Citerank: (67) 340964Tackling obesity in the UKWith concern growing that the Foresight analysis—that 50% of the UK population could be obese by 2050, at an annual cost to the nation of around £50 billion per year [2]—substantially underestimates the scale of the unfolding obesity crisis, the College of Contemporary Health is working with the wider policy community to develop a whole systems map of the obesity crisis and the potential responses.7F1CEB7, 348679Focus outcomes indicators on action by primary health professionalsThe Quality Outcomes Framework indicators on obesity should include, and focus on, indicators on the action taken by primary healthcare professionals on behalf of overweight or obese patients. [1]565CA4D9, 348700Health Professionals84E4A378, 348703Actions – Industry2794CAE1, 349151AMRCThe Academy of Medical Royal Colleges comprises the 20 medical Royal Colleges and Faculties across the UK and Ireland whose presidents meet regularly to agree direction in common healthcare matters. It provides a collective, clear and sure voice for the bene?t of patients and healthcare professionals across the four nations of the UK.58D3ABAB, 352368AMRC – RecommendationsThe AMRC presents 10 key recommendations – an ‘action plan’ – of steps that it believes must be taken to make real inroads into tackling the obesity crisis in the UK. The recommendations fall into three areas: actions to be taken by the healthcare professions; changing the ‘obesogenic’ environment; and making the healthy choice the easy choice.565CA4D9, 352369Actions to be taken by the healthcare professionsActions to be taken by the healthcare professions suggested by the AMRC.565CA4D9, 352370Changing the ‘obesogenic’ environment565CA4D9, 352371Making the healthy choice the easy choice565CA4D9, 352373Invest in weight management servicesThe departments of health in the four nations should extend and increase the provision of weight management services across the country, to mirror the provision of smoking cessation services.565CA4D9, 352374Improve nutritional standards for food in hospitalsIntroduce food-based standards—in line with those put in place for schools in England in 2006—in all UK hospitals in the next 18 months; with commissioners working with a delivery agent similar to the Children’s Food Trust to put these measures into place.565CA4D9, 352375Increase support for new parentsThe current expansion of the health visitor workforce in England should be accompanied by 'skilling up' the wider early years workforce to deliver basic food preparation skills to new mothers and fathers, and to guide appropriate food choices which will ensure nutritionally balanced meals, encourage breastfeeding and use existing guidance in the Personal Child Health Record as a tool to support this.565CA4D9, 352376Improve nutritional standards in schoolsThe existing mandatory food- and nutrient-based standards in England should be applied to all schools including free schools and academies. This should be accompanied by a new statutory requirement on all schools to provide food skills, including cooking, and growing – alongside a sound theoretical understanding of the long-term effects of food on health and the environment.565CA4D9, 352377Reduce fast food outlets near schoolsPublic Health England should, in its first 18 months of operation, undertake an audit of local authority licensing and catering arrangements with the intention of developing formal recommendations on reducing the proximity of fast food outlets to schools, colleges, leisure centres and other places where children gather.565CA4D9, 352378Restrict junk food advertisingBan television advertisements of foods high in saturated fats, sugar and salt before 9pm, and seek agreement with commercial broadcasters not to advertise these foods on internet ‘on-demand’ services. [2]565CA4D9, 352379Pilot a 20%+ tax on all sugary, soft drinks for 1 yearFor an initial one year, a duty should be piloted on all sugary soft drinks, increasing the price by at least 20%. This would be an experimental measure, looking at price elasticity, substitution effects, and to what extent it impacts upon consumption patterns and producer/retailer responses.109FDEF6, 352380Improve food labellingMajor food manufacturers and supermarkets should agree in the next year a unified system of traffic light food labelling (to be based on percentage of calories for men, women, children and adolescents) and visible calorie indicators for restaurants, especially fast food outlets.565CA4D9, 352381Mandatory health impact assessments for local planning decisionsLocal authority planning decisions should be subject to a mandatory health impact assessment, which would evaluate their potential impact upon the populations’ health.565CA4D9, 352560Existing training is inadequate and ineffectiveTraditional methods of training for healthcare professionals are inadequate and ineffective with respect to obesity.1198CE71, 352713Who should improve obesity training for healthcare professionals?Who should improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 370328Some clinicians are insensitive in dealing with obese patientsSome clinicians continue to be insensitive, ineffective, and lack confidence when dealing with patients who have problems with their weight.1198CE71, 370330Weight management services are in short supplyThe Academy of Medical Royal Colleges notes that doctors don't have sufficient services available to refer people – that there are a limited number of well-designed fully evidence-based, effective and transferable weight management programmes, available for use in routine NHS primary care.1198CE71, 370331Most obese UK children lack access to weight management programmesThe majority of obese children in the UK don't have access to an evidence-based, proven, multicomponent child weight management programme as recommended by NICE (2006).1198CE71, 370332Early intervention programmesThe investment in weight management services should include greater provision for early intervention programmes.109FDEF6, 370334Weight management service provision is poor in comparison to smokingFrom a clinical perspective, weight management provision needs to mirror the coverage that smoking cessation services have achieved; yet, the investment in smoking cessation programmes remains significantly higher than the investment in weight management programmes. As a comparator, the NHS spent £88.2 million on smoking cessation services in 2011/12.1198CE71, 370336Require and examine obesity knowledge as part of curriculaKnowledge, understanding and training in nutrition, physical activity, exercise and the public health aspects of obesity should be an essential part of undergraduate and postgraduate curricula in every discipline because complications of obesity cross all specialty and professional boundaries. This knowledge should be examined. 