Introduction
Making Life Better is the Northern Ireland Executive’s ten year public health strategic framework. It seeks to create the conditions for individuals and communities to take control of their own lives. The vision for Northern Ireland (NI) is that all NI’s people are enabled and supported to achieve their full health and wellbeing potential and to reduce health inequalities.
Nurses, Midwives and Allied Health Professionals have a crucial contribution to make in promoting health and wellbeing and treating ill health.
All Our Health is an approach to maximise the impact Nurses, Midwives and Allied Health Professionals within NI have on improving the health and wellbeing for everyone and reducing inequalities in health.
Obesity
Obesity continues to be one of the most important public health challenges facing NI. Its impact is wide ranging throughout society and across the life course. Obesity can contribute to and increase the risk, of life threatening diseases such as Type 2 diabetes, cardiovascular disease, elevated blood pressure and some cancers (WHO, 2009). Obesity affects individuals, families, communities, the economy and society as a whole.
Obesity and being overweight are an important issue for the Department of Health (DoH) who published a regional strategy to tackle the issue and take a life course approach A Fitter Future for All – A Framework for Preventing and Addressing Overweight and Obesity in Northern Ireland 2012-2022 (DHSSPS, 2012).
A cross sector Obesity Prevention Steering Group and a Regional Obesity Prevention Implementation Group have been established to oversee the implementation of the actions outlined in the strategy at Deparmental and non-Departmental level respectively.The financial cost of obesity is high and rising rapidly as the prevalence of obesity increases. In 2009 the total cost to the Northern Ireland economy came to £370 million; 25% were direct healthcare costs and 75% were indirect costs (such as lost productivity). The direct costs represent 2.8% of the total healthcare costs for 2009 (Safefood, 2012).
Facts about obesity in Northern Ireland
Data from the Health Survey Northern Ireland (HSNI) 2013/2014 (DHSSPS, 2014) showed that:
- 68% of males and 25% of females were overweight or obese
- the proportion of males classed as obese has increased since 1997, from 17% to 25% in 2013/14, whereas there was no difference in the proportion of females classed as obese
- 25% of children were classed as overweight or obese
- a greater proportion of girls (21%) were overweight compared with boys (15%), but the same proportion of boys and girls were classed as obese (7%)
- the proportion of children classified as either obese or overweight (25%) has not changed since 2005/06
Supportive environments and communities are fundamental in shaping people’s choices. Being overweight or obese is largely preventable. Healthier choice of foods that are accessible, available and affordable and regular physical activity need to become the best choice for people and therefore preventing obesity (WHO, 2015).
Strategic context
Making Life Better - A whole system strategic framework for Public Health 2013 -2023 is a ten year public health strategic framework which provides direction for policies and actions to improve the health and wellbeing of the people in Northern Ireland.
This strategy adopts a life course approach involving:
- preconception, antenatal , maternal and early years
- children and young people
- adults and general population
Healthy Child, Healthy Future (DHSSPS, 2010) is a framework for the Universal Child Health Promotion Programme in Northern Ireland from birth to 19 years. It is a whole child approach which involves the family in adopting health enhancing behaviours.
The Food in schools policy, Healthy foods for Health Outcomes advocates a whole school approach to all food provided in schools. It was developed jointly by DHSSPS and DE in response to concerns about rising levels of obesity in children and young people.
Breastfeeding - A great start: A strategy for Northern Ireland 2013-2023 aims to improve the health and well-being of mothers and babies in Northern Ireland through breastfeeding. It sets out the strategic direction to protect, promote, support and normalise breastfeeding in Northern Ireland for the next ten years.
Core Principles
All Nurses, Midwives and Allied Health Professionals have a crucial role in promoting health and wellbeing.
Each Nurse, Midwife and Allied Health Professional delivers key messages about promoting health and wellbeing at every contact.
Interventions
Population
Nurses, Midwives and Allied Health Professionals should be aware of the interventions at a population level and the population context of obesity.
The Choose to Live Better campaign is supported by a website that help individuals assess whether they are overweight by using their waist measurement and provides advice on how they can take small steps to reduce their waist size.
Let’s take on childhood obesity (safefood, 2013) is a 3 year campaign that aims to communicate practical actions which parents can take in order to tackle the everyday habits associated with excess weight in childhood.
The evidence and rationale for the UNICEF UK baby friendly initiative standards. The underpinning evidence and rationale for the standards.
Community
Nurses, Midwives and Allied Health Professionals can promote and support health and wellbeing at a community level working with local communities and schools.
Promoting the standards of the UNICEF baby friendly initiative in community settings will improve the uptake and maintenance of breastfeeding.
In 2015, 93% of births in Northern Ireland took place in a UNICEF BFI accredited hospital, which is the highest rate of any region of the UK.
Early movers - Helping under-5s live active & healthy lives (BHF, 2012). This helps community health professionals to plan and organise developmentally appropriate, physically active, play environments for children under five.
Cook it! Fun, fast food for less was developed for use in Northern Ireland and is a community-based nutrition education, cooking skills programme. It is delivered in the community by trained facilitators with a wide range of groups, including young/single parents, young people leaving residential care, offenders during rehabilitation programmes and older people in sheltered accommodation.
Promoting the use of community allotments is a good way to encourage exercise and a better diet by growing fruit and vegetables free from pesticides.
The Early Years Organisation in SHSCT area and Old Library Trust in WHSCT area are funded by the Public Health Agency to provide family lifestyle programmes (called the Family Health Initiative and SWEET respectively) free of charge to families in the local area.
