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Energise Knowsley
2009 – 2012 Healthy Weight Strategy
June 2009
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1. Foreword 3
2. Introduction 4■ Background■ Causes of Obesity■ Impact of Obesity■ Benefits of Weight Loss
3. The Size of the Problem: Obesity Prevalence 6■ National Obesity Prevalence■ Knowsley Obesity Prevalence■ Inequalities and Local Patterns of Obesity
4. National Policies & Strategies 12■ Healthy Weight, Healthy Lives: A Cross Government Strategy for England■ A Framework for Local Action■ National Targets and Indicators■ Local Targets and Indicators■ Reversing Obesity Levels Back to the Year 2000 - What Does This Mean
for Knowsley?
5. Review of: Energise Knowsley – Obesity Strategy 2004 – 2008 19■ Progress to Date and What We Have Already Delivered■ Activities and Service Developments 2004 - 2008■ Overall Impact of Energise Knowsley 2004 - 2008
6. Moving Forward: Energise Knowsley 2 – Healthy Weight Strategy 31■ Developing the Strategy – Community Engagement and Involvement■ Vision■ Aims■ Underpinning Principles ■ Objectives■ How We Will Deliver the Strategy■ Research and Evaluation
7. A New Approach: Becoming More Targeted 36■ Evidence of What Works■ A Commissioning Approach to Obesity Interventions■ What We Plan to Do Next■ How Will the Strategy be Funded?
8. Conclusion 42
9. Energise Knowsley Healthy Weight Action Plan 2009 – 2012 43
10. References 60
11. Appendices:A. Defining Obesity and Overweight 62B. Healthy Weight Pathways 63C. Summary of Evidence; Infants and Children 65D. Prevention for Overweight and Obesity in Adults 66E. Membership of Healthy Weight Partnership Board 67
12. Acknowledgements 68
ContentsPage
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1. Foreword
In Knowsley, obesity has been seen as a priority for action since 2004, when welaunched the first Energise Knowsley Obesity Strategy. Since then, an enormousamount of work has been undertaken within the Borough, to make it easier for peopleto eat more healthily and become more physically active.
This strategy document summarises the activities and the impact of the 2004-2008Energise Knowsley Strategy and describes the way forward for the next three years,2009-12. The aim is to enable all residents of the Borough to achieve a healthyweight, and there is a particular emphasis on encouraging a healthy weight for youngchildren and their families; the evidence shows that reducing obesity in young childrenand their families will have the greatest impact on the future health of the residentsof the Borough.
We commend this strategy to you.
Dr Diana Forrest Damian AllenDirector of Public Health Executive Director of Children and Family Services
June 2009
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2. Introduction
Background
Obesity is now recognised as an increasing threat to the health of individuals andcommunities and is viewed as a major public health issue. It has been identified as one ofthe most important preventable challenges to health, second only to smoking (1).
The prevention and management of obesity should be a priority for all, because of theconsiderable health benefits from maintaining a healthy weight and the health risksassociated with overweight and obesity (2) (The definition of Obesity is given in Appendix A).
Energise Knowsley - Healthy Weight Strategy 2009 - 2012 has been developed and basedupon the first obesity strategy ‘Energise Knowsley 2004’. The focus of this new healthyweight strategy is to deliver a more targeted approach to prevention by identifying andsupporting children and families most at risk of obesity. Therefore this strategy aims tostabilise obesity levels locally, reducing the incidence of new cases particularly targetingchildren and families with the longer term goal of reducing obesity rates overall. This strategywill build on the universal population based approaches of encouraging people to undertakemore physical activity and improve their diets.
In light of the new national target, which prioritises children in the first instance and the lackof any adult target nationally or in the Local Area Agreement, it is appropriate to considerprioritising children and family based interventions for the next 3 years. The universal healthylifestyle programmes will still continue across the whole population and the adult orientatedsupport and treatment options will also still remain. However this new focus will allow for newdevelopments and commissioning to prioritise gaps in current provision around targeting ofchildren & families.
The Strategy Action Plan for 2009-12 (pages 43 - 59) has been divided into three sections -(1) children and families, (2) adults and (3) the obesogenic environment. Each section has anumber of actions some of which are continuations of existing programmes from EnergiseKnowsley 2004, and others are new developments for the next three years. The Action Planincludes details of interventions and projects, how they will be measured and how theseactions link to other key local strategies and documents.
Causes of Obesity
Obesity is a condition where an individual’s body fat stores are enlarged to an extent thatimpairs health. Some people are more susceptible to weight gain for genetic reasons. Alsoa broad range of environmental, social and individual lifestyle factors interact to contribute tocausing obesity. However the main reasons for increasing obesity in the population are theincreased consumption of high fat, high sugar foods, increasing levels of alcohol consumptionand the reduced levels of physical activity throughout the population.
The core of the obesity problem is simple – we eat too much and undertake too little physicalactivity. The solution is more complex. Due to the acknowledged complexity of obesity, theproblem will not be reversed by any single approach. A successful strategy will need tochange many aspects of people’s lives and the environment which encourages obesity. Manyof the causes of obesity are woven into the fabric of modern lifestyles. The way forward is tohelp people make healthy choices from childhood through to old age. The term ‘obesogenicenvironment’ refers to the role environmental factors may play in determining both energyintake and expenditure. It has been defined as the ‘sum of the influences that thesurroundings, opportunities or conditions of life have on promoting obesity in individuals andpopulations’ (3). The term embraces the entire range of social, cultural and infrastructuralconditions that influence an individual’s ability to adopt a healthy lifestyle. The aim of thisEnergise Knowsley - Healthy Weight Strategy is to try and counteract the causes of obesityand to promote and achieve healthy weight and healthy lifestyles for Knowsley residents.
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Impact of Obesity
Being overweight or obese can have a severe impact on an individual’s physical health – bothare associated with an increased risk of diabetes, cancer, and cardio-vascular and liverdisease among others. Adult obesity causes a reduced life expectancy of 8-10 years mainlythrough those diseases (4). It can also impair a person’s well-being and quality of life.
The rise in childhood obesity has the potential to reverse the trend in life expectancy. For thefirst time in two centuries, children may not live as long as their parents (5). There is strongevidence to associate childhood obesity with increased risk of: cardiovascular disease; raisedblood pressure; adverse lipid profiles; adverse changes in the heart; and over-production ofinsulin. Overweight and obesity in childhood are known to impact on the psychological well-being of children, with many developing poor self-esteem (6, 7). Children who are overweightand obese are likely to continue to be overweight and obese as adults, with weight gainincreasing with age.
Obesity and the associated illnesses put pressure on families, the NHS and society morebroadly and, without action, the cost to society is forecast to reach £50 billion per year by 2050 (5).
Benefits of Weight Loss
It therefore makes sense that weight loss in obese and overweight people should beencouraged, bringing with it a variety of significant health benefits. Surprisingly markedbenefits to an individual’s health can be demonstrated with only a modest body weight lossof 10%, including more than a 20% reduction in total mortality (8).
Summary of Health Benefits Associated with a 10% Body Weight Loss (8)
Mortality > 20% fall in total mortality> 30% fall in diabetes - related deaths> 40% fall in obesity - related cancer deaths
Blood Pressure Fall of approximately 10mmHg systolic and diastolic
Diabetes Fall of 50% in fasting glucose
Lipids Fall of 10% total cholesterolFall of 15% low density lipoproteins (LDL)Fall of 30% triglyceridesIncrease of 8% high density lipoproteins (HDL)
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3. The Size of the Problem: Obesity Prevalence
National Obesity Prevalence
Obesity levels are rising in the United Kingdom. The prevalence of obesity among adults inEngland has increased from 6% in males and 8% in females in 1980 to 23.7% & 24.2%respectively in 2006. In England alone, nearly a quarter of men and women are now obeseand two thirds of adults are either overweight or obese (13).
Body Mass Index (BMI) among adults in England, by age and gender, 2006
Weight Category All 16-24 25-34 35-44 45-54 55-64 65-74 75+adults % % % % % % % %
MenUnderweight 1.2 5.5 0.2 0.4 0.1 0.5 0.4 0.6Normal 31.7 60.8 37.7 26.5 23.7 19.9 19.2 30.5Overweight 43.4 24.7 41.3 48.1 48.1 46.6 49.4 51.0Obese 23.7 9.0 20.7 25.0 28.1 33.0 31.1 17.8Overweight 67.1 33.7 62.0 73.1 76.2 79.6 80.4 68.8including obeseMorbidly obese 1.5 0.9 1.1 1.6 1.7 2.7 1.2 0.2WomenUnderweight 2.1 6.5 2.2 1.0 0.7 1.2 1.3 2.3Normal 41.8 61.8 50.3 45.2 36.9 33.0 26.5 28.7Overweight 31.9 19.7 29.2 30.1 35.2 35.7 37.5 41.6Obese 24.2 12.0 18.2 23.7 27.2 30.2 34.7 27.4Overweight 56.1 31.7 47.5 53.8 62.4 65.9 72.2 69.0including obeseMorbidly obese 2.7 1.4 2.0 3.1 3.1 3.4 3.6 1.6
Source: Health Survey for England 2006. The Information Centre
The trends for children are even more cause for concern. Almost a fifth of 2 to 5 year oldsare obese, while a third are either overweight or obese (14). A report from the National ChildMeasuring Programme (2008) (14) that measures children at age 4/5years and 10/11yearsstates that:
• Almost 1 in 4 of 4 - 5 year olds was either overweight or obese and nearly 1 in 3 10 - 11 year olds
• Obesity was higher in boys than in girls for both age groups• Obesity levels were higher in 10 - 11 year olds than in 4 - 5 year olds• Childhood obesity levels were higher in urban areas than rural• There is a strong positive link between deprivation and obesity prevalence.
The Health Select Committee (15), states that most overweight or obese children becomeoverweight or obese adults; overweight and obese adults are more likely to bring upoverweight children. Children from families where at least one parent is obese are at greaterrisk, and a child who has two overweight or obese parents is six times more likely to beoverweight or obese than a child with two healthy weight parents.
Current trends indicate that without clear action, these figures will rise to almost nine in tenadults and two-thirds of children by 2050 and Britain will become a mainly obese society (5).
Age Group
Age Group
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Knowsley Obesity Prevalence
Adults
The 2006 Adult Health and Lifestyle Survey (16a) showed that Knowsley reflects the nationaltrend of rising obesity levels. Over a 5 year period from 2001 - 2006 obesity has increasedfrom 14.1% to 20% in the respondent adult population. This increase is reflected across allages from 18 years to 65+ years.
Adult Obesity in Knowsley, 2001 and 2006
According to the same survey between 2001 and 2006, the proportion of overweight adultsin Knowsley reduced by nearly 15% to 35.5%. This was reflected across all the age groups.The proportion of respondents in Knowsley who are overweight or obese has also fallenbetween 2001 and 2006 in each of the age groups and overall from 64% to 56% respectively.
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Children
Since 2005/6 Knowsley has participated in the Department of Health National Child Weighingand Measuring Programme. This is carried out annually and includes Reception (4/5 year olds)and Year 6 (10/11 year olds) children. For 2007/8, the Department of Health target was toweigh 90% of reception year and 85% of year 6 school children. NHS Knowsley met this target.
Childhood Obesity in Knowsley, 1998 - 2008
The levels of obesity in reception year children vary from year to year and have rangedbetween 8.6% and 13.7%. The proportion decreased to 11.8% in 2007/8, In 2007/8, Englandand the North West had obesity levels of 9.6% and 10% in reception year (17).
For Year 6 children, obesity levels were at their highest in 2001/2 at 21.6% and have nowfallen to 21%. Regional and national obesity levels for year 6 children in 2007/8 were 18.3%respectively.
Inequalities & Local Patterns of Obesity
Deprivation
The recent Foresight 'Tackling Obesities: Future Choices' report (5) predicted that those whoare already disadvantaged are more likely to suffer obesity and the considerable problemsassociated with it. This disparity is most evident among women and children: 32% of womenin the poorest fifth of English households are obese compared to only 19% of women in therichest fifth (28); while children from the lowest income households are almost twice as likelyto be obese than those from the highest income households (28). Studies consistently showthat residents of neighbourhoods characterised by socio-economic disadvantage tend toexhibit higher rates of obesity.
People from the poorest households are least likely to meet the recommended levels ofphysical activity. They are also the most likely to be sedentary – achieving less than 30minutes of physical activity per week. For example, 44% of women and 34% of men in thepoorest households in England are sedentary, compared to only 33% of women and 28% ofmen in the wealthiest households (28). People living in deprived areas are also less likely tomeet physical activity recommendations. These low physical activity levels are a significantcause of health inequalities, with inactive groups suffering poorer health and living shorterlives than the general population.
Childhood Obesity in Knowsley: Reception Year & Year 6Source: Knowsley Public Health Intelligence Team
11.2%12.2%
8.6%
13.7%
10.9%
13.1%
11.8%
16.5%
21.6%
18.2%
21.0%
12.4%
11.3%
8.9%
20.3%
21.6%
14.6%
16.5%
0%
5%
10%
15%
20%
25%
30%
1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08School Year
Per
cen
tag
e o
f O
bes
e C
hil
dre
n
Year R
Year 6
* Please note that no data was collected for Year 6 in 2003/4 & 2004/5
Source: Knowsley Public Health Intelligence Team
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Knowsley has a relatively young population, with a proportionally higher number of peopleunder 25 years of age. It is also noted that around 43% of the children and young peopleaged under 16 live in families where income deprivation is key – this compares to a 14%national figure. As is the case in many parts of the UK, the number of older people (over 65)in the borough has steadily increased over the last 20 years. It rose by 25% between 1985and 2006. Almost half (46%) of people in Knowsley live in communities classed as beingwithin the 10% most deprived in England, this equates to approximately 69,900 people in theborough living in severe deprivation. An additional 24,060 people in Knowsley reside withinthe 20% most deprived areas in England. This presents great challenges in relation totackling obesity and requires specific targeted interventions that are designed to offer supportand opportunities to key groups for example, activities for older people.
Ethnic Minority Groups
People from some black and ethnic minority (BME) groups may be at higher risk of obesity,and identification of this risk is highlighted to Health Professionals by reference to NICE 43guidelines (2) and Knowsley’s Healthy Weight Care Pathway documents. However, theprevalence of BME in Knowsley has been identified at 2.6% population not Caucasian (and0.67% Asian). Therefore, individual services are not targeted towards these groups, howeverservices or initiatives do adapt to the needs of the client if required.
Physical Disabilities
Epidemiologic studies have shown that people with physical disabilities have a 1.2 - 3.9 foldincrease in obesity prevalence (29). People with physical disabilities are less active and morelikely to be sedentary than the general population, and are also more likely to suffer frompoor health and obesity (30). In Knowsley, the ‘Wheels for All’ cycling project has been designedto offer cycling opportunities for children and adults, and regular boccia and indoor curlingleagues have been formed following capital investment.
Child Poverty
In Knowsley, 58% of children live in poverty, the second highest of the Merseyside boroughs(with Liverpool at 60%) and greater than the averages for the North West (46%) and England(40%). Children in workless lone parent families have a 56% risk of poverty. Knowsley hastwice the national average of lone parents (4.5% compared with 2.2%), concentrated mainlyin North Huyton (7.4%) and North and South Kirkby (5.7% and 5.9% respectively).
The pattern of obesity amongst children at the age they are starting school (4/5 years) mirrorthose amongst children at most risk of poverty in the Borough. The highest rates of obesityappear to be in Stockbridge, North Huyton and Northwood in Kirkby. Rates for all wards areabove National and North West rates (2006/07) (1, 17)
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Childhood Obesity – Reception Year, 2005 - 06 to 2007 - 08
By the age of 10/11 years the wards or hotspots for obesity levels have changed with PrescotEast and Whiston North showing the highest rates at a level of between 24% - 31%. Themajority of wards have obesity rates above regional and national levels of obesity, which are18.3%.
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Childhood Obesity – Year 6, 2005 - 06 to 2007 - 08
By year 6 the pattern of prevalence of obesity has completely changed from the pattern atreception. The link with the most deprived wards is less evident amongst children at age10/11 years and levels of obesity are starting to mirror adult levels.
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4. National Policies and Strategies
Since the launch of the 2004 Energise Knowsley - Obesity Strategy (9) there have been anumber of national policy documents, frameworks & reports which support the need to tacklethe rise in obesity and call for co-ordinated action across a range of government departments,non-government organisations, industry, consumers and schools. These include:
2004 • Wanless Report Securing Good Health for the Whole Population highlighted that a step-
change would be required to lift us on to the ‘fully engaged’ trajectory to reduce preventableillness and deaths from diseases such as obesity.
• National Service Framework for Children, Young People and Maternity Services (DoH,2004).
• Storing up problems: the medical case for a slimmer nation by The Royal College ofPhysicians recommends a range of public health measures to address the causes of theoverweight ‘epidemic’.
• Choosing Health: Making Healthier Choices Easier, highlights obesity as one of its sixpriorities with a focus on a new cross-government campaign to raise awareness of thehealth risks of obesity, and the steps people can take through diet and physical activity toprevent it.
2005• Choosing Health Topic Reports: Choosing a Better Diet: a food & health action plan; and
Choosing Activity: A physical activity action plan• Department of Health, You're Welcome quality criteria: Making health services young
people friendly. Downloaded fromhttp://www.dh.gov.uk/en/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/DH_4121562
2006• Department of Health, Standards for Better Health (updated April 2006). Downloaded
from:http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4086665
• National Service Framework for Children, Young People and Maternity Services,particularly Standards 1, 2 and 3’8.
• National Institute for Health and Clinical Excellence. Obesity: Guidance on the Prevention,Identification, Assessment and Management of Overweight and Obesity in Adults andChildren.
2007• Lightening the Load: Tackling Overweight and Obesity – A Toolkit for Developing Local
Strategies to Tackle Overweight and Obesity in Children and Adults (National Heart Forum,Faculty of Public Health and NHS).
• Maternity Matters: Choice, Access and Continuity of Care in a Safe Service.• Foresight Tackling Obesities Future Choices: (Government Office for Science).• Department of Health. Legislative changes to the National Child Measurement
Programme (NCMP) (Nov.)• Confidential Enquiry into Maternal and Child Health (2007). Saving Mothers’ Lives:
Reviewing maternal deaths to make motherhood safer - 2003-2005. Executive Summaryand Key Recommendations (Dec.)
2008• Physical Activity and the Environment (National Institute for Health and Clinical Excellence
(NICE). • Department of Health. Healthy Weight, Healthy Lives: A Cross Government Strategy for
England (Jan.)
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• Department of Health. How to set and monitor goals for prevalence of child obesity:guidance for Primary Care Trusts (PCTs) and local authorities. (Feb.)
• A North West Framework to Achieve Healthy Weight for Children and Families within theContext of Food and Nutrition and Physical Activity (NHS North West).
• Department of Health. Healthy Weight, Healthy Lives: Guidance for Local Areas. Sets outwhat actions PCTs and local authorities, and their partners, can take to deliver their childobesity goals as part of the NHS Operating Framework Vital Signs and the LocalGovernment National Indicator Set. (March)
• Department of Health. Updated Child Health Promotion Program; builds on the children’sNational Service Framework and is intended as a best practice guide for children’sservices to provide preventative services tailored to the individual needs of children andfamilies. (March)
• NICE public health guidance 11. Maternal and child nutrition. Improving the nutrition ofpregnant and breastfeeding mothers and children in low-income households. (March)
• Royal College of Obstetricians and Gynaecologists Standards for Maternity CareReport of a Working Party. Download from: (June).www.rcog.org.uk/resources/public/pdf/MATStandardsWPR0608.pdf
• Department of Health. First-year evaluation of the Family Nurse Partnership (July)• Department of Health. The National Child Measurement Programme Guidance for PCTs:
2008/09 school year. (Sept)• Department of Health. Healthy Weight, Healthy Lives: A toolkit for developing local
strategies. (Oct)• Department of Health. Change4Life assets, and principles and guidelines for Government
and NHS. (Oct)• Department of Health. Healthy Weight, Healthy Lives: Consumer Insight Summary. (Nov)• Department of Health. Healthy Weight, Healthy Lives: Commissioning weight management
services for children and young people. (Nov)• Department of Health. National Service Framework for children, Families and Maternity
Services. Downloaded from:http://www.dh.gov.uk/en/Healthcare/NationalServiceFrameworks/Children/DH_4089111
2009 • National Institute of Health and Clinical Excellence. Promoting physical activity for children
and young people. Promoting physical activity, active play and sport for pre-school andschool-age children and young people in family, pre-school, school and communitysettings.
• Healthy Lives, Brighter Futures. The Strategy for children and young people’s health.Department for Children, Schools and Families and Department of Health.
• Hillsdon, M. Tools to measure physical activity in local level weight managementinterventions, a rapid review. National Obesity Observatory.
• Cross Government Obesity Unit. Healthy Weight, Healthy Lives: Child weightmanagement programme and training providers framework. H. M. Government, March.
• National Obesity Observatory. Standard evaluation framework for weight managementinterventions. March.
• HM Government. Healthy Weight, Healthy Lives: One Year On. Department of Health &Department for children, schools and families.
Healthy Weight, Healthy Lives: A Cross Government Strategy for England
In January 2008 the Government launched the national healthy weight strategy (1), which isthe first step towards the new ambition of enabling everyone in society to maintain a healthyweight. The strategy calls for collective action across a variety of settings and services torecognise, own and address the growing obesity problem.
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Tackling Obesity: The delivery chain
Source taken from Department of Health (2008). Healthy Weight, Healthy Lives: A Cross GovernmentStrategy for England.
The Government strategy focuses on 5 main policy areas:
1. To promote children’s healthy growth; 2. To promote healthy food; 3. To build physical activity into our lives; 4. To provide incentives for better health by supporting workplace health schemes to
promote health more widely;5. To provide effective personalised support when people become over weight or obese
(See next page)
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A Framework for Local Action
Framework for What success looks likeLocal Actions
Source taken from Department of Health (2008). Healthy Weight, Healthy Lives: A Cross GovernmentStrategy for England.
