TACKLING OBESITY IN ENGLANDRegional <strong>Office</strong>s of the NHS Executive andhealth authorities1.8 The Department of Health also assumes overallresponsibility for ensur<strong>in</strong>g that appropriate treatmentsare identified and made available through the <strong>National</strong>Health Service. The eight Regional <strong>Office</strong>s of the NHSExecutive work with health authorities to ensure thateach region has a set of Health ImprovementProgrammes which address local needs and areconsistent with the national priorities of the NHS.Health authorities have a strategic role to co-ord<strong>in</strong>atethe local health economy to deliver on the NHSpriorities, <strong>in</strong>clud<strong>in</strong>g by provid<strong>in</strong>g the standards andservice models set out <strong>in</strong> <strong>National</strong> Service Frameworks.In compil<strong>in</strong>g its Health Improvement Programme, eachhealth authority is required to <strong>in</strong>volve a wide range oflocal stakeholders <strong>in</strong>clud<strong>in</strong>g Primary Care Groups andTrusts, NHS Trusts, general practices, local authorities,and local agencies and communities.NHS providers1.9 As detailed <strong>in</strong> the <strong>National</strong> Service Framework forcoronary heart disease 6 , NHS Trusts and Primary CareGroups and Trusts are required to contribute to thedelivery of local programmes of effective policies forreduc<strong>in</strong>g overweight and obesity.1.10 General practices are where 95 per cent of patientcontacts with the NHS occur 8 . General practitioners arerequired to offer all newly registered patients aconsultation with a full physical exam<strong>in</strong>ationcompris<strong>in</strong>g the measurement of height and weight.Thereafter, general practitioners are required to offerphysical exam<strong>in</strong>ations for the purpose of identify<strong>in</strong>g andreduc<strong>in</strong>g the risk of disease. The <strong>National</strong> ServiceFramework for coronary heart disease sets out aprogramme of action to improve services for coronaryheart disease. The first priority is to identify and treatpeople with established cardiovascular disease. A laterstage will be to identify people at significant risk ofcardiovascular disease and to offer appropriate adviceand treatment to reduce their risks. This <strong>in</strong>cludes adviceon reduction <strong>in</strong> weight or referral to appropriatespecialists. General practices also provide a forum tooffer broad advice to patients on healthy liv<strong>in</strong>g, such ason healthy eat<strong>in</strong>g and the benefits of physical activity.1.11 The NHS more widely f<strong>in</strong>ances and monitors specialisthelp for obese patients referred by general practitioners,<strong>in</strong>volv<strong>in</strong>g dietetics, hospital-based cl<strong>in</strong>ics and, <strong>in</strong> somecases, surgery. Hospital admissions also provide anopportunity to assess health risks associated with excessweight and to refer patients for appropriate help.Other Government departments1.12 The Public Health Group of the Department of Healthliaises with the representatives of other Governmentdepartments <strong>in</strong> order to advise on policies and <strong>in</strong>itiativesto improve health, <strong>in</strong> particular <strong>in</strong> relation to dietand nutrition, health education, transport andphysical recreation.1.13 Relevant Government departments and agencies<strong>in</strong>clude the Department for Culture, Media and Sport,Sport <strong>England</strong> and the Sports Councils; the Departmentfor Education and Employment; the Department of theEnvironment, Transport and the Regions and theHighways Agency; the Food Standards Agency; and theM<strong>in</strong>istry of Agriculture, Fisheries and Food. They have ageneral duty to work with the Department of Health aspart of jo<strong>in</strong><strong>in</strong>g up government with<strong>in</strong> the overallumbrella of the Modernis<strong>in</strong>g Government <strong>in</strong>itiative 9 .They also have specific objectives that relate toprotect<strong>in</strong>g the public health and promot<strong>in</strong>g healthylifestyles, for example through improv<strong>in</strong>g diet, achiev<strong>in</strong>gwider participation <strong>in</strong> sport and physical activity, andencourag<strong>in</strong>g healthy modes of transport.part one9
TACKLING OBESITY IN ENGLANDStudy methodology1.14 Our methodology is set out <strong>in</strong> detail <strong>in</strong> Appendix 1. The ma<strong>in</strong> features are:n literature review and consultation withrepresentatives of a wide range of <strong>in</strong>terested parties,<strong>in</strong>clud<strong>in</strong>g voluntary bodies represent<strong>in</strong>g obesepeople;nnnadvice from a panel of em<strong>in</strong>ent experts on obesity;a cost-of-illness study undertaken for us by theDepartment of Economics at City University.Appendix 6 conta<strong>in</strong>s the detailed methodology forthis study;a survey of all health authorities <strong>in</strong> the Summer of1999 to exam<strong>in</strong>e their role <strong>in</strong> plann<strong>in</strong>g and coord<strong>in</strong>at<strong>in</strong>g<strong>in</strong>itiatives to address obesity and promotehealthy lifestyles;n a postal survey of a representative sample of 1,200general practitioners and 1,200 practice nurses<strong>in</strong> Summer 1999 to establish how overweightand obese patients visit<strong>in</strong>g their general practiceare managed;nnnface-to-face <strong>in</strong>terviews with 20 general practitionersand 16 practice nurses <strong>in</strong> November and December1999 to learn more about their experiences oftreat<strong>in</strong>g obese patients and their perceptions ofthe problem;<strong>in</strong>terviews with policy personnel at the relevantGovernment departments to exam<strong>in</strong>e howeffectively departments were work<strong>in</strong>g together andwith other agencies to promote healthy lifestyles;andsite visits to exam<strong>in</strong>e local <strong>in</strong>itiatives at schools andhospitals and specialist centres.part one10