Agenda item

Derys Pragnell (Consultant in Public Health, Oxfordshire County Council) has been invited to present a report providing an update on the work undertaken by Oxfordshire County Council and its partners to promote healthy weight amongst Oxfordshire residents.

 

Please note: The report submitted for this item includes input from the BOB Integrated Care Board so as to take account of the NHS’s work around healthy weight in Oxfordshire.

 

There are FOUR documents attached to this item:

 

1. The main report.

 

2. Appendix 1: Recommendations from Healthy Weight Health Needs Assessment 

 

3. Appendix 2: Whole systems approach to healthy weight action plan 23/24

 

4. Appendix 3: Oxfordshire WSA To excess weight: Work undertaken or in progress update 2024 

 

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

 

Derys Pragnell, Consultant in Public Health, was invited to present a report providing an update on the work undertaken by Oxfordshire County Council and its partners to promote healthy weight amongst Oxfordshire residents. Ansaf Azhar (OCC Director of Public Health), Claire Gray (Public Health Practitioner), Angela Jessop (Personalised Care Lead BOB ICB), and Alicia Siraj (Head of Health Promotion, Health Prevention, and Personalised Care BOB ICB) also attended to answer the Committee’s questions.

 

The OCC Director of Public Health and Consultant in Public Health introduced the Oxfordshire Healthy Weight report. Post-COVID-19, addressing excess weight was crucial owing to its links with long-term conditions such as type 2 diabetes. A whole system approach involving all organisations across the County Council was needed. Rising obesity rates both nationally and locally necessitated changes in the food environment and sedentary habits. A four-pillar approach was introduced, emphasising that no single intervention would suffice. Local data showed robust information on children but less information on adults, highlighting higher weights among children in some areas compared to the national average.

 

Angela Jessop, a Tier 3 weight management lead at the ICB, explained the weight management tier system. Tier 2 services were for individuals with lower BMIs and included programs such as Slimming World and online support. Tier 3 services were for those who had not successfully lost weight in Tier 2 and targeted people with higher BMIs and those considering surgery. This tier adopted a multidisciplinary approach including dietetics, psychological support, and physical activity, with programs typically lasting around 12 months. Oxfordshire residents could access face-to-face services at Luton and Dunstable Hospital and a remote service available across the Buckinghamshire, Oxfordshire, and Berkshire West (BOB) geography, which supported non-English speakers and those with learning disabilities or low health literacy. The program included access to weight loss medications, aiming for 60% of patients to lose 5% of their weight within six months. Tier 4 services were for patients who may opt for surgery after Tier 3. At the time, Oxford University Hospitals NHS Foundation Trust (OUH) was not accepting new referrals, so patients were directed to Luton and Dunstable Hospital or the Royal Berkshire Hospital. In 2023-24, approximately 25 patients from Oxfordshire underwent Tier 4 surgery.

 

Members expressed concerns about the link between arthritis and obesity. They wanted to know what support was provided for individuals with both conditions. Officers explained that General Practitioners (GPs) were proactive in recognising the link between excess weight and arthritis. They often recommended lifestyle changes and referred patients to Tier 2 and Tier 3 weight management services to help manage weight and improve arthritis symptoms.

 

Healthy Weight Services worked closely with long-term condition groups to raise awareness about the importance of weight management in managing arthritis. They provided tailored support to help individuals with arthritis adopt healthier lifestyles. The Move Together Program specifically targeted individuals with long-term conditions, including arthritis. It aimed to improve mobility, reduce falls, and decrease the number of GP appointments. The program had shown positive outcomes, such as a 23% reduction in falls and a 50% reduction in GP appointments.

 

Efforts were also made to train clinicians on the importance of addressing weight management in patients with arthritis. This included initiatives like the clinical champions training, which educated healthcare providers on how to effectively refer patients to appropriate weight management programs.

 

Concerns over the mental health and support for those suffering from and living with obesity were raised by Members who wanted to know about the pathways and services available to support individuals. It was responded that specific pathways were established to support individuals with mental health conditions who were also dealing with obesity. This included both serious mental health conditions and lower-level mental health issues. The new healthy weight service included a pilot program focused on better supporting people with mental health conditions, recognising the different needs based on the severity of the condition.

 

Emphasis was placed on recognising the relationship between mental well-being and obesity. The approach aimed to reduce stigma and guilt associated with obesity, promoting a supportive environment for behaviour change. Efforts were made to frame healthy weight messages in a way that avoided blame and encouraged positive changes without inducing shame.

 

The Move Together program, which targeted people with long-term conditions, also addressed mental health by promoting physical activity and reducing social isolation. Health coaches and social prescribers in GP practices worked together to help patients with obesity and mental health conditions make healthier lifestyle changes. Collaboration with the voluntary sector, such as with organisations like Homestart, ensured that support extended beyond clinical settings to community-based initiatives.