• A clear understanding of the prevalence of obese and overweightindividuals and behaviours that contribute to this across the local area
• PCTs have well-developed local plans in place to tackle child obesity, inconjunction with LAs, through the LAA process where appropriate
• Clearly identified responsibility for actions, with overall leadership andgovernance agreed by all partners
• As many mothers breastfeeding up to 6 months as possible, withfamilies knowledgeable about healthy weaning and feeding of theiryoung children
• All children growing up with a healthy weight by eating well, for exampleby eating at least 5 portions of fruit and vegetables a day
• All children growing up with a healthy weight by enjoying being active, forexample by doing at least one hour of moderately intensive physicalactivity each day
• Parents have the knowledge and confidence to ensure that their childreneat healthily and are active and fit
• All schools are Healthy Schools, and parents who need extra help aresupported through children’s centres, health services and their localcommunity
• More eligible families signing up to the Healthy Start scheme• Less consumption of high fat, sugar, salt (HFSS) foods, especially by
children• More consumption of fruit and vegetables – more people eating 5 A DAY,
especially children• More healthy options in convenience stores, school canteens, vending
machines, at supermarket tills and at non-food retailers• More people, more active, more often, particularly those individuals and
families who are currently the most inactive• Reduced car use, especially for trips under a mile in distance• More outdoor play by children• More workplaces that promote healthy eating and activity, with the public
sector acting as an exemplar, both through the location and design ofthe buildings on the government estate and through staff engagementprogrammes
• Everyone able to access appropriate advice and information on healthyweight
• Increasing numbers of overweight and obese individuals able to accessappropriate support and services
• Local staff/practitioners understanding their role and empowered to fulfil it• Clear indicators of success for all programmes• Robust monitoring of performance, to update and improve programmes• Evaluation built into all programmes so that activities are contributing to
the evidence base• Everyone working at a local level is clear about their role in promoting
the benefits of a healthy weight• Appropriate training is available so that both health and non-health
professionals feel confident in sensitively raising the issue of weight withthose who are overweight or obese
Understanding theproblem in yourarea and settinglocal goals
Localleadership
Choosing Interventions
Children: healthygrowth andhealthy weight
Promotinghealthier foodchoices
Building physicalactivity into ourlives
Creatingincentives forbetter health
Personalisedsupport foroverweight andobese individuals
Monitoringand evaluation
Building localcapabilities
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National Targets and Indicators
The Government has set itself a new ambition, which forms part of the Government’s 2008Public Service Agreement (PSA). PSA agreement 12 which focuses on the health and well-being of children & young people has five key areas, three of which are contributory factorsin children’s healthy weight:
• Prevalence of breastfeeding at 6-8 weeks• Percentage of pupils who have school lunches• Between 2007-10 to reduce the rate of increase in obesity among children under 11
as a first step towards a long-term national ambition by 2020 to reduce the rate ofoverweight and obese children to year 2000 levels in the context of reducing obesityacross the population. (The new national Public Service Agreement (PSA) target)
The Department of Health is responsible for the overall ambition on healthy weight and isjointly responsible with the Department for Children, Schools and Families (DCSF) fordelivering the PSA on Child Health. The Government has included obesity as a nationalpriority within the NHS Operational Framework Vital Signs (11). In which it states, all PCT’sare required to “pay special attention to obesity as one of the most serious and growinghealth challenges for children”
The Healthcare Commission Annual Health check indicators (12) include healthy weight inrelation to:
• All NHS Trusts, including PCT’s need to demonstrate compliance with NICE Guidance43 for Trusts as employers, to have plans for the development of Public Health policiesto prevent and manage obesity, which follows existing guidance and local obesitystrategy.
• Achieving the annual coverage target for the National Child Weighing and MeasuringProgramme.
• To demonstrate improvements in coverage in relation to General Practitioner recordingof Adult BMI in last 15 months.
Nationally indicators have been suggested to measure progress towards achieving areduction in levels of obesity and will be used to monitor local strategy action plans. These are:
• Breastfeeding initiation and continuation rates • Participation in PE/school sport – the National School Sport Survey collects data
relating to take up of PE and sport within the school day• Number of schools participating in the National Healthy Schools Programme and
achieving National Healthy School Status• Adult participation in sport through the Sport England’s Active People Survey can
Identify areas having low rates of physical activity in young people and adults (aged16 and over)
• Number of schools with school travel plans and mode of travel. Mode of travel datais available via the DCSF Annual Schools Report
• Take up of school lunches • TellUs survey data on children’s perceptions on life, their school and their local area• Local play opportunities.
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Local Targets and Indicators
Adults
The adult obesity data is not considered to be robust. No national target exists for adultobesity and next year there will be no local adult target in the Local Area Agreement (LAA).However, as part of the performance frameworks that the Primary Care Trust (PCT)implement, the height and weight of people registered on General Practice registers isrequired to be recorded. The PCT's were set a target of measuring 55% of the 16years+population by 2008/09. Although below target at the end of the reporting point Knowsley PCTachieved the highest percentage of people weighed and measured within the north west and8th highest nationally. Since April 2008 this is no longer a target, the Health Care Commissionwill continue to monitor future progress.
Adult Height and Weight Measurement in Knowsley General Practices
Percentage of GP Practice Population Aged 16 & Over being Weighed (LDPr) Sources: Vision Audit Manager & personal contact with GP Practices
32.3% 32.7%
42.6%41.7% 41.6%
34.7%
40.5%
37.0%36.7%36.3%35.7%32.9%
41.4% 41.4%
47.0%
49.7%
52.3%
55.0%
0%
10%
20%
30%
40%
50%
60%
Q12005/06
Q2 Q3 Q4 Q12006/07
Q2 Q3 Q4 Q12007/08
Q2 Q3 Q4 Q12008/09
Q2
Per
cen
tag
e W
eig
hed
% Weighed
% Weighed Target
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Children
Knowsley has set local targets for childhood obesity and has included NI56 from the nationalindicator set in relation to levels of obesity in year 6 as part of the LAA. Knowsley PSAtargets are ambitious and intend to reduce and stabilise the rates of obesity for children inrelation to the National Weight Measurement Programme indicators between 2008 – 11.Knowsley has also set coverage targets for measuring above the current nationalrequirement.
Knowsley Child Obesity Target (PSA10a)Calculations for Target Figures
'In line with National Guidance, the target is set to stabilise and 08/9 9/10 10/11reverse back to 2000 levels by (the year) 2020’ (1). Target Target Target
Percentage of children in Reception with height and weight 13% 13% 13%recorded who are obese.
Percentage of children in Reception with height and weight 90% 90% 90%recorded.
Percentage of children in Year 6 with height and weight recorded 21% 20.3% 20%who are obese.
Percentage of children in Year 6 with height and weight recorded. (85%) 86% 87%
(Note: The national coverage requirement for weighing and measuring is 85%)
Reversing Obesity Levels Back to the Year 2000: What Does This Mean forKnowsley?
Obesity levels in Reception Year for 2000 were 11.3% and in 2007/8 11.8% = Target of 0.5% decrease.
Obesity levels in 2000 for Year 6 were 16.5% and in 2007/8 21% = Target of 4.5% decrease.
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5. Review of Energise Knowsley: Obesity Strategy 2004 – 2008
Locally obesity was identified as a key area of concern in 2004. In response, KnowsleyPrimary Care Trust and Knowsley Borough Council jointly developed the Energise Knowsley - Obesity Strategy for the Borough, which had an action plan to take us through to2007/8 (9).
Progress to Date and What We Have Already Delivered
The aim of the Energise Knowsley Strategy was for there to be no increase in obesity levelsin Knowsley over the next 5 years. At the end of 2007/8 there has been an increase in obesitylevels for adults in line with the national trends. Locally there has however, been a significantdecrease in the number of adults overweight. The rates of obese children have fluctuatedduring this period but have not changed significantly.
Underpinning phase one of the strategy was the principle that the quantity and quality offood intake and the low levels of physical activity in the local communities are the two keyinteracting lifestyle issues contributing to the problem of obesity and also a recognition weneeded to develop support for those people who were already obese in Knowsley.Consequently, the strategy main strands reflected this: healthy eating, physical activity andtreatment of obesity. There has been progress and developments in relation to all 3 areas ofthe strategy.
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Activities and Service Developments 2004 – 2008
Activities
The first phase (2004-8) of the Energise Knowsley – Obesity Strategy has delivered a lot ofactivity and the growing realisation that solving obesity is a complex issue. A problem thathas been 30 years in the making is not going to be solved in a few years if we are to seesustained changes. The strategy has and will continue to deliver population basedapproaches aimed at universal prevention of obesity. Such activities are intended to havewide appeal and be accessible to the local population.
Each year Knowsley PCT funds an annual 5K race held in thegrounds of Knowsley Hall. Knowsley MBC events team holdthis event, which has proved to be very popular, with over 770participants taking part in 2008.
Knowsley’s ‘Race for Life’ is an annual sponsored race forwomen to raise money to fight Cancer. This event is co-ordinated by KMBC.
Since 2004 Knowsley PCT has organised an annual walkingfestival, which aims to promote walking in the borough. Thesuccess of this event has proven as the participation targethas now been increased to 200 people per year.
Energising the Arts in Knowsley was a joint initiative betweenKnowsley PCT and Knowsley MBC made up of 5 projects.The emphasis of these projects was to use creative healthymessages to encourage people in Knowsley to adopt a dietand lifestyle that would reduce the risk of obesity.Current programmes run by the Arts in Health team include amusical rap group for young men with mental health problemsand fun story walks for children making use of local parks.
Community Cooks began in 2004, and work in Knowsley topromote healthy eating and cookery skills to a wide range ofgroups in community venues. They work with all ages andabilities and their service includes cookery groups, afterschool clubs, weaning courses, cooking on a budget, cookingfor one, family cookery and taster sessions. These coursesvary in length and are tailored to the needs and abilities ofthe participants, each year over 2500 people engage with thisservice.
Cycling projects have delivered an annual programme ofcommunity cycle rides in the summer and winter acrossKnowsley since 2005. The cycle rides are open to allmembers of the public and aim to demonstrate the fun andfitness value associated with cycling and to encourage thetake up of independent cycling for leisure or travel.
ACTIVITIES DEVELOPED IN PHASE ONE OF ENERGISE KNOWSLEY
Healthy Lifestyles - Physical Activity & Healthy Eating
Knowsley Active Challenge(Adults & Children)
Race for Life(Adults)
Knowsley Walking Festival(Adults & Children)
Arts in Health(Adults & Children)
Community CooksProgramme
(Adults & Children)
Community Cycle Rides(Adults & Children)
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Based on the success and popularity of the community rides,‘Pedal Away’ is a four year Big Lottery funded initiativecommencing September 2008. The initiative will have a remitto work with people who are difficult to engage and to offercycling as an activity to help them become more active withintheir daily routines. Options will include led group cycle rides,training for staff and community members along withinstruction for beginners and cycle maintenance courses.
In 2006, NRF funding enabled a ‘Wheels for All’ centre to beestablished in Halewood Leisure Centre. This providesadapted cycles for people with disabilities. Wheels for all willcontinue to grow under the Pedal Away project and will followthe same model i.e. accessible rides and training for staff andparticipants.
Measure Up is a community weight management programmerun by the Community Health Development Team. Sessionsinclude an hour long education segment – for exampleworkshops around physical activity, nutrition and goal setting,followed by an hour long aerobic physical activity session.The programme is designed for people with a BMI 25-35, andis available across the borough. People can be sign postedto the programme or may contact the service to jointhemselves.
North Huyton locality is involved in recruiting communitymembers to a 12 month programme, which aims to improvetheir health status through three main combined interventions:smoking cessation, health eating and physical activity.Participants receive a KMBC gold leisure pass and a weeklysupply of fruit and vegetables supplied for the entirety of theproject, which helps encourage more physical activity andhealthier eating. This programme ran for 3 years but from2009 is being replaced by ‘measure-up’ as listed above.
A 12 week exercise GP referral programme delivered byLeisure Services. This is followed by the Activity for Life Plusexercise programme that provides a further 12 weeks ofsubsidised physical activity. Programmes are available inHalewood, Kirkby & Huyton Leisure Centres and over 700people annually access the programme.
In 2006 a local Lifestyle Advisor Service was set up with therecruitment of 8 local people who have been trained to offerone to one support to people who want to make lifestylechanges to improve health. The programme offers a listeningear, advice & information and buddying as a way ofovercoming barriers to making changes relating to stoppingsmoking, healthy eating and becoming more active.
Healthy Schools is part of the DoH and DCSF NationalHealthy Schools Programme. The impact of this programmeis based on a Whole School Approach to physical andemotional health and wellbeing. Schools achieving NationalHealthy Schools validation demonstrate they are addressingnational criteria for the promotion of healthy eating andexercise; they have evidenced implementation of wholeschool food and physical activity policies and in so doing aretaking an active role in tackling childhood obesity.
Pedal Away Initiative(Adults & Children)
Wheels for All(Adults & Children)
Measure Up(Adults)
It’s a Fit Up(Adults)
Lifestyle Advisors(Adults)
Healthy Schools(Children)
Activity for Life (Adults)
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To combat the rising levels of overweight and obese under5yrs (pre-reception) children in the borough, several courseshave been developed from 2007 onwards to improve nutritionand activity levels in this age group;Families Learning Active Play (FLAP): a 6 week course forparent and child on benefits of active play with activities andresources to take away and keep.Family Cookery for parent and toddlers: same model asabove but covering the benefits of healthier eating withcooking tips and skills.Busy Bees: one day training course for staff from early yearssettings (PVI) with ideas and resources for games to play withthe children in their care and resource to take away and keep.Early Years Healthy Eating Guidelines: an evidence basedset of guidelines for early years settings to adhere to and useto support their own in house rules regarding; breastfeeding,rewards and celebrations, snacks, lunches, drinks, stafftraining and the dinning environment.
Healthy Schools has accessed funding from the PCT tofacilitate the implementation of healthy tuck shops andbreakfast clubs in schools. To date 38 schools have receivedfunding and training to set up breakfast clubs and 45 havereceived funding for tuck shops. In these schools and allschools accredited to the NHSP only healthy food options aremade available in order to comply with latest Governmentguidance. To facilitate this Knowsley Healthy Schools teamworked with the schools to have all the vending machinesremoved to reduce access to high fat and sugary foods.
The Knowsley Infant Feeding Strategy 2008-2011 iscommitted to supporting families in achieving the best startfor their children. It is recognised that breastfeeding is thebest nutritional start a child can have and breastfeeding ratesin Knowsley have continually been lower than the nationalaverage. Over recent years, there has been an increase from24% initiation rates in 2004 to 39% at the end of 2007/08. Toraise these levels further, a large proportion of the strategyentails the promotion of breastfeeding. The strategy supportsthe wider Knowsley Healthy Weight Strategy as research hasshown that breastfeeding also protects against obesity. TheInfant Feeding Strategy also aims to promote healthy weaningpractices to support parents/carers to make healthy foodchoices for infants by providing appropriately timedinformation and support and laying a foundation for lifelonghealthy eating.
Compliance with School Food Trust guidance is ensured by aclose working relationship between Healthy Schools (DCS)and school meal providers (DND). This covers food standardsfor school lunches and food other than school lunches.School Meals Lead Team advise on expenditure of theGovernment’s Schools Lunch Grant 2008-11. Due to thiscapital investment, every Knowsley school now has its ownfull production kitchen where meals are prepared, cooked andserved on the premises using predominately freshingredients. This contributes to pupils eating more healthily asthe weekly menu of fat, sugar and salt levels are more easilycontrolled (analysed using computer software).
Early Years(Adults & Children)
Breakfast Clubs and Healthy Tuck Shops
(Children)
School Meals CapitalInvestment
Infant Feeding Strategy(Children)
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Knowsley school meals service has made significantinvestments over the last four years which has resulted in anincrease uptake of paid school meals. All school cooks havereceived at least NVQ Level II in Food Preparation and CraftSkills. Knowsley is also the first UK authority to achieve CIEHLevel 3 Food Safety qualifications. In recognition of the goodwork undertaken by Knowsley meals service, there has beena significant improvement in attitudes and customersatisfaction amongst pupils and parents and severalprestigious industry awards have been won. Most noted,Knowsley were awarded Hospitality Assured for the sixth yearrunning in 2008, and were only the second authority in thecountry to achieve this quality standard.
The Family Cookery Course was developed by members ofthe Family Learning, Healthy Schools and Community Cooksteams in 2006. The course promotes and supports thedevelopment of healthy lifestyles amongst families byincreasing parents/carers and children’s cookery and foodpreparation skills, and provides participants with informationand encouragement about healthy diet. The course isdelivered by school staff (e.g. teachers, classroom assistants,parent mentors) following 2 days training. To date, the courseshave been very successful with almost 200 families taking part.This has been adapted for use with parents and 3-4 year olds.
Fitbods is a Healthy Schools initiative with the purpose ofpromoting fun physical activity programmes in primary schoolsthroughout the school day as curricular and extra curricularactivities and games. 100% of primary schools have now hadaccess to training to deliver the programme and received apackage of equipment to support it’s implementation. Thenext development in the Fitbods programme includes a peerled initiative to train Junior Play Leaders (year 5 pupils) incollaboration with the School Sports Coordinators (SSCO’S),so they can lead on FITBODS activities.In collaboration with Knowsley’s PE and Sports Manager andthe SSCO’S the Healthy Schools programme supportsschools in reaching full accreditation for physical activity.Healthy Schools also work with School Travel Plan Advisorsand various PCT and community based initiatives to supportphysical activity in the wider community.
A unique target wellbeing big lottery programme to bedelivered in partnership between Knowsley Council forVoluntary Services and Homestart Knowsley aiming to provideparents and children with the skills, knowledge and opportunityto improve mental and physical wellbeing, while enabling themto live healthier more active lifestyles.
Ageing Well is a national initiative which encourages groupsof older people (50+) to become Health Mentors. In Kirkby,we have a group of residents who meet on a weekly basis todiscuss health issues. Big lottery funding has been securedto employ a co-ordinator who will roll out this programmeacross the Borough.
School Meals CurrentActivities and Developments
(Children)
Healthy Eating – Skills(Adults & Children)
Families Fit for Life(Adults & Children)
Ageing Well Plus(Adults)
Healthy Schools PhysicalActivity
(Children)
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NHS Knowsley and MBC workforce aim to promote healthylifestyle behaviours to approximately 8000 members of staff.Initiatives include improved access to healthier food throughcatering options and fruit on desk schemes, installation ofcycle storage facilities, access to exercise classes, shapemanagement courses, lunch time walks and acupressuretherapy sessions. There are options to access smokingcessation support during work hours as part of the Fag EndsKnowsley Quit@work programme.
Produced March 2007 to help make healthy eating in theworkplace an easier choice. Aims to provide evidence-basedguidance, which can be applied to catering for differentsettings and population/client groups across the Council andthe Primary Care Trust, along with other organisations.
In 2003 all learning disabilities service staff were offered foodand nutrition training to help increase clients knowledge andimprove physical activity practice. All centres received freefruit for 6 months three times a week and had sessions onmaking smoothies and fruit kebabs. Since then all centreshave bought smoothie makers and provide fruit regularly.Further investment provided equipment for physical activityand now centres have regular league games for boccia andcurling (held in leisure centres), and there is a Wheels for Allcentre with state of the art adapted cycles. The work done bythe team earned a CSIP award in 2006 for Promoting PositiveHealth.
Knowsley currently has two School Sport Partnerships,Bowring and Brookfield. From September 2008 bothpartnerships will work closely with the LEA towards theGovernment’s new Public Service Agreement (PSA 22) – tooffer at least 2 hours of quality PE in schools and a further 3hours extra curricular to all 5-16yr olds. Currently 89% ofKnowsley’s 5-16yr olds are involved in 2 hours of quality PEand school sport, within and beyond the curriculum.The work carried out by the Partnership is embedded withineach school’s development ensuring that high standards arecontinually maintained throughout the delivery of PE andschool sport. The programme not only increases participationin PE and school sport but also contributes to reducingchildhood obesity. This partnership also organises an annualPE and School Sport Conference.
School Travel Plans, outline measures which are designed toimprove safety and reduce the dependence on car use bypupils, parents and staff on the journeys made to and fromschool. Plans encourage walking, cycling, public transportuse, car sharing and any other measure that offers accessible,sustainable and healthier travel choices and should be viewedas a long term commitment by a school to develop orintroduce safe sustainable travel habits. The aim is to have allschools in Knowsley owning a travel plan by 2010. Currently69/73 schools have travel plans in place.
Healthy Workforce(Adults)
Healthy Catering Guidelines
(Adults)
Healthy LifestylesInterventions for Adults with
Learning Difficulties &Mental Health Problems
School Travel Plans(Children)
Knowsley School SportPartnerships
(Children)
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The Environmental Health Team visit businesses in theborough, to raise awareness of good work practice andhealthier living. Workplaces may request information or applyfor health promotion literature, smoking cessation courses,discount gym memberships for local leisure centres andinformation on local ‘step into health’ walks.
Set up in 2004, the Veggie Van provides a mobile servicetaking fresh fruit and vegetables to areas with little or noaccess to fresh produce from local shops. This uses acombination of street trading, home deliveries and groupschemes and also redeems Healthy Start vouchers anddelivers to school fruit tuck shops and workplace fruit on deskschemes.
To help ensure consistent messages on healthy eating arebeing given out across the borough, a training pack has beendeveloped to deliver simple and basic messages to key staffin a position to influence clients’/customers’/patients’ foodchoices and utilise the Food Standards Agency’s ‘eat well’plate.
To ensure consistent messages on physical activity have beenpromoted across the Borough, a training pack has beendeveloped to deliver simple and basic messages to key staffin a position to influence clients/customers/patients activitylevels.
The food and physical activity training sessions (as above)have been merged into a 1 hour training session, which iscurrently being promoted to team managers (PCT, Counciland third sector) and delivered via team meetings. Thesession aims to provide staff with the knowledge & skillsnecessary to conduct a brief intervention aimed atencouraging clients to eat healthily / take more physicalactivity. This is based on NICE guidance which recommendsthat ‘primary care practitioners should take the opportunity,whenever possible, to identify inactive adults and advise themto aim for 30 mins of moderate activity on 5 or more days ofthe week (or more).’
Knowsley’s ‘Step into Health programme is based on the‘National Walking the Way to Health’ programme led byNatural England and aims to increase the number of peoplewalking more often in the borough. Local staff and volunteershave been trained to lead local 30 minute health walks. Thereare currently 3 regular walks in Kirkby and Stockbridge Villageand Halewood with an aim of having at least one regular walkin each area of the Borough by 2009.
Wider Workforce(Adults)
Veggie Van(Adults & Children)
Food and Nutrition,Physical Activity and Brief
Interventions(Adults & Children)
Food and Nutrition(Adults & Children)
Walking(Adults & Children)
Physical Activity(Adults & Children)
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A big lottery funded programme, community based danceproject offering nine week courses of two weekly dancesessions in twelve neighbourhoods. The project provides anaccessible form of exercise promoting active lifestyles in whichdance will be used to break down perceptions and barrierswhich may exist with more traditional physical activityprogrammes.
