Healthy Weight

Being overweight or obese is a major public health concern being directly associated with serious illnesses including type 2 diabetes, heart disease, and some cancers. Obesity and overweight is also linked to musculoskeletal and mental health problems. Obesity is believed to be the third biggest risk factor contributing to premature death (Source: WHO). In children, obesity has long-term effects on physical, social, educational, and mental health outcomes. Problems related to excess weight tend to persist across the life course with overweight or obese children being significantly more likely to become overweight or obese adults (Source: OHID). Excess weight results in a cost of £6.1 billion per year to the NHS, with over 1 million obesity related admissions in 2019-20 (Source: DHSC). Confounded by the COVID pandemic, obese people were much more likely to be admitted to hospital, to need intensive care and to die as a result of the coronavirus (Source: DHSC). Being underweight affects far fewer people than excess weight, both nationally and locally, but is also linked to increased risk of ill-health. 

Whilst obesity can be the result of an underlying health condition or the side effects of certain drugs, the vast majority of cases arise from poor dietary and lifestyle behaviours, because energy intake (food and drink) exceeds energy used (metabolic processes and physical activity). The Foresight Report (2007) described over 100 factors that may contribute towards weight gain. Over the last few decades, social and technological changes have increased sedentary jobs, the mass ownership of cars, easy access to highly processed foods and the normalisation of sedentary lifestyles. This has resulted in a steep increase in excess weight and obesity across the globe. Close interrelationships between the causes of unhealthy weights makes this a complex area to address, requiring a joined-up, long-term approach. This is reflected in the current emphasis on ‘whole system’ ways of working involving cross-sector collaboration and strategy. 

In 2011 the government set out its approach to obesity in Healthy Lives, Health People: a call to action on obesity, recommending concerted action across all sectors of society. Government strategy was updated in 2020 in Tackling Obesity: Empowering Adults and Children to Live Healthier Lives which outlined national consultations on food and drink labelling and unhealthy food advertising. The paper also introduced the Better Health awareness campaign and included a commitment to increase weight management services  

The NHS Long-Term Plan (2019) includes a chapter on prevention and health inequalities outlining the NHS response to obesity. This includes targeting support at the most at-risk groups, extending the diabetes prevention programme, increasing services for extremely overweight children and enhancing training for medical students. 

The 2016 Childhood Obesity Strategy (COS) entailed actions for the food and drink industry, such as the Soft Drinks Industry Levy, Sugar Reduction Programmes and improved nutritional labelling. The COS also introduced changes to OFSTED criteria increasing an the emphasis on healthy diets and exercise. Chapter two of the COS (2018) focused on reducing inequalities as well as stating the government’s aim to reduce childhood obesity by 50% by 2030. Chapter three was included in the 2019 Green Paper Advancing Our Health: prevention in the 2020s, and outlined proposals for a ban on the sale of energy drinks to under-16s, consultation on the labelling and marketing of infant food and a commitment to better support families with children aged 0-5. 

The National Food Strategy 2020/2021 includes measures, such as the extension of the Holidays Activity and Food (HAF) and School Food Standards programmes, that will have an impact on childhood obesity through the promotion of physical activity and healthier diets.  

NICE provides guidance around weight loss, weight management, and obesity, across all age groups through the following pathways: obesity, weight management and behaviour change. 

The Lincolnshire Joint Health and Wellbeing Strategy (2018) includes adult obesity and childhood obesity amongst its priorities. The strategy emphasises the need for a ‘whole system’ approach which, as well as supporting individuals, encourages development of ‘healthy places’ by engaging with planning and environmental agencies. 

Active Lincolnshire work with local stakeholders to deliver the Let’s Move Lincolnshire physical activity strategy 

Prevalence of excess weight and obesity amongst adults and children in Lincolnshire tends to be above the England average, with considerable variation across the county (Source: OHID).  

