TACKLING OBESITY IN ENGLANDAppendix7Department of Health policies and<strong>in</strong>itiatives which address obesity, diet andphysical activityInitiativeSummaryNHS Plan (July 2000)Five-a-day Pilot Project<strong>National</strong> School Fruit SchemeGuidance on Implement<strong>in</strong>g thePreventive Aspects of the <strong>National</strong>Service Framework for CoronaryHeart DiseaseHealthy Schools ProgrammeBreakfast ClubsActive for Life ProgrammeThe <strong>National</strong> Alliance for PhysicalActivity (NAPA)Inter-M<strong>in</strong>isterial Group to ImproveChildren's Diet and ActivitySafe and Sound ChallengeTeacher Tra<strong>in</strong><strong>in</strong>g Guide on Safe andActive School TravelThe Infant Feed<strong>in</strong>g InitiativeHealth Survey for <strong>England</strong>Systematic Review of Interventions<strong>in</strong> the Treatment and Prevention of<strong>Obesity</strong>Directory of Weight ManagementServicesEvaluation of Weight ManagementServicesDiet and nutrition and physical activity are important elements of the NHS Plan for improv<strong>in</strong>g health and reduc<strong>in</strong>g<strong>in</strong>equalities. Action is planned to tackle obesity and physical <strong>in</strong>activity, <strong>in</strong>formed by advice from the new HealthDevelopment Agency established <strong>in</strong> April 2000. The NHS Plan also <strong>in</strong>cludes action to <strong>in</strong>crease fruit and vegetableconsumption and work with the food <strong>in</strong>dustry to improve the overall balance of the 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.Local <strong>in</strong>itiatives are underway <strong>in</strong> five pilot sites to <strong>in</strong>crease consumption of fruit and vegetables across the wholecommunity, particularly <strong>in</strong> poorer areas. Based on evidence of effective <strong>in</strong>terventions, the national roll-out of the schemewill beg<strong>in</strong> <strong>in</strong> 2002.The NHS Plan aims to establish a <strong>National</strong> School Fruit Scheme by 2004. Under the scheme every school child aged fourto six will be entitled to a free piece of fruit each school day, as part of a national campaign to improve children's diets.The practicalities of the scheme will be exam<strong>in</strong>ed through pilots, beg<strong>in</strong>n<strong>in</strong>g <strong>in</strong> Health Action Zones.The Health Development Agency has issued guidance cover<strong>in</strong>g the development of local strategies and <strong>in</strong>terventions topromote healthy lifestyles, relevant to coronary heart disease prevention. This <strong>in</strong>cludes advice on physical activity, healthyeat<strong>in</strong>g and other measures to reduce the prevalence of overweight and obesity.This programme has been developed jo<strong>in</strong>tly with the Department for Education and Employment to improve educationalachievement and, <strong>in</strong> the longer term, to improve public health and address health <strong>in</strong>equalities. The programme encouragesschools to improve the health education and awareness of pupils, staff and the local community by develop<strong>in</strong>g healthyschool activities, <strong>in</strong>clud<strong>in</strong>g those which promote healthy eat<strong>in</strong>g and physical activity. All Local Education Authority areashave an Education and Health Partnership to support local programmes and assist schools work<strong>in</strong>g towards the <strong>National</strong>Healthy School Standard.Breakfast Club pilots were set up across the eight NHS Regions <strong>in</strong> 1999, with fund<strong>in</strong>g through to March 2001. TheDepartment has commissioned an evaluation of the pilots from the University of East Anglia to look at the contributionbreakfast clubs can make to health and educational improvement <strong>in</strong> schools, to exam<strong>in</strong>e their susta<strong>in</strong>ability and cost, andto identify models of good practice.<strong>National</strong> health promotion campaign commissioned from the Health Education Authority from 1996 - 2000 to encouragemore people to take part <strong>in</strong> more physical activity. The programme <strong>in</strong>volved the provision of tra<strong>in</strong><strong>in</strong>g, guidance andpromotional material to health promotion units and physical activity campaigners across <strong>England</strong>, <strong>in</strong>clud<strong>in</strong>g advice onwhat works based on the Health Education Authority's effectiveness reviews. The campaign placed particular emphasis onactivities that were accessible to all and could be built <strong>in</strong>to daily liv<strong>in</strong>g, such as cycl<strong>in</strong>g and walk<strong>in</strong>g.NAPA was convened by the Health Education Authority, with fund<strong>in</strong>g and direction from the Department of Health. It metfrom 1996-2000 to provide a forum for debate on physical activity issues, and direction for the