 

Members noted the importance of self-worth and self-confidence, when dealing with obesity, and questioned the proportion of patients, for either physical obesity or mental health, who were socially prescribed physical activity.

 

It was explained to the Committee that social prescribers in GP practices played a crucial role in discussing healthy lifestyle changes with patients, including those with obesity and mental health issues. They worked alongside health coaches to support patients in adopting physical activity as part of their treatment plan. Health coaches, who were present in around 10 GP practices in Oxfordshire, collaborated with social prescribers to help patients for whom a healthier weight and increased physical activity could significantly improve their overall health. A clinical champion was also involved in training GPs and clinicians about the importance of referring patients to physical activity programs. This training aimed to increase the number of referrals and ensure that patients with obesity and mental health issues received appropriate support for physical activity.

 

Concerns were raised by the Committee about the support offered to women, following a pregnancy, in relation to obesity. Concerns were raised about potentially distressing health checks after pregnancy where BMI had been raised. Members questioned what support was being offered to promote health lifestyles and practices post pregnancy, especially in relation to breastfeeding.

 

It was explained that breastfeeding was highlighted as a key component in promoting weight loss post-pregnancy. It was noted that the energy demands of breastfeeding were greater than those of gestation, making it an effective practice for weight management. There was a comprehensive breastfeeding support provision through the recently commissioned 0-19 service, which integrated with maternity services to support mothers, especially those struggling with breastfeeding.

 

Health visiting services provided mandated visits and support to new mothers, including discussions about overall well-being, physical activity, and weight management. These services aimed to offer a holistic approach to post-pregnancy health. The Move Together program had expanded to include maternity services, supporting physical activity from conception through early years. This program aimed to promote healthy lifestyles and reduce long-term health risks for both mothers and children.

 

There was an emphasis on co-production with women, partners, and the wider community to understand the reality of maintaining a healthy weight post-pregnancy. This included working with voluntary sector organisations like Homestart to provide support beyond clinical settings. Training for clinicians, such as the This Mums Moves training, also focused on delivering effective messages about physical activity and healthy weight management during and after pregnancy.

 

Members moved on to discuss obesity within school settings. The Committee highlighted the statistics of obesity in schools with one in three students leaving year 6 obese. Members questioned what was being done to support and encourage healthy eating and lifestyles in schools, as well as at home.

 

It was responded that a new role had been created to focus on schools, particularly in areas of deprivation. This advisor works within school improvement to influence school policies and practices around healthy eating and physical activity.

 

Efforts were being made to address the contents of children's lunch boxes, promoting healthier options. This included providing policy examples and resources that could be used by schools to encourage healthy eating habits among students. A school cooking project was also being developed to support children and young people in learning to cook from scratch. This program aimed to extend its reach into the community, helping families adopt healthier eating practices at home. There was a strong emphasis on early years, recognising that the earlier healthy habits were developed, the better. This included targeted work in preschools and early settings to promote healthy weight from a young age.

 

The importance of involving parents and the wider community was highlighted. Initiatives like the Move Together program and partnerships with organisations like Homestart aimed to provide support beyond the school environment, ensuring that healthy practices were reinforced at home. Programs like the Daily Mile and walk-to-school projects were encouraged to increase physical activity among students. These initiatives had been designed to be fun and engaging, promoting a culture of regular physical activity.

 

Specific projects and resources were being directed towards schools in areas of deprivation to address higher levels of excess weight. This included tailored interventions and support services to meet the unique needs of these communities.

 

Cllr Champken-Woods joined online at this point

 

Members raised concerns regarding the quality of support provided to community food banks and larders in their efforts to offer healthier food options. They also emphasised the importance of promoting healthy cooking skills and habits among both younger and older residents. It was explained to the Committee that there was a focus on supporting families in using fresh fruits and vegetables, which were often available but not taken due to lack of knowledge or preference. Initiatives like the school cooking project aimed to extend into the community, helping both younger and older residents develop healthy cooking skills and habits. Good Food Oxfordshire was involved in projects like Oxfam to Fork, which looked at the food supply chain to ensure excess fruits and vegetables reached community food services. This initiative aimed to increase the availability of healthy food options in food banks and larders.

 

A community food map coordinated by Good Food Oxfordshire captured information about various food-related initiatives, including food banks and larders. This map helped identify areas where healthier food options could be promoted and supported. There was an emphasis on celebrating the role of the voluntary sector in providing healthy food options. This included recognising and promoting the efforts of food banks and larders in supporting healthy eating habits within the community.

 

The challenges of cooking and the cost of cooking healthy meals were acknowledged. Efforts were being made to address these issues, ensuring that families had the resources and knowledge to prepare healthy meals at home.

