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Healthy Weight Strategy 2015- 2020
Healthy Weight for all in Waltham Forest
[draft 4]
Waltham Forest Healthy Weight Strategy 2015-2020
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Acknowledgements
This strategy was written by Karen Bernard with further input from Sue Hogarth
(Public Health, London Borough of Waltham Forest). We would like to acknowledge
and thank the Waltham Forest Healthy Weight Steering Group for their full and
thoughtful comments and contributions to the development of this strategy and to
Waltham Forest’s Health and Wellbeing Board members for their comments and
feedback.
Waltham Forest Healthy Weight Strategy 2015-2020
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Contents
Page
Healthy Weight for All in Waltham Forest - Plan on a page
1. Introduction
1.1 Our Vision
1.2 Our Objectives
1.3 Our Approach
2. Background: Strategic Context
2.1 National Strategic Context
2.2 Waltham Forest Strategic Context
3. Obesity risk and the burden of disease
3.1 Who is most at risk?
3.2 Health Burden
3.3 Social Burden
3.4 Economic Burden
4. Overweight and Obesity rates
4.1 National Overweight and Obesity rates
4.2 Waltham Forest Overweight and Obesity rates
4.2.1 Children
4.2.2 Adults
5. Where are we now: Current support provision
6 What more needs to be done: Gaps in support provision and the
Waltham Forest response
Groups:
6.1 Pregnancy and early years (0-4)
6.2 Childhood (5 -17 years) including schools
6.3 Adulthood (18-59 years)
6.4 Older people (60+ years)
Cross Cutting Themes:
6.5 Workplace
6.6 Planning and Built Environment
6.7 Other settings (public buildings, residential settings,
Housing, Job centres and Pharmacies)
6.8 Weight Management services
6.9 Training
6.10 Communication
6.11 Data and Evaluation
6.12 General
7. Monitoring and Evaluation
8. Next Steps
Appendix 1. Definition of overweight and obese
Appendix 2. Healthy Weight Steering Group Members
Appendix 3. Modelling Life Course Timeline & Opportunities
Appendix 4. National Strategic Context
Appendix 5. Current Weight Management Services in Waltham Forest:
Tiers 1-4
Appendix 6. Weight Management Commissioning Landscape 2013-14
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Healthy Weight for All in Waltham Forest - Plan on a page
Our Vision
To provide an environment that enables all Waltham Forest residents to make healthy food choices, to stay physically active and to maintain a healthy weight throughout their lives
Our objectives
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To increase participation in active travel and physical activity by creating and promoting socially and culturally appropriate safe physical environments.
To increase healthy eating by increasing and promoting the availability of, and access to healthy food choices and reducing the availability of and access to foods that are high in fat, sugar
and salt.
To ensure that all health, social care and educational settings across the life course encourage and support healthy eating, active travel and physical activity, particularly early years to
enable a healthy start for children.
To create healthy workplaces that encourages and support healthy eating, active travel and physical activity.
To up-skill residents and health, social care and educational staff so that they have access to consistent, evidence-based information and advice on healthy eating, active travel and
physical activity.
To increase access to appropriate, evidence-based weight management interventions across the life course targeting those at highest risk and greatest health inequalities.
To achieve the objectives actions are planned across the life course
Pregnancy &
Early years: (0-4 years)
Childhood: (5-17 years)
including schools
Adulthood: (18-59 years)
Older People: (60+ years)
and within cross cutting themes
Workplace
Planning and Built Environment
Settings (Public buildings, residential settings, Housing, Job centres and Pharmacies)
Training (staff and residents)
Communication
Data and Evaluation
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1. Introduction
The obesity epidemic is a public health problem that experts have stated is
comparable with climate change, both in terms of scale and complexity1. There has
been a clear rise in obesity rates, which accelerated in the late 1980s and early
1990s and is a trend repeated almost universally in developed and increasingly
developing nations.2 It has been identified as one of the most important preventable
challenges to health, second only to smoking3 and is the fifth leading cause of death
globally.4
Almost two-thirds of adults and a third of children in England are either overweight or
obese (see appendix 1 for definitions of overweight and obese). Work by the
Government for Science’s Foresight5 programme suggests that, without clear action,
these figures will increase to almost nine out of ten adults and two-thirds of children
by 2050. The trend of increasing weight problems in children is of particular concern
because evidence suggests a ‘conveyor belt’ effect in which excess weight in
children continues into adulthood.6
Many aspects of life affect the amount and types of food eaten and the physical
activity taken. The rising levels of overweight and obesity are associated with
changes in7:
 Work and leisure time
 Town and transport planning
 Food production and marketing
 Lifestyle messages
 Inequalities
Three aspects of obesity combine to make it a public health problem: its impact on
health, its prevalence and its resistance to change.
Obesity also plays a role in widening health inequalities. As rates of adult and
childhood obesity have increased, so too have inequalities. There are higher rates of
obesity amongst individuals from poorer backgrounds, particularly for women and
girls. The contribution of obesity to a range of chronic health problems links it with the
broader health inequalities agenda, further strengthening the need for action.8
However, this situation can be reversed. It is possible for people to control their
weight, take control of their diet and take part in physical activity. This includes
encouraging the development of an environment to help healthier choices become
easier.
This strategy provides a public health framework, not just to support residents who
are overweight or obese, but to ensure healthy weight is achieved among adults and
children in Waltham Forest.
1 Department of Health (2008) Healthy Weight, Healthy Lives: A Cross-Government Strategy for England, DH,
London
2 ibid
3 Foresight (2007) Tackling Obesities: Future Choices – Project Report. Government Office for Science. Available at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/287937/07-1184x-tackling-obesitiesfuture-choices-report.pdf
4 World Health Organisation, Overweight and obesity, fact sheet No 311;
5 Foresight (2007) Tackling Obesities: Future Choices – Project Report. Government Office for Science
6 Department of Health (2008) Healthy Weight, Healthy Lives: A Cross-Government Strategy for England, DH,
London
7 RCP (2004) Storing up problems, The medical case for a Slimmer Nation, Report Of A Working Party
8 Department of Health Public Health Research Consortium (2007) Law C, Power C, Graham H, Merrick D, Obesity &
Health inequalities. Obesity Reviews;8(Suppl.1):19-22
Waltham Forest Healthy Weight Strategy 2015-2020
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1.1 Our Vision
The vision of this strategy is to provide an environment that enables all Waltham
Forest residents to make healthy food choices, to stay physically active and to
maintain a healthy weight throughout their lives.
