Since there is no definitive measure of the proportion of overweight or obese adults, national modelled estimates of adult obesity rates were developed from population survey data. In Merton, these estimates suggest that overall 19.1% of adults (aged over 16 years) are obese, lower than London and England. Further estimates within the borough (at middle super output area level, about 7,000 of the population) suggest the highest levels are in the more deprived areas, with prevalence ranging from 10.6% (1 in 10) to 28.4% (1 in 3) across the borough.

In Merton, it is estimated that only 7.7% (1 in 13) of residents take part in enough physical activity to benefit their health – and that 92% of residents do not. This compares with 11% of Londoners and 11.8% nationally. Over half (51.2%) of Merton residents reported that they had taken part in no physical activity at all in the past four weeks. 1 Data from across the country, reflected in the London-wide data, shows that disabled groups, non-white groups and older groups are less likely to be active. Activity levels are also lower among residents in routine occupations and those that have never worked or are long-term unemployed, compared with those residents in higher and managerial professions. Groups that have been identified as having the lowest levels of physical activity are girls and women (particularly young adults), people with physical and mental health disabilities, older adults, ethnic minority groups and socially deprived communities.

Key commissioning recommendations

Tackling obesity and helping people achieve a healthy weight are key to preventing future illness. With an increasing population and rising numbers of people projected to live longer, helping to prevent future ill health, such as diabetes, cancer and heart disease, is vitally important if health and social care services are going to be able to cope in the future. There is no simple solution to the challenge of obesity. It is important that an integrated and wide-ranging programme of solutions involving national and local action should be adopted to help tackle the growing problem.

Tackling obesity requires a multi-agency response across all ages, including whole family approaches, promoting healthy food choices, building physical activity into our day-to-day lives, providing safe open spaces, promoting walking and cycling, promoting the role of employers and providing personalised advice and support to individuals. As the lead organisation for public health and health improvement, Merton Council is well placed to address these areas across all council policies, including planning, housing, leisure services and social care.

Commissioners should prioritise the development of a clear weight management and obesity pathway, to ensure that services are available to support Merton residents with the level of expertise that they need in a setting that is appropriate and of interest to them.

Commissioners should also ensure that a prevention agenda is embedded across all contracts delivered in Merton by the Council, Merton CCG and its partners e.g. healthy vending in leisure centres and community dieticians delivering training to local people on how to eat healthily with minimal time and money.

Health services have a vital role to play in providing support and care; with consistent messages on achieving and maintaining a healthy weight and increasing levels of physical activity from health and other professionals being essential. How these messages are presented and delivered seems to be key to support behaviour change and to provide an opportunity to explore how to develop training for and ensure consistent messages are conveyed by all frontline workers in Merton.

Key facts on healthy weight

Obesity has become one of the major public health challenges for the 21st century. The cause of obesity is complex having behavioural, genetic, environmental and social components. This makes it a key health inequality issue. The health risks associated with being overweight or obese are many, including increasing risk of diabetes, cancer, heart and liver disease, and these risks increase the more weight people put on.

The national ‘Call to Action on Obesity’ (2011) spells out the key challenges for local government and the NHS in tackling obesity: to build effective partnerships, to invest to ensure future health, to take effective action to reduce inequalities at a local level and to establish health as a way of life for individuals and communities. This builds on a number of earlier policies, including the Public Health White Paper:'Choosing Health (2004), the Children’s National Service Framework and the earlier National Strategy on Obesity, Healthy Weight, Healthy Lives'.

Since there is no definitive measure of the proportion of overweight or obese adults, national modelled estimates of adult obesity rates were developed from population survey data.

In Merton, these estimates suggest that overall 19.1% of adults (aged over 16 years) are obese, lower than in London and England.

Estimated prevalence of obesity in adults, compared with statistical neighbours and London boroughs, 2006-08.

Further estimates within the borough (at middle super output area level, about 7,000 population) suggest the highest levels are in the more deprived areas, with prevalence ranging from 10.6% (1 in 10) to 28.4% (1 in 3) across the borough.

Achieving a healthy weight by area estimated levels of healthy eating (adults) by middle super output area (MSOA), 2006-08.

Source: Association of Public Health Observatories - Estimates of Adults' Health and Lifestyles, Percentage of the adult population that eat healthily, 2006-08, by MSOA

©Crown copyright 2012. All rights reserved. ©1994-2012 ACTIVE Solutions Europe Ltd.

Key facts on healthy eating and physical activity

Simplistically, achieving a healthy weight has two components: energy in and energy out; in essence, eating healthily and being physically active to burn off the calories consumed.