 

Members asked about the County, City, and District Councils' advertising policies for healthier food options and if they had strategies to promote such choices. It was explained that there were aims to implement high fat, salt, and sugar (HFSS) policies in council-owned advertising spaces by replacing ads for unhealthy foods with those for healthier options like fresh produce. Evidence showed this could positively influence buying behaviour without affecting council revenue.

 

Members also inquired about Oxfordshire's role in national obesity efforts, particularly regarding advertising. The OCC Director of Public Health noted ongoing national work to restrict unhealthy food ads, a key factor in fighting obesity. The Association of Directors of Public Health (ADPH), including Oxfordshire, advised the government on these issues.

 

Local initiatives in Oxfordshire, like HFSS policies in council-owned ads, served as examples influencing national policies. Successful local measures supported broader regulations. Ongoing discussions addressed ultra-processed foods and the need for stricter food content and advertising regulations, considering the link between diet and rising cancer rates.

 

Members questioned what restrictions on hot food takeaways had been considered, and whether it was necessary or possible for the Council to seek new powers to deal with the rise and influence of hot food takeaways.

 

Officers referenced that the levers to restrict new hot food takeaways already existed. Many areas had successfully implemented policies to restrict the opening of new hot food takeaways, particularly around schools or in areas with high levels of excess weight. Examples included Newcastle, which had implemented such restrictions across the geography. The process involved incorporating restrictions into local plans or adding supplementary policies to existing plans. This approach had been shown to be effective and straightforward to implement.  The issue was in misunderstanding or hesitation among some local authorities about the feasibility of implementing these restrictions. The public health team had provided detailed information and examples to help clarify and support the implementation of these policies.

 

There was a discussion about the possibility of seeking new powers from the government to make it easier for local authorities to implement these restrictions. This could involve additional support or changes to national planning frameworks to facilitate the process. The idea of requesting new powers was seen as a way to strengthen the ability of local authorities to manage the proliferation of hot food takeaways and create a healthier food environment.

 

The public health team was actively working to support local authorities in implementing these restrictions and was advocating for stronger national policies. This included providing bespoke information for each district and city to help them understand and apply the available levers effectively.

 

Members questioned what progress had been made in relation to any KPIs and what data was available to demonstrate how successful or unsuccessful initiatives had been. Additionally, Members were curious as to whether there were sufficient and sustainable funding avenues for the work to promote healthy weight across the tier system.

 

Officers stated that many of the projects were new, and their outcomes were being evaluated rather than measured against specific KPIs. This was because the nature of the projects made it difficult to set traditional KPIs. For example, the food price marketing project aimed to change purchasing behaviour, which would take time to measure. Some initiatives did have KPIs, such as breastfeeding rates, but overall, the focus was on evaluating the impact of the projects rather than setting rigid KPIs. The overarching KPI remained the reduction in overweight and obesity rates.

 

It was explained to the Committee that the Health and Wellbeing Board provided overall governance for these initiatives, with specific updates and reports being presented to the Health Improvement Board. An update was expected in February, which was intended to deliver more detailed information on the progress and outcomes of the initiatives. The 10 priorities in the Health and Wellbeing Strategy served as the framework for governance and assurance of the initiatives to promote healthy weights. Progress was measured through proxy indicators, and the Health and Wellbeing Board oversaw and monitored the progress through regular updates and reports.

 

There was an acknowledgement that there was a need for more funding and resources to expand the initiatives and support the work across the system. The current funding was not sufficient to cover all the needs, and there was a continuous effort to secure additional resources. The funding issue was particularly critical for new initiatives and expanding existing programs to reach more people and have a broader impact.

 

The discussion highlighted the importance of sustainable funding avenues to ensure the long-term success of the initiatives. This included exploring various funding sources and advocating for more support at both the local and national levels.

 

Members concluded by debating the benefits and risks of obesity medication. The Committee questioned whether there had been clear communication with residents regarding the benefits and risks of such medication. Furthermore, Members thought it was important to ascertain whether the ICBs were each developing their own pathways for supporting healthy weight or if there was a standardised national pathway in place.

 

It was responded that clear communication regarding the benefits and risks of obesity medications was paramount. It was mentioned that the new digital provider would be able to provide medication as part of the Tier 3 service, but it was crucial to ensure that this was not seen as a direct pathway for medication. Instead, it should be considered a treatment option within a broader weight management strategy. The focus was on making sure that the right people received medication and that it was used as a tool rather than a standalone solution. This approach aimed to avoid widening inequalities and ensure that those who could not access medication in other ways were supported.

 

Officers clarified that each ICB was developing its own pathways for healthy weight support. There was no national pathway in place, which meant that each ICB was responsible for creating and implementing its own strategy based on local needs and resources. This allowed for tailored solutions that addressed the specific challenges and opportunities within each ICB's area. However, it also meant that there was a need for coordination and sharing of best practice to ensure consistency and effectiveness across different regions.

 

The Committee AGREED to finalise a list of recommendations to be issued to system partners outside the meeting.