Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLANDPart 3Management of obesity in theNational Health Service3.1 In this part we consider the roles and activities of theDepartment of Health and NHS bodies, at national andlocal level, which contribute to the twin objectives oftreatment and prevention of obesity. We look at fourdistinct areas of activity:a) Action by the Department of Health and the NHSExecutive;b) Local strategies to address obesity;c) Managing obesity in general practice; andd) Interventions elsewhere in the NHS.a) Action by the Department of Healthand the NHS Executive3.2 Responsibility for policy on public health aspects of dietand nutrition and physical activity, including obesity,falls to the Department's Public Health Group.Appendix 7 provides details of policies and initiativescommissioned or supported by the Department ofHealth since 1997 which address aspects of obesity andthe related areas of diet and physical activity.3.3 Some of the key initiatives that demonstrate theimportance attributed by the Department of Health tothe prevention of obesity include the following:nnnThe NHS Plan 7 . This states the intention to tackleobesity and physical inactivity, informed by advicefrom the Health Development Agency. Action isplanned over the next five years to improve diet,including by increasing fruit and vegetableconsumption and reducing salt, fat and sugar intake;The National Service Framework for coronary heartdisease 6 . This focuses on local action designed toprevent coronary heart disease, such as bypromoting healthy eating and physical activity andreducing overweight and obesity;The annual Health Survey for England 1 . Thisprovides an important source of trend data onphysical activity, eating habits, height, weight andbody shape;nnExercise referral schemes. These give patients whowould benefit from increased physical activityaccess to a subsidised exercise programme throughtheir general practitioner. The Department of Healthplan to release guidance on 'General PractitionerReferral Frameworks' in 2001;Dissemination of the report 'Tackling Obesity- aToolbox for Local Partnership Action', produced bythe Faculty of Public Health Medicine of the RoyalColleges of Physicians 21 . This provides a frameworkfor developing local action plans to prevent andcontrol obesity. The Department paid for this reportto be sent to all health authorities.Central guidance on the management ofobesity3.4 There are no national guidelines for health authoritieson the way in which their plans should address obesity.The most relevant guidance was published inMarch 2000 as part of the National Service Frameworkfor coronary heart disease 6 . The Framework identifiesthe need for each health authority to develop, byApril 2001, effective policies for promoting healthyeating and physical activity and reducing overweightand obesity, and by April 2002 to have in placearrangements for monitoring their implementation. TheHealth Development Agency has produced guidelinesto support the Framework which cover interventionsrelated to lifestyle issues such as physical activity,healthy eating and obesity prevention.3.5 The National Service Framework also identifies the roleof general practitioners and primary care teams intackling overweight and obesity. It sets out a 10 yearprogramme of action with a first priority of treating andadvising those with established cardiovascular disease.A later stage will be to identify and treat those at highrisk of developing cardiovascular disease, but who haveyet to develop symptoms, and to offer appropriateadvice and treatment to reduce their risks. The adviceshould include information about these risks and howthey can be reduced as well as advice about physicalactivity, diet and weight management.part three19