As a proxy for healthy eatcing, an estimated proportion of people eating healthily has been modelled based on national survey data for people eating at least five portions of fruit and vegetables a day. In general people in Merton eat more healthily compared with London and the rest of England and it is estimated that just under 40% of adults eat five a day. However, this masks a variation across the borough with more deprived areas eating less healthily.

Healthy eating compared with statistical neighbours and London boroughs, 2006-08.

In 2011, the Chief Medical Officer issued new guidelines for physical activity ‘Start Active, Stay Active’. The guidance has a renewed focus on being active everyday and spells out the recommended minimum levels of activity for adults in order to achieve health benefits:

  • Adults (19-64 years old) and older people (65+): 150 minutes – two and half hours – each week of moderate to vigorous intensity physical activity (and adults should aim to do some physical activity every day). Muscle strengthening activity should also be included twice a week.

In Merton, it is estimated that only 7.7% (1 in 13) of residents take part in enough physical activity to benefit their health – and that 92% of residents do not. This compares with 11% of Londoners and 11.8% nationally. Over half (51.2%) of Merton residents reported that they had taken part in no physical activity at all in the past four weeks.1

Data from across the country, reflected in the London-wide data, shows that disabled groups, non-white groups and older groups are less likely to be active. Activity levels are also lower among residents in routine occupations and those that have never worked or are long-term unemployed, compared with those residents in higher and managerial professions.

Most recent data (Active people survey (APS) Q3 to APS7 Q2) estimated that 23.1% of adults participate in 3x30 minutes of activity a week, which is an increase of 1.2% since 2005-06 (APS5/6).

Adult participation in sport and physical activity (3x30), 2011-13.

This also estimated that 35.25% of adults participate in 1x30 of activity a week.

Groups that have been identified as having the lowest levels of physical activity are girls and women (particularly young adults), people with physical and mental health disabilities, older adults, ethnic minority groups and socially deprived communities.

Adult participation in sport and physical activity (1x30), 2012-13.

What works and best practice

  

Guidance on working with local communities to achieve a healthy weight (NICE 2012) recommends to:

  • develop a coherent sustainable, community-wide, multi-agency approach
  • align action to tackle obesity with other disease-specific prevention and health improvement strategies, such as for CHD and diabetes
  • ensure strategic leadership and support at all levels
  • coordinate local action and communication in public health teams, local business and social enterprises, voluntary and community organisations
  • train and develop all partners, professionals and those in local services
  • communicate strategy through appropriate branding, language and advocacy
  • monitor and evaluate of cost-effectiveness
  • embed scrutiny and accountability.

For relevant information on the NICE guidance see Obesity:working with local communities (NICE website)

Guidance on weight management before, during and after pregnancy (NICE 2010) recommends:

  • weight management for women with a BMI 30 or more preparing for pregnancy
  • help for pregnant women to adopt healthy lifestyles during pregnancy especially those with BMI 30 or more
  • supporting women after childbirth at postnatal check-ups
  • community-based services
  • adequate skills for involved professionals

Weight Management Before, During and After Pregnancy (NICE website)

Guidance on walking and cycling (NICE 2010) recommends

  • developing a local strategy and policy support for walking and cycling networks and infrastructure
  • developing road safety partnerships and strategies
  • addressing motor traffic speeds and introducing engineering measures
  • ensuring all relevant planning considers walking and cycling
  • developing cross-sector walking and cycling programmes
  • commissioning personalised travel planning
  • community-wide walking programmes, including for older people and providing individual support
  • developing cycling programmes.

For relevant information on the NICE guidance see Walking and Cycling (NICE website)

Merton Voice

Overview

To support the development of services and programmes to support healthy lifestyles, a programme of engagement was led by Public Health in late 2012/early 2013. This insight focused on childhood immunisations and vaccinations, healthy eating, breastfeeding, physical activity in young adults and the use of physical health services by people with severe mental illness.

[Public Health] engaged with local residents, frontline workers and health professionals to explore provision, barriers and motivations, and produced a number of common themes. Although the numbers of people engaged in the process were relatively small, the insights gained could help form the golden thread of what local residents would like to see.

Continuity of care and consistent messages

Local residents sometimes feel they do not know who to address or trust, as each time

they come into contact with the health service they see new people, and different health professionals can also give differing/conflicting advice.

Using available local resources effectively

There are lots of trusted local community groups and resources (e.g. gyms and local clubs and mental health community groups), which could be engaged to support the health agenda more effectively and sustainably.