1.2 Our objectives
In order to deliver the vision the following objectives have been identified (see
section 1.3 below for how these were developed):
 To increase participation in active travel and physical activity by creating and
promoting socially and culturally appropriate safe physical environments.
 To increase healthy eating by increasing and promoting the availability of, and
access to healthy food choices and reducing the availability of and access to
foods that are high in fat, sugar and salt.
 To ensure that all health, social care and educational settings across the life
course encourage and support healthy eating, active travel and physical
activity, particularly early years to enable a healthy start for children.
 To create healthy workplaces that encourages and support healthy eating,
active travel and physical activity.
 To up-skill residents and health, social care and educational staff so that they
have access to consistent, evidence-based information and advice on healthy
eating, active travel and physical activity.
 To increase access to appropriate, evidence-based weight management
interventions across the life course targeting those at highest risk and
greatest health inequalities.
1.3 Our Approach
There is no ‘golden bullet’ for tackling obesity9. Therefore, the extent of the issue
demands that a population approach is taken at sufficient scale across the life course
that is, from birth to older age. To facilitate this, Waltham Forest has a multidisciplinary and multi-agency Healthy Weight Steering Group (see appendix 2 for
membership). Part of the development phase of this strategy involved mapping
services commissioned by the London Borough of Waltham Forest (LBWF), Waltham
Forest Clinical Commissioning Group (CCG), North East London Foundation Trust
(NELFT), NHS England (NHSE) and the Community and Voluntary Sector (see
section 5). A large obesity stakeholders event was held in September 2014, this
further informed the first draft of the strategy which was presented to the Waltham
Forest Health and Wellbeing Board in November 2014. This version incorporates
comments and suggestions from the Board. Also during 2014, a bid was submitted
for Waltham Forest to become a London Flagship Food Borough10, whilst
unsuccessful, there was great partner involvement, and elements of the application
have been incorporated into this strategy.
In January 2015, a workshop with the Healthy Weight Steering Group members was
held to develop the actions (see section 6) required to meet the strategy objectives.
Appendix 3 contains the diagram that was used to think through and identify the
gaps and actions required in our current service provision across the life course and
BMJ (2006) Physical activity to prevent obesity in young children: cluster randomised controlled trial; 333:1041
London Flagship Food Borough programme - https://www.london.gov.uk/priorities/business-economy/working-inpartnership/london-food-board/london-boroughs/london-flagship-food-boroughs
9
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Waltham Forest Healthy Weight Strategy 2015-2020
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in a variety of settings. From this diagram has been identified the following headings
under which local action is required:
Groups
 Pregnancy and early years (0-4 years)
 Childhood (5 -17 years) including schools
 Adulthood (18-59 years)
 Older people (60+ years)
Cross Cutting Themes
 Workplace
 Planning and Built Environment
 Other settings (public buildings, residential settings, Housing, Job centres and
Pharmacies)
 Weight Management services
 Training
 Communication
 Data and Evaluation
 General
The Healthy Weight Steering Group agreed that the objectives will be achieved
through:
 Working in partnership with policymakers, local communities, service
providers and business to deliver healthy weight initiatives to those most in
need in the most appropriate way
 Working across all settings where our residents are located e.g. hospitals,
schools, children centres, workplace
 Moving away from short-term to long-term sustainable solutions
 Making health everyone’s business through training of all frontline staff to
provide prevention advice and referrals and ensuring that all local authority
policies and regulations are healthy weight friendly
 Working at multiple levels - Individuals, Families, Communities, Organisations
and Environments, using the three Es – environment, empowerment, and
encouragement11
 Ensuring interventions are at sufficient scale to make an impact
 Using pilots to provide learning to roll out effective interventions to wider
groups
 Increasing access to weight management services, particularly targeting
those at highest risk and greatest health inequalities
 Ensuring that services commissioned are evidence based or meet best
practice guidelines.
 All programmes being evaluated; this will determine service cost
effectiveness and future development of service
2. Background: Strategic Context
2.1 National Strategic Context
The issue of overweight and obesity has been addressed in a number of significant
reports and Government White Papers. The policy issues raised have been
translated into national delivery plans, National Service Frameworks and toolkits, see
11 Royal College of Physicians (2004) Storing up problems, The medical case for a Slimmer Nation, Report Of A
Working Party: pp 28-30
Waltham Forest Healthy Weight Strategy 2015-2020
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appendix 4 for a full list. These documents are designed to help partners to develop
and support local action plans. The most recent document ‘Healthy Lives, healthy
people: a call to action on obesity in England’12 provides a partnership approach on
what can be done to tackle this problem. Waltham Forest’s Healthy Weight Strategy
has been developed in line with these national policies.
2.2 Waltham Forest Strategic Context
There are also a number of local policies and strategies across Waltham Forest that
are relevant to achieving a healthy weight. It is important that these policies and
strategies are all aligned and compliment the healthy weight agenda, they are:
• Health and Wellbeing Strategy
• Best start in Life Children & Young People strategy
• Waltham Forest Local Development Framework Core Strategy
• Waltham Forest Hot Food Takeaway Planning
• Joint Strategic Needs Assessment
• Waltham Forest Catering School Meal Strategy
• Convergence Framework and Action Plan 2011-15
• Active Travel workstream
• NHS Waltham Forest CCG Primary Care Strategy 2014/15-2019/20
• NHS Waltham Forest CCG Self Care Strategy
3. Obesity risk and the burden of disease
Individuals unduly affected by excess weight are also those who are likely to
experience wider health inequalities and therefore their need for health and social
care support is further compounded. Overweight and obesity have a substantial
human and financial cost by contributing to the onset of disease and premature
death.
3.1 Who is most at risk?
Some sectors of the population are at considerably higher risk of developing obesity,
with an associated increase in the incidence and prevalence of related comorbidities.
Specific groups at risk are:
 Children13 and adults experiencing increased socioeconomic deprivation, for
example 14% of women in social class I are obese compared with 28% in
social class V14
 Children from certain ethnic minority groups such as Bangladeshi, Black
Caribbean and Black African were found to be at a higher risk of obesity15.