The programmes provided are as follows:
- an eight-week obesity prevention programme for parents and children 0 – 5 years
- initiative twelve week obesity management programme for parents and children 8 – 11 years
Fit 4 U Active Lifestyles is a programme funded jointly by Public Health Agency and the Southern Local Commissioning Group in the Southern SHSCT area that aims to empower people with physical/sensory disabilities to improve their health through participation in a range of physical activity and leisure opportunities, which promote independence and citizenship.
The Active Belfast project aims to promote healthy living and increase physical activity for all. This is a partnership approach to developing a range of activities to encourage a healthier lifestyle.
Individual and family interventions
Nurses, Midwives and Allied Health Professionals can promote and support health and wellbeing at an individual level.
At the individual/family level people should be encouraged to:
limit energy intake from total fats and sugars increase consumption of fruit and vegetables as well as legumes, whole grains and nuts engage in regular physical activity as outlined in Start Active, Stay Active, a four countries CMOs’ report, which emphasises the importance of activity at each stage of the life course Physical Activity Adults, Physical Activity for Children and Get a Life get Active.
Weigh to a healthy pregnancy is a programme offered to all women with a BMI of 40+ kg/m2 at her booking-in appointment. The programme is delivered by midwives, dietitians and physios and aims to limit gestational weight gain by providing extra information and support to women and their families and monitoring weight during pregnancy.
Weigh2Live is a free online interactive resource to help people assess whether they need to lose weight and provides supportive resources.
Physical Activity Referral Schemes (PARs) are funded by the Public Health Agency across Northern Ireland for delivery in local council leisure facilities. The programmes aim to promote active lifestyles among patients with specific health conditions (including those with a body mass index (BMI) of more than 25) that are referred by their doctor or healthcare professional
Food in Schools
The Healthy Food for Healthy Outcomes is Food in schools policy. This policy advocates a whole school approach to all food provided and consumed in schools. It develops knowledge and skills in relation to healthy eating and lifestyles.
The PHA has worked closely with the Department of Education through the Food in Schools Forum on this policy and provides ongoing support for catering staff in schools to ensure compliance with the Nutritional standards for school lunches and the Nutritional standards for other food and drinks in schools as well as providing support for other Food in schools related activities.
Healthier lunch boxes is an initiative to promote healthier food and drink choices in lunch boxes. It looks at how healthcare practitioners and teachers can work with parents and carers, and the wider school community, to ensure that consistent food and nutrition messages are communicated.
Measuring outcomes
A fitter future for all - Framework for preventing and addressing overweight and obesity in Northern Ireland 2012-2022 (DHSSPS, 2012) includes outcome measures grouped by the following life course stages:
- pre-conception, antenatal, maternal, and early years
- children and young people
- adults and the general population
- supporting pillars of food and nutrition; promoting physical activity
- data and research
Each measure provides short term, medium term and long term outcomes, identifies the delivery partners that will work together to achieve the outcomes, and the indicators by which success will be measured.
A fitter future for all - outcome framework 2015 - 2019 (DHSSPS, 2015) updates on the short term outcomes for the years, 2015-2019.
Health Survey NI (HSNI) 2014 -2015, is NI’s annual health survey.
State of the Nation’s Waistline – obesity in the UK: analysis and expectations is a cross-UK analysis of the scale of obesity, the effectiveness of UK policy, with recommendations for changes.
Guidance
Guidance for the Management of Obesity in Secondary Care (CREST, 2005)
Maternal and pre-school child nutrition guidelines Infant feeding practice, enabling health professionals to give clear, consistent evidence based advice to parents and carers.
NICE guidance
PH53: Weight management: lifestyle services for overweight or obese adults(2014) - This guideline makes recommendations on the provision of effective multi-component lifestyle weight management services for adults who are overweight or obese (aged18 and over). It covers weight management programmes, courses, clubs or groups that aim to change someone’s behaviour to reduce their energy intake and encourage them to be physically active.
CG189: Obesity: identification, assessment and management of overweight and obesity in children, young people and adults(2014) Evidence-based advice on the care and treatment of obesity.
PH27: Weight management before, during and after pregnancy (2010) Aimed at NHS and other commissioners, managers and professionals who have a direct or indirect role in caring for women who are pregnant, planning a pregnancy or who have had a baby in the last 2 years.
PH47: Weight management - lifestyle services for overweight or obese children and young people (2013) Recommendations on lifestyle and weight management (sometimes called tier 2) services for overweight and obese children and young people under 18 years of age. These services are just one part of a comprehensive approach to preventing and treating obesity.
PH42: Obesity working with local communities overview (2012) Aims to support effective, sustainable and community-wide action to prevent obesity. It sets out how local communities, with support from local organisations and networks, can achieve.
Public Information
The Pregnancy Book provides useful advice for mums to be on healthy eating and exercise during pregnancy.
The Birth to Five Book provides useful information about healthy nutrition for infants and children under five years of age.
Is your waistline creeping up on you? If you think you could be inching towards bad health then this leaflet is packed with tips and advice to help you keep your weight and waistline healthy. It also includes food and physical activity diaries to complete, and a pull-out section for a weekly meal planner and shopping list.
Enjoy healthy eating. What we eat every day has a big impact on our health – from the amount of energy we have when we get up in the morning to our risk of developing conditions like heart disease and cancer in the future. A healthy diet doesn’t have to be boring or restrictive – we can still eat a wide range of delicious foods, while keeping an eye on our intake of sugar, fat and salt.
Healthy breaks for pre-school children – A guide for parents. Leaflet for parents explaining why a healthy break is so important for pre-school children and some tips and ideas for healthy, nutritious breaks.
Healthy breaks for schools – A guide for pupils and parents. Guidance on healthy breaks for schoolchildren with tips and ideas.
Are you packing a healthy lunch? This booklet is designed to improve pupils' nutrition and implement healthier eating and drinking practices. It contains practical tips for parents, carers and children on how to pack an appetising, healthy lunchbox.