People like to hear from people ‘like them’

Local residents sometimes feel that their peers have a greater empathy for

their situation than health professionals and so that increased levels of peer support and advice will help local audiences to improve their health. This could be as simple as giving local people visibility in literature and ensuring their voices are heard.

Information needs to be local and specific

In some of the health issues like healthy eating and physical activity there is a lot of

information available but to make it as easy as possible to adopt behaviours people need information about what is around the corner and feasible for them rather than generic, national or even borough-level information.

Use appropriate marketing channels effectively

Local residents, particularly parents, often prefer to receive information face to face that can be tailored specifically for them. Engagement events could help to deliver this and to address several health issues (e.g. breastfeeding, immunisations and healthy eating). However, online channels (particularly Facebook and via smartphones) are increasingly where young adults first turn to for information.

Healthy eating specific insight

The research around healthy eating identified 13 barriers to healthy eating amongst target families, which can be grouped into three broad categories:

Knowledge and understanding

  • Cooking inspiration – parents lack confidence in cooking, especially from scratch.
  • Lack of understanding confusion over healthy eating guidelines and what constitutes a healthy diet.
  • Lack of knowledge food labelling and conflicting or unclear messaging from food Manufacturers.
  • Healthy is punitive – association of healthy eating messaging being negative rather than supporting.
  • Confusion over portion sizes.
  • Rise in snacking culture – snacking as a norm and symbols of parental love and nurturing.

Cost and time

  • The perceived cost of healthy food – fresh fruit, vegetables and meat are perceived as being expensive, especially amongst low socioeconomic groups.
  • Difficulty finding the ‘time’ for healthy eating – especially in relation to easing stress levels by feeding children tried-and-tested meals.
  • Catering for fussy eaters – the challenges of children that won’t eat and the stress it can cause parents.

Influence of others

  • The influence of others – absent parents, grandparents and other influencers who believe in ‘treats’.
  • Resistance to labelling their children (or themselves) – difficulty accepting their child may be overweight or obese.
  • Following the ‘Joneses’ – social norms and feeling guilty removing unhealthy foods if they think other families are not adopting healthy behaviours.
  • Own role modelling overlooked parents often have one rule for themselves and another for their children.

The research also identified six values around healthy eating that need to be understood to ensure that healthy eating interventions are relevant:

  • Keep it local families consistently place a great deal of importance on access to local facilities, information and support.
  • Appetite for healthy eating (and physical activity) is growing families are showing greater awareness of their health risk behaviours in relation to their diet and activity choices.
  • Child happiness is a key motivator often being ‘happy’ is equated with being ‘healthy’.
  • Short-term often trumps long-term more value placed on short-term benefits than on those that will only occur in the distant future.
  • Obesity and weight is a sensitive issue – the delivery of messaging in this context was criticised as unsupportive.
  • But parents do want to ‘monitor progress’ – parents are keen to know about their children’s weight, however current worries are more that they might be underweight or lacking vital nutrients.

Key commissioning recommendations

Tackling obesity and helping people achieve a healthy weight are key to preventing future illness. With an increasing population and rising numbers of people projected to live longer, helping to prevent future ill health, such as diabetes, cancer and heart disease, is vitally important if health and social care services are going to be able to cope in the future. There is no simple solution to the challenge of obesity. It is important that an integrated and wide-ranging programme of solutions involving national and local action should be adopted to help tackle the growing problem.

Tackling obesity requires a multi-agency response across all ages, including whole family approaches, promoting healthy food choices, building physical activity into our day-to-day lives, providing safe open spaces, promoting walking and cycling, promoting the role of employers and providing personalised advice and support for individuals. As the lead organisation for public health and health improvement, Merton Council is well placed to address these areas across all council policies, including planning, housing, leisure services and social care.

Commissioners should prioritise the development of a clear weight management and obesity pathway, to ensure that services are available to support Merton residents with the level of expertise that they need in a setting that is appropriate and of interest to them.

Commissioners should also ensure that a prevention agenda is embedded across all contracts delivered in Merton by the Council, Merton CCG and its partners e.g. healthy vending in leisure centres and community dieticians delivering training to local people on how to eat healthily with minimal time and money.

Health services have a vital role to play in providing support and care; with consistent messages on achieving and maintaining a healthy weight and increasing levels of physical activity from health and other professionals being essential. How these messages are presented and delivered seems to be key to support behaviour change and to provide an opportunity to explore how to develop training for and ensure consistent messages are conveyed by all frontline workers in Merton.

References

1.^ ab Sport England: Active People Survey (APS) (2012)