959C6EF, 370338Weight management services can save more money than they costSome well-designed fully evidence-based, effective and transferable weight management programmes are even economically ‘dominant’ (i.e. they save the NHS more money than it costs to provide the service).1198CE71, 370339Many smaller providers lack formal evidence to support interventionsWhile some of the larger commercial providers have had their efficacy assessed by means of randomised control trials and other evaluative methods, many smaller providers have no such formal evidence to support their interventions.1198CE71, 370342Training should reflect the different needs of different team membersDifferent members of the team will need different training. For example, the role of the GP in an initial consultation differs greatly from that of the bariatric surgeon and his or her team assessing a patient’s suitability for surgery. Different teams need different skills for different patients in different scenarios but healthcare professionals’ education.959C6EF, 370346Training should include sensitive recognition and appropriate referralAll health professionals should have some basic training in sensitive recognition and appropriate referral for overweight and obese patients.959C6EF, 370347NICE guidance has been ignored on bariatric servicesAn investigation by GP newspaper published in December 2014 found that over half of the UK's primary care organisations (PCOs) do not follow NICE or SIGN guidance on bariatric surgery [2].1198CE71, 371449Early years’ intervention is vital to reducing health inequalities1198CE71, 371774Protect and increase green spacesPublic Health England should provide guidance to Directors of Public Health in working with Local Authorities to encourage them to protect or increase green spaces.565CA4D9, 371802Improved engagement and concentrationImproving the food and dining environment for children increases the likelihood that children will be engaged and concentrate in afternoon lessons.1198CE71, 371803Apply mandatory food- and nutrient-based standards to all schoolsThe existing mandatory food- and nutrient-based standards in England should be applied to all schools including free schools and academies.565CA4D9, 371804Require all schools to provide food skills and understandingIntroduce a statutory requirement on all schools to provide food skills, including cooking, and growing, alongside a sound theoretical understanding of the long-term effects of food on health and the environment.565CA4D9, 396117Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399556Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399572Improve food labellingMajor food manufacturers and supermarkets should agree in the next year a unified system of traffic light food labelling (to be based on percentage of calories for men, women, children and adolescents) and visible calorie indicators for restaurants, especially fast food outlets.565CA4D9, 399577Improve nutritional standards for food in hospitalsIntroduce food-based standards—in line with those put in place for schools in England in 2006—in all UK hospitals in the next 18 months; with commissioners working with a delivery agent similar to the Children’s Food Trust to put these measures into place.565CA4D9, 399578Improve nutritional standards in schoolsThe existing mandatory food- and nutrient-based standards in England should be applied to all schools including free schools and academies. This should be accompanied by a new statutory requirement on all schools to provide food skills, including cooking, and growing – alongside a sound theoretical understanding of the long-term effects of food on health and the environment.565CA4D9, 399592Invest in weight management servicesThe departments of health in the four nations should extend and increase the provision of weight management services across the country, to mirror the provision of smoking cessation services.565CA4D9, 399598Mandatory health impact assessments for local planning decisionsLocal authority planning decisions should be subject to a mandatory health impact assessment, which would evaluate their potential impact upon the populations’ health.565CA4D9, 399602Protect and increase green spacesPublic Health England should provide guidance to Directors of Public Health in working with Local Authorities to encourage them to protect or increase green spaces.565CA4D9, 399605Existing training is inadequate and ineffectiveTraditional methods of training for healthcare professionals are inadequate and ineffective with respect to obesity.1198CE71, 399606Who should improve obesity training for healthcare professionals?Improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 399607Many healthcare professionals are overweight and obeseDoctors continue to be a trusted and respected source of advice and guidance for patients over their lifestyle choices; however, many healthcare professional struggle with their own weight which can make them less effective both as messengers and exemplars. 1198CE71, 399653Increase support for new parentsThe current expansion of the health visitor workforce in England should be accompanied by 'skilling up' the wider early years workforce to deliver basic food preparation skills to new mothers and fathers, and to guide appropriate food choices which will ensure nutritionally balanced meals, encourage breastfeeding and use existing guidance in the Personal Child Health Record as a tool to support this.565CA4D9, 399674Improved engagement and concentrationImproving the food and dining environment for children increases the likelihood that children will be engaged and concentrate in afternoon lessons.1198CE71, 399675Apply mandatory food- and nutrient-based standards to all schoolsThe existing mandatory food- and nutrient-based standards in England should be applied to all schools including free schools and academies.565CA4D9, 399676Require all schools to provide food skills and understandingIntroduce a statutory requirement on all schools to provide food skills, including cooking, and growing, alongside a sound theoretical