Obesity Pathway GOV WALES

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Overweight and obesity are also risk factors for chronic conditions such as cardiovascular disease. and some cancers Any increases in the levels of such illnesses not only affect the individuals. concerned and their families but also puts pressures on the NHS and society more generally It is. said that we are facing a public health problem that is comparable with climate change both in its. scale and complexity,Summary of key evidence, The Foresight report Tackling Obesities Future Choices and the National Institute for Health and. Clinical Excellence NICE Guidance on obesity have provided a better understanding of the nature of. the challenge and of the interventions needed to make an impact It is clear from these. comprehensive evidence based reports that strategies and interventions should. be long term,focus on healthy weight not just obesity. include all individuals with a focus on children particularly early in a child s development. take a societal approach and tackle obesity at multiple levels personal family community and. tackle the impact that the environment can have on people s ability to be active and eat a healthy. apply evidence based behaviour change theories alongside traditional health education. involve partnership working across Government and with partners in local government LHBs. schools non government organisations industry and the wider society. Further details of the evidence base can be found at. http www foresight gov uk OurWork ActiveProjects Obesity Obesity asp. http www nice org uk CG043, It is recognised that for changes in behaviour to be supported action must occur at a variety of levels. and in different settings addressing the broader determinants of health as described in the diagram. The Role of the Pathway, The Obesity Pathway is a tool for Health Boards working jointly with Local Authorities and key. stakeholders to map local policies services and cross departmental multi agency activity for both. children and adults against the four tiers and then to identify gaps Health Boards and Local. Authorities will then be asked to indicate how they are planning to implement and manage activity. across the full range of determinants which cause obesity and overweight This should be considered. as part of the Health Needs Assessment that will inform Health Social Care and Wellbeing Planning. implementation and evaluation The Pathway should also influence Health Social Care and Wellbeing. Plans Children and Young People s Plans Community Plans and Local Development Plans The. Pathway should inform which services should be available to support the management of obesity but. it is not intended to inform individual clinical treatment plans. Health Boards Local Authorities and their partners in the third and private sectors need to work. closely together through local partnership arrangements to determine how they will contribute to. tackling the challenge of rising levels of overweight and obesity in line with this Pathway A true multi. agency approach is the key to tackling obesity This needs to engage a wide variety of professions. many of which may not currently see improving health as part of their role For example town and. transport planners architects etc can have a huge influence on making the built environment. conducive to physical activity, Specific target groups such as people with learning or physical disabilities black and ethnic.
minorities and low socio economic groups may need additional services planning and which should. be considered during the implementation of the pathway. The minimum service requirements within each tier of the Pathway reflect research evidence from a. variety of different types including randomised controlled trials and qualitative research but most of. the evidence has been presented in systematic reviews The priorities you select from the action. areas highlighted in the tables for each tier of the Pathway will depend upon the gaps identified. through the mapping exercise, National policies programmes and services have been mapped against each of the levels in Annex 1. to enable Health Boards Local Authorities and others to make sure they have the fullest range of. effective interventions available,Links to National Policy and Planning Mechanisms. The new Health Boards have responsibility across the four tiers addressed by this Pathway and are. developing 5 year plans that set out how they will take advantage of the opportunity for integrated. services that this offers There is an expectation that they will aim to rebalance services to. strengthen early effective interventions that reduce the need for later more expensive treatments. Our Healthy Future which aims to improve the quality and length of life and to ensure that everyone. in Wales has a fair chance to lead a healthy life has as two of its ten priorities reducing unhealthy. eating and increasing participation rates in physical activity The development of Health Social Care. and Well being Strategies and Children and Young People Plans will be an opportunity for Health. Boards and Local Authorities to work closely together to create a comprehensive and community. wide approach to managing these issues covering both prevention approaches and access to. treatment for those who need it, The Food and Fitness Promoting Healthy Eating and Physical Activity for Children and Young. People in Wales 5 year implementation plan 2006 sets out some of the ways in which the. Assembly Government is helping to support parents children and young people in their efforts to eat. well be active and achieve the highest standard of health possible It recognises the fact that the. effects of diet and physical activity on health interact particularly in relation to obesity and the need. to integrate healthy eating and physical activity policy and programmes Creating an Active Wales. Strategic Action Plan 2010 aims to contribute to addressing the increase in obesity in combination. with actions to improve healthy eating, This work is also fundamentally linked to the national programme for Chronic Conditions. Management and the details set out in the Model Framework and Service Improvement Plan It also. links to other related areas such as self care and wider primary and community health service. developments, In the current financial climate it is essential that public expenditure is closely scrutinised to ensure.