 Looked after children are more likely to be overweight and obese compared
with their peers.16
 Certain points in life have also been found to be associated with weight gain:
pregnancy, menopause and smoking cessation.17
Department of Health (2011) Healthy Lives, healthy people: a call to action on obesity in England. Available at:
https://www.gov.uk/government/publications/healthy-lives-healthy-people-a-call-to-action-on-obesity-in-england
13 PHE, Health inequalities, http://www.noo.org.uk/NOO_about_obesity/inequalities, date accessed 13/11/14
14 Foresight (2007) Tackling Obesities: Future Choices – Project Report. Government Office for Science
15 GLA Intelligence Unit 2011 Childhood obesity in London
16 Hadfield, S.C. & Preece, (2008), Obeisty in looked after children:is foster are protective to the dangers of obesity?
Child:Care,Health & Development,Vol 34(6):pp710-712
17 NICE (2006) Obesity: Full guidelines – section 3 Prevention – evidence, statements & reviews
12
Waltham Forest Healthy Weight Strategy 2015-2020
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People who use mental health services, in particular those with a diagnosis of
schizophrenia or dipolar disorder, have been identified as being at increased
risk of greater levels of obesity and associated conditions, such as heart
disease and diabetes18
There is evidence to suggest that levels of obesity are higher in people with
learning disabilities19
Older people: Increasing age is associated with increasing prevalence in
obesity up to the age of 64 years, when a decline in the prevalence begins.
Young mothers (over 21 years) of white ethnicity are significantly less likely to initiate
breastfeeding than any other ethnic group.20 There is evidence that weaning earlier
than current recommendations leads to rapid weight gain in infancy which may in turn
increase the risk of child obesity.21 Early weaning has also been found to be
associated with increased weight and body fat at age 7 years.22 Exclusive
breastfeeding has been found to be associated with a modest reduction in childhood
obesity risk23
In addition to the groups at risk listed above, it is important to also consider the needs
of those groups for whom barriers to accessing services are known to exist,
including: people with mental health problems, people with a disability and people for
whom English is not their first language.
3.2 Health Burden
Overweight and obesity can lead to increasingly adverse effects on physical and
mental health and wellbeing. Excess weight is a major risk factor for diseases such
as type 2 diabetes, cancer and heart disease, deep vein thrombosis and pulmonary
embolism. There are also potential problems including reproductive and urological,
respiratory, non-alcoholic fatty liver disease and gastrointestinal disease.24 Alongside
the serious ill-health, it can reduce people’s prospects in life, affecting individuals’
ability to obtain and keep work, their self-esteem and their underlying mental health.25
Preventing obesity will help maintain people’s health and quality of life. For people
who are overweight or obese achieving moderate weight reduction has significant
health benefits. Table 1 shows the benefits expected from a 10% weight loss in a
person initially weighing 100kg.
Department of Health (2006) Choosing Health: Supporting the physical health needs of people with severe mental
illness, DH, London
19 Department of Health (2011). Healthy Lives, Healthy People: A call to action on obesity in England
20 Baker, D, Garrow A, & Shiels C (2008), Child Health and Ethnicity in Manchester. Centre for Public Health
Research, Institute for Health and Social Care Research, University of Salford
21 Sloan S, et al (2007) Early weaning is related to weight and weight gain in infancy, child care, health and
development, 34,1,59-64
22 Wilson AC et al(1998) Relation of infant diet to childhood health: seven year follow up of cohort of children in
Dundee infant feeding study, BMJ, 31621-25
23 Armstrong J,Reilly J (2002) Breastfeeding and lowering the risk of childhood obesity. The Lancet; 359:2003-2004
24 PHE. Health Risks of Adult Obesity.
http://www.noo.org.uk/NOO_about_obesity/obesity_and_health/health_risk_adult
25 Department of Health (2011), Healthy Lives, Healthy People: A call to action on obesity in England
18
Waltham Forest Healthy Weight Strategy 2015-2020
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Table 1: Benefits expected from a 10% weight loss in a person initially
weighing 100kg26
MORTALITY
BLOOD PRESSURE
DIABETES
LIPIDS
> 20% fall in total mortality
> 30% fall in diabetes related deaths
> 40% fall in obesity-related deaths
Fall of approximately 10mmHg systolic pressure
Fall of approximately 20mmHg diastolic pressure
Fall of 50% in fasting glucose
Fall of 10% in total cholesterol
Fall of 15% in low-density lipoproteins
Fall of 30% in triglycerides
Increase of 8% in high-density lipoproteins
For older adults the benefits of not being obese include functional independence,
less risk of falls and fractures and protection from age related diseases.27
A recent Canadian survey found that among those who are morbidly obese (BMI
over 35), one in six have been diagnosed with depression or anxiety. More than half
report having low self-esteem and recognise that their weight problems have an
impact on many daily activities and on their relationships.28
A Health Impact of Physical Inactivity (HIPI) tool has been developed by Public
Health England. This tool estimates the number of cases of certain diseases that
could be prevented in each local authority if the population aged 40-79 were to
engage in recommended amounts of physical activity. For Waltham Forest the HIPI
estimated: 122 out of 671 deaths could be prevented if 100% of the resident
population were physically active.29 WHO also highlighted that there is a clear causal
relationship between the amount of physical activity people do and all-cause
mortality.30
3.3 Social Burden
People who are obese are more likely to suffer from prejudice and discrimination in
some situations for example employment, travel and healthcare. It is also linked to
poor academic success, social exclusion in schools and in some instances teasing
and bullying.