Knowsley currently has two School Sport Partnerships,Bowring and Brookfield. From September 2008 bothpartnerships will work closely with the LEA towards theGovernment’s new Public Service Agreement (PSA 22) – tooffer at least 2 hours of quality PE in schools and a further 3hours extra curricular to all 5-16 year olds. Currently 89% ofKnowsley’s 5-16 year olds are involved in 2 hours of qualityPE and school sport, within and beyond the curriculum.The work carried out by the Partnership is embedded withineach school’s development ensuring that high standards arecontinually maintained throughout the delivery of PE andschool sport. The programme not only increases participationin PE and school sport but also contributes to reducingchildhood obesity. This partnership also organises an annualPE and School Sport Conference.
The Knowsley Sports and Physical Activity Alliance is astrategic partnership including PCT, KMBC and LEA staff. TheKnowsley Sports and Physical Activity Alliance aims toincrease participation in physical activity by 1% each year froma baseline of 19.6% in the Active People Survey 2007/08. TheSPAA action plan contains actions around 6 themes which are; Health – Using sport and physical activity to improve physicaland mental health and wellbeing and to encourage a healthierlifestyle for Knowsley people and familiesActive Communities – Using sport & physical activity todevelop safer and stronger communities Education and Lifelong Learning – Using sport and physicalactivity to promote education and lifelong learning, developskills and contribute to delivering the five outcomes of EveryChild MattersWidening Access – to sport and physical activity for allmembers of the communityRegeneration and Economy – Using sport and physical activityas a vehicle for regeneration and economic developmentPathways and Progression – maximising opportunities forongoing participation and achieving sporting success.
All children and young people aged under 16 years and in fulltime education are entitled to swim in KMBC swimming poolsfor free. From April 2009, this will also be extended to peopleaged 60 years plus and apply to timetabled sessions.
The KMBC’s Sports Development Team deliver a range ofopportunities for children and adults to try out different sportsand strengthen local clubs and club links to schools soinvolvement in sports can be lifelong. They also delivernumerous holiday physical activities for children and youngpeople e.g. football camps.
Shimmy, Shimmy,Shake, Shake
(Adults)
Knowsley School SportPartnerships
(Children)
The Knowsley Sports andPhysical Activity Alliance
(SPAA) (Adults & Children)
Sports Development
Free Swimming
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Service Developments
Since the launch of 2004 Energise Knowsley (9) there has been an increasing emphasis onprevention, management and treatment of obesity in recognition of the proportion of thepopulation who are overweight and obese and the need to address the problem. The aim ofmanaging overweight and obesity is to achieve and maintain weight loss by promotingsustainable changes in lifestyle.
In 2007/8, a Healthy Weight Partnership Board was established by Public Health. One of theboards’ first tasks has been to develop Healthy Weight Care Pathways for Adults & Children.(See Appendix B)
In Knowsley there is now a range of local treatment and support options in place which havebeen developed under the strategy:
SUPPORT & TREATMENT OPTIONS FOR OVERWEIGHT & OBESEAdults:• Exercise Referral programmes - since 2004 Activity for Life has more than doubled the number of
GP referrals to over 700 with plans to increase capacity to 2500 over the next 3 years (by 2012).• Community Healthy Lifestyle programmes have increased from one programme for residents in
North Huyton to an extra three 12 week ‘Measure Up’ community programmes running in North,South & Central Knowsley.
• A commercial weight management service has been set up as a result of a successful pilot withAston GP practices. In December 2007 a commercial weight management service, Slimming Worldwas commissioned via Public Health on behalf of Aston and Kirkby PBC groups to provide a 12 -week support for patients to lose weight in the community. In February 2008 the service startedreceiving GP referrals and over the 2 year contract has a capacity for 800 referrals.
• Specialist Adult Weight Management Service ‘CHANGES’ dietetics service was set up in 2006/7 andcommissioned via Public Health. This is a referral based service that offers specialist long-termdietetic group and 1to1 support for patients identified with a BMI >35 plus. This service currentlyhas capacity for over 500 Knowsley patients. An area of development for this service is to improvelinks with maternal services and to offer tailored weight loss support to new mothers, menopausalwomen and linking with smoking cessation services in line with NICE guidance. These pathwaysare in development.
• ‘CHANGES’ Weight Management also offers similar but less intensive group and 1 to 1 support andassessment in community settings, for patients identified as class 1 - obesity, or who are overweightand have co-morbidities.
• Pharmacotherapy or anti-obesity drugs are available via the GP.• Hospital referral for bariatric surgical intervention. Knowsley is part of a northwest commissioning
arrangement with Spire Hospitals to provide surgical interventions to appropriate Knowsley referrals.The service became operational in October 07 and by year (March 08) had received 8 referrals fromKnowsley. There were 37 referrals in 2008/9.
Children Services:• In 2007/8 a family based healthy lifestyle intervention programme for obese children and their
families was established. Previously piloted in Halewood, The 12 week programme ‘Family Futures’has since taken place in Kirkby and just completed in Huyton. The programme will continue to run3 times a year in North, South and Central Knowsley.
• Additional investment in dietetics has provided for 2 paediatric dieticians, one specifically focusingon childhood obesity. The investment has also provided for more specialist advice domiciliarysupport. A dietetic assistant has been employed to work on the above ‘Family Futures’ programme.
• Pharmacological interventions are not recommended and should be considered for children onlyafter dietary, exercise and behaviour approaches (NICE, reference 1.2.5.1). NICE guidance statesthat ‘younger than 12 years - may be used in exceptional circumstances’, and at ’12 years and older,co-morbidities, or severe psychological’ should be present (NICE references 1.2.5.6, 1.2.5.7). InKnowsley children and young people should be referred to the paediatric weight managementservice, for a joint assessment along with the growth and nutrition clinician.
• Bariatric surgery is not considered a primary treatment for young people’s obesity. However NICEguidance (2) does refer to a protocol. Children and young people should be referred to the paediatricweight management service, for a joint assessment along with the growth and nutrition clinician fora full medical assessment, and further referral if appropriate.
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Overall Impact of Energise Knowsley 2004 - 2008
Progress has been made in all 3 areas of the strategy with healthy eating indicators showingan increase in fruit & vegetables consumption and a decrease in poor dietary choices,children being more physically active and the development of treatment services for adultsand children. Locally this has had some impact on levels of obesity and overweight.
Outcomes
• Locally we have managed to halt the year on year rise in childhood obesity with no overall increase in obesity levels (16a-b).
• The proportion of adults in Knowsley who are overweight or obese has decreased from64% to 56% respectively (16a-b).
• The percentage of adults eating five or more portions of fruit and vegetables per day morethan doubled from 8.9% to 17.7%, a statistically significant increase (16a-b).
• Generally, in terms of food choices the proportion of people reporting with ‘poor diets’ hasfallen across all age bands. For the adult population as a whole, the change from 25.6%to 19.3% is statistically significant.
• The School Health Related Behaviour Survey, which is carried out annually in schoolsasked year 6,8,10 pupils about their fruit & vegetable consumption. Overall all pupils inall 3 groups have increased fruit & vegetables consumption.
• The School Health Related Behaviour Survey asked how regularly and hard childrenexercised on a weekly basis. In all 3 age groups there has been an increase in activityamong girls. For boys there has been an increase in activity among year 8 and year 6 boyswith a slight 1% decrease reported by year 10 boys.
• Since 2004, ‘Activity for Life’ has more than doubled the number of annual GP referrals toover 700 with plans to increase capacity to 2500 by 2012.
• Over 200 people have accessed a commercial weight management service, SlimmingWorld via their GP since it started in March 2008.
• Since 2006 over 3000 people have accessed ‘CHANGES’ Adult Weight ManagementService. All service users who completed this programme experienced over 5% weightloss.
• During 2008, 25 obese children and their families have attended the community basedhealthy lifestyles programme ‘Family Futures’.
• 160 people were referred by their GPs to Slimming World, and 48% completed 10 weeks.Of those who completed 10 weeks, 56% experienced over 5% weight loss.
What we will be taking forward
In light of the new national target, which prioritises children in the first instance and the lackof any adult target nationally or in the Local Area Agreement, it is appropriate to considerprioritising children and family based interventions for the next 3 years. The universal healthylifestyle programmes will still continue across the whole population and the adult orientatedsupport and treatment options will still remain. But this new focus will allow for newdevelopments and commissioning to prioritise gaps in current provision around targeting ofchildren & families.
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Childhood obesity levels amongst 10 - 11 year olds are mirroring adult levels and aresignificantly higher than levels of obesity at 4-5 year olds. A recent Health Needs Assessmentconducted on Childhood Obesity in Knowsley (March 2009), found that approximately 447children aged two and three years are obese and 651 are overweight. An estimated 4488children aged 4 -17 years are obese and 5102 are overweight. 11,151 children have an obeseparent in Knowsley and are therefore classified as ‘at risk’ of becoming obese. This reporthighlighted that If Knowsley aims to achieve the national 2020 obesity target for receptionyear and year 6 further investment and development into services to prevent and treatchildhood obesity are essential. Recommendations from this report included developing:
• Targeted family-based interventions for overweight and obese children lessthan five years (pre-school)
• Targeted family-based intervention for children at high-risk through one obeseparent
• Tailored family-based intervention for children in low income families
• Early identification of children’s weight status and appropriate signposting andreferral to suitable
• Early identification of overweight in pregnancy and intervention
• Cultural sensitivity and interventions for BMEG children.
Nationally and locally there has been an increase in adult obesity and there has been littleimpact on levels of physical activity amongst adults where more than half of the Knowsleypopulation lead a sedentary lifestyle. Therefore we plan to increase access to leisure &physical activity by building capacity within Activity for Life and leisure facilities to supportpeople to become more active is important for future change.
Knowsley’s vision is for all organisations and people within Knowsley to join together in acollective effort to provide the opportunity for all Knowsley people regardless of background,to achieve and maintain a healthy weight wherever possible. The overall aim of EnergiseKnowsley – Healthy Weight Strategy is to stabilise obesity levels locally, reducing theincidence of new cases particularly targeting children and families with the longer-term goalof reducing obesity rates overall.
Breastfeeding
The promotion of breastfeeding will be central to the strategy, as exclusive breastfeeding forthe first six months is recognised to be a significant factor which contributes to a reductionchildhood in overweight and obesity. Knowsley Health and Wellbeing will, therefore, worktowards achieving UNICEF Baby Friendly Community Accreditation by September 2012 andwill continue to expand the Breastfeeding Welcome Scheme, ensuring that all Knowsleywomen feel comfortable and confident to breastfeed their babies.
In addition, the current pool of volunteer peer supporters for breastfeeding will bestrengthened and opportunities will be created to provide employment for paid peer supportworkers recruited from our local community.
The maternity service will also be enhanced within Knowsley as a means of building capacityand capability within the community. This raft of measures will serve to ensure all residentsreceive a consistent approach in the promotion and support of breastfeeding and thataccurate, evidence based information is available to all in relation to infant feeding.
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Seven new Centres for Learning provide an opportunity toestablish ‘Healthy Schools’ that take a whole school approachto supporting children’s and young peoples health. Includinghealthy catering, quality PE and access to healthy extracurricula activities, cross curricula programmes for learningabout health and developing health related behaviour skills. Onsite health clinics/services.
The 16 Children Centres provide a great opportunity tointroduce and co-ordinate local programmes to support parentsto give their child a healthy start in life from breastfeeding, toweaning and establishing good habits for the whole family.
Community based CVD health checks will help to identifyadults over weight and obese and signpost/refer to appropriatelevel of support.
Over 60% of the local NHS and council workforce are Knowsleyresidents and benefit from a range of healthy lifestyle workforceinterventions to become more active and eat a healthier diet.
NHS Knowsley and KMBC are working together to develop apolicy to limit the density of fast food outlets in the Borough, andthat consideration of this issue should form a part of our widerefforts to take on board health issues within planning policy.
Knowsley has committed £25m to revitalising ageing leisurefacilities including the creation of a central ‘hub’ sports villagein the middle of the Borough to compliment the new facilities inthe North (Kirkby Leisure Centre) and the South (HalewoodLeisure Centre). Together with Centres for Learning and otherleisure ‘satellite’ provision, the opportunity is there to attractand engage people in regular physical activity that supportschanging needs and expectations from leisure facilities anduses Active People data to target specific groups.
Knowsley has been awarded more than £800,000 as part of theNorth West Target: Wellbeing programme funded by the BigLottery. The local programme is managed via the KnowsleyHealth and Wellbeing Partnership. Target Wellbeing aims to helppeople achieve healthier and happier lives. It is a programme ofover 90 projects in the North West that increase exercise,encourage healthier eating and promote mental wellbeing.Funded £8.9m from the Big Lottery Fund, it is managed byGroundwork for the benefit of targeted disadvantagedcommunities across the Northwest. There are 8 projects in theKnowsley programme, offering something for everyone.
Knowsley’s Green Space Strategy has health as a strategicpriority that cuts across all actions. There are specific linksaround play pathfinder, quality of parks, green corridors andallotments. The link between physical activity and green spaceis one that Knowsley’s green spaces team are keen to promote.
Building Schools for theFuture
Children Centres
Cardio Vascular DiseaseProgramme - KnowsleyAt Heart
Workforce HealthProgramme
Food Outlets -Planning andDevelopment
Third Sector/Big Lottery
Parks and Open Spaces
Leisure Strategy
Opportunities
There are a number of new local developments and initiatives, which can support theimplementation of the next phase of the Energise Knowsley Strategy. These include:
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6. Moving Forward: Energise Knowsley 2009: Healthy Weight Strategy
Developing the Strategy – Community Engagement and Involvement
During 2008 partners from a wide range of organisations came together to review the firstEnergise Knowsley Strategy and develop a new action plan for 2009-2012. There have beenthree stakeholders events for key staff; a childhood obesity briefing for senior officers, anupdate report and position statement produced. Consultation with members of the public wassought through the Community Health Forums and the Patient and Engagement Conferenceconducted via the Practice Based Commissioning groups during February 2009. Moreover,individual services have consulted with their service users and have changed and improvedtheir programmes to meet the needs of their clients based on the recommendations of theseresearch reports. This strategy document has been formed as a result of these collaborationsand outlines what we intend to do in Knowsley to tackle obesity.
Vision
For all organisations and people within Knowsley to join together in a collective effort to providethe opportunity for all Knowsley people, to achieve and maintain a healthy weight whereverpossible.
Aims
The overall aim of this Energise Knowsley 2009 – 2012 Healthy Weight Strategy is to stabiliseobesity levels locally, reducing the incidence of new cases and particularly targeting childrenand families with the longer-term goal of reducing obesity rates overall.
Underpinning Principles
• The achievement of a healthy weight for all people is a shared ambition of the NHSKnowsley and the Borough Council.
• A commitment to a joined up multi-sector approach, engaging the public sector, voluntarysector, private sector and local communities. This engagement should be from theoutset in developing the strategy, implementation & delivery and performance monitoring.
• This strategy will focus on actions which can be achieved at a local level within thecontext of what is being developed nationally, as part of the Health Weight, HealthyLives Strategy.
• To address health inequalities by ensuring services are available to those in greatestneed.
Objectives
Overall Objectives
a. To develop an environment that supports healthy eating and physical activity at a level inthe local population to prevent obesity.
b. To develop more understanding of the influences on the local population which areresulting in an increase in obesity levels.
c. To raise public awareness of the influences of healthy food and physical activity in thedevelopment of obesity in order that they can take control of factors that impact onmaintaining a healthy weight and healthy lifestyles.
d. To implement evidence based recommendations for the prevention and treatment ofobesity and to contribute to the emerging evidence through research and evaluation oflocal programmes.
32
e. To prioritise those at most risk of obesity, particularly children and families, for targetedinterventions.
f. To performance monitor the Strategy Action Plan to measure progress, evaluate successand to monitor local obesity trends.
g. For NHS Knowsley and Knowsley Council to be exemplar organizations in the preventionof obesity, through their corporate role and employer responsibility.
h. To ensure high quality commissioning of Healthy Weight & Obesity Services which reflectthe priorities and principles within the strategy.
Action Plan
Section 1 Children & Families
1. To increase activity levels of children in early years settings (under 5 years)2. To improve food and nutrition in early years (under 5 years)3. To increase participation of families (with children under 5) in healthy lifestyle courses4. To co-ordinate programmes to identify and support early years children to develop healthy
weight5. To increase healthy eating in school aged children 6. To increase the uptake of physical activities by all children inside and outside the school
curriculum 7. To increase participation and monitoring of the National Child Measurement Programme8. To identify and support children identified as overweight or obese9. To promote health & wellbeing in vulnerable children
Section 2 Adults
10. To increase physical activity in Knowsley11. To increase participation levels for people at high risk of developing heart disease e.g.
diabetes, hypertension (e.g identified by CVD programme) and vulnerable adults12. To improve healthy eating 13. To provide advice and interventions to over weight/obese women
Section 3 The Obesogenic Environment
14. To increase access to and consumption of healthy food choices15. To develop the built environment to support active lifestyles16. To increase healthy behaviours of Knowsley PCT and KMBC workforces and implement
action plan17. To provide appropriate services at the right level18. To promote healthier lifestyles
How We Will Deliver the Strategy
The strategy requires engagement with all stakeholders to ensure that all plans, where obesityhas been identified as a priority, are aligned.
Since 2004 there have been a number of steering groups for example, the Food & HealthGroup and the Physical Activity Forum have been established to help to deliver and overseeprogress in relation to Energise Knowsley. In 2007 the Healthy Weight Partnership Board wasset up, led by Public Health. This is a strategic group with wide representation; this group isresponsible for strategy review and prioritising for obesity. It links into a wider network ofgroups which have healthy weight and reducing obesity as a key priority (See Healthy WeightDelivery Network Diagram on page 33).
33
Health and Wellbeing Partnership Board
Workforce Health Strategy Group
Sport and Physical Activity Alliance
Physical Activity Group
Health Promotion Steering Group
School Meals
Lead Group
Food and Health Steering Group
Healthy Schools Partnership Board
Children and Young People’s Healthy Weight
Group
Breastfeeding Steering Group
Maternal Health Board Healthy Weight Partnership Board
Children and Young People’s Partnership Board
The Healthy Weight Delivery Network
34
How Performance Will be Measured in Knowsley
The overall obesity targets are shown on page 31
Local indicators to measure progress towards achieving a reduction in levels of obesity havebeen selected and will be used to monitor the local Knowsley strategy action plan between2009 –12. These are:
The Strategy Action Plan (See pages 43-59) will be reviewed annually. Monitoring data will be collected via the delivery network groups and reports collated andpresented to the Healthy Weight Partnership Board.
Local Indicators
Measure Baseline Target
To Increase breastfeeding initiation
and continuation rates
2007/2008 Year end
rate: 32 %
Target 2009/2010:
39%
Increase uptake of healthy meal
options in schools
2008 baseline: 44% To increase by 5% by
2011
All schools to be healthy schools by
2011
July 2008: 64%
July 2009 – 75%
Dec 2010 – 85%
2011-100%
All schools by 2010 delivering at least
2 hours curriculum PE
2008 PSA target (22) working towards
the 5 hour activity offer
Baseline from
academic year
2006/07 = 85%
Delivering 2hrs P.E.
2 hour Target
2008/09 = 92%
2009/10 =95%
Target for 5 hour offer=
2009/10 to establish 5
hour baseline data
No. of schools with travel plans, to
increase number of children
walking/cycling to school
Baseline March
2008:55
(75%) achieved
March 2009: 64 (88%)
March 2010: 73 (100%)
National target to have
all schools with travel
plan by 2010
To increase fruit and vegetable
consumption in amongst adults
To increase fruit & vegetables
consumption amongst children
Baseline
Adults: 2006:17.7%
Girls: Av 18%
Boys: Av 16% (2007)
To Increase by 1% year
on year.
18.7% by 2007/8
20.7% by 2010/11
To increase by 1% year
on year
Increase Eat Well Award
Environmental Health Award venues
March 2008: 43 Target
2008/09: 40 venues
2009/10: 75 venues
2010/11: 100 venues
To increase physical activity
participation levels in the population
Results of Active
People Survey
2007/08 baseline
19.6%
Targets to increase by
1% annually
2008/09= 20.6%
2009/2010= 21.6%
2010/11= 22.6%
To increase the number of excellent or
good standard play spaces
27 new or refurbished /
new play spaces by
2010
35
Research & Evaluation
Progress in terms of trends in behavioural changes amongst the local population will continueto be reported in 2 main ways:
• The Adult Health and Lifestyle Survey last carried out in 2006, will continue every 5years reporting next in 2011.
• The Exeter Healthy Schools Survey, is carried out in Knowsley schools every year andthe full survey every 4 years with years 6, 8 and 10 pupils.
Evaluation of individual and specific interventions and services will continue to be factoredinto programmes to support the development of an evidence-based approach.
36
7. A New Approach: Becoming More Targeted
In light of the new national target (1), which prioritises children in the first instance, combined withthe absence of any adult target nationally or in the Local Area Agreement it is appropriate toconsider prioritising children and family based interventions for the next 3 years in the updatedEnergise Knowsley Strategy. The universal healthy lifestyle programmes will still continue acrossthe whole population and the adult orientated support and treatment options will still remain.This new focus will allow for new developments and commissioning to prioritise gaps in currentprovision around targeting of children & families.
Evidence of What Works
Children
The importance of establishing healthy behaviours in childhood is well established, as is theidea that parents and carers are important role models for children. Therefore parents andcarers should be encouraged and supported to adopt good food and physical activity practicesin relation to weight, e.g. the encouragement of active play, undertaking physical activity as afamily, reducing sedentary activities, families eating together regularly meals, that are healthyand the correct portion size.
The prevention, development and treatment of childhood obesity is complex, and risk factorsrelated to developing obesity start from the initial decisions parents make before and followingbirth. For example children who are breast fed up to 6 months of age have a lower risk ofdeveloping obesity compared to those who are bottle fed or weaned before 6 months (18).
Prevention of childhood obesity must encourage families, schools and communities to adopthealthy lifestyle habits, and support children to make healthy eating and activity choices.Interventions and treatment for childhood overweight and obesity should address lifestyle withinthe family and in social settings, offering frequent and long-term support and advice (1, 2). A summary of the evidence and recommendations for the prevention and treatmentof childhood obesity can be found in Appendix C.
