Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLAND3.6 The main source of guidance to health careprofessionals and the NHS on the effectiveness ofinterventions to treat obesity was published in 1995 inan 'Effective Healthcare Bulletin' commissioned by theDepartment from the NHS Centre for Reviews andDissemination at the University of York 22 .b) Local strategies to address obesityOver four fifths of health authorities hadidentified obesity as an issue in their HealthImprovement Programmes as at April 19993.7 Health authorities are required to co-ordinate thedevelopment of Health Improvement Programmes fortheir local area, identifying local health priorities, andtaking account of national strategic directions includingNational Service Frameworks 23 . We undertook a surveyof all 100 health authorities in England (Appendix 1) inthe Summer of 1999 to identify to what extent they hadaddressed obesity in their plans. At the time of oursurvey, there were no milestones set centrally for thedevelopment of local policies for the reduction ofoverweight and obesity.3.8 We found that a substantial majority of healthauthorities had included obesity, healthy eating orphysical activity in their Health ImprovementProgrammes produced in April 1999. Eighty-threeper cent identified obesity either as a risk to publichealth in its own right or as a risk factor for a specificdisease area such as coronary heart disease or diabetes.The extent to which health authorities had developedand implemented relevant strategies, however, variedconsiderably.Some health authorities have action in handto address obesity3.9 Whilst most health authorities had identified obesity asa health risk in their Health Improvement Programme,far fewer saw it as a priority area to be addressedthrough local action. In total, 32 health authorities(34 per cent of the 94 that responded) told us they hadidentified obesity as a local priority, of which 26 saidthat they had taken action to address it. Thirteen had putin place a dedicated strategy or action plan to preventand treat obesity whilst, in the other 13, actions toaddress obesity had been incorporated into widerstrategies to address associated diseases.3.10 Of those health authorities without an obesity strategy,14 were in the process of developing one. For those notdoing so, this was most commonly because the healthauthority had more urgent priorities. About half of thehealth authorities without an obesity strategy told us thattheir plans addressed obesity implicitly by encouragingphysical activity or healthy eating as part of coronaryheart disease or cancer prevention programmes.3.11 The expectation of the Department of Health is that thepublication of the National Service Framework forcoronary heart disease, coupled with the HealthDevelopment Agency's guidance on implementingpreventive measures of proven effectiveness, willencourage all NHS providers and local authorities todevelop such strategies by April 2001.Some health authorities have developedlocal targets for the reduction of obesity3.12 We found a number of examples of quantified andmeasurable targets directly addressing obesity, some ofwhich were based on sub-regional baseline surveyscarried out by the health authority to assess the extent ofthe problem. Most of these targets involved a significantreduction in the local prevalence of obesity, over a fiveto 10 year period, to well below national levels.3.13 Target-setting demonstrates a commitment to take theissue of obesity seriously. However, there is a risk that,unless an obesity prevention strategy is already wellestablished,local targets to reduce the prevalence ofobesity significantly in the medium term may beunrealistic, given the steeply rising trend throughoutEngland. A more realistic five year aim might be to keepthe local prevalence of obesity constant, which itselfwould require effective interventions in order to arrestthe rising trend.3.14 A few health authorities had developed local targets forincreasing physical activity and improving diet. Someexamples are provided in Figure 10. In the short term,targets that provide a direct measure of the effectivenessof interventions in influencing behaviour amongst thelocal population may be the most useful milestones toindicate progress towards halting the rise in theprevalence of overweight and obesity. Clearly, suchtargets must be both realistic and measurable if they areto have any benefit.part three20