Adults in East Lindsey and Boston have typically shown much higher rates than Lincolnshire as a whole, with only West Lindsey and Lincoln tending to have a lower-than-average prevalence. For children, North Kesteven has shown significantly lower rates of obesity than the population as a whole, whilst, over recent years South Holland and Boston have had amongst the highest rates of obesity of year six children in England. There are variations across age groups within districts, with some areas showing a marked reduction of obesity, and others a significant increase in obesity rates in children and adults.  Analysed at district level there appears to be no simple explanation for variation in obesity rates across Lincolnshire. Key risk factors for obesity, in particular, increasing age and deprivation, show no straightforward relationship with child or adult obesity. This may be in part due to differences with respect to those risk factors within districts; some areas, for example, whilst relatively affluent overall will have significant pockets of deprivation which may signal elevated obesity levels. Risk factors may also act to enhance or offset each other. For example, Lincoln has very high levels of deprivation, which is associated with high rates of obesity, but also has a much younger median age than the rest of the county, which can indicate a lower population rate of excess weight. Obesity levels will also be affected by a wide range of local circumstances such as opportunities for physical activity and active travel, the nature of the employment market, cultural attitudes towards weight and physical activity, and access to affordable healthy food. This highlights the importance of analysing population needs at small scale as well as large, district level, scale.  

We know, nationally, there is a strong association between childhood obesity and deprivation, with an increase in obesity rates, for boys and girls, from the least – to the most deprived centiles (Source: OHID). Children in the most deprived centile are more than twice as likely as those in the least centile to be obese. A similar pattern is seen for women in the most deprived quintile being 1.8 times more likely to be obese than those in the least deprived quintile. For men, the picture is a little less clear. Whilst men in the most deprived quintile are significantly more likely to be obese than those in the least, there is no significant difference between the other four quintiles (Source: PHE).   

Obesity data broken down by ethnicity is not available locally; however, nationally we know the picture is complex with Asian men having by far the lowest prevalence of obesity; and, whilst obesity rates for black men is approximately in line with the national average, black women are almost twice as likely to be obese as the population as a whole (Source: PHE).  Despite this variation, maintaining healthy weight is regarded, by health professionals, as particularly important for all South Asian, Black African and Black Caribbean people because, the increased risk of obesity-related diseases, particularly type 2 diabetes, occurs at a lower BMI than it does for white people.   

An adult weight management intervention is delivered by One You Lincolnshire (OYL) as part of their Integrated Lifestyle Service (ILS). The current ILS is commissioned to June 2024 and offers a range of programmes to help people lose weight. These include: a 12-week weight management course that offers advice on diet and exercise; vouchers for individuals to access local weight loss groups such as Slimming World; digital support, provided by a dedicated dietician as well as a peer support group; and a 14-week ‘Man V Fat’ football programme. To be eligible for support people must be aged 18+ and have a BMI of 30+ (27.5 for some ethnic minority groups) and fulfil one or more of the following criteria: a diagnosis for at least one specified long-term illness, be an unpaid carer, or be an employee of LCC.  

Individuals with poor social connectedness appear to be at greater risk of not engaging in the full range of preventative services than individuals with good social connectedness (Source: Lancet Public Health). Positive social connections with family, friends and wider networks have numerous physical and mental benefits. It is therefore important to offer a range of local healthy weight interventions, including group based and virtual sessions to support individuals who may be feeling lonely or are rurally isolated. 

NHS Health Checks, delivered by GPs, are offered every five years to people aged 40 – 74 who do not have a pre-existing health condition. They are designed to spot the early signs of a range of diseases for which obesity is a risk factor. The Health Check includes advice about nutrition, healthy weight and physical activity as well as signposting and referral to lifestyle services. 

A Child and Family Weight Management (CFWM) Service is to be piloted from summer 2022. The programme will be open to primary-school-aged children and will involve group-based weight management and healthy lifestyle support for children and their parents. In addition to the core group-based courses, the providers will offer tailored individual support to families with complex needs or children with extremely high BMI scores. The CFWM programme will be closely aligned to the National Child measurement Programme but will also seek referrals from a range of partners such as schools, Primary Care and Health Visitors.  