Adults
Information on the effectiveness of different interventions for patients has become available onlyrelatively recently. Although there are gaps in the evidence, a report by the National Institutesof Health (19) identified a number of potentially effective weight loss interventions:
1. Diet 2. Exercise 3. Behavioural strategies 4. The preceding three in combination where possible5. Limited use of pharmaceutical interventions in conjunction with strategies to change lifestyle 6. Surgery for selected morbidly obese patients.
Recommendations also include the use of maintenance strategies such as continued therapistcontact and prevention strategies such as screening and counselling (2).
Guidelines suggest that weight loss programmes should aim initially to reduce body weight by10% from baseline, at a rate of 1 to 2 lb a week. Exercise should be encouraged for alloverweight patients, including those physically challenged, by promoting exercise designed toachieve increased energy expenditure rather than aerobic fitness. (See summary of evidencein Appendix D).
37
Obesogenic Environment
The term ‘obesogenic environment’ refers to the role environmental factors may play indetermining both energy intake and expenditure. It has been defined as the ‘sum of theinfluences that the surroundings, opportunities or conditions of life have on promoting obesityin individuals and populations’ (3). The term embraces the entire range of social, cultural andinfrastructural conditions that influence an individual’s ability to adopt a healthy lifestyle.
It is now widely accepted that the form of the built environment is a strong determinant ofphysical activity levels (20, 21). People from the most disadvantaged groups are more likely tobe subject to an environment which discourages walking and cycling, perceiving theirneighbourhoods to be busier with traffic, less attractive, and less supportive of walking (22).Knowsley Council’s Transportation, Green Spaces teams and NHS Knowsley work togetherto ensure that health is a consideration in environmental developments. The Knowsley atHeart Cardiovascular Disease Programme aims to promote and sustain a health promotingenvironment, for example this work has helped to create a new public health post basedwithin the KMBC Directorate of Regeneration, Economy, and Skills. This worker will sit withinboth the regeneration team and town planners to systematically ensure health is in all policies,encourage the use of health impact assessments, and develop policy guidance on healthyshopping parades, as well as acting as a health influencer across the directorate. The GreenSpaces Strategy 2008 sets out a commitment towards quality green spaces in the boroughincluding play pathfinders investment and quality of parks, green corridors and allotments.
The aim of this Energise Knowsley - Healthy Weight Strategy is to try and counteract thecauses of obesity to promote and achieve healthy weight and lifestyles across the whole ofKnowsley borough, and this will require engagement with local services and communities toconsider ways to improve access to health promoting services and resources (such as accessto healthy food and safe, affordable opportunities to be physically active).
38
Nationally a commissioning tool has been development for obesity and healthy weight, whichwill enable local areas to assess need and develop a commissioning framework (24) .
Priorities for Action in 2009-12
The provision of a universal approach is important to minimise stigma associated with obesity,and promote a healthy lifestyle for all. These activities may promote healthy lifestyles, forexample a physical activity focus and/or healthy eating. There has been investment in suchprogrammes in the schools, early years setting and Health at Work during phase one of theEnergise Knowsley Strategy and this prevention work must be ongoing.
During this next phase of the strategy we plan to become more targeted in our approach.Strategically the emphasis for commissioning in the short to medium term will focus onidentifying children who are overweight or obese and children in families at risk. The maininvestment will be in community based multi component family interventions that supportchildren who are overweight and obese and their families.
Healthy Weight Commissioning Structure
Acute Specialist
Commissioning
Lead:
Paul Brickwood
Director of Finance
and Commissioning
Services:
Bariatric Surgery,
Children & Adults
Provider:
Classic Hospitals
Community
Services
Commissioning
Lead:
Nita Cresswell
Director of Community
Services
Commissioning
Services:
Dietetic Services in
Community
Provider:
Nutrition & Dietetics
Service, KIPS
Health and
Wellbeing
Commissioning
Lead:
Diana Forrest
Director of Public Health
Services:
Weight Management
Services for Adults &
Children.
Provider:
Nutrition and Dietetics
Service, KIPS (Adult &
Paediatric)
Slimming World
Primary Care
Activity for Life
Leisure and Culture
Children’s
Commissioning Board
Children’s Services
Commissioning
Lead:
Liz Gaulton
Service Director for
Family Support and
Children’s Health
Services:
Universal Children
Services
Provider:
School Health Service
Community Nursing
Services
Learning Centres
Children’s Centres
Leisure and Culture
Health & Wellbeing Commissioning Board
A Commissioning Approach to Obesity Interventions
In 2006 the reorganisation of the NHS, Moving Towards A Patient led NHS (23), PCT’s wererequired to separate their role as service commissioners from the directly provided services.In terms of obesity and healthy weight services this is delivered through Specialist and Acutecommissioning, Health and Well-being Commissioning, Community Services Commissioningand Children’s Services Commissioning, as shown in the following diagram:-
39
There are five initiatives that have been selected and identified within the CommissioningStrategic Plan.
1. Department of Health - National Child Weighing and Measuring Programme
The new requirements for Department of Health Child Weighing and Measuring Programmewill need further investment if we are to reach coverage targets. Additionally the requirementto inform parents of results will create a demand for advice, support and interventions forwhich we have very limited capacity within the Universal School Health Service.
2. Early Years Healthy Weight
The Healthy Child Programme (25) (Formally known as: Child Health Promotion ProgrammeCHPP) reinforces and highlights the responsibility that early years practitioners have inpromoting healthy weight and preventing obesity (and if necessary provide treatment) forchildren under 5 years old. As such, the promotion of healthy weight is threaded through alluniversal contacts that health care practitioners have with families throughout pregnancy andthe early years. Early identification and prevention are integral to the programme and familiesidentified as having additional needs in respect of healthy weight will be offered a packageof support tailored to meet their individual needs.
To support this process, the Department of Health recommends the Heath Exercise Nutritionfor the Really Young (HENRY) project (26). HENRY is an exciting new initiative designed totackle early childhood obesity by training community and health practitioners to work moreeffectively with parents and young families, at a one to one level with parents and in the groupprogrammes. The training helps staff to raise the issue of healthy weight and identify if thechild is ‘at risk’ of developing obesity. These children and families could then be offered agroup programme, which will cover the key lifestyle topics, such as healthy eating, active play,and family communication. This programme will be measured by the number of children whoreceive one-one screening and healthy weight advice, estimated to be over 2500 contactsannually, and the number of families who participate within the group programmes, estimatedat 160 annually.
3. Childhood Overweight Programme
During 2008, Knowsley’s Public Health Intelligence team estimated that approximately 5100children (under 16 years old) in Knowsley were overweight. It has been identified that in orderto prevent obesity and to achieve our target of reducing the obesity levels in children, that wemust provide programmes and advice to prevent those children who are most likely to becomeobese from doing so. During 2008, a trial programme ‘Families4Life’ was conducted for thispopulation group; initial evaluations reveal that engagement and outcomes from theprogramme have been successful. The strategic commissioning plan has provided financialsupport to commission a borough wide programme, to reach a 10% service delivery targetto children indicated as overweight (Target: 510 families annually).
4. Family Futures: Childhood Obesity Service
Family Futures has been running successfully in the borough for 2 years. This is a treatmentservice provided for children who have been identified as clinically obese, and delivered bya multi-faceted team. Public Health Intelligence (2008) estimates that Knowsley hasapproximately 4500 obese children within the borough (<16 years of age), it is thereforeimportant that this service provision provides capacity to offer support to these families. Thestrategic commissioning plan has provided financial support to increase capacity of theservice so that by 2011/12 the service will support 230 families annually.
40
5. Social Marketing – Healthy Weight
Social marketing techniques will be used to aid the understanding of individuals and thesituational and environmental factors that influence the behaviour of the target audience.This understanding (also called ‘insight’) helps us understand not just what is happening andwhat individuals’ attitudes are, but importantly, ‘why’ individuals behave in the way they do.Understanding the ‘why’, helps us begin to change behaviour. This ‘insight’ will help to informspecific social marketing interventions aimed at supporting individuals to change theirbehaviour. Interventions will look at engaging a specific target audience and/or informingservice delivery/design. The segmentation work undertaken will be developed to createbetter understanding of issues relating to equality of access for individuals on the basis ofgender, ethnicity, disability, sexuality and deprivation. All interventions will be evaluated fortheir performance and effectiveness.
Change4Life – Eat Well, Move More, Live Longer.Change4Life is a new movement, supported by theDepartment of Health, which aims to prevent peoplefrom becoming overweight by encouraging them toeat better and move more. The Change4Lifeadvertising campaign began on 3 January 2009 –on TV, in the press, on billboards and online. NHSKnowsley has pledged to ‘actively demonstratesupport for the national ‘Change4life’ campaign (27).Change4life will be promoted and incorporated intoour social marketing and NHS Knowsley’s HealthyWeight Programmes from 2009 onwards.
What We Plan to Do Next
The Strategy Action Plan for 2009 -12 has been divided into 3 sections: 1. Children & Families2. Adults 3. The Obesogenic Environment
Each section has a number of actions, some of which are continuations of existingprogrammes from Energise Knowsley (2004) and others are new developments for the next3 years. The Action Plan includes details of how actions will be measured and links to otherkey local strategies and documents. (See Action Plan pages 43-59)
Action Plan Objectives:
Section 1 Children & Families
1. To increase activity levels of children in early years settings (under 5 years)2. To improve food and nutrition in early years (under 5 years)3. To increase participation of families (with children under 5) in healthy lifestyle courses4. To co-ordinate programmes to identify and support early years children to develop healthy
weight5. To increase healthy eating in school aged children 6. To increase the uptake of physical activities by all children inside and outside the school
curriculum 7. To increase participation and monitoring of the National Child Measurement Programme8. To identify and support children identified as overweight or obese9. To promote health & wellbeing in vulnerable children
41
Section 2 Adults
10. To increase physical activity in Knowsley11. To increase participation levels for people at high risk of developing heart disease e.g.
diabetes, hypertension (e.g identified by CVD programme) and vulnerable adults12. To improve healthy eating 13. To provide advice and interventions to over weight/obese women
Section 3 The Obesogenic Environment
14. To increase access to and consumption of healthy food choices15. To develop the built environment to support active lifestyles16. To increase healthy behaviours of Knowsley PCT and KMBC workforces and
implement action plan17. To provide appropriate services at the right level18. To promote healthier lifestyles
How Will the Strategy be Funded?
Much of the work, which is to be delivered through 2009 -12 has already secured funding viathe lead organisations, departmental budgets and a Public Health Obesity Allocation (SeeAction Plan). Additional funding will need to be sourced for new interventions, services andcampaigns or social marketing which we may want to develop locally. Healthy Weightinitiatives have been prioritised for funding within NHS Knowsley Strategic CommissioningPlan for 2009-12. A total additional investment of £1,648,000 has been agreed for the nextthree years.
In a demonstration of their commitment to the Healthy Weight, Healthy Lives Strategy theGovernment has pledged to increase financial resources within the overall NHS baselineallocations to help to tackle obesity at a local level.
Knowsley’s Healthy Weight financial allocation over the next three years
2009/10
2010/11 2011/12 TOTAL
Public Health Obesity Allocation
200k 200k 200k 600k
Strategic Commissioning Plan/
Working Neighbourhoods Funding
(identified initiatives)
236k 388k 424k 1,048k
Weight Management
(including CHANGES, Activity for
Life, and Slimming World)
1,162k 1,162k 1,162k 3,486k
Bariatric Surgery Variable:
funded on
a case by
case
bases
Variable:
funded on
a case by
case
bases
Variable:
funded on
a case by
case
bases
TOTAL 1,598k 1,750k 1,786k 5,134k
In addition a proportion of the Health
Promotion budget contributes to the
delivery of the Healthy Weight
Agenda (*figure of complete budget
provided)
528k 528k 528k 1,584k
42
8. Conclusion
This strategy aims to deliver a more targeted approach to the prevention of obesity by placingmore emphasis on identifying and supporting children and families most at risk of obesity. Itproposes to build on phase one of the strategy, which focused on the universal populationbased approaches of encouraging people to undertake more exercise and healthier eating.Tackling obesity within Knowsley is a complex issue that will only be achieved if we are to seesustainable changes in the way people live their everyday lives. It requires all sectors to worktogether to create a local environment that is supportive to achieving and maintaining ahealthy weight regardless of where people live.
43
Se
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9. E
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now
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Pla
n 2
009 -
2012
44
Ob
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nts /ca
re
rs a
nd
ch
ild
re
n
He
art o
f M
erse
y
Pu
blic H
ea
lth
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
Qu
arte
rly
T
arg
et W
ellb
ein
g B
ig
Lo
tte
ry b
id u
p to
Ma
rch
2
01
0
2.4
W
ea
nin
g co
urse
s; 2
w
ee
k
co
urse
fo
r p
are
nts, d
elive
re
d in
ch
ild
re
n’s
ce
ntre
s
1 co
urse
p
er lo
ca
lity
pe
r q
ua
rte
r
16
co
urse
s e
ach
ye
ar
Co
mm
un
ity C
oo
ks
Ch
ild
re
n’s
C
en
tre
s
Qu
arte
rly
C
om
mu
nity H
ea
lth
De
ve
lop
me
nt
In
fa
nt F
ee
din
g
Stra
te
gy
2.5
T
em
ptin
g T
ots; se
ssio
ns
de
live
re
d to
p
are
nts o
f ch
ild
re
n
un
de
r 5
ye
ars h
igh
lig
htin
g th
e
imp
orta
nce
o
f h
ea
lth
y sn
ackin
g
fo
r o
ra
l h
ea
lth
a
nd
g
en
era
l
we
llb
ein
g
To
m
ain
ta
in 1
00
%
sch
oo
ls p
artic
ipa
tin
g
in p
ro
gra
mm
e.
Ora
l H
ea
lth
Pro
mo
tio
n T
ea
m
un
til 2
01
3
Qu
arte
rly
O
ra
l H
ea
lth
B
ud
ge
t
Ora
l H
ea
lth
Im
pro
ve
me
nt
Stra
te
gy
2.6
In
te
gra
te
th
e p
ro
mo
tio
n o
f
He
alth
y W
eig
ht in
to
a
ll e
lem
en
ts
of th
e H
ea
lth
y C
hild
p
ro
gra
mm
e
De
ve
lop
a
K
no
wsle
y
He
alth
y C
hild
Pro
gra
mm
e d
urin
g
20
09
Ma
te
rn
al H
ea
lth
Bo
ard
He
alth
V
isitin
g
Te
am
s
Mid
wife
ry T
ea
ms
Ch
ild
re
n C
en
tre
Te
am
s
6 M
on
th
ly
No
ne
D
eve
lop
me
nt
of H
ea
lth
y
Ch
ild
Pro
gra
mm
e
Se
rvic
e
Sp
ecific
atio
n
3. T
o in
cre
ase
pa
rtic
ipa
tio
n o
f
fa
milie
s (w
ith
ch
ild
re
n u
nd
er 5
ye
ars) in
h
ea
lth
y
life
style
co
urse
s
3.1
R
oll o
ut a
n e
du
ca
tio
n
pro
gra
mm
e fo
r p
are
nts a
nd
3
- 4
ye
ar o
lds fo
r jo
int a
ctiv
e p
lay
activ
itie
s a
nd
sim
ple
re
so
urce
s
fo
r h
om
e a
ctiv
itie
s. (F
am
ilie
s
Le
arn
ing
A
ctiv
e P
lay –
F
LA
P)
20
09
/1
0: 5
co
urse
s
20
10
/1
1: 1
0 co
urse
s
20
11
/1
2: to
b
e
re
vie
we
d.
Co
urse
s w
ill b
e
offe
re
d in
th
e
se
ttin
gs w
hic
h ta
ke
up
th
e tra
inin
g
Fa
mily L
ea
rn
ing
Te
am
Co
mm
un
ity H
ea
lth
De
ve
lop
me
nt
Pu
blic H
ea
lth
Sch
oo
l S
po
rts
De
ve
lop
me
nt
Ma
na
ge
rs
Pa
re
nt
Me
nto
rs/S
ta
ff
Qu
arte
rly
H
ea
lth
P
ro
mo
tio
n
20
08
/0
9: £
25
00
20
09
/1
0: £
25
00
20
10
/1
1: £
50
00
20
11
/1
2: to
b
e
re
vie
we
d
45
Ob
je
ctiv
e
Ac
tio
n/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y
an
d P
artn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
3
.2
R
oll o
ut th
e F
am
ilie
s F
it fo
r
Life
p
ro
gra
mm
es, w
hic
h a
ims to
pro
vid
e p
are
nts a
nd
ch
ild
re
n w
ith
th
e skills
, kn
ow
led
ge
a
nd
op
po
rtu
nity to
im
pro
ve
m
en
ta
l
an
d p
hysic
al w
ellb
ein
g, e
na
blin
g
th
em
to
live
h
ea
lth
ier m
ore
a
ctiv
e
life
style
s. F
am
ilie
s w
ith
ch
ild
re
n
un
de
r 5
ye
ars
Ta
rg
et
20
09
/1
0: 2
co
urse
s
20
10
/1
1: 2
co
urse
s
Ho
me
S
ta
rt
KC
VS
Pu
blic H
ea
lth
Co
mm
un
ity H
ea
lth
De
ve
lop
me
nt
6 M
on
th
ly
Ta
rg
et W
ellb
ein
g B
ig
Lo
tte
ry fu
nd
ed
fo
r 3
ye
ars (2
00
8-2
01
1)
4. T
o co
-o
rd
ina
te
pro
gra
mm
es to
ide
ntify a
nd
su
pp
ort e
arly
ye
ars
ch
ild
re
n to
d
eve
lop
he
alth
y w
eig
ht
4.1
T
o in
cre
ase
th
e n
um
be
r o
f
ch
ild
re
n u
nd
er 5
ye
ars w
ho
a
re
ide
ntifie
d a
s o
ve
rw
eig
ht o
r o
be
se
,
an
d p
ro
vid
e a
dvic
e a
nd
su
pp
ort
as a
pp
ro
pria
te
Co
mm
issio
nin
g o
f
se
rvic
e 2
00
9/1
0 -
Ea
rly
Y
ea
rs S
ta
ff
tra
inin
g a
ro
un
d
ide
ntifyin
g ch
ild
re
n
as ‘a
t ris
k’ fo
r
ob
esity. N
um
be
r o
f
sta
ff tra
ine
d 2
00
8
In
fo
rm
atio
n
re
so
urce
s to
b
e
de
ve
lop
ed
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
Pa
ed
iatric
Co
mm
un
ity
Die
te
tic
s
6 M
on
th
ly
Ob
esity B
ud
ge
t,
Pu
blic H
ea
lth
£4
00
0
HE
NR
Y
5. T
o in
cre
ase
he
alth
y e
atin
g in
sch
oo
l a
ge
d
ch
ild
re
n
5.1
In
cre
ase
u
pta
ke
o
f h
ea
lth
y
me
al o
ptio
ns in
P
rim
ary a
nd
Se
co
nd
ary sch
oo
ls
20
08
b
ase
lin
e 4
4%
To
in
cre
ase
b
y 5
%
by 2
01
1-1
2
Sch
oo
l M
ea
ls
Se
rvic
e
He
alth
y S
ch
oo
ls
6 M
on
th
ly
Sch
oo
l M
ea
ls S
ervic
e
He
alth
y
Sch
oo
ls
Bu
sin
ess P
lan
5
.2
N
utritio
na
l sta
nd
ard
s o
f
sch
oo
l m
ea
ls, h
ea
lth
y tu
ck sh
op
s
an
d b
re
akfa
st clu
bs to
co
mp
ly
with
–
S
ch
oo
l F
oo
d T
ru
st
Nu
tritio
na
l S
ta
nd
ard
s
Sch
oo
l fo
od
pro
vis
ion
co
mp
lie
s
with
S
ch
oo
l F
oo
d
Tru
st N
utritio
n
Gu
ide
lin
es.
All p
rim
ary sch
oo
ls
by S
ep
t 2
00
8
All se
co
nd
ary
sch
oo
ls b
y S
ep
t
20
09
To
b
e m
ain
ta
ine
d
20
10
/1
1
Sch
oo
l M
ea
ls
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
An
nu
ally
Sch
oo
l M
ea
ls S
ervic
e
He
alth
y
Sch
oo
ls
Bu
sin
ess P
lan
46
Ob
je
ctiv
e
Ac
tio
ns
/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y
an
d P
artn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
5.3
H
ea
lth
y L
un
ch
bo
x in
itia
tiv
e to
be
d
istrib
ute
d to
a
ll p
rim
ary
sch
oo
ls a
nd
le
arn
ing
d
isa
bilitie
s
ce
ntre
s
Prim
ary sch
oo
ls /
lea
rn
ing
d
isa
bilitie
s
se
rvic
es to
re
po
rt
imp
ro
ve
me
nt in
lu
nch
bo
x co
nte
nt.