best value This Pathway is the tool to enable that to happen in relation to expenditure on the. prevention and treatment of obesity within existing resources. Health Boards and Local Authorities need to assess how much obesity and overweight and the. associated problems will cost them over time and the value of investment of energy and resources. upstream in minimising this They need to recognise that the impact of changing priorities in tackling. obesity will not be seen immediately results will be long term This should not prevent action being. taken now The Pathway indicates the wide range of approaches required in improving people s. opportunities for a healthy life and it is vital that in planning services and using resources local. bodies take a balanced view of the response they need. Existing patterns of investment should be critically examined For example prescription of obesity. drugs may not offer such good value as training key staff to deliver weight management courses. The pattern and effectiveness of different approaches should be regularly assessed. Obesity Pathway,Minimum service requirements,everyone should have access to. Level 4 Specialist medical and surgical,services including bariatric surgery. Intensive physician led specialist obesity,Level 4 management by multi disciplinary team of. Specialist expert practitioners,Access to specialist assessment and surgery. medical and at a bariatric surgery centre offering a choice. surgical of surgical interventions,Provision of specialist long term post.
services operative follow up and support with agreed. criteria for discharge back to levels 2,Targeted one to one physician led. intermediate or secondary care multi,Targeted gateway. disciplinary team intervention if level,one to one MDT 3 interventions exhausted. Level 3 Level 3 Specialist multi disciplinary,team weight management services. Specialist weight management services e g, Specialist multi disciplinary weight management clinics.
in the community intermediate or secondary,MDT weight care and dietetic weight management. Co morbidity,BMI waist circumference, management programmes that incorporate physical activity. and behavioural change components, services Pharmacological interventions initiated by. physicians supported by targeted,programmes,Targeted dietetic and physical activity. Targeted gateway dietetic weight management intervention if. and physical activity support level 2 interventions exhausted. BMI waist circumference,Level 2 Level 2 Community and primary care.
weight management services, Community and Identification of people who are overweight. Complexity co morbidity,obese with risk factors, primary care Primary care weight management services. Complexity,weight Community based weight management. programmes referred into by primary care,management. Community Intervention for, Targeted gateway Community overweight obese if level 1.
Intervention for overweight obese interventions exhausted. Level 1 Community based prevention,and early intervention self care. All relevant policies to incorporate the health, Level 1 agenda and contribute to the creation of an. environment that supports promotes a,healthy weight. Community based Lifestyle advice and information signposting. prevention and early to public health interventions services. Combined nutrition and physical activity,intervention self care programmes in key settings. Opportunities across settings age groups to,develop skills knowledge on healthy eating.
and physical activity,Self referral and opportunistic community. based weight management programmes that,meet best practice guidelines. Best practice, The risk associated with obesity and the level of intervention required should be interpreted and. discussed with the individual and should take into account BMI waist circumference and existence of. co morbidities see Annex 2, Community based prevention and early intervention self care. The aim of this level is to ensure availability and promotion to the public of a range of opportunities to. support children young people and adults in achieving and maintaining a healthy body weight without. the need to access specific health services backed by the provision of a supportive environment. Evidence suggests that interventions for prevention should focus on four factors. Major socio economic determinants of unhealthy eating and physical inactivity at the. population level,Environmental determinants of behaviour.
A combination of community neighbourhood workplace school and individual approaches. Whole family approaches, Minimum service Action Areas Examples of possible local. requirements practice, All relevant policies Action focused on the physical Planning policy to support. to incorporate the environment changing the physical activity and healthy. health agenda and obesogenic environment to eating e g provision of. contribute to the enable people to have easy safer cycling environment. creation of an access to healthy food choices both on and off road well lit. environment that and be physically active walking routes. supports promotes a Implementation of healthy food development of safe play. healthy weight and drink and physical activity areas and limiting number. guidelines policy across key of fast food outlets, settings including early years Policy to promote access to. schools further and higher healthier food choices e g. education workplaces and encouraging shops and,other community settings caterers to promote. healthier food choices,through signage price,promotions etc promotion.
of healthier choices at,public events provision of. healthy food choices at,leisure centres,Active travel planning. Schools developing and,implementing a food and,fitness policy. Lifestyle advice and Use of the Change4Life sub Local Health Challenge. information brand of Health Challenge websites providing details of. signposting to public Wales for healthy eating and local opportunities such as. health physical activity branding and walking groups food co. interventions services messages in marketing of local ops free swimming. interventions services exercise and fitness classes. Effective marketing of and cookery classes,consistent accurate messages branded Change4Life. to the public Local promotion of national,Effective marketing of local schemes such as the.
opportunities Healthy Start programme,Community pharmacists. providing opportunistic,lifestyle advice and,information. Combined nutrition Combined nutrition and Through the Welsh Network. and physical activity physical activity interventions in of Healthy School. programmes in key the following settings adopting Schemes schools introduce. settings whole setting approaches a range of initiatives such. Community as opportunities for outdoor,Early Years play cookery clubs. Obesity Pathway Introduction In Wales as in many other countries the proportion of adults and children who are not maintaining a healthy body weight is increasing The most recent data from the Welsh Health Survey 2008 shows that over half of men 62 and women 53 are classified as overweight or obese the proportions rising to 72 and 62 respectively among 45 64 year olds The

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