Active for Life programme.Members were drawn from across the physical activity world, <strong>in</strong>clud<strong>in</strong>g representatives from the ma<strong>in</strong> Governmentdepartments, sport, academia, the fitness <strong>in</strong>dustry, schools and local authorities. The group was disbanded follow<strong>in</strong>g theclosure of the Health Education Authority, but the Department is consider<strong>in</strong>g conven<strong>in</strong>g a similar group <strong>in</strong> the future.The Group was set up <strong>in</strong> response to the f<strong>in</strong>d<strong>in</strong>gs of the <strong>National</strong> Diet and Nutrition Survey of Young People aged 4-18 18 ,published <strong>in</strong> June 2000. The group aims to map out cross-departmental action already taken to improve young peoples'diet and physical activity, to identify models of good practice, and to co-ord<strong>in</strong>ate future projects and <strong>in</strong>itiatives. The Groupis chaired by M<strong>in</strong>isters from the Department of Health and the Department for Education and Employment and <strong>in</strong>volvesM<strong>in</strong>isters from several Government departments.The Safe and Sound scheme encourages schools to develop <strong>in</strong>itiatives to promote healthy, active and safe modes of travelto school, with cash prizes awarded to the most <strong>in</strong>novative schemes. In 2000/01, the scheme has targeted schools <strong>in</strong>socially deprived areas.This document expla<strong>in</strong>s to tra<strong>in</strong>ee teachers how physically active modes of travel can be taught as part of the primaryschool curriculum.Research suggests that bottle-fed babies are 50 per cent more likely to become obese than babies breast-fed exclusivelyfor the first 3-4 months. The Infant Feed<strong>in</strong>g Initiative was set up to reduce <strong>in</strong>equalities by encourag<strong>in</strong>g those women leastlikely to breast-feed to do so.Annual survey on the health status of the people of <strong>England</strong>, <strong>in</strong>clud<strong>in</strong>g data on physical activity, eat<strong>in</strong>g habits, height,weight and body shape. It provides authoritative data on the prevalence of overweight and obesity analysed by gender,age group, socio-economic status, household <strong>in</strong>come and geographical region.Review of published research commissioned by the Department from the NHS Centre for Reviews and Dissem<strong>in</strong>ation <strong>in</strong>1997. The aim of the review was to <strong>in</strong>form the work of the Department by identify<strong>in</strong>g the latest state of knowledge ofobesity and highlight<strong>in</strong>g future research needs.Directory of local weight management programmes compiled by self-completion pro-forma sent out by NHS Regional<strong>Office</strong>s and published <strong>in</strong> March 1998. Conta<strong>in</strong>s details of several hundred <strong>in</strong>itiatives, rang<strong>in</strong>g from cl<strong>in</strong>ics and researchprogrammes to buses tak<strong>in</strong>g overweight and obese people to leisure centres and swimm<strong>in</strong>g pools.Analysis of 13 self-evaluations of weight management programmes, published <strong>in</strong> 1998. Concluded that successfulsusta<strong>in</strong>ed cl<strong>in</strong>ically significant weight loss <strong>in</strong> obese patients was rare, and that more work was needed to developstrategies to improve long term weight ma<strong>in</strong>tenance.appendix seven63
TACKLING OBESITY IN ENGLANDInitiativeSummary"Fight<strong>in</strong>g Fat, Fight<strong>in</strong>g Fit" BBC seriesExercise on PrescriptionDissem<strong>in</strong>ation of report '<strong>Tackl<strong>in</strong>g</strong><strong>Obesity</strong> - A Toolbox for LocalPartnership Action'Television series broadcast <strong>in</strong> early 2000 with support from the Department of Health to raise awareness of the risks ofobesity and educate people about ways to achieve and ma<strong>in</strong>ta<strong>in</strong> a healthy weight.Scheme allow<strong>in</strong>g patients who would benefit from physical activity to be referred by their general practitioner tosubsidised exercise programmes with a tra<strong>in</strong>ed <strong>in</strong>structor. The Department is develop<strong>in</strong>g a <strong>National</strong> Quality AssuranceFramework for exercise referral systems to provide best practice guidel<strong>in</strong>es and improve the quality of physical tra<strong>in</strong><strong>in</strong>gprovided.Document produced by Faculty of Public Health Medic<strong>in</strong>e of the Royal College of Physicians provid<strong>in</strong>g a practicalframework for develop<strong>in</strong>g local action plans to prevent and control obesity. The Department has paid for the toolbox to besent to all health authorities.Source: Department of Healthappendix seven64
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