All sch
oo
ls to
h
ave
he
alth
y lu
nch
bo
x
po
licy a
s se
t o
ut o
n
th
e S
ch
oo
l F
oo
d T
ru
st
We
bsite
. 2
00
8/0
9
To
b
e m
ain
ta
ine
d
20
09
-2
01
1
He
alth
y S
ch
oo
ls
Sch
oo
l N
utritio
n
Actio
n G
ro
up
LE
A
An
nu
ally
Prin
tin
g co
sts
fro
m O
be
sity B
ud
ge
t,
Pu
blic H
ea
lth
£3
50
0: 2
00
8/0
9
£3
50
0: 2
00
9/1
0
£3
50
0: 2
01
0/1
1
He
alth
y
Sch
oo
ls
Bu
sin
ess P
lan
5.4
In
cre
ase
co
nsu
mp
tio
n o
f fru
it
an
d ve
ge
ta
ble
s in
lin
e w
ith
5
a
da
y m
essa
ge
a
s re
co
rd
ed
in
Sch
oo
ls E
xe
te
r S
urve
y
Pie
ce
o
f fru
it g
ive
n
da
ily to
e
ve
ry in
fa
nt
sch
oo
l ch
ild
in
Kn
ow
sle
y (a
ge
s 4
-7
)
Re
po
rte
d via
a
nn
ua
l
He
alth
R
ela
te
d
Be
ha
vio
ur S
urve
y
Re
gio
na
l
Pu
blic H
ea
lth
In
te
llig
en
ce
He
alth
y S
ch
oo
ls
SN
AG
G
ro
up
An
nu
ally
Fu
nd
ing
fro
m N
HS
su
pp
ly ch
ain
a
gre
ed
un
til 2
01
1 (to
b
e
re
vis
ed
a
t a
nytim
e)
(T
el 0
16
1 9
52
4
35
8)
He
alth
y
Sch
oo
ls
Bu
sin
ess P
lan
5.5
H
ea
lth
y S
ch
oo
l A
ccre
dita
tio
n;
All sch
oo
ls to
b
e h
ea
lth
y sch
oo
ls
by 2
01
1 w
hic
h in
clu
de
s h
avin
g
wh
ole
sch
oo
l fo
od
p
olicy co
ve
rs,
bre
akfa
st clu
bs, tu
ck sh
op
s,
re
wa
rd
s a
nd
ce
leb
ra
tio
ns
De
c 2
00
8: 7
2%
Ju
ly 2
00
9: 7
5%
De
c 2
00
9: 7
8%
De
c 2
01
0: 8
5%
Ma
r 2
01
0 : 1
0%
o
f
sch
oo
ls to
h
ave
en
ha
nce
d se
rvic
es
He
alth
y S
ch
oo
ls
Sch
oo
l N
utritio
n
Actio
n G
ro
up
6 M
on
th
ly
Ob
esity B
ud
ge
t,
Pu
blic H
ea
lth
. £
40
00
(1
0 x b
re
akfa
st
clu
bs/tu
ck sh
op
s)
He
alth
y
Sch
oo
ls
Bu
sin
ess P
lan
5.6
F
am
ily co
oke
ry p
ro
gra
mm
e
fo
r ke
y sta
ge
2
a
ge
d 7
-1
1 ye
ars
ch
ild
re
n a
nd
th
eir
p
are
nts/ca
re
rs.
Sta
ff /vo
lun
te
ers tra
ine
d fro
m th
e
ind
ivid
ua
l sch
oo
ls. T
ho
se
sta
ff
de
live
r 6
w
ee
k co
urse
s to
p
are
nts
an
d ch
ild
re
n in
th
eir
sch
oo
l
Pro
gra
mm
e to
co
ntin
ue
in
1
5 e
xis
tin
g
sch
oo
ls a
nd
h
ave
5
ne
w sch
oo
ls 2
00
8/0
9
1 tra
inin
g co
urse
offe
re
d p
er ye
ar.
09
/1
0: 2
0 co
urse
s
10
/1
1: 2
0 co
urse
s
Co
urse
s w
ill b
e
offe
re
d in
th
e se
ttin
gs
wh
ich
ta
ke
u
p th
e
tra
inin
g
Co
mm
un
ity
Co
oks
Fa
mily L
ea
rn
ing
Te
am
He
alth
y S
ch
oo
ls
6 m
on
th
ly
Fu
nd
ing
fro
m O
be
sity
Bu
dg
et, P
ub
lic H
ea
lth
20
09
/1
0: £
10
00
0
20
0/1
1: £
10
00
0
He
alth
y
Sch
oo
ls
Bu
sin
ess P
lan
47
49
Ob
je
ctiv
e
Ac
tio
n/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y
an
d P
artn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
5
.7
C
oo
kin
g fo
r p
are
nts/ca
re
rs. 4
we
ek co
urse
te
ach
ing
co
okin
g fo
r
fa
milie
s b
ase
d o
n th
e ‘E
atw
ell
Pla
te
’ m
od
el o
f h
ea
lth
y e
atin
g
20
09
/1
0: 4
co
urse
s
20
10
/1
1: 6
co
urse
s
Co
mm
un
ity C
oo
ks
Te
am
Ch
ild
re
n’s
C
en
tre
s
6 m
on
th
ly
Co
mm
un
ity H
ea
lth
De
ve
lop
me
nt B
ud
ge
t
Ch
ild
re
n’s
C
en
tre
s
(C
re
ch
e)
6. T
o in
cre
ase
th
e
up
ta
ke
o
f p
hysic
al
activ
itie
s b
y a
ll
ch
ild
re
n in
sid
e a
nd
ou
tsid
e th
e sch
oo
l
cu
rric
ulu
m
6.1
T
he
S
ch
oo
l S
po
rts
Pa
rtn
ersh
ips w
ill lin
k e
xis
tin
g
pro
vid
ers a
nd
d
eve
lop
n
ew
pa
rtn
ersh
ips w
ith
o
th
er a
ge
ncie
s
to
w
ork to
wa
rd
s th
e 2
01
0
am
bitio
n d
elive
rin
g o
n a
t le
ast 2
ho
urs cu
rric
ulu
m P
E a
nd
a
n
ad
ditio
na
l 2
-3
h
ou
rs b
eyo
nd
th
e
sch
oo
l d
ay. P
SA
ta
rg
et
20
09
o
nw
ard
s: ‘a
ll 5
-1
9 ye
ar o
lds
to
b
e o
ffe
re
d o
pp
ortu
nitie
s to
pa
rtic
ipa
te
in
a
fu
rth
er 3
h
ou
rs o
f
sp
ortin
g a
ctiv
itie
s
En
ha
nce
th
e ta
ke
u
p
of sp
ortin
g
op
po
rtu
nitie
s b
y 5
-1
6
ye
ar o
lds m
ea
su
re
d
in th
e D
CM
S P
AS
b
y
th
e %
o
f sch
oo
l
ch
ild
re
n w
ho
sp
en
d
a m
inim
um
o
f 2
ho
urs e
ach
w
ee
k o
n
hig
h q
ua
lity P
E a
nd
sch
oo
l sp
ort w
ith
in
an
d b
eyo
nd
th
e
cu
rric
ulu
m.
20
09
/2
01
0 ta
rg
et ye
t
to
b
e se
t n
atio
na
lly.
20
08
/0
9 K
no
wsle
y
ta
rg
et w
as 8
5%
b
ut
ach
ieve
d 8
8%
.
Esta
blish
a
b
ase
lin
e
of n
um
be
rs o
f
ch
ild
re
n ta
kin
g p
art
in 2
h
ou
rs a
nd
ad
ditio
na
l 3
h
ou
rs -
su
rve
y to
b
e p
ilo
te
d
in N
DC
a
re
a b
y
Yo
uth
S
po
rts T
ru
st
an
d D
CS
F
20
09
/2
01
0 th
en
loo
kin
g fo
r 5
%
incre
ase
ye
ar o
n
ye
ar
Sch
oo
ls S
po
rts
Pa
rtn
ersh
ip
Sp
orts a
nd
P
hysic
al
Activ
ity A
llia
nce
Ch
ild
re
n’s
a
nd
Yo
un
g P
eo
ple
s
Stra
te
gic
P
lan
(2
00
7- 2
01
0)
An
nu
ally
Sch
oo
l S
po
rts
Pa
rtn
ersh
ip F
un
ds
SP
AA
’
48
Ob
je
ctiv
e
Ac
tio
n/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y
an
d P
artn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
6.2
H
ea
lth
y S
ch
oo
ls B
us
pro
mo
tin
g p
hysic
al a
ctiv
ity a
nd
he
alth
y e
atin
g
Bu
s to
vis
it a
ll
prim
ary sch
oo
ls in
20
09
/1
0 fo
r ke
y
sta
ge
2
p
up
ils.
20
10
/1
1: to
b
e
re
vie
we
d
KM
BC
L
eis
ure
He
alth
y S
ch
oo
ls
Eve
rto
n F
oo
tb
all
Clu
b
An
nu
ally
KM
BC
L
eis
ure
6.3
W
ork w
ith
S
po
rts
De
ve
lop
me
nt to
id
en
tify a
nd
de
ve
lop
a
ccre
dite
d clu
bs
In
cre
ase
d n
um
be
r o
f
ch
ild
re
n in
vo
lve
d in
clu
bs 0
7/0
8: 2
5%
In
cre
ase
d sch
oo
l
clu
b lin
ks
20
08
/0
9 =
2
5%
No
. o
f a
ccre
dite
d
clu
bs in
b
oro
ug
h;
20
07
/0
8: 3
clu
bs
20
08
/0
9: 1
5 clu
bs
20
09
/1
0: 3
0 clu
bs
20
10
/1
1: 5
5 clu
bs
De
pt o
f L
eis
ure
&
Co
mm
un
ity
Se
rvic
es
LE
A
Sch
oo
ls
An
nu
ally
Sin
gle
Y
ou
th
O
ffe
r
Sp
orts D
eve
lop
me
nt
SP
AA
6.4
In
te
gra
te
d S
wim
min
g
Pro
gra
mm
e to
co
-o
rd
ina
te
sch
oo
l
an
d p
ub
lic sw
imm
ing
sch
em
es
Nu
mb
er o
f ch
ild
re
n
th
at ca
n sw
im 2
5m
at K
S2
.
Re
fre
sh
o
f le
arn
to
sw
im sch
em
e to
b
e
co
mp
lete
d b
y n
ew
sw
imm
ing
de
ve
lop
me
nt
ma
na
ge
r
LE
A
PD
M’s
SD
U
Prim
ary S
ch
oo
ls
An
nu
ally
In
div
idu
al sch
oo
l
Bu
dg
et a
nd
De
pa
rtm
en
t o
f
Ch
ild
re
n, S
ch
oo
ls a
nd
Fa
milie
s T
op
-u
p
SP
AA
6.5
D
eve
lop
a
nd
im
ple
me
nt
sch
oo
l tra
ve
l p
lan
s, to
in
cre
ase
nu
mb
er o
f ch
ild
re
n
wa
lkin
g/cyclin
g to
sch
oo
l
Na
tio
na
l ta
rg
et to
ha
ve
a
ll sch
oo
ls w
ith
tra
ve
l p
lan
b
y 2
01
0
Ma
rch
2
00
9 n
= 6
4
(8
8%
)
Ma
rch
2
01
0 n
= 7
3
(1
00
%)
De
pa
rtm
en
t o
f
Re
ge
ne
ra
tio
n a
nd
Ne
igh
bo
urh
oo
d
LE
A
Sch
oo
ls
Lo
ca
l T
ra
ve
l P
lan
2
.
An
nu
ally
Hig
hw
ays C
ap
ita
l
Fu
nd
ing
.
Ca
pita
l G
ra
nts
ava
ila
ble
;
Prim
ary
£3
,7
50
+
£
5 p
er p
up
il
Se
co
nd
ary
£5
,0
00
+
£
5 p
er p
up
il
SP
AA
49
Ob
je
ctiv
e
Ac
tio
n/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y
an
d P
artn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
6
.6
S
him
my S
him
my S
ha
ke
Sh
ake
. C
om
mu
nity D
an
ce
Pro
ject. A
va
ila
ble
fo
r e
arly
ye
ars,
ch
ild
re
n, fa
milie
s a
nd
a
du
lts
Da
nce
a
ctiv
itie
s to
be
b
ase
d in
co
mm
un
ity ve
nu
es
acro
ss th
e b
oro
ug
h
Sh
imm
y S
him
my
Sh
ake
S
ha
ke
Ta
rg
et W
ellb
ein
g
Pu
blic H
ea
lth
Qu
arte
rly
T
arg
et W
ellb
ein
g B
ig
Lo
tte
ry B
id 2
01
0
SP
AA
7.1
N
atio
na
l C
hild
M
ea
su
re
me
nt
Pro
gra
mm
e to
b
e co
nd
ucte
d in
Re
ce
ptio
n a
nd
Y
ea
r 6
p
up
ils
Ta
rg
et
Re
ce
ptio
n ye
ar:
90
% m
ea
su
re
d
Ye
ar 6
:
20
09
/1
0: 8
7%
20
10
/1
1: 8
8%
20
11
/1
2: 8
9%
Sch
oo
l H
ea
lth
Se
rvic
e
An
nu
ally
Sch
oo
l H
ea
lth
B
ud
ge
t
He
alth
y W
eig
ht
Stra
te
gy
Sch
oo
l H
ea
lth
Se
rvic
e P
lan
7. T
o in
cre
ase
pa
rtic
ipa
tio
n a
nd
mo
nito
rin
g o
f
Na
tio
na
l C
hild
Me
asu
re
me
nt
Pro
gra
mm
e
7.2
P
are
nts to
b
e ro
utin
ely
pro
vid
ed
w
ith
th
eir
ch
ild
’s re
su
lts
fro
m th
e N
CM
P (N
atio
na
l C
hild
Me
asu
re
me
nt P
ro
gra
mm
e)
Fe
ed
ba
ck o
n
pro
ce
ss a
nd
im
pa
ct
of le
tte
r to
b
e
eva
lua
te
d
Sch
oo
l H
ea
lth
Se
rvic
e
Pu
blic H
ea
lth
An
nu
ally
Ob
esity B
ud
ge
t,
Pu
blic H
ea
lth
£
20
00
20
09
/1
0
He
alth
y W
eig
ht
Stra
te
gy
Sch
oo
l H
ea
lth
Se
rvic
e P
lan
8. T
o id
en
tify a
nd
su
pp
ort ch
ild
re
n
ide
ntifie
d a
s
ove
rw
eig
ht o
r
ob
ese
8.1
T
o p
ro
mo
te
a
nd
d
eve
lop
sta
nd
ard
ise
d p
ro
ce
du
re
s in
e
arly
ye
ars in
lin
e w
ith
C
hild
H
ea
lth
Pro
gra
mm
e
Nu
mb
er o
f fa
milie
s
se
ekin
g su
pp
ort
Nu
mb
er o
f re
fe
rra
ls
ma
de
to
fu
rth
er
se
rvic
es
Nu
mb
er o
f sig
np
osts
to
o
th
er se
rvic
es
Pu
blic H
ea
lth
He
alth
V
isito
rs
Ea
rly
Y
ea
rs T
ea
m
6 M
on
th
ly
C
hild
ho
od
He
alth
y W
eig
ht
Pa
th
wa
y
8
.2
T
o p
ro
mo
te
a
nd
d
eve
lop
sta
nd
ard
ise
d p
ro
ce
du
re
s w
ith
in
sch
oo
l se
ttin
gs a
llo
win
g ch
ild
re
n
an
d fa
milie
s to
a
cce
ss
info
rm
atio
n a
nd
su
pp
ort a
s
re
qu
ire
d
Nu
mb
er o
f ch
ild
re
n
se
ekin
g su
pp
ort
Nu
mb
er o
f re
fe
rra
ls
ma
de
to
fu
rth
er
se
rvic
es
Nu
mb
er o
f sig
np
osts
to
o
th
er se
rvic
es
(P
artic
ipa
tio
n ra
te
s
in P
.E
. a
nd
sp
ortin
g
activ
itie
s in
cre
ase
d)
Sch
oo
l H
ea
lth
Pu
blic H
ea
lth
Die
te
tic
s
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
le’s
H
ea
lth
y
We
igh
t G
ro
up
6 M
on
th
ly
Sch
oo
l H
ea
lth
B
ud
ge
t
Ch
ild
ho
od
He
alth
y W
eig
ht
Pa
th
wa
y
50
Ob
je
ctiv
e
Ac
tio
n/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y
an
d P
artn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
8.3
T
o ro
ll o
ut in
te
rve
ntio
n
pro
gra
mm
e to
ch
ild
re
n a
nd
th
eir
fa
milie
s id
en
tifie
d a
s o
ve
rw
eig
ht
or a
t ‘r
isk’
Co
mm
issio
n
pro
gra
mm
e a
cro
ss
bo
ro
ug
h 2
00
9/2
01
0
Pu
blic H
ea
lth
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
Qu
arte
rly
O
be
sity B
ud
ge
t,
Pu
blic H
ea
lth
n
ew
co
st fro
m C
SP
Ye
ar 2
a
nd
3
co
sts
TB
C fo
r ro
ll-o
ut
CS
P
Co
mm
issio
nin
g
Stra
te
gic
P
lan
8.4
‘F
am
ily F
utu
re
s’ T
o p
ro
vid
e
ta
ilo
re
d fa
mily in
te
rve
ntio
n to
ch
ild
re
n id
en
tifie
d a
s o
be
se
’
20
09
/1
0: 7
2 fa
milie
s
20
10
/1
1: 2
00
fa
milie
s
20
11
/1
2: 2
30
fa
milie
s
Die
te
tic
s
Pu
blic H
ea
lth
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
Qu
arte
rly
£
30
k: C
SP
£4
0k: L
TC
£7
0k: O
be
sity
CS
P
Co
mm
issio
nin
g
Stra
te
gic
P
lan
8.5
T
o a
sse
ss ch
ild
re
n w
ith
pro
lon
ge
d o
be
sity fo
r m
ed
ica
tio
n
inte
rve
ntio
ns if a
pp
ro
pria
te
.
Pa
th
wa
y to
b
e d
eve
lop
ed
a
nd
re
vie
we
d
20
09
Nu
mb
er o
f ch
ild
re
n
pre
scrib
ed
me
dic
atio
n fo
r
ob
esity.
Ch
an
ge
in
B
MI
Die
te
tic
s
Co
mm
un
ity
Pa
ed
iatric
T
ea
m
Me
dic
ine
s
Ma
na
ge
me
nt
Pu
blic H
ea
lth
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
Qu
arte
rly
M
ed
icin
es
Ma
na
ge
me
nt
Die
te
tic
s B
ud
ge
t
‘Ch
an
ge
s’
Se
rvic
e P
lan
8
.6
P
ath
wa
y fo
r se
co
nd
ary ca
re
of o
be
se
ch
ild
re
n to
b
e re
vis
ed
.
Sp
ecia
list C
om
mis
sio
nin
g
Pa
th
wa
y to
b
e
de
ve
lop
ed
a
nd
co
mm
issio
ne
d
20
09
/1
0
Nu
mb
er o
f ch
ild
re
n
re
fe
rre
d to
b
e
mo
nito
re
d
Sp
ecia
list
Co
mm
issio
nin
g
Die
te
tic
s
Co
mm
un
ity
Pa
ed
iatric
T
ea
m
Me
dic
ine
s
Ma
na
ge
me
nt
Pu
blic H
ea
lth
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
Qu
arte
rly
S
pe
cia
list
Co
mm
issio
nin
g.
Fu
nd
ing
im
plica
tio
n.
B
51
Ob
je
ctiv
e
Ac
tio
n/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y
an
d P
artn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
9. T
o p
ro
mo
te
he
alth
a
nd
we
llb
ein
g in
vu
lne
ra
ble
ch
ild
re
n
9.1
A
ll C
hild
re
n L
oo
ke
d A
fte
r
(C
LA
) to
h
ave
a
h
ea
lth
asse
ssm
en
t a
nd
p
lan
.
All ca
re
rs to
p
ro
mo
te
h
ea
lth
y
life
style
, a
nd
sig
n-p
ose
d to
ap
pro
pria
te
in
fo
rm
atio
n /
pro
gra
mm
e
By 2
01
0 a
ll ch
ild
re
n
loo
ke
d a
fte
r fo
r m
ore
th
an
1
2 m
on
th
s to
ha
ve
a
p
erso
na
l
he
alth
a
sse
ssm
en
t.
Mo
nito
r n
um
be
r o
f
ch
ild
re
n re
qu
irin
g
ove
rw
eig
ht/o
be
sity
inp
ut
DH
SC
PC
T
Mo
nth
ly
Ma
instre
am
C
ou
ncil
an
d P
CT
sta
ff tra
inin
g
aro
un
d
ob
esity/h
ea
lth
y
life
style
s. O
be
sity
Bu
dg
et, P
ub
lic H
ea
lth
£1
50
0
52
Se
ctio
n 2
: A
du
lts
Ob
je
ctiv
e
Ac
tio
ns
/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y
an
d P
artn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
10
.1
T
o d
eve
lop
&
su
pp
ort th
e
wo
rk o
f S
po
rt &
P
hysic
al
Activ
ity A
llia
nce
Re
su
lts o
f A
ctiv
e
pe
op
le su
rve
y
20
07
/0
8 b
ase
lin
e
19
.6
%.
Ta
rg
ets to
in
cre
ase
by 1
% a
nn
ua
lly
20
08
/0
9: 2
0.6
%
20
09
/2
01
0: 2
1.6
%
20
10
/1
1: 2
2.6
%
SP
AA
Le
isu
re
Pu
blic H
ea
lth
An
nu
ally
Activ
e P
eo
ple
2
su
rve
y d
ata
n
ot
ye
t re
lea
se
d.
N/A
SP
AA
10
.2
In
cre
ase
p
artic
ipa
tio
n in
wa
lkin
g in
th
e b
oro
ug
h.
De
ve
lop
a
nd
im
ple
me
nt a
Wa
lkin
g fo
r H
ea
lth
A
ctio
n P
lan
1 m
on
th
ly ste
p in
to
he
alth
w
alk
to
b
e
intro
du
ce
d to
e
ach
are
a o
f th
e b
oro
ug
h
20
09
/1
0
1 p
er a
re
a
pa
rtn
ersh
ip 2
01
0/1
1
Pu
blic H
ea
lth
Co
mm
un
ity H
ea
lth
De
ve
lop
me
nt
Qu
arte
rly
C
om
munity H
ealth
Develo
pm
ent B
udget
Health P
rom
otio
n,
Public H
ealth B
udget
SP
AA
10
. T
o in
cre
ase
ph
ysic
al a
ctiv
ity in
Kn
ow
sle
y
10
.3
In
cre
ase
o
pp
ortu
nitie
s to
pa
rta
ke
in
lo
ca
l a
ctiv
ity a
nd
life
style
e
ve
nts. In
cre
ase
up
ta
ke
o
f th
e K
no
wsle
y a
nn
ua
l
eve
nts in
clu
din
g -
Activ
e C
ha
lle
ng
e
Ju
nio
r A
ctiv
e C
ha
lle
ng
e
Ra
ce
fo
r L
ife
Wa
lkin
g F
estiv
al
In
2
00
8; n
=2
84
5 -
are
a p
artn
ersh
ip
pa
rtic
ipa
nts fo
r a
du
lt
activ
e ch
alle
ng
e
Pa
rtic
ipa
nts in
ju
nio
r
ch
alle
ng
e.
Ra
ce
fo
r life
.
Wa
lkin
g F
estiv
al.
To
ta
l; 2
84
5
In
cre
ase
o
ve
ra
ll
ta
rg
et b
y 3
%, to
n
=
29
30
b
y 2
01
0/1
1
KM
BC
E
ve
nts
Te
am
Pu
blic H
ea
lth
Sch
oo
l S
po
rts
Pa
rtn
ersh
ip
An
nu
ally
Pu
blic H
ea
lth
B
ud
ge
t
fo
r A
ctiv
e C
ha
lle
ng
e.