understanding of the long-term effects of food on health and the environment.565CA4D9, 399677Restrict junk food advertisingBan television advertisements of foods high in saturated fats, sugar and salt before 9pm, and seek agreement with commercial broadcasters not to advertise these foods on internet ‘on-demand’ services. [2]565CA4D9, 399695Focus outcomes indicators on action by primary health professionalsThe Quality Outcomes Framework indicators on obesity should include, and focus on, indicators on the action taken by primary healthcare professionals on behalf of overweight or obese patients. [1]565CA4D9, 399716Weight management services are in short supplyThe Academy of Medical Royal Colleges notes that doctors don't have sufficient services available to refer people – that there are a limited number of well-designed fully evidence-based, effective and transferable weight management programmes, available for use in routine NHS primary care.1198CE71, 399717Most obese UK children lack access to weight management programmesThe majority of obese children in the UK don't have access to an evidence-based, proven, multicomponent child weight management programme as recommended by NICE (2006).1198CE71, 399718Early intervention programmesThe investment in weight management services should include greater provision for early intervention programmes.109FDEF6, 399719Weight management service provision is poor in comparison to smokingFrom a clinical perspective, weight management provision needs to mirror the coverage that smoking cessation services have achieved; yet, the investment in smoking cessation programmes remains significantly higher than the investment in weight management programmes. As a comparator, the NHS spent £88.2 million on smoking cessation services in 2011/12.1198CE71, 399720Weight management services can save more money than they costSome well-designed fully evidence-based, effective and transferable weight management programmes are even economically ‘dominant’ (i.e. they save the NHS more money than it costs to provide the service).1198CE71, 399721Many smaller providers lack formal evidence to support interventionsWhile some of the larger commercial providers have had their efficacy assessed by means of randomised control trials and other evaluative methods, many smaller providers have no such formal evidence to support their interventions.1198CE71, 399735Some clinicians are insensitive in dealing with obese patientsSome clinicians continue to be insensitive, ineffective, and lack confidence when dealing with patients who have problems with their weight.1198CE71, 399738Require and examine obesity knowledge as part of curriculaKnowledge, understanding and training in nutrition, physical activity, exercise and the public health aspects of obesity should be an essential part of undergraduate and postgraduate curricula in every discipline because complications of obesity cross all specialty and professional boundaries. This knowledge should be examined. 959C6EF, 399739Training should reflect the different needs of different team membersDifferent members of the team will need different training. For example, the role of the GP in an initial consultation differs greatly from that of the bariatric surgeon and his or her team assessing a patient’s suitability for surgery. Different teams need different skills for different patients in different scenarios but healthcare professionals’ education.959C6EF, 399740Training should include sensitive recognition and appropriate referralAll health professionals should have some basic training in sensitive recognition and appropriate referral for overweight and obese patients.959C6EF, 399767Early years’ intervention is vital to reducing health inequalities1198CE71, 399777Reduce fast food outlets near schoolsPublic Health England should, in its first 18 months of operation, undertake an audit of local authority licensing and catering arrangements with the intention of developing formal recommendations on reducing the proximity of fast food outlets to schools, colleges, leisure centres and other places where children gather.565CA4D9, 399796NICE guidance has been ignored on bariatric servicesAn investigation by GP newspaper published in December 2014 found that over half of the UK's primary care organisations (PCOs) do not follow NICE or SIGN guidance on bariatric surgery [2].1198CE71, 399872Pilot a 20%+ tax on all sugary, soft drinks for 1 yearFor an initial one year, a duty should be piloted on all sugary soft drinks, increasing the price by at least 20%. This would be an experimental measure, looking at price elasticity, substitution effects, and to what extent it impacts upon consumption patterns and producer/retailer responses.109FDEF6

We heard from many patients that doctors continue to be a trusted and respected source of advice and guidance and so can potentially have great influence over an individual’s lifestyle choices. While this serves as a source of encouragement for clinicians anxious about engaging in difficult conversations with patients, it also raises two thorny issues. The first is that the messenger may well be as important as the message. The second is that the message the NHS sends out corporately is vitally important.

This first point is perhaps the most difficult of all the issues that the clinical workforce must face in holding up a mirror to itself. Although obesity amongst doctors, nurses and dieticians is less prevalent than in wider society, nonetheless it is still a significant challenge. There is evidence to suggest that the private battles that individual clinicians face with their own weight can affect their own personal efficacy in providing advice. On one level this is a private matter for doctors but on another it is for the NHS, and in particular its occupational medicine function, to support NICE guidance within the NHS workplace. The RCP and Faculty of Occupational Medicine’s audits of implementation in the NHS found that only 15% of hospitals had a plan to implement this guidance, and only 31% offer overweight or obese staff multi-component intervention. Clearly this is not good enough. There needs to be a presumption within all secondary and primary care settings that the physical manifestation of a doctor’s health will send important signs to patients and the potential to inspire change by seeing examples of healthcare professionals addressing their own health issues. Therefore, occupational health has a key role for NHS staff.