TACKLING OBESITY IN ENGLAND4.27 The <strong>National</strong> Diet and Nutrition Survey is a programmeof cross-sectional surveys to assess the diet andnutritional status of different age groups with<strong>in</strong> thepopulation of Great Brita<strong>in</strong>. The Food Standards Agencyand the Department of Health work together to design,commission and manage the surveys to ensure that theresults support the implementation and monitor<strong>in</strong>g ofnutrition policy. The surveys are funded jo<strong>in</strong>tly by theAgency and the Department.4.28 The Department of Health's Nutrition Researchprogramme is fund<strong>in</strong>g a number of projects relevant toobesity:nna systematic review of the characteristics of childrenwho become obese adults;the development of a family based <strong>in</strong>tervention toprevent obesity <strong>in</strong> a high risk group;4.30 The 'Balance of Good Health' plate is a diagrammaticrepresentation of the types and proportions of foods thatmake up a healthy, balanced diet. This model depictsGovernment advice on healthy eat<strong>in</strong>g <strong>in</strong> the form offoods rather than <strong>in</strong> terms of nutrients. The FoodStandards Agency is consider<strong>in</strong>g plans for furtherdissem<strong>in</strong>ation of the model.4.31 In July 2000, the Department of Health announced aspart of the NHS Plan 7 proposals to improve diet andnutrition by a series of measures by 2004 <strong>in</strong>clud<strong>in</strong>g:nna five-a-day programme to <strong>in</strong>crease fruit andvegetable consumption, and a new national schoolfruit scheme;reform of the welfare foods programme to ensurechildren <strong>in</strong> poverty have access to a healthy diet,and <strong>in</strong>creased support for breast feed<strong>in</strong>g;nthe extent to which energy and fat consumption canbe estimated from supermarket receipts; andna hospital nutrition policy to improve the outcome ofcare for patients;na longitud<strong>in</strong>al analysis of child and adolescentpredictors of adult obesity based on the 1958 birthcohort.4.29 The Food Standards Agency, <strong>in</strong> consultation with theDepartment of Health, is also sponsor<strong>in</strong>g research <strong>in</strong>tofood acceptability and choice, aim<strong>in</strong>g to encourage ashift away from fatty foods and towards a greaterconsumption of starchy foods and fruit and vegetables.nnwork with <strong>in</strong>dustry- <strong>in</strong>clud<strong>in</strong>g producers as well asretailers- to <strong>in</strong>crease provision and access to fruitand vegetables with local <strong>in</strong>itiatives, wherenecessary, to establish local food co-operatives; and<strong>in</strong>itiatives with the food <strong>in</strong>dustry- <strong>in</strong>clud<strong>in</strong>gmanufacturers and caterers- to improve the overallbalance of diet <strong>in</strong>clud<strong>in</strong>g salt, fat and sugar <strong>in</strong> food,work<strong>in</strong>g with the Food Standards Agency.21 The Balance of Good Healthpart fourSource:Food Standards Agency38
TACKLING OBESITY IN ENGLANDInitiatives target<strong>in</strong>g children and youngpeopleiv. Equipp<strong>in</strong>g young people for a healthylifestyle4.32 For most people, the values, perceptions and patterns ofbehaviour that are formed dur<strong>in</strong>g childhood andadolescence are an important <strong>in</strong>fluence on their lifestyle<strong>in</strong> adulthood. Moreover, levels of fatness seem to be<strong>in</strong>creas<strong>in</strong>g amongst schoolchildren 34 , and the <strong>National</strong>Diet and Nutrition Survey, published <strong>in</strong> 2000 18 , givescause for concern about children's diets, nutritionalstatus and physical activity levels. Young peopletherefore need an understand<strong>in</strong>g both of the risks thatobesity poses to health, and of the ways to ma<strong>in</strong>ta<strong>in</strong> ahealthy weight.4.33 The Department for Education and Employment is amajor player at central Government level <strong>in</strong>encourag<strong>in</strong>g the education of young people <strong>in</strong> thebenefits of a healthy lifestyle, <strong>in</strong>clud<strong>in</strong>g the benefits ofphysical activity and a healthy diet. The Department alsohas a role <strong>in</strong> ensur<strong>in</strong>g that a healthy environment isprovided <strong>in</strong> schools: <strong>in</strong> particular that schools offernutritious lunches, such as by provid<strong>in</strong>g fruit andvegetables and avoid<strong>in</strong>g an excess of foods with a highfat, salt or sugar content; and that they provideopportunities and encouragement for physical activity.These aims fall with<strong>in</strong> the Department's generalobjective to ensure that all young people reach 16 withthe skills, attitudes and personal qualities that will givethem a secure foundation for lifelong learn<strong>in</strong>g, work andcitizenship <strong>in</strong> a rapidly chang<strong>in</strong>g world. They are alsocongruent with the Department of Health's objective toencourage people to live healthily.4.34 Figure 22 illustrates where the policy objectives of thetwo departments <strong>in</strong>tersect <strong>in</strong> relation to diet andphysical activity, and shows which type of cross-cutt<strong>in</strong>g<strong>in</strong>tervention they have used.4.35 The Department of Health and the Department forEducation and Employment consult one another to worktowards achiev<strong>in</strong>g these mutual objectives. This<strong>in</strong>volves:nnnnhigh level consultation on policy issues, such aswhen a White Paper or draft legislation is prepared;ongo<strong>in</strong>g liaison at a work<strong>in</strong>g level over relevantaspects of the school curriculum, <strong>in</strong> particularbefore any changes are made;staff secondments or loans to raise mutual awarenessand encourage collaboration. This <strong>in</strong>cludes the longstand<strong>in</strong>garrangement <strong>in</strong> which the Department ofHealth has provided a member of medical staff tocontribute to policy and services, and advise theDepartment for Education and Employment onaspects of the education system where a knowledgeof health issues and policy is needed; anddetailed liaison, <strong>in</strong>clud<strong>in</strong>g through sett<strong>in</strong>g up jo<strong>in</strong>tteams and work<strong>in</strong>g groups, to consider specificissues. For example, the recent development ofnutrition standards for school meals necessitatedalmost daily <strong>in</strong>formal contact at a work<strong>in</strong>g level overa period of several months.4.36 The Department for Education and Employment told usthat there were four ma<strong>in</strong> areas of the curriculum wherechildren have the opportunity to acquire the knowledgeand skills that will help them to live healthily: personal,social and health education; physical education;nutrition; and food technology. We exam<strong>in</strong>e physicaleducation, nutrition and food technology at paragraphs4.46-4.64 overleaf.22 The l<strong>in</strong>ks between health and educationDepartment of HealthTo improve healthand reduce health<strong>in</strong>equalitiesEnsur<strong>in</strong>g that education is providedon health, diet and physical activityand that the school environmentpromotes healthy lifestylesDepartment forEducation and EmploymentTo ensure young peoplereach 16 with the skills,attitudes and personalqualities to give them asecure foundation forlifelong learn<strong>in</strong>g, workand citizenshipHealth DevelopmentAgencyTo provide evidence andguidance on what worksto improve healthn Regular consultation on aspects of the school curriculumn Shar<strong>in</strong>g <strong>in</strong>formation to <strong>in</strong>crease mutual awarenessn Jo<strong>in</strong>t teams on specific issues (eg school travel and school meals)n Second<strong>in</strong>g staff to encourage collaborationn Jo<strong>in</strong>t publications and guidancen Inter-M<strong>in</strong>isterial Grouppart fourSource:<strong>National</strong> <strong>Audit</strong> <strong>Office</strong>39