• · Taking out 20% of sugar in products
• · Support innovation to enable business to make healthier products
• · Developing a new framework for updating the nutrient profile,
• · Making healthy options available in the public sector
• · Providing support with the cost of healthy foods for those who need it most.
• · Helping all children to enjoy an hour of physical activity every day
• · Improving the co-ordination of sports and physical activity programmes for schools
• · Creating a new healthy rating scheme for schools
• · Making School food healthier
• · Clearer food labelling
• · Supporting early year setting
• · Harnessing the best new technology
• · Enabling health professionals to support families

The full report can be found here.

• When local young people were asked about their health and lifestyle in the 2013 Health Related Behaviour Questionnaire:
• 43% of Year 6 pupils said that they'd like to lose weight, which is much higher than the 33% of pupils who said the same across the rest of England
• 10% of pupils reported that they felt afraid to go to school because of bullying 'often' or 'very often' and 26% said that they had been bullied at or near school in the last 12 months
• Only 33% of year 6 pupils (combined girls and boys) recorded high levels of self-esteem, which is lower than the 42% average for the wider England sample.
• In terms of self-esteem in older young people, a clear gender difference is apparent with fewer girls recording high levels of self-esteem compared to boys, for example 26% of year 10 girls, compared with  44% of boys.
• Key worries for 14 - 15 year old boys and girls were exams and tests (42% and 65% respectively). Second on the list for girls (52%) and last for boys (18%) was 'the way they look'
• 65% of 14 - 15 year old girls said that they would like to lose weight.

National Strategies and Plans

Childhood Obesity 'A plan for Action'

Obesity in children and young people: prevention and lifestyle weight management programmes

Healthy Lives Healthy People 'A call to action on obesity in England'

Additional Resources

NCMP Local Authority Data

Last updated: March 2017