Eve
nts T
ea
m
ma
na
ge
th
is b
ud
ge
t,
ne
ed
s to
b
e
su
pp
orte
d a
s th
e
eve
nt g
ro
ws.
£7
00
0 2
00
9/1
0, p
lus
£2
50
0 H
ea
lth
Pro
mo
tio
n.
SP
AA
53
Ob
je
ctiv
e
Ac
tio
n/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y
an
d P
artn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
1
0.4
T
o in
cre
ase
n
um
be
r o
f
pe
op
le cyclin
g. F
ina
lise
a
nd
su
pp
ort th
e im
ple
me
nta
tio
n o
f a
cyclin
g a
ctio
n p
lan
fo
r
Kn
ow
sle
y. In
clu
din
g P
ed
al
Aw
ay, a
nd
W
he
els
fo
r A
ll
Esta
blish
b
ase
lin
e
da
ta
o
f cyclin
g
20
08
/0
9
To
ra
ise
a
ctiv
ity
leve
ls o
f P
ed
al A
wa
y
pa
rtic
ipa
nts.
To
h
ave
5
tra
ine
d
Pe
da
l A
wa
y cycle
lea
de
rs 2
00
8/0
9
Actio
n P
lan
fo
rm
ally
ag
re
ed
S
ep
t 2
00
8
Pe
da
l A
wa
y
DR
N
Tra
nsp
ort P
lan
Pu
blic H
ea
lth
Pe
da
l A
wa
y
He
alth
De
ve
lop
me
nt
KM
BC
Tra
nsp
orta
tio
n
KM
BC
L
eis
ure
Qu
arte
rly
£
10
0,0
00
p
er ye
ar
(D
ep
t R
eg
en
era
tio
n
De
ve
lop
me
nt
To
b
e m
atch
ed
ag
ain
st E
U fu
nd
ing
Big
L
otte
ry
He
alth
P
ro
mo
tio
n
Bu
dg
et £
16
75
Tra
nsp
ort B
ud
ge
t
£1
67
5
Pe
da
l A
wa
y B
ud
ge
t
SP
AA
11
.1
In
cre
ase
p
artic
ipa
tio
n in
Activ
ity fo
r L
ife
.
Cu
rre
ntly
o
pe
ra
te
w
ith
6
80
Se
rvic
e cu
rre
ntly
un
de
r re
vie
w
Ta
rg
ets
20
09
/1
0: 9
60
20
10
/1
1: 1
50
0
20
11
/1
2: 2
50
0
Activ
ity fo
r L
ife
Pro
gra
mm
e
Le
isu
re
S
ervic
es
De
pa
rtm
en
t o
f
Ne
igh
bo
urh
oo
d
De
live
ry
6 M
on
th
ly
Sp
ort E
ng
lan
d m
on
ey
Le
isu
re
S
ervic
es
11
.2
A
gin
g W
ell P
lus p
ro
ject:
aim
s to
tra
in o
lde
r p
eo
ple
to
be
co
me
vo
lun
te
er to
h
ea
lth
me
nto
r o
th
er o
lde
r p
eo
ple
to
he
lp m
ake
h
ea
lth
ier life
style
ch
oic
es
Ta
rg
ets to
b
e
co
nfir
me
d
Ag
e C
on
ce
rn
Co
mm
un
ity H
ea
lth
De
ve
lop
me
nt
He
alth
a
nd
S
ocia
l
Ca
re
(M
ary F
arre
ll).
Qu
arte
rly
T
arg
et W
ellb
ein
g B
ig
Lo
tte
ry
CV
D
Pro
gra
mm
e
Pla
n
11
. T
o in
cre
ase
pa
rtic
ipa
tio
n o
f
pe
op
le a
t h
igh
ris
k o
f
de
ve
lop
ing
h
ea
rt
dis
ea
se
e
.g
.
dia
be
te
s,
hyp
erte
nsio
n (e
.g
.
ide
ntifie
d b
y C
VD
pro
gra
mm
e) a
nd
vu
lne
ra
ble
a
du
lts
11
.3
B
ack to
…S
po
rt. D
elive
r
sp
orts a
nd
p
hysic
al a
ctiv
ity
se
ssio
ns fo
r a
du
lts in
ce
rta
in
de
priv
ed
a
re
as o
f th
e b
oro
ug
h,
as id
en
tifie
d b
y A
ctiv
e P
eo
ple
ma
rke
t se
gm
en
ta
tio
n d
ata
Ta
rg
ets
20
09
/1
0: 4
15
20
10
/1
1: 8
30
20
11
/2
01
2: 1
24
5
Le
isu
re
S
ervic
es
KM
BC
SP
AA
G
ro
up
6 M
on
th
ly
Sp
orts E
ng
lan
d
fu
nd
ed
Le
isu
re
S
ervic
es
Aw
ay a
nd W
heel
s fo
r A
ll
54
Ob
je
ctiv
e
Ac
tio
n/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y a
nd
Pa
rtn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
12
. T
o im
pro
ve
he
alth
y e
atin
g
12
.1
T
o in
cre
ase
fru
it a
nd
ve
ge
ta
ble
co
nsu
mp
tio
n in
Kn
ow
sle
y re
sid
en
ts
To
In
cre
ase
b
y 1
% ye
ar
on
ye
ar.
Me
asu
re
d th
ou
gh
Life
style
S
urve
y a
nd
Sch
oo
l B
eh
avio
ur
Su
rve
y.
Ba
se
lin
e 2
00
6: 2
01
2/1
3
Pu
blic H
ea
lth
In
te
llig
en
ce
An
nu
ally
5%
in
cre
ase
ne
xt life
style
su
rve
y
Fu
nd
ing
fro
m:
Kn
ow
sle
y P
CT
Sa
les
MB
C (a
tte
nd
an
ce
at e
ve
nts)
Su
re
S
ta
rt
Vo
uch
ers
He
alth
y S
ta
rt
Vo
uch
ers
13
.1
B
MI p
re
gn
an
cy id
en
tifie
d a
t
th
e 1
2th
w
ee
k b
oo
kin
g a
s b
ein
g
ove
rw
eig
ht/o
be
se
to
b
e g
ive
n
ad
vic
e o
n h
ea
lth
y w
eig
ht in
pre
gn
an
cy
To
re
vie
w a
nd
d
eve
lop
info
rm
atio
n g
ive
n o
ut to
pre
gn
an
t w
om
en
a
t 1
2th
we
ek b
oo
kin
g a
nd
o
n
pa
re
nt cra
ft co
urse
s
Wh
isto
n H
osp
ita
l 2
00
8
Liv
erp
oo
l W
om
en
’s b
y
20
10
, O
rm
skir
k b
y 2
01
0
Pu
blic H
ea
lth
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
Mid
wife
ry T
ea
m
Die
te
tic
s
(C
HA
NG
ES
)
6 M
on
th
ly
Die
te
tic
B
ud
ge
t
Ma
te
rn
al H
ea
lth
‘Ch
an
ge
s’
Se
rvic
e P
lan
13
.2
P
ostn
ata
l re
fe
rre
d fo
r
die
te
tic
su
pp
ort in
‘C
HA
NG
ES
’
We
igh
t M
an
ag
em
en
t S
ervic
es
Nu
mb
er o
f re
fe
rra
ls to
‘CH
AN
GE
S’ re
co
rd
ed
GP
s
Die
te
tic
s
Pu
blic H
ea
lth
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
Mid
wife
ry T
ea
m
Die
te
tic
s
(C
HA
NG
ES
)
Qu
arte
rly
D
iete
tic
s B
ud
ge
t
‘Ch
an
ge
s’
Se
rvic
e P
lan
13
.3
M
ea
su
re
-u
p co
mm
un
ity
ba
se
d w
eig
ht m
an
ag
em
en
t
pro
gra
mm
e o
ffe
rin
g p
hysic
al
activ
ity, n
utritio
n a
dvic
e a
nd
be
ha
vio
ura
l su
pp
ort
Ta
rg
et to
ru
n 3
pro
gra
mm
es p
er ye
ar
Co
mm
un
ity H
ea
lth
De
ve
lop
me
nt
Die
te
tic
s
Qu
arte
rly
C
om
mu
nity
He
alth
De
ve
lop
me
nt
Bu
dg
et
He
alth
Pro
mo
tio
n, P
ub
lic
He
alth
B
ud
ge
t
Ad
ult H
ea
lth
y
We
igh
t
Pa
th
wa
ys
13
. T
o p
ro
vid
e
ad
vic
e a
nd
inte
rve
ntio
ns to
ove
rw
eig
ht/o
be
se
wo
me
n
13
.4
P
ilo
t p
ha
rm
acy co
mm
un
ity
we
igh
t m
an
ag
em
en
t su
pp
ort to
be
d
eve
lop
ed
/ in
clu
din
g th
e
mo
nito
rin
g o
f a
pp
ro
pria
te
d
ru
g
ma
na
ge
me
nt fo
r o
be
sity
Nu
mb
er o
f a
sse
ssm
en
ts/
nu
mb
er o
f m
ed
ica
tio
ns
mo
nito
re
d/ch
an
ge
d.
Ave
ra
ge
B
MI ch
an
ge
Pu
blic H
ea
lth
Me
dic
ine
s
Ma
na
ge
me
nt,
Ph
arm
acy
Die
te
tic
s
Qu
arte
rly
M
ed
icin
es
Ma
na
ge
me
nt
55
Ob
je
ctiv
e
Ac
tio
ns
/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y a
nd
Pa
rtn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
13
.5
T
ho
se
id
en
tifie
d a
s ra
ise
d
BM
I (o
ve
rw
eig
ht o
r o
be
se
) to
b
e
offe
re
d fre
e vo
uch
er sch
em
e in
to
‘slim
min
g o
n re
fe
rra
l’ w
ith
Slim
min
g W
orld
. R
oll-o
ut a
cro
ss
Kir
kb
y a
nd
A
sto
n H
ea
lth
ca
re
gro
up
Mo
nito
r n
um
be
r
acce
ssin
g ‘s
lim
min
g o
n
re
fe
rra
l’
Ch
an
ge
in
life
style
, B
MI
sta
tu
s
80
0 re
fe
rra
ls u
p to
M
arch
20
10
GP
P
ra
ctic
es
Pu
blic H
ea
lth
Slim
min
g W
orld
Qu
arte
rly
C
om
mis
sio
ne
d
Se
rvic
e
PB
C B
ud
ge
t
Co
mm
issio
n a
n
SL
A D
ocu
me
nt
13
.6
T
o in
cre
ase
th
e re
fe
rra
ls
into
th
e d
iete
tic
s w
eig
ht
ma
na
ge
me
nt se
rvic
es, via
pro
mo
tio
n o
f se
rvic
e re
fe
rra
l
crite
ria
’
Nu
mb
er o
f re
fe
rra
ls
re
ce
ive
d
Nu
mb
er o
f a
sse
ssm
en
ts
co
nd
ucte
d
Nu
mb
er o
f clie
nts
be
gin
nin
g in
te
rve
ntio
ns
Die
te
tic
s (C
HA
NG
ES
& C
om
mu
nity)
Pu
blic H
ea
lth
Qu
arte
rly
D
iete
tic
s B
ud
ge
t
13
.7
D
ru
g p
ath
wa
y -
de
ve
lop
cle
ar g
uid
elin
es fo
r th
e
pre
scrip
tio
n a
nd
a
dm
inis
tra
tio
n
of a
nti-
ob
esity m
ed
ica
tio
ns
Nu
mb
er o
f p
re
scrip
tio
ns
Su
cce
ss ra
te
o
f
pre
scrip
tio
ns
Die
te
tic
s (C
ha
ng
es &
Co
mm
un
ity)
Me
dic
ine
s
Ma
na
ge
me
nt
Pu
blic H
ea
lth
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
An
nu
ally
Me
dic
ine
s
Ma
na
ge
me
nt
13
.8
S
urg
ery - B
aria
tric
Cla
rify re
fe
rra
l, ca
re
p
ro
to
co
l a
nd
po
st-ca
re
fo
r su
rg
ica
l
inte
rve
ntio
ns
Nu
mb
er o
f re
fe
rra
ls
Nu
mb
er a
cce
pte
d fo
r
re
fe
rra
l.
BM
I ch
an
ge
.
20
09
/1
0 se
rvic
e co
ntra
ct
to
b
e re
vie
we
d
Sp
ecia
list
Co
mm
issio
nin
g
He
alth
y W
eig
ht
Pa
rtn
ersh
ip B
oa
rd
Pu
blic H
ea
lth
Die
te
tic
s
(C
HA
NG
ES
)
An
nu
ally
Sp
ecia
list
Co
mm
issio
n
Bu
dg
et id
en
tifie
d.
Sp
ecia
list
Co
mm
issio
nin
g
Do
cu
me
nt
56
Se
ctio
n 3
: O
be
so
ge
nic
E
nv
iro
nm
en
t
Ob
je
ctiv
e
Ac
tio
ns
/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y a
nd
Pa
rtn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
14
.1
T
ra
in lo
ca
l p
eo
ple
in
;
sh
op
pin
g o
n a
b
ud
ge
t a
nd
co
okin
g skills
, a
nd
p
ortio
n siz
e
20
08
/0
9 1
6 co
urse
s ru
n
ea
ch
ye
ar ( 4
p
er e
ach
loca
lity) 2
00
9-2
01
1
co
urse
s to
b
e
ma
inta
ine
d
Co
mm
un
ity C
oo
ks
Qu
arte
rly
C
om
mu
nity
He
alth
De
ve
lop
me
nt
Bu
dg
et
14
.2
In
cre
ase
d co
nsu
mp
tio
n o
f
fru
it a
nd
ve
ge
ta
ble
fo
r K
no
wsle
y
re
sid
en
ts a
nd
w
orkp
lace
s via
Fru
it o
n D
esks, a
nd
V
eg
gie
V
an
(B
ag
a
B
arg
ain
)
2
00
7/2
00
8 3
60
p
iece
s
of fru
it o
rd
ere
d p
er w
ee
k
acro
ss 1
2 sch
em
es.
Ap
pro
x a
nn
ua
l
co
nsu
mp
tio
n 1
50
0
pie
ce
s.
Ve
gg
ie V
an
ta
rg
ets fo
r
20
08
-2
01
1 cu
rre
ntly
be
ing
re
vie
we
d
Pu
blic H
ea
lth
En
vir
on
me
nta
l H
ea
lth
DN
D
An
nu
ally
Wo
rkfo
rce
H
ea
lth
W
orkfo
rce
He
alth
S
tra
te
gy
14
.3
In
cre
ase
E
at W
ell A
wa
rd
En
vir
on
me
nta
l H
ea
lth
A
wa
rd
Ve
nu
es
Ta
rg
et
Ba
se
lin
e - 4
0
20
09
/1
0: 7
5 ve
nu
es
20
10
/1
1: 1
00
ve
nu
es
En
vir
on
me
nta
l H
ea
lth
A
nn
ua
lly
En
vir
on
me
nta
l
He
alth
Wo
rkfo
rce
He
alth
S
tra
te
gy
14
.4
C
afé
S
ocie
ty B
ig L
otte
ry
pro
ject: to
su
pp
ort a
nd
tra
in
loca
l p
eo
ple
b
e a
ble
to
o
pe
n a
co
mm
un
ity ca
fé
-so
cia
l
en
te
rp
ris
e
Ta
rg
et
20
09
/1
0: 1
ca
fé
to
b
e
op
en
ed
20
09
/1
0: L
oca
l
co
mm
un
ity m
em
be
rs to
be
tra
ine
d
Sq
ua
sh
N
utritio
n
An
nu
ally
Ta
rg
et W
ellb
ein
g
Big
L
otte
ry fu
nd
ed
Sq
ua
sh
N
utritio
n
14
. T
o in
cre
ase
acce
ss to
a
nd
co
nsu
mp
tio
n o
f
he
alth
y fo
od
ch
oic
es
14
.5
P
lan
nin
g re
qu
ire
me
nts
Re
du
ce
n
um
be
r o
f fa
st fo
od
Pro
du
ce
a
nd
d
isse
min
ate
a
do
cu
me
nt w
ith
N
HS
re
co
mm
en
da
tio
ns re
ga
rd
ing
ho
w a
nd
w
hy h
ea
lth
y life
style
ch
oic
es sh
ou
ld b
e co
nsid
ere
d in
pla
nn
ing
lo
ca
l d
eve
lop
me
nts
20
09
D
ocu
me
nt to
b
e
pro
du
ce
d a
nd
dis
se
min
ate
d.
Fe
ed
ba
ck fro
m C
ou
ncil
KM
BC
P
lan
ne
rs
Pu
blic H
ea
lth
D
ep
t
Ne
igh
bo
urh
oo
d
Re
ne
wa
l
An
nu
ally
N/A
C
VD
Pro
gra
mm
e
Pla
n
57
Ob
je
ctiv
e
Ac
tio
ns
/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y a
nd
Pa
rtn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
14
.6
T
o su
pp
ort a
nd
im
ple
me
nt
Eu
ro
pe
an
a
nd
n
atio
na
l fo
od
po
licie
s
Su
pp
ort p
olicy
de
ve
lop
me
nt w
ork o
f
He
art o
f M
erse
y a
nd
wh
ere
p
ossib
le a
nd
ap
pro
pria
te
a
lig
n
ou
rse
lve
s w
ith
E
uro
pe
an
po
licie
s o
n fo
od
He
art o
f M
erse
y
Pu
blic H
ea
lth
An
nu
ally
14
.7
F
oo
d G
ro
win
g S
ch
em
es.
Pro
mo
tin
g g
ro
win
g o
f fru
it a
nd
ve
ge
ta
ble
s w
ith
in th
e b
oro
ug
h
De
ve
lop
a
re
so
urce
offe
rin
g in
fo
rm
atio
n a
nd
ad
vic
e a
ro
un
d g
ro
win
g
fru
it a
nd
ve
ge
ta
ble
s.
Pro
du
ce
a
d
isse
min
atio
n
pla
n a
nd
e
va
lua
te
imp
lem
en
ta
tio
n
Pu
blic H
ea
lth
Ap
ril –
Se
pte
mb
er
20
09
Pu
blic H
ea
lth
-
He
alth
P
ro
mo
tio
n
Bu
dg
et
Lin
ks to
Ch
ild
re
n’s
Ce
ntre
s ta
rg
ets
15
.1
Im
pro
ve
G
re
en
S
pa
ce
s a
nd
su
pp
ort G
re
en
S
pa
ce
s S
tra
te
gy
De
live
r 2
7 im
pro
ve
me
nt
sch
em
es (n
ew
o
r
re
fu
rb
ish
me
nts) a
nd
brin
g a
ll p
lay sp
ace
s u
p
to
e
xce
lle
nt o
r g
oo
d
sta
nd
ard
b
y M
arch
20
10
.
20
09
/ 2
01
0 n
= 1
3
KM
BC
D
ep
artm
en
t
Ne
igh
bo
urh
oo
d
De
ve
lop
me
nt (D
ND
)
De
pa
rtm
en
t o
f
Ch
ild
re
n’s
S
ervic
es
(D
CS
)
Mo
nth
ly
De
pa
rtm
en
t o
f
Ch
ild
re
n a
nd
Fa
mily S
ervic
es.
Gre
en
S
pa
ce
s
Stra
te
gy
15
. T
o d
eve
lop
th
e
bu
ilt e
nvir
on
me
nt
to
su
pp
ort a
ctiv
e
life
style
s
15
.2
T
he
G
re
at O
utd
oo
rs,
La
nd
life
P
ro
ject p
ro
mo
te
u
se
o
f
gre
en
sp
ace
s to
p
ro
mo
te
b
ette
r
he
alth
. G
ard
en
ing
p
ro
ject
Ta
rg
ets to
b
e co
nfir
me
d
La
nd
life
Ta
rg
et W
ellb
ein
g
Qu
arte
rly
T
arg
et W
ellb
ein
g
Big
L
otte
ry fu
nd
ed
Ob
esity w
ith
in
Kn
ow
sle
y P
lay
Stra
te
gy
16
. T
o in
cre
ase
he
alth
y b
eh
avio
urs
of K
no
wsle
y P
CT
an
d M
BC
wo
rkfo
rce
s a
nd
imp
lem
en
t a
ctio
n
pla
n
16
.1
F
re
e/d
isco
un
te
d cla
sse
s
ava
ila
ble
to
K
PC
T a
nd
K
MB
C
Sta
ff
2,2
00
n
ew
p
artic
ipa
nts
to
in
cre
ase
b
y 1
0%
ye
ar
on
ye
ar
KM
BC
S
po
rts a
nd
Activ
e L
eis
ure
KP
CT
Wo
rkfo
rce
A
ctiv
ato
r
An
nu
ally
Sp
ort E
ng
lan
d
In
co
me
g
en
era
te
d
th
ro
ug
h
me
mb
ersh
ips
Wo
rkfo
rce
He
alth
Bor
ough
58
Ob
je
ctiv
e
Ac
tio
ns
/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y a
nd
Pa
rtn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
16
.2
In
cre
ase
d u
pta
ke
o
f
Kn
ow
sle
y M
BC
3
0%
d
isco
un
te
d
leis
ure
ce
ntre
m
em
be
rsh
ips b
y
KM
BC
a
nd
K
PC
T sta
ff
Ba
se
lin
e 2
00
7/0
8 4
81
sta
ff to
ta
l. (4
55
K
MB
C,
26
P
CT
)
Fu
tu
re
ta
rg
ets to
b
e
ag
re
ed
KM
BC
S
po
rts a
nd
Activ
e L
eis
ure
KP
CT
Wo
rkfo
rce
A
ctiv
ato
r
An
nu
ally
Wo
rkfo
rce
H
ea
lth
Bu
dg
et
Wo
rkfo
rce
He
alth
16
.3
P
ro
mo
te
co
rp
ora
te
fra
me
wo
rk fo
r h
ea
lth
y e
atin
g
inclu
din
g tra
inin
g fo
r sta
ff w
ho
ord
er re
fre
sh
me
nts fo
r m
ee
tin
gs
an
d e
ve
nts
Nu
mb
er o
f tra
inin
g
se
ssio
ns
Pu
blic H
ea
lth
KM
BC
An
nu
ally
Wo
rkfo
rce
H
ea
lth
W
orkfo
rce
He
alth
16
.4
In
cre
ase
n
um
be
r o
f b
ike
sh
elte
rs a
t P
CT
a
nd
C
ou
ncil
site
s. C
urre
ntly
2
3 a
t 2
site
s
20
08
p
ro
du
ce
tw
o
co
ve
re
d b
ike
sta
nd
s
(1
K
irkb
y, 1
H
uyto
n, 1
0
bik
es e
ach
).