When obesity becomes severe, it can affect normal daily activities. A person with
severe obesity may find their ability to perform their chosen occupation so
compromised that they are deemed as disabled disability. This disability can have
resource implications for social care services including, housing adaptations, trained
carers and provision of suitable transport and facilities.31
3.4 Economic Burden
The cost to the State for treating obesity is great. Currently, around 5-6% of NHS
total budget is spent on the disease consequences of overweight and obesity32. An
analysis of the economic burden of a range of risk factors for chronic disease
Scottish Intercollegiate Guidelines Network (SIGN) (1996) Obesity in Scotland: Integrating prevention with weight
management, SIGN report No.8 Edinburgh: Royal College of Physicians
27 The Toronto Charter for physical activity: A global call for action, May 2010
28 Canadian Obesity Network (2011) Obesity Survey Report
29 Health Impact of Physical Inactivity (HIPI), Burden of Disease and Death from physical inactivity ages (40-79), by
county and unitary authority, http://www.apho.org.uk/addons/_122359/atlas.html
30 WHO. 2010. Global Recommendations on Physical Activity for Health, WHO
31 LGA and PHE (2013) Social care and obesity – a discussion paper
32 Department of Health (2011) Healthy Lives, Healthy People: A Call to Action on obesity in England,
26
Waltham Forest Healthy Weight Strategy 2015-2020
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estimated that overweight and obesity now costs the NHS £5.1bn per year33. The
local estimated annual cost to the NHS of diseases related to overweight and obesity
is £75.5 million.34
4. Overweight and Obesity rates
4.1 National Overweight and Obesity rates
In England, currently 24.7% of adults (aged 16 years and over) are obese, an
increase from 15% in 1993. A further 37% of adults are overweight. This means a
total of 62% of adults have excess weight in England.35
By 2050 obesity is predicted to affect 60% of adult men, 50% of adult women and
25% of children.36
The United Kingdom ranks as one of the most obese nations in Europe – and there
are few signs yet of a sustained decline.37
4.2 Waltham Forest Overweight and Obesity rates
4.2.1 Children
The height and weight of every school child (Reception and Year 6 classes) in
England is measured as part of the National Child Measurement Programme
(NCMP). Figure 1 shows the trend in prevalence of overweight and obesity in
reception year from 2006/07 to 2013/14 for Waltham Forest, London and England. In
2013/14 in Reception Year, 22.8% of children in Waltham Forest were overweight or
obese, compared to 23.1% in London and 22.5% in England.
Figure 1: Trend in the prevalence of overweight or obesity in Reception Year
(ages 4-5 years) in Waltham Forest, London and England, 2007/08 to 2013/14
Source: Health and Social Care Information Centre, National Child Measurement Programme
In 2013/14 in Reception year in Waltham Forest, 11.3% of children were obese only,
compared to 10.0% in London and 9.5% in England.
Scarborough P,Bhatnagar P, Wickramasinghe K et al (2011) The economic burden of ill health due to diet, physical
inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS cost, Journal of Public Health
34 Department of Health (2008) Healthy Weight, Healthy Lives: A toolkit for developing local strategies (Tool
D3 Estimating the local cost of obesity). Available at: http://www.fph.org.uk/uploads/full_obesity_toolkit-1.pdf
35 Health Survey for England (2012)
36 Foresight (2007) Tackling Obesities: Future Choices – Project Report. Government Office for Science
37 Department of Health (2011) Health Lives, Healthy People: A call to action on obesity in England
33
Waltham Forest Healthy Weight Strategy 2015-2020
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Figure 2 shows the trend in prevalence of overweight and obesity in Year 6 from
2006/07 to 2013/14 for Waltham Forest, London and England. In 2013/14 in Year 6,
37.8% of children in Waltham Forest were overweight or obese, compared to 37.6%
in London and 33.5% in England.
Figure 2: Trend in the prevalence of overweight or obesity in Year 6 in Waltham
Forest, London and England, 2007/08 to 2013/14
Source: Health and Social Care Information Centre, National Child Measurement Programme
In 2013/14 in Year 6 in Waltham Forest 23.4% of children were obese only,
compared to 22.4% in London and 19.5% in England.
4.2.2 Adults
Unlike the NCMP, there is no national measurement programme for adults. In
Waltham Forest, 54.6% of adults are overweight or obese, compared to 57.3% in
London and 63.8% in England38.
Figure 3 shows the prevalence of overweight and obesity in adults across London in
2012.
Figure 3: Prevalence of overweight and obesity among adults in London
Boroughs, compared to London and England as a whole, 2012
Source: Active People Survey, Sport England 2012
PHE (2014) London Update Briefings, PHOF –Obesity data, Tobacco Profiles Longer Lives, Public Health
Outcomes Framework (Indicator 2.12 - Excess Weight in Adults) www.phoutcomes.info Using 2012 data
38
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5. Where we are now: Current support provision
Weight management services are categorised in Tiers as defined according to the
terminology from the Department of Health:39
Tier 1: Universal Interventions: - Client group - everyone
Environmental & population-wide services and initiatives, e.g. community based
services
Tier 2: Lifestyle interventions: - Client group – overweight and obese
Multicomponent weight management service e.g. Exercise on referral, community
based dietetic services,
Tier 3: Specialist Services: - Client group - obese
Multi-disciplinary team providing behavioral therapy, psychological services, medical
support
Tier 4: Surgery: - Client group – morbidly obese
Bariatric surgery (adults only, not generally recommended for children or young
people. Bariatric surgery may be considered for young people only in exceptional
circumstances and if they have achieved, or nearly achieved physiological maturity)40
As described in section 1.3 a mapping exercise for both children and adults using
the tier model can be found in appendix 5. Further details of these support services
is detailed in appendix 6.
6. What more needs to be done: Gaps in support provision and the Waltham
Forest response
The following pages contain identified gaps and corresponding actions that should be
taken across the multiple agencies in Waltham Forest to meet both the gaps, and the
wider strategy’s objectives. They have been developed with a high level of input from
the Healthy Weight Steering group and comments from the Health and Wellbeing
Board. They incorporate what we know about those most at risk of overweight and
obesity, as outlined in section 3.1.
Department of Health (2013) Developing A Specification For Lifestyle Weight Management Services, Best practice
Guidance For Tier 2 Services
40 NICE (2006) Guidelines CG43 Obesity, the Prevention, Identification, Assessment and Management of overweight
and Obesity in Adults and Children.
39
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6.1 Pregnancy and early years (0-4 years)
Gaps
1. Lack of nutritional element in antenatal classes.
2. No support services for overweight and obese pregnant women .
3. Lack of joint working between Homerton Midwifery team and Whipps
Cross Midwifery team.
4. UNICEF Baby Friendly Accreditation scheme not implemented in the
community.
5. Few designated areas for breastfeeding women in the Borough.
6. No infant feeding team to support children with feeding difficulties in the
community.
7. Insufficient capacity within the dietetic service to address the needs of
pre-term babies requiring specialist feeding support.
8. Inadequate prevention activities into early years setting e.g. infant
feeding support and dietetic input into children centres/baby clinics and
nurseries.
9. No ‘Healthy Children’s Centres’ schemes like ‘Healthy Schools’
programme.
10. Lack of healthy food in both public and private nurseries.
11. Not enough physical activity and healthy eating activities for 0-4 years
children.
Actions
1. Ensure antenatal classes across the borough include a focus on healthy
eating, physical activity and breast feeding promotion.
2. Provide local support for pregnant women with a high BMI in line with other
London boroughs including a review of the booking-in information pack given
to pregnant women to ensure information is consistent, appropriate and
adequate.