The nationally mandated National Child Measurement Programme provides data for OHID’s Outcomes Framework. It is delivered in schools by the LCC Early Help Team and involves weighing and measuring the height of all Reception and Year Six children (for whom parental consent has been given).  

The Holidays Activities and Food (HAF) programme has been running in Lincolnshire since 2020. The focus is on physical activity, diet and nutrition. The programme is open to children up to year 11 (ages 15 to 16) who are in receipt of free school-meals, although 15% of funding can support children outside this group. The HAF runs over the main school holidays and is delivered in a range of community settings. 

LCC has been chosen as one area to trial the Department of Education and the Food Standards Agency’s School Food Standards (SFS) pilot which will support schools to meet the SFS and to publish statements on arrangements for their ‘whole school approach’ to food. The pilot is expected to begin in September 2022. 

Active Lincolnshire works in partnership with local organisations to influence change and advocate for improvement for physical activity opportunities across Lincolnshire. Active Lincolnshire provide the Activity Finder, a directory of physical activity services. 

The Lincolnshire Food partnership brings together communities and statutory and private sector organisations to influence local food systems. Its focus is not specifically on healthy weight, but it does support several school and community projects promoting healthy eating. 

The Dietetics team at ULHT provide a nutrition education and obesity management service. Much of the work is tailored to support people with specific health conditions such as diabetes, coronary heart disease, renal disease or a mental health condition. ULHT teams work in close partnership with GPs, community health services and the local mental health trust (LPFT). 

The Diabetes Prevention Programme provides lifestyle support across Lincolnshire for people at high risk of developing type 2 diabetes. Participants receive support for nine months, attending either group sessions or a one-to-one digital service. The programme educates about healthy diets and physical activity and offers holistic wellbeing advice.  

Key partner organisations and services include One You Lincolnshire, schools, GPs, Children’s Services, the local healthcare trusts, NHS dietetics, Active Lincolnshire, private sector weight management providers, pharmacies, universities and frontline health and care staff. Local services interact with the public and capture their views regarding the quality of the services as they are delivered.  

New developments, such as the Child & Family Weight Management Service, will capture service user views to inform evaluation and performance management.  

Lincolnshire’s NHS currently offer no ‘tier three’ or ‘tier four’ weight management services. Tier three involves intensive, specialist weight management interventions delivered by a clinician-led multi-disciplinary team to patients with very high or morbid obesity. Tier four services usually involve bariatric surgery and are only available to patients via tier three. Lincolnshire residents can currently only access these services outside of Lincolnshire, the nearest being in Derbyshire. 

The NCMP and the CFWM service are only available to primary school-aged children. The ILS’s adult weight management support is only offered to people aged 18+. Consequently, there is a gap in provision for children between the ages of twelve and eighteen.  

The ILS is only available to people who are already obese (i.e., with a BMI ≥ 30). No preventative service is currently available for overweight people with a BMI between 25 and 30.  

NICE guidance (PH 47) acknowledges a lack of robust evidence around the impact of child weight management programmes, particularly regarding which aspects of multi-component programmes may be having the most beneficial effects and how child weight management interventions affect long-term health inequalities. Lincolnshire’s CFWM programme aims to contribute to this area.  

The CMO’s 2021 annual report highlighted the “striking” lack of evidence around the health needs of coastal communities – those in Lincolnshire show some of the highest rates of obesity in the county. 

Work will continue on the adult weight management component of the ILS. An external evaluation, conducted by the University of Lincoln, will provide findings to effectively review the programme, ensuring continuous improvement. 

The CFWM service will commence over the coming months and be fully operational by late summer 2022. This will allow it to work in close alignment with the NCMP and HAF programmes. 

Opportunities to obtain national research funding to support a study of the impact of the CFWM programme are being sought in partnership with the University of Lincoln. This would allow Lincolnshire to make an important contribution to the national evidence-base.