3 P
CT
b
uild
ing
s to
h
ave
bik
e sta
nd
s, (K
irkb
y,
Nu
tg
ro
ve
V
illa
, W
his
to
n)
La
nd
life
Pu
blic H
ea
lth
-
Ta
rg
et W
ellb
ein
g
An
nu
ally
KM
BC
Wo
rkfo
rce
H
ea
lth
Wo
rkfo
rce
He
alth
S
tra
te
gy
17
.1
T
o d
isse
min
ate
‘h
ea
lth
y
we
igh
t’ stra
te
gy
20
09
T
o b
e d
istrib
ute
d
an
d p
ro
mo
te
d a
cro
ss
PC
T a
nd
co
un
cil, a
nd
vo
lun
ta
ry se
cto
rs in
Kn
ow
sle
y
Pu
blic H
ea
lth
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
Qu
arte
rly
H
ea
lth
De
ve
lop
me
nt
Fu
nd
ing
N
/A
He
alth
y W
eig
ht
Stra
te
gy
17
.2
T
o d
eve
lop
se
rvic
e
sp
ecific
atio
n a
nd
p
ro
to
co
l fo
r
ch
ild
o
ve
rw
eig
ht p
ro
gra
mm
e in
Kn
ow
sle
y to
co
mm
issio
n
20
09
se
rvic
e to
b
e
co
mm
issio
ne
d b
y Ju
ly
20
09
, a
nd
d
elive
ry
effe
ctiv
e fro
m
Se
pte
mb
er 2
00
9
Pu
blic H
ea
lth
CS
P H
ea
lth
y W
eig
ht
Pro
ject T
ea
m
Ch
ild
re
n a
nd
Y
ou
ng
Pe
op
les H
ea
lth
y
We
igh
t G
ro
up
An
nu
ally
He
alth
De
ve
lop
me
nt
Fu
nd
ing
N
/A
Ch
ild
re
n &
Yo
un
g P
eo
ple
pla
n
17
. T
o p
ro
vid
e
ap
pro
pria
te
se
rvic
es a
t th
e rig
ht
leve
l
17
.3
T
o ro
ll o
ut tra
inin
g to
P
CT
an
d co
un
cil sta
ff
20
09
sta
rt ro
llo
ut to
P
CT
sta
ff
Pu
blic H
ea
lth
Die
te
tic
s, T
ra
inin
g
(W
orkfo
rce
De
ve
lop
me
nt)
Qu
arte
rly
O
be
sity B
ud
ge
t,
Pu
blic H
ea
lth
£5
00
0: 2
00
9/1
0
2
01
0/1
1
2
01
1/1
2
59
Ob
je
ctiv
e
Ac
tio
n/P
ro
je
cts
M
ea
su
ra
ble
Ou
tc
om
es
a
nd
Tim
es
ca
le
s
Le
ad
A
ge
nc
y a
nd
Pa
rtn
ers
Su
mm
ary
o
f
Ac
tiv
ity
Ev
id
en
ce
Co
lle
cte
d
Fin
an
cia
l/
Re
so
urc
es
Id
en
tifie
d
Sh
are
d
Prio
rity
W
ith
18
.1
C
ha
ng
e4
L
ife
–
N
atio
na
l
so
cia
l m
arke
tin
g ca
mp
aig
n to
en
su
re
co
-o
rd
ina
te
d m
essa
ge
s
aro
un
d h
ea
lth
y
Na
tio
na
l re
so
urce
s to
b
e
cir
cu
late
d fo
r u
se
lo
ca
lly
De
pa
rtm
en
t o
f H
ea
lth
A
nn
ua
lly
Na
tio
na
lly fu
nd
ed
D
H H
ea
lth
y
We
igh
t H
ea
lth
y
Liv
es S
tra
te
gy
18
. T
o p
ro
mo
te
he
alth
ier life
style
s
18
.2
T
o d
eve
lop
lo
ca
l so
cia
l
ma
rke
tin
g ca
mp
aig
n re
ga
rd
ing
he
alth
y w
eig
ht
Pro
ject p
lan
d
eve
lop
ed
20
09
He
alth
y W
eig
ht
Pa
rtn
ersh
ip B
oa
rd
Ma
rke
tin
g &
Co
mm
un
ica
tio
ns
A
nn
ua
lly
PC
T fu
nd
ing
P
CT
S
tra
te
gic
Co
mm
issio
nin
g
Pla
n
60
10. References
1. Department of Health (2008). Healthy Weight, Healthy Lives: A Cross GovernmentStrategy for England (Government Office for Science, Jan 2008.)
2. National Institute for Health and Clinical Excellence (2006). Obesity: Guidance onthe Prevention, Identification, Assessment and Management of Overweight andObesity in Adults and Children. www.nice.org.uk/CG43
3. Egger G, Swinburn B. An 'ecological' approach to the obesity pandemic. Br Med J 1997; 315: 477– 480
4. Kopelman, P. 2007. Health Risks Associated with Overweight and Obesity. ShortScience Review. Foresight Tackling Obesities: Future Choices. Obesity Reviews,8(s1):13–17 (http://www.foresight.gov.uk).
5. Foresight Tackling Obesities: Future Choices (2007). Government Office for Science.http://www.foresight.gov.uk
6. Dietz,W. (1998). Health Consequences of Obesity in Youth: Childhood. Pediatrics,101;3S.
7. Sheslow, D., Hassink, S., Wallace, W., & Delancey, E. (1993). The relation betweenself esteem and depression in obese children. Annals of the New York Academy ofSciences, 699, 289-291.
8. Jung RT (1997) Obesity as a disease. British Medical Bulletin 53: 307–21.
9. Energise Knowsley - Obesity Strategy, 2004. Produced by Obesity Strategy Group,Public Health, Knowsley PCT & Council
10. PSA Delivery Agreement 12: Improve the health and wellbeing of children andyoung people April 2008. HM Government. http://www.hm-treasury.gov.uk/d/pbr_csr07_psa12.pdf
11. Department of Health (2008). The Operating Framework for 2009/10 for the NHS inEngland. High Quality Care for All.http://www.dh.gov.uk/en/Publicationsandstatistics/Publications
12. The health care commissioning annual health check indicators can be accessed athttp://www.cqc.org.uk/
13. Health Survey for England 2006 Latest Trends (2008). The Information Centre.http://www.ic.nhs.uk/webfiles/publications/HSE06/Health%20Survey%20for%20England%202006%20Latest%20Trends.pdf
14. Department of Health (2008). The National Child Measurement Programme,Guidance for PCTs: 2008/09 school year.
15. House of Commons Health Committee (2004) Obesity. Third Report of Session2003-04. London: The Stationery Office.
61
16. a. Knowsley Adult Health and Lifestyle Survey 2006, NHS Knowsley Public `Health Intelligence
b. Knowsley Adult Health and Lifestyle Survey 2001, NHS Knowsley Public Health Intelligence
17. Government Office for the North West (2008). A North West Framework, To achievehealthy weight for children & families within the context of food & nutrition andphysical activity.
18. Department of Health (2008) Child Health Promotion Programme: pregnancy andthe first 5 years of life www.dh.govt.uk
19. National Institutes of Health. Clinical guidelines on the identification, evaluation, andtreatment of overweight and obesity in adults: the evidence report. Bethesda, MD:National Institutes of Health; 1998. [NIH Publication No. 98 – 9043]
20. Fox KR, Hillsdon M. Physical activity and obesity. Obes Rev. 2007;8 Suppl 1:115-21
21. Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design,physical activity, and time spent in cars. Am J Prev Med (2004) 27:87 – 96.
22. Giles-Corti B, Macintyre S, Clarkson J, et al. Environmental and lifestyle factorsassociated with overweight and obesity in Perth, Australia. Am J Health Promot(2003) 18:93–102
23. Department of Health (2007). Creating a Patient-led NHS - Delivering the NHSImprovement Plan.
24. Department of Health (2008). Healthy Weight, Healthy Lives: Commissioningweight management services for children and young people.
25. Department for children, schools and families and department of Health (2009).Healthy Lives, brighter futures. The Strategy for children and young people’s health.
26. Health Exercise Nutrition for the Really Young, HENRY. http://www.henry.org.uk/
27. 2008. Department of Health. Change4Life assets, and principles and guidelines forGovernment and NHS. (Oct)
28. NHS Information Centre (2008) National Child Measurement Programme: 2006/07school year headline results www.ic.nhs.uk/pubs/ncmp0607
29. Liou TH, Pi-Sunyer FX, Laferrère B (2005). Physical disability and obesity. Nutr Rev. 2005 Oct; 63 (10):321-31
30. Spivock et al, 2007 Neighborhood-level active living buoys for individuals withphysical disabilities, American Journal of Preventive Medicine, 32
62
Appendix A
Defining Obesity & Overweight
Obesity is defined as a body mass index greater than 30kg/m2. There are 3 classificationsof adult obesity, as defined by the World Health Organisation. (Table 1)
Table 1. Classification of Obesity in Adults
Classification Body Mass Index
Weight in Kg
(Height in Metres)2
Class 3 obesity (very severe) Over 40
Class 2 obesity (severe) 35-39.9
Class 1 obesity (moderate) 30-34.9
Obese Over 30
Overweight 25-29.9
Healthy weight 18.5-24.9
Under weight Less than 18.5
Classification of Obesity in Children
For children, a number of measures can be used, the cut off point of Body Mass Index, whichdefines obesity varies with the age of the child. The most commonly used measures are theUK 1990 BMI reference curves, which are produced according to age and gender specificinformation (NICE 2006). Children over the 95th percentile are classified as obese and thoseover the 85th percentile as overweight. For clinical purposes, when dealing with individualchildren and the need for treatment services, guidelines recommend that obese children bedefined as those with a Body Mass Index over the 98th percentile on the UK BMI referencecurves (SIGN, 2003)
63
Appendix B
Healthy Weight Pathways
The following provides a pathway of prevention, management and treatment of care, whichprimarily focuses on weight management issues and promotes healthy lifestyles. Serviceshave been organised into four levels, which indicate the degree of weight management advicerequired, according to the Body Mass Index of the client. Level 1 is open to all Knowsleyresidents aiming to improve their lifestyle, Body Mass Index status may not have beenidentified by a health professional but clients may access these services independentlywithout necessarily making contact with a health professional first. However, clients identifiedto be overweight with a Body Mass Index between 25 - 29.9, should be encouraged to attendone or more of these lifestyle services. Services available at levels 2-4 are categorisedaccording to the clients identified increased risk and BMI. Level 4 services are the mostintense and comprehensive services available to those clients with very high BMI status.
Adults: Healthy Weight Care Pathway
Health Trainers/
Level 1: Community Based Services Healthy Weight - Prevention / Maintenance and Overweight -‘Increased Risk’
(BMI all, Encourage overweight clients to attend: BMI 25-29.9) Self-referral Groups / Step into Health/ Community cooks / Health Trainers /
‘Measure-up’ Programme/ Activity for Life-Exercise on Prescription/ GP or Practice Nurse/ Voluntary/ Leisure Centres
Level 2: Weight management Obese - class I ‘Moderate Risk’
BMI 30 plus or BMI 27 with co-morbidities General Practice
Community Dietetics Medication-drug treatment
Also available, services listed in level 1 above
Level 3: Specialist Weight Management Services Obese - class II ‘Severe Risk’
BMI 35 plus ‘CHANGES’ weight management service
Medication-drug treatment General Practice
Also available, services listed in level 1 & 2
Level 4: Extended Specialist Service Secondary Care
Obese - class III ‘Very Severe Risk’ BMI 40 plus OR BMI 35 with co-morbidities
Services listed in level 3 Surgical Assessment Treatment
Also available, services listed in levels above
Slimming World - GP Referral Scheme BMI 26 - 30
64
Children’s: Healthy Weight Care Pathway
Level 1
Universal programme
Children only
Healthy Lifestyle
messages
Level 3
Family Futures
Specialist Multidisciplinary
Delivered Family
intervention
Intense support, medical
input, advance behavioural
support. May require more
time, family support, and
emotional /psychological
wellbeing
Level 3 +
Pharmacological
support
Not recommended
for under 12 year
olds. Unless have
co-morbidity, or
psychological
issues (NICE
guidance)
Level 3 ++
Secondary care
Full Dietetic, medical,
and psychological
assessment for
Bariatric surgery
(NICE guidance)
Healthy Schools
School Health
Community Cooks
Community Health Dev
Sports and leisure
etc
Sports Development
Dietetics
Community Cooks
Community Health
Development
Youth and Play
School Health
Dietetics
Psychology
Nurse Clinician/
Paediatrician
Sports Development
Community Cooks
Health Trainers
School Health
Dietetics
Psychology
Nurse Clinician
Psychology
GP
School Health
Dietetics
Nurse Clinician
Psychology
GP
Commissioned
Service
Level 2
Overweight & at risk
Requires parent
involvement
Fun activity, healthy
eating messages, and
basic Behavioural
change techniques
To be commissionedSummer 2009
65
Ap
pen
dix
C
Su
mm
ary
of
Evi
den
ce:
Infa
nts
& C
hild
ren
Ag
e
Pre
ve
ntio
n
Ov
erw
eig
ht
Ob
es
e
Re
co
mm
en
da
tio
n
Ea
rly
Ye
ars
(U
nd
er 5
ye
ars
old
)
• B
re
ast-fe
d &
w
ea
ne
d n
o e
arlie
r
th
an
6
m
on
th
s h
ave
a
lo
we
r
ris
k o
f b
eco
min
g o
ve
rw
eig
ht.
• In
fa
nts a
nd
pa
re
nts sh
ou
ld b
e
en
co
ura
ge
d to
a
do
pt h
ea
lth
y
life
style
a
ctiv
itie
s a
nd
inte
rve
ntio
ns sh
ou
ld p
ro
mo
te
he
alth
y e
atin
g a
nd
a
ctiv
e p
lay.
• N
o cle
ar g
uid
an
ce
/e
vid
en
ce
to
wa
rd
s e
ffe
ctiv
e tre
atm
en
t
ava
ila
ble
.
• M
ulti-
co
mp
on
en
t h
ea
lth
y
life
style
in
fo
rm
atio
n, a
dvic
e
an
d su
pp
ort to
b
e p
ro
vid
ed
.
• N
o cle
ar g
uid
an
ce
o
f e
vid
en
ce
to
wa
rd
s e
ffe
ctiv
e tre
atm
en
t
ava
ila
ble
(e
vid
en
ce
de
ve
lop
ing
)
• M
ulti-
co
mp
on
en
t h
ea
lth
y
life
style
in
fo
rm
atio
n, a
dvic
e
an
d su
pp
ort to
b
e p
ro
vid
ed
.
Stru
ctu
re
d W
eig
ht
Ma
na
ge
me
nt.
• N
IC
E (2
00
6) re
co
mm
en
ds th
at a
ll n
urse
rie
s a
nd
ch
ild
ca
re
fa
cilitie
s sh
ou
ld im
pro
ve
ch
ild
re
n’s
d
ieta
ry in
ta
ke
s a
nd
ph
ysic
al a
ctiv
ity le
ve
ls b
y:
1.
Min
imis
ing
se
de
nta
ry a
ctiv
itie
s d
urin
g le
isu
re
tim
e;
pro
vid
ing
re
gu
lar o
pp
ortu
nitie
s fo
r a
ctiv
e p
lay &
p
ro
vid
ing
stru
ctu
re
d p
hysic
al a
ctiv
ity se
ssio
ns.
2.
Im
ple
me
ntin
g th
e D
epa
rtm
en
t fo
r E
du
ca
tio
n a
nd
S
kills
&
Fo
od
S
ta
nd
ard
Ag
en
cy g
uid
an
ce
o
n fo
od
p
ro
cu
re
me
nt &
he
alth
ier ca
te
rin
g.
3.
All a
ctio
n a
ime
d a
t p
re
ve
ntin
g e
xce
ss w
eig
ht g
ain
&
imp
ro
vin
g d
iet a
nd
a
ctiv
ity le
ve
ls in
ch
ild
re
n sh
ou
ld
activ
ely
in
vo
lve
pare
nts a
nd
ca
re
rs.
Sc
ho
ol
Ag
ed
Ch
ild
ren
(5
-1
5
ye
ars)
• C
hild
re
n sh
ou
ld b
e
en
co
ura
ge
d to
ta
ke
pa
rt in
6
0
min
ute
s a
d
ay o
f p
hysic
al
activ
ity. P
hysic
al a
ctiv
ity
pro
gra
mm
es in
sch
oo
ls h
ave
pro
du
ce
d g
oo
d o
utco
me
s.
Th
ey m
ay e
nco
ura
ge
life
lon
g
ph
ysic
al a
ctiv
ity a
nd
e
nh
an
ce
aca
de
mic
a
ctiv
ity.
• F
acto
rs th
at a
pp
ea
r to
im
pro
ve
th
e e
ffe
ctiv
en
ess o
f h
ea
lth
y
ea
tin
g in
te
rve
ntio
ns a
re
sch
oo
l
or co
mm
un
ity-b
ase
d, m
ulti-
fa
ce
te
d a
pp
ro
ach
es, th
e
invo
lve
me
nt o
f m
em
be
rs o
f th
e
fa
mily &
sch
oo
l co
mm
un
ity, &
th
e u
se
o
f d
ire
ct in
te
ra
ctio
ns
with
fo
od
.
• S
ch
oo
l-b
ase
d h
ea
lth
pro
mo
tio
n (cla
ssro
om
cu
rric
ulu
m to
re
du
ce
te
levis
ion
,
vid
eo
ta
pe
&
vid
eo
g
am
e u
se
)
ma
y p
re
ve
nt o
be
sity &
ove
rw
eig
ht.
• S
ch
oo
l &
fa
mily b
ase
d
pro
gra
mm
es u
sin
g a
m
ulti-
fa
ce
te
d a
pp
ro
ach
p
ro
mo
tin
g
incre
ase
d p
hysic
al a
ctiv
ity;
die
ta
ry ch
an
ge
s a
nd
a
re
du
ctio
n in
se
de
nta
ry
be
ha
vio
urs ca
n p
ro
mo
te
he
alth
y w
eig
ht.
• In
te
rve
ntio
ns in
clu
de
nu
tritio
n e
du
ca
tio
n,
pro
mo
tio
n o
f p
hysic
al
activ
ity, b
eh
avio
ura
l th
era
py,
te
ach
er tra
inin
g, cu
rric
ulu
m
ma
te
ria
ls a
nd
m
od
ific
atio
n
of sch
oo
l m
ea
ls a
nd
tu
ck
sh
op
sto
ck.
• In
te
rve
ntio
n sh
ou
ld b
e m
ulti-
co
mp
on
en
t (i.e
. d
ieta
ry
ad
vic
e a
lon
e is
n
ot
ap
pro
pria
te
).
• S
tru
ctu
re
W
eig
ht M
an
ag
em
en
t
to
b
e p
ro
vid
ed
.
• F
am
ily-b
ase
d p
ro
gra
mm
es
sh
ou
ld a
dd
re
ss d
iet a
nd
ph
ysic
al a
ctiv
ity a
nd
o
ffe
r
be
ha
vio
ur ch
an
ge
su
pp
ort.
• A
ll in
te
rve
ntio
ns fo
r o
be
se
ch
ild
re
n sh
ou
ld a
ctiv
ely
invo
lve
pa
re
nts d
ue
to
th
e
fa
milie
s in
flu
en
ce
o
n
be
ha
vio
ur.
• A
sse
ssm
en
t in
clu
de
s a
me
dic
al ch
eck a
nd
tre
atm
en
t
offe
rs a
ste
pp
ed
ca
re
ap
pro
ach
, w
he
re
by life
style
su
pp
ort a
nd
in
te
rve
ntio
ns a
re
offe
re
d fir
st fo
llo
we
d b
y fu
rth
er
asse
ssm
en
t a
nd
m
ed
ica
l in
pu
t
if a
pp
ro
pria
te
.
• N
IC
E (2
00
6) re
co
mm
en
ds th
at a
ll sch
oo
ls sh
ou
ld e
nsu
re
th
at im
pro
vin
g th
e d
iet a
nd
a
ctiv
ity le
ve
ls o
f ch
ild
re
n a
nd
yo
un
g p
eo
ple
is
a
p
rio
rity fo
r a
ctio
n to
h
elp
p
re
ve
nt e
xce
ss
we
igh
t g
ain
a
nd
to
h
elp
ra
ise
sta
nd
ard
s. T
he
y a
lso
re
co
mm
en
d th
at a
ll sch
oo
ls co
nsid
er th
e im
plica
tio
n o
f a
ll
sch
oo
l p
olicie
s o
n th
e a
bility o
f ch
ild
re
n to
m
ain
ta
in a
he
alth
y w
eig
ht, e
at a
h
ea
lth
y d
iet a
nd
b
y p
hysic
ally a
ctiv
e,
inclu
din
g p
olicie
s re
latin
g to
ca
te
rin
g p
ro
vis
ion
(in
clu
din
g
ve
nd
ing
), fo
od
b
ro
ug
ht in
b
y ch
ild
re
n, ta
ug
ht cu
rric
ulu
m,
be
fo
re
a
nd
a
fte
r sch
oo
l clu
bs, sch
oo
l tra
ve
l p
lan
s a
nd
he
alth
y sch
oo
ls p
ro
gra
mm
es.
• H
ea
lth
y W
eig
ht H
ea
lth
y L
ive
s (2
00
8) re
co
mm
en
d th
at
ch
ild
ho
od
o
ve
rw
eig
ht/o
be
se
in
te
rve
ntio
ns a
im to
m
ain
ta
in
BM
I o
r re
du
ce
B
MI ra
te
o
f in
cre
ase
, b
y o
ffe
rin
g m
ulti-
co
mp
on
en
t fa
mily b
ase
d in
te
rve
ntio
ns
66
Ag
e
Pre
ve
ntio
n
Ov
erw
eig
ht
Ob
es
e
Re
co
mm
en
da
tio
n
Ad
ults
Ag
ed
16
p
lus
Evid
en
ce
sh
ow
s th
at th
e p
re
ve
ntio
n o
f
ob
esity is
co
mp
lex a
nd
sh
ou
ld in
clu
de
ind
ivid
ua
l, co
mm
un
ity, e
nvir
on
me
nta
l
an
d lo
ca
l ch
an
ge
s to
su
pp
ort h
ea
lth
y
life
style
s.