3. Ensure Homerton and Whipps Cross Midwifery team have representation on
Waltham Forest Healthy Weight Steering Group in future.
4. Work with partners to work towards UNICEF Baby Friendly Accreditation
across Waltham Forest.
5. Re-launch the ‘Love Mums’ breastfeeding scheme with businesses in the
borough.
6. Develop peer to peer infant feeding training and support opportunity to
improve responsive support of families.
7. Work with local dietetic services to increase the support for pre-term babies
requiring specialist feeding support.
8. Ensure all practices nurses/midwives/nursery nurses/health visitors/Children’s
Centre staff have basic training around healthy eating and physical activity to
ensure all early year providers give consistent messages.
9. Work with Children’s Centres and Health Visitors to devise an early years
healthy accreditation scheme emphasising physical activity and healthy
eating modelled on the ‘Healthy Schools’ programme.
10. Work with local nurseries and Children’s Centres to improve their food
provision, including exploring the possibility of implementing weight
management programmes in Children’s Centres.
11. Ensure there is more focus in the community on outdoor play.
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6.2 Childhood (5-17 years) including schools
Gaps
1. Inadequate provision to follow up children who have been identified
as being overweight or obese following the NCMP.
2. No weight management service for 5-7 years old.
3. Inadequate healthy weight work with schools including special
needs schools.
4. Inadequate assurance of the nature of food available in all schools
and colleges.
5. Not all children are able to swim 25 metres.
6. Schools generally do not have current school travel plans to
promote Active Travel.
Actions
1. To implement a referral mechanism to GPs for children who are overweight or
obese following NCMP including clear guidance and training around what
onward advice, monitoring and referrals GPs should make following NCMP
notification.
2. Work with schools and weight management providers to make available
venues in the community to conduct weight management programme for
children aged 5-7 who are classified as overweight or obese.
3. Implement Healthy Lifestyle Programmes in all schools that cover diet, food
groups, exercise, including:
a. Support and encourage schools to address healthy weight as a priority
for the Healthy School London Silver award.
b. Identify Personal Social Health and Economic (PSHE) education leads
in each school (including special needs school) and provide
support/training around nutrition/exercise and ensure they are linked
with name school nurse and other appropriate services.
4. Public Health, Community Dieticians, Head of Catering and Head teachers to
work together to review the food available in schools and colleges including
ensuring schools are aware and updated on links to the OFSTED inspection
framework e.g. food school standards www.schoolfoodplan.com/standards.
5. Work with the sports and leisure team to explore the possibility of providing
swimming lessons for children who are unable to swim 25 meters.
6. Work with schools, LBWF Transport department to develop a policy around
Active Travel which will include school travel plans to encourage families and
pupils to walk or cycle to school.
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6.3 Adulthood (18 – 59 years)
Gaps
1. Little sport/physical activity in educational establishments for 18+ age
groups.
2. No ‘Healthy Colleges’ scheme.
3. No healthy eating support in the borough to support people on low
income budgets.
4. No provision in place for clients with specific needs to access
supervised physical activity and weight management programmes in
line with the general adult population.
Actions
1. Investigate initiatives to increase physical activity in educational
establishments for 18+ age groups.
2. Implement ‘Healthy Colleges’ programme modelled on the ‘Healthy Schools’
programme.
3. Work with local communities to provide cooking sessions, supermarkets and
market visits for people on low income.
4. Work with weight management providers, voluntary sector, CCG and NELFT
to provide services for mental health clients. Ensure that provisions are made
for employees with disabilities and long-term health conditions in line with
NICE guidelines if it includes guidance on healthy weight (to be published, end
2015).
6.4 Older Years (60+ years)
Gaps
1. Lack of information and support for older people around healthy eating.
2. Unclear healthy food provision in inpatient or residential settings/facilities
or those in receipt of meals-on-wheels.
3. Inadequate provision of appropriate physical activity services generally for
older people including provision within the falls agenda.
Actions
1. Public Health and Community Dieticians to work with the community and
voluntary sector to provide information and support to older people around
healthy eating cooking sessions, supermarkets and market visits for older
people on low incomes.
2. Ensure that those residents receiving meals-on-wheels services, inpatients or
in residential settings/facilities have healthy meals in line with Food
Standard’s Agency guidance.
3. Ensure care, residential homes and day centres provide appropriate physical
activity interventions. Provide more walking based activities – walking football,
disk golf. Work with the CCG to link increase in physical activity into the Falls
agenda.
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6.5 Workplace
Gaps
1. No ’Active Buildings’ promoted within the borough.
2. Lack of consistent Healthy Workplace programmes in place in
Waltham Forest organisations.
3. Some organisations do not have staff rooms and shower facilities.
Actions
1. Discuss the ‘Active Buildings’41 research with local partners to explore changes
that could be made to the work environment to increase physical activity.
2. Work with Human Resources departments across the borough to implement
and promote a range of workplace initiatives to enable staff to lead a healthy
lifestyle including
a. walking and cycling between sites e.g. expand the LBWF bike scheme
to NHS staff in CCG, hospital and community services
b. encouragement of walking and running clubs
3. Encourage organisations within the borough to have install changing room
facilities.
6.6 Planning and Built Environment
Gaps
1. Lack of use of planning and licensing tools to increase physical
activity and healthy eating across the borough.
2. ‘Healthier Catering Commitment’ not implemented in the borough
3. Inadequate use of empty spaces in the borough.
4. No ‘healthy walking’ schemes within the borough.
5. No Active travel strategy in place in LBWF, Waltham Forest CCG,
Barts Health, NELFT.
6. Lack of Borough-wide safe cycling routes.
7. No bike storage facilities on estates.
Actions
1. Public Health and Planning departments to use appropriate planning and
licensing tools including Health Impact Assessment42 that includes
consideration for physical activity and healthier food options.
2. Implement the ‘Healthier Catering Commitment’43 in the borough.
3. Work with planning and housing providers to optimise the use of empty green
spaces and provide more allotment spaces to residents for food growing and
physical activity including activities in the evenings.
4. Work with the LBWF Sports and Leisure team to implement healthy walking
trails. Optimise the use of Transport for London’s (TFL) available resources to
encourage an increase in walking.
5. LBWF Transport Team are currently working on Active Travel strategy for
LBWF and working with Barts Health to develop theirs. Work with partners to
UCL. Active Buildings - http://www.activebuildings.co.uk/about
WHO. Health Impact Assessment - http://www.who.int/hia/en/
43 CIEH. Healthier Catering Commitment - http://www.cieh.org/healthier-catering-commitment.html
41
42
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ensure all major organisations are working towards the development of an
active travel strategy.
