Agenda item

Philip Williams, Head of Localities Commissioning made a presentation on a new strategic approach to healthy weight in Barking and Dagenham. He outlined the scale of the problem with the Borough having one of the highest rates of overweight and obese adults and children in London leading to increased risk of morbidity and mortality from conditions such as type 2 diabetes, hypertension, cardiovascular diseases, liver disease and some cancers. National child weight measurements had recently been issued which were not good, but also masked some considerable differences across the Borough with some schools having up to 70% of the children that were considered overweight or obese compared to an overall average of around 40%.

The primary means for tackling the issue has been through the delivery of individualised weight management programmes, with the focus of many of these programmes focussing on supporting individuals who were at higher risk of disease due to their unhealthy weight. Given there were of the order of 100,000 adults classified as overweight/obese it would take more than 150 years to offer everybody a programme, which was simply not practical. Also, evidence showed that generally this approach did not lead to sustained changes in healthy behaviours beyond the life of the programme. Therefore, this has necessitated a different way of doing things at a population level. There were many different interconnecting factors involved with the issue from environment, social, economic, cultural, biological, to where people live etc. Consequently, this needed to be addressed in the round rather than focussing on simply being overweight. There were hard choices to make and certainly no quick fixes, but it was vital to start somewhere.

The approach needed to be a whole Borough Partnership. It was not feasible for one body such as the Council to solve the problem. It would require a partnership approach around food, activity, the environment collectively supporting work around healthy weight. The proposal involved designing a new model of support that recognises all these factors, providing upstream interventions connecting heath, the Council, the VCS and local community groups.

To achieve the aims of this new approach this Forum needs to facilitate the change working with a provider who will act as an enabler in the process, using their expertise in engaging with communities, networks and partners, and their experience of developing innovative healthy weight initiatives.  Once a partner was in place it was proposed to engage them to do the design work in Phase 1 between July 2024 and March 2025 and implement a Health Weight Plan under Phase 2 from April 2025.

Mr Williams outlined what the Plan would look like, which would involve amongst other things, supporting ongoing partnership work around food, activity, and the environment, facilitating the delivery of co-produced community weight and nutrition activities, and working with the likes of the VCFS and partners, to build a volunteer/ network of healthy weight champions and peer support groups.

There were of course inherent risks. It would be a lot harder to achieve, but unless it was tackled as a system approach then inevitably it would fail. It needed to be inclusive and accessible and something that fitted in with people’s lives. Tackling obesity would require a sustained and integrated set of measures to address social norms so that over time healthy behaviours would become easier for all. When delivered across a whole system multiple small changes in large numbers of people can have a large impact at population level.

The Chair recognised that this was a huge shift for everybody, but seeing the results of recent engagement work around healthy lifestyles it was clear that residents were keen to make positive changes, and therefore the challenge for this Forum, was: are we ready to help our residents make those changes?.

The approach being advocated was very much supported by this Forum as clearly the current strategy was not working for residents, although along with lifestyle changes it was important to consider pathways as currently there was not a pathway for obese children in the Borough.

A lot of work was achieved in the recent Borough wide pop up where child height and weight measurements were undertaken. The results of that work showed that a number fell into the overweight category. According to the parents there was very little knowledge as to where to seek help and advice. Most of the parents wanted to see a family approach. Dr Hara who did this work would be happy to share the results with this Forum, as she had with the Public Health team, whom she was working with on childhood obesity.

Dr Hara requested that the membership and co production of the strategy needed to be a little wider, suggesting that it would be helpful to reach out to the likes of Tesco and other major supermarket chains who run young children activity and lifestyle programmes, to see how the Borough might tap into the resources they have. A lot of her patients were getting obese as they could not afford the cost of fresh fruit and vegetables, and to that end perhaps the supermarkets could be asked to support us, and then we could ‘retrain their plate’ to eat more healthier, seeing many have an emotional connection to their plate.

Craig Nikolic, Together First CIC said that they now had considerably more data, and the right level of demographic information, and were now in a position to target those with severe obesity in a more informed way. The Chair responded that whilst we might have the data, the key was how do we change the overall approach, not just eating habits, but also the lack physical exercise, seeing that the Borough has the least active population in the Country. A whole system approach needed to be tackled and what represented the biggest challenge.

Fiona Taylor, Chief Executive added that all partners could get behind the strategy. She stated that in the past most had run programmes with no definable outcomes, thinking that was enough. Moving forward we needed to identify what are the key things that as system leaders we can really impact change and certainly obesity was one of those things. This forms an essential part of the localities model which as Fiona Russell added needed to be community lead. In terms of system wide and it being a priority, the recent Peer Review into Public Health indicated that partners had too many priorities and made too many commitments. Therefore, there needed to be a clear focus and to that end coming together behind childhood obesity, felt like a step in the right direction.

Other comments expressed were about the wider aspects of the strategy, highlighting as an example that if we advocate greater exercise in green spaces, then how safe do people feel about using these spaces and consequently we may need to consider other factors such as the prevalence of knife crime in certain parts of the Borough. Acknowledging this point, there was already a Childhood Obesity Task and Finish Group, the membership of which could be expanded to consider these aspects. On this point the Cabinet Member for Enforcement and Community Safety outlined the work of the SNT’s in the Council’s parks and open spaces which was having a positive effect in reducing anti-social behaviour and knife crime, and leading to a greater use of our green spaces by the community.

Charlotte Pomery, ICB and Deputy Chair in supporting the whole system approach made a few comments. She recognised that whilst it was a good start there was clearly a lot more work required such as what would the strategy mean for commissioning, if health services adopted something that was less individually based, and what would this look like. She was pleased it was aligned to localities and proposed to be community led, as this sent a powerful message and something she would be keen to run with across NEL. She was also aware that a lot was being done around health equalities funding and whether we should top slice some of that. She felt that there was a lot more that could be done to achieve a wider population health approach to commissioning of the health services.

Ann Hepworth, BHRUT felt that we must accept that we cannot fix the problem and that for this whole system approach to succeed we must not follow the usual path and potentially suffocate this with our processes such as Task and Finish Groups, but instead support communities to find their own solutions and create possibilities.

Healthwatch were putting together its work plan for next year and would be happy to revisit this topic and build on its existing community engagement and equally would be keen to co plan. This was particularly welcomed by Dr Sharma, Clinical Director, Barking & Dagenham who was keen to get our workforces involved, as maintaining staff health and wellbeing was vital in terms of helping and supporting residents.

Mention was made that whilst families may have the knowledge and awareness to buy and cook fresh food, the fact that many were in fuel poverty was a significant factor and should form part of the whole system approach. This had been highlighted by parents in the engagement feedback, with one solution being to establish communal kitchens where families could prepare and eat together. This could build on similar initiatives which community groups are operating in the Borough.

In conclusion in welcoming the report, the HWBB and Committees in Common recognised the need to urgently change the approach to managing healthy weight in Barking and Dagenham and therefore AGREED the new strategic way forward as presented.