Th
e p
ro
mo
tio
n o
f h
ea
lth
y e
atin
g a
nd
ph
ysic
al a
ctiv
ity, ca
n b
e a
ch
ieve
d b
y:
- p
ro
vid
ing
e
asy a
cce
ss to
fru
it &
ve
ge
ta
ble
s
-p
ro
vid
ing
o
pp
ortu
nitie
s fo
r re
sid
en
ts
to
im
pro
ve
kn
ow
led
ge
a
nd
skills
a
bo
ut
h
ea
lth
y e
atin
g/co
okin
g
- o
ffe
rin
g co
mm
un
ity g
ro
up
s to
p
ro
mo
te
h
ea
lth
y life
style
- p
ro
mo
tin
g a
ffo
rd
ab
le a
nd
a
cce
ssib
le
p
hysic
al a
ctiv
ity in
itia
tiv
es in
co
mm
un
itie
s, su
ch
a
s w
alk
fo
r h
ea
lth
sch
em
es.
NIC
E (2
00
6) sta
te
s th
at a
du
lts
sh
ou
ld b
e o
ffe
re
d w
eig
ht
ma
na
ge
me
nt m
ulti-
co
mp
on
en
t
inte
rve
ntio
ns to
e
nco
ura
ge
:
- in
cre
ase
d p
hysic
al a
ctiv
ity
- im
pro
ve
d e
atin
g b
eh
avio
ur
- su
pp
ort b
eh
avio
ur ch
an
ge
.
Offe
r m
ulti-
co
mp
on
en
t
inte
rve
ntio
ns to
e
nco
ura
ge
:
- in
cre
ase
d p
hysic
al a
ctiv
ity
- im
pro
ve
d e
atin
g b
eh
avio
ur.
We
igh
t m
an
ag
em
en
t
pro
gra
mm
es sh
ou
ld in
clu
de
be
ha
vio
ur ch
an
ge
stra
te
gie
s to
incre
ase
p
eo
ple
’s p
hysic
al
activ
ity le
ve
ls o
r d
ecre
ase
ina
ctiv
ity, im
pro
ve
e
atin
g
be
ha
vio
ur a
nd
th
e q
ua
lity o
f th
e
pe
rso
n’s
d
iet a
nd
re
du
ce
e
ne
rg
y
inta
ke
.
Dru
g tre
atm
en
t m
ay b
e
effe
ctiv
e, a
lth
ou
gh
e
vid
en
ce
sh
ow
s th
at th
ose
w
ho
re
ce
ive
be
ha
vio
ura
l ch
an
ge
su
pp
ort a
nd
we
igh
t m
an
ag
em
en
t a
dvic
e,
alo
ng
sid
e d
ru
g tre
atm
en
ts a
re
mo
re
su
cce
ssfu
lly a
t lo
ng
-te
rm
we
igh
t lo
ss.
B
aria
tric
S
urg
ery m
ay b
e
ap
pro
pria
te
a
s a
w
eig
ht lo
ss
tre
atm
en
t, b
ut sh
ou
ld b
e
co
nsid
ere
d o
n a
n in
div
idu
al
ba
sis
b
y a
m
ulti-
dis
cip
lin
ary
te
am
.
Tre
atm
en
t a
nd
ca
re
sh
ou
ld ta
ke
in
to
a
cco
un
t
pe
op
le’s
in
div
idu
al n
ee
ds a
nd
p
re
fe
re
nce
s.
Mu
lti-
co
mp
on
en
t in
te
rve
ntio
ns a
re
th
e tre
atm
en
t o
f
ch
oic
e.
Evid
ence taken from
H
ealthy W
eig
ht H
ealthy Liv
es (2008); N
IC
E G
uid
ance (2006); F
oresig
ht R
eport (2007)
Ap
pen
dix
D
Pre
ven
tio
n o
f O
verw
eig
ht
and
Ob
esit
y in
Ad
ult
s
Nam
eJo
b T
itle
Co
nta
ct D
etai
ls
1P
at B
arto
nC
omm
unity
Pae
dia
tric
ian
Pa
t.Bar
ton@
know
sley
.nhs
.uk
2B
arba
ra B
owes
Nur
se C
linic
ian
– C
hild
Hea
lthB
arba
ra.b
owes
@kn
owsl
ey.n
hs.u
k
3Ji
ll C
olbe
rtJo
int C
omm
issi
onin
g Le
adJi
ll.C
olbe
rt@
know
sley
.gov
.uk
4M
iche
lle C
reed
Ass
ista
nt D
irect
or o
f M
oder
nisa
tion
& S
ervi
ce D
evel
opm
ent
Mic
helle
.Cre
ed@
know
sley
.nhs
.uk
5Li
sa E
llis
Inte
gra
ted
Chi
ld &
Fam
ily H
ealth
Ser
vice
Man
ager
Lisa
.elli
s2@
know
sley
.nhs
.uk
6K
errie
Fra
nce
Loca
lity
Man
ager
Ker
rie.F
ranc
e@kn
owsl
ey.n
hs.u
k
7S
ara
Har
rison
Prin
cipa
l Die
ticia
n fo
r 'C
hang
es' t
he S
peci
alis
t Wei
ght M
anag
emen
t Ser
vice
ssa
ra.h
arris
on@
know
sley
.nhs
.uk
8D
erek
Jon
esH
ead
of S
port
and
Act
ive
Leis
ure
dere
k.jo
nes@
know
sley
.gov
.uk
9M
atth
ew K
earn
eyG
P P
ublic
Hea
lth P
ract
ition
erM
atth
ew.K
earn
ey@
know
sley
.nhs
.uk
10P
aul L
angt
onP
ublic
Hea
lth In
telli
genc
e M
anag
erP
aul.L
angt
on@
know
sley
.nhs
.uk
11Jo
anne
Par
ryC
hild
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12. Acknowledgements
The Strategy was compiled by Public Health:
Julie Tierney Assistant Director of Wellbeing and CommissioningDr. Lisa Newson Public Health - Programme Manager Healthy WeightSusannah Jones Healthy Lifestyles Officer
Membership of Health and Wellbeing Partnership Board
Name Job Title/Organisation
Councillor Ron Round Leader of the Council
Rosemary Hawley Chair of the Primary Care Trust
Councillor Norman Keats (1) Nominated Council Member
Councillor Jayne Aston (2) Nominated Council Member
Councillor Ken Keith (3) Nominated Council Member
Councillor Graham Wright (4) Nominated Council Member
Peter Hinton (1) Nominated Primary Care Trust Board Member
Councillor Christine O’Hare (2) Nominated Primary Care Trust Board Member
Paul Coogan (3) Nominated Primary Care Trust Board Member
Jane Marshall (4) Nominated Primary Care Trust Board Member
Sheena Ramsey Chief Executive of Knowsley MBC
Anita Marsland Chief Executive of Primary Care Trust and Executive Director Health and Social Care
Ian Davies Deputy Chief Executive of Knowsley PCT (Deputy)
Mike Harden Executive Director of Corporate Resources, Knowsley MBC
James Duncan Borough Treasurer, Knowsley MBC
Paul Brickwood Director of Finance and Commissioning, Knowsley PCT
Dr Diana Forrest Director of Public Health, Knowsley PCT / Knowsley MBC
69
Membership of Children’s and Young People’s Partnership Board
Name Job Title/Organisation
Councillor G Wright Cabinet Member for Children's Services (Chairman)
Councillor Ms J E Aston Cabinet Member for Health and Social Care (Vice – Chairman)
Damian Allen Lead Officer/Executive Director of Children's Services
Bernie Brown Service Director - Safeguarding & Youth Offending Service,Knowsley MBC
Chief Inspector Merseyside PoliceAlistair Buckley
Jan Coulter Director of Health & Social Care, Knowsley MBC/PCT
Richard Davies Merseyside Fire & Rescue Service
John Kelly 5 Borough's Partnership NHS Trust
Kitty Ferris Service Director - Targeted and Specialist Services, Knowsley MBC
Dr Diana Forrest Director of Public Health, Knowsley MBC/PCT
Stephanie Hall S.P.A.R.K
Kieran Gordon Greater Merseyside Connexions
Angela Cholet Voluntary Sector Representative
Tim Hall Greater Merseyside Learning and Skills Council
Mike Harden Executive Director of Corporate Resources, Knowsley MBC
Vacancy S.P.A.R.K
Pam Jervis Head of Kirkby College
Nick Kavanagh Executive Director of Change and Transformation,Knowsley MBC
Susan Lane Knowsley Community College
Anita Marsland Chief Executive of Knowsley PCT and Executive Director of Health and Social Care
David Metherell Probation Service
Tim Molten New Deal for Communities North Huyton
Viv Murray Service Director - Universal and Preventative Services,Knowsley MBC
Dr Chris Mimnagh PEC Representative
Councillor C M O'Hare Non-Executive Children's Champion, Knowsley PCT
Moya Sutton Acute Health Trust, NHS
Patricia Thomas Special School Head Teacher Representative
70
Membership of Healthy Weight Partnership Board
Name Job Title/Organisation
Pat Barton Community Paediatrician, Knowsley PCT
Barbara Bowes Nurse Clinician – Child Health, Knowsley PCT
Jill Colbert Joint Commissioning Lead, Knowsley MBC
Michelle Creed Asst. Director of Modernisation & Service Development,Knowsley PCT
Lisa Ellis Integrated Child & Family Health Service Manager, KnowsleyPCT
Kerrie France Locality Manager, Knowsley PCT
Sara Harrison Principal Dietician for 'Changes' the Specialist Weight Management Services, Knowsley PCT
Derek Jones Head of Active Leisure, Knowsley DWS
Matthew Kearney GP Public Health Practitioner, Knowsley PCT
Paul Langton Public Health Intelligence Manager, Knowsley PCT
Joanne Parry Children’s Centre Area Manager Whiston and Prescot,Knowsley MBC
Breeda McQuillan Strategic Manager Knowsley Children’s Centres and PlayService, Knowsley MBC
Dr. Lisa Newson Public Health – Programme Manager Healthy Weight, Knowsley PCT
Marjorie Oliver Practice Nurse, Knowsley PCT
Nicola Over Head of Dietetics, Knowsley PCT
Fiona Parr Primary Care Pharmacist, Knowsley PCT
Liz Saunders Workforce Development Officer – Health, Knowsley PCT
Julie Tierney Assistant Director of Wellbeing and Commissioning, Knowsley PCT
Kendra Greatrex Primary Care Manager, Knowsley PCT
Collette Greaves School Health Team Manager, Knowsley PCT
71
Membership of Breastfeeding Steering Group
Name Job Title/Organisation
Paula Simpson Public Health Commissioning Manager, NHS Knowsley/ Knowsley DCFS (Chair)
Liz Gaulton Service Director for Family Support and Children’s Health, Knowsley MBC
Helen Moore Infant Feeding Coordinator, Knowsley PCT
Vacant Post Infant Feeding Project Support Officer, Knowsley PCT
Vacant Post Infant Feeding Co-ordinator, Training and Development PCT
Julia Kemp Public Health Development Midwife, Knowsley PCT
Janet Morris Integrated Universal and Prevention Child Health ServicesManager, Knowsley PCT
Joy Stewart Infant feeding Specialist, Liverpool Women’s Hospital Trust
Nicki Jones Infant Feeding Coordinator, St Helens & Knowsley Hospital Trust
Kerry Hesketh Infant Feeding Co-ordinator, Southport and Ormskirk DistrictGeneral Hospital
Pauline Buxton Community Midwife, St Helens & Knowsley Hospital Trust
Brenda McQuillan Strategic Manager Knowsley Children's Centre and Play Service, Knowsley MBC
Alison Cooke Teenage Pregnancy Co-ordinator, Knowsley MBC
Carole Brazier Senior Midwife, Ormskirk Hospital Trust
Susannah Jones Healthy Lifestyles Officer, Knowsley PCT
Barbara Bowes Nurse Clinician, Knowsley PCT
Carol Skinley Specialist Public Health Nurse, Knowsley PCT
Membership of Children’s and Young People’s Healthy Weight Group
Name Job Title/Organisation
Dr Lisa Newson Public Health – Programme Manager Healthy Weight,Knowsley PCT (chair)
Susannah Jones Healthy Lifestyles Officer, Knowsley PCT
Paula Taylor Arts in Health Officer, Knowsley PCT
72
Paula Simpson Public Health Commissioning Manager, Knowsley MBC
Joanne Parry Children’s Centre Area Manager Whiston and Prescot,Knowsley MBC
Breeda McQuillan Strategic Manager Knowsley Children’s Centre and Play Service, Knowsley MBC
Jane Watts PE & School Sports Manager, Knowsley MBC
Maureen Craig Healthy Schools Advisor, Knowsley MBC
Paula Cain Healthy Schools Manager, Knowsley MBC
Lesley Hollinshead Children Services Manager, Knowsley MBC
Lynn Passey Community Health Development Manager, Knowsley PCT
Susannah Green Community Health Development Officer/Community Cooks Team Leader, Knowsley PCT
Laura Evans Paediatric Weight Management Dietician, Knowsley PCT
Lindsay Whittle Child Minders Network Co-ordinator, Knowsley MBC
Gill Downey Family Learning Co-ordinator, Knowsley MBC
Barbara Bowes Nurse Clinician, Knowsley PCT
Linda Saleh Health Visiting Team Leader, Knowsley PCT
Julie Macklin Early Years Project Officer, Heart of Mersey
Nicola Jones Infant Feeding Co-ordinator, St Helens and Knowsley Hospital Trust
Neil Hutchinson Area Manager – Leisure Services, KMBC
Derek Jones Head of Active Leisure, Knowsley DWS
Kevin Lynch Senior Sports Development Officer, Knowsley MBC
Linda Spakouskas Midwifery Manager, Knowsley PCT
Annette Mercer Senior Oral Health Promotions Co-ordinator, Knowsley PCT
Carol Skinley Specialist Public Health Nurse, Knowsley PCT
Karen Moss School Health Manager, Knowsley PCT
Marjie Brown Partnership Development Manager, Knowsley MBC
Kerstine Hogg School Sport Partnership Development Manager, Knowsley MBC
Helen Moore Knowsley Infant Feeding Strategy Co-ordinator, Knowsley PCT
73
Membership of Health Promotion Steering Group
Name Job Title/Organisation
Donna Barry Workplace Activator, Knowsley MBC
Paula Cain Healthy Schools Manager, Knowsley MBC
Maria Caves Clinical Lead Nurse Mental Health, Knowsley PCT
Maureen Craig Healthy Schools Advisor, Knowsley MBC
Tracy Dickinson Public Health Safety Manager. Knowsley MBC
Zena Eccleston Principal Compliance and Prevention Officer, Knowsley MBC
Mark Fox Sport & Physical Active Alliance Manager, Knowsley MBC
Sarah Howarth Service Manager, Knowsley PCT
Susannah Jones Healthy Lifestyles Officer, Knowsley PCT
Shirley King Health and Well-Being Partnership Programme Manager, Knowsley MBC
Johanna Lee Clinical Lead Nurse – Learning Disabilities, Knowsley PCT
Kevin Lynch Senior Sports Development Officer, Knowsley MBC
Julie Macklin Early Years Project Officer, Heart of Mersey
Paul Mavers Manager, Knowsley CVS
Annette Mercer Senior Oral Health Promotion Co-ordinator, Knowsley PCT
Jayne Moore Mental Health Promotion Specialist, Knowsley PCT
Lynn Passey Community Health Development Manager, Knowsley PCT
Liz Saunders Workforce Development Officer – Health, Knowsley PCT
Karen Simpson Health Trainer’s Co-ordinator, Knowsley PCT
Paula Taylor Arts in Health Officer, Knowsley PCT
Emma Thomas Public Health Support Project Officer, Knowsley MBC
Julie Tierney Asst. Director of Wellbeing and Commissioning, Knowsley PCT(Chair)
Carol Winstanley Projects Support Officer, Knowsley PCT
74
Membership of Knowsley Healthy Schools Scheme Partnership Board
Name Job Title/Organisation
Julie Tierney Asst. Director of Wellbeing and Commissioning, Knowsley PCT
Paula Cain Healthy Schools Manager, Knowsley MBC
Steve Clarke Principal Educational Psychologist, Knowsley MBC
Sue Stannard School Health Team Manager, Knowsley PCT
Breeda McQuillan Strategic Manager Knowsley Children’s Centre and Play Service, Knowsley MBC
Jane Watts PE & School Sports Manager, Knowsley MBC
Annette Mercer Senior Oral Health Promotions Co-ordinator, Knowsley PCT
Gill Price Representative of Primary and Special Heads
Alison Cooke Teenage Pregnancy Co-ordinator, Knowsley MBC
Sandra Feerick Extended Schools Manager, Knowsley MBC
Patricia Jackson Participation Team Manager, Knowsley MBC
Lesley Roughley Youth Interventions Team Manager, Knowsley MBC
Joanne Parry Children’s Centre Area Manager Whiston and Prescot, Knowsley MBC
Membership of Food and Health Steering Group
Name Job Title/Organisation
Annette Mercer Senior Oral Health Promotions Co-ordinator, Knowsley PCT
Johanna Lee Clinical Lead Nurse – Learning Disabilities, Knowsley PCT
Julie Tierney Assistant Director of Wellbeing and Commissioning, KnowsleyPCT
Justin Waters Head of Facilities Management, Knowsley MBC
Liz Saunders Workforce Development Officer – Health, Knowsley PCT
Lynn Passey Community Health Development Manager, Knowsley PCT
Mary Farrell Public Health Development Manager, Knowsley PCT
Susannah Jones Healthy Lifestyles Officer, Knowsley PCT
75
Maureen Craig Healthy Schools Advisor, Knowsley MBC
Nicola Over Head of Dietetics, Knowsley PCT
Paula Cain Healthy Schools Manager, Knowsley MBC
Paula Taylor Arts in Health Officer, Knowsley PCT
Sheelagh Rutherford Facilities Manager (School Meals), Knowsley MBC
Tracy Dickinson Public Health Safety Manager, Knowsley MBC
Zena Eccleston Principal Compliance and Prevention Officer, Knowsley MBC
Julie Macklin Early Years Project Officer, Heart of Mersey
Membership of School Meals Lead Group
Name Job Title/Organisation
Justin Waters Head of Facilities Management, Knowsley MBC
Robbie Bannister Facilities Manager, Knowsley MBC
Paula Cain Healthy Schools Manager, Knowsley MBC
Vicki Carolan Finance Technician, Knowsley MBC
Mike Cooper Head Teacher, Huyton with Roby
Steve Dixon Head Teacher, Cherryfield
Gill Price Representative of Primary and Special Heads
Chris Wilkinson LTP Co-ordinator
Julie Tierney Asst. Director of Wellbeing and Commissioning, Knowsley PCT
Membership of Sport and Physical Activity Alliance
Name Job Title/Organisation
Angela Ball Head of Music and Performing Arts Service, Knowsley DCS
Marjie Brown Brookfield Partnership Development Manager
Emma Bush Schools & Community Arts Service Manager, Knowsley DCS
Cllr. Eddie Connor Cabinet Member for Leisure and Cultural Services
76
Madeline Cotson Head of Bowring Sports College
Dave Garry Fire Service Representative
Diana Forrest Director of Public Health, Knowsley MBC/PCT
Mark Fox Sport & Physical Active Alliance Manager, Knowsley MBC
Kerstine Hogg Bowring Sports College Partnership Development Manager
Janet Tildsley Knowsley’s Older Peoples Voice
Pam Jervis Head of Kirkby Sports College (Chair)
Derek Jones Head of Active Leisure, Knowsley DWS
Julie Leasor Merseyside Sports Partnership Representative, Liverpool JohnMoores University
Mark Holmes Knowsley Community College
Andrew McCormick Service Director Leisure and Cultural Services, KnowsleyDWS (Vice Chair)
Mike Kearns Knowsley District Sports Council
Tim Molten New Deal for Communities Representative North Huyton
Gill Price Representative of Primary & Special Heads
Steve Stewart Service Director - Standards Taskforce, Knowsley DCFS
Julie Tierney Asst. Director of Wellbeing and Commissioning, Knowsley PCT
Jane Watts PE & School Sports Manager & Chair of Knowsley Board for School Sports Partnership
Viv Murray Service Director – Universal Services, Knowsley DCFS
Matt Cochrane Higher Education Representation (Edge Hill University)
Membership of Physical Activity Steering Group
Name Job Title/Organisation
Derek Jones Head of Active Leisure, Knowsley MBC
Donna Barry Workplace Activator, Knowsley MBC
Fiona Mather Greenspace Strategy Manager, Knowsley MBC
Jane Watts PE and School Sports Manager, Knowsley MBC
Julie Tierney Assistant Director of Wellbeing and Commissioning, KnowsleyPCT
77
Kelly McKeown Pedalaway Co-ordinator
Kerstine Hogg School Sport Partnership Development Manager, KnowsleyMBC
Lynn Passey Community Health Development Manager, Knowsley PCT
Marjie Brown School Sport Partnership Development Manager, Knowsley MBC
Mark Fox Sport & Physical Active Alliance Manager, Knowsley MBC
Maureen Craig Healthy Schools Advisor, Knowsley MBC
Paul Buntin Travel Plan Advisor, Knowsley MBC
Paula Cain Healthy Schools Manager, Knowsley MBC
Phil Cantillon Sports Development Manager, Knowsley MBC
Membership of Workforce Health Strategy
Name Job Title/Organisation
Julie Tierney Asst. Director of Wellbeing and Commissioning, Knowsley PCT
Mary Farrell Public Health Development Manager, Knowsley MBC/PCT
Kelly Hunt MEL Research
Donna Barry Workforce Activator, Knowsley MBC
Derek Jones Head of Active Leisure, Knowsley MBC
Dr Diana Forrest Director of Public Health Knowsley PCT/MBC (Chair)
Jane Raven Executive Director of Human Resources, Health and WellbeingServices
Mark Fox Sport & Physical Active Alliance Manager, Knowsley MBC
Ian Burkinshaw Corporate Intelligence Manager, Knowsley MBC
Tracy Dickinson Head of Environmental Health & Consumer Protection, Knowsley MBC
Anne Forshaw MEL Research
Bernie Green Assistant Head of Human Resources, Knowsley MBC
Elaine Plumridge Human Resources Co-ordinator, Knowsley MBC
Samantha Worsfold Corporate Finance Advisor, Knowsley MBC
82
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