6. Work with the LBWF Transport Team to investigate borough wide safe
cycling routes incorporating the work of Mini Holland utilising TFLs resources.
7. Work with LBWF Transport Team to increase bike racks and storage spaces
on estates.
6.7 Other settings (public buildings, residential settings, Housing, Job
centres and Pharmacies)
Gaps
1. Insufficient numbers of vending machines in public buildings across
the borough contain healthy food.
2. Eating times in residential settings are not appropriate to facilitate
healthy eating.
3. Housing providers have not been sufficiently engaged in the healthy
weight agenda.
4. Job centres have not been sufficiently engaged in the healthy weight
agenda.
5. Pharmacies have not been sufficiently engaged in the healthy
weight agenda.
Actions
1. Work with partners to install healthy vending machines in public buildings.
2. Meal times in care settings need to be flexible to accommodate those whose
daily sleep-wake patterns may be disrupted by ill-health e.g. older adults,
mental health. They must also not be too early in the day that residents are
compelled to access less healthy food options to satisfy hunger later in the
day.
3. Work with local housing providers to utilise and optimise their access to
residents to increase healthy eating and physical activity.
4. Work with job centres to investigate providing appropriate information on
healthy lifestyles and the services available to clients.
5. Engage pharmacies in the healthy weight agenda including ensuring that local
support services information be given with weight management drugs.
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6.8 Weight Management services
Gaps
1. Current weight management services do not meet NICE guidelines.
2. Inadequate weight management services (Tier 2) for children and
adults.
3. No specialist weight management services (Tier 3) for children and
adults.
4. No specialist weight management service (Tier 4) for children.
5. Lack of targeted support for certain specific groups e.g. Looked After
Children, Carers or Troubled Families.
6. Lack of engagement with religious groups or community centres.
7. People with severe mental health issues and those with learning
disabilities do not have equal access to weight management services
as the general population.
See also section 6.2, gap and action 1 for Care Pathway work.
Actions
1. Work with providers to ensure current services adhere to NICE guidelines and
with commissioners to ensure that future services are adherent.
2. Ensure that findings of recent Tier 2 review is embedded in Care Pathway.
3. The CCG is currently tendering for a Tier 3 weight management service for
children and adults.
4. Discuss with NHS England and CCG regarding commissioning Tier 4 service
for children.
5. Work with partners working with Looked After Children, Carers and Troubled
Families teams to ensure that clients have access to healthy weight support
and services.
6. Identify and work with local religious and community groups to ensure they
have access to appropriate healthy weight information and have awareness to
services available.
7. Work with providers to support people with severe mental health issues and
those with learning disabilities accessing weight management support.
6.9 Training
Gaps
1. Lack of training for health and social services staff around issues relating
to healthy weight, including infant feeding and benefits of physical activity.
2. Lack of awareness of staff around support services, including the referral
criteria for those services.
3.
Actions
1. To scope the following
a. current training available to staff regarding healthy weight
b. opportunities where existing training/training programmes can include
information on healthy weight.
2. Work with frontline staff to ensure awareness of services and referral criteria
using a range of communication channels e.g. newsletters and provider
meetings. See also section 6.2, gap and action 1 for Care Pathway work.
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6.10 Communication
Gaps
1. Some healthy weight services are underutilised by residents.
 Inadequate use of social media and social marketing including
lack of awareness of NHS-approved apps that support and
maintain healthy weight.
Actions
1. Work with Communications departments of all partner organisations to make
full and regular use of communication channels to promote Tier 1
interventions, evidence-based ‘apps’ and healthy weight messages, including
partner organisations:
a. websites
b. Facebook
c. Twitter.
6.11 Data and Evaluation
Gaps
1. Monitoring and evaluation of commissioned services is not consistent.
2. Lack of information sharing amongst organisations.
3. Lack of performance monitoring for healthy weight in general.
Actions
1. Improve monitoring and performance management of commissioned services
ensuring that there is a consistent approach to monitoring and evaluation
using tools developed by PHE.
2. Explore the need for a providers forum for those delivering healthy weight
services.
3. Devise a performance dashboard for physical activity, healthy eating,
overweigh and obesity to be regularly discussed at Health and Wellbeing
Board.
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6.12 General
Gaps
1. There is a lack of integration and central co-ordination of services and
services are not at sufficient scale.
2. A general lack of engagement with at risk or vulnerable groups e.g. mental
health clients, people with learning and physical disabilities, the visually
impaired, BME group, carers and those they care for (including young
carers).
3. Inadequate representation at the Healthy Weight Steering group from a full
range of colleagues.
4. Lack of engagement with local supermarket chains and local convenient
shops.
Actions
1. Develop a Healthy Weight Care Pathway for children and adults to ensure
that it limits duplication, includes clear referral criteria and achieves the
required scale, as part of this work:
a. Develop a single point of information for residents.
b. Develop a single entry point for health and social care professionals
with clear referral criteria for healthy weight services. Partners are
currently looking into developing a social prescribing model in the
borough which should facilitate this.
2. Investigate relevant community and voluntary organisations to work with high
risk groups, including ensuring that the findings of the focus groups held with
visually impaired clients are taken into account in the relating action plan for
this strategy.
3. Public Health to discuss with colleagues including Mental Health, Community
and Voluntary Sector, Schools, Young Carers Group, midwifery and
Pharmacies to ensure their representation on the Healthy Weight Steering
Group.
4. Work with local convenient stores to provide good quality, low price fruit and
vegetables.
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7. Monitoring, Evaluation and Governance
The Public Health Outcomes Framework (PHOF) provides a monitoring mechanism
regarding increasing healthy life expectancy and reducing differences overall
between communities.
Tackling obesity falls within Domain 2 and Domain 4 of the PHOF. Local Authorities
will need to report on these indicators.
Domain 2: Healthy Improvement: People are helped to live healthy lifestyles, make
healthy choices and reduce inequalities
Domain 4: Healthcare public health and preventing premature mortality: Reduced
numbers of people living with preventable ill health and people dying prematurely
while reducing the gap between communities
Work to tackle obesity is also in line with the Adult Social Care Outcomes
Framework
Domain 1: Enhancing quality of life for people with care and support needs.
The Healthy Weight Steering Group will monitor the implementation of this strategy,
led by Public Health using the proposed performance dashboard. This will be done at
the quarterly meetings and reports sent as appropriate to the Health and Wellbeing
Board who will have oversight of the strategy from a governance perspective.
8. Next steps
Much of the infrastructure is already in place to deliver the strategy. As soon as the
strategy has been through relevant decision-making forums in Waltham Forest, a full
action plan will be developed, with named individuals against actions, and costed by
the Healthy Weight Steering Group, ensuring that actions to be taken are evidence
based. This plan will have clear milestones to cover the life of the strategy. The
strategy implementation will be phased from Years 1 to 5.
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Appendix 1
Definition of overweight and obese
What is healthy weight?
Healthy weight has been defined as having the body weight most appropriate for an
individual’s height, which produces the greatest health benefits. This complements
the widely accepted, yet rather vague definition of overweight and obesity as
abnormal or excessive fat accumulation that may be detrimental to health and
wellbeing.
Overweight and obesity are terms used to describe increasing degrees of excess
body fatness which can lead to increasingly adverse effects on health and wellbeing.
Both are commonly assessed by using Body Mass index (BMI) which is defined as
the person’s weight in kilograms divided by the square of their height in metres
(kg/m²).44 See table 1 for BMI definitions by category.
Table 1: WHO classifications to define weight in adults
Category
BMI
Underweight
<18.5
Healthy weight
18.5 – 24.9
Overweight
25.0 – 29.9
Obesity I
30.0 – 34.9
Obesity II
35.0 – 39.9
Obesity III
>40
Source: The Public Health England Obesity Knowledge and Intelligence Team
National Heart Forum (2007) Lightening the Load Tackling overweight and obesity: A toolkit for developing local
strategies to tackle overweight and obesity in children and adults, DH, London
44
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Appendix 2
Healthy Weight Steering Group Members
Public Health Consultant - LBWF
Public Health Strategist - LBWF
Head of Sports and Leisure - LBWF
Head of Catering – LBWF
Head of Spatial Planning – LBWF
Senior Transport Planner – LBWF
Early Years Group Manager – LBWF
Community Dietician – NELFT
Operational Lead, Infant feeding and Health Improvement - NELFT
General Practitioner lead
Senior Commissioning Manager - CCG
Greenwich Leisure Limited
Mental Health (no current representation)
Community and Voluntary Sector (no current representation)
Consultant Paediatrician – Barts Health – Whipps Cross
Pharmacies (no current representation)
Representative from schools (no current representation)
Representative from young carers group (no current representation)
Midwife – Barts Health – Whipps Cross (no current representation)
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Appendix 3
‘Modelling life course timeline & opportunities for making the healthy choice the easy choice’
Source: A Kingdom Oct 07 (draft 1.0)
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Appendix 4
National Strategic context
Policy Drivers










Health Lives, Healthy People: A call to action on obesity in England (2011)
Change4Life Three Year Social Marketing Strategy (2011)
Start Active, Stay Active, A report on physical Activity for Health for the four home
countries’ Chief Medical Officers (2011)
‘Choosing Health White Paper’ and subsequent delivery plans, Delivering
Choosing Health: Making Healthier Choices Easier’; Choosing a Better Diet: A
Food and Health Action Plan; and ‘Choosing Activity: A Physical Activity Action
Plan’ (2005)
Lightening the Load: Tackling Overweight and Obesity – A Toolkit for Developing
Local Strategies to Tackle Overweight and Obesity in Children and Adults’
(National Heart Forum, Faculty of Public health and the NHS 2007)
National Service Framework for Children, Young People and Maternity Services,
Standards 1,2, and 3 (November 2006)
Maternity Matters: Choice, Access and Continuity of Are in a Safe Service (April
2007)
Physical Activity and the Environment (National Institute for Health and Clinical
Excellence (NICE), 2008)
Healthy Weight, Healthy Lives: A cross Government Strategy for England
(January 2008)
Let’s Get Moving Commissioning Guidance A new physical activity care pathway
for the NHS (September 2009)
In addition, The National Institute of Health and Clinical Excellence (NICE) has produced:
 NICE ph47 Managing overweight and obesity among children and young people:
lifestyle weight management services (October 2013)
 Clinical Guidance Number 43: Obesity: the Prevention, Identification,
Assessment and Management of overweight and Obesity in Adults and Children
(November 2006)
 NICE Dietary interventions and physical activity interventions for weight
management before, during and after pregnancy (July 2010)
 NICE guidance on promoting and creating built or natural environments that
encourage and support physical activity
Public Health Responsibility Deal
The Public Health Responsibility Deal aims to tap into the potential for businesses and
other influential organisations to make a significant contribution to improving public health
by helping shape a healthy environment.
The Responsibility Deal involves organisations taking voluntary action in one or more of
the following areas to help people lead healthier lives:
 Alcohol
 Food
 Health at work
 Physical activity
The food pledges encourage organisations to agree to specific actions: calorie
information for food and non-alcoholic drink, removal of ingredients that contain artificial
transfats, reviewing portion sizes, education and information. The physical activity deal
focuses on encouraging and assisting people to become more physically active.
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Appendix 5
Current weight management services in Waltham Forest: Tiers 1- 4
*Homerton Hospital have stage 1 accreditation in maternity unit
Whipps Cross Hospital are working towards stage 1
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Appendix 6
Weight Management Commissioning Landscape 2013-14
The following is a mapping services commissioned by the Local Authority, Clinical Commissioning Group, NHS England and the Community
Voluntary Sector. There are other weight management services in the borough that are not commissioned by these bodies. These have been
excluded from the mapping due to time constraints.
Children
Tier
Name of service
1
Leisure services
1
1
Community dieticians
Healthy Child Programme 0-5
(Health Visitors)
1
Healthy Child Programme 5-19 &
NCMP (School Nurses)
1
Healthy Schools Programme
1
Restriction of Hot food takeaways
Brief Description of Service
Free swimming for under 18s
Junior Gym for 11-15 years old
Dieticians service in the children centres including food clubs and weaning sessions
Universal preventative service, providing families with a programme of health and developmental reviews (10-14
days, 1 year and 2 years) including open child health clinics supplemented by advice around health, wellbeing and
parenting and signposting.
Universal and progressive services for children and young people to promote optimal health and wellbeing. Offers
a variety of health reviews (reception, year 6/7 and mid-teen), screening tests, information and signposting
including NCMP
Role of support program is to encourage and enable schools to participate in the programme, which leads to an
increased emphasis on healthy eating and activity, including encouraging take-up of healthy school meals
£1 million set aside annually to fund breakfast clubs and healthy snack-packs for reception and year 6 pupils in
schools, with 55 schools (69%) already signed up
Around £2m invested in improving school kitchens and dining facilities for 2013-17, plus reinvesting 50% of
school-meal surplus income
Food For Life (FFL) Silver Catering Mark for primary school menus and Bronze for secondary for schools using
the Council’s in-house school meals service
Ranked 10th for leading in good food practice in the Good Food for London report 2014
46 schools signed up for the healthy schools London, with 12 achieving Bronze. Under the previous national
Healthy Schools systems, 93% achieved Bronze or above
Universal Infant Free School Meals implemented from September 2014
Planning policies in place which seek to reduce the proliferation of Hot food Takeaways, particularly near schools
as a means of combating their known adverse impact on community health
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1
Hornbeam
1
Waltham Forest Somali Bravanese
Action Group
The Asian centre
TSP Youth Space
The Limes Community & Children’s
Centre
Aquavision North London
1
1
1
1
1
1
2
2
3
4
Leyton United Football Youth
Community Academy
The London Playing Fields
Foundation
Go For it & Teen Why Weight
Universal dietetic services (1:1
sessions
Multi- Discipline weight management service
Bariatric Surgery
Adults
Tier
Name of Service
1
6 Leisure centres
1
1
1
Parks and Open spaces including
outdoor gyms, play areas & sports
pitches
Disability Sport
Our Parks
Healthy Start vouchers can be used to buy fruit and vegetables at the stalls or box scheme. Activities - under 5s
Nature explorers, cooking, bike club
Provide advice, information and guidance to the Somali and Bravanese community in Waltham forest and
surrounding boroughs. Run football club project to the Somali youth in Waltham Forest.
Activities- Youth Club & One to One Mentoring for 13 – 19 year old, Taekwondo
An activity centre that meets the needs of all the family. Jungle gym downstairs for the under 8s.
Run fully inclusive services for disabled and non-disabled 0-25 year olds, the sessions run at various days and
times, activities such as cooking
Provides recreational and competitive synchronised swimming club. Offers synchronised swimming classes from
aged 8 and above. Free taster sessions to anyone interested in trying synchronised swimming or anyone who just
wants to improve their swimming and fitness.
Runs family friendly youth football clubs and training sessions in the community. Teams from under 8 are through
to under 21’s.
Provide playing fields to schools, clubs, disadvantaged and under-represented groups to play sports and to
providing training courses for coaches and volunteers.
Go for it – 10 weeks weight management programme for children (7- 11 years old)and parents
Teen why weight - 4 weeks weight management programme for teenagers
Overweight/obese children with co-morbidities e.g. children with diabetes and learning disabilities
Multi-disciplinary team providing behavioural therapy, psychological services and medical support
Current gap in service provision
Current gap in service provision
Brief Description of Service
Free swimming for over 60s and disabled residents.
Gym Station with cardiovascular and resistance equipment, free weights area and aerobics sessions
Healthy Vending Machines in Leisure centre
Free sports & recreational activities
Archery, Athletics, Forest Flyer2 hockey, Multi Sports Session, Swimming
A free fitness classes which will be held in 4 parks. Each park will have 10 hours of free activities taking place
every week. Our Parks is funded for 2 years
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1
1
1
1
1
1&2
1
1
1
1
Active Travel (cycle Training)
Scope in Waltham Forest
Mobile Green Grocer project
Initiatives around nourishment
from early years
Age UK Waltham Forest
Redbridge CVS
William Morris Community Centre
Users Association
Waltham Forest Disability
Resource Centre
Waltham Forest Asian Seniors'
Club
1
1
Waltham Forest Cycling
Campaign
The Mill
Waltham Forest Age UK
1
City and Hackney Mind
1
The Health Works
1
Tamil Elders Welfare Association
1
1
2
Tamil Elders Association
Soul 2 Dance
Exercise on Referral
2
Better weight management
service
Why Weight
1:1 session with Dietitian
2
2
Cycle trainers
Support for disabled people and their families at home and in the community
A food van providing affordably priced fresh produce within identified ‘food deserts’
Love Mums breastfeeding support programme
Maternal and new-born vitamin distribution
Activities- Balance and exercise classes for the over 60s, Saturday Morning Tai Chi for over 50s, Yoga for the
over 60s
Fit for Fun provides 20 week of free exercise classes for voluntary and community sector groups in the borough
Diabetic association meeting, Ju Jitsu club, Karate club
Provide a range of activities to choose from such as, gardening, multi-sports session with Boccia, Skittles and
bowling, as well as a choice of exercise classes.
WFASC is dedicated to serving the welfare of Asian older adults above 50; provide social, recreational, cultural
and health promotion activities for our members. Activities include: gentle exercise, tai chi, luncheon club, advice
sessions, health and nutrition advice
Work to encourage people to cycle more often and lobby for better conditions for cycling.
The Mill, Walthamstow’s activities for all ages, many of them FREE such as cycle club, yoga
For older adults in Waltham Forest. Balance and exercise classes for the over 60s. Saturday Morning Tai Chi to
music for over 50s. Yoga for the over 60s
Activities in the day centre: Gardening, Yoga, Gym, Women’s only gym. Offers a subsidised freshly cooked
nutritious lunch.
Belly dance and Zumba classes for adults. Yoga and Pilates lessons are held weekly, including ante and post
natal.
Helping elders with healthcare, health check-ups every three months for BP and blood sugar levels. Health talks
from doctors, chair based exercises every meeting. Yoga expert twice a month.
Areas of Activity: Older People, Leisure, sport & healthy living
Soul 2 Dance believe in two things: dancing, and having fun, classes provide plenty of both
EOR involves structured exercise session with supervision from an NVQ-level 3 plus GP referral trained instructor
Level 4 – Cardiac Rehabilitation
Weight management service for clients BMI >25
6 weeks Weight Management programme provided by the community dietician
For Diabetic patients provided by the community dieticians
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2
2
3
4
X-pert
Prescribing
Multi- Discipline weight
management service
Bariatric Surgery
6wks session for newly diagnosed Type 2 diabetic clients
Prescribing Anti-obesity drugs
Multi-disciplinary team providing behavioural therapy, psychological services and medical support